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152
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Abbas M, Paul M, Huttner A. New and improved? A review of novel antibiotics for Gram-positive bacteria. Clin Microbiol Infect 2017. [DOI: 10.1016/j.cmi.2017.06.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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153
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Once-Daily Treatments for Methicillin-Susceptible Staphylococcus aureus Bacteremia: Are They Good Enough? Curr Infect Dis Rep 2017; 19:43. [PMID: 28942574 DOI: 10.1007/s11908-017-0599-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF THE REVIEW Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia is a common cause of morbidity and mortality. First-line treatment requires frequent daily doses of an anti-staphylococcal beta-lactam. However, some physicians prescribe simpler once-daily regimens to improve compliance and improve healthcare utilization. We reviewed the literature regarding advantages, pitfalls, and efficacy of once-daily treatment options for MSSA bacteremia. RECENT FINDINGS Several once-daily antibiotics are effective in vitro against MSSA (ceftriaxone, daptomycin, telavancin, dalbavancin, oritavancin, tedizolid, ertapenem, fluoroquinolones, and others), but there is insufficient evidence to support these agents for MSSA bacteremia. Ceftriaxone may be considered for therapy completion with MSSA bacteremia from osteomyelitis, and daptomycin may be considered in patients who cannot tolerate first-line therapy. However, they have not been compared to traditional second-line agents, and their role remains uncertain. Current evidence does not support the use of once-daily treatment options for MSSA bacteremia.
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154
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Quirke M, Curran EM, O'Kelly P, Moran R, Daly E, Aylward S, McElvaney G, Wakai A. Risk factors for amendment in type, duration and setting of prescribed outpatient parenteral antimicrobial therapy (OPAT) for adult patients with cellulitis: a retrospective cohort study and CART analysis. Postgrad Med J 2017; 94:25-31. [PMID: 28874503 DOI: 10.1136/postgradmedj-2017-134968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/11/2017] [Accepted: 07/16/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE OF THE STUDY To measure the percentage rate and risk factors for amendment in the type, duration and setting of outpatient parenteral antimicrobial therapy (OPAT) for the treatment of cellulitis. STUDY DESIGN A retrospective cohort study of adult patients receiving OPAT for cellulitis was performed. Treatment amendment (TA) was defined as hospital admission or change in antibiotic therapy in order to achieve clinical response. Multivariable logistic regression (MVLR) and classification and regression tree (CART) analysis were performed. RESULTS There were 307 patients enrolled. TA occurred in 36 patients (11.7%). Significant risk factors for TA on MVLR were increased age, increased Numerical Pain Scale Score (NPSS) and immunocompromise. The median OPAT duration was 7 days. Increased age, heart rate and C reactive protein were associated with treatment prolongation. CART analysis selected age <64.5 years, female gender and NPSS <2.5 in the final model, generating a low-sensitivity (27.8%), high-specificity (97.1%) decision tree. CONCLUSIONS Increased age, NPSS and immunocompromise were associated with OPAT amendment. These identified risk factors can be used to support an evidence-based approach to patient selection for OPAT in cellulitis. The CART algorithm has good specificity but lacks sensitivity and is shown to be inferior in this study to logistic regression modelling.
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Affiliation(s)
- Michael Quirke
- Emergency Care Research Unit (ECRU),Royal College of Surgeons Ireland (RCSI), Dublin, Ireland
| | - Emma May Curran
- Department of Medicine, RCSI, Beaumont Hospital, Dublin, Ireland
| | - Patrick O'Kelly
- Department of Statistics, Renal Medicine Unit,Beaumont Hospital, Dublin, Ireland
| | - Ruth Moran
- VHI Homecare, Waverly Business Park, Dublin, Ireland
| | - Eimear Daly
- VHI Homecare, Waverly Business Park, Dublin, Ireland
| | | | - Gerry McElvaney
- Department of Medicine, RCSI, Beaumont Hospital, Dublin, Ireland
| | - Abel Wakai
- Emergency Care Research Unit (ECRU),Royal College of Surgeons Ireland (RCSI), Dublin, Ireland.,Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland
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155
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Recently approved antibacterials for methicillin-resistant Staphylococcus aureus (MRSA) and other Gram-positive pathogens: the shock of the new. Int J Antimicrob Agents 2017; 50:303-307. [DOI: 10.1016/j.ijantimicag.2017.05.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 04/30/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022]
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156
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Vanegas Múnera JM, Ocampo Ríos AM, Urrego DM, Jiménez Quiceno JN. In vitro susceptibility of methicillin-resistant Staphylococcus aureus isolates from skin and soft tissue infections to vancomycin, daptomycin, linezolid and tedizolid. Braz J Infect Dis 2017; 21:493-499. [PMID: 28432878 PMCID: PMC9425527 DOI: 10.1016/j.bjid.2017.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 01/12/2023] Open
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Pulido-Cejudo A, Guzmán-Gutierrez M, Jalife-Montaño A, Ortiz-Covarrubias A, Martínez-Ordaz JL, Noyola-Villalobos HF, Hurtado-López LM. Management of acute bacterial skin and skin structure infections with a focus on patients at high risk of treatment failure. Ther Adv Infect Dis 2017; 4:143-161. [PMID: 28959445 DOI: 10.1177/2049936117723228] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Over the last 25 years, the terminology of skin and soft tissue infections, as well as their classification for optimal management of patients, has changed. The so-called and recently introduced term 'acute bacterial skin and skin structure infections' (ABSSSIs), a cluster of fairly common types of infection, including abscesses, cellulitis, and wound infections, require an immediate effective antibacterial treatment as part of a timely and cautious management. The extreme level of resistance globally to many antibiotic drugs in the prevalent causative pathogens, the presence of risk factors of treatment failure, and the high epidemic of comorbidities (e.g. diabetes and obesity) make the appropriate selection of the antibiotic for physicians highly challenging. The selection of antibiotics is primarily empirical for ABSSSI patients which subsequently can be adjusted based on culture results, although rarely available in outpatient management. There is substantial evidence suggesting that inappropriate antibiotic treatment is given to approximately 20-25% of patients, potentially prolonging their hospital stay and increasing the risk of morbidity and mortality. The current review paper discusses the concerns related to the management of ABSSSI and the patient types who are most vulnerable to poor outcomes. It also highlights the key management time-points that treating physicians and surgeons must be aware of in order to achieve clinical success and to discharge patients from the hospital as early as possible.
