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The Financial Times expresses a deeper concern for the growing “silent pandemic of antibiotic resistance”

Prof Marc Mendelson is head of the infectious diseases and HIV medicine division at Groote Schuur Hospital, University of Cape Town.

• As a South-African doctor, he recently admitted a 39-year old man with multi-drug resistant tuberculosis and kidney failure who had stopped his HIV treatment some months before. His tuberculosis was treated with seven different drugs and started to respond but after eight days his temperature spiked, his blood pressure dropped and we identified extensively drug-resistant Klebsiella pneumonia bacteria in his blood. The only option was colistin, an antibiotic of last resort, but he continued to deteriorate and succumbed to overwhelming infection.
• First-line workhorse antibiotics such as penicillins are no longer effective in hospitalised patients and increasingly in the community. That pushes doctors to prescribe broader-spectrum antibiotics that are effective but affect many more types of bacteria in our bodies. The result is a vicious cycle, selecting out bacteria able to resist the antibiotics and culminating in rising demand for last-resort drugs. 
• Five years since the publication of the WHO’s Global Action Plan to mitigate antimicrobial resistance, progress has been mixed. The problem has been recognised as requiring an integrated response that spans human, animal and environmental health. A Global Leaders Group, drawing on a broad range of experience, is the latest in a line of governance structures that have been established to help. 
• Most national action plans remain largely or entirely unfunded. Supporting the full range of the Global Action Plan’s interventions is beyond the capacity of these nations. In trying to tackle everything, low- and middle-income countries risk neglecting core interventions that will bring the greatest results. More focus should be on programmes to increase public awareness to change human behaviour, optimise antimicrobial use and prevent infection.
• “We should invest in regional centres of excellence where such frontline staff can be trained and regional partnerships built to share knowledge and research. Governments, local partners and global funding agencies have the resources but will need to be bold in diverting some of the millions of dollars currently channelled into research and development for new drugs.”

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