There is increasing concern globally about the enormity of the threats posed by antimicrobial resistance (AMR) to human, animal, plant and environmental health. A proliferation of international, national and institutional reports on the problems posed by AMR and the need for antibiotic stewardship have galvanised attention on the global stage. However, the AMR community increasingly laments a lack of action, often identified as an ‘implementation gap’. At a policy level, the design of internationally salient solutions that are able to address AMR’s interconnected biological and social (historical, political, economic and cultural) dimensions is not straightforward. This multidisciplinary paper responds by asking two basic questions: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes, what hallmarks characterise ‘good’ antibiotic policy? Our multistage analysis revealed four central challenges facing current international antibiotic policy: metrics, prioritisation, implementation and inequality. In response to this diagnosis, we propose three hallmarks that can support robust international antibiotic policy. Emerging hallmarks for good antibiotic policies are: Structural, Equitable and Tracked. We describe these hallmarks and propose their consideration should aid the design and evaluation of international antibiotic policies with maximal benefit at both local and international scales.

Background Ethiopia is one of the countries with a high burden of tuberculosis (TB). Jimma Zone has the lowest TB case notification rate compared to the national and World Health Organization's (WHO) targets. The aim of the present study was to identify barriers, and explore the origin of these barriers in relation to TB case finding. Methods A qualitative study was conducted by using different data collection methods and sources. Sixty in-depth interviews with TB treatment providers, program managers and TB patients were included. In addition, 42 governmental health facilities were observed for availability of resources. Data obtained from the in-depth interviews were transcribed, coded, categorized and thematized. Atlas.ti version 7.1 software was used for the data coding and categorizing. Results Inadequate resources for TB case finding, such as a shortage of health-care providers, inadequate basic infrastructure, and inadequate diagnostic equipment and supplies, as well as limited access to TB diagnostic services such as an absence of nearby health facilities providing TB diagnostic services and health system delays in the diagnostic process, were identified as barriers for TB case finding. We identified the absence of trained laboratory professionals in 11, the absence of clean water supply in 13 and the electricity in seven health facilities. Furthermore, we found that difficult topography, the absence of proper roads, an inadequate collaboration with other sectors (such as education), a turnover of laboratory professionals, and a low community mobilization, as the origin of some of these barriers.

Robert Koch's identification of the tuberculosis pathogen in 1882 is held to be his greatest scientific achievement. In the eyes of his friend and colleague, Friedrich Löffler, the discovery was a “world-shaking event” which resulted in both instant and everlasting fame, turning Koch “overnight into the most successful and outstanding researcher of all times”. Paul Ehrlich, remembering Koch's presentation in Emil du Bois Reymond's Institute for Physiology in Berlin on 24 March 1882, called it “my single greatest scientific experience”. The sensational character of Koch's achievement, which is noted in Löffler's and Ehrlich's retrospective statements, seems to have been obvious to contemporaries of the event. Albert Johne, writing a history of tuberculosis in 1883, found that history had, in a way, come to an end: “resulting from the latest of Koch's publications, the pathogenic aspects of the tubercle question are settled at large”. Koch himself profited from the overwhelming reception by being promoted to the rank of a senior executive officer, Geheimer Regierungsrath, in June 1882. March 24, 1882 thus came to stand for two things: Koch's breakthrough to world fame and a sort of doomsday for tuberculosis. Not surprisingly, the event was held in similar esteem by later biographers: Bernhard Möllers in 1950 called it the “greatest and most important success of his life”, and Thomas Brock, Koch's most recent biographer, assessed the discovery of the tubercle bacillus as the first of two steps on Koch's road to fame in the early 1880s. In conjunction with the 1883–84 cholera expedition, which made Koch a hero for the public, the tubercle bacillus indicated his breakthrough in the scientific world.

This paper analyses how research on antibiotic resistance has been a driving force in the development of new antibiotics. Drug resistance, while being a problem for physicians and patients, offers attractive perspectives for those who research and develop new medicines. It imposes limits on the usability of older medicines and simultaneously modifies pathologies in a way that opens markets for new treatments. Studying resistance can thus be an important part of developing and marketing antibiotics.

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