A Brief History of Antimicrobial Resistance

Despite mounting attention in recent years, health threats posed by antimicrobial resistance are not new.Antimicrobial resistance has dogged infectious disease treatment processes since the first modern antimicrobials were discovered.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM .Physicians should claim only the credit commensurate with the extent of their participation in the activity. An Evolutionary Arms RaceWhen recounting the history of medicine, few triumphs compare to the emergence and widespread use of antimicrobials.Alexander Fleming's serendipitous discovery of penicillin on his petri dish 1 brought about a new era in biomedicine.Suddenly, pathogens that had wreaked havoc for generations-spreading untold morbidity and mortality in their wake-were at the mercy of our chemical armamentarium.Seemingly overnight, infectious diseases receded before the ever-rising tide of antimicrobials, and optimistic observers in the United States and Europe predicted a swift and righteous victory over the scourge of infection.Of course, such a victory was not achieved.Antibiotics are derived from the evolutionary arms race between microbes and their ecological competitors (fellow microbes, fungi, plants, and animals), and, as a result, the emergence of resistance is entirely predictable.As swiftly as we claimed new victories, microbes began evading our latest weapons, altering their cell walls, upregulating drug efflux systems, and dismantling and detoxifying our new wonder drugs. 2,3is story of innovation and setbacks is as old as time, familiar to anyone who works with pathogens, cares for patients, or develops new drugs.It begins with the early investigators and innovators who first recruited naturally occurring and synthetic chemicals in the fight against infectious diseases, and it continues toward an uncertain future.