The Problem of Microbial Drug Resistance

In this chapter, we give a brief history of the origins, development, and use of conventional antibiotics through the “Golden Age of Antibiotics.” We then describe how the misuse of these agents up to the present day has acted as a selection pressure to drive the emergence of bacteria with multiple drug resistance (MDR) with reference to the MDR mechanisms of major pathogens from Gram-negative and Gram-positive bacteria. Bacterial drug resistance is currently a major threat to public health, but a growing threat is the emergence of viruses and fungi with MDR, which is also described here. Finally, we consider the implications arising from the threat posed by MDR pathogens in relation to factors such as medical practice and economics, along with an overview of recent practices and measures proposed to contain this threat, such as the introduction of stewardship programs.