The ongoing explosion of antibiotic-resistant infections continues to plague global
and US health care. Meanwhile, an equally alarming decline has occurred in the research
and development of new antibiotics to deal with the threat. In response to this microbial
"perfect storm," in 2001, the federal Interagency Task Force on Antimicrobial Resistance
released the "Action Plan to Combat Antimicrobial Resistance; Part 1: Domestic" to
strengthen the response in the United States. The Infectious Diseases Society of America
(IDSA) followed in 2004 with its own report, "Bad Bugs, No Drugs: As Antibiotic Discovery
Stagnates, A Public Health Crisis Brews," which proposed incentives to reinvigorate
pharmaceutical investment in antibiotic research and development. The IDSA's subsequent
lobbying efforts led to the introduction of promising legislation in the 109 th US
Congress (January 2005-December 2006). Unfortunately, the legislation was not enacted.
During the 110 th Congress, the IDSA has continued to work with congressional leaders
on promising legislation to address antibiotic-resistant infection. Nevertheless,
despite intensive public relations and lobbying efforts, it remains unclear whether
sufficiently robust legislation will be enacted. In the meantime, microbes continue
to become more resistant, the antibiotic pipeline continues to diminish, and the majority
of the public remains unaware of this critical situation. The result of insufficient
federal funding; insufficient surveillance, prevention, and control; insufficient
research and development activities; misguided regulation of antibiotics in agriculture
and, in particular, for food animals; and insufficient overall coordination of US
(and international) efforts could mean a literal return to the preantibiotic era for
many types of infections. If we are to address the antimicrobial resistance crisis,
a concerted, grassroots effort led by the medical community will be required.