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Future trends in antibiotic therapy.

The 1990s will probably see fewer new antibiotics being registered than occurred during the 1970s and 1980s. The main reason for this is the excessive costs involved in the development of a new chemical entity. It is probable that more fluoroquinolones will be introduced and some of them will have improved antibacterial activities compared to current derivatives. Another class of antibiotics likely to develop during the next decade is the macrolides, with the emergence of drugs like azithromycin. Among the beta-lactams, new carbapenems and extended spectrum cephalosporins will be developed to meet the problems of increasing numbers of enterobacteria producing class I beta-lactamases, as well as the new broad-spectrum TEM enzymes. These resistance mechanisms against beta-lactams are also likely to give rise to a new era for beta-lactamase inhibitors. A field which presently looks less promising is that of drugs which are active against methicillin-resistant staphylococci; teicoplanin and daptomycin seem to have only minor advantages over vancomycin. Other developments that can be expected are those facilitating the administration of antibiotics, especially once-daily injectable antibiotics for intensive home care.