Excerpt

Through invited presentations and participant discussion, the February 6–7, 2002, Forum (Institute of Medicine Forum on Emerging Infections) workshop explored the causes and consequences of the resistance phenomenon. The Forum discussion also examined the scientific evidence supporting current and potential strategies for containment of resistance in microbes, vectors, and animal and human hosts. Additionally, the methods and measures of a response for industry, federal regulation, domestic and international public health, federal and academic research, and the private health care sector were debated.

Contents

• THE NATIONAL ACADEMIES
• FORUM ON EMERGING INFECTIONS
• BOARD ON GLOBAL HEALTH
• Reviewers
• Preface
• Summary and Assessment
  • FRAMING THE ISSUE
  • MICROBE RESISTANCE
  • VECTOR RESISTANCE
  • FACTORS CONTRIBUTING TO THE EMERGENCE OF RESISTANCE
  • EMERGING TOOLS AND TECHNOLOGY FOR COUNTERING RESISTANCE
  • STRATEGIES TO CONTAIN THE DEVELOPMENT AND CONSEQUENCES OF RESISTANCE
• 1. Introduction
  • MICROBIAL RESISTANCE: ADOPTING AN EVOLUTIONARY APPROACH
  • ARMS RACES AND ANTIMICROBIAL RESISTANCE: USING EVOLUTIONARY SCIENCE TO SLOW EVOLUTION
  • ANTIBIOTIC RESISTANCE 1992–2002: A DECADE'S JOURNEY
  • REFERENCES
• 2. Microbe Resistance
  • OVERVIEW
  • NEW STRATEGIES AGAINST MULTI-DRUG-RESISTANT BACTERIAL PATHOGENS
  • MALARIA AND THE PROBLEM OF CHLOROQUINE RESISTANCE
  • DRUG RESISTANCE IN TREATMENT OF SCHISTOSOMIASIS
  • BACTERIAL INFECTION IN IRRADIATED MICE: THERAPY AND PROPHYLAXIS (ANTHRAX, A SPECIAL CONSIDERATION)
  • REFERENCES
• 3. Vector Resistance
  • OVERVIEW
  • INSECTICIDE RESISTANCE IN INSECT VECTORS OF HUMAN DISEASE
  • MANAGING THE EMERGENCE OF PESTICIDE RESISTANCE IN VECTORS
  • WHAT IS THE ROLE OF INSECTICIDE RESISTANCE IN THE RE-EMERGENCE OF MAJOR ARTHROPOD-BORNE DISEASES?
  • REFERENCES
• 4. The Economics of Resistance
  • OVERVIEW
  • WHAT DOES ECONOMICS HAVE TO OFFER IN THE WAR AGAINST ANTIMICROBIAL RESISTANCE?
  • ECONOMIC INSTRUMENTS FOR THE CONTROL OF ANTIMICROBIAL RESISTANCE
  • ECONOMIC RESPONSES TO THE PROBLEM OF DRUG RESISTANCE
  • REFERENCES
• 5. Factors Contributing to the Emergence of Resistance
  • OVERVIEW
  • ANTIBIOTIC USE AND RESISTANCE IN DEVELOPING COUNTRIES
  • HEALTHCARE-ACQUIRED INFECTIONS: HOSPITALS AS A BREEDING GROUND FOR ANTIMICROBIAL RESISTANCE
  • THE USE OF ANTIMICROBIALS IN FOOD-PRODUCING ANIMALS
  • REFERENCES
• 6. Emerging Tools and Technology for Countering Resistance
  • OVERVIEW
  • EVOLUTION OF MULTIPLE MECHANISMS OF RESISTANCE TO β-LACTAM ANTIBIOTICS
  • USING PHAGE LYTIC ENZYMES TO CONTROL ANTIBIOTIC-RESISTANT PATHOGENIC BACTERIA ON MUCOUS MEMBRANES
  • ROLES FOR PHARMACOKINETICS AND PHARMACODYNAMICS IN DRUG DEVELOPMENT FOR RESISTANT PATHOGENS
  • REFERENCES
• 7. Strategies to Contain the Development and Consequences of Resistance
  • OVERVIEW
  • DEVELOPMENT OF THE PUBLIC HEALTH ACTION PLAN TO COMBAT ANTIMICROBIAL RESISTANCE AND CDC ACTIVITIES RELATED TO ITS IMPLEMENTATION
  • ANTIBIOTIC RESISTANCE: ENCOURAGING THE DEVELOPMENT OF NEW THERAPIES, PRESERVING THE USEFULNESS OF CURRENT THERAPIES
  • THE CENTERS FOR DISEASE CONTROL AND PREVENTION'S CAMPAIGN TO PREVENT ANTIMICROBIAL RESISTANCE IN HEALTH CARE SETTINGS
  • ANTIMICROBIAL RESISTANCE CONTAINMENT STRATEGIES OF THE RATIONAL PHARMACEUTICAL MANAGEMENT PLUS PROGRAM
  • ANTIMICROBIAL RESISTANCE AND FUTURE DIRECTIONS
  • REFERENCES
• Appendixes
  • Appendix A Public Health Consequences of Use of Antimicrobial Agents in Agriculture
  • Appendix B Issues of Resistance: Microbes, Vectors, and the Host
  • Appendix C Information Resources
  • Appendix D WHO Global Strategy for Containment of Antimicrobial Resistance: Executive Summary
  • Appendix E Interventions Against Antimicrobial Resistance: A Review of the Literature and Exploration of Modelling Cost-Effectiveness
  • Appendix F A Public Health Action Plan to Combat Antimicrobial Resistance
  • Appendix G Forum Member, Speaker, and Staff Biographies

Support for this project was provided by the U.S. Department of Health and Human Services' National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Agency for International Development; U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; U.S. Department of Agriculture; American Society for Microbiology; Burroughs Wellcome Fund; Eli Lilly & Company; Pfizer; GlaxoSmithKline; and Wyeth-Ayerst Laboratories.

This report is based on the proceedings of a workshop that was sponsored by the Forum on Emerging Infections. It is prepared in the form of a workshop summary by and in the name of the editors, with the assistance of staff and consultants, as an individually authored document. Sections of the workshop summary not specifically attributed to an individual reflect the views of the editors and not those of the Forum on Emerging Infections. The content of those sections is based on the presentations and the discussions that took place during the workshop.

NOTICE: The project that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.