The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed.

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Antibiotic resistance—the need for global solutions

Chlamydial infections (first of three parts).

Chlamydia trachomatis was isolated from the urethra from 48 (42 per cent) of 113 men with non-gonococcal urethritis (NGU), four (7 per cent) of 58 without overt urethritis, and 13 (19 per cent) of 69 with gonorrhea. Postgonococcal urethritis (PGU) developed in 11 of 11 men who had C. trum antibody to C. trachomatisis developed. The immunotype specificity of chlamydial antibody corresponded to the immunotype isolated. Among culture-negative patients. chlamydial antibody prevalence correlated with the number of past sex partners and with previous NGU. Herpesvirus hominis, cytomegalovirus, T-mycoplasma, Mycoplasma hominis, other bacteria, and Trichomonas vaginalis were not implicated in NGU or PGU. Thus, the cause of chlamydia-negative NGU and PGU remains obscure. Endocervical chlamydia were found in sex partners of 15 of 22 NGU patients with and two of 24 without urethral chlamydial infection (p smaller than 0.001). Tetracycline treatment of both sex partners appears advisable.

Etiology of Nongonococcal Urethritis

The recent marked increase in incidence of gonorrhea prompted this analysis of the systemic manifestations of gonococcal infection. Of 42 patients with disseminated infection, 79% were wom...

Disseminated gonococcal infection.

Introduction and Historical Aspects ALTHOUGH the first isolation of a mycoplasma from a human being, a patient with a genital infection,1 was reported in 1937, it is only in the past few years that convincing evidence has appeared linking these organisms to disorders of the human genital tract. Genital mycoplasmas have now been associated with nongonococcal urethritis, acute salpingitis, abortion, post-partum fever and, most recently, with low birth weight. This review will attempt to evaluate critically the role of the genital mycoplasmas in human disease and to indicate areas of future investigations. Mycoplasmas were prominent in veterinary medicine long before . . .

The Genital Mycoplasmas

Treatment of gonorrhea in men with a single intramuscular dose of 2,400,000 units of procaine penicillin G, recommended by the US Public Health Service and the armed forces in 1965, continues to result in 20% to 30% treatment failures among military personnel in the Far East. In studies of confined populations aboard air-craft carriers, 63 men with gonorrhea received 2,400,000 units of procaine penicillin G with 18 (29%) treatment failures; 58 men received 2,400,000 units procaine penicillin Gplus probenecidorally, with only one failure. Resistance to 0.06 units of penicillin per milliliter of medium was noted in 26 of 41 (63%) and 57 of 74 (77%)Neisseria gonorrhoeaeisolates from the respective groups. Thirty men received tetracycline hydrochloride orally, with no failures. In areas where treatment of gonorrhea with large parenteral doses of penicillin G is becoming less effective, adequate therapy is possible with probenecid plus penicillin or with tetracycline.

https://jamanetwork.com/journals/jama/articlepdf/336083/jama_202_6_008.pdf

Studies of Venereal Disease: I. Probenecid-Procaine Penicillin G Combination and Tetracycline Hydrochloride in the Treatment of Penicillin-Resistant Gonorrhea in Men

Postgonococcal urethritis (PGU) occurred in nearly two thirds of men with gonorrhea acquired in the Far East who were "successfully" treated with 2,400,000 units of procaine penicillin G plus probenecid. PGU occurred less often after treatment of gonorrhea with tetracycline hydrochloride, and PGU itself responded to tetracycline, suggesting a microbial etiology for the condition. The syndrome was associated to a highly significant degree withMycoplasmainfection of the urethra, and occurred more often after infection with Neisseriagonorrhoeaeof lessened penicillin sensitivity. The high incidence of the syndrome, one of the most common infectious diseases among military personnel in the Far East, requires a reexamination of the traditional use of penicillin in the treatment of gonorrhea in men.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=336087&pdfFileName=jama_202_6_009.pdf

Studies of Venereal Disease: II. Observations on the Incidence, Etiology, and Treatment of the Postgonococcal Urethritis Syndrome

Previous studies of the treatment of nongonococcal urethritis (NGU) have generally not been closely controlled, and have often produced conflicting results. In the present study, 96 men with NGU were treated with placebo or tetracycline hydrochloride while "confined" aboard an aircraft carrier at sea. A seven-day tetracycline regimen was more effective than a four-day tetracycline regimen or placebo in the short-term cure of NGU.

https://jamanetwork.com/journals/JAMA/articlepdf/336090/jama_202_6_010.pdf

Studies of Venereal Disease: III. Double-Blind Comparison of Tetracycline Hydrochloride and Placebo in Treatment of Nongonococcal Urethritis

Postgonococcal urethritis (PGU) occurred in nearly two thirds of men with gonorrhea acquired in the Far East who were "successfully" treated with 2,400,000 units of procaine penicillin G plus probenecid. PGU occurred less often after treatment of gonorrhea with tetracycline hydrochloride, and PGU itself responded to tetracycline, suggesting a microbial etiology for the condition. The syndrome was associated to a highly significant degree with Mycoplasma infection of the urethra, and occurred more often after infection with Neisseria gonorrhoeae of lessened penicillin sensitivity. The high incidence of the syndrome, one of the most common infectious diseases among military personnel in the Far East, requires a reexamination of the traditional use of penicillin in the treatment of gonorrhea in men.

II. Observations on the Incidence, Etiology, and Treatment of the Postgonococcal Urethritis Syndrome LT King K. Holmes, MC, USNR; LCDR David W. Johnson, MC, USN;

Thomas M. Floyd

Papers

Studies of Venereal Disease: I. Probenecid-Procaine Penicillin G Combination and Tetracycline Hydrochloride in the Treatment of Penicillin-Resistant Gonorrhea in Men

Studies of Venereal Disease: II. Observations on the Incidence, Etiology, and Treatment of the Postgonococcal Urethritis Syndrome

Studies of Venereal Disease: III. Double-Blind Comparison of Tetracycline Hydrochloride and Placebo in Treatment of Nongonococcal Urethritis

II. Observations on the Incidence, Etiology, and Treatment of the Postgonococcal Urethritis Syndrome LT King K. Holmes, MC, USNR; LCDR David W. Johnson, MC, USN;