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Affiliation(s)
| | | | - Abel Jalife-Montaño
- Department of General Surgery, Hospital General de México, México City, México
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158
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Kim Y, Kim A, Lee S, Choi SH, Lee DY, Song JS, Lee H, Jang IJ, Yu KS. Pharmacokinetics, Safety, and Tolerability of Tedizolid Phosphate After Single-dose Administration in Healthy Korean Male Subjects. Clin Ther 2017; 39:1849-1857. [PMID: 28865799 DOI: 10.1016/j.clinthera.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/01/2017] [Accepted: 08/02/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Tedizolid phosphate is a next-generation oxazolidinone prodrug that is transformed into the active moiety tedizolid. Its indication is acute bacterial skin and skin structure infections caused by gram-positive species, including methicillin-resistant Staphylococcus aureus. Although tedizolid phosphate has been marketed in Korea, no data on the pharmacokinetic (PK) properties or tolerability of tedizolid phosphate in Korean subjects are available. This study was designed to evaluate the PK properties, oral bioavailability, and tolerability with a single-dose oral and intravenous administration of tedizolid phosphate in healthy Korean male subjects. METHODS A block-randomized, double-blind, placebo-controlled, single-dose study was conducted in 3 groups (200, 400, and 600 mg; 10 subjects in each group). In the second part of the study, subjects from the 200-mg group received administration orally and intravenously (1-hour infusion) via 2-way crossover for the evaluation of absolute bioavailability. There was a 7-day washout period between treatments in the absolute bioavailability part of the study. Serial blood samples for PK analysis were collected for up to 72 hours. Tolerability was assessed by analysis of adverse events. FINDINGS Thirty healthy Korean subjects completed the study and were included in the PK and tolerability analyses. Tedizolid phosphate was rapidly converted into tedizolid. After a single oral dose, the Tmax of tedizolid was observed to be 1.5 to 2.5 hours, and the plasma concentration-time curve of tedizolid showed a 2-phase elimination pattern, with a half-life of ~11 hours. Dose-dependent increases were observed in the AUClast value (29,441-78,062 μg · h/L) and in the Cmax value (2679-6980 μg/L) with the administration of tedizolid phosphate 200 to 600 mg PO. The absolute bioavailability of tedizolid was 95.2% (90% CI, 92.7%-97.8%) in the 200-mg administration group. There were no serious adverse events or clinically significant changes in the tolerability assessment. IMPLICATIONS Tedizolid phosphate at doses of up to 600 mg was well-tolerated in these healthy Korean male subjects. Tedizolid shows dose linearity with oral administration, and no dose adjustment of tedizolid phosphate 200 mg would be needed when switching administration routes. ClinicalTrials.gov identifier: NCT02097043.
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Affiliation(s)
- Yun Kim
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Anhye Kim
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea; Clinical Trial Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Sung-Hak Choi
- Research Center, Dong-A ST Co., Ltd., Yongin, Republic of Korea
| | - Dae Young Lee
- Research Center, Dong-A ST Co., Ltd., Yongin, Republic of Korea
| | - Ji-Su Song
- Department of Clinical Development, Dong-A ST Co., Ltd., Seoul, Republic of Korea
| | - Howard Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea; Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - In-Jin Jang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
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159
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Wilcox MH, Dmitrieva N, Gales AC, Petukhova I, Al-Obeid S, Rossi F, M Blondeau J. Susceptibility testing and reporting of new antibiotics with a focus on tedizolid: an international working group report. Future Microbiol 2017; 12:1523-1532. [PMID: 28812924 DOI: 10.2217/fmb-2017-0106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Inappropriate use and overuse of antibiotics are among the most important factors in resistance development, and effective antibiotic stewardship measures are needed to optimize outcomes. Selection of appropriate antimicrobials relies on accurate and timely antimicrobial susceptibility testing. However, the availability of clinical breakpoints and in vitro susceptibility testing often lags behind regulatory approval by several years for new antimicrobials. A Working Group of clinical/medical microbiologists from Brazil, Canada, Mexico, Saudi Arabia, Russia and the UK recently examined issues surrounding antimicrobial susceptibility testing for novel antibiotics. While commercially available tests are being developed, potential surrogate antibiotics may be used as marker of susceptibility. Using tedizolid as an example of a new antibiotic, this special report makes recommendations to optimize routine susceptibility reporting.
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Affiliation(s)
- Mark H Wilcox
- Leeds Teaching Hospitals NHS Trust & University of Leeds, Leeds, UK
| | | | - Ana Cristina Gales
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Suleiman Al-Obeid
- Microbiology Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Flavia Rossi
- Hospital das Clínicas da Faculdade de Medicina, Seção de Microbiologia, Divisão de Laboratório Central LIM03, Universidade de São Paulo, São Paulo, Brazil
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Bal AM, David MZ, Garau J, Gottlieb T, Mazzei T, Scaglione F, Tattevin P, Gould IM. Future trends in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection: An in-depth review of newer antibiotics active against an enduring pathogen. J Glob Antimicrob Resist 2017; 10:295-303. [PMID: 28732783 DOI: 10.1016/j.jgar.2017.05.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/20/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major public health problem. Vancomycin and teicoplanin have been in clinical use for several decades but their drawbacks are well described. In the last 10 years, several antibiotics have been made available for clinical use. Daptomycin and linezolid have been extensively used during this period. Other agents such as ceftaroline, ceftobiprole, dalbavancin, oritavancin, tedizolid and telavancin have been approved by regulatory agencies since 2009. Many others, such as the newer tetracyclines, fluoroquinolones, oxazolidinones and pleuromutilins, are in various stages of development. In addition, an ongoing multicentre trial is investigating the role of combination of vancomycin or daptomycin with β-lactam antibiotics. This review discusses the role of the newer antibiotics, reflecting the views of the 6th MRSA Consensus Conference meeting of the International Society of Chemotherapy MRSA Working Group that took place in 2016.
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Affiliation(s)
- A M Bal
- Department of Microbiology, University Hospital Crosshouse, Kilmarnock KA2 0BE, UK.
| | - M Z David
- Departments of Medicine, Paediatrics, and Public Health Sciences, University of Chicago, Chicago, IL 60637, USA
| | - J Garau
- Department of Medicine, Hospital Universitari Mútua de Terrassa, Plaza Dr Robert 5, Barcelona 08221, Spain
| | - T Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW 2139, Australia
| | - T Mazzei
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Firenze, Firenze, Italy
| | - F Scaglione
- Department of Oncology and Onco-Haematology, University of Milan, Via Vanvitelli 32, 20129 Milan, Italy
| | - P Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 35033 Rennes, France
| | - I M Gould
- Department of Microbiology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
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161
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Joseph WS, Culshaw D, Anuskiewicz S, De Anda C, Prokocimer P. Tedizolid and Linezolid for Treatment of Acute Bacterial Skin and Skin Structure Infections of the Lower Extremity versus Non-Lower-Extremity Infections Pooled Analysis of Two Phase 3 Trials. J Am Podiatr Med Assoc 2017; 107:264-271. [PMID: 27533787 DOI: 10.7547/15-218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tedizolid phosphate, the prodrug of the oxazolidinone tedizolid, has been approved in a number of countries, including the United States, those in the European Union, and Canada, for treatment of patients with acute bacterial skin and skin structure infections (ABSSSI). Two phase 3 trials demonstrated the noninferior efficacy of tedizolid (200 mg once daily for 6 days) to linezolid (600 mg twice daily for 10 days) in patients with ABSSSI. Because of the challenges of treating lower-extremity ABSSSI, the efficacy and safety of tedizolid and linezolid for treating lower-extremity versus non-lower-extremity infections were compared. METHODS This was a post hoc analysis of pooled data from patients with lower-extremity infections enrolled in two phase 3 studies, ESTABLISH-1 (NCT01170221) and ESTABLISH-2 (NCT01421511), comparing tedizolid to linezolid in patients with ABSSSI. RESULTS Lower-extremity ABSSSI were present in 40.7% of tedizolid-treated and 42.2% of linezolid-treated patients. Methicillin-resistant Staphylococcus aureus (MRSA) was present in 34.7% of all patients with a baseline causative pathogen. Early clinical responses at 48 to 72 hours and investigator-assessed responses at the post-therapy evaluation were similar between tedizolid and linezolid, regardless of ABSSSI type. With both treatments, the early clinical response was slightly higher in patients with non-lower-extremity infection than in those with lower-extremity ABSSSI (tedizolid, 84.8% versus 77.0%; linezolid, 81.4% versus 76.6%, respectively); however, by the post-therapy evaluation visit, response rates were similar (tedizolid, 87.1% versus 86.3%; linezolid, 86.6% versus 87.2%, respectively). Gastrointestinal adverse events and low platelet counts were observed more frequently with linezolid treatment. CONCLUSIONS Post-therapy evaluations showed that the clinical response of lower-extremity ABSSSI to tedizolid and linezolid was comparable to that of ABSSSI in other locations. A short 6-day course of once-daily tedizolid was as effective as a 10-day course of twice-daily linezolid in treating patients with lower-extremity ABSSSI.
