Intensive Care Medicine

, Volume 16, Supplement 3, pp S206–S211 | Cite as

The emergence of antibiotic resistance: Myths and facts in clinical practice

  • J. M. T. Hamilton-Miller


Selection pressure, caused by the use of antibiotics — especially in hospitals — is the main factor responsible for the emergence of antibiotic-resistant bacteria. Resistance can arise endogenously by mutation (onestep, as found forMycobacterium tuberculosis to rifampicin, or multi-step, as in gonococci to benzylpenicillin), or exogenously by transfer of R-factors. Mechanisms of resistance may involve a decrease in permeability, chemical modification of the antibiotic, or a change in the affinity of the target site. There are many misconceptions concerning the incidence, nature and spread of antibiotic resistance, and some of the most important of these are discussed. The emergence and spread of resistance can be controlled by adhering to antibiotic policies and by preventing or controlling outbreaks of infection. The importance of resistant organisms can be diminished by the development of new antibiotic agents, preferably containing new chemical entities.

Key words

Antibiotic resistance Infection 


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Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • J. M. T. Hamilton-Miller
    • 1
  1. 1.Department of Medical MicrobiologyRoyal Free Hospital and School of MedicineLondonUK

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