Use of very old and very new antibiotics in intensive care units in Germany

Sir, The increasing problem of multidrug-resistant Gram-positive and Gram-negative bacteria causing severe infections has led to a re-evaluation of old drugs and the application of newly developed reserve antibiotics. Polymyxins and chloramphenicol were discovered in 1947. Both drugs were gradually withdrawn from clinical practice in Europe and the USA because of reports about toxicity. However, the emergence of Pseudomonas aeruginosa and Acinetobacter baumannii strains that are resistant to almost all available antibiotics has led to a revival of polymyxins given parenterally.1 Chloramphenicol is still prescribed to a majority of the populations in developing countries because of its low cost of production and its broad spectrum. Fosfomycin, which was discovered in 1969, is effective against numerous Gram-positive and Gram-negative bacteria and acts synergistically against methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and multiresistant P. aeruginosa strains.2 Quinupristin/dalfopristin, linezolid and tigecycline are considered to be new antibiotics with a spectrum that also covers multiresistant pathogens; they were approved by the FDA in 1999, 2000 and 2005, respectively. Quinupristin/dalfopristin is effective against Gram-positive bacteria including MRSA and vancomycin-resistant Enterococcus faecium, linezolid is effective against Gram-positive bacteria including MRSA and VRE and tigecycline is effective against Gram-positive and Gram-negative bacteria including MRSA, VRE and extended-spectrum β-lactamase producers.3