Comeback of the antibiotic trimethoprim

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Antibiotic trimethoprim could be successfully used against streptococci in certain regions

The antibiotic trimethoprim could be used again in the future. So far, experts have assumed that streptococci are resistant to the drug. However, scientists at the Helmholtz Center for Infection Research (HZI) in Braunschweig, with the National Reference Center for Streptococci in Aachen, came to the conclusion that this was a mistake. Especially in less developed countries, the antibiotic could be used against the bacteria due to its effectiveness.

Low resistance of streptococci to the antibiotic trimethoprim The bacterium Streptococcus pyogenes causes inflammation of the skin and scarlet fever, among other things. Late effects of the infections include rheumatic fever and kidney inflammation. In this country, doctors mostly prescribe penicillin against streptococci. The antibiotic trimethoprim is usually not prescribed because experts believed that the bacteria were resistant to the drug from the outset. In a study in which samples from infected patients from Germany and India were evaluated for their resistance to trimethoprim, Dr. Patric Nitsche-Schmitz from the HZI and his team found out that the extent of the resistance is much lower than expected. "This shows that trimethoprim is effective for many Streptococcus pyogenes infections," explains Nitsche-Schmitz. The wrong assumption was based on previous studies that used a "nutrient medium that weakens the antimicrobial effects of trimethoprim," according to a statement by the HZI.

Antibiotic Trimethoprim could be used especially in less developed countries. The Braunschweig scientists were also interested in cases where the antibiotic was not effective. In doing so, they discovered various causes of resistance. "Mutations can occur spontaneously in the gene for dihydrofolate reductase, so that trimethoprim can no longer attack the enzyme that has been changed as a result and becomes ineffective," reports Nitsche-Schmitz. The researchers detected a mutation of this gene in many of the samples. In addition, bacteria are able to pass copies of modified variants of the dihydrofolate reductase gene on to one another. In this way, resistance spreads very quickly. Braunschweig identified two of these genes as another reason for resistance. "We found three causes for the rapid spread of resistance," reports Nitsche-Schmitz.

The drug could be used particularly in less developed countries, since expensive penicillin is hardly available there. It also does not work against the Staphylococcus aureus bacterium, which often causes co-infection. Trimethoprim, on the other hand, fights both types of bacteria. "As with all antibiotics, it is important that trimethoprim is not prescribed unnecessarily and that patients take it as prescribed," emphasizes Nitsche-Schmitz. "It's like a sword that quickly loses focus." The scientists published their study results in the specialist magazine "Antimicrobial Agent and Chemotherapy". (ag)

Image: Sebastian Karkus /

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