Fleming’s Foresight
Today's global crisis in antimicrobial resistance should never have come as a big surprise. In 1945, 17 years after Alexander Fleming announced his monumental discovery of penicillin (1928), he wrote:
Antimicrobial Misuse and Resistance
The microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out.... In such cases the thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin – resistant organism. I hope this evil can be averted.
- Alexander Fleming
Antimicrobial Misuse and The Dearth of New Drugs
70 years of antibiotic use have borne out Fleming’s dismal prediction. Today, antibiotic resistance has risen to one of the top three global health problems, and with it, substantial healthcare and economic impacts1,2 – the consequence of decades of imprudent antimicrobial use in hospitals, clinics, farm food animals, aquaculture and agriculture. In addition, the developing world is burdened by rampant self-medication from unregulated over-the-counter sales. One by one, we have watched the gradual undermining of multiple classes of antimicrobial drugs, starting with the sulfonamides and followed by the penicillins and tetracyclines.
With a serious deficit of new antimicrobials emerging from the antibiotic pipeline, some researchers predict an ominous return to the pre-antibiotic era.1
Fig. 2 New antibacterial agents approved in the United States, 1983–2013
Source: adapted from Spellberg, B. et al. (2008) The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin infect Dis 46:155-64.1
Fig. 1 Mechanisms of DNA exchange between bacteria
Source: adapted from Levy, S.B. (2002) The Antibiotic Paradox - How the misuse of antibiotics destroys their curative powers. Perseus Publishing. p84.3
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Antimicrobial Stewardship Implementation
In its broader holistic sense, antibiotic stewardship is the careful and responsible management of antibiotic resources in the interest of long-term sustainability.