Antimicrobials: new solutions badly needed - Editorial overview

Even as resistance to our current arsenal of previously reliable antibiotics continues to spread among dangerous pathogens, the predominant trend in the pharmaceutical industry is away from a commitment to develop new drugs in this therapeutic area. For example, we learned recently that the long-feared emergence of high-level vancomycin resistance in clinical isolates of Staphylococcus aureus is now a reality [1]. The appearance of VanA-determined vancomycin-resistant S. aureus (VRSA) has been discussed for at least the past decade as the 'nightmare scenario' that should galvanize the industry in its efforts to discover new therapeutic agents active against the resistant strains [2]. Yet, we also learned over the past year that several major pharmaceutical companies have either discontinued research and development efforts in the antimicrobial area (e.g. Roche, Lilly and Bristol-Myers Squibb) or have scaled back their efforts significantly (e.g. Abbott and Glaxo-SmithKline). In other cases, mergers or acquisitions threaten to result in a net decrease in drug-development activities in either the antibacterial or antifungal areas (e.g. Pharmacia/Pfizer). Moreover, this disturbing exodus from the antimicrobial therapeutic area includes some smaller, innovative companies (e.g. Millennium, Essential Therapeutics/Microcide), as well as larger, more traditional research and development organizations. How are we to explain this paradoxical trend, particularly in view of the relatively large market for antimicrobial therapeutics, which topped US$32 billion (around 20.5 billion/32.5 billion Euros) worldwide in 2001 [3]?.