2012 and beyond: potential for the start of a second pre-antibiotic era?

The past decade has seen an alarming confluence of circumstances antithetical to development of new antibacterials, and most of the very few new drugs under development have problems with their microbiology, toxicity, or pharmacokinetics and pharmacodynamics. Most large pharmaceutical companies have divested themselves of their antibiotic portfolios, and the promise that start-up companies would fill the niche has not been fulfilled. What is left of the field is being stifled by bureaucratic regulations, problems with approval, lack of expertise and a general lack of understanding of how serious the situation is. In paediatrics, in particular, there is no sign of any new antibacterial in the foreseeable future. Waiting for initiatives and deliberations will probably take too long, and a vigorous and deliberate effort to educate the public-who in their turn can apply the needed pressure--seems to be the only way of achieving a rapid turnaround of this most dangerous situation.