A comprehensive review over the antimicrobial resistance crisis and a proposal for future antibiotic research
Antibiotics are arguably one of the most influential breakthroughs of the 20th century, making routine surgery possible and virtually eliminating infectious diseases. However, the overuse and misuse of antibiotics have substantially eroded their effectiveness in treating bacterial disease, primarily due to the rise of antimicrobial resistance (AMR). Subtherapeutic levels of antibiotics contribute to the development of AMR by placing stress on bacteria. Such conditions encourage bacteria to mutate and select for antibiotic resistance. Resistant bacteria can then spread their antibiotic resistance genes to other species of bacteria through horizontal gene transfer (HGT), making it challenging to eradicate AMR once it has emerged. As of 2021, the antibiotic discovery pipeline has experienced a 40-year drought during which only two new classes of antibiotics have come to market. AMR has grown significantly worse and become more widespread during this period, and scientists have now identified resistance to nearly every antibiotic in the arsenal of modern medicine. Repeat exposure to various antimicrobials has also generated multidrug-resistant bacteria (MDR), and worse, extensively drug-resistant (XDR) bacteria. Organizations such as the CDC and the WHO have accordingly deemed AMR a global public health crisis. Worldwide, more than 700,000 people die each year from antibiotic-resistant infections. Yet, estimates predict that bacterial disease will be the leading cause of death globally by 2050, accounting for 10 million deaths annually. However, humanity has chosen to fight back. A substantial number of scientists are actively working toward finding solutions to the AMR crisis. I have compiled a comprehensive review of the early history of antibiotics, the current antimicrobial resistance crisis, and various future outlooks that humanity is exploring to try and avert calamity.