WHO Global Strategy for Containment of Antimicrobial Resistance: Executive Summary

Acknowledgements The World Health Organization (WHO) wishes to acknowledge with gratitude the significant support from the United States Agency for International Development (USAID) and additional assistance for this work from the United Kingdom Department for International Development and the Ministry of Health, Labour and Welfare, Japan. This strategy is the product of collaborative efforts across WHO, particularly in the clusters of Commu-nicable Diseases, Health Technology and Pharmaceuticals, and Family and Community Health, with significant input from the staff at WHO Regional Offices and from many partners working with WHO worldwide. In particular, WHO would like to acknowledge the important contributions made to the drafting of the strategy UK—that enabled them to spend time at WHO. WHO also wishes to thank all those who participated and contributed their expertise in the consultations (see Annex B) and those individuals and organizations that provided valuable comments on drafts of this document. This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. The designations employed and the presentation of the material in this document, including tables and maps, do not imply the expression of any opinion whatsoever on the part of the secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

[1]  T. Sharpe,et al.  Patient compliance with antibiotic regimens. , 1974, American journal of hospital pharmacy.

[2]  D. Kyle,et al.  Randomised double-blind placebo-controlled trial of SPf66 malaria vaccine in children in northwestern Thailand , 1996, The Lancet.

[3]  H. Dupont,et al.  Use of antimicrobial agents in animal feeds: implications for human health. , 1987, Reviews of infectious diseases.

[4]  N. E. Jensen,et al.  Surveillance of antimicrobial resistance in bacteria isolated from food animals to antimicrobial growth promoters and related therapeutic agents in Denmark , 1998, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.

[5]  E. Threlfall,et al.  Increasing incidence of resistance to trimethoprim and ciprofloxacin in epidemic Salmonella typhimurium DT104 in England and Wales. , 1997, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[6]  D. Milatovic,et al.  Development of resistance during antibiotic therapy , 1987, European Journal of Clinical Microbiology.

[7]  S. Levy Antibiotic Use for Growth Promotion in Animals: Ecologic and Public Health Consequences. , 1987, Journal of food protection.

[8]  M. Pichichero,et al.  Shortened course of antibiotic therapy for acute otitis media, sinusitis and tonsillopharyngitis. , 1997, The Pediatric infectious disease journal.

[9]  R. Sanson-Fisher,et al.  Effects of intervention on antibiotic compliance in patients in general practice. , 1987, The Medical journal of Australia.

[10]  A. Audurier,et al.  Changes in microbial ecology and use of cloxacillin. , 1994, The Journal of hospital infection.

[11]  M. Nichter,et al.  Agenda for an anthropology of pharmaceutical practice. , 1994, Social science & medicine.

[12]  R A Weinstein,et al.  Strategies to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in Hospitals. A challenge to hospital leadership. , 1996, JAMA.

[13]  Jerome J. Schentag,et al.  Genesis of methicillin-resistant Staphylococcus aureus (MRSA), how treatment of MRSA infections has selected for vancomycin-resistant Enterococcus faecium, and the importance of antibiotic management and infection control. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  T. Frieden,et al.  Tuberculosis in New York City--turning the tide. , 1995, The New England journal of medicine.

[15]  R. Swanstrom,et al.  Human immunodeficiency virus type-1 protease inhibitors: therapeutic successes and failures, suppression and resistance. , 2000, Pharmacology & therapeutics.

[16]  D. Horn,et al.  Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. , 1998, JAMA.

[17]  D. Heymann,et al.  Considerations regarding mass vaccination against typhoid fever as an adjunct to sanitation and public health measures: potential use in an epidemic in Tajikistan. , 1999, The American journal of tropical medicine and hygiene.

[18]  H. Haak Pharmaceuticals in two Brazilian villages: lay practices and perceptions. , 1988, Social science & medicine.

[19]  J J Schentag,et al.  Understanding and managing microbial resistance in institutional settings. , 1995, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[20]  A. Glenny,et al.  Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials , 1998, The British journal of surgery.

[21]  R. Albert,et al.  Hand-washing patterns in medical intensive-care units. , 1981, The New England journal of medicine.

[22]  Inge Kaul,et al.  Global Public Goods: International Cooperation in the 21st Century , 1999 .

[23]  H. Endtz,et al.  Quinolone resistance in campylobacter isolated from man and poultry following the introduction of fluoroquinolones in veterinary medicine. , 1991, The Journal of antimicrobial chemotherapy.

