After the introduction of sulfa drugs and penicillin, there was great hope that such drugs would soon eliminate most bacterial diseases. It is now recognized, however, that drug resistance limits the usefulness of all known antimicrobials. As these drugs are increasingly used and misused, the bacterial strains that are resistant to their effects have a selective advantage over their sensitive counterparts (figure 21.13). For example, when penicillin G was first introduced, less than 3% of Staphylococcus aureus strains were resistant to its effects. Heavy use of the drug, measured in hundreds of tons per year, progressively eliminated sensitive strains, so that 90% or more are now resistant. This development is understandably of great concern to health professionals because of the impact on the cost, complications, and outcomes of treatment. Understanding the mechanisms and the spread of antimicrobial resistance is an important step in curtailing the problem, and it may also allow pharmaceutical companies to develop new drugs that foil common resistance mechanisms.
522 Chapter 21 Antimicrobial Medications
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