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162
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Flanagan S, Minassian SL, Passarell JA, Fiedler-Kelly J, Prokocimer P. Pharmacokinetics of Tedizolid in Obese and Nonobese Subjects. J Clin Pharmacol 2017; 57:1290-1294. [PMID: 28510339 DOI: 10.1002/jcph.928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/28/2017] [Indexed: 01/21/2023]
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164
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Clinical Response of Tedizolid versus Linezolid in Acute Bacterial Skin and Skin Structure Infections by Severity Measure Using a Pooled Analysis from Two Phase 3 Double-Blind Trials. Antimicrob Agents Chemother 2017; 61:AAC.02687-16. [PMID: 28264845 DOI: 10.1128/aac.02687-16] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/26/2017] [Indexed: 11/20/2022] Open
Abstract
Tedizolid phosphate is approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). In a pooled analysis of 1,333 ABSSSI patients from the ESTABLISH clinical trials, treatment with tedizolid or linezolid demonstrated similar early and posttherapy clinical responses in nonsevere and severe disease, irrespective of the parameters used to measure ABSSSI severity. Shorter 6-day treatment of ABSSSI, including those that were severe, with tedizolid phosphate demonstrated efficacy comparable to that of 10-day treatment with linezolid. (The ESTABLISH studies discussed in this paper have been registered at ClinicalTrials.gov under identifiers NCT01170221 and NCT01421511.).
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165
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Charles PE, Dargent A, Andreu P. Nouvelles molécules anti-infectieuses. Quelle place en médecine intensive réanimation pour le tédizolide, la ceftaroline et le ceftobiprole ? MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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166
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Esposito S, Bassetti M, Concia E, De Simone G, De Rosa FG, Grossi P, Novelli A, Menichetti F, Petrosillo N, Tinelli M, Tumbarello M, Sanguinetti M, Viale P, Venditti M, Viscoli C. Diagnosis and management of skin and soft-tissue infections (SSTI). A literature review and consensus statement: an update. J Chemother 2017; 29:197-214. [PMID: 28378613 DOI: 10.1080/1120009x.2017.1311398] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Skin and soft-tissue infections (SSTIs) are among the most common bacterial infections, posing considerable diagnostic and therapeutic challenges. Fourteen members of the Italian Society of Infectious Diseases, after a careful review of the most recent literature using Medline database and their own clinical experience, updated a previous paper published in 2011 by preparing a draught manuscript of the statements. The manuscript was successively reviewed by all members and ultimately re-formulated the present manuscript during a full day consensus meeting. The microbiological and clinical aspects together with diagnostic features were considered for necrotizing and not necrotizing SSTIs in the light of the most recent guidelines and evidences published in the last five years. The antimicrobial therapy was considered as well - both empirical and targeted to methicillin-resistant Staphylococcus aureus and/or other pathogens, also taking into account the epidemiological and bacterial resistance data and the availability of new antibacterial agents.
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Affiliation(s)
- Silvano Esposito
- a Department of Infectious Diseases, AOU San Giovanni di Dio e Ruggi d'Aragona , University of Salerno , Salerno , Italy
| | - Matteo Bassetti
- b Infectious Diseases Division , Santa Maria Misericordia Hospital , Udine , Italy
| | - Ercole Concia
- c Division of Infectious Diseases, Department of Pathology , AOU di Verona, Policlinico 'G.B. Rossi' , Verona , Italy
| | - Giuseppe De Simone
- a Department of Infectious Diseases, AOU San Giovanni di Dio e Ruggi d'Aragona , University of Salerno , Salerno , Italy
| | - Francesco G De Rosa
- d Department of Medical Science , University of Turin, Infectious Diseases Amedeo di Savoia Hospital , Turin , Italy
| | - Paolo Grossi
- e Infectious Diseases Unit , University of Insubria and University Hospital 'ASST Sette Laghi' , Varese , Italy
| | - Andrea Novelli
- f Department of Health Sciences, Section of Clinical Pharmacology and Oncology , University of Florence , Florence , Italy
| | | | - Nicola Petrosillo
- h National Institute for Infectious Diseases Lazzaro Spallanzani-INMU IRCCS , Rome , Italy
| | - Marco Tinelli
- i Division of Infectious and Tropical Diseases , Hospital of Lodi , Lodi , Italy
| | - Mario Tumbarello
- j Institute of Infectious Diseases , Catholic University of the Sacred Hearth, A. Gemelli Hospital , Rome , Italy
| | - Maurizio Sanguinetti
- k Institute of Microbiology , Università Cattolica del Sacro Cuore , Rome , Italy
| | - Pierluigi Viale
- l Department of Medical Surgical Sciences , Alma Mater Studiorum University of Bologna , Bologna , Italy
| | - Mario Venditti
- m Department of Public Health and Infectious Diseases , 'Sapienza' University of Rome , Italy
| | - Claudio Viscoli
- n Infectious Diseases Division , University of Genoa and IRCCS San Martino-IST , Genoa , Italy
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Le VTM, Le HN, Pinheiro MG, Hahn KJ, Dinh ML, Larson KB, Flanagan SD, Badiou C, Lina G, Tkaczyk C, Sellman BR, Diep BA. Effects of Tedizolid Phosphate on Survival Outcomes and Suppression of Production of Staphylococcal Toxins in a Rabbit Model of Methicillin-Resistant Staphylococcus aureus Necrotizing Pneumonia. Antimicrob Agents Chemother 2017; 61:e02734-16. [PMID: 28137816 PMCID: PMC5365717 DOI: 10.1128/aac.02734-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 01/24/2017] [Indexed: 01/30/2023] Open
Abstract
The protective efficacy of tedizolid phosphate, a novel oxazolidinone that potently inhibits bacterial protein synthesis, was compared to those of linezolid, vancomycin, and saline in a rabbit model of Staphylococcus aureus necrotizing pneumonia. Tedizolid phosphate was administered to rabbits at 6 mg/kg of body weight intravenously twice daily, which yielded values of the 24-h area under the concentration-time curve approximating those found in humans. The overall survival rate was 83% for rabbits treated with 6 mg/kg tedizolid phosphate twice daily and 83% for those treated with 50 mg/kg linezolid thrice daily (P = 0.66 by the log-rank test versus the results obtained with tedizolid phosphate). These survival rates were significantly greater than the survival rates of 17% for rabbits treated with 30 mg/kg vancomycin twice daily (P = 0.003) and 17% for rabbits treated with saline (P = 0.002). The bacterial count in the lungs of rabbits treated with tedizolid phosphate was significantly decreased compared to that in the lungs of rabbits treated with saline, although it was not significantly different from that in the lungs of rabbits treated with vancomycin or linezolid. The in vivo bacterial production of alpha-toxin and Panton-Valentine leukocidin, two key S. aureus-secreted toxins that play critical roles in the pathogenesis of necrotizing pneumonia, in the lungs of rabbits treated with tedizolid phosphate and linezolid was significantly inhibited compared to that in the lungs of rabbits treated with vancomycin or saline. Taken together, these results indicate that tedizolid phosphate is superior to vancomycin for the treatment of S. aureus necrotizing pneumonia because it inhibits the bacterial production of lung-damaging toxins at the site of infection.
