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Assessment of antiviral and antibiotic combination treatment in influenza-A H1N1 induced acute kidney injury among hospitalized patients

Ishaqui AA, Khan AH, Syed Sulaiman SA, Alsultan MT, Khan I, Al Nami H

Pak J Pharm Sci, 2019 May;32(3 (Supplementary)):1225-1233.
PMID: 31326884

The aim of the study is to assess and compare the impact of antiviral drug alone and in combination with antibiotic for prevention of Influenza-A H1N1 induced acute kidney injury (AKI) in hospitalized patients. Hospitalized admitted patients with confirmed diagnosis of Influenza-A H1N1 infection were divided into two groups: group 1, which received antiviral (oseltamivir) drug alone and group 2, which received antiviral (oseltamivir) in combination with empirically prescribed antibiotic. Patients of both groups were assessed for incidences of AKI by two criteria i.e Acute Kidney Injury Network (AKIN) and RIFLE. A total of 329 patients (176 for group 1 and 153 for group 2) were enrolled. According to RIFLE criteria, 23(13%) of group 1 and 9(6%) patients of groups 2 were suffered from AKI with statistically significant difference (P<0.05). Also as per AKIN criteria, the incidence of AKI is statistically significantly difference (P<0.05) between both groups with 18(10%) patients and 6(4%) patients of group 1 and 2 respectively. Length of hospitalization was statistically less (P<0.05) in group 2 patients. The incidences of AKI in Influenza-A H1N1 treated with antiviral and antibiotic combination was statistically less as compared to patients who were given antiviral alone for treatment of influenza infection.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Detection of secreted antimicrobial peptides isolated from cell-free culture supernatant of Paenibacillus alvei AN5

Alkotaini B, Anuar N, Kadhum AA, Sani AA

J Ind Microbiol Biotechnol, 2013 Jun;40(6):571-9.
PMID: 23508455 DOI: 10.1007/s10295-013-1259-5

An antimicrobial substance produced by the Paenibacillus alvei strain AN5 was detected in fermentation broth. Subsequently, cell-free culture supernatant (CFCS) was obtained by medium centrifugation and filtration, and its antimicrobial activity was tested. This showed a broad inhibitory spectrum against both Gram-positive and -negative bacterial strains. The CFCS was then purified and subjected to SDS-PAGE and infrared spectroscopy, which indicated the proteinaceous nature of the antimicrobial compound. Some de novo sequencing using an automatic Q-TOF premier system determined the amino acid sequence of the purified antimicrobial peptide as Y-S-K-S-L-P-L-S-V-L-N-P (1,316 Da). The novel peptide was designated as peptide AN5-1. Its mode of action was bactericidal, inducing cell lysis in E. coli ATCC 29522 and S. aureus, and non-cell lysis in both S. marcescens and B. cereus ATCC 14579. Peptide AN5-1 displayed stability at a wide range of pH values (2-12) and remained active after exposure to high temperatures (100 °C). It also maintained its antimicrobial activity after incubation with chemicals such as SDS, urea and EDTA.

Matched MeSH terms: Anti-Bacterial Agents/isolation & purification*; Anti-Bacterial Agents/pharmacology; Anti-Bacterial Agents/chemistry
Design, synthesis and antimicrobial evaluation of novel glycosylated-fluoroquinolones derivatives

Mohammed AAM, Suaifan GARY, Shehadeh MB, Okechukwu PN

Eur J Med Chem, 2020 Sep 15;202:112513.
PMID: 32623216 DOI: 10.1016/j.ejmech.2020.112513

Herein we report the design, synthesis and biological evaluation of structurally modified ciprofloxacin, norfloxacin and moxifloxacin standard drugs, featuring amide functional groups at C-3 of the fluoroquinolone scaffold. In vitro antimicrobial testing against various Gram-positive bacteria, Gram-negative bacteria and fungi revealed potential antibacterial and antifungal activity. Hybrid compounds 9 (MIC 0.2668 ± 0.0001 mM), 10 (MIC 0.1358 ± 00025 mM) and 13 (MIC 0.0898 ± 0.0014 mM) had potential antimicrobial activity against a fluoroquinolone-resistant Escherichia coli clinical isolate, compared to ciprofloxacin (MIC 0.5098 ± 0.0024 mM) and norfloxacin (MIC 0.2937 ± 0.0021 mM) standard drugs. Interestingly, compound 10 also exerted potential antifungal activity against Candida albicans (MIC 0.0056 ± 0.0014 mM) and Penicillium chrysogenum (MIC 0.0453 ± 0.0156 mM). Novel derivatives and standard fluoroquinolone drugs exhibited near-identical cytotoxicity levels against L6 muscle cell-line, when measured using the MTT assay.

