Antibacterial agents such as sulfonamides, penicillin, and streptomycin
became available in the 1930s and 1940s and were quickly adopted into clinical
practice. It was noted early on that bacteria, when exposed to antimicrobial agents,
rapidly developed strategies to resist them. Penicillin resistance in Staphylococcus
aureus was detected as early as in 1945. From the 1950s onwards, a large number of
antimicrobial drugs became clinically available and had a major impact on the treatment
of infections. Most recently, bacterial antibiotic resistance has grown exponentially
along with the increasing use of antimicrobial agents, while at the same time the
development of new antimicrobial agents has decreased dramatically. This has led to
major global crises of infections with drug-resistant microbes, increased morbidity, and
mortality, and increased health care costs.
Antibiotic resistance results from mutations or acquisition of new genes in bacteria that
reduce or eliminate the effectiveness of antibiotics. According to the CDC, every year
more than 2 million people in the US develop an illness due to antibiotic resistant
bacteria and 23,000 of them die. There are multiple reasons for the development and
spread of antibiotic-resistant bacteria. Overuse and inappropriate use of antibiotics are
prevalent in clinical practice. The spread of resistant bacteria in hospitalized patients
raises grave concerns for increased local antibiotic resistance. Non-human use of
antibiotics for animal growth promotion is a major cause of development of global
antibiotic resistance.
A multifaceted approach is needed to detect, prevent, and control antibiotic resistance at
local, national, and global levels. The National Action Plan for Combating Antibioticresistant
Bacteria was developed by the CDC, and it provides a roadmap to guide the
US in rising to this challenge. Implementation of antimicrobial stewardship programs,
diligent surveillance for resistant bacteria, rigorous implementation of infection control
practices, restriction of antibiotics for non-human and non-infectious purposes are
needed to combat the growing threat of antibiotic resistance. Another important strategy
to counter the menace of antimicrobial resistance is to develop new antibiotics with
novel mechanisms of action.
This chapter describes the global threat of antibiotic resistance, the mechanisms of
development of antimicrobial resistance, the major causes of increased incidence of this
problem, and the possible local, national, and global solutions to fight the scourge of
antibiotic resistance.
Keywords: Antibiotics, antimicrobials, antibiotic resistance, infections,
healthcare associated infection.
