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Year : 2011  |  Volume : 133  |  Issue : 3  |  Page : 352-353

Antimicrobial resistance: Beyond the breakpoint

Sir Dorabji Tata Centre for Research in Tropical Diseases, Innovation Centre, Indian Institute of Sciences Campus, Bangalore 560 029, India

Date of Web Publication6-Apr-2011

Correspondence Address:
D Raghunath
Sir Dorabji Tata Centre for Research in Tropical Diseases, Innovation Centre, Indian Institute of Sciences Campus, Bangalore 560 029
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Raghunath D. Antimicrobial resistance: Beyond the breakpoint. Indian J Med Res 2011;133:352-3

How to cite this URL:
Raghunath D. Antimicrobial resistance: Beyond the breakpoint. Indian J Med Res [serial online] 2011 [cited 2021 Aug 5];133:352-3. Available from:

Antimicrobial resistance: Beyond the breakpoint, J.T. Weber, editor (S. Karger, Basel, Switzerland)

2010. 174 pages. Price: US$ 189.00

ISBN 978-3-8055-9323-6

The introduction of antibiotic therapy in 1940 changed medicine. The discovery of novel agents with different and often, broader spectrum of activity appeared to signal a definitive conquest of infectious diseases. However, quite early in the antibiotic era it was realized that bacteria could develop drug resistance. So long as there were newer antibiotics in the pipeline, this did not materially affect practice. Therapeutic options were available. However, when newer antibiotics become fewer, largely, due to a change in the research policies of the pharmaceutical industry, the 'comfort zone' narrowed. The continued use of antibiotics, rationally or irrationally, increased drug/bacterium interaction and stimulated the prokaryote genetic versatility to generate 'super bugs' that could withstand the available armamentarium. With the result, it becomes difficult to choose an antibiotic for a specific infection. The rise of molecular biology and the imperatives of clinical practice have supported extensive research activity in antibiotic resistance. While antibiotics have not yet become totally useless, lately there is considerable thought given to 'the post-antibiotic era'. The sustained susceptibility of Streptococcus pyogenes to penicillin is an extraordinary exception to the rule that there are no automatic choices. In the average infection it would be necessary to identify the pathogen, determine its antibiotic susceptibility and make a conscious choice of the therapeutic agent based on clinical and pharmaceutical considerations. Even after the start of treatment it is necessary to monitor the course of treatment to ensure effective clearance of the infecting agent with minimal toxicity.

Antibiotic susceptibility tested in vitro is the standard input to determine treatment. The process of testing has a number of technical variables which need to be addressed to ensure good results. Antibiotic susceptibility testing (AST) has been developed into a technology with different methods designed to deliver results. The result is normally delivered as 'Susceptible', 'Intermediate' or 'Resistant' in the clinical context with respect to the pathogen/antibiotic interaction. The terms have been developed taking into consideration the activity of the antibiotic and its pharmacokinetics. Thus a susceptible result should predict satisfactory therapy and a resistant result poor outcome. This simple expectation is often vitiated by antimicrobial resistance. It is this aspect, "Beyond the Breakpoint"; that is the subject of this book. The book is the sixth of a series on "Issues on Infectious Diseases" covering different topics. The subject of this book is opportune. It deals with facets of antimicrobial resistance that became important among the different determinants of recovery from infection. The 10 chapters deal with different subjects covering pathogen characters, public health subjects and operational issues. The subjects have been chosen in the context of current concerns. The first two chapters deal with two phenomena that have exercised workers in infectious diseases. The emergence of community associated methicillin resistant Staphylococcus aureus (MRSA) in the mid-1990s changed our concepts. MRSA started as a laboratory curiosity, then a clonal hospital associated pathogen to a typical nosocomial entity. The community associated variety shattered the beliefs. It not only demonstrated unique pathogenicity but also changed the treatment modalities. These aspects and the epidemiology of the strains have been well brought out. Extended spectrum β-lactamases (ESBL) also started as interesting property encountered in coliforms. These organisms have diversified and acquired resistance determinants from environmental bacteria. ESBL property has now permeated practically all the genera of Gram-negatives influencing the infections caused by these bacteria and their treatment options. The third chapter on flouroquinolone resistance is a good review of a subject that is becoming important. The ease with which bacteria have become resistant to a class of synthetic antibacterials is an example of the versatility of the prokaryotes.

The ongoing H1N1 influenza pandemic has revived an old fear. The secondary bacterial infections that caused the mortality in the pre-antibiotic era 1917-18 pandemic should have been controlled by antibiotics if the resistance factors had not complicated the issue. The present scenario has been well brought out in this chapter. Chapters 5-7 look at the problems of antimicrobial resistance in the community, the institution and the impact it has on health care and costs. In a way the articles are related and highlight the difficulty of ensuring rational antibiotic usage, decrease emergence of resistance and controlling unnecessary cost to health care institutions.

The ability to adapt to noxious agents is inherent in all living beings. It is interesting to note that eukaryotes and multicellular organisms are able to develop resistance to control agents. The phenomenon and the implications of the susceptibility changes to mass drug administration in parasite control programmes and livestock rearing have been bought out in chapter 8. In India this is important in the context of the filariasis eradication programme. Similarly chapter 9 draws attention to the phenomenon of drug resistance in fungi.

Bennet's chapter on HIV drug resistance (chapter10) looks at the ongoing therapeutic coverage of HIV/AIDS cases in the less developed (more infected) parts of the world. The positive aspects of the programmes and the benefits have been highlighted. The much feared spread of drug resistant HIV infections due to compliance issues in developing societies has been placed in proper perspective.

In summary, the book presents well written articles on the theme of antibiotic resistance. It would make stimulating reading for consultants and postgraduate students of microbiology and infectious diseases.


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