[24]  F. Aarestrup,et al.  Detection of the satA gene and transferability of virginiamycin resistance in Enterococcus faecium from food-animals. , 1998, FEMS microbiology letters.

[25]  I. Okeke,et al.  Antimicrobial resistance in developing countries , 1998, BMJ.

[26]  D. Quade,et al.  The SENIC Project. Study on the efficacy of nosocomial infection control (SENIC Project). Summary of study design. , 1980, American journal of epidemiology.

[27]  D. Leaper Use of antibiotic prophylaxis in clean non-implant wounds. , 1998, The Journal of antimicrobial chemotherapy.

[28]  H. Claus,et al.  Decreased incidence of VanA-type vancomycin-resistant enterococci isolated from poultry meat and from fecal samples of humans in the community after discontinuation of avoparcin usage in animal husbandry. , 1999, Microbial drug resistance.

[29]  J. Coast,et al.  An economic perspective on policy to reduce antimicrobial resistance. , 1998, Social science & medicine.

[30]  B. Rowe,et al.  Increasing ciprofloxacin resistance in salmonellas in England and Wales 1991-1994. , 1996, The Journal of antimicrobial chemotherapy.

[31]  E J Threlfall,et al.  Molecular epidemiology of antibiotic resistance genes in multiresistant epidemic Salmonella typhimurium DT 104. , 1998, Microbial drug resistance.

[32]  S. Gulnik,et al.  Protease inhibitors: resistance, cross-resistance, fitness and the choice of initial and salvage therapies. , 1999, AIDS.

[33]  H. Hogerzeil,et al.  Promoting rational prescribing: an international perspective. , 1995, British journal of clinical pharmacology.

[34]  M. McDonald,et al.  Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review. , 1998, The Australian and New Zealand journal of surgery.

[35]  S. Schrag,et al.  Resistant pneumococcal infections: the burden of disease and challenges in monitoring and controlling antimicrobial resistance , 2001 .

[36]  David A. Sack,et al.  Antimicrobial resistance in shigellosis, cholera and campylobacteriosis , 2001 .

[37]  M. Struelens The epidemiology of antimicrobial resistance in hospital acquired infections: problems and possible solutions , 1998, BMJ.

[38]  E. Dellinger,et al.  Current guidelines for antibiotic prophylaxis of surgical wounds. , 1998, American family physician.

[39]  H. Sørensen,et al.  Changes in reimbursement policy for antibiotics and prescribing patterns in general practice. , 1997, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[40]  R. Glass,et al.  Antibiotic use in a rural community in Bangladesh. , 1982, International journal of epidemiology.

[41]  S. Levy,et al.  Changes in intestinal flora of farm personnel after introduction of a tetracycline-supplemented feed on a farm. , 1976, The New England journal of medicine.

[42]  S. Holmberg,et al.  Drug-resistant Salmonella from animals fed antimicrobials. , 1984, The New England journal of medicine.

[43]  J. Coast,et al.  Controlling antimicrobial resistance: a proposed transferable permit market. , 1998, Health policy.

[44]  J Lexchin,et al.  Enforcement of codes governing pharmaceutical promotion: what happens when companies breach advertising guidelines? , 1997, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[45]  A. Mijch,et al.  Emergence of multidrug resistance in Campylobacter jejuni isolates from three patients infected with human immunodeficiency virus. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[46]  A. Franklin Current status of antibiotic resistance in animal production. , 1999, Acta veterinaria Scandinavica. Supplementum.

[47]  M. Zervos,et al.  Antimicrobial Resistance in Enterococci Isolated from Turkey Flocks Fed Virginiamycin , 1998, Antimicrobial Agents and Chemotherapy.

[48]  H L Rieder,et al.  Global surveillance for antituberculosis-drug resistance, 1994-1997. World Health Organization-International Union against Tuberculosis and Lung Disease Working Group on Anti-Tuberculosis Drug Resistance Surveillance. , 1998, The New England journal of medicine.

[49]  E. Stobberingh,et al.  The effect of banning avoparcin on VRE carriage in The Netherlands. , 2000, The Journal of antimicrobial chemotherapy.

[50]  G. Ayliffe The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[51]  M. Espinal Epidemiology of multidrug-resistant tuberculosis in low- and middle-income countries , 2000 .

