[Antibiotics, new pathogens, new drug resistance]

The 20th century is the century of the discovery of numerous pathogenic microorganisms. It is also the century of discovery of antimicrobial drugs and the beginning of the antibiotic era. While the development of antifungal drugs and of antivirals is on its rise, many infectious disease physicians and microbiologists feel that we might be on the edge of the beginning of the post-antibiotic era--50 years after antibiotic use in man and animals. Antibiotics have certainly been a major progress in modern medicine. Mortality and morbidity from many infectious diseases have been substantially reduced by effective antimicrobial therapy. The use of antibiotics has also been a prerequisite for major advances in clinical oncology, transplantation medicine, and surgery. The emergence and spread of resistant pathogens, however, has necessitated the development of broader and more active drugs and has resulted in excessive antimicrobial drug use with consequent selective pressure. Every 3rd patient admitted to a hospital is given antibiotics--often in the form of stepwise escalated therapy eventually including combinations of expensive agents. If the aim is to minimize the emergence of resistance and to contain costs, a much more critical indication for antimicrobial drug therapy will be necessary. Also, programmes on a local, regional, and perhaps even national level will be needed to help rationalize antimicrobial drug use.