Pressure on hospital beds and changes in cleaning contracts have contributed to the growing problem of antibiotic resistance, a government report has concluded.

The Standing Medical Advisory Committee's sub-group on anti-microbial resistance reported last week that the problem is now 'critical', and made a well-publicised call for a national campaign to 'increase professional and public awareness of antibiotic prescribing issues'.

But it also called for greater use of computer-assisted prescribing in hospitals, where a small proportion of patients receive 20 per cent of the antibiotics issued in the UK.

The Path of Least Resistance says demands on intensive care units and admission wards and the prevalence of 'hot bedding' have contributed to the spread of resistance.

'There is also considerable, albeit anecdotal evidence that alterations in cleaning contracts and reduced resources have led to a detrimental effect on the cleanliness of hospitals compared with 10 or 20 years ago,' it adds.

'Under pressure of work, simple precautions such as hand-washing between patients are also omitted.'

The report says more guidance is also required on infection control in nursing homes and the community.

It emphasises the importance of hygiene in long-term care facilities which 'often represent reservoirs of patients colonised or infected with multi-resistant bacteria, especially methicillin-resistant Staphylococcus aureus.

The report calls for more research and monitoring of resistance, and notes 'with grave concern' the downgrading of medical microbiology as an academic specialty in many teaching hospitals.

The report paints a grim picture of a whole range of organisms that have the capacity to become resistant to antibiotics and a dearth of new drugs to treat them.

MRSA, which accounts for 32 per cent of all Staphylococcus aureus infections in the UK, could become resistant to even stronger antibiotics according to evidence from the US, Japan a nd France.

Effective control, as achieved in the Netherlands and Scandinavia, depends on 'identification and treatment of carriers, isolation or cohorting of those with the MRSA infection and strict hygiene policies within hospitals'.

Chief medical officer Sir Kenneth Calman welcomed the report. He said there was 'growing concern' that resistance could 'ultimately jeopardise our ability to treat infections', and warned that antibiotics had to be used 'prudently and appropriately'.

The Path of Least Resistance. The Standing Medical Advisory Committee sub-group on antimicrobial resistance. www.open.gov.uk/doh/smac.htm

Computer-aided decision-support systems for hospitals and GPs should be developed.

A national resistance surveillance strategy, including a network of sentinel laboratories, should be established 'as swiftly as possible'.

Greater emphasis should be put on teaching antimicrobial prescribing to trainee doctors, dentists, nurses and pharmacists.

Antibiotics should not be prescribed for simple coughs, colds and viral sore throats.

Prescribing over the telephone to be limited to 'exceptional cases' only.