More than 11,000 infectious disease specialists, microbiologists, epidemiologists, physicians from a range of other disciplines, research scientists, nurses, and other healthcare professionals gathered at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy (41st ICAAC) held in Chicago, Illinois, on December 16-19, 2001, to hear the latest information concerning the prevention, epidemiological surveillance, detection, and treatment of a wide variety of infectious diseases. There was great stress placed on the serious problem of bacterial resistance, with particular emphasis on the rapid global spread of antimicrobial resistance among the pathogens associated with community-acquired respiratory tract infections (CARTIs), which are among the most common and important infections seen by practicing physicians. Taking into consideration this growing worldwide crisis, an international group of experts has prepared a global antimicrobial initiative to help solve this difficult predicament.

The Global White Paper on Bacterial Resistance in Community-Acquired Respiratory Tract Infections
Leading experts from around the world put forth a global challenge to policy makers and healthcare professionals to combat the crisis of rapidly increasing antimicrobial resistance, according to Roger G. Finch, MD, professor of infectious diseases, the University of Nottingham and The City Hospital, Nottingham, United Kingdom, and the president of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).

"Despite numerous international and national recommendations for resistance control, few large-scale interventions have been implemented and audited and little has been accomplished in the fight against resistant bacteria," Dr. Finch declared. "The Global White Paper on Bacterial Resistance in Respiratory Tract Infections is long overdue and has come at a crucial time to help focus on what needs to be achieved to tackle the ever-increasing problem of antimicrobial resistance."

The scope of the problem
Community-acquired respiratory tract infections are a major public health concern in terms of morbidity, mortality, and costs. Among the most common infections seen, CARTIs involve the sinuses, the airways, and the lungs. Those infections caused by bacteria include community-acquired pneumonia (CAP), acute exacerbations of chronic bronchitis (AECB), tonsillitis/pharyngitis, acute bacterial sinusitis, acute or chronic otitis media, and related bacteremias.

Over the past decade, the antimicrobial treatment of CARTIs has been complicated by a rapid increase in resistance to antibiotics among virtually all of the bacteria that cause CARTIs, particularly Streptococcus pneumoniae, the microorganism most commonly implicated in these infections. A major global surveillance study—PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin)—is being carried out at 89 centers in 26 countries. The study has collected over 10,000 isolates globally, 3,362 of which were isolates of S. pneumoniae. During 1999-2000, the worldwide rate of penicillin resistance in S. pneumoniae isolates from patients with respiratory tract infections (RTIs) was 36.3%, 31.3% of S. pneumoniae isolates were macrolide-resistant (erythromycin A), and 16.0% were resistant to both penicillin and macrolides. This demonstrates that existing antimicrobials are becoming increasingly ineffective against even the most common causes of infections.

How the global white paper was developed
The Global White Paper is the first publication of the International Forum for Antibiotic Resistance (IFAR), an organization established in 2001 with the aim of developing publications to raise the profile of, and the level of debate concerning bacterial resistance. Currently, the membership extends to a multidisciplinary faculty of world-renowned experts from six continents, including infectious diseases specialists, microbiologists, epidemiologists and patient advocates.

The global antimicrobial resistance initiative was presented during a symposium officially supported by the Infectious Disease Society of America (IDSA), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and the International Society for Infectious Diseases (ISID), with the participation of the Centers for Disease Control and Prevention (CDC) and discussed by an international faculty of experts as a prelude to the 41st ICAAC. It is the first truly global initiative to focus on identifying and addressing the challenges in controlling antibiotic resistance in the community via a recommended partnership in action.

Key actions called for by the Global White Paper
The major actions required according to the Global White Paper include:

• Robust, uniform, global, resistance surveillance research studies to quantify the true impact of resistance on the health of patients with CARTIs
• Consideration by organizations responsible for resistance control of the factors driving bacterial resistance, including antibiotic use
• Education regarding the significance of resistance and optimal antibiotic usage for RTIs
• Patient involvement in measures to control resistance and development of more convenient, patient-friendly antibiotic regimens

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