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New Potent, Broad-spectrum Treatments for Serious Urinary Tract Infections
substance classes should be developed in order to enlarge the efficacy in patients and the degree of emergence of resistance are
antibacterial spectrum and reduce the propensity to induce needed in that respect.
resistance. New substance classes with new molecular targets should
be developed. New treatment strategies are needed in order to maintain effective
treatment of UTIs. There are a number of new derivatives of classes in
Less active antibiotic classes ought to be reserved and restricted to use. In most cases these derivatives are subject to cross-resistance
frequent but non-severe infections, such as uncomplicated cystitis. inherent to the whole substance class. Therefore, new classes of
Novel antimicrobial strategies that use, for example, bacteriophages or
bacteriophagal enzymes have shown interesting in vitro results.
Further development of this target may be promising because highly
The substantial difference compared
conserved evolutionary mechanisms that have proved to be efficacious
in nature over millions of years are exploited. Prevention of UTIs should
with non-infectious diseases is that
be vigorously followed. This encompasses vaccination as well as
the management of an infection in a
infection control.
single patient always has an effect on
What are the parameters for new drugs to become included in the the environment.
treatment of UTIs? Although there are no exact quantitative
prerequisites, the following qualities should be considered:
antibiotics with unrelated modes of action are a more valuable
• coverage of the respective bacterial spectrum; development. The indications for treatment of such novel substances
• antimicrobial activity in urine in an acidic as well as an alkaline should be selected carefully in order to conserve new substance classes
environment; and for as long as possible. However, for a variety of reasons new
• sufficient urinary excretion of the drug. substance classes will become increasingly difficult to launch.
Therefore, new derivatives of classes in use should be screened for
Conclusion their potential to induce resistance. Substances with a low potential
The most important drawback in the treatment of UTIs is the will be highly welcome. In this respect, combinatory agents that
development of antimicrobial resistance. Therefore, the action of impede general widespread mechanisms of resistance, such as efflux
currently available antimicrobial substances and the structure–property pump inhibitors, will be important. The ongoing process in the
relationships have to be understood to allow the prudent use of treatment of infectious diseases is highly dynamic. The substantial
antibiotics. Pharmacokinetic and pharmacodynamic parameters are difference compared with non-infectious diseases is that the
increasingly used to improve dosing strategies of the current anti- management of an infection in a single patient always has an effect on
infective agents and guide the development of new derivatives and the environment. Considering this, the management of infectious
new agents for the treatment of UTIs. Models that are able to predict diseases must be highly responsible. ■
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