Antimicrobial Prescribing in the United States: Good News, Bad News

Antimicrobial resistance is a global public health problem facing both the developed and developing world (1). It affects our ability to treat infections of major international importance, such as HIV infection, tuberculosis, and malaria, as well as common infections primary care physicians face daily, such as otitis media, sinusitis, and pneumonia. During the 1990s, pneumococcal drug resistance rose dramatically. By 1998, 24% of invasive isolates in the United States were resistant to penicillin and 14% were resistant to three or more drug classes (2).

Antimicrobial resistance is promoted by antimicrobial use, whether that use is appropriate or inappropriate (3). The more antimicrobials are used, the greater the selective pressure for the emergence of resistant bacteria. Inappropriate use only compounds the problem. A paper by McCaig and Hughes (4), published in 1995, focused attention on the issue of inappropriate antimicrobial prescribing. On the basis of data from the National Ambulatory Medical Care Survey, a population-based analysis of physician practices in 1992, the U.S. Centers for Disease Control and Prevention (CDC) estimated that more than 40% of antimicrobial courses prescribed in physicians' offices were inappropriate (5). In 1995, the CDC launched a campaign to promote appropriate antimicrobial use, joining with other groups around the …