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Afterword: A Course of Action > Drug Discovery and Surveillance

Drug Discovery and Surveillance

From an industry perspective, the question of resistance needs to enter the drug discovery process at an early stage. Drug resistance discussions currently come into serious play after a drug is introduced into the market. We argue that the criteria for developing new compounds should make prevention of resistance equal to considerations of safety and efficacy. For new drugs, a combination of creative chemistries and new performance criteria should lead to better antibiotics that last longer in the clinic. Indeed, in the future, only compounds that seriously restrict the emergence of resistance will experience widespread use because the others will be held back for “emergencies.”

Some hope for short-term, local solutions can be seen in the aggressive effort being mounted with MRSA in several small European countries. The effort is best described by the “search and destroy” policy that Dutch and Danish health authorities have taken against MRSA. In Denmark, all MRSA-positive persons are offered eradication treatment, and guidelines recommend that they be issued personal MRSA identification cards. These cards must be shown at each contact with healthcare workers. Moreover, physicians are required to report all MRSA cases.298 Such policies appear to be keeping the prevalence of hospital-associated MRSA low. Whether these policies will continue to contain the MRSA problem is uncertain, because a large reservoir is being generated in farm animals. Also unknown is whether aggressive policies will work in larger countries that have a higher prevalence of drug resistance or with diseases spread by routes other than direct contact. We are encouraged that many states in the United States now require reporting of pathogens such as MRSA. Moreover, individual institutions are beginning to assess the value of patient and healthcare worker decolonization strategies to prevent infection.


  

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