Managing community acquired pneumonia in the elderly – the next generation of pharmacotherapy on the horizon

Abstract

INTRODUCTION Community acquired pneumonia (CAP) is associated with high rates of morbidity and mortality, especially among the elderly. Antibiotic treatment for CAP in the elderly is particularly challenging for many reasons, including compliance issues, immunosuppression, polypharmacy and antimicrobial resistance. There are few available antibiotics that are able to address these concerns. AREAS COVERED After a systematic review of the current literature, we describe seven novel antibiotics that are currently in advanced stages of development (phase 3 and beyond) and show promise for the treatment of CAP in those over the age of 65. These antibiotics are: Solithromycin, Pristinamycin, Nemonaxacin, Lefamulin, Omadacycline, Ceftobiprole and Delafloxacin. Using a novel conceptual framework designed by the present authors, known as the ‘San Antonio NIPS model’, we evaluate their strengths and weaknesses based on their ability to address the unique challenges that face the elderly. EXPERT OPINION All seven antibiotics have potential value for effective utilization in the elderly, but to varying degrees based on their NIPS model score. The goal of this model is to reorganize a clinician’s focus on antibiotic choices in the elderly and bring attention to a seldom discussed topic that may potentially become a health-care crisis in the next decade.

Challenges in severe community-acquired pneumonia: a point-of-view review

“…Nemonoxacin is a novel nonfluorinated quinolone with a wide antimicrobial spectrum covering Gram-positive cocci and Gram-negative bacilli, including the common CAP pathogens. One published phase 2 trial and two unpublished phase 3 trials suggest that Nemonoxacin is non-inferior to levofloxacin for the treatment of CAP [92,93].…”

Shen-ling-bai-zhu-san ameliorates inflammation and lung injury by increasing the gut microbiota in the murine model of Streptococcus pneumonia-induced pneumonia

“…Ever since the introduction of pneumococcal vaccine, morbidity and mortality of pneumonia have reduced significantly; however, global coverage of vaccine is inadequate [5]. Current pneumonia therapeutic strategies, including antimicrobial regimens, antibiotics, and adjunctive therapies, often lead to drug resistance [6]. Thus, it is necessary to find alternative drugs for the alleviation of pneumonia-induced tissue injury and death.…”

Updates on community acquired pneumonia management in the ICU

“…With growing microbial resistance and continued need for appropriate coverage, several newer antibiotics have been studied in patients with CAP, with an ability to cover both typical, atypical and resistant CAP microbes, including newer generation cephalosporins, such as ceftaroline, ceftobiprole, ceftazidime-avibactam, and ceftolozane-tazobactam; newer macrolides like solithromycin; next generation fluoroquinolones like nemonoxacin zabofloxacin and delafloxacin; tetracyclines like omadacycline, and potent semisynthetic agents such as lefamulin ( Table 3 ) ( Amalakuhan, Echevarria, and Restrepo, 2017 ). However, their usage in SCAP is yet not completely understood, but offers potential antibiotic options that should be reserved for patients with resistant pathogens.…”