Since their introduction into medicine in the 1940s,antibiotics have been central to modern healthcare.Their role has expanded from treating seriousinfections to preventing infections in surgical patients,protecting cancer patients and people with compromisedimmune systems, and promoting growth and preventingdisease in livestock and other food animals.Now, however, once-treatable infections are becoming difficultto cure, raising costs to healthcare facilities, and patientmortality is rising, with costs to both individuals and society.Decreasing antibiotic effectiveness has risen from being aminor problem to a broad threat, regardless of a country’sincome or the sophistication of its healthcare system. Manypathogens are resistant to more than one antibiotic, and new,last-resort antibiotics are expensive and often out of reach forthose who need them.Antibiotic resistance is a direct result of antibiotic use. Thegreater the volume of antibiotics used, the greater the chancesthat antibiotic-resistant populations of bacteria will prevail in thecontest for survival of the fittest at the bacterial level.Two trends are contributing to a global scale-up in antibioticconsumption. First, rising incomes are increasing accessto antibiotics. That is saving lives but also increasing use—both appropriate and inappropriate—which in turn is drivingresistance. Second, the increased demand for animal proteinand resulting intensification of food animal production is leadingto greater use of antibiotics in agriculture, again driving resistance.This State of the World’s Antibiotics report records the statusof this important global resource and provides critical policyanalysis on three issues:• global patterns and trends in antibiotic resistance andantibiotic use in human beings and animals;• the existing antibiotic supply and the research anddevelopment pipeline; and• interventions that have been shown to help rationalizeantibiotic use and are practicable in all countries.We present a comprehensive country-level policy response,consisting of six strategies, based on the experience of theGlobal Antibiotic Resistance Partnership (GARP), which hasfostered the development of locally driven antibiotic policy ineight countries. The strategies should be particularly relevantfor the many countries that have not yet formally addressedantibiotic resistance.
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