Future Antibacterial Strategies: From Basic Concepts to Clinical Challenges

Conventional antibiotics have cured more diseases than all other drug classes combined. However, the pipeline of novel antibiotics is running dry while multi-drug resistance (MDR) is increasing at an alarming rate. Even though vaccines and antibodies are part of the toolkit against antimicrobial resistance, broadening the concept of 'antibiotic' is essential for innovation. Original roadmaps are needed to tackle the overwhelming MDR bacterial infections. The majority of 'in-use' antibacterial drugs derived from secondary metabolites that are produced by cultured soil microorganisms. Ongoing investigations extend large scale microbiome analyses to new natural sources, target the host-pathogen interface, include nanotechnologies and rejuvenate old paths, such as phages and bacteriocins. Host immune modulators and virulence-resistance suppressors are also being developed, with RNA therapeutics. These strategies should help to improve future prevention and treatment of MDR bacterial infections, but numerous challenges limit their introduction into clinical practice.