Combination therapy for carbapenem-resistant Gram-negative bacteria

Expert Rev Anti Infect Ther. 2013 Dec;11(12):1333-53. doi: 10.1586/14787210.2013.845523. Epub 2013 Nov 6.

Abstract

The emergence of resistant to carbapenems Gram-negative bacteria (CR GNB) has severely challenged antimicrobial therapy. Many CR GNB isolates are only susceptible to polymyxins; however, therapy with polymyxins and other potentially active antibiotics presents some drawbacks, which have discouraged their use in monotherapy. In this context, along with strong pre-clinical evidence of benefit in combining antimicrobials against CR GNB, the clinical use of combination therapy has been raised as an interesting strategy to overcome these potential limitations of a single agent. Polymyxins, tigecycline and even carbapenems are usually the cornerstone agents in combination schemes. Optimization of the probability to attain the pharmacokinetic/pharmacodynamic targets by both cornerstone drug and adjuvant drug is of paramount importance to achieve better clinical and microbiological outcomes. Clinical evidence of the major drugs utilized in combination schemes and how they should be prescribed considering pharmacokinetic/pharmacodynamic characteristics against CR GNB will be reviewed in this article.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacokinetics
  • Anti-Bacterial Agents / therapeutic use*
  • Carbapenems / pharmacokinetics
  • Carbapenems / therapeutic use*
  • Drug Administration Schedule
  • Drug Dosage Calculations
  • Drug Synergism
  • Drug Therapy, Combination
  • Gram-Negative Bacteria / drug effects
  • Gram-Negative Bacteria / physiology
  • Gram-Negative Bacterial Infections / drug therapy*
  • Gram-Negative Bacterial Infections / microbiology
  • Humans
  • Minocycline / analogs & derivatives*
  • Minocycline / pharmacokinetics
  • Minocycline / therapeutic use
  • Polymyxins / pharmacokinetics
  • Polymyxins / therapeutic use*
  • Tigecycline
  • beta-Lactam Resistance / physiology

Substances

  • Anti-Bacterial Agents
  • Carbapenems
  • Polymyxins
  • Tigecycline
  • Minocycline