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The treatment of an infection is often described in military terms: the war on microbes, the war on infections, or the battle against antimicrobial resistance. We believe the chance of winning the ‘war on antimicrobial resistance’ by escalation is about as likely as the chance of winning the ‘war on terror’. Our war should be against human error, particularly the erroneous belief that new drug discoveries will be the solution to resistance development. We should de-escalate rather than escalate antibiotic use, invest in diagnostics, ensure our hospitals do not act as ‘resistance amplifiers’, and try to prevent infections.
Downie et al1 describe Staphylococcus aureus, Escherichia coli and Klebsiella species as the most common causes of community-acquired neonatal and infant bacteraemic infection in developing countries. The importance of Klebsiellae is surprising. This genus is classically associated with nosocomial infections. Some of the primary studies in this review may not have separated nosocomial from true community-acquired sepsis adequately, particularly the largest study by Sharma et al, from India. Nonetheless this meta-analysis of in vitro evidence1 shows that the WHO recommended antibiotic regimen for neonatal sepsis, penicillin and gentamicin, covers only just over half the isolates. The alternative of a third generation cephalosporin, often used because it is cheap and ‘broad spectrum’, does not improve coverage.
Most antibiotics are derived from naturally occurring microbial products. Environmental bacteria found in caves which had been isolated from the outside world for 4 million years have been …