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Affiliation(s)
- Vien T M Le
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Hoan N Le
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Marcos Gabriel Pinheiro
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Kenneth J Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Mary L Dinh
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | | | | | - Cedric Badiou
- INSERM U1111, Université Lyon 1, CNRS UMR5308, ENS Lyon, Lyon, France
- Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Bron, France
| | - Gerard Lina
- INSERM U1111, Université Lyon 1, CNRS UMR5308, ENS Lyon, Lyon, France
- Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Bron, France
| | - Christine Tkaczyk
- Department of Infectious Diseases, MedImmune, Gaithersburg, Maryland, USA
| | - Bret R Sellman
- Department of Infectious Diseases, MedImmune, Gaithersburg, Maryland, USA
| | - Binh An Diep
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
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Rademacher J, Welte T. [New antibiotics - standstill or progress]. Med Klin Intensivmed Notfmed 2017; 112:206-213. [PMID: 28314920 DOI: 10.1007/s00063-017-0271-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/15/2017] [Indexed: 11/28/2022]
Abstract
The development of resistance to antibiotics has been ignored for a long time. But nowadays, increasing resistance is an important topic. For a decade no new antibiotics had been developed and it is not possible to quickly close this gap of new resistance and no new drugs. This work presents six new antibiotics (ceftaroline, ceftobiprole, solithromycin, tedizolid, ceftolozane/tazobactam, ceftazidime/avibactam). In part, only expert opinions are given due to lack of study results.The two 5th generation cephalosporins ceftaroline and ceftobiprole have beside their equivalent efficacy to ceftriaxone (ceftaroline) and cefipim (ceftobiprole) high activity against MRSA. The fluoroketolide solithromycin should help against macrolide-resistant pathogens and has been shown to be noninferior to the fluorochinolones. The oxazolidinone tedizolid is effective against linezolid-resistant MRSA. The two cephalosporins ceftolozane/tazobactam and ceftazidime/avibactam are not only effective against gram-negative pathogens, but they have a very broad spectrum. Due to the efficacy against extended-spectrum β‑lactamases, they can relieve the selection pressure of the carbapenems. We benefit from all new antibiotics which can take the selection pressure from other often used antibiotics. The increasing number of resistant gram-negative pathogens worldwide is alarming. Thus, focusing on the development of new drugs is extremely important.
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Affiliation(s)
- J Rademacher
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 306125, Hannover, Deutschland.
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 306125, Hannover, Deutschland
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Characterization of Neurologic and Ophthalmologic Safety of Oral Administration of Tedizolid for Up to 21 Days in Healthy Volunteers. Am J Ther 2017; 24:e227-e233. [PMID: 27941424 DOI: 10.1097/mjt.0000000000000534] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antibacterials that inhibit protein synthesis may be associated with mitochondrial toxicity, manifested as serious optic or peripheral neuropathy or myelosuppression. Tedizolid is a novel oxazolidinone antibacterial that may have reduced the potential for mitochondrial toxicity. STUDY QUESTION Based on the results of 2 studies (NCT01623401 and NCT00671814) conducted early in the tedizolid development program, what is the potential for drug-induced optic and peripheral neuropathies with tedizolid treatment? METHODS Two phase-1 studies were conducted in healthy volunteers. The first was an open-label study in which subjects received 200 mg of oral tedizolid phosphate once daily for 10 days. The second was a double-blind, placebo- and active-controlled, dose-escalating (multiple-administration) study in which subjects received 200, 300, or 400 mg of oral tedizolid phosphate once daily or 600 mg of oral linezolid twice daily or oral placebo for 21 days. Overall safety and tolerability were assessed, and extensive ophthalmologic and neurologic assessments were performed in both studies. RESULTS In these 2 studies in healthy subjects, tedizolid administered for up to 21 days was not associated with drug-related ophthalmologic or neurologic adverse events. Incidences of adverse events involving the eye or the nervous system were generally low, and no clinically meaningful changes in ophthalmologic or neurologic test results were recorded during either study. CONCLUSIONS Using an extensive battery of ophthalmologic tests and detailed neurologic clinical examination, there was no evidence of clinical or subclinical neurologic or ophthalmologic changes suggestive of peripheral or optic neuropathy in healthy volunteers who received therapeutic and supratherapeutic doses of oral tedizolid for periods of up to 21 days.
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170
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Wintenberger C, Guery B, Bonnet E, Castan B, Cohen R, Diamantis S, Lesprit P, Maulin L, Péan Y, Peju E, Piroth L, Stahl JP, Strady C, Varon E, Vuotto F, Gauzit R. Proposal for shorter antibiotic therapies. Med Mal Infect 2017; 47:92-141. [PMID: 28279491 DOI: 10.1016/j.medmal.2017.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 01/30/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Reducing antibiotic consumption has now become a major public health priority. Reducing treatment duration is one of the means to achieve this objective. Guidelines on the therapeutic management of the most frequent infections recommend ranges of treatment duration in the ratio of one to two. The Recommendation Group of the French Infectious Diseases Society (SPILF) was asked to collect literature data to then recommend the shortest treatment durations possible for various infections. METHODS Analysis of the literature focused on guidelines published in French and English, supported by a systematic search on PubMed. Articles dating from one year before the guidelines publication to August 31, 2015 were searched on the website. RESULTS The shortest treatment durations based on the relevant clinical data were suggested for upper and lower respiratory tract infections, central venous catheter-related and uncomplicated primary bacteremia, infective endocarditis, bacterial meningitis, intra-abdominal, urinary tract, upper reproductive tract, bone and joint, skin and soft tissue infections, and febrile neutropenia. Details of analyzed articles were shown in tables. CONCLUSION This work stresses the need for new well-conducted studies evaluating treatment durations for some common infections. Following the above-mentioned work focusing on existing literature data, the Recommendation Group of the SPILF suggests specific study proposals.
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Affiliation(s)
- C Wintenberger
- Département de médecine interne, CHU de Grenoble Alpes, 38043 Grenoble, France
| | - B Guery
- Service de maladies infectieuses, CHU vaudois et université de Lausanne, Lausanne, Switzerland
| | - E Bonnet
- Équipe mobile d'infectiologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, hôpital Eugenie, boulevard Rossini, 20000 Ajaccio, France
| | - R Cohen
- IMRB-GRC GEMINI, unité Court Séjour, université Paris Est, Petits Nourrissons, centre hospitalier intercommunal de Créteil, ACTIV France, 40, avenue de Verdun, 94000 Créteil, France
| | - S Diamantis
- Service de maladies infectieuses et tropicales, centre hospitalier de Melun, 2, rue Fréteau-de-Peny, 77011 Melun cedex, France
| | - P Lesprit
- Infectiologie transversale, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - L Maulin
- Centre hospitalier du Pays-d'Aix, avenue de Tamaris, 13616 Aix-en-Provence, France
| | - Y Péan
- Observatoire national de l'épidémiologie de la résistance bactérienne aux antibiotiques (ONERBA), 10, rue de la Bonne-Aventure, 78000 Versailles, France
| | - E Peju
- Département d'infectiologie, CHU de Dijon, 14, rue Gaffarel, 21079 Dijon cedex, France
| | - L Piroth
- Département d'infectiologie, CHU de Dijon, 14, rue Gaffarel, 21079 Dijon cedex, France
| | - J P Stahl
- Infectiologie, université, CHU de Grenoble Alpes, 38043 Grenoble, France
| | - C Strady
- Cabinet d'infectiologie, clinique Saint-André, groupe Courlancy, 5, boulevard de la Paix, 51100 Reims, France
| | - E Varon
- Laboratoire de microbiologie, hôpital européen Georges-Pompidou, 75908 Paris cedex 15, France
| | - F Vuotto
- Service de maladies infectieuses, CHU vaudois et université de Lausanne, Lausanne, Switzerland
| | - R Gauzit
- Réanimation et infectiologie transversale, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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McBride D, Krekel T, Hsueh K, Durkin MJ. Pharmacokinetic drug evaluation of tedizolid for the treatment of skin infections. Expert Opin Drug Metab Toxicol 2017; 13:331-337. [PMID: 28140693 DOI: 10.1080/17425255.2017.1290080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Tedizolid is indicated for the treatment of acute bacterial skin and skin structure infections (ABSSSI). Although tedizolid shares many similar properties with linezolid, another oxazolidinone used to treat ABSSSI, the two antibiotics have several key differences. Areas covered: This review provides a detailed summary of the overall pharmacodynamics, pharmacokinetics, clinical efficacy, and safety of tedizolid for the treatment of ABSSSI. Expert opinion: Compared to other antibiotics used for ABSSSI, tedizolid has several advantages. Tedizolid has a long half-life, allowing for once daily dosing. Tedizolid also has broad spectrum of activity against Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus, Coagulase-negative Staphylococci, and Enterococci - including isolates demonstrating resistance to linezolid. It is available in both oral and intravenous formulations, and, has outstanding oral bioavailability, allowing for oral-step down therapy. There is also some evidence that, tedizolid has fewer significant interactions with serotonin reuptake inhibitors or monoamine oxidase inhibitors than linezolid. Finally, thrombocytopenia may occur less often with tedizolid than linezolid. However, these benefits must be weighed against the financial cost of tedizolid and the availability of alternative antibiotic choices.
