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

We use them to cure infectious diseases,

but also to safely facilitate everything 
from surgery to chemotherapy

to organ transplants.

Without antibiotics,

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

And we’re at risk of losing them.

Antibiotics are chemicals 
that prevent the growth of bacteria.

Unfortunately, some bacteria 
have become resistant

to all currently available antibiotics.

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

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

But first, how did we 
get into this situation?

The first widely used antibiotic 
was penicillin,

discovered in 1928 by Alexander Fleming.

In his 1945 Nobel Prize 
acceptance speech,

Fleming warned that bacterial resistance 
had the potential to ruin

the miracle of antibiotics.

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

resistant bacteria 
already began to appear.

From then until the 1980s,

pharmaceutical companies 
countered the problem of resistance

by discovering many new antibiotics.

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

Over time, a couple things changed.

Newly discovered antibiotics 
were often only effective

for a narrow spectrum of infections,

whereas the first ones 
had been broadly applicable.

This isn’t a problem in itself,

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

making them less profitable.

In the early days, 
antibiotics were heavily overprescribed,

including for viral infections 
they had no effect on.

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

At the same time, 
companies began to develop more drugs

that are taken over a patient’s lifetime,

like blood pressure 
and cholesterol medications,

and later anti-depressants 
and anti-anxiety medications.

Because they are taken indefinitely, 
these drugs more profitable.

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

But bacteria continued to acquire 
resistance and pass it along

by sharing genetic information 
between individual bacteria

and even across species.

Now bacteria that are resistant 
to many antibiotics are common,

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

So, what can we do about this?

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

combat resistance to new 
and existing drugs,

and find new ways to fight 
bacterial infections.

The largest consumer 
of antibiotics is agriculture,

which uses antibiotics not only 
to treat infections

but to promote the growth of food animals.

Using large volumes of antibiotics

increases the bacteria’s exposure 
to the antibiotics

and therefore their opportunity 
to develop resistance.

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

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

and spread through international trade 
and travel networks.

In terms of finding new antibiotics,

nature offers the most promising 
new compounds.

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

to live in competitive environments—

meaning they often contain 
antibiotic compounds

to give them a survival advantage 
over certain bacteria.

We can also package antibiotics 
with molecules that inhibit resistance.

One way bacteria develop resistance 
is through proteins of their own

that degrade the drug.

By packaging the antibiotic with molecules
that block the degraders,

the antibiotic can do its job.

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

are one promising new avenue 
to combat bacterial infections.

Developing vaccines for common infections,
meanwhile,

can help prevent disease 
in the first place.

The biggest challenge to all 
these approaches is funding,

which is woefully inadequate 
across the globe.

Antibiotics are so unprofitable 
that many large pharmaceutical companies

have stopped trying to develop them.

Meanwhile, smaller companies 
that successfully bring new antibiotics

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

New therapeutic techniques 
like phages and vaccines

face the same fundamental problem 
as traditional antibiotics:

if they’re working well, 
they’re used just once,

which makes it difficult to make money.

And to successfully counteract resistance 
in the long term,

we’ll need to use 
new antibiotics sparingly—

lowering the profits 
for their creators even further.

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

For example, the United Kingdom 
is testing a model

where healthcare providers 
purchase antibiotic subscriptions.

While governments are looking for ways 
to incentivize antibiotic development,

these programs are still 
in the early stages.

Countries around the world 
will need to do much more—

but with enough investment 
in antibiotic development

and controlled use of our current drugs,

we can still get ahead of resistance.