The problem of antibiotic resistance is not easy to solve. In an attempt to tackle the issue, policies are being implemented with some successes. But the successes, however encouraging, will not be enough to stop the spread of resistance, say the authors. Advice to restrict the use of antibiotics so that they are prescribed only when necessary (e.g. not for viral infections just to placate a patient) is useful, say the authors, but, they say, we might need to go further. They make the controversial argument that antibiotic resistance might be stopped only by putting society before the individual, perhaps by banning antibiotic treatment for mild bacterial infections, or using them only for life-threatening illnesses. Everyone has the right to treatment, and acting against the patient's interest is not usually considered ethical. In some situations, however, what is good for an individual patient may not be good for the health of society as a whole, say the authors – drastic problems sometimes necessitate drastic solutions.

At WHO's behest, the Alliance for the Prudent Use of Antibiotics (APUA) undertook a review of 25 key reports on antibiotic resistance to identify areas of consensus in expert recommendations and to suggest ways of translating the advice into action.

The reports were chosen because they were highly cited in medical literature and had input from a wide variety of expert policy groups. The review authors separated their comments into five areas: surveillance; education of patients and providers; prevention; R&D; and antibiotic use in animals.

Education, says the review, needs to happen in medical schools and among the general public. Surveillance of antibiotic resistance occurs but is fragmented – coordinated local surveillance networks could do much to tackle resistance before it spreads. Healthcare institutions need committees to assess antibiotic use data and enforce infection control measures. In terms of use in animals, the review recommends that farmers prevent infection with good hygiene and not just antimicrobials, and calls for the reduced use of antibiotics as growth promoters.