Bacteria are rapidly developing resistance to the antibiotics they are exposed to. Alexander Fleming discovered penicillin in 1928, and during his Nobel lecture on 11 December 1945, he had already warned about the potential dangers of antibiotic resistance, saying: “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
Nearly a century later, these predictions have become a reality. The widespread and often indiscriminate use of antibiotics in human medicine and agriculture has driven the emergence and rapid spread of antibiotic-resistant genes. Bacteria have evolved sophisticated mechanisms to evade antibiotics, including limiting drug uptake, degrading drugs, modifying targets and forming biofilms.
In 2021, an estimated 4.71 million deaths were associated with bacterial antimicrobial resistance (AMR), based on an estimation from 22 pathogens, 84 pathogen-drug combinations and 11 infectious syndromes across 204 countries and territories. Between 1990 and 2021, deaths from AMR increased by over 80% among adults aged 70 and older.
If left unchecked, drug resistance threatens to undo many of the medical advancements of the past century. Routine infections could become significantly harder to treat and common surgeries could carry much greater risks. In a worst-case scenario, the world may face a return to the pre-penicillin era, where even minor infections could be fatal.
Human actions have allowed the crisis to escalate over recent decades. On the supply side, regulatory barriers and market dynamics have made antibiotic R&D economically unattractive compared to high-priced drugs for chronic conditions. On the demand side, the widespread availability of low-cost generic antibiotics has led to overuse and misuse in both human medicine and agriculture. Alarmingly, over 70% of medically important antibiotics are used in agriculture, driving resistance through the transmission of resistant pathogens to humans and the excretion of active pharmaceutical ingredients by animals.
Before exploring potential solutions, we must first assess the current state across three key areas:
- Inadequate infection management
- Inappropriate antibiotic use
- Barriers to innovation.
Infections continue to spread widely due to limited infection control measures. In many healthcare systems, funding is not directly tied to infection prevention or responsible antibiotic use, allowing resistant pathogens to proliferate unchecked.
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