Preface

Modern society has benefited from the life changing discoveries that include antibiotics, which have positively influenced health and wellbeing during the second half of the twentieth century. The concept of the killer infectious disease had become a bad memory from a distant past or a nightmare vision of a dystopian future. It is only in the last couple of years that society and policy-makers are beginning to realise that this version of the future is not science fiction but a distinct possibility.

Infections are caused by a wide variety of pathogens including bacteria, fungi and viruses. But it is worth remembering that pathogenic microbes are only a tiny fraction of the microbial world. Recent technological advances are unveiling a seemingly never-ending stream of new microbial genomes that microbiologists simply haven't managed to culture in a laboratory environment. Although viruses have been responsible for some of the most deadly diseases that have shaped our modern society, it appeared as if scientists had found or developed the tools to combat bacterial infections. Without a doubt, significant advances in public health, combined with the political will to tackle certain life threatening diseases head on have delivered real success stories in the battle against infections. Some of the most significant scientific discoveries of the twentieth century are the identification and commercial production of a variety of chemical compounds with antibiotic properties. However, the unbridled optimism that accompanied these discovery masked the fact that antibiotic resistance was emerging at the same rate and with the same frequency.

I am lucky enough to have spent time working at one of the top microbiology research institutes in the country. At the turn of the 21st century, I was working with scientists who were world experts in the fields of antibiotic discovery and antibiotic resistance. At least a decade before society had woken up to the looming threat of antibiotic resistant pathogens, a committed group of microbiologists and clinicians had already recognised the potential crisis that was emerging across the globe. Even as the large pharmaceutical companies were withdrawing funding from antibiotic discovery programmes, passionate pockets of scientists continued to work in research laboratories, actively searching for new antimicrobial compounds while trying to understand the myriad ways that microbes are developing resistance to these precious resources.

This book has been written to introduce readers to the ticking time bombs of increasing antibiotic resistance combined with a lack of new drugs and how this is impacting on society's ability to successfully treat infectious diseases. It explains how bacteria develop antibiotic resistance and how this resistance is spread among other bacterial species. Although the spread of antibiotic resistance is a natural phenomenon, this book will describe how human behaviour is adding to the problem by ensuring that antibiotic resistance is spread successfully across the globe.

Antibiotic resistance is a phenomenon normally associated with bacteria that is included in the much broader term of Antimicrobial Resistance (AMR). AMR occurs when a microbe evolves to become more or fully resistant to antimicrobials that previously could treat it. Antibiotic resistance is a significant threat. It will take commitment from a variety of stakeholders to provide solutions. To emphasise the seriousness of the problem we are facing, just as this book is going to print The General Assembly of the United Nations convened for only the fourth time to highlight a health issue (the others were HIV, noncommunicable diseases, and Ebola). The high-level meeting was convened by the President of the 71st session of the UN General Assembly, H.E. Peter Thomson. Mr Thomson stated “Member States have today agreed upon a strong Political declaration that provides a good basis for the international community to move forward. No one country, sector or organisation can address this issue alone.” The need for antibiotic stewardship is paramount and this book outlines the roles that members of the public can play to combat this major health issue.

This book could not have been written without the generosity of friends and colleagues who have supported me throughout the writing process. First of all, I am incredibly grateful to the scientists and antibiotic resistance fighters who have taken time to provide the individual case studies that highlight their own personal research stories. The case studies demonstrate the different approaches that are being taken to combat this imminent threat. In no particular order, I would like to thank Professor Neil Gow, Professor Nicola Stanley Wall, Professor Alan Johnson, Professor Matt Hutchings, Dr Lindsay Hall, Dr Lesley A. Robertson, Professor Tony Maxwell and Tamar Ghosh who is leading the development and delivery of the Longitude Prize at Nesta.

I would like to thank my husband Richard Bowater for taking the time to check many aspects of the science and for creating some of the illustrations, my sister Clare Mackie, the Grammar Queen who generously took time to read and check every individual chapter (sometimes more than once!) to ensure they made sense for subsequent readers. My brother Alistair McWalter also deserves thanks for providing illustration for the book, especially the front cover. To those of you in office Med 2.16 (you know who you are), the coffee, cake and encouragement was much appreciated. Richard, Ellie, Charlotte, and Avril, I hope this book makes you proud. You make me proud and I wouldn't have and couldn't have written his book without you all. To my lovely dad, I know you will never read this book, but your influence is throughout. Finally, I would like to thank the staff at the Royal Society of Chemistry for their help and encouragement during the production of the book.

Laura Bowater