Do we need new antibiotics?

Area of Science:

• Microbiology and Infectious Diseases
• Antimicrobial Resistance Surveillance
• Public Health Policy

Background:

• Widespread media and scientific reports suggest a global increase in antibiotic resistance, particularly concerning multidrug-resistant (MDR) bacteria.
• Concerns exist regarding the potential for untreatable infections and high mortality rates associated with MDR bacterial strains worldwide.
• The development of new antibiotics is frequently cited as a critical need in response to escalating resistance.

Purpose of the Study:

• To critically evaluate the reality of pandrug-resistant bacteria and the global increase in antibiotic resistance.
• To examine the purported link between antibiotic resistance and patient mortality.
• To assess the necessity for developing novel antibiotics in light of current therapeutic options.

Main Methods:

• Review and synthesis of available data on antibiotic resistance patterns, focusing on European surveillance data for key invasive bacteria.
• Analysis of clinical outcomes and mortality rates in patients infected with MDR versus non-MDR bacteria.
• Evaluation of the efficacy of existing antibiotic classes, including older agents, against contemporary resistant bacterial phenotypes.

Main Results:

• European data indicate that, excluding *Klebsiella pneumoniae* in specific countries, resistance to three or more antibiotic classes (MDR phenotype) has been low and stable over five years.
• Therapeutic options remain available for both reference and older antibiotics against prevalent resistant bacteria.
• The clinical impact and attributable mortality of MDR bacterial infections are subjects of ongoing debate and remain controversial.

Conclusions:

• The current arsenal of available antibiotics, including older ones, appears sufficient to manage emerging bacterial resistance.
• The notion of widespread untreatable infections due to MDR bacteria may be overstated.
• Existing antibiotic resources should be preserved as a 'World Heritage' and managed through a non-profit, internationally regulated model.