Discovery of antimicrobials by the pharmaceutical industry is one of the most important advances in the history of human health which helped to steadily decrease the suffering of humanity from disease and saved several millions of lives over the past seventy years. Antimicrobial agents are medicines used to treat infections caused by bacteria, fungi, parasites, and viruses. But, today many infections can no longer be treated effectively with common antimicrobial drugs. Resistance to drugs poses a growing threat to the treatment and control of infectious diseases, ranging from those that have long been endemic in human populations namely malaria, tuberculosis, sexually transmitted infections and even recent pandemics such as HIV and influenza virus. Antimicrobial resistance threatens the control of several other community-acquired infections. It is the use and misuse of antimicrobials in human medicine and animal husbandry over the years that led to a relentless rise in the number and types of micro-organisms resistant to these medicines leading to death, increased suffering and disability and thereby higher healthcare costs. Antimicrobial resistance and its global spread now threaten the continued effectiveness of many medicines used today to treat the sick. The drug resistance, at the same time, also jeopardizes important advances being made against major infectious killers.
One of the major disease burden the world facing today is on account of multi drug resistant TB. MDR TB is resistant to two most commonly used drugs in the current four-drug regimen namely isoniazid and rifampicin. The disease is no more restricted to the developing world and several cases are being reported even from developed countries. In 2008, an estimated 440,000 cases of multidrug-resistant TB cases were reported worldwide. Two other drugs which have become resistant are artemisinin derivatives and chloroquin phosphate for the treatment of deadly malaria. Resistance to artestinate was first reported in 2009 in certain geographical areas at the Thai-Cambodian border, where the drug has been used as monotherapy for many years. In India, the DCGI has recently asked the state drug controllers to cancel all the manufacturing licenses and stop export of the drug as there is an increasing evidence that the use of the artemisinin derivatives as monotherapy is one of the main factors which contributes to the development and spread of resistance. Monotherapy with artemisinin poses a great threat to global malaria control as resistance can be detrimental to the use of artemisinin-based combination therapy in other parts of the world. TB and malaria have thus re emerged as two major killer diseases threatening lives of millions of poor people. And the tragedy is that pharmaceutical industry has no new drugs to offer for treating these diseases and it has nothing in the pipeline. Many pharmaceutical companies have slowed or halted their antimicrobial research and are mostly developing drugs for lifestyle diseases over the past two decades. This is an approach directly contrast to the trend of antimicrobial development research observed in the 1970s, 1980s, and early 1990s. The main reason for this change in direction is the high risk and low returns from developing such drugs and increasing bureaucratic control to gain regulatory approval. Although there has been no serious attempt to develop antimicrobial drugs by large pharmaceutical companies now, some smaller companies have remained committed to addressing the need for new antimicrobials. How far they will succeed in their efforts is to be seen. What is therefore important is a collective initiative by the government laboratories of the developing world to address this issue with utmost urgency.