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Report of a symposium on use and abuse of antibiotics worldwide.

A collaborative symposium of the Quality of Care and Technologies Programme of the World Health Organization's Regional Office for Europe and the Department of Hospital Epidemiology of the University Hospital, Freiburg, was held in Freiburg, FRG, in September 1988 to consider the use and abuse of antibiotics worldwide. Participants from developing countries provided estimates of use of antibiotics and problems of resistance in their countries. Because much of the information either is anecdotal or may not be representative of the vast, heterogenous populations in these countries, it is difficult to provide exact guidelines for the use of antibiotics. There is a need for better etiologic definition of the causes of acute respiratory tract infection and diarrheal disease and for surveillance of resistant bacterial strains. Because of the difficulty of making an etiologic diagnosis, a set of empiric guidelines has been developed for diagnosis and management of common conditions. Recommendations for the use of antibiotics must take into account the economics, medical manpower, social constraints, and emergence of resistant bacteria in both developed and developing countries. There is a need to establish a coordinated, worldwide network to obtain representative data and to organize clinical trials pertinent to the conditions of both developed and developing countries to define the best antimicrobial agent(s), the dosage, and duration of treatment for specific conditions.