THE NEW ANTIBIOTICS - 05/09/11

Doi : 10.1016/S0733-8627(05)70153-X

Diane Birnbaumer, MD ^a,^b, Madonna Fernández-Frackelton, MD ^b

^a Department of Medicine, University of California Los Angeles, Los Angeles (DB)

^b Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Torrance, California (DB, MF)

Résumé

Since the first use of antibiotics in the early 20th century, researchers have strived to add to the arsenal of available agents. Antibiotics have dramatically changed the practice of medicine in this century. Roughly one third of all hospitalized patients receive a course of antibiotics, resulting in millions of lives saved that would certainly have been lost because of infection. Unfortunately, these agents also have become some of the most widely misused and abused medications available today, resulting in many multi–drug-resistant pathogens.^{40 Goodman L.S., Gilmann A.G. The Pharmacologic Basis of Therapeutics New York: McGraw-Hill (1996).

Cliquez ici pour aller à la section Références}

The development of new antibiotics slowed in the 1980s when focus and funding shifted toward the development of new antiviral and antiretroviral agents in the fight against the human immunodeficiency virus (HIV). Today, polydrug-resistant bacteria are responsible for over one half of hospital-acquired infections, and even in the newest group of antibiotics, the quinolones, resistance is emerging. Enterococci sp. are now major nosocomial pathogens, and vancomycin-resistant Enterococci sp. (VRE) have presented a serious problem for the past several years. Vancomycin-resistant, methicillin-resistant Staphylococcus aureus has already been reported in Japan.^{74 Mitchell P. Rearming in the fight against bacteria Lancet 1998 ; 352 : 462 [cross-ref]

Cliquez ici pour aller à la section Références} The 1990s have consequently brought a resurgence of research into the development of new antibiotics.

There are other factors contributing to the need for new antibacterial agents. In this era of managed care, efforts are being made to decrease hospital admissions and costs of treatment. New oral (PO) antibiotics with improved absorption could replace intravenous (IV) infusion of certain antibiotics and obviate the need for admission in some patients. Many of the newer antibiotics offer once-daily dosing, increasing patient compliance and decreasing outpatient treatment failures. Adding to the antibiotic armamentarium also improves the choices available for patients with multiple drug allergies and those in whom drug-drug interactions are of concern.^{37 Gleckman R., De La Roda G. How do the newer oral antimicrobials stack up against traditional agents? Postgrad Med 1998 ; 104 : 119-126

Cliquez ici pour aller à la section Références}

This article reviews the antibiotics newly available in the past 5 to 7 years. It is important to remember that new does not necessarily equal better. The new antibiotics are as effective as, although more costly than, many of the standard regimens for common infections (Table 1). The inappropriate use or overuse of antibiotics has caused the major problem of polydrug resistance, and resistance patterns of bacteria to the new antibiotics are likely to parallel the extent to which they are prescribed.^{13 Bradley J.S. Meropenem: A new, extremely broad-spectrum beta-lactam antibiotic for serious infections in pediatrics Pediatr Infect Dis 1997 ; 16 : 263-268 [cross-ref]

Cliquez ici pour aller à la section Références}

Le texte complet de cet article est disponible en PDF.

Plan

Address reprint requests to Diane Birnbaumer, MD, Harbor-University of California Los Angeles Medical Center, Department of Emergency Medicine, 1000 West Carson Street, Box 21, Torrance, CA 90509, e-mail: dianeb@emedharbor.edu