remained in existence in 2002 and not one new class of antibiotics is in advanced development. Likewise, antivirals for only a limited number of viral diseases are available, and few are in development. In the event of a natural or intentionally introduced microbial threat, antimicrobials may be the only available first line of response. A readily available supply, therefore, should be a priority of preparedness plans.

The U.S. Secretary of Health and Human Services should ensure the formulation and implementation of a national strategy for developing new antimicrobials, as well as producing an adequate supply of approved antimicrobials. The U.S. Secretary of Health and Human Services should work closely with other relevant federal agencies (e.g., DOD, the Department of Homeland Security), Congress, industry, academia, and the public health community to carry out this responsibility.

The U.S. Secretary of Health and Human Services and the U.S. Secretary of Homeland Security should protect our national security by ensuring the stockpiling and distribution of antibiotics, antivirals (e.g., for influenza), and antitoxins for naturally occurring or intentionally introduced microbial threats. The federal government should explore innovative mechanisms, such as cooperative agreements between government and industry or consortia of government, industry, and academia, to accelerate these efforts.

Inappropriate Use of Antimicrobials

The world is facing an imminent crisis in the control of infectious diseases as the result of a gradual but steady increase in the resistance of a number of microbial agents to available therapeutic drugs. The problem is of global concern and is creating dilemmas for the treatment of infections in both hospitals and community health care settings. Moreover, as noted above, the pharmaceutical industry is developing fewer new antimicrobials than in previous years. Therefore, immediate action must be taken to preserve the effectiveness of available drugs by reducing the inappropriate use of antimicrobials in human and animal medicine.

CDC, FDA, professional health organizations, academia, health care delivery systems, and industry should expand efforts to decrease the inappropriate use of antimicrobials in human medicine through (1) expanded outreach and better education of health care providers, drug dispensers, and the general public on the inherent dangers associated with the inappropriate use of antimicrobials, and (2) the increased use



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