New treatment options against gram-negative organisms
Critical Care, 04/15/2011
Bassetti M et al. – Infections due to multi–drug resistant (MDR) Gram–negative bacteria, such as extended–spectrum beta–lactamases (ESBLs) or carbapenemase–producing Enterobacteriaceae and A. baumannii or P. aeruginosa remain a serious problem in the hospital setting. Although some promising novel molecules are in the late stages of development, few new antibiotics have been advanced for the treatment of most of the ESKAPE pathogens. Among agents potentially active against Gram–negatives are novel cephalosporins, carbapenems and (beta)–lactamase inhibitors.
Fifth generation cephalosporins have acquired activity against MRSA, but they offer no advantage against Gram-negatives.
They are inactive against MDR bacteria, and efficacy of ceftaroline was less than that of aztreonam against P. aeruginosa.
Some of the novel carbapenems are active against resistant Gram-positives, but when difficult Gram-negatives are involved, their activity is similar to that of meropenem.
(beta)-lactamase inhibitors seem the most promising as they might restore the activity of already known (beta)-lactams against (beta)-lactamase-producing strains.
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