Matched MeSH terms: Anti-Bacterial Agents/chemical synthesis; Anti-Bacterial Agents/pharmacology*; Anti-Bacterial Agents/chemistry
Fulltext Cellulitis from terrestrial leech bite in a 2-month-old baby

Fahisham Taib, Suhailah Badruddin, Mohd Anas Che Nik, Ariffin Nasir, Ramiza Ramza Ramli

Malaysian Journal of Paediatrics and Child Health, 2018;24(2):1-3.
MyJurnal

Cellulitis in human following leech bite is rae, many of the case reports were associated with the use of medical leech. We report the first documented case of cellulitis following the bite of land leech (Haemodipsa species), known locally as 'pacat', in a 2 month-old-baby. The baby developed fever but subsided following an antibiotic cover. The baby had uneventful stay in the hospital and the cellulitis was successfully treated following a week cource of Cloxacillin.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Effects of phenylpyruvate feeding with polymyxin B in Klebsiella pneumoniae

Wong, A. S-L., Nusaibah Abdul Rahim

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):5-5.
MyJurnal

Introduction: Polymyxin B (PMB) is one of the remaining antibiotics that is effective against multidrug resistant (MDR) Gram-negative bacteria. However, PMB monotherapy is not able to achieve sustained killing hence, combination with other antibiotics are usually employed. Besides antibiotics, studies are now moving towards non-antibiotic alternatives such as metabolite feeding against MDR pathogens. This study aimed to investigate the susceptibility
and bacterial killing of PMB in combination with metabolite phenylpyruvate against Klebsiella pneumoniae isolates. Methods: Broth microdilution was used to determine PMB minimum inhibitory concentration (MIC) alone and with phenylpyruvate against two Klebsiella pneumoniae isolates. Time kill studies were performed over 24 h (initial inoculum: ~106 CFU/mL), using PMB 2 mg/L and phenylpyruvate 2 mmol/L, alone and in combination, against the
PMB-resistant isolate. Microbiological responses were examined using the log-change method. Results: The MIC of PMB was reduced by phenylpyruvate in both isolates. In the time kill studies, during the first hour, PMB monotherapy demonstrated the highest bacterial killing activity even compared to the combination. Phenylpyruvate monotherapy showed negligible activity against K. pneumoniae. A significant reduction in bacterial burden was seen at 1 h following PMB monotherapy and combination therapy but an equally rapid regrowth was seen at 4 h. Notably at 24 h, the regrowth following combination therapy was >1-log10 CFU/mL less than PMB monotherapy. Conclusion: Our results suggest that phenylpyruvate increased PMB susceptibility in K. pneumoniae and may minimise the emergence of resistance to PMB. Future studies investigating phenylpyruvate at higher concentrations against more isolates are
warranted.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Dispensing of antibiotics in community pharmacy in Iraq: a qualitative study

Alkadhimi A, Dawood OT, Hassali MA

Pharm Pract (Granada), 2020 12 12;18(4):2095.
PMID: 33343772 DOI: 10.18549/PharmPract.2020.4.2095

Objective: This study aimed to understand the dispensing practice of antibiotics in community pharmacy in Iraq, in addition to explore the community pharmacists' perception about dispensing antibiotics without prescription.
Methods: A qualitative design was conducted on community pharmacists in Baghdad, Iraq. Pharmacists were selected conveniently from different gender, age group, pharmacy type and years of experience. Face-to-face semi-structure interview was used with all the pharmacists to get in-depth understanding about their dispensing practice of antibiotics without prescription in community pharmacy. The data was coded and classified for thematic analysis.
Results: This study found that dispensing of antibiotics without prescription was a common practice in community pharmacy. Pharmacists' perception towards dispensing antibiotics without prescription was associated with the medical condition, safety and efficacy of antibiotics, patients request antibiotics by name, emergency cases, regular customer, promotions from pharmaceutical companies, saving time and cost, brand medications, and poor healthcare services. In addition, there were inadequate knowledge about antibiotic resistance and lack of awareness about antibiotic stewardship leading to inappropriate dispensing practice.
Conclusions: Community pharmacists have poor perception towards dispensing antibiotics without prescription. Educational interventions about antibiotics use focusing on community pharmacists are needed. This will help to optimize the practice of dispensing of antibiotics in the community. In addition, training programs about antibiotic resistance are important to enhance pharmacists' understanding about antibiotic stewardship.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Shape-dependent antibacterial activity against escherichia coli of zinc oxide nanoparticles

Nor Hazliana Harun, Mydin, Rabiatul Basria S.M.N., Sreekantan, Srimala, Khairul Arifah Saharudin, Norfatehah Basiron, Fakrul Radhi, et al.

