Two important documents have appeared this year which highlight the depth of the problem that we find ourselves in with regard to antibiotic resistance throughout the world.
首先是一个特定国家，全球情境分析of the challenge of antibiotic resistance produced by the World Health Organization in April, 2015.
第二个是由疾病动态经济学和政策中心创建的文件，该文件是华盛顿特区和印度新德里的智囊团，其标题为“世界抗生素状态2015。”
Both documents provide a sobering reminder of how dire the situation has become in many areas of the world and how progressive antimicrobial resistance now threatens the sustainability of antimicrobial chemotherapy as a standard treatment option for many common infectious diseases.
How could the wonder drugs of the 20th到21年代初，世纪迅速成为“濒危物种”英石century?
一种few statistics to consider
Of the tens of thousands of tons of antibiotics produced each year, at least two-thirds of these precious drugs are used for non-medical use (to support animal husbandry or as pesticides for agriculture).
一种t least 50% of their use in agriculture is given in subtherapeutic levels presumably as growth stimulants, for which there is little evidence this use of antibiotics actually works. Antibiotics pollute the fields of farms and ranches serving as a breeding ground of the generation and spread of resistance genes among soil bacteria that later end up in the food chain.
水出生的抗生素的广泛释放，以防止感染和支持迅速发展的水产养殖业具有巨大的不利环境后果，有利于传播抗菌抗性基因。
所有用于人类使用的抗生素中，多达80％用于门诊感染。最令人不安的是，估计表明，每年由医生每年产生的抗生素处方中至少有三分之一被认为是不合适的，并且不会改善患者的临床状况。
What can be done at the present time to stem the tide of antibiotic resistance?
抗生素耐药性问题的许多元素在我们开处方抗生素的方式的控制之内。作为临床医生，至少有十件事可以改善这种情况：
1）首要任务是认识到它对所有公民的健康构成威胁。令人振奋的是，各国都将实现这一认识，例如由戴维·卡梅伦（David Cameron）在英国开展的抗生素耐药计划以及总统的研究命令，以减少美国抗生素耐药性的发病率。需要采取类似的社会举措来解决抗生素耐药性问题。
临床医生可以通过倡导中止对农业中抗生素和抗生素使用的非医学使用来改善情况。
2）临床医生可以通过倡导中止对农业中抗生素和抗生素使用的非医学使用来改善情况。这必须停止，必须以聪明的方式进行监管。显然，抗生素可以帮助兽医医学治疗动物的感染，但是它们用作生长促进剂和农药对环境具有破坏性，应禁止。
3）There should be strict control over antibiotic manufacturing and prescribing. There should be no over-the-counter (OTC) antibiotics available. This is in the purview of licensed physicians who are responsible for their safe and correct use. India has taken bold steps recently to ban OTC antibiotics and other countries should do the same.
4)We need to educate physicians and their patients, veterinarians and lawmakers about the threat of antibiotic resistance and need to curtain the unnecessary use of antibiotics. These drugs are a precious commodity for humankind and should not be wasted.
5)We need to continue to promote the development of new classes of antimicrobial agents to replace older agents which are no longer effective because of progressive antibiotic resistance. This has become a real challenge as relatively small numbers of new drugs have recently entered the market to deal with antibiotic-resistant pathogens. This situation has been improving in the last year or two where a substantial number of new antibiotics have been added to our therapeutic armamentarium.
我们需要促进使用非抗生素疗法来预防或治疗传染病。
6)我们需要促进使用非抗生素疗法来预防或治疗传染病。Vaccines against common bacterial pathogens such as肺炎链球菌，，，，嗜血杆菌流感，脑膜炎球菌疾病一直非常有效，并减少了用抗菌剂治疗这些感染的需求。还需要支持其他基于免疫的疗法或益生菌的微生物组，噬菌体的改变以及其他数量的非抗生素治疗方法的传染病疗法。
7)We need to encourage the healthy and wealthy nations to invest time and effort in the prevention treatment of infectious diseases worldwide. This idea of ‘enlightened self-interest’ is particularly true in the treatment of contagious infectious diseases such as tuberculosis, influenza and other readily transmittable pathogens which can effect low and middle income countries but also spread rapidly to be global health issues. We should not ignore the plight of our colleagues in low income countries who are dealing with multiple drug resistant (MDR) pathogens on a daily basis.
8)我们必须提高诊断能力，以迅速确定谁具有对抗微生物剂反应的可治疗感染。
在各种调查中发现，世界上至少有15％的抗菌剂供应不合格。
9）不合格抗生素的使用是一个主要问题。一种t least 15% of the world’s supply of antimicrobial agents has been found in various surveys to be substandard (either adulterated in their formulation, having reduced concentrations of antibiotics than listed on the label, and post- dated antibiotics which have lost activity because of inadequate storage and no longer have potency). This is a particular problem in low income countries where they can ill afford to be burdened with substandard antibiotics.
10)Protect the antibiotics we have and prevent the spread of MDR-pathogens in health care settings. We all need to advocate for appropriate antibiotic use and become stewards for these magnificent drugs. Lastly, get involved. Join WAAAR (world alliance against antimicrobial resistance). This is an academic advocacy group started by Jean Carlet in Paris a few years ago that champions the cause of saving antibiotics for future generations.
一种recent seriesof papers have been listed inCritical Care强调了抗生素耐药性的问题，并提供了一些潜在的解决方案。这些论文详细介绍了抗生素管理的价值，预防了在重症监护病房中的MDR病原体的传播，从而为治疗极端耐药的病原体提供了指导。
The value of selective decontamination of the digestive tract as a way of preventing the spread of antibiotic resistance genes rather than promoting antibiotic resistance is also discussed. This controversial topic is covered in a recent review inCritical Care。
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