Clinical Review

Science, medicine, and the future

BMJ 1998; 317 doi: (Published 05 September 1998) Cite this as: BMJ 1998;317:643
  1. Richard Wise, professor in clinical microbiology
  1. Department of Medical Microbiology, City Hospital Trust, Birmingham B18 7QH

    The past 50 years have shown how successful the pharmaceutical industry has been in developing antimicrobial agents. Until the 1980s a steady stream of new agents (or at least older modified agents) had become available. The 1980s saw little investment in new antibacterials,1 but now this is changing. There is a need for new agents. The knowledge obtained from bacterial genetics, along with improvements in biotechnology, has given the impetus to the search for new compounds, as an understanding of the genome allows new targets to be identified. Vaccine development also holds promise for the treatment and prevention of common diseases. Group B meningococcal vaccines and HIV vaccines are currently under study but not expected in the near future.

    The key development strategies fall into three groups — new modifications of existing agents, genomic approaches, and vaccine development.

    Modifications of existing

    Antimicrobial agents with ever broader spectrums of activity have been developed, and there will be an extension to the antibacterial spectrum of current compounds. Recently, fluoroquinolones have appeared and are soon to be marketed (such as trovafloxacin which is active against anaerobic bacteria2) or will be available in 2-3 years (such as SmithKline Beecham's SB265805, which has enhanced activity against Gram positive bacteria3). The β lactam structure has been such a fruitful source of compounds in the past with the penicillins, cephalosporins, and carbapenems (among others) being so useful. Future modification of such drugs seems unlikely, although there is interest in multicyclic structures with broad spectrum activity and resistance to the novel β lactamases …

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