Abstract
The 1980s and 1990s saw the spread of resistant Grampositive cocci and a lack of new antibiotics directed against them.1 Concern about this situation has spread to governments and the lay press. Nevertheless, pharmaceutical progress has continued amidst the gloom—a point not yet recognized by the pessimists—and rather a lot of new anti-Gram-positive drugs are now progressing. The Table summarizes six drugs to have reached or passed Phase II (proof of efficacy). It excludes antibiotics in laboratory research and Phase I. Also excluded are the new quinolones and ketolides, which may offer new options for the treatment of respiratory infections but have borderline activity against most methicillin-resistant Staphylococcus aureus (MRSA) and enterococci.2,3 Linezolid and daptomycin4 are members of new chemical classes with new mechanisms of action. Compounds related to quinupristin/ dalfopristin and evernimicin (everninomicin)5 have been used previously as growth promoters for animals; LY-3333286 is a glycopeptide that retains activity against vancomycin-resistant enterococci and GAR-9367 is a new tetracycline that evades efflux and ribosomal resistance mechanisms. This article concentrates on quinupristin/ dalfopristin, which was recently licensed in the UK, Europe and the USA, and on linezolid, for which licensing is anticipated in 2000. Data on daptomycin,4 evernimicin,5 LY-3333286 and GAR-9367 have been presented recently elsewhere. Development of evernimicin has recently been suspended, and no other of these compounds seems likely to be licensed within the next year or so.