Intended for healthcare professionals

Letters Antimicrobial resistance

Incentives for developing new antibiotics or antimicrobial strategies

BMJ 2013; 346 doi: (Published 08 April 2013) Cite this as: BMJ 2013;346:f2136
  1. Ulf R Dahle, department director1,
  2. Fernanda C Petersen, associate professor2
  1. 1Norwegian Institute of Public Health, 0403 Oslo, Norway
  2. 2Department of Oral Biology, Faculty of Dentistry, University of Oslo, Norway
  1. ulf.dahle{at}

Neonatal mortality approaches 50% in parts of Norway, cholera and typhoid fever force families to abandon their homes, parts of cities are quarantined. Tuberculosis mortality is 400/100 000 and 50% of children are absent from school. These were Norwegian statistics 100 years ago.1 The focus on antimicrobial resistance is highly relevant.2 If infections reach such proportions again, resistance will lead to the collapse of health and social systems.

Resistant micro-organisms are already among us. Tourists become colonised with drug resistant micro-organisms. In Norway, 10% of patients with gastrointestinal infections caused by resistant bacteria reported no recent travel, whereas the carrier rate was 33% among those travelling abroad within the past six months.3 Resistant pathogens are incorporated into our microbiota, where horizontal gene transfer may escalate the problem. Studies with streptococci show, for instance, that resistance can be transferred from commensals to pathogenic species colonising humans,4 indicating that microbiota may serve as a reservoir of resistance genes. Results from our laboratory show that gene transfer between commensals and pathogens may also include large DNA pieces encoding virulence factors, such as the pneumococcal capsule locus.5

Challenges related to the absence of effective antimicrobials will differ from those of the past. Vaccines, food and water safety, screening, diagnostics, sewer infrastructure, hygiene, housing, and nutritional conditions will reduce the likelihood that resistance will lead to devastating epidemics in developed countries. For compromised patients, however, such opportunistic infections may be fatal.

The drug industry is reluctant to develop antimicrobial agents because costs are not recovered before drugs become inefficient.6 England’s chief medical officer intends to find incentives for industry to develop new antibiotics or antimicrobial strategies; these should be extended to all research institutions.


Cite this as: BMJ 2013;346:f2136


  • Competing interests: None declared.


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