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Affiliation(s)
- Darrell McBride
- a Department of Medicine, Division of Infectious Diseases , Washington University School of Medicine , St. Louis , MO , USA
| | - Tamara Krekel
- b Department of Pharmacy , Barnes-Jewish Hospital , St. Louis , MO , USA
| | - Kevin Hsueh
- a Department of Medicine, Division of Infectious Diseases , Washington University School of Medicine , St. Louis , MO , USA
| | - Michael J Durkin
- a Department of Medicine, Division of Infectious Diseases , Washington University School of Medicine , St. Louis , MO , USA
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172
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Goldstein EJ, Citron DM, Tyrrell KL, Leoncio ES, Merriam CV. The underappreciated in vitro activity of tedizolid against Bacteroides fragilis species, including strains resistant to metronidazole and carbapenems. Anaerobe 2017; 43:1-3. [DOI: 10.1016/j.anaerobe.2016.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/25/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
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Surveillance of tedizolid activity and resistance: In vitro susceptibility of Gram-positive pathogens collected over 5 years from the United States and Europe. Diagn Microbiol Infect Dis 2017; 87:133-138. [DOI: 10.1016/j.diagmicrobio.2016.10.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/08/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022]
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174
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McCool R, Gould IM, Eales J, Barata T, Arber M, Fleetwood K, Glanville J, Kauf TL. Systematic review and network meta-analysis of tedizolid for the treatment of acute bacterial skin and skin structure infections caused by MRSA. BMC Infect Dis 2017; 17:39. [PMID: 28061827 PMCID: PMC5219662 DOI: 10.1186/s12879-016-2100-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/07/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Tedizolid, the active moiety of tedizolid phosphate, is approved in the United States, the European Union, Canada and a number of other countries for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by certain susceptible bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). This network meta-analysis (NMA) evaluates the comparative effectiveness of tedizolid and other antibacterials indicated for the treatment of ABSSSI caused by MRSA. METHODS Systematic review of 10 databases was undertaken to inform an NMA to estimate the relative effectiveness of tedizolid and established monotherapy comparators (ceftaroline, daptomycin, linezolid, teicoplanin, tigecycline, vancomycin) for treating MRSA-associated ABSSSI. Randomized controlled trials enrolling adults with ABSSSI or complicated skin and skin structure infections caused by suspected/documented MRSA were eligible for inclusion. Networks were developed based on similarity of study design, patient characteristics, outcome measures and available data. Outcomes of interest included clinical response at end of therapy (EOT), post-therapy evaluation (PTE) or test-of-cure assessment and treatment discontinuations resulting from adverse events (AEs). Bayesian NMA was conducted for each outcome using fixed-effects and random effects models. RESULTS Literature searches identified 3,618 records; 15 trials met the inclusion criteria and were considered suitable for NMA comparison. In fixed-effects models, tedizolid had higher odds of clinical response at EOT (odds ratio [OR], 1.7; credible interval, 1.0, 3.0) and PTE than vancomycin (OR, 1.6; credible interval, 1.1, 2.5). No differences in odds of clinical response at EOT or PTE were observed between tedizolid and other comparators. There was no evidence of a difference among treatments for discontinuation due to AEs. Results from random effects and fixed-effects models were generally consistent. CONCLUSIONS Tedizolid was superior to vancomycin for clinical response at EOT and PTE. There was no evidence of a difference between tedizolid and other comparators and no evidence of a difference between tedizolid and all comparators when evaluating discontinuation due to AEs. These findings suggest that tedizolid provides an alternative option for the management of serious skin infections caused by suspected or documented MRSA. This study is subject to the limitations inherent in all NMAs, and the results should be interpreted accordingly.
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Affiliation(s)
- Rachael McCool
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ UK
| | - Ian M. Gould
- Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, AB25 2ZN UK
| | - Jacqui Eales
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ UK
| | - Teresa Barata
- Quantics, 28 Drumsheugh Gardens, Edinburgh, EH3 7RN UK
| | - Mick Arber
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ UK
| | | | - Julie Glanville
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ UK
| | - Teresa L. Kauf
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033 USA
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Abstract
Staphylococcus aureus, although generally identified as a commensal, is also a common cause of human bacterial infections, including of the skin and other soft tissues, bones, bloodstream, and respiratory tract. The history of S. aureus treatment is marked by the development of resistance to each new class of antistaphylococcal antimicrobial drugs, including the penicillins, sulfonamides, tetracyclines, glycopeptides, and others, complicating therapy. S. aureus isolates identified in the 1960s were sometimes resistant to methicillin, a ß-lactam antimicrobial active initially against a majority S. aureus strains. These MRSA isolates, resistant to nearly all ß-lactam antimicrobials, were first largely confined to the health care environment and the patients who attended it. However, in the mid-1990s, new strains, known as community-associated (CA-) MRSA strains, emerged. CA-MRSA organisms, compared with health care-associated (HA-) MRSA strain types, are more often susceptible to multiple classes of non ß-lactam antimicrobials. While infections caused by methicillin-susceptible S. aureus (MSSA) strains are usually treated with drugs in the ß-lactam class, such as cephalosporins, oxacillin or nafcillin, MRSA infections are treated with drugs in other antimicrobial classes. The glycopeptide drug vancomycin, and in some countries teicoplanin, is the most common drug used to treat severe MRSA infections. There are now other classes of antimicrobials available to treat staphylococcal infections, including several that have been approved after 2009. The antimicrobial management of invasive and noninvasive S. aureus infections in the ambulatory and in-patient settings is the topic of this review. Also discussed are common adverse effects of antistaphylococcal antimicrobial agents, advantages of one agent over another for specific clinical syndromes, and the use of adjunctive therapies such as surgery and intravenous immunoglobulin. We have detailed considerations in the therapy of noninvasive and invasive S. aureus infections. This is followed by sections on specific clinical infectious syndromes including skin and soft tissue infections, bacteremia, endocarditis and intravascular infections, pneumonia, osteomyelitis and vertebral discitis, epidural abscess, septic arthritis, pyomyositis, mastitis, necrotizing fasciitis, orbital infections, endophthalmitis, parotitis, staphylococcal toxinoses, urogenital infections, and central nervous system infections.
