Crisis in infectious diseases: time for a new paradigm?

Current practices in the treatment of infectious diseases are the result of two fundamental changes in antimicrobial therapy that occurred in the mid-20th century: the transition from pathogen-specific therapy to non-pathogen-specific therapy and the shift toward emphasis on antiinfective strategies that target microbial pathogens over those that enhance host immunity. The alarming rise in antimicrobial-resistant strains, the increasing frequency of serious infections in immunocompromised patients, and the paucity of new types of antibiotics suggest the need for reevaluation of the manner in which infections are treated. In the short term, the situation may be addressed-at least in part-by increased emphasis on improved diagnosis and, when possible, the use of specific or narrow-spectrum treatments. In the long term, a return to pathogen-specific therapy, possibly in combination with adjunctive immunotherapy, may be an attractive and desirable option provided that significant advances are made in diagnostic microbiology and drug discovery.