The absolutely uncritical use of antibiotics is reflected in figures of the German Institute for Medical Statistics (IMS). The use of antibiotics in Germany has more than doubled between 1987 and 1997, and it has increased by a factor of six for some indications. For example, it is interesting to note that, while the number of upper respiratory tract diseases has tripled, their treatment with antibiotics has increased by a factor of five. The trend to overprescription particularly affects children. The IMS figures for 1996 reveal that 64% of infants and children under four received antibiotics. Every fourth child was treated up to three times a year with antibiotics. In the period from 1994 to 1996, almost half of all antibiotics were prescribed to four million children with diseases of the ENT area, as compared with 76 million mostly adults with the same indication (17).

This chemotherapeutic bombardment results in a considerable ecological selection pressure. Multiple resistances have developed, and the media are full of reports on killer microbes and the end of the era of antibiotics. Meanwhile, it is becoming obvious that there has been no development of new, effective agents against microbes during the last 20 years, because it was thought that the issue of infectious diseases has been dealt with. Also vancomycin, which is used today as the last resort, is failing increasingly often. Resistant Staphylococcus strains have already developed even against the most recently introduced line-zolid.

The uncontrolled use of antibiotics creates ideal selection conditions for pathogens, and the numerous new variants of these pathogens can spread easily due to global mass tourism. The dramatic increase in multiresistant pathogens could have been far less alarming, without jeopardizing the health of entire populations, if antibiotics had been used in a more controlled manner as demanded by medical microbiologists.

On the contrary, there are indications that immediate administration of antibiotics to children with otitis and tonsillitis resulted in a relapse rate after four weeks that was twice as high as in children without treatment with antibiotics (KVH aktuell 16/1996). Shifts in the composition of symbiotic microbial populations are direct consequences of the extensive use of antibiotics. Postantibiotic colitis is caused by Clostridium difficile and is the result of antibiotic treatment. It has also been documented that the propagation of pathogenic fungi, such as Candida albicans, is a result of antibiotic treatment. The significant increase in at-opic disorders in industrialized countries has been correlated in recent studies with excessive hygiene, antibiotic decontamination, and lack of contact with the microbial environment. The fecal flora in atopic patients and, above all, in children exhibits considerable abnormalities; these abnormalities are evident in a significant propagation of pathogenic yeasts and enteric bacteria as well as a significant reduction in bifidobacteria and lactoba-cilli.

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