[52]  H. Mcgavock,et al.  How has fundholding in Northern Ireland affected prescribing patterns? A longitudinal study , 1997, BMJ.

[53]  M Graham,et al.  Frequency and duration of handwashing in an intensive care unit. , 1990, American journal of infection control.

[54]  B. Balkau,et al.  Low dosage and long treatment duration of beta-lactam: risk factors for carriage of penicillin-resistant Streptococcus pneumoniae. , 1998, JAMA.

[55]  P. Blake,et al.  The significance of hospitals as reservoirs for endemic multiresistant Salmonella typhimurium causing infection in urban Brazilian children. , 1984, The Journal of infectious diseases.

[56]  L. Morris,et al.  The attitudes of consumers toward direct advertising of prescription drugs. , 1986, Public health reports.

[57]  J M Hughes,et al.  Approaches to limiting emergence of antimicrobial resistance in bacteria in human populations. , 1997, Clinical Infectious Diseases.

[58]  Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination. Recommendations of the Immunization Practices Advisory Committee (ACIP). , 1991, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[59]  J. Trostle Medical compliance as an ideology. , 1988, Social science & medicine.

[60]  M. Lipsky,et al.  The opinions and experiences of family physicians regarding direct-to-consumer advertising. , 1997, The Journal of family practice.

[61]  R. Morrow,et al.  Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial , 2000, The Lancet.

[62]  F. Goldstein,et al.  Consequences of increasing resistance to antimicrobial agents. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[63]  B. Beermann,et al.  Antibiotic prophylaxis in surgery: summary of a Swedish-Norwegian Consensus Conference. , 1998, Scandinavian journal of infectious diseases.

[64]  E. Bouza,et al.  Failure of ciprofloxacin therapy for invasive nontyphoidal salmonellosis. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[65]  A. Branthwaite,et al.  Pan-European Survey of Patients' Attitudes to Antibiotics and Antibiotic Use , 1996, The Journal of international medical research.

[66]  J Lexchin,et al.  Interactions between physicians and the pharmaceutical industry: what does the literature say? , 1993, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[67]  C. Oon,et al.  Human hepatitis B virus mutants: significance of molecular changes , 1999, FEBS letters.

[68]  M. Nichter,et al.  Changing patterns of pharmaceutical practice in the United States. , 1997, Social science & medicine.

[69]  J. Coast,et al.  Superbugs: should antimicrobial resistance be included as a cost in economic evaluation? , 1996, Health economics.

[70]  I. Bowler,et al.  Emerging quinolone resistance in campylobacters , 1992, The Lancet.

[71]  K. Mulholland Evaluation of vaccines to prevent childhood pneumonia: lessons relevant to planning tuberculosis vaccine trials. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[72]  G. Papanicolaou,et al.  Outbreak of ceftazidime resistance caused by extended-spectrum beta-lactamases at a Massachusetts chronic-care facility , 1990, Antimicrobial Agents and Chemotherapy.

[73]  Jerry Avorn,et al.  Cultural and Economic Factors That (Mis)Shape Antibiotic Use: The Nonpharmacologic Basis of Therapeutics , 2000, Annals of Internal Medicine.

[74]  M. Shapiro Regulating pharmaceutical advertising: what will work? , 1997, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[75]  Eduardo Zárate Cárdenas,et al.  Prescribing habits of Peruvian physicians and factors influencing them. , 1995 .

[76]  F. Bro,et al.  The effect of reimbursement on the use of antibiotics. , 1993, Scandinavian journal of primary health care.

[77]  R. Recco,et al.  Antibiotic control in a municipal hospital. , 1979, JAMA.

[78]  L. Nicolle Infection control programmes to contain antimicrobial resistance , 2001 .

[79]  A. Khomenko,et al.  Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries. , 2000, JAMA.

[80]  E. Bouza,et al.  Evolution of susceptibilities of Campylobacter spp. to quinolones and macrolides , 1994, Antimicrobial Agents and Chemotherapy.

[81]  Randolph L. Gordon,et al.  Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). , 1997, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[82]  G. Drusano Infection in the intensive care unit: beta-lactamase-mediated resistance among Enterobacteriaceae and optimal antimicrobial dosing. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[83]  S. Norrby Antibiotic resistance: a self‐inflicted problem , 1996, Journal of internal medicine.