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176
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Ferrández O, Urbina O, Grau S. Critical role of tedizolid in the treatment of acute bacterial skin and skin structure infections. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 11:65-82. [PMID: 28053508 PMCID: PMC5191846 DOI: 10.2147/dddt.s84667] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Tedizolid phosphate has high activity against the Gram-positive microorganisms mainly involved in acute bacterial skin and skin structure infections, such as strains of Staphylococcus aureus (including methicillin-resistant S. aureus strains and methicillin-sensitive S. aureus strains), Streptococcus pyogenes, Streptococcus agalactiae, the Streptococcus anginosus group, and Enterococcus faecalis, including those with some mechanism of resistance limiting the use of linezolid. The area under the curve for time 0-24 hours/minimum inhibitory concentration (MIC) pharmacodynamic ratio has shown the best correlation with the efficacy of tedizolid, versus the time above MIC ratio and the maximum drug concentration/minimum inhibitory concentration ratio. Administration of this antibiotic for 6 days has shown its noninferiority versus administration of linezolid for 10 days in patients with skin and skin structure infections enrolled in two Phase III studies (ESTABLISH-1 and ESTABLISH-2). Tedizolid's more favorable safety profile and dosage regimen, which allow once-daily administration, versus linezolid, position it as a good therapeutic alternative. However, whether or not the greater economic cost associated with this antibiotic is offset by its shorter treatment duration and possibility of oral administration in routine clinical practice has yet to be clarified.
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Affiliation(s)
- Olivia Ferrández
- Hospital Pharmacy, Hospital Universitari del Mar, Barcelona, Spain; Nursing Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Olatz Urbina
- Hospital Pharmacy, Hospital Universitari del Mar, Barcelona, Spain
| | - Santiago Grau
- Hospital Pharmacy, Hospital Universitari del Mar, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
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177
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Nathwani D, Corey R, Das AF, Sandison T, De Anda C, Prokocimer P. Early Clinical Response as a Predictor of Late Treatment Success in Patients With Acute Bacterial Skin and Skin Structure Infections: Retrospective Analysis of 2 Randomized Controlled Trials. Clin Infect Dis 2016; 64:214-217. [PMID: 28003218 DOI: 10.1093/cid/ciw750] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 12/07/2016] [Indexed: 11/14/2022] Open
Abstract
In the treatment of acute bacterial skin and skin structure infections, pooled data from 2 clinical trials (N = 1333 patients) showed that programmatic and investigator-assessed early treatment success both had a high positive predictive value (94.3%-100.0%) for late clinical cure, including among hospitalized patients. The negative predictive value of programmatic early success was <20%. These exploratory findings require prospective real-world evaluation. CLINICAL TRIALS REGISTRATION NCT01170221; NCT01421511.
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Affiliation(s)
- Dilip Nathwani
- Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Ralph Corey
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Anita F Das
- Biostatistics, InClin, San Mateo, California, and
| | - Taylor Sandison
- Merck Research Laboratories, Merck & Co, Inc., Kenilworth, New Jersey
| | - Carisa De Anda
- Merck Research Laboratories, Merck & Co, Inc., Kenilworth, New Jersey
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178
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Zahedi Bialvaei A, Rahbar M, Yousefi M, Asgharzadeh M, Samadi Kafil H. Linezolid: a promising option in the treatment of Gram-positives. J Antimicrob Chemother 2016; 72:354-364. [PMID: 27999068 DOI: 10.1093/jac/dkw450] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Linezolid, an oxazolidinone antimicrobial agent that acts by inhibiting protein synthesis in a unique fashion, is used in the treatment of community-acquired pneumonia, skin and soft-tissue infections and other infections caused by Gram-positive bacteria including VRE and methicillin-resistant staphylococci. Currently, linezolid resistance among these pathogens remains low, commonly <1.0%, although the prevalence of antibiotic resistance is increasing in many countries. Therefore, the development of resistance by clinical isolates should prompt increased attention of clinical laboratories to routinely perform linezolid susceptibility testing for this important agent and should be taken into account when considering its therapeutic use. Considering the importance of linezolid in the treatment of infections caused by Gram-positive bacteria, this review was undertaken to optimize the clinical use of this antibiotic.
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Affiliation(s)
| | - Mohammad Rahbar
- Department of Microbiology, Iranian Reference Health Laboratory, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehdi Yousefi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asgharzadeh
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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179
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Tatarkiewicz J, Staniszewska A, Bujalska-Zadrożny M. New agents approved for treatment of acute staphylococcal skin infections. Arch Med Sci 2016; 12:1327-1336. [PMID: 27904526 PMCID: PMC5108382 DOI: 10.5114/aoms.2016.59838] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/05/2015] [Indexed: 11/17/2022] Open
Abstract
Vancomycin has been a predominant treatment for methicillin-resistant Staphylococcus aureus (MRSA) infections for decades. However, growing reservations about its efficacy led to an urgent need for new antibiotics effective against MRSA and other drug-resistant Staphylococcus aureus strains. This review covers three new anti-MRSA antibiotics that have been recently approved by the FDA: dalbavancin, oritavancin, and tedizolid. The mechanism of action, indications, antibacterial activity profile, microbial resistance, pharmacokinetics, clinical efficacy, adverse effects, interactions as well as available formulations and administration of each of these new antibiotics are described. Dalbavancin is a once-a-week, two-dose, long-acting intravenous bactericidal lipoglycopeptide antibiotic. Oritavancin, a lipoglycopeptide with bactericidal activity, was developed as a single-dose intravenous treatment for acute bacterial skin and skin-structure infections (ABSSSI), which offers simplifying treatment of infections. Tedizolid is an oxazolidinone-class bacteriostatic once-daily agent, available for intravenous as well as oral use. Increased ability to overcome bacterial resistance is the main therapeutic advantage of the novel agents over existing antibiotics.
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Affiliation(s)
- Jan Tatarkiewicz
- Department of Pharmacodynamics, CEPT Laboratory, Medical University of Warsaw, Warsaw, Poland
| | - Anna Staniszewska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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180
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Molina KC, Huang V. Resistance to Non-glycopeptide Agents in Serious Staphylococcus aureus Infections. Curr Infect Dis Rep 2016; 18:47. [PMID: 27873126 DOI: 10.1007/s11908-016-0553-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of vancomycin in the treatment of serious Staphylococcus aureus infections, both methicillin-susceptible and methicillin-resistant, is becoming increasingly ineffective due to increasing MIC and failure. The development of reduced vancomycin susceptibility by S. aureus to glycopeptides highlights the need for clinicians to reexamine the roles of non-glycopeptide therapy. As the use of these alternative non-glycopeptides antimicrobials increases, it will become pertinent to monitor the rates of resistance. Large surveillance programs have provided data for resistance against S. aureus for the non-glycopeptides (daptomycin, ceftaroline, tigecycline, linezolid, and tedizolid). The current published literatures suggest that worldwide resistance rates to these non-glycopeptides for serious MRSA infections are still low. Implementation of antimicrobial stewardship programs will be crucial in prevention of resistance of these antimicrobials against S. aureus.
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Affiliation(s)
- Kyle C Molina
- Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern University, 19555 N. 59th Ave., Glendale, AZ, 85308, USA
| | - Vanthida Huang
- Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern University, 19555 N. 59th Ave., Glendale, AZ, 85308, USA.
