prescribing of these newer drugs, even in areas where there is no demonstrated resistance to first-line therapies. The use of first-line therapies must be continued in areas where resistance has not been documented, and newer therapies should be used only when first-line therapies are ineffective or in areas of resistance. To this end, it is essential to monitor resistance patterns around the world.

Decreasing the inappropriate use of antimicrobials in human medicine is a complex task that requires a multipronged effort fueled by a sense of urgency. The inappropriate use of antibiotics for treatment of viral diseases can be averted by the increased use of available diagnostic tests and the development of better point-of-care, inexpensive, rapid, sensitive, and specific diagnostic tests, which would enable the rational use of new antivirals as they become available (see the earlier discussion of the development of diagnostics). The decreased use of antibacterials for viral respiratory infections and other syndromes should lessen selective pressures for the emergence of resistant bacteria. FDA has recently included this message on label inserts of antibiotics.

If this important objective is to be achieved, the general public and health care providers must be better educated and informed about the importance of administering antimicrobial therapy properly. The need is urgent to both educate and monitor all categories of practitioners and drug dispensers in developing countries where medicines are sold directly to the public over the counter and dispensed by private practitioners in an ad hoc manner. More attention needs to be given to improving practitioner education and compliance. Patient care would be improved by the development and dissemination of better evidence-based treatment guidelines. More research is needed on methods for treating infections to minimize the emergence of resistance without a loss of efficacy. Infection control programs must be supported in hospitals in an effort to decrease the transmission of resistance both within the hospitals and in the community. Surveillance for patterns of resistance in hospitals and in the community must be continued and expanded; this will require a coordinated effort among public health organizations, private medicine, and industry. Because resistant microbes arise throughout the world and travel broadly to all regions, the needs and problems of the economically and health care disadvantaged regions of the world must be considered.

The world is facing an imminent crisis in the control of infectious diseases as the result of a gradual but steady increase in the resistance of a number of microbial agents to available therapeutic drugs. Although defining the precise public health risk of emergent antimicrobial resistance is not