Infections caused by antibiotic-resistant microbes such as methicillin-resistant Staphylococcus aureus impact clinicians practicing in every ﬁeld of medicine. Given their breadth of effect and signiﬁcant impact on morbidity and mortality, multidrug-resistant microbes are considered a substantial threat to public health and national security according to the Infectious Disease Society of America (IDSA).
What is the cause of antibiotic resistance?
It was believed that physician misuse of antibiotics is the cause of antibiotic resistance in microbes and that, if physicians will be convinced to use antibiotics responsibly, we could “win the war against microbes.” Unfortunately, this belief is a fallacy.
As diverse as human beings are, the adaptability of microbes is unrivalled. On reﬂection, perhaps it would be wise to reconsider the frequently used metaphor of humans being “at war with microbes”. It is absurd to believe that we could claim victory in a war against organisms that outnumber us by a factor of 1022, outweigh us by a factor of 108, existed for 1000 times longer than our species, and can undergo as many as 500,000 generations during one of our generations.
How about antibiotics?
We need to remember that human beings did not invent antibiotics; we merely discovered them. If misuse of antibiotics causes drug resistance, the solution that would allow humans to forever defeat microbial resistance would be for us to strictly use antibiotics only when truly indicated. On the other hand, if misuse of antibiotics affects the rate of spread of resistance but does not actually cause resistance, then using antibiotics correctly will not stop microbial resistance, it will only slow it down so that we can ﬁnd a real solution to the problem.
What is the cause of decreasing antibiotic development?
It is indisputable that antibiotic development has slowed dramatically over the past 25 years. In fact there were only 5 systemic antibacterial new molecular entities developed in 2004. Antibiotics have a relatively lower rate of return on investment than do other drugs.
Antibiotics, alone among all classes of drugs, become less effective the more they are used. Therefore, thought leaders appropriately encourage restriction of the use of new, powerful antibiotics, and this inevitably negatively impacts sales.
While the regulatory authorities revisit the drug policies on antibiotic use, physicians should prescribe antibiotics appropriately to minimize the rate of spread of drug resistance. Most importantly, global awareness can provide a rational balance to this issue.
The time for action is now.