Journal of Biomedical and Clinical Sciences, 2018;3(2):35-38.
MyJurnal

Zinc oxide (ZnO) nanoparticles (NPs) has become as promising candidate for antibacterial agents against Escherichia coli (E.coli), commensal hospital- acquired infections (HAIs). This study investigates the antibacterial action of ZnO NPs in three difference shapes; nanorod, nanoflakes and nanospheres against E.coli ATCC 25922. The antibacterial activity of ZnO NPs was determine through two standard protocols known as Clinical Laboratory Standards Institute (CLSI) MO2-A11 under light conditions of 5.70 w/m2 and American standard test method (ASTM) E-2149. Preliminary screening shows ZnO NPs did not inhibit the growth of E.coli. Further analysis using ASTM E-2149 in dynamic conditions revealed antibacterial activity after 3 hours with 100% reduction for ZnO NPs nanoflakes and 6 hours with 94.63% reduction for ZnO nanospheres, respectively. It demonstrated the ZnO NPs in nanoflakes and nanospheres exerted higher antibacterial activity possibly through release of ios, free radicals, ROS generation and electrostatic collision which contribute to bacterial death. Further analysis is needed to investigate biocompatibility of these samples for future biomedical applications.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Population pharmacokinetic meta-analysis of individual data to design the first randomized efficacy trial of vancomycin in neonates and young infants

Jacqz-Aigrain E, Leroux S, Thomson AH, Allegaert K, Capparelli EV, Biran V, et al.

J Antimicrob Chemother, 2019 08 01;74(8):2128-2138.
PMID: 31049551 DOI: 10.1093/jac/dkz158

OBJECTIVES: In the absence of consensus, the present meta-analysis was performed to determine an optimal dosing regimen of vancomycin for neonates.
METHODS: A 'meta-model' with 4894 concentrations from 1631 neonates was built using NONMEM, and Monte Carlo simulations were performed to design an optimal intermittent infusion, aiming to reach a target AUC0-24 of 400 mg·h/L at steady-state in at least 80% of neonates.
RESULTS: A two-compartment model best fitted the data. Current weight, postmenstrual age (PMA) and serum creatinine were the significant covariates for CL. After model validation, simulations showed that a loading dose (25 mg/kg) and a maintenance dose (15 mg/kg q12h if <35 weeks PMA and 15 mg/kg q8h if ≥35 weeks PMA) achieved the AUC0-24 target earlier than a standard 'Blue Book' dosage regimen in >89% of the treated patients.
CONCLUSIONS: The results of a population meta-analysis of vancomycin data have been used to develop a new dosing regimen for neonatal use and to assist in the design of the model-based, multinational European trial, NeoVanc.

Matched MeSH terms: Anti-Bacterial Agents
Influence of roxithromycin as antibiotic residue on volatile fatty acids recovery in anaerobic fermentation of waste activated sludge

Chen H, Zeng X, Zhou Y, Yang X, Lam SS, Wang D

J Hazard Mater, 2020 07 15;394:122570.
PMID: 32244145 DOI: 10.1016/j.jhazmat.2020.122570

The removal of antibiotics and resistance genes in wastewater treatment plants has attracted widespread attention, but the potential role of residual antibiotics in the disposal of waste activated sludge (WAS) has not been clearly understood. In this study, the effect of roxithromycin (ROX) on volatile fatty acid (VFA) recovery from WAS anaerobic fermentation was investigated. The experimental results showed that ROX made a positive contribution to the production of VFAs. With the increase of ROX dosages from 0 to 100 mg/kg TSS, the maximum accumulation of VFAs increased from 295 to 610 mg COD/L. Mechanism studies revealed that ROX promoted the solubilization of WAS by facilitating the disruption of extracellular polymeric substances. In addition, ROX enhanced the activity of acetate kinase and inhibited the activities of α-glucosidase and coenzyme F420, and showed a stronger inhibitory effect on methane production than the hydrolysis process, thus resulting in an increase in VFA accumulation. These findings provide a new insight for the role of antibiotics in anaerobic fermentation of WAS.

