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Antibiotics: behind the scenes, [br]they enable much of modern medicine.

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We use them to cure infectious diseases,

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but also to safely facilitate everything [br]from surgery to chemotherapy

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to organ transplants.

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Without antibiotics,

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even routine medical procedures [br]can lead to life-threatening infections.

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And we’re at risk of losing them.

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Antibiotics are chemicals [br]that prevent the growth of bacteria.

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Unfortunately, some bacteria [br]have become resistant

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to all currently available antibiotics.

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At the same time, [br]we’ve stopped discovering new ones.

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Still, there’s hope that we can get ahead [br]of the problem.

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But first, how did we [br]get into this situation?

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The first widely used antibiotic [br]was penicillin,

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discovered in 1928 by Alexander Fleming.

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In his 1945 Nobel Prize [br]acceptance speech,

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Fleming warned that bacterial resistance [br]had the potential to ruin

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the miracle of antibiotics.

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He was right: in the 1940s and 50s,

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resistant bacteria [br]already began to appear.

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From then until the 1980s,

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pharmaceutical companies [br]countered the problem of resistance

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by discovering many new antibiotics.

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At first this was a highly successful— [br]and highly profitable— enterprise.

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Over time, a couple things changed.

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Newly discovered antibiotics [br]were often only effective

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for a narrow spectrum of infections,

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whereas the first ones [br]had been broadly applicable.

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This isn’t a problem in itself,

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but it does mean that fewer doses [br]of these drugs could be sold—

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making them less profitable.

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In the early days, [br]antibiotics were heavily overprescribed,

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including for viral infections [br]they had no effect on.

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Scrutiny around prescriptions increased, [br]which is good, but also lowered sales.

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At the same time, [br]companies began to develop more drugs

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that are taken over a patient’s lifetime,

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like blood pressure [br]and cholesterol medications,

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and later anti-depressants [br]and anti-anxiety medications.

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Because they are taken indefinitely, [br]these drugs more profitable.

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By the mid-1980s, no new chemical classes [br]of antibiotics were discovered.

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But bacteria continued to acquire [br]resistance and pass it along

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by sharing genetic information [br]between individual bacteria

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and even across species.

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Now bacteria that are resistant [br]to many antibiotics are common,

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and increasingly some strains [br]are resistant to all our current drugs.

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So, what can we do about this?

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We need to control the use [br]of existing antibiotics, create new ones,

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combat resistance to new [br]and existing drugs,

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and find new ways to fight [br]bacterial infections.

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The largest consumer [br]of antibiotics is agriculture,

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which uses antibiotics not only [br]to treat infections

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but to promote the growth of food animals.

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Using large volumes of antibiotics

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increases the bacteria’s exposure [br]to the antibiotics

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and therefore their opportunity [br]to develop resistance.

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Many bacteria that are common in animals, [br]like salmonella, can also infect humans,

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and drug-resistant versions can pass [br]to us through the food chain

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and spread through international trade [br]and travel networks.

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In terms of finding new antibiotics,

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nature offers the most promising [br]new compounds.

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Organisms like other microbes and fungi [br]have evolved over millions of years

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to live in competitive environments—

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meaning they often contain [br]antibiotic compounds

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to give them a survival advantage [br]over certain bacteria.

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We can also package antibiotics [br]with molecules that inhibit resistance.

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One way bacteria develop resistance [br]is through proteins of their own

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that degrade the drug.

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By packaging the antibiotic with molecules[br]that block the degraders,

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the antibiotic can do its job.

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Phages, viruses that attack bacteria [br]but don’t affect humans,

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are one promising new avenue [br]to combat bacterial infections.

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Developing vaccines for common infections,[br]meanwhile,

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can help prevent disease [br]in the first place.

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The biggest challenge to all [br]these approaches is funding,

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which is woefully inadequate [br]across the globe.

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Antibiotics are so unprofitable [br]that many large pharmaceutical companies

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have stopped trying to develop them.

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Meanwhile, smaller companies [br]that successfully bring new antibiotics

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to market often still go bankrupt, [br]like the American start up Achaogen.

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New therapeutic techniques [br]like phages and vaccines

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face the same fundamental problem [br]as traditional antibiotics:

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if they’re working well, [br]they’re used just once,

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which makes it difficult to make money.

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And to successfully counteract resistance [br]in the long term,

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we’ll need to use [br]new antibiotics sparingly—

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lowering the profits [br]for their creators even further.

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One possible solution is to shift profits [br]away from the volume of antibiotics sold.

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For example, the United Kingdom [br]is testing a model

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where healthcare providers [br]purchase antibiotic subscriptions.

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While governments are looking for ways [br]to incentivize antibiotic development,

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these programs are still [br]in the early stages.

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Countries around the world [br]will need to do much more—

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but with enough investment [br]in antibiotic development

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and controlled use of our current drugs,

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we can still get ahead of resistance.