Safeguarding future antimicrobial options: strategies to minimize resistance

Current antimicrobial therapy for community-acquired respiratory tract infe ctions (RTIs) is empirical and is influenced by local differences in etiolo gy and bacterial susceptibility. As the rates of resistance and cross-resis tance to currently available classes of antimicrobial agents increase, thei r effectiveness becomes compromised. These issues demand improved strategie s for antimicrobial usage, and the development of new agents that do not se lect resistance are essential to safeguard future antimicrobial efficacy. S trategies to minimize antimicrobial resistance among common RTIs include re ducing antimicrobial consumption and controlling the development and spread of resistance through appropriate prescribing and the use of short-duratio n, once-daily treatments to improve patient compliance. Importantly, the ke tolides, which are a new family of antimicrobials, have been recently devel oped specifically for the treatment of community-acquired RTIs. The first m ember of this new family, telithromycin, has been shown to have potent acti vity against common and atypical respiratory pathogens, including beta -lac tam- and macrolide-resistant strains, and has a low potential to select for or induct cross-resistance. These properties, combined with its good toler ability across patient groups, make telithromycin an attractive option for the first-line empiric treatment of RTIs with the potential to limit the fu ture development of resistance.