The future - Can we learn from the past?

We know that the current problems of resistance among bacterial pathogens to commonly prescribed antibiotics is, in part, attributable to inappropriate prescribing. If we are to rectify matters, we must learn from past mistakes and take appropriate measures to ensure that community-acquired infections do not become as untreatable as certain nosocomial infections are now. This means that we must be able to predict efficacy outcomes better so that we can make more effective use of available antibiotics. Animal studies suggest that the duration of time that an antibiotic exceeds the MIC of the causative pathogen (i.e., at least 40 to 50% of the dosing interval) is a good prognostic indicator for the efficacy of beta-lactam antibiotics. Clinical studies are now being published that confirm the value of time above MIC. Use of this information should enhance efficacy and may delay the pace of developing antibiotic resistance, allowing time for new antimicrobial agents to be researched and brought to market. (C) 1997 Elsevier Science Inc.