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The path of least resistance

  • Document type:
  • Author:
    Standing Medical Advisory Committee, Sub-Group on Antimicrobial Resistance
  • Published date:
    1 September 1998
  • Primary audience:
  • Gateway reference:
  • Pages:
  • Copyright holder:
    Crown Copyright

In July 1997, the Chief Medical Officer asked the Standing Medical Advisory Committee (SMAC) to examine the issue of antimicrobial resistance in relation to medical prescribing.

SMAC responded by setting up an inter-disciplinary Sub-Group with the following Terms of Reference:

In the light of the increasing clinical importance of resistance to antimicrobial drugs, to:

  • identify the major and emerging problems of antimicrobial resistance in clinical practice
  • identify clinical practices that may predispose to the development of resistance
  • identify practices in antimicrobial use that might help to limit the development and spread of resistance
  • identify priorities for changing practice in the use of antimicrobial agents
  • advise on how such changes might most effectively be achieved for both professionals and the public

Membership of the Sub-Group included cross-representation from the Standing Advisory Committees for Dentistry, Pharmacy, Nursing and Midwifery and consumer, veterinary medicine and pharmaceutical industry representation.

The main report reviews the problem at several levels:

  • Case-studies explore day-to-day antimicrobial prescribing problems faced by doctors.
  • The basis and impact of resistance are reviewed. Aspects of antimicrobial use and misuse that exacerbate resistance are identified, together with strategies to conserve the usefulness of antimicrobial agents.
  • Recommendations are made. These recognise that the decisions concerning antimicrobial prescribing are often complex, and are as much about minimising harm as about maximising benefit.
  • Methods for implementation of the recommendations are reviewed.

The Report does not claim to address all the issues, or to make recommendations that will solve all the problems associated with antimicrobial use. Nevertheless, key areas are identified where innovative approaches may lessen a problem that affects us all.

The synopsis presents the key points from the main Report. It follows the same section numbering as the main Report to ease cross-referral. The main Report also contains a full set of references and a glossary of terms.

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