Antibacterial drug discovery and development has slowed considerably in recent years with novel classes discovered decades ago and regulatory approvals tougher to get. This article describes newer classes of antibacterial drugs introduced or approved after year 2000, their mechanisms of action/ resistance, improved analogs, spectrum of activity and clinical trials. It also discusses new compounds in development with novel mechanisms of action as well as novel unexploited bacterial targets and strategies which may pave the way for combating drug resistance and emerging pathogens in the 21 st century.
Keywordsantibacterial; drug discovery; drug resistance Infectious diseases are one of the leading causes of death worldwide, especially in low and middle income (LMIC) countries where second line antibacterial drugs against resistant bacteria are generally unavailable or unaffordable. In upper income countries (UIC), the emergence of multi-drug resistance in both community and hospital acquired infections has outpaced development and delivery of new drugs to the clinic. Most recently, the emergence of carbapenem resistance among Klebsiella sp. and related Gram negative bacteria illustrates the magnitude of the problem, as these multi-drug resistant infections are associated with high mortality rates and few treatment options 1. While the market potential for new antibacterial drugs is estimated in the many billions of dollars 2 , the discovery pipelines of most major pharmaceutical companies run near empty. The paucity of new antibacterial drugs has led the Infectious Disease Society of America (IDSA) and others to call for action in rebuilding infrastructure and efforts to develop next generation drugs.Despite the many grim predictions of failure in combating infectious diseases in the future 3 , 4 , all is not lost, as several classes of new antibacterial compounds as well as derivatives of older therapeutics have emerged. In this review we examine some of these new antibacterial drugs that have recently been approved by the FDA (and EMEA) or are in late stages (phase II development or beyond) of the pipeline. These new drugs belong to the following classes of compounds that include: oxazolidinones, glycopeptides, ketolides, glycylcyclines, carbapenems and fluoroquinolones (Table 1). This article will describe in detail the mechanism of action (novelty), spectrum of activity, selected in vivo efficacy and mechanisms of resistance to these antibacterial drugs and also discusses briefly more new drugs in development (Table 2). We also have included unpublished information reported at the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the Infectious Disease
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NIH-PA Author ManuscriptSociety of America (IDSA) 46th Annual Meeting in 2008 and here after noted as ICAAC/ IDSA. In addition, we also explore novel strategies such as targeting host infection response pathways, anti-infective antibodies or the vitamin cofactors of...