A crisis looms. In the very near and rapidly approaching future, the wonder-drugs of the 20th century, antibiotics, may cease to be useful. The benefits of antibiotics hardly need to be restated, but their availability has contributed to major advances in health and substantially increased life expectancy. Yet, despite warnings from many, including Alexander Fleming, that resistance would be a problem, antibiotics have been used with great profligacy—prescribed pointlessly for viral infections, added to animal feed to boost growth of livestock, and handed out like cough sweets in the community.
The antibiotic soup that now permeates health-care facilities, farms, and our bodies, has exerted a selection pressure on pathogens and commensal organisms alike, and resistance has proliferated and spread such that many bacteria can withstand almost all drugs. The golden age of antibiotic discovery, when the rate of discovery of new molecules kept pace with bacterial innovation, is now a distant memory, and the drug discovery pipeline for antibiotics is not so much dry as arid.
Against this bleak backdrop, the global activities of Antibiotic Awareness Week, starting November 18, seek to draw attention to a dire situation that threatens to take us back to a preantibiotic era. For our part, The Lancet Infectious Diseases launches a Commission, entitled Antibiotic resistance—the need for global solutions. The goal of the Commission is not to convince readers that there is an urgent problem with dire consequences if we do not act now. Our readers know this. Rather, the Commission explores why antibiotic resistance has become such a problem worldwide, and, most importantly, proposes solutions to avert the impending crisis.
The Commission is launched at a pivotal time when there is global academic, industry, and governmental recognition that action is urgently required. To maintain and build on current interest, antibiotic resistance should feature prominently in discussions of post-2015 development goals. We hope that the Commission will provide encouragement that, although the picture is bleak, there is hope.