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May 27, 1974

Trends of Antibiotic Use In the United States

Author Affiliations

Walter Reed Army Institute of Research Washington, DC

JAMA. 1974;228(9):1098. doi:10.1001/jama.1974.03230340014012

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To the Editor.—  Simmons and Stolley refer to "a shift of the bacterial ecological equilibrium to selectively ecovor the Gram-negative organisms." But the commentary en bloc does not emphasize and analyze the microbiological basis of the Gram-negative bacterial disease problem. This omission is regrettable because the problem, once generated, may not readily disappear in response to legislative or committee actions.A large part of the problem is multiple chemotherapeutic drug resistance of Gram-negative bacteria. During the first two decades of the sulfonamide-antibiotic era, bacterial resistance to single chemotherapeutic drugs was seen as the result of selective breeding of spontaneous chromosomal bacterial mutants under drug pressure. This entailed cross-resistance only to drugs that were closely related in chemical structure and mechanism of action. The last decade, however, has witnessed a worldwide emergence of multiresistance of Gram-negative bacteria caused by extrachromosomal elements of bacterial heredity, the R-factors. Under pressure of one drug,