**3.3 Therapeutic concerns and the need for continued antibiotic development**

The concern over the current antibiotics available is that the majority function via one or two general mechanisms. Currently the carbapenems are "last line" therapy for many resistant bacteria; the emergence of the NDM-1 gene demonstrates not only an organism's ability to withstand treatment from the majority of available antibiotics, but also demonstrates the threat of effective transposition based spreading from the gene. Many "newer" antibiotics function via some slight variation of previous mechanisms, for example inhibiting protein synthesis by binding one of the ribosomal subunits at a different location or a with a different affinity. Bacteria are likely to rapidly develop resistance mechanisms for antibiotics that function so similarly. Currently there are very few approved antibiotics with novel mechanisms and the "drug development pipeline" does not include a substantial number of new designs.

The emergence of the multidrug resistance element NDM-1 suggests the urgency for the development of drastically novel function antibiotics. The over publicized, and perhaps mispublicized, evolution of "superbugs" has forced both public and government attention to the uncertain nature of our microbial defense. The necessity of government support through funding is essential in order to develop drugs that are positioned to enter the "pipeline." Considering the time required for drug development, the risk of global spread of resistance is alarming.
