Ever since the beginning of modern antibiotic era with the discovery of penicillin in 1929, there has been an exponential growth worldwide in terms of both availability and use of β -lactam and non β-lactam agents. Currently antibiotics constitute a significant proportion of NHS budget, and in the year 2011 this amounted to £221,898,900 (≈2.5% of all prescription cost) in the primary care alone. Antibiotic therapy has improved mortality amongst acute infections such as meningitis, increased longevity amongst chronic infections such as HIV and also enabled delivery of more complex care such as transplantation and complex surgeries. However antimicrobial resistance that was noticed early in the modern era is posing a significant threat. At the same time availability of newer antimicrobial agents has decreased. The implications of antimicrobial resistance on clinical outcome are indisputable. World Health Organisation (WHO) has acknowledged antimicrobial resistance as top health priority and was indeed the theme of World health day on 07/04/2011 and European antibiotic awareness day on 18/11/2011. Infections are a common problem faced by frontline clinicians working in both primary and secondary care. Often in these settings, the causative pathogen and especially antimicrobial susceptibility is not known. Initiation of an early and appropriate empirical antimicrobial therapy has a positive impact on clinical outcome, especially in severe infections. Considering the above factors i.e. increasing resistance and decreasing therapeutic options along with a drive to initiate early appropriate antimicrobial therapy, prescribing antibiotics in the front line clinical services is becoming a challenge. This review article addresses the current trends in antimicrobial resistance from an UK perspective and challenges faced by frontline clinicians in prescribing antimicrobial therapy, giving a brief summary of use of older/existing agents and the forthcoming newer antimicrobial agents.
- Antimicrobial therapy
- Frontline clinicians