Faced with bacteria resistant to conventional drugs, what do we have?

Since 1900, Pasteurian hygiene and the fight against infectious diseases have largely contributed to the increase in life expectancy. From barely 45 years for men in 1900, we have risen to over 75-77 years in the early 2000s. Life expectancy for women now exceeds 85. Anti-infective agents have largely contributed to this evolution, with simple tools at the beginning of the ^20th century, then increasingly sophisticated ones as research progressed. The discovery and identification of microbes (Pasteur, Koch et al.) preceded the preparation by Paul Ehrlich (Nobel Prize 1908) of the first antiparasitic molecules, atoxyl and salvarsan, capable of killing the trypanosome, the parasite responsible for sleeping sickness. This was followed by the discovery of sulfonamides (e.g. prontosil) by Gerhardt Domagk (Nobel Prize 1939), for which Jacques Tréfouël (Institut Pasteur, Paris) demonstrated that the active species was a sulfonamide metabolite. In 1937, a formulation of prontosil with ethylene glycol in the United States killed 76 people. This disaster led to the creation of the FDA(Food and Drug Administration). Fleming's 1928 observation at Saint Mary's Hospital in London of the inhibition of bacterial growth by the fungus Penicillium notatum led to the discovery of antibiotics. It would take the work of Florey and Chain from 1939 to 1944 to perfect the extraction, purification and industrial production of penicillin, carried out as part of a consortium involving Eli-Lilly, Park-Davis and Merck. The structure of penicillin, established by Dorothy Hodgkin (Nobel Prize 1964), highlighted the key role of the b-lactam motif in the biological activity of this series of antibiotics. From 1945 to 1970, the race was on to find new strains of fungi or other microorganisms with the ability to inhibit bacterial growth. This golden age of antibacterial research led to the development of the arsenal of effective antibiotics we have today (cephalosporins, etc.). We currently have over 120 antibiotics to treat bacterial and mycobacterial infections. Is this too much or too little? In fact, we haven't discovered any new classes of antibiotics for a long time, and our current arsenal is running out: many bacterial strains are becoming multi-resistant. It is to be feared that this phenomenon will develop significantly over the next few years. We already have over 4,000 hospital-acquired infection-related deaths in France every year, a figure higher than road deaths (fewer than 3,400 deaths in 2013). What do we have to fight these multi-resistant bacteria? This question was addressed after looking at the main mechanisms of action of the different classes of antibiotics and how resistance sets in among bacteria. In 1960, only 10% of staphylococci were resistant to penicillin-G; today it's 100%.