Affiliation: Via del Parco Margherita 24, 80121 Napoli, Italy
Multidrug-resistant Gram-positive bacteria have become an increasing problem for the management of serious infections. Also extended-spectrum β-lactamase producing Gram-negative bacilli is a growing concern. A number of novel parenteral or oral cephalosporins have been synthesized and evaluated in vitro in order to overcome these resistances. In particular, today research in the cephem field is more focused on narrow spectrum antibacterials. Unfortunately, many new compounds will not be studied in clinical setting because they only show a slight improvement over existing therapies that does not justify the excessive costs involved in the development of a new chemical entity. We believe that the continuous attempts to discover structural changes able to induce real improvements in the spectrum of action of cephalosporins are now unproductive, probably because there is no room for further really useful modifications.