Politicians and public health officials have joined specialist professionals in recognising antibiotic resistance as a threat to modern medicine. Their response has centred on minimising unnecessary antibiotic prescribing, aiming to reduce selection pressure for resistance. Despite a few hopeful trends (e.g., declining penicillin resistance among pneumococci in the UK), established resistance is proving hard to displace; moreover, new resistances continue to emerge and to proliferate at new sites. There consequently remains a strong need for new antibiotics, particularly those directed against multiresistant Gram-negative bacteria in hospitals. Already some nonfermenters of the genera Acinetobacter and Pseudomonas are resistant to all good antibiotics and many Enterobacteriaceae are resistant to all except carbapenems. There is also a growing need for new agents against community-acquired pathogens, including the agents of tuberculosis, gonorrhoea and urinary tract infections. Unless antibacterial development is re-energised, there is a serious risk that a growing proportion of infections, especially in hospitals, will become effectively untreatable.
