CONCLUDING REMARKS

5. CONCLUDING REMARKS

It is evident that increasing insight in dose–effect relationships of anti- microbials has led to a re-appreciation of the meaning of susceptible and resistance. In a world where resistance is an escalating problem there is both a need to have the ability for fast intervention as well as a requisite to treat patients in the best way possible. In retrospect, it is not surprising that the limitations of one breakpoint system encompassing both these key elements have lead to controversies, as they were anticipated in the report by Ericsson and Sherris in 1971(Ericsson and Sherris, 1971).

The approach that EUCAST is now taking, by formulating both clinical breakpoints and wild-type cut-off values (or epidemiological breakpoints), to distinguish between the two objectives can therefore also be regarded as a con- tinuance of that earlier work. Although it may be difficult to reach global consensus on clinical breakpoints (actually impossible because of differences in dosing), global consensus should easily be reached for wild-type cut-off values. Comparisons between resistance rates will then be more rational, while early intervention will be more likely.

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Chapter 22