Multiresistant bacteria and current therapy - the economical side of the story

Abstract

Severe infections with multiresistant bacteria (MRB) are a medical challenge and a financial burden for hospitals. The adequate antibiotic therapy is a key issue in multiresistant bacteria management. Several major cost drivers have been identified. Remarkably drug acquisition costs are not necessarily included. Most significant are the length of stay in hospital, the hours of mechanical ventilation and the time treated on an intensive care unit.In a systematic review of the literature the following aspects were investigated:- Do generic treatment strategies contribute in cost savings?- Are there specific results for recent antibiotics?Early adequate and effective antimicrobial treatment, switch from i.v. to oral therapy, adjusted duration of therapy and adherence to guidelines have been found to be successful strategies.Looking at specific antibiotics, the best evidence for cost-effectiveness is found for Linezolid in treatment of cSSTI as well as in HAP. Daptomycin shows good economic results in bloodstream infections, so possibly being a cost-effective alternative to vancomycin. Looking at tigecycline the published data show neither higher costs nor savings compared to imipeneme. Doripenem as one of the newest therapy options has proven to be highly cost-saving in HAP when compared with imipenem. However, most analyses are based on pharmacoeconomic modelling rather than on directly analysing trial data or real life clinical populations.ConclusionUsing modern antibiotics in whole is not more expensive than using established therapies. Modern antibiotics are cost-effective and sometimes even cost-saving. This is especially true if an effective therapy is initiated as early as possible.

Functionalised iron nanoparticle–penicillin G conjugates: a novel strategy to combat the rapid emergence of β-lactamase resistance among infectious micro-organism

“…It generates a need to develop effective and resistant antimicrobial molecules. [1][2][3][4][5][6] However, the steady discovery of novel antibiotics in the period 1940-1980 could not be sustained. Only few antibiotic classes joined the approved list after 1990 onwards.…”

“…Because of these, clinical treatment of these infections is a big clinical challenge. [2] Antibiotic-resistant bacteria are emerging as a threat to the favourable outcome of common infections in community and hospital settings. [1,2] It is either due to horizontal gene transfer or unlinked point mutations in the pathogen genome.…”

“…[2] Antibiotic-resistant bacteria are emerging as a threat to the favourable outcome of common infections in community and hospital settings. [1,2] It is either due to horizontal gene transfer or unlinked point mutations in the pathogen genome. This acquired character in the microbes will be inherited to their offspring and will result in a fully resistant colony.…”

“…[3] There are many mechanisms by which micro-organisms exhibit resistance to antimicrobials. [2,3] Among all these antibiotic-resistance mechanisms, drug inactivation by b-lactamase is inducing maximum clinical threat to b-lactam antibiotic family. [4] These enzymes specifically cleave the b-lactam ring at the position of amide bond, which is the reactive part in the b-lactam antibiotic.…”

In vitro antimalarial activity of tigecycline against Plasmodium falciparum culture-adapted reference strains and clinical isolates from the Brazilian Amazon

“…This drug is currently registered only for intravenous use, and a twice-daily dosing regimen is relatively easy to administer and is generally well tolerated 7 . Clinical studies have shown that tigecycline possesses an expanded spectrum of in vitro and in vivo activity against Gram-positive, Gram-negative, atypical, anaerobic, and other difficult-to-treat pathogens 8 . However, there is insufficient information on the drug's clinical efficacy for malaria treatment, as only two previous studies have demonstrated in vitro anti-P. falciparum activity for this drug 9,10 .…”