products that contain antibacterial agents. This “antibacterial craze” defies the critical message that washing with soap and water is sufficient to provide hygiene to healthy individuals. Moreover, some studies indicate that bacteria emerging with resistance to these chemicals show decreased susceptibility to a number of antibiotics.

The unrelenting spread of antimicrobial resistance has been recognized for some time, with a number of public and private organizations issuing reports calling for action by the health care community, governments, and the public. The World Health Organization (WHO), for example, has declared antimicrobial resistance to be one of the top three issues in global health. Yet, efforts to manage antimicrobial resistance have, in general, remained insufficient in the face of the magnitude of the problem.

Not only are more—and better coordinated—efforts required. There also is a need to view antimicrobial resistance in a fundamentally different way. Where we once concentrated primarily on developing chemicals to eradicate pathogens, we now need to pay closer attention to the ecology and evolution of infection. Developing a fuller understanding of how microbes evolve when faced with drugs that threaten their survival may lead to innovative ways to bring them under control.

Indeed, genetics and evolutionary science hold some important lessons. Over the past 10 years, for example, scientists have expanded their knowledge of the breadth and complexity of the genetics of antimicrobial resistance. Hundreds of genes have been identified that render a variety of microbes resistant to a variety of drugs. These findings are encouraging laboratories, both public and private, to step up efforts to define new resistance genes and investigate their biochemical activity.

Evolutionary science has grown in sophistication and predictive power, and a body of theory and practical observation now exists that suggests possible strategies for helping to solve some of the problems that arise from the continued “arms races” between humans and microbes. For example, a number of ways have been demonstrated to slow down the evolution of drug resistance. These approaches include, among others, drug overkill strategies that reduce a microbe’s potential for genetic mutation, direct observation therapy to ensure that patients complete their full courses of treatment, and alternating use of various antibiotic drugs to lessen the genetic pressure that promotes resistance. Another promising avenue beginning to be explored involves developing drugs that “engineer” a microbe’s genetic mutations in a way that imposes a fitness cost and renders the pathogen less able to survive or evolve in its human host.

Use of such tactics follows from the realization that fighting infectious disease is only part of the health care battle. Suppressing the emergence of these diseases also should be an integral part of the agenda to foster the long-term promotion of human health.



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