Much has happened in the world of antimicrobial chemotherapy since the first edition of this book was published in 1983. Well over 70 new antimicrobial compounds have appeared on the market in the UK and many more in other countries of the world. Some of these represent genuine advances; others display little discernable advantage over their predecessors. All add to the confusion felt by students and qualified practitioners alike as they try to understand the competing claims of the numerous agents now available to the prescriber for the treatment of infection. Regular editions of this book have been needed to keep up with new arrivals on the scene and other developments in antimicrobial chemotherapy. Each has been gratifyingly well received as offering straightforward guidance on the properties of antimicrobial agents of all kinds, and on the principles that underlie their use.
The present edition has required extensive revision to take account of recent developments, notably (but by no means exclusively) in the area of antiviral agents, in which there has been remarkable progress in recent years, largely stimulated by the HIV pandemic. We have also taken the opportunity for a thorough overhaul of the whole text, not only to bring it up to date, but also to prevent the size from getting out of hand. To accommodate a new chapter on anti-retroviral agents, the chapters on antimicrobial susceptibility testing and antibiotic assay have been merged to form a single, somewhat shorter topic.
The last few years have seen an unprecedented world-wide growth in public and professional awareness of the problems of antimicrobial drug resistance. In the UK there have been several wide-ranging official enquiries (listed in the recommendations for further reading at the end of the book) that have reached alarming conclusions about our continued capacity to treat microbial infection. Although we are still a long way from the doomsday scenario that some envisage, there is undoubtedly an urgent need to conserve the uniquely valuable resource that antimicrobial agents provide. Strong and specific recommendations have been made that much greater emphasis should be placed on more effective teaching about antimicrobial chemotherapy at the undergraduate and postgraduate levels. Whether this plea will be taken up by those charged with the design of medical school curricula—already seriously overloaded—must be doubtful; but if sensible use of antimicrobial agents is to be fostered, introducing students and young doctors to good prescribing habits in their formative years is surely essential. A proper emphasis on the management of infection as a component of Continuing Professional Development courses for doctors and other health-care workers is equally important.
Setting forth the principles of rational antimicrobial chemotherapy is the whole purpose of this book. We sincerely hope that it will furnish students and all health care professionals throughout the world with the necessary framework for understanding what antimicrobial agents will and will not do, and provide a firm basis for their informed use in the treatment and control of infection.