Matched MeSH terms: Anti-Bacterial Agents
Conventional and emerging technologies for removal of antibiotics from wastewater

Phoon BL, Ong CC, Mohamed Saheed MS, Show PL, Chang JS, Ling TC, et al.

J Hazard Mater, 2020 12 05;400:122961.
PMID: 32947727 DOI: 10.1016/j.jhazmat.2020.122961

Antibiotics and pharmaceuticals related products are used to enhance public health and quality of life. The wastewater that is produced from pharmaceutical industries still contains noticeable amount of antibiotics, and this has remained one of the major environmental problems facing public health. The conventional wastewater remediation approach employed by the pharmaceutical industries for the antibiotics wastewater removal is unable to remove the antibiotics completely. Besides, municipal and livestock wastewater also contain unmetabolized antibiotics released by human and animal, respectively. The antibiotic found in wastewater leads to antibiotic resistance challenges, also emergence of superbugs. Currently, numerous technological approaches have been developed to remove antibiotics from the wastewater. Therefore, it was imperative to critically review the weakness and strength of these current advanced technological approaches in use. Besides, the conventional methods for removal of antibiotics such as Klavaroti et al., Homem and Santos also discussed. Although, membrane treatment is discovered as the ultimate choice of approach, to completely remove the antibiotics, while the filtered antibiotics are still retained on the membrane. This study found, hybrid processes to be the best solution antibiotics removal from wastewater. Nevertheless, real-time monitoring system is also recommended to ascertain that, wastewater is cleared of antibiotics.

Matched MeSH terms: Anti-Bacterial Agents
Topical delivery of salicylates

Yeoh SC, Goh CF

Drug Deliv Transl Res, 2021 Apr 28.
PMID: 33907986 DOI: 10.1007/s13346-021-00988-5

Salicylates have a long history of use for pain relief. Salicylic acid and methyl salicylate are among the widely used topical salicylates namely for keratolytic and anti-inflammatory actions, respectively. The current review summarises both passive and active strategies, including emerging technologies employed to enhance skin permeation of these two salicylate compounds. The formulation design of topical salicylic acid targets the drug retention in and on the skin based on the different indications including keratolytic, antibacterial and photoprotective actions, while the investigations of topical delivery strategies for methyl salicylate are limited. The pharmacokinetics and metabolisms of both salicylate compounds are discussed. The current overview and future perspectives of the topical delivery strategies are also highlighted for translational considerations of formulation designs.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Isolation and Characterization of Antibacterial Compounds from Ganoderma boninense Against Methicillin-Resistant Staphylococcus aureus (MRSA)

Syahriel Abdullah, Ling, Yee Soon, Daim, Sylvia Jerome, Chong, Khim Phin

Borneo Journal of Medical Sciences, 2018;12(101):11-12.
MyJurnal

Community and nosocomial-associated methicillin-resistant Staphylococcus aureus (MRSA) infections in Malaysian healthcare setting are terrifically increasing in recent years. There is an urgent need for an effective antibacterial agent to cope with this important issue. Due to the development of new antibiotics is not parallel with the increase of cases of infections, researchers have initiated isolation of compounds from natural resources to develop new potent therapeutic agent. Meanwhile, Ganoderma boninense is an oil palm devastating pathogen, which has been known to contain many bioactive compounds that might be potential to be developed as a new source of therapeutic agent.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Streptococcus pneumoniae Meningitis and Intracranial Vasculopathy: Clinical Correlation with Improving Transcranial Doppler Hemodynamics

Idris MI, Tai SML, Tan CT, Tan KS

Case Rep Neurol, 2020 12 14;12(Suppl 1):106-109.
PMID: 33505281 DOI: 10.1159/000500950

Streptococcus pneumoniae are Gram-positive bacteria that are responsible for many types of illnesses including pneumonia, sinus infections, and community-acquired meningitis. One important complication of bacterial meningitis is intracranial vasculopathy. Possible etiologies include vasculitis, vasospasm, endocarditis, or intra-arterial thrombosis. We present a case report of S. pneumoniae meningitis treated with antibiotics in which clinical improvement correlated with serial transcranial Doppler ultrasonography (TCD) improvement, suggesting vasospasm or vasculitis as a possible mechanism for intracranial vasculopathy.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Design, synthesis and biological profile of heterocyclic benzimidazole analogues as prospective antimicrobial and antiproliferative agents

Tahlan S, Kumar S, Ramasamy K, Lim SM, Shah SAA, Mani V, et al.

