IS THE AGE OF ANTIBIOTICS OVER? Introduction Antibiotic resistance is one of the most important health threats facing the world today. Our ability to treat bacterial infections effectively is central to providing lifesaving healthcare in all parts of the world. Only recently policy makers have come to understand the catastrophic consequences of not taking urgent robust action to combat the threat of antibiotic resistance. In particular, the Review on Antimicrobial Resistance led by Jim O'Neill, commissioned by UK Prime Minister in July 2014, estimated by 2050 antimicrobial resistance would be attributed to 10 million deaths every year, more than even cancer1. Furthermore, it was estimated antimicrobial resistance will cause a total loss in world GDP of $100.2 trillion between 2014 and 20501. This marked a key turning point in the global effort against antibiotic resistance as it kickstarted a new enthusiasm and commitment by world leaders to take action. In particular, the World Health Organisation (WHO)'s 2015 Global Action Plan on Antimicrobial Resistance provides the fundamental unified global policy framework to coordinate the international effort to tackle antibiotic resistance2. The most important action that must be taken is a regulatory overhaul to stop the inappropriate use of existing and new antibiotics in clinical and industrial settings, which has accelerated this crisis. Between 2000tt2015, globally there has been a dramatic increase in antibiotic consumption, in High Income Countries (HICs) as well as in Low Income Countries (LICs) and Middle Income Countries (MICs) where the burden of infectious disease is the
highest, but the global response to this has been slow and inadequate3. A key challenge will be maintaining a commitment to increasing the access of lifesaving antibiotics to the poorest communities in LICs and MICs as well as enforcing regulation on antibiotic stewardship. Particularly governments must enforce new laws reducing the extensive and unnecessary use of antibiotics in agriculture as well as their dissemination into the environment4. Reducing inappropriate consumption of antibiotics in clinics involves both changing the way antibiotics are prescribed and consumedused. Educating medical practitioners about the recommended clinical guidelines in treating bacterial infections is essential as well as introducing interventions to increase adherence to these guidelines. In coordination, educating the general population on the dangers of inappropriately taking antibiotics is also very important, especially to reduce overttthettcounter and internet online purchaseing of antibiotics.