The concept for the antivirulence therapeutics approach as alternative to antibiotics: hope or still a fiction?

AbstractWhile the development of antibiotics since their first discovery brought about a revolutionary step forward in the fight against infectious microorganisms, unfortunately its side effect was the highly increasing risks of antibiotic resistance. Resistance development poses the urgent task for discovery of novel prospective approaches in the fight against multidrug resistant bacteria. Together with the search for new antibacterials, there is a growing interest in novel non-traditional approaches. Such non-traditional approaches are the attempts to suppress bacterial virulence and the development of virulence-related phenotypes, instead of killing the bacteria. The focus of this review falls on the bacterial regulatory mechanisms of virulence expression via quorum sensing (QS), and the formation of multicellular communities—biofilms, that protect bacteria from the host defenses and the antibacterial substances. The review gives a general outline of two types of approaches for control of bacterial virulence-related phenotypes. One is the search for reagents with expected antivirulence efficacy via the inhibition of QS, for example among low molecular weight metabolites of different medicinal plants. The other is directed to the possible prevention and/or destruction of bacterial biofilms, which are a well-recognized source of chronic, persistent and recurrent infections. The concerns regarding possible practical applications are considered as well