BMC Chem, 2019 Dec;13(1):50.
PMID: 31384798 DOI: 10.1186/s13065-019-0567-x

Background: Nitrogen containing heterocycles are widely used and investigated by pharmaceutical industry, as they are important in discovery and designing of new drug molecules. Drugs with a benzimidazole nucleus possess exclusive structural features and electron-rich atmosphere, which enable them to bind to a number of biologically important targets and result in a wide range of activities. This has served as the basis of the present study whereby new scaffolds with benzimidazole moiety were designed and synthesized.
Methods: The structures of synthesized compounds were confirmed by physicochemical and spectral means. The synthesized compounds were screened for their antimicrobial and antiproliferative activities by tube dilution and Sulforhodamine B (SRB) assays, respectively.
Results and conclusion: The in vitro biological screening results revealed that compound Z24 exhibited promising antimicrobial and anticancer activities which are comparable to standards.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext Draft Genome Sequence of the Extended-Spectrum β-Lactamase-Producing Escherichia coli Isolate INF13/18/A, Recovered from Kelantan, Malaysia

Wan Makhtar WR, Mohd Azlan M, Hassan NH, Aziah I, Samsurizal NH, Yusof NY

Microbiol Resour Announc, 2020 Aug 13;9(33).
PMID: 32817162 DOI: 10.1128/MRA.01497-19

We describe here the draft genome sequence and basic characteristics of Escherichia coli isolate INF13/18/A, which was isolated from Universiti Sains Malaysia (USM) Hospital. This isolate was identified as an extended-spectrum β-lactamase-producing Escherichia coli strain harboring the antimicrobial resistance genes TEM, CTX-M-1, and CTX-M-9.

Matched MeSH terms: Anti-Bacterial Agents
Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital

Leong CL, Buising K, Richards M, Robertson M, Street A

Intern Med J, 2006 Jan;36(1):37-42.
PMID: 16409311

BACKGROUND: Aminoglycoside antibiotics are commonly prescribed for the treatment of Gram-negative infections. Appropriate dosing and therapeutic monitoring of aminoglycosides are important because these agents have a narrow therapeutic index.
AIM: To audit gentamicin use at our hospital, focusing on selection of the initial dose and therapeutic monitoring practices, and to compare the results against recommendations in the existing hospital aminoglycoside guidelines, which had recently been promoted to doctors.
METHODS: This audit included all inpatients receiving gentamicin at The Royal Melbourne Hospital from 1 February to 12 March 2004. The principal researcher checked the drug charts of all inpatients to identify those receiving gentamicin and collected data from the medical records and the pathology database. Doses were considered 'concordant' if the dose given was within the recommended dosing range +/-20 mg.
RESULTS: A total of 132 courses of gentamicin was included in the study. Gentamicin was prescribed for prophylaxis in 31.1% of courses. Thirty-six per cent of patients prescribed gentamicin were more than 65 years of age. Eighty-two per cent of the gentamicin used therapeutically was given as a single daily dose. Sixty-six per cent of gentamicin initial dosing was not in accordance with existing hospital guidelines. Seventy-seven per cent of gentamicin courses requiring therapeutic drug monitoring received such monitoring; however, in only 8.8% of these was the monitoring conducted according to guidelines.
CONCLUSION: Aminoglycoside prescribing practices at our hospital are suboptimal, despite ready access to prescribing guidelines. Provision of a guideline and education sessions with doctors do not necessarily lead to widespread adoption of recommended practices. We suggest that changes to hospital systems related to prescribing and monitoring of aminoglycosides are required.

Matched MeSH terms: Anti-Bacterial Agents/administration & dosage; Anti-Bacterial Agents/blood; Anti-Bacterial Agents/therapeutic use*
Fulltext Draft Genome Sequences of Three Multidrug-Resistant Staphylococcus spp. Isolated from Hospital Wastewater in Malaysia

Ahmad Sabri NS, Mohd Zulkeflle SN, Yusof N, Md Akhir FN, Othman N, Zakaria Z, et al.

Microbiol Resour Announc, 2021 May 06;10(18).
PMID: 33958405 DOI: 10.1128/MRA.00332-21

Staphylococcus spp. are Gram-positive bacteria that reside within the normal microbiota of humans and animals but pose a health threat as reservoirs of antimicrobial resistance genes. Here, we present the draft genome sequences of three Staphylococcus sp. strains isolated from hospital wastewater in Malaysia that demonstrated resistance to multiple antibiotics.