[84]  V. Yu,et al.  Antibiotic therapy for Pseudomonas aeruginosa bacteremia: outcome correlations in a prospective study of 200 patients. , 1989, The American journal of medicine.

[85]  T. Tupasi,et al.  Social, behavioral, and practical factors affecting antibiotic use worldwide: report of Task Force 4. , 1987, Reviews of infectious diseases.

[86]  F. Aarestrup,et al.  Use of antimicrobial growth promoters in food animals and Enterococcus faecium resistance to therapeutic antimicrobial drugs in Europe. , 1999, Emerging infectious diseases.

[87]  L. Palmisano,et al.  Antiretroviral therapy: state of the HAART. , 2000, Antiviral research.

[88]  A. Antoniadou,et al.  The effect of monitoring of antibiotic use on decreasing antibiotic resistance in the hospital. , 1997, Ciba Foundation symposium.

[89]  S B Soumerai,et al.  Efficacy and cost-containment in hospital pharmacotherapy: state of the art and future directions. , 1984, The Milbank Memorial Fund quarterly. Health and society.

[90]  C. Dye,et al.  Rational 'DOTS plus' for the control of MDR-TB. , 1999, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[91]  S. Spector,et al.  Virologic characterization of primary human immunodeficiency virus type 1 infection in a health care worker following needlestick injury. , 1995, The Journal of infectious diseases.

[92]  M. Glynn,et al.  Emergence of multidrug-resistant Salmonella enterica serotype typhimurium DT104 infections in the United States. , 1998, The New England journal of medicine.

[93]  D. Goldmann,et al.  Control of nosocomial antimicrobial-resistant bacteria: a strategic priority for hospitals worldwide. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[94]  R. Mcdonald,et al.  Massive outbreak of antimicrobial-resistant salmonellosis traced to pasteurized milk. , 1987, JAMA.

[95]  R. Foley,et al.  Method of physician remuneration and rates of antibiotic prescription. , 1999, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[96]  B. Berger,et al.  Effect of sulbactam on infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus. , 1993, The Journal of infectious diseases.

[97]  J. M. Hughes,et al.  Nosocomial Infection Surveillance in the United States: Historical Perspective , 1987, Infection Control.

[98]  PHARMACOKINETICS AND PHARMACODYNAMICS IN THE DEVELOPMENT OF ANTIBACTERIAL MEDICINAL PRODUCTS , 2000 .

[99]  G. Hofmeyr,et al.  Antibiotic prophylaxis for cesarean section. , 2010, The Cochrane database of systematic reviews.

[100]  M H Samore,et al.  Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. , 2000, Circulation.

[101]  W. Craig,et al.  Pharmacokinetic/pharmacodynamic Parameters: Rationale for Antibacterial Dosing of Mice and Men Tions Were Associated with Only a Slight Reduction in Bacterial , 2022 .

[102]  N. Britten,et al.  Prospective case-control study of role of infection in patients who reconsult after initial antibiotic treatment for lower respiratory tract infection in primary care , 1997, BMJ.

[103]  A. Indalo Antibiotic sale behaviour in Nairobi: a contributing factor to antimicrobial drug resistance. , 1997, East African medical journal.

[104]  I Lind,et al.  Antimicrobial resistance in Neisseria gonorrhoeae. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[105]  J. Meer,et al.  Implementation of an educational program and an antibiotic order form to optimize quality of antimicrobial drug use in a department of internal medicine , 1997, European Journal of Clinical Microbiology and Infectious Diseases.

[106]  Lung Disease,et al.  Anti-tuberculosis drug resistance in the world : the WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance , 1997 .

[107]  M. Ainsworth,et al.  Breaking the silence: setting realistic priorities for AIDS control in less-developed countries , 2000, The Lancet.

[108]  Jerome J. Schentag,et al.  Benchmark analysis of strategies hospitals use to control antimicrobial expenditures. , 1996, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[109]  L. Piddock,et al.  Does the use of antimicrobial agents in veterinary medicine and animal husbandry select antibiotic-resistant bacteria that infect man and compromise antimicrobial chemotherapy? , 1996, The Journal of antimicrobial chemotherapy.

[110]  E. Larson,et al.  Compliance with handwashing and barrier precautions. , 1995, The Journal of hospital infection.

[111]  S. Weis,et al.  The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis. , 1994, The New England journal of medicine.

