Perspectives on the development of new antimicrobial agents for resistant gram-positive pathogens.
There is great public and professional concern related to antimicrobial resistance, especially among Gram-positive pathogens associated with high morbidity and mortality. Penicillin-nonsusceptible Streptococcus pneumoniae, glycopeptide resistant enterococci, and oxacillin-resistant (MRSA) or vancomycin-intermediate (VISA) Staphylococcus aureus isolates continue to escalate in occurrence leading to the widespread use of empiric combination regimens. Newer, often novel, agents seem necessary to combat these pathogens. Among these, quinupristin/dalfopristin (Synercid), evernimicin or SCH 27899 (Ziracin), and linezolid (Zyvax) have the highest potency, widest spectrum, and most clinical experience. Among the quinolones (gatifloxacin, gemifloxacin, moxifloxacin), gatifloxacin is closest to clinical use and appears safe based on initial trial reports. Several broad-spectrum beta-lactams ("fourth-generation" cephalosporins, carbapenems) are expected to be used with increasing frequency as a result of the emerging high rates of specific beta-lactamases that compromise the use of ceftriaxone, ceftazidime, and many beta-lactamase inhibition/ penicillin combinations. Among these agents, cefepime and meropenem are the most potent and broadest in clinical application in their respective classes. Physicians must stay informed about drug development and antimicrobial resistance by using results from local surveillance programs. When these data are unavailable, physicians should consider the use of national or global monitoring systems (SENTRY) to direct empiric antimicrobial selection.
Jones
R N
RN
Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa 52242, USA. ronald-jones@uiowa.edu
D000900:Anti-Bacterial Agents / Q000737:chemistry* / Q000494:pharmacology*; D004352:Drug Resistance, Microbial; D014943:Global Health; D006094:Gram-Positive Bacteria / Q000187:drug effects*; D006801:Humans; D018571:Sentinel Surveillance; D014769:Virginiamycin / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D014769:Virginiamycin; C062940:quinupristin-dalfopristin