Ronald Jay Lubelchek and Robert A Weinstein

The mid-twentieth century discovery and subsequent mass-production of antimicrobial agents ushered in a period during which previously deadly infectious diseases, such as Streptococcus pneumoniae meningitis and Staphylococcus aureus endocarditis, could at last be cured. Optimism abounded during the early days of the antibiotic era. By 1967, the US Surgeon General reportedly stated that we could "close the book" on infectious diseases (Fauci, 2001). Yet even as these apocryphal words were spoken, bacteria - driven by the selection pressure of antimicrobial exposure and enabled by an astounding degree of genetic mutability - had begun to develop antibiotic resistance, thus undermining the era's "magic bullets." Today, despite our extensive armamentarium of antimicrobial agents, infectious diseases represent the second leading cause of death and a primary cause of disability worldwide (Fauci, 2001). Between 1980 and 1992, deaths attributed to infectious diseases increased by 58 percent. Though the HIV/AIDS epidemic comprises half of the increase, other emerging infections, including those due to antibiotic-resistant bacteria, contribute significantly to the escalation in infectious disease-related mortality (Pinner et al., 1996).

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