[The history of antibiotics]. / Historien om antibiotika.

The development of chemical compounds for the treatment of infectious diseases may be divided into three phases: a) the discovery in the 1600s in South America of alkaloid extracts from the bark of the cinchona tree and from the dried root of the ipecacuanha bush, which proved effective against, respectively, malaria (quinine) and amoebic dysentery (emetine); b) the development of synthetic drugs, which mostly took place in Germany, starting with Paul Ehrlich's (1854-1915) discovery of salvarsan (1909), and crowned with Gerhard Domagk's (1895-1964) discovery of the sulfonamides (1930s); and c) the discovery of antibiotics. The prime example of the latter is the development of penicillin in the late 1920s following a discovery by a solitary research scientist who never worked in a team and never as part of a research programme. It took another ten years or so before drug-quality penicillin was produced, with research now dependent on being conducted in large collaborative teams, frequently between universities and wealthy industrial companies. The search for new antibiotics began in earnest in the latter half of the 1940s and was mostly based on soil microorganisms. Many new antibiotics were discovered in this period, which may be termed «the golden age of antibiotics¼. Over the past three decades, the development of new antibiotics has largely stalled, while antibiotic resistance has increased. This situation may require new strategies for the treatment of infectious diseases.

[Tigecycline--a new antibiotic]. / Tigesyklin--et nytt antibiotikum.

Tigecycline belongs to a new class of antimicrobial agents, the glycylcyclines, which are structurally derived from tetracyclines. It is effective against both gram positive and gram negative bacteria, aerobes and anaerobes and bacteria that have developed resistance against the classic tetracyclines. Although there is an increased risk for serious adverse events, tigecycline is important for treatment of patients with complicated infections of moderate severity where other antimicrobials cannot be used.

[Daptomycin--a new antibiotic for the treatment of skin and soft tissue infections]. / Daptomycin--et nytt antibiotikum mot hud- og bløtdelsinfeksjoner.

Daptomycin (Cubicin) is a bactericidal lipopeptide antibiotic that was approved in February 2006 for the European market, including Norway, for the treatment of patients with complicated skin and soft tissue infections caused by Gram-positive cocci. Daptomycin is administered intravenously and eliminated mainly by the kidneys. Dose reduction is therefore necessary in patients with impaired renal function. The drug is active only against Gram-positive cocci. Daptomycin therapy of patients with complicated skin and soft tissue infections caused by Gram-positive cocci, is as effective as standard therapy with intravenous semi-synthetic penicillin or vancomycin. The agent is usually well tolerated, but side effects in skeletal muscles are more prevalent than with semi-synthetic penicillins or vancomycin. To prevent development of daptomycin resistance, the agent should be reserved for the treatment of patients with infections caused by Staphylococcus aureus that are resistant to antibiotics commonly used for the treatment of skin and soft tissue infections, e.g. penicillins or clindamycin.