Nature
Volume 509 Number 7502 pp533-656 29 May 2014
http://www.nature.com/nature/current_issue.html

Global health: Deadly dinners
Polluting biomass stoves, used by one-third of the global population, take a terrible toll. But efforts to clean them up are failing.
Meera Subramanian

Nature | Comment
Policy: An intergovernmental panel on antimicrobial resistance
Mark Woolhouse & Jeremy Farrar
22 May 2014
Drug-resistant microbes are spreading. A coordinated, global effort is needed to keep drugs working and develop alternatives, say Mark Woolhouse and Jeremy Farrar.
Excerpt from full text
Last month, the World Health Organization (WHO) produced a global map1 of antimicrobial resistance, warning that a ‘post-antibiotic’ world could soon become a reality. In some ways, it already has.
Drugs that were once lifesavers are now worthless. Chloramphenicol, once a physician’s first choice against typhoid, is no longer effective in many parts of the world. Strains of extensively drug-resistant tuberculosis (TB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Escherichia coli and Klebsiellapneumoniae are serious threats to public health. Plasmodium falciparum (the parasite that causes the most dangerous form of malaria) is developing resistance to all known classes of anti¬malarial drug, threatening the remarkable progress that has been made against the disease. HIV is increasingly resistant to first-line antiviral drugs. Every class of antibiotic is increasingly compromised by resistance, as are many antivirals, antiparasitic and antifungal drugs.
It could get worse: routine medical care, surgery, cancer treatment, organ transplants and industrialized agriculture would be impossible in their present form without antimicrobials. And the treatment of many infectious human and livestock diseases now relies on just one or two drugs.
Resistance has spread around the world. MRSA has spread between continents2, as have resistant strains of TB, malaria, HIV and pneumococci. Genes conferring resistance to β-lactams — antibiotics used against a broad range of infections, including E. coli and K. pneumoniae — have spread to bacterial populations worldwide, probably originating in the Indian subcontinent3. Numerous drug-resistant malaria strains have spread from southeast Asia to Africa.