Dramatic changes in the epidemiology and susceptibility patterns of Gram-positive cocci during the last decade have mandated new approaches to the management of many
bacterial infections. For example, there has been a sharp increase in the incidence of
infections caused by Staphylococcus aureus, particularly those resistant to
methicillin (MRSA), and methicillin-resistant
coagulase-negative staphylococci, particularly those associated with
foreign bodies and indwelling medical devices. Additionally, the worldwide spread of Streptococcus pneumoniae strains resistant to
penicillin and
macrolides, and the emergence of enterococci (particularly Enterococcus faecium) resistant to
vancomycin,
teicoplanin and other
antibiotics, present further therapeutic problems. New
antibacterial agents are urgently required to meet the challenges posed by these epidemiological trends. The semisynthetic
streptogramins, a unique class of antibacterials currently under development, offer promise in the treatment of such multiresistant
infections. Possible future applications include treatment of
infections caused by the following organisms: MRSA, enterococci resistant to
vancomycin,
macrolides or
lincosamides; and beta-lactam-resistant streptococci. They may also prove useful as
therapy for children with
staphylococcal infection and patients with multiresistant
infections who are unable to tolerate
vancomycin, including patients with skin and
soft tissue infections caused by Gram-positive pathogens, patients with
osteomyelitis,
foreign body associated
infections,
endocarditis and
sepsis due to Gram-positive bacteria. Clinical trials are required to evaluate the efficacy and tolerability of
streptogramins in these settings.