Antibiotic resistance: the perfect storm.

The worldwide epidemic of antibiotic resistance is in danger of ending the golden age of antibiotic therapy. Resistance impacts on all areas of medicine, and is making successful empirical therapy much more difficult to achieve. Antibiotic choices are often severely restricted, and the pipeline of new antibiotics is almost dry. Resistance cannot be prevented, but its development and spread can be slowed. One of the tools at our disposal is maximising diversity in our prescribing. The advent of tigecycline, the first in a new class of intravenous antibiotics, is important in this context, giving us a further monotherapy option for severe infections. Another strategy is seriously to curtail the large amount of unnecessary antibiotic use in many areas of life, not only medical practice. The various aspects of this strategy are briefly reviewed.