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The path of least resistance
SMAC Sub-Group on Antimicrobial Resistance |
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, of which this is the synopsis, 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.
The full report is available in a single
PDF file  of
2.6 MB, or in a series of smaller files as listed below.
The synopsis is available in a single
PDF file of 3.7Mb,
or in a series of smaller files as listed below
The executive report is available in
a single PDF file of
1.7MB
Contents of full report:
- Front cover
- Contents
- Chapters 1-9
- 1 INTRODUCTION
- 2 RECOMMENDATIONS
- 3 LOOKING INTO THE ABYSS
- 4 ANTIMICROBIAL AGENTS
- 5 BASIS OF RESISTANCE
- 6 DOES USE OF ANTIMICROBIAL AGENTS CAUSE RESISTANCE?
- 7 TO PRESCRIBE OR NOT TO PRESCRIBE?
- 8 WHERE ARE ANTIMICROBIAL AGENTS USED?
- 9 THE EXTENT OF BACTERIAL RESISTANCE IN THE UK
- Chapters 10-11
- 10 CURRENT RESISTANCE PROBLEMS IN THE UK AND WORLD-WIDE
- 11 AREAS OF CLINICAL PRACTICE WHERE ANTIMICROBIAL RESISTANCE HAS,
OR IS LIKELY TO HAVE, THE GREATEST IMPACT
- Chapters 12-19
- 12 WHAT PRACTICES BY CLINICIANS AND THE PUBLIC PREDISPOSE TO THE
DEVELOPMENT OF ANTIMICROBIAL RESISTANCE?
- 13 PREVENTING THE DEVELOPMENT OF ANTIMICROBIAL RESISTANCE
- 14 DEVELOPMENT OF NEW ANTIMICROBIAL AGENTS
- 15 PROMOTING GOOD PRACTICE
- 16 PROMOTING BETTER PRESCRIBING
- 17 SURVEILLANCE OF RESISTANCE
- 18 RESEARCH ON RESISTANCE AND ON NEW ANTIMICROBIAL AGENTS
- 19 CHANGING PRACTICE
- Chapters 20-25
- 20 INDEPENDENT REVIEW OF THE LITERATURE
- 21 REFERENCES
- 22 LIST OF RECOMMENDATIONS
- 23 GLOSSARY OF TERMS
- 24 ACKNOWLEDGEMENTS
- 25 MEMBERSHIP OF SUB-GROUP
Contents of synopsis
- Front cover
- Chapters 1-2
- 1 INTRODUCTION
- 2 RECOMMENDATIONS
- Chapters 3-10
- 3 LOOKING INTO THE ABYSS
- 4 ANTIMICROBIAL AGENTS
- 5 BASIS OF RESISTANCE
- 6 DOES USE OF ANTIMICROBIAL AGENTS CAUSE RESISTANCE?
- 7 TO PRESCRIBE OR NOT TO PRESCRIBE?
- 8 WHERE ARE ANTIMICROBIAL AGENTS USED?
- 9 THE EXTENT OF BACTERIAL RESISTANCE IN THE UK
- 10 CURRENT RESISTANCE PROBLEMS IN THE UK AND WORLD-WIDE
- Parts 11-25
- 11 AREAS OF CLINICAL PRACTICE WHERE ANTIMICROBIAL RESISTANCE HAS,
OR IS LIKELY TO HAVE, THE GREATEST IMPACT
- 12 WHAT PRACTICES BY CLINICIANS AND THE PUBLIC PREDISPOSE TO THE
DEVELOPMENT OF ANTIMICROBIAL RESISTANCE?
- 13 PREVENTING THE DEVELOPMENT OF ANTIMICROBIAL RESISTANCE
- 14 DEVELOPMENT OF NEW ANTIMICROBIAL AGENTS
- 15 PROMOTING GOOD PRACTICE
- 16 PROMOTING BETTER PRESCRIBING
- 17 SURVEILLANCE OF RESISTANCE
- 18 RESEARCH ON RESISTANCE AND ON NEW ANTIMICROBIAL AGENTS
- 19 CHANGING PRACTICE
- 20 INDEPENDENT REVIEW OF THE LITERATURE
- 21 REFERENCES
- 22 LIST OF RECOMMENDATIONS
- 23 GLOSSARY OF TERMS
- 24 ACKNOWLEDGEMENTS
- 25 MEMBERSHIP OF SUB-GROUP
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The Report is available from
Publications Unit
PHLS
Headquarters Office
61 Colindale Avenue
London NW9 5DF
tel: 020 8200 1295
or in Portable Document Format
as listed on this page
Download
Adobe Acrobat reader for PDF files
Help with Portable Document Format
Government Response to the House of Lords Select Committee on Science
& Technology Report: Resistance to antiobiotics and other antimicrobial
agents - available on The Stationery
Office website
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