[112]  H. Whittle,et al.  A randomised trial of a Haemophilus influenzae type b conjugate vaccine in a developing country for the prevention of pneumonia--ethical considerations. , 1999, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[113]  H. Margolis,et al.  Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease , 1998 .

[114]  R. Gleckman Emerging drug resistance and vaccination for typhoid fever. , 1998, JAMA.

[115]  R. W. Hansen,et al.  Research and development costs for new drugs by therapeutic category. A study of the US pharmaceutical industry. , 1995, PharmacoEconomics.

[116]  F. Aarestrup,et al.  Glycopeptide resistance in Enterococcus faecium from broilers and pigs following discontinued use of avoparcin. , 1999, Microbial drug resistance.

[117]  The failure of a preprinted order form to alter physicians' antimicrobial prescribing pattern. , 1992, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[118]  Action Programme on Essential Drugs How to investigate drug use in health facilities : selected drug use indicators , 1993 .

[119]  K. Mulholland Strategies for the control of pneumococcal diseases. , 1999, Vaccine.

[120]  L R Ward,et al.  A case control study of infection with an epidemic strain of multiresistant Salmonella typhimurium DT104 in England and Wales. , 1994, Communicable disease report. CDR review.

[121]  M R Couper,et al.  Strategies for the rational use of antimicrobials. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[122]  A. MacGowan Concentration controlled and concentration defined clinical trials: do they offer any advantages for antimicrobial chemotherapy? , 1996, The Journal of antimicrobial chemotherapy.

[123]  M. Chamberland,et al.  Risk and Management of Blood-Borne Infections in Health Care Workers , 2000, Clinical Microbiology Reviews.

[124]  R Hartley,et al.  Scientific versus commercial sources of influence on the prescribing behavior of physicians. , 1982, The American journal of medicine.

[125]  P. Mertens,et al.  High prevalence of colonization with vancomycin- and pristinamycin-resistant enterococci in healthy humans and pigs in The Netherlands: is the addition of antibiotics to animal feeds to blame? , 1997, The Journal of antimicrobial chemotherapy.

[126]  M. Wierup,et al.  Animal consumption of antibiotics and chemotherapeutic drugs in Sweden during 1980, 1982 and 1984 , 2004, Veterinary research communications.

[127]  Anne Gunn,et al.  List of Participants , 2007, Numerical Algorithms.

[128]  F. Aarestrup,et al.  An outbreak of multidrug-resistant, quinolone-resistant Salmonella enterica serotype typhimurium DT104. , 1999, The New England journal of medicine.

[129]  J A Lewis,et al.  Trials to assess equivalence: the importance of rigorous methods , 1996, BMJ.

[130]  P. Dubbert,et al.  Increasing Handwashing in an Intensive Care Unit , 1986, Infection Control.

[131]  Jerome J. Schentag,et al.  Pharmacodynamic Evaluation of Factors Associated with the Development of Bacterial Resistance in Acutely Ill Patients during Therapy , 1998, Antimicrobial Agents and Chemotherapy.

[132]  L. Weekes,et al.  Drug and Therapeutics Committees in Australia: expected and actual performance. , 1996, British journal of clinical pharmacology.

[133]  J. Avorn,et al.  Reduction of incorrect antibiotic dosing through a structured educational order form. , 1988, Archives of internal medicine.

[134]  David Classen,et al.  Implementing Antibiotic Practice Guidelines through Computer-Assisted Decision Support: Clinical and Financial Outcomes , 1996, Annals of Internal Medicine.

[135]  Christopher J. L. Murray,et al.  Tuberculosis: Commentary on a Reemergent Killer , 1992, Science.

[136]  A. Christmas,et al.  Prophylactic Antibiotics in Surgery and Surgical Wound Infections , 2000, The American surgeon.

[137]  R. Huebner,et al.  Immunogenicity and impact on nasopharyngeal carriage of a nonavalent pneumococcal conjugate vaccine. , 1999, The Journal of infectious diseases.

[138]  D. Gilbert,et al.  European guidelines for anti-infective drug products. Introduction. , 1993, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[139]  Rian,et al.  QUINOLONE-RESISTANT CAMPYLOBACTER JEJUNI INFECTIONS IN MINNESOTA , 1992 – 1998 , 2022 .

[140]  E. Hoen Direct-to-consumer advertising: for better profits or for better health? , 1998, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.