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181
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Abstract
PURPOSE OF REVIEW The occurrence of methicillin-resistance in Staphylococcus aureus, that represents the most frequent cause of complicated skin and soft tissue infections (cSSTIs) worldwide, is a major concern and has been associated with increased length of stay, health care costs, and overall mortality. Although vancomycin is still considered the standard therapy in this setting, limitations of its use in clinical practice are represented by a progressive increase in methicillin-resistant S. aureus (MRSA) minimum inhibitory concentrations, drug-related toxicity, and the lack of an oral formulation. New therapeutic options for MRSA cSSTIs have recently become available, with promising implications for the management of cSSTIs in clinical practice. RECENT FINDINGS A number of new antimicrobials with activity against MRSA have been recently approved for the treatment of cSSTIs, and other agents are under investigation. We have reviewed the recent developments, with a specific focus on the possible advantages of new drugs for the management of cSSTIs into the everyday clinical practice. SUMMARY The new approved drugs for the treatment of cSSTIs are expected to offer many advantages for the management of patients with suspected or confirmed MRSA cSSTIs. The most promising features of the new compounds include the availability of oral formulations, once-weekly intravenous regimens, and broad spectra of activity.
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182
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Li S, Guo Y, Zhao C, Chen H, Hu B, Chu Y, Zhang Z, Hu Y, Liu Z, Du Y, Gui Q, Ji P, Zeng J, Cao B, Fu Q, Zhang R, Wang Z, Zhuo C, Feng X, Jia W, Jin Y, Xu X, Liao K, Ni Y, Yu Y, Xu X, Hu Z, Lei JE, Yang Q, Wang H. In vitro activities of tedizolid compared with other antibiotics against Gram-positive pathogens associated with hospital-acquired pneumonia, skin and soft tissue infection and bloodstream infection collected from 26 hospitals in China. J Med Microbiol 2016; 65:1215-1224. [PMID: 27599998 DOI: 10.1099/jmm.0.000347] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Shuguang Li
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing 100044, PR China
| | - Yu Guo
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing 100044, PR China
| | - Chunjiang Zhao
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing 100044, PR China
| | - Hongbin Chen
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing 100044, PR China
| | - Bijie Hu
- Zhongshan Hospital Fudan University, Shanghai 200032, PR China
| | - Yunzhuo Chu
- The First Hospital of China Medical University, Shenyang 110001, PR China
| | - Zhijie Zhang
- Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Yunjian Hu
- Beijing Hospital, Beijing 100730, PR China
| | - Zhiyong Liu
- Affiliated Xinan Hospital of Third Military Medical University, Chongqing 400038, PR China
| | - Yan Du
- First Affiliated Hospital of Kunming Medical University, Kunming 650032, PR China
| | - Qiaodi Gui
- Shanxi Provincial People’s Hospital, Xi’an 710068, PR China
| | - Ping Ji
- The First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, PR China
| | - Ji Zeng
- Affiliated Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China
| | - Bin Cao
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Quan Fu
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, PR China
| | - Rong Zhang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, PR China
| | - Zhongxin Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230022, PR China
| | - Chao Zhuo
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, PR China
| | - Xianju Feng
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, PR China
| | - Wei Jia
- General Hospital of Ningxia Medical University, Yinchuan 750004, PR China
| | - Yan Jin
- Shandong Provincial Hospital, Jinan 250021, PR China
| | - Xuesong Xu
- China-Japan Union Hospital of Jilin University, Changchun 130033, PR China
| | - Kang Liao
- First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, PR China
| | - Yuxing Ni
- Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Yunsong Yu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, PR China
| | - Xiuli Xu
- Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, PR China
| | - Zhidong Hu
- Tianjin Medical University General Hospital, Tianjin 300052, PR China
| | - Jin-E Lei
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, PR China
| | - Qing Yang
- The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, PR China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing 100044, PR China
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183
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Panagopoulos P, Papanas N, Maltezos E. Tedizolid in skin and skin structure infections: brave new world? Expert Opin Pharmacother 2016; 17:2249-2251. [PMID: 27718751 DOI: 10.1080/14656566.2016.1244525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Periklis Panagopoulos
- a Unit of Infectious Diseases, Second Department of Internal Medicine , Democritus University of Thrace , Alexandroupolis , Greece
| | - Nikolaos Papanas
- b Diabetic Foot Clinic, Diabetes Centre, Second Department of Internal Medicine , Democritus University of Thrace , Alexandroupolis , Greece
| | - Efstratios Maltezos
- a Unit of Infectious Diseases, Second Department of Internal Medicine , Democritus University of Thrace , Alexandroupolis , Greece
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184
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In vitro activity of tedizolid against Staphylococcus aureus and Streptococcus pneumoniae collected in 2013 and 2014 from sites in Latin American countries, Australia, New Zealand, and China. Eur J Clin Microbiol Infect Dis 2016; 35:1933-1939. [PMID: 27677280 DOI: 10.1007/s10096-016-2744-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/01/2016] [Indexed: 01/30/2023]
Abstract
Tedizolid is an oxazolidinone with an antimicrobial in vitro potency advantage against Gram-positive bacterial pathogens compared to other currently marketed drugs in this class, including linezolid. Tedizolid was compared to linezolid when tested against Staphylococcus aureus and Streptococcus pneumoniae isolates collected from countries in Latin America and the Asia-Pacific. Isolates were tested by broth microdilution susceptibility methods against tedizolid, linezolid, and non-class comparators in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines. The activity of tedizolid against S. aureus was potent and consistent in Latin America (MIC90, 0.5 mg/L), Australia and New Zealand (MIC90, 0.25 mg/L), and China (MIC90, 0.5 mg/L). Based on MIC90 results, tedizolid was four- to eight-fold more active than linezolid against S. aureus, including both methicillin-susceptible and -resistant isolates. Only two tedizolid non-susceptible strains were observed; both had intermediate minimum inhibitory concentration (MIC) values of 1 mg/L, for which the MICs of linezolid was higher (≥2 mg/L). Tedizolid (MIC90, 0.25 mg/L) was four-fold more potent than linezolid (MIC90, 1 mg/L) against S. pneumoniae in all countries that provided isolates. The findings from this study support the global clinical development of tedizolid for Gram-positive infections.
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185
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Powers JH, Das AF, De Anda C, Prokocimer P. Clinician-reported lesion measurements in skin infection trials: Definitions, reliability, and association with patient-reported pain. Contemp Clin Trials 2016; 50:265-72. [PMID: 27530088 DOI: 10.1016/j.cct.2016.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Outcome assessments as clinical trial endpoints should be well-defined, reliable, and reflect meaningful treatment benefits. For acute bacterial skin and skin structure infections (ABSSSI) trials, recent recommendations suggest a primary endpoint of reduction in skin lesion area. Objectives were: evaluate ABSSSI lesion area measurement reliability, evaluate impact of various lesion area definitions on treatment effect size, and explore relationships between lesion area and pain. METHODS Data from two randomized, double-blinded Phase 3 trials comparing tedizolid to linezolid in ABSSSI and one open-label, non-comparative Phase 2 study of tedizolid in cellulitis/erysipelas and skin abscess were analyzed. Repeated lesion area measurements were prospectively obtained in all studies. In the open-label study, lesion area was measured by two investigators, using four different definitions. Repeated pain assessments using two patient-reported outcome instruments (Visual Analog Scale [VAS] and Faces Rating Scale [FRS]) were elicited in the randomized trials. RESULTS At baseline, lesion size did not correlate with pain intensity: r=0.02 for VAS and r<0.01 for FRS pain scores. However, decreasing lesion size and decreasing pain were strongly associated over time, regardless of initial lesion size or pain intensity (r=0.20 for VAS and r=0.21 for FRS scores at Day 10-13). Each lesion area definition demonstrated high inter-observer reliability (intra-class correlation coefficient>0.95). CONCLUSIONS Decreasing lesion area (indirect clinician-reported measure of benefit) and pain (direct patient-reported measure of benefit) were strongly associated over time, and lesion area measurements were reliable, regardless of their definition. These findings support both measures as outcome assessments in ABSSSI clinical trials. REGISTRATION Clinicaltrials.govNCT01519778, NCT01170221, and NCT01421511.
