New anti-Gram-positive agents

As the prevalence of resistant Gram-positive organisms in the critical care unit has increased, so have the associated morbidity and mortality and the cost of their treatment. As a result, more toxic and less active second-line agents and combinations of agents are used, often with limited evidence of clinical benefit. Although widely used, the role of glycopeptides is limited by increasing resistance and poor pharmacokinetics. New agents now in use, such as quinupristin/dalfopristin and Linezolid (Zyvox; Pharmacia & Upjohn, Kalamazoo, MI), show promise, as do diverse agents in development. The future is likely to bring greater therapeutic choice but, inevitably, further resistance.