Antibiotic resistance once a term appreciated only by microbiologists has become a common
topic in the popular press. Stuart Levy one of the contributors to this collection bears some
of the responsibility for increasing public awareness with the publication of his book The
Antibiotic Paradox in 1992: Misuse of antibiotics resulting in increased bacterial resistance
had previously been recognized in the infectious disease community. However Dr. Levy's
eloquent public warning about the shrinking efficacy of our antibi otic armamentarium served to
alert the lay person to the potential consequences of this de mise in useful therapy. Because
of the proliferation of diverse antibiotic classes with increasing potency and broader activity
spectra it had been assumed that any ordinary bacterial infection could be eradicated with the
proper selection of drug. However it has become evident that we are surrounded by resistant
bacteria many of which were introduced unwittingly into our en vironment through the
unnecessary use of antibiotics. When it became evident that a number of people were returning
for multiple visits to their family physicians for persist ent ear infections or non-responsive
bronchitis questions were raised about the antibiotic treatments that were being prescribed.
Bacteria resistant to common antibiotic regimens were being isolated more frequently often as
organisms classified as multi-resistant with decreased susceptibilities to two or more
structural classes of agents. Nosocomial spread of these resistances was aided by the
transmission of plasmid-mediated resistance factors between species.
