The rapid emergence of resistant bacteria is occurring worldwide, endangering the efficacy of antibiotics, which have transformed medicine and saved millions of lives. Many decades after the first patients were treated with antibiotics, bacterial infections have again become a threat. The antibiotic resistance crisis has been attributed to the overuse and misuse of these medications, as well as a lack of new drug development by the pharmaceutical industry due to reduced economic incentives and challenging regulatory requirements. The Centers for Disease Control and Prevention (CDC) has classified a number of bacteria as presenting urgent, serious, and concerning threats, many of which are already responsible for placing a substantial clinical and financial burden on the U.S. health care system, patients, and their families. Coordinated efforts to implement new policies, renew research efforts, and pursue steps to manage the crisis are greatly needed.

Go to:THE HISTORY AND BENEFITS OF ANTIBIOTICSHistory of AntibioticsThe management of microbial infections in ancient Egypt, Greece, and China is well-documented.4 The modern era of antibiotics started with the discovery of penicillin by Sir Alexander Fleming in 1928. Since then, antibiotics have transformed modern medicine and saved millions of lives. Antibiotics were first prescribed to treat serious infections in the 1940s. Penicillin was successful in controlling bacterial infections among World War II soldiers.4However, shortly thereafter, penicillin resistance became a substantial clinical problem, so that, by the 1950s, many of the advances of the prior decade were threatened. In response, new beta-lactam antibiotics were discovered, developed, and deployed, restoring confidence. However, the first case of methicillin-resistant Staphylococcus aureus (MRSA) was identified during that same decade, in the United Kingdom in 1962 and in the United States in 1968. Unfortunately, resistance has eventually been seen to nearly all antibiotics that have been developed. Vancomycin was introduced into clinical practice in 1972 for the treatment of methicillin resistance in both S. aureus and coagulase-negative staphylococci. It had been so difficult to induce vancomycin resistance that it was believed unlikely to occur in a clinical setting. However, cases of vancomycin resistance were reported in coagulase-negative staphylococci in 1979 and 1983.From the late 1960s through the early 1980s, the pharmaceutical industry introduced many new antibiotics to solve the resistance problem, but after that the antibiotic pipeline began to dry up and fewer new drugs were introduced.7As a result, in 2015, many decades after the first patients were treated with antibiotics, bacterial infections have again become a threat.