Towards targeted prescribing: will the cure for antimicrobial resistance be specific, directed therapy through improved diagnostic testing?

The discovery of antimicrobial agents was one of the major events of the twentieth century. However, with the 'antibiotic era' barely five decades old, we are now faced with the global problem of emerging resistance in virtually all pathogens. Guidelines and admonishments to improve prescribing have had little effect. At this point, in the twenty-first century, we are on the threshold of another era of discovery-that of molecular diagnostics. We postulate that the development and use of new molecular microbiological testing, coupled with an ever-improving understanding of how best to use these precious drugs in the treatment of infection, offers the greatest hope yet for physician prescribing that can retard, or perhaps even reduce, the development of drug resistance in many microbial species. This diagnostic advance could preserve the utility of antimicrobial agents well into the future for the benefit of all people.