Is antibiotic resistance inevitable?
Resistance problems emerge when the numbers of resistant bacterial infectious agents reach a high proportion. The development of resistance as a clinical problem is not inevitable. It is the steady use of the antibiotic and the continous selection that propels the rare resistant mutants to prominence in an environment. A resistance problem has arrived when you see that your patient has a resistant bacterial infection. The chance of finding a multiresistant pneumococcal infection in a child is probably millions of times greater now than it was 10 or 15 years ago. The acquisition of resistance may be a rare event; an integration event may occur only once in 10 million bacteria. But once it has occurred, it can be selected and propagated. The reverse situation, loss of resistance gene(s), is not selectable. Moreover, when the new gene inserts into the chromosome or plasmid, it may cause changes which prevent it from coming out by the same way it went in. Therefore, the forward movement, t
