Fig. 1

Crude death rate for infectious diseases – United States, 1900–1996 (adapted by the CDC from [112]). Mortality from infectious diseases began to decrease before the advent of antimicrobials. The slope of decrease in crude mortality does not show evidence of being affected by the introduction of antimicrobials. The first clinical use of sulfonamids was in 1935, penicillin in 1943, with others throughout the following decades, albeit with decreasing frequency of novel compounds. The 1918 spike in mortality was caused by the Spanish flu pandemic which is estimated to have infected 500 million people, one third of the world’s population at that time, and killed between twenty and fifty million people