Antibiotic resistance

Antimicrobial resistance is a serious increasing problem for man in all micro-organisms, from HIV through all bacterial species to Plasmodium spp. At present, we are managing to keep one step ahead of this resistance. However, some patients are dying with untreatable infections such as extreme-resistant tuberculosis. Others in hospital tend to acquire more resistant flora and this can cause troublesome delay in recovery from illness and surgery. Resistance is driven by antimicrobial use and some approaches to reducing this use are discussed. Nevertheless, our priority as physicians is to adequately treat people with infection, and we are having to reach more for newer and more expensive agents to do this successfully. A large investment in finding newer targets for antimicrobials and constructing new molecules has been disappointing. There may be some advantage in returning to old antibiotics. This article deals with current knowledge about resistance: molecular biology methods have been very useful in revealing mechanisms. However, whatever is written today will be out of date when you read this because evolution in bacteria happens at a phenomenal rate.