Disarming pathogens: benefits and challenges of antimicrobials that target bacterial virulence instead of growth and viability

Free to read on publisher website Currently, antibiotics are failing fast while rates of drug-resistant bacteria are increasing worldwide. With almost no new drugs coming to market and with even last-resort antibiotics like colistin becoming ineffective [1], a global scale public health crisis appears unavoidable. In fact, WHO has declared that with no action “a post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century” [2]. With more annual deaths predicted by 2050 from antibiotic-resistant infections than cancer [3], we urgently need effective alternatives to combat this crisis. This has resulted in a resurgence of research activity into various alternative antibacterial approaches, which are at various stages of clinical and preclinical development. Given continued funding and appropriate investment by industry and governments, these alternatives could deliver much-needed antimicrobials for clinical use in the immediate future [4]. One such approach, the antivirulence approach, is promising to provide antimicrobial therapies predicted to be superior to conventional antibiotics [5]. This editorial presents some of the latest evidence to support this notion, highlighting at the same time some of the issues that need to be considered when evaluating antivirulence drugs. For a more detailed discussion on the topic, readers are referred to current pieces by the author [6] and others [7–9]...