Science
6 March 2015 vol 347, issue 6226, pages 1041-1168
http://www.sciencemag.org/current.dtl

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Perspective
Infectious Disease
A sustainable model for antibiotics
Manos Perros
Author Affiliations
AstraZeneca Innovative Medicines and Early Development, Gatehouse Drive, Waltham, MA 02451, USA.

Despite the alarming increase in the prevalence of drug-resistant bacterial infections, far fewer new antibiotics have been approved in the past decade than at the peak in the 1980s (1). The situation is particularly alarming for serious infections by Gram-negative bacteria, some of which are becoming untreatable by modern antibiotics (2–4). Particularly in low- and middle-income countries, untreatable infections are becoming an everyday reality in hospital and care settings (5). Increasing recognition of this problem is spurring a number of public and private initiatives on both sides of the Atlantic (6–8). To more effectively counter the threat of emerging resistance, we must increase the number of innovative new antibiotics in development and harness advances in diagnostic technology to preserve their efficacy.

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Perspective
Infectious Disease
A return to the pre-antimicrobial era?
Stephen Baker1,2,2
Author Affiliations
1Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
2Centre for Tropical Medicine, Oxford University, Oxford, UK.
3London School of Hygiene and Tropical Medicine, London, UK.

After many years out of the limelight, antimicrobial resistance (AMR) in bacteria is firmly back on the international political and scientific agenda (1, 2). The potential impact of AMR on hospital-acquired bacterial infections such as Staphylococcus aureus and Acinetobacter baumannii in higher-income countries has created both fear and a surge of motivation aimed at providing new solutions for the problem (3, 4). The political will and momentum to tackle AMR lies in higher-income countries, but the medical, social, and economic effects of AMR are likely to be felt more in lower-income countries, particularly those in South and Southeast Asia and in sub-Saharan Africa. The identification and development of new drugs is a potential solution but is challenging and costly; any novel therapies introduced into low-income settings without a suitable infrastructure to understand and prevent the rapid development of resistance will likely be expensive and futile.