Matched MeSH terms: Anti-Bacterial Agents
Fulltext The Missing Piece: Recent Approaches Investigating the Antimicrobial Mode of Action of Essential Oils

Yang SK, Tan NP, Chong CW, Abushelaibi A, Lim SH, Lai KS

Evol Bioinform Online, 2021;17:1176934320938391.
PMID: 34017165 DOI: 10.1177/1176934320938391

Antibiotic resistance is a major global health issue that has seen alarming rates of increase in all parts of the world over the past two decades. The surge in antibiotic resistance has resulted in longer hospital stays, higher medical costs, and elevated mortality rates. Constant attempts have been made to discover newer and more effective antimicrobials to reduce the severity of antibiotic resistance. Plant secondary metabolites, such as essential oils, have been the major focus due to their complexity and bioactive nature. However, the underlying mechanism of their antimicrobial effect remains largely unknown. Understanding the antimicrobial mode of action of essential oils is crucial in developing potential strategies for the use of essential oils in a clinical setting. Recent advances in genomics and proteomics have enhanced our understanding of the antimicrobial mode of action of essential oils. We might well be at the dawn of completing a mystery on how essential oils carry out their antimicrobial activities. Therefore, an overview of essential oils with regard to their antimicrobial activities and mode of action is discussed in this review. Recent approaches used in identifying the antimicrobial mode of action of essential oils, specifically from the perspective of genomics and proteomics, are also synthesized. Based on the information gathered from this review, we offer recommendations for future strategies and prospects for the study of essential oils and their function as antimicrobials.

Matched MeSH terms: Anti-Bacterial Agents
Infections by multidrug-resistant Gram-negative Bacteria: What's new in our arsenal and what's in the pipeline?

Koulenti D, Song A, Ellingboe A, Abdul-Aziz MH, Harris P, Gavey E, et al.

Int J Antimicrob Agents, 2019 Mar;53(3):211-224.
PMID: 30394301 DOI: 10.1016/j.ijantimicag.2018.10.011

The spread of multidrug-resistant bacteria is an ever-growing concern, particularly among Gram-negative bacteria because of their intrinsic resistance and how quickly they acquire and spread new resistance mechanisms. Treating infections caused by Gram-negative bacteria is a challenge for medical practitioners and increases patient mortality and cost of care globally. This vulnerability, along with strategies to tackle antimicrobial resistance development, prompts the development of new antibiotic agents and exploration of alternative treatment options. This article summarises the new antibiotics that have recently been approved for Gram-negative bacterial infections, looks down the pipeline at promising agents currently in phase I, II, or III clinical trials, and introduces new alternative avenues that show potential in combating multidrug-resistant Gram-negative bacteria.

Matched MeSH terms: Anti-Bacterial Agents/isolation & purification*; Anti-Bacterial Agents/pharmacology; Anti-Bacterial Agents/therapeutic use
Multidrug-resistant Acinetobacter baumannii infections: Current evidence on treatment options and the role of pharmacokinetics/pharmacodynamics in dose optimisation

Mohd Sazlly Lim S, Sime FB, Roberts JA

Int J Antimicrob Agents, 2019 Jun;53(6):726-745.
PMID: 30831234 DOI: 10.1016/j.ijantimicag.2019.02.016

Acinetobacter baumannii remains a difficult-to-treat pathogen that poses a significant challenge to clinicians and costs to the healthcare system. There is a lack of clinical efficacy data to aid in the selection of optimal treatment for multidrug-resistant (MDR) A. baumannii infections. This paper aimed to review recent literature on the treatment of MDR A. baumannii infections and novel agents in the pipeline and to discuss the clinical data supporting their use. Colistin has been widely studied as monotherapy or as part of combination therapy, but its use is limited due to nephrotoxicity. The clinical benefit of combination therapy, whether empirical or targeted, has yet to be demonstrated owing to a lack of definitive evidence from randomised controlled trials (RCTs). Most available clinical studies are retrospective and lack control groups, which offers low-grade evidence. Novel agents such as cefiderocol, plazomicin, eravacycline and sulbactam/ETX2514 combination are promising options for the treatment of different infectious pathologies caused by MDR A. baumannii, but these have yet to be evaluated in RCTs. A better understanding of the pharmacokinetics/pharmacodynamics of the 'old' antibiotics is required to optimise their dosing regimens in order to maximise bacterial killing, minimise toxicities and improve clinical outcomes.

Matched MeSH terms: Anti-Bacterial Agents

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