Antimicrobial resistance (AMR) poses an immense threat to humans- from directly killing people to complicating medical to procedures to even impacting agriculture and threatening food sources. We still have a long way to go before we can call AMR a problem of the past, but it is important to take a step back and appreciate how far we have come. Reflecting on the past, present and future of the field may provide insights and inspiration to carry on the battle against AMR. 

The Past

The first ever time that resistance to an antimicrobial was mentioned was in 1907 by Paul Ehrlich, during a lecture to the Royal Institute of Public Health. There he mentioned the ability of trypanosomes to become resistant to the arsenic based compounds used to control infection and that these traits are passed down in subsequent generations.  Yet it wasn’t until 1940, when Edward Abraham and Ernst Chain observed bacteria that are able to produce compounds against penicillin, that researchers began to look more closely at AMR. Notably, Milislav Demerec showed that resistance arises from random genetic mutations in bacteria- opening the doors to a whole new field of research (1).  

The Present  

As of 5th February 2025, there are over 26,000 articles on PubMed related to “antimicrobial resistance”. An incredible amount of research has gone into describing the mechanisms and development of AMR and looking for new treatments. However, it is important to recognise that lower- and middle-income countries are disproportionately affected by AMR (2). So, while having the scientific research is important, we must not neglect the significance of developing good infrastructure and public health policies. The WHO has recently laid out a document on accelerating global and national responses to AMR, where they present four strategic priorities including “universal access to affordable, quality diagnosis and treatment of infections” and “strategic information science and innovation” (3).  

The Future

A combination of scientific discovery, social and cultural change with policy changes are needed to successfully combat AMR. The emergence of mRNA technology opens the doors for creation of new vaccines to prevent infection against common resistant pathogens. With advancements in genetic sequencing, personalised medicine may take front stage, with each person being given an antimicrobial suited perfectly for them and the pathogen infecting them. Policy changes, particularly related to antimicrobial use in farming, ensuring that antimicrobials are given only when needed and changing public perception towards antimicrobials  will be invaluable.  

We have truly made many advancements in our understanding of pathogens, how they develop resistance and how to combat AMR. There is still a lot more to be done, from systemic policy changes to searching for new antimicrobials to educating the public. However, looking back from where the battle against AMR started and perhaps even before the existence of antibiotics, humanity has made many leaps forward. Therefore, I’d say congratulations are due for what we have done and encourage ourselves to take another leap forward. 

  References 

1. Hunt D and Kates OS. A Brief History of Antimicrobial Resistance. AMA J Ethics. 2024; 26(5):E408-417. doi: 10.1001/amajethics.2024.408.
2. WHO. Fact Sheets: Antimicrobial Resistance [internet]. 2023 [cited 5 Feb 25]. Available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance 
3.   WHO Director-General. Antimicrobial Resistance: accelerating national and global responses. WHO strategic and operational priorities to target drug-resistant bacterial infections in the human health sector 2025-2035. Seventy-Seventh World Health Assembly Provisional agenda item 11.8. 11 Apr 2024. Available at: https://apps.who.int/gb/ebwha/pdf_files/WHA77/A77_5-en.pdf