Read the following passage and mark the letter A, B, C or D on your answer sheet to indicate the option that best fits each of the numbered...

More than half a century after antibiotics transformed modern medicine, their effectiveness continues to decline in ways that many researchers find deeply troubling. A recent multinational report, which examined prescribing data from over 150 healthcare systems, introduced a measure called “selection pressure”, a concept that takes into account not only how often an antibiotic is prescribed but also (18) __________. When researchers compared data from 2014 to 2023, they found that resistance rates had risen across several major bacterial groups, a pattern that suggests mounting strain on public health systems.

The rise in antibiotic resistance is linked to two interrelated developments: clinicians are relying on larger volumes of antibiotics, and (19) __________, a shift that has been driven by the rapid spread of resistant infections. As resistance intensifies, health systems that depend heavily on pharmaceutical treatment often feel compelled to adopt broader-spectrum drugs, which, although effective in the short term, (20) __________. Certain antibiotic classes, particularly fluoroquinolones and third-generation cephalosporins, have attracted growing concern because of the selective pressure they exert across a wide range of pathogens.

Efforts to reduce unnecessary antibiotic use, while widely supported, involve difficult trade-offs, (21) __________, thereby increasing the likelihood of complications in vulnerable patients. Although many countries have pledged to curb inappropriate antibiotic use by 2030, (22) __________, leaving specialists concerned that current policy frameworks may be inadequate to the scale of the problem.