Intended for healthcare professionals


Meeting the challenge of antibiotic resistance

BMJ 2008; 337 doi: (Published 18 September 2008) Cite this as: BMJ 2008;337:a1438
  1. Otto Cars, professor1,
  2. Liselotte Diaz Högberg, researcher2,
  3. Mary Murray, freelance consultant; member of the WHO expert panel on national drug policy; visiting research fellow and freelance consultant on rational use of medicines3,
  4. Olle Nordberg, former executive director4,
  5. Satya Sivaraman, journalist5,
  6. Cecilia Stålsby Lundborg, associate professor and professor67,
  7. Anthony D So, director8,
  8. Göran Tomson, professor international health system research and director of doctoral programme69
  1. 1Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  2. 2Department of Medical Sciences, Uppsala University
  3. 3Wee Jasper, University of South Australia School of Pharmacy and Medical Sciences, Adelaide, Australia
  4. 4Dag Hammarskjöld Foundation, Uppsala
  5. 5New Delhi, India
  6. 6Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm
  7. 7Nordic School of Public Health, Göteborg, Sweden
  8. 8Program on Global Health and Technology Access, Terry Sanford Institute of Public Policy, Duke University, Durham, NC, USA
  9. 9Medical Management Centre (MMC), Karolinska Institutet, Stockholm
  1. Correspondence to: O Cars{at}
  • Accepted 15 May 2008

A concerted global response is needed to tackle rising rates of antibiotic resistance, say Otto Cars and colleagues

Antibiotics changed the world. Since their discovery almost eight decades ago, they have revolutionised the treatment of infections, transforming once deadly diseases into manageable health problems. The growing phenomenon of bacterial resistance, caused by the use and abuse of antibiotics and the simultaneous decline in research and development of new medicines, is now threatening to take us back to a pre-antibiotic era. Without effective treatment and prevention of bacterial infections, we also risk rolling back important achievements of modern medicine such as major surgery, organ transplantation, and cancer chemotherapy.

Data from low income and middle income countries indicate that, because of the development of resistance to first line antibiotics, 70% of hospital acquired neonatal infections could not be successfully treated by using WHO’s recommended regimen.1 A recently published study of Tanzanian children confirmed that ineffective treatment of bloodstream infections due to antibiotic resistance predicts fatal outcome independently of underlying diseases.2 In that hospital based study, mortality from bloodstream infections caused by Gram negative bacteria was more than double the mortality from malaria.

The BMJ talks to Professor Otto Cars, infectious disease specialist at Sweden's University of Uppsala, about what is needed to tackle antibiotic resistance.

Antibiotic resistance is becoming important in high income countries. In England and Wales, for example, the number of registered deaths in which meticillin resistant Staphylococcus aureus (MRSA) is mentioned increased from less than 50 in 1993 to more than 1600 in 2006. In 2007 there was a slight decrease.3 The European Centre for Disease Prevention and Control, in its first epidemiological report on communicable diseases in Europe, states that the most important disease threat in Europe is from micro-organisms that have become resistant to …

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