title: Antibiotics in the second half of the 1980s. Areas of future development and the effect of new agents on aminoglycoside use.
abstract: Articles in this supplement have examined in detail the role of aminoglycosides in the therapy of infections, addressing problems of resistance, toxicity, and efficacy. This article discusses other agents and their potential utility and effect on aminoglycosides. Penem antibiotics, which have activity against only aerobic gram-negative bacteria, have recently been synthesized. These agents have proved effective in animal experiments; to date, however, results of human clinical trials are not available. Carboxypenicillins and ureidopenicillins will still have to be administered with aminoglycosides in patients with serious life-threatening infections or in those institutions in which organisms such as Klebsiella, Enterobacter, and Pseudomonas exhibit high levels of resistance. What will be the role of aminothiazolyl cephalosporins? In some institutions, these agents might be used as sole therapy, particularly if they become less costly as a result of competition. In other settings, concern over the resistance of organisms, such as Enterobacter cloacae, Citrobacter freundii, Serratia marcescens, and Pseudomonas aeruginosa, will result in the use of aminoglycosides with these relatively beta-lactamase-stable cephalosporins. It will be necessary to monitor the development of resistance to the new antibiotics and to determine whether the use of aminoglycosides plus third-generation cephalosporin combinations results in decreased resistance. Other agents to be considered include the directed therapy monobactams aztreonam and carumonam, the broad-spectrum carbapenem imipenem, and the penems under development. It is unclear whether these compounds might be used with aminoglycosides in critically ill, infected patients. It is also unclear what role oral beta-lactamase-stable cephalosporins will have in the therapy of nosocomial infections, since they probably will not be effective against many of the urinary or cutaneous infections that are treated with aminoglycosides. Quinolone agents can be used successfully against many infections. However, the likelihood of bacterial resistance developing and their potential for toxicity are still unknown. Thus, despite the emergence of many new agents, it appears that the time-tested aminoglycosides will continue to play an important role in antimicrobial therapy for some time to come.
authors.forename: H C
authors.initials: HC
authors.lastname: Neu
mesh_terms: D000617:Aminoglycosides / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000138:chemical synthesis / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002511:Cephalosporins / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D015378:Imipenem; D008997:Monobactams / Q000627:therapeutic use; D010403:Penicillin Resistance; D010406:Penicillins / Q000627:therapeutic use; D013329:Structure-Activity Relationship; D013845:Thienamycins / Q000627:therapeutic use
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D008997:Monobactams; D010406:Penicillins; D013845:Thienamycins; D015378:Imipenem