This chapter outlines acceptable approaches to the use of antimicrobials, both in hospital practice and in the community. General principles are outlined in Box 2.1 and summarised in the antibiotic creed.

In hospitals, drug choice may be influenced by such local factors as trends in susceptibility of current isolates, cost of the drugs, and in some instances traditional preference or familiarity. Each hospital’s drug and therapeutics committee should produce its own antimicrobial policies, within the overall framework suggested by these guidelines. Resistance to antimicrobials is common in hospitals and, increasingly, in the community, due to the selective pressure exerted by high drug levels in the biosphere, together with facilitated transfer of organisms between staff and patients. Restraint in prescribing and adherence to the principles discussed in this chapter are equally necessary in both settings.