Resistance drives antibacterial drug development

New resistance challenges continue to evolve and spread worldwide. In an otherwise mature field, antibacterial drug development is primarily driven by resistance trends with a focus on development of new analogs of known scaffolds to strengthen them against class-specific resistance mechanisms. Currently new analogs of cephalosporins (with or without beta-lactamase inhibitors), oxazolidinones, glycopeptides, quinolones, aminoglycosides, tetracyclines, and ketolides are in clinical studies. While showing some benefit, these new analogs only partially address the clinical crisis of multidrug-resistant pathogens; this is especially the case for Gram-negative bacteria. The medical community faces grim reality — general solutions to the treatment of rapidly spreading multidrug-resistant bacteria are neither on the horizon nor anticipated.

► Escalating drug resistance is the primary driver of antibacterial R&D.
► Clinical development concentrates on analogs of known antibacterial classes maintaining focus on Gram-positive bacteria.
► New analogs address some class-specific resistance challenges and will buy some time.
► The race between drug development and emergence of resistance continues with resistance holding the lead.