Emerging drugs for nosocomial pneumonia

Abstract

There are several promising compounds on their way, as tedizolid-a new oxazolidone, iclaprim-a novel drug, related to trimethoprim, plazomicin-a new aminoglycoside and two combinations of ceftazidime/avibactam and ceftolozane/tazobactam against MDR bacteria, especially against MRSA and Gram-negative ESBL bacteria.

Molecular characterization of methicillin-resistant Staphylococcus aureus clinical strains from the endotracheal tubes of patients with nosocomial pneumonia

“…Antibiotics currently approved for MRSA nosocomial pneumonia are linezolid (an oxazolidinone), vancomycin (a glycopeptide), ceftobiprole (an extended-spectrum cephalosporin) and Telavancin (a lipoglycopeptide). Tedizolid (a second-generation oxazolidinone) is pending authorization for systemic treatment of HAP [5]. Other secondary options when these agents cannot be used include, either alone or in combination, quinolones (ciprofloxacin or levofloxacin), macrolides (erythromycin), aminoglycosides (gentamicin), tetracyclines, clindamycin (a lincosamide), and fusidic acid.…”

How Should We Treat HAP/VAP Caused by Carbapenemase-Producing Enterobacteriaceae?

“…9,37,38 Therefore, we believe that for patients with suspected CRE HAP/VAP empirical use of carbapenem associated with colistin and/ or tigecycline may be justified. 9,37,38 Ceftazidime-avibactam could be an alternative option for empirical treatment associated with fosfomycin or gentamicin (►Fig. 1).…”

“…[43][44][45] Carbapenems Carbapenem-containing regimens have always constituted a pivotal therapy for VAP and demonstrated a survival benefit, primarily in serious infections caused by CRE, compared with other combinations and could serve as a therapeutic backbone. 34,37,38 Real-time pharmacokinetic/pharmacodynamic optimization of high-dose continuous infusion (extension of the infusion time from 30 minutes up to 6 hours every 6 hour) meropenem may represent a valuable approach for the treatment of disseminated KPC-Kp infections even when caused by meropenem-resistant strains and has been associated with higher rate of clinical cure in VAP. 46 Some studies have ascertained the role of meropenem could be especially relevant when included in combination regimens with other active agents, if the MIC of the pathogen is < 16 mg/L.…”

“…46 Some studies have ascertained the role of meropenem could be especially relevant when included in combination regimens with other active agents, if the MIC of the pathogen is < 16 mg/L. 9,38 However, a recent study demonstrated that high-dose continuous-infusion meropenem optimized in real-time might allow successful clinical outcomes in the treatment of KPC-Kp infections even when caused by meropenem-resistant strains with an MIC 64 mg/L. 10 In this setting the use of meropenem therapeutic drug monitoring (TDM) is highly recommended to adjust the antibiotic dosage depending on the MIC.…”

What is the role of the new β-lactam/β-lactamase inhibitors ceftolozane/tazobactam and ceftazidime/avibactam?

“…A possible new indication could be the treatment of nosocomial pneumonia by MDR pathogens, especially P. aeruginosa [39]. Pending the outcomes of ongoing clinical trials, the results of off-label experiences with P. aeruginosa pneumonia are promising [40].…”