The golden era of antibiotics started in 1942 with the advent of commercially available penicillin. Newspaper headlines hailed it as a miracle drug. Penicillin saved lives of thousands of soldiers in World War II, and has saved millions globally. It was surmised at the time that it would be possible soon to cure all diseases caused by microbes. The discovery of penicillin was followed by the discovery and commercial production of many other antibiotics, including streptomycin, chloramphenicol and tetracycline. Most of the antibiotic classes we use as medicines today were discovered and marketed between 1940 and 1970. Impact on society The advent of antibiotics had a profound effect on human society, contributing enormously to extension of lifespan, dramatically reducing the number and severity of illnesses and death from life-threatening infections, such as pneumonia, typhoid and bacterial endocarditis. Surgeons now had the carte blanch to operate without fear of post-surgical infections. Discovery of antibiotics played an important role in reducing infant and maternal mortality rates. Use of antibiotics also resulted in better animal health care, livestock industry and food technology. Antibiotics may also be given as a preventive measure. This is usually limited to at-risk populations such as those with a weakened immune system (particularly in HIV cases to prevent pneumonia), those taking immunosuppressive drugs, cancer patients, and those having surgery. Emergence of antibiotics resistance The triumph over bacteria proved short-lived. It was soon discovered that some bacteria had developed resistance. Alexander Fleming, who discovered penicillin, had predicted that. The number of bacteria resistant to antibiotics has been increasing. Antibiotic resistance is the resistance of a microbe to an antibiotic that used to be effective in treating or preventing an infection caused by that microbe. Antibiotic resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria. As a result, standard treatment becomes ineffective; infections persist and may spread to others. It is feared that, owing to the rising incidence of resistance, doctors may one day run out of options. Among reporting countries, where penicillin has been used for decades to treat pneumonia, ranges from zero to 51 per cent. Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become high risk. The triumph over bacteria proved short-lived. It was soon discovered that some of the bacteria had developed resistance. Alexander Fleming, who discovered penicillin, had predicted that. The number of bacteria resistant to antibiotics is increasing Antibiotic resistance has emerged as a major health crisis in all sectors, including human, veterinary, agriculture and environment, and threatens the major gains that have been made in medicine. It has spread to almost all countries and regions, including Pakistan. It is no longer an apocalyptical fantasy. It seems that human race is heading for a post-antibiotic era in which most antibiotics will be ineffective and the bacteria will have a free hand to destroy human and animal life. Antibiotic resistance accounts for hundreds of thousands of deaths annually. Its projected increase has made the WHO recognize it as a major global health threat. Currently, at least 700,000 people die each year worldwide due to drug-resistant diseases, including 230,000 people from multi-drug-resistant tuberculosis. Each year in the US, at least two million people get an antibiotic-resistant infection, and at least 23,000 people die of it. Antibiotic resistance claims 25,000 lives each year in Europe, equal to a Boeing 747 crashing each week. Review of Antimicrobial Resistance has forecast that by 2050 antibiotic-resistant infections could kill 10 million people per year – more than all cancers combined. Multi-drug-resistant bacteria Microbes resistant to more antibiotics than one have been reported in hospital environments as well as community setting. While some strains of pathogens are resistant to one antibiotic, others have become resistant to many antibiotics and chemotherapeutic agents. Some strains have become resistant to practically all of the commonly available agents. MRSA case of Carlos Don Carlos was a cheerful and healthy boy, 12 years of age, involved in football and fishing. On a fateful morning, he was brought from the school in a critical state. He was frail and lethargic, running high temperature and coughing. In the urgent care, he was diagnosed as a case of bilateral pneumonia. The physician prescribed commonly used antibiotics and the lad was sent home, but his condition worsened. He was then shifted to the ICU at a nearby hospital where a new regimen of treatment comprising different antibiotics was introduced but to no avail. As his lungs and heart were not functioning efficiently, he was placed on a heart-assist device. Doctors explained that his condition was deteriorating because the isolated bug was multi-drug-resistant staphylococcus; that is why pneumonia is not responding to the administered antibiotics. After a two weeks stay at the ICU, it was found that his lung tissue was dead and heart was too weak to function. As there was no chance of survival, parents allowed the doctors to remove him from life support machines. The case has been reported by Infectious Diseases Society of America. Multi-drug-resistant tuberculosis is becoming increasingly prevalent, and requires treatment with expensive and toxic drugs for up to two years to cure. Before the emergence of multi-drug-resistant bacteria, cure would take six to nine months. Typhoid, a serious but common community infection, has so far been treatable with oral antibiotics. However, alarming reports of drug-resistant typhoid are beginning to emerge. As a result its future mode of treatment is now uncertain. (To be continued) The writer is Chest specialist in San Francisco