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Donald E. Low, MD; W. Michael Scheld, MD

JAMA. 1998;279:394-395.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Antimicrobial resistance is a rapidly emerging global problem. Appropriate antibiotic use is an essential component of any program to prevent and control resistance. However, even if indiscriminate use of antibiotics in humans, animals, and farming were curtailed today, there would still be intense selective pressure for the emergence of bacterial resistance from discriminate use.^1-2 Therefore, to develop more encompassing control strategies, it is essential that physicians understand all those factors that favor the evolution of resistant strains and facilitate their dissemination.

For Streptococcus pneumoniae there is evidence to suggest that it is not just exposure to the antimicrobial agent that is important, but that the concentration of the antimicrobial and the level of resistance of the strain are critical factors. Negri et al³ demonstrated in vitro that exposure of mixed populations of S pneumoniae with different penicillin susceptibilities (0.015, 0.5, 1, and . . . [Full Text of this Article]

From the Department of Laboratory Medicine and Pathobiology and Medicine, University of Toronto, and Mt Sinai Princess Margaret Hospitals, Toronto, Ontario (Dr Low), and the Infectious Diseases Division, University of Virginia Medical Center, Charlottesville (Dr Scheld).

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