[Current trends in antibacterial chemotherapy (author's transl)].

Antibiotics account for about 15% of world pharmaceutical consumption, but with the rapid development of antibacterial agents capable of reaching most bacterial cell target structures, many bacterial species have become resistant, including S. pneumoniae, H. influenzae and N. gonorrhoeae, which until recently had remained susceptible to penicillin. Moreover, intrinsically resistant species have been selected and are now responsible for nosocomial infections. These shortcomings of chemotherapy, as well as the toxicity and side-effects of a number of drugs, have prompted a search for antibiotics with wider spectrum, lesser sensitivity to bacterial enzymes, reduced toxicity and improved pharmacokinetic properties. During the last 20 years, attempts to extract new antibiotics from natural sources have met with little success, but considerable progress has been achieved in the hemisynthesis of known molecules, such as 6-aminopenicillanic acid or 7-aminocephalosporanic acid, and various changes in these molecules have yielded a variety of new beta-lactam compounds, some of which being still under study and other in clinical use. Changes in the original aminoglycoside molecules have also produced compounds that are less toxic and less susceptible to inactivating enzymes. Among macrolides and sulfonamides, recent developments, although limited, have led to new products or to synergistic combinations. Finally, the search for new compounds which would inhibit two successive steps in the bacterial metabolic pathways constitutes a modern, rational and promising approach to antibacterial chemotherapy.