The causes of antibiotic resistance are complex and include human behaviour at many levels of society, according to a report from The Lancet Infectious Diseases Commission, an international team. The consequences affect everybody in the world, they say, adding that similarities with climate change are evident.

Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally.

Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections.

Within just a few years, we might be faced with dire setbacks, medically, socially and economically, unless real and unprecedented global coordinated actions are immediately taken.

In this paper, the authors describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed.

It is divided into nine parts:

1. Global epidemiology of antibiotic resistance and use
2. Getting out of the impasse
3. Minimising the time to effective treatment: rapid diagnostic testing
4. The interface between people and animals
   • Antibiotic use in animals
   • Use for growth promotion
   • Veterinary use
   • Complex pathways
   • Evidence of spread
   • The effect
   • Time to move on from blame and shame
5. The access and excess dilemma
6. Challenges of antibiotic resistance in weak health systems
7. Improving the interface between academics and the pharmaceutical industry
8. Beyond antibiotics: alternative strategies for prevention and treatment
9. Call to action
   • Measuring the extent of the problem and its consequences
   • Regulation, rational use, and infection control in human medicine
   • The need for rapid diagnostics
   • The animal sector and the environment
   • New antibiotics and alternative strategies
   • Governmental coordination and action
   • Global governance

Reference

Laxminarayan R., A. Duse, C. Wattal, A.K.M. Zaidi, H.F.L. Wertheim, N. Sumpradit, E. Vlieghe, G.L. Hara, I.M. Gould, H. Goossens, C. Greko, A.D. So, M. Bigdeli, G. Tomson, W. Woodhouse, E. Ombaka, A.Q. Peralta, F.N. Qamar, F. Mir, S. Kariuki, Z.A. Bhutta, A. Coates, R. Bergstrom, G.D. Wright, E.D. Brown and O. Cars. 2013. Antibiotic resistance - the need for global solutions. The Lancet. Published online on 17 November 2013. http://dx.doi.org/10.1016/S1473-3099(13)70318-9