Perspective

Surveillance tells us when our antibiotic use policies fail to control resistance. In general, the global distribution of antibiotic resistance is uneven: Pockets of resistance develop and expand. In many cases, we have good explanations for the development of resistance, and in some situations the resistance problems were predictable. For example, the MDR tuberculosis outbreak in the prisons of the former Soviet Union was certain to spread when inmates were released to the community without adequate support.¹⁵⁵ But providing workable solutions is difficult due to the scale of the problem and to the failure of the general public to heed the warnings provided by surveillance. Some pockets of success are also seen, such as the control of hospital-associated MRSA in Denmark and The Netherlands. But most of the hope is placed on the development of new antibiotics, which we discuss in the next chapter.