Antimicrobial resistance: considerations on present and future strategies

Antimicrobial resistance (AMR) is a global emergency that requires the use of short and long-term strategies. The existence of this phenomenon had been hypothesized by the discoverer of penicillin already in the first years in which this antibiotic drug began to be used, however the historical analysis on the onset and growth of the problem, together with an epistemological approach concerning its possible overcoming, suggest that research and production of new antibiotics cannot be its definitive solution. This may represent the main short-term strategy, to be pursued also thanks to economic incentives in favor of the pharmaceutical industries and privileged institutional pathways in the health sector, but future strategies to combat AMR must be based on an evolutionary vision of biomedicine. Approaches based on the evolutionary mechanisms of natural selection, the fight for existence and biological competition to occupy specific niches, represent the integrative methods of the present and above all the innovative ones of the future. The use of available vaccinations to combat specific bacterial and viral infections, the production of vaccines directed against resistant bacteria, therapies that use specific viruses capable of infecting and killing bacteria (phage therapies), non-chemical but biological sanitation systems of the surfaces in hospital environment (microbiological cleaning), biological therapies with the administration of populations of non-pathogenic bacteria capable of contrasting and eliminating pathogenic bacteria (microbiological therapy), microbiome transplants to transform the microbiological population of man in a means therapeutically useful against resistant bacteria (macrobiome transplant), are the strategies against AMR that will be discussed in this paper. Key messages Promote the production of new antibiotics in the present to win AMR. Evolutionary medicine is the key for futures strategies against AMR.