Department of Molecular Microbiology and Immunology and Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Clin Infect Dis. 2017 Apr 1;64(7):823-828. doi: 10.1093/cid/cix067.
The development of nontoxic broad-spectrum antimicrobial drugs in the mid-20th century led to a culture of empiricism, underdevelopment of diagnostics, neglect of immunotherapy, and selection for drug resistance, which together created the conditions that underlie the current crisis. In 1996 an article in this journal predicted a crisis in infectious diseases, which subsequently unfolded with a paucity of new drugs, increases in antimicrobial resistance, and underdevelopment in both immunotherapy and diagnostics. This article argues that the root cause of the current-day problems lies in the enormous success of the mid-20th century antibiotic revolution. The availability of low-toxicity broad-spectrum drugs fostered a culture of empiricism and widespread use, which in turn stunted the development of both the specialty and rapid diagnostics while promoting increases in resistance. Two decades later, there are promising signs that widespread recognition of these problems is leading to fundamental changes in the approach to the therapy of infectious diseases. Ultimately, a concerted effort to simultaneously develop pathogen-specific drugs, immunotherapy, and improved diagnostics could provide a qualitatively new platform for confronting the challenge of infectious diseases, which now also includes host dysbiosis.
20 世纪中叶，无毒广谱抗菌药物的发展导致了经验主义文化的形成，诊断技术发展滞后，免疫疗法被忽视，耐药性选择增强，这些因素共同为当前的危机创造了条件。1996 年，本刊的一篇文章预测了传染病的危机，随后新药物的缺乏、抗菌药物耐药性的增加以及免疫疗法和诊断技术的发展滞后都一一应验。本文认为，当前问题的根源在于 20 世纪中期抗生素革命的巨大成功。低毒性广谱药物的出现促进了经验主义文化的发展和广泛应用，这反过来又阻碍了该专业和快速诊断技术的发展，同时也促进了耐药性的增加。20 年后，有迹象表明，人们普遍认识到这些问题正在导致传染病治疗方法的根本改变。最终，共同努力同时开发针对病原体的药物、免疫疗法和改进的诊断方法，可以为应对传染病挑战提供一个全新的平台，而现在这一挑战也包括宿主的菌群失调。
