Questions about the 10 x ′20 Initiative

This letter to the editor of Clinical Infectious Diseases explores the "10 x ′20 initiative" — a global commitment to develop 10 new antimicrobials by 2020. The authors question the development costs, the current clinical trial system, and the neglection of current antimicrobials. They also examine issue of quality versus quantity and conclude that "... we need to set priorities to achieve a balance between antibiotic conservation and new drug development, focusing on policies that will best serve public health. If new antibiotics emerge that meet predetermined public health goals, we need a plan in place to reward companies while conserving drugs for the most valuable clinical uses — something akin to a Strategic Antibiotic Reserve. Anything less, and in a decade we'll need a 20 x ′30 initiative."