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Affiliation(s)
- John H Powers
- George Washington University School of Medicine, Washington, DC, USA.
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Abstract
BACKGROUND There is no more challenging a group of pharmaceuticals than antimicrobials. With the antibiotic era came great optimism as countless deaths were prevented from what were previously fatal conditions. Although antimicrobial resistance was quickly identified, the abundance of antibiotics entering the market helped cement attitudes of arrogance as the "battle against pestilence appeared won". Opposite emotions soon followed as many heralded the return of the pre-antibiotic era, suggesting that the "antibiotic pipeline had dried up" and that our existing armament would soon be rendered worthless. DISCUSSION In reality, humans overrate their ecological importance. For millions of years there has been a balance between factors promoting bacterial survival and those disturbing it. The first half century of the "antibiotic era" was characterised by a cavalier attitude disturbing the natural balance; however, recent efforts have been made through several mechanisms to respond and re-strengthen the antimicrobial armament. Such mechanisms include a variety of incentives, educational efforts and negotiations. Today, there are many more "man-made" factors that will determine a new balance or state of ecological harmony. CONCLUSION Antibiotics are not a panacea nor will they ever be inutile. New resistance mechanisms will be identified and new antibiotics will be discovered, but most importantly, we must optimise our application of these extraordinary "biological tools"; therein lays our greatest challenge - creating a society that understands and respects the determinants of the effectiveness of antibiotics.
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Affiliation(s)
- Sze-Ann Woon
- Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Dale Fisher
- Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore, Singapore. .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Level 10, Singapore, 119228, Singapore.
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187
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Nathwani D, Dryden M, Garau J. Early clinical assessment of response to treatment of skin and soft-tissue infections: how can it help clinicians? Perspectives from Europe. Int J Antimicrob Agents 2016; 48:127-36. [DOI: 10.1016/j.ijantimicag.2016.04.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/01/2016] [Accepted: 04/19/2016] [Indexed: 01/27/2023]
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Chen R, Shen K, Chang X, Tanaka T, Li L, Hu P. Pharmacokinetics and Safety of Tedizolid after Single and Multiple Intravenous/Oral Sequential Administrations in Healthy Chinese Subjects. Clin Ther 2016; 38:1869-79. [PMID: 27461846 DOI: 10.1016/j.clinthera.2016.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/16/2016] [Accepted: 06/23/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Tedizolid phosphate is a new antibacterial agent under investigation for the treatment of Gram-positive infections in China. This study was conducted to assess the pharmacokinetic (PK) properties, oral bioavailability, and safety of once daily tedizolid phosphate 200 mg in Chinese subjects to support its further clinical development in China. METHODS This Phase I single-center study, conducted in 16 healthy Chinese male subjects, consisted of a single-dose administration, 1:1 randomized, two-way, intravenous (IV)/oral (PO) crossover of tedizolid phosphate 200 mg (Part 1) and, after a 7-day washout, a nonrandomized, multiple-dose, 7-day tedizolid phosphate 200 mg once daily administration (IV for 3 days, PO for 4 days; Part 2). Blood samples were collected for up to 72 hours after single dosing and for up to 2 hours on Day 3 and 72 hours on Day 7 of multiple dosing to determine PK parameters. Adverse events (AEs) were recorded throughout the entire study. FINDINGS The Cmax and AUC of tedizolid (the active moiety of tedizolid phosphate) were 3.02 µg/mL and 30.50 µg • h/mL after single IV dosing of tedizolid phosphate, and 2.25 µg/mL and 26.10 µg • h/mL after single PO dosing, respectively, and the mean half-life was 10.1 hours for both administration routes. The oral bioavailability of tedizolid was 85.5%. PK parameters of tedizolid were similar after single and multiple dosing of tedizolid phosphate, indicating no time dependency. Only minor accumulation of tedizolid was observed after multiple dosing (expressed as accumulation ratios RAAUC: 1.18 for PO dosing, and RACmax: 1.16 and 1.05 for IV and PO dosing, respectively). Steady state of tedizolid was reached after about 3 days, and trough concentrations remained constant when switching from IV to PO dosing. Tedizolid phosphate was well tolerated with 6 subjects (37.5%) in Part 1 and 5 subjects (31.3%) in Part 2 experiencing an AE; all AEs but one were related to the study drug assessed by the investigator. All AEs were of mild intensity and had recovered or resolved by the end of the study. No serious AEs were observed, and no subjects prematurely discontinued the study due to an AE. IMPLICATIONS The results of this Phase I study conducted in Chinese male subjects indicate that no dosage adjustment of tedizolid phosphate 200 mg would be required when switching administration routes in this population. Tedizolid phosphate was well tolerated in healthy Chinese subjects. China Food and Drug Administration clinical trial permission numbers 2014L00360 and 2014L00361.
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Affiliation(s)
- Rui Chen
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Beijing China
| | - Kai Shen
- Clinical Science China, Bayer, Beijing, China
| | | | | | - Li Li
- Global Medical Affairs, Bayer, Berlin, Germany
| | - Pei Hu
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Beijing China.
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189
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Bruun T, Oppegaard O, Hufthammer KO, Langeland N, Skrede S. Early Response in Cellulitis: A Prospective Study of Dynamics and Predictors. Clin Infect Dis 2016; 63:1034-1041. [PMID: 27402819 PMCID: PMC5036916 DOI: 10.1093/cid/ciw463] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/30/2016] [Indexed: 11/15/2022] Open
Abstract
In this prospective study of cellulitis, several nonpharmacological factors were associated with lack of early response. Such early nonresponse was rarely related to inappropriate therapy but strongly predictive of early treatment escalation, suggesting that broadening antibiotic treatment often may be premature. Background. Skin and soft tissue infections are common reasons for medical care. Use of broad-spectrum therapy and costs have increased. Assessment of early treatment response has been given a central role both in clinical trials and everyday practice. However, there is a paucity of data on the dynamics of response, causes of early nonresponse, and how early nonresponse affects resource use and predicts outcome. Methods. We prospectively enrolled 216 patients hospitalized with cellulitis. Clinical and biochemical response data during the first 3 days of treatment were analyzed in relation to baseline factors, antibiotic use, surgery, and outcome. Multivariable analysis included logistic lasso regression. Results. Clinical or biochemical response was observed in the majority of patients the day after treatment initiation. Concordance between clinical and biochemical response was strongest at days 2 and 3. Female sex, cardiovascular disease, higher body mass index, shorter duration of symptoms, and cellulitis other than typical erysipelas were predictors of nonresponse at day 3. In contrast, baseline factors were not predictive of clinical failure assessed posttreatment. Among cases with antibiotic treatment escalation by day 2, 90% (37/41) had nonresponse at day 1, but only 5% (2/40) had inappropriate initial therapy. Nonresponse at day 3 was a predictor of treatment duration >14 days, but not of clinical failure. Conclusions. Nonpharmacological factors had a major impact on early response dynamics. Delayed response was rarely related to inappropriate therapy but strongly predictive of early treatment escalation, suggesting that broadening antibiotic treatment may often be premature.
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Affiliation(s)
- Trond Bruun
- Department of Clinical Science, University of Bergen.,Department of Medicine
| | - Oddvar Oppegaard
- Department of Clinical Science, University of Bergen.,Department of Medicine
| | | | - Nina Langeland
- Department of Clinical Science, University of Bergen.,National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Steinar Skrede
- Department of Clinical Science, University of Bergen.,Department of Medicine
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Effects of therapeutic and supratherapeutic doses of oral tedizolid phosphate on cardiac repolarisation in healthy volunteers: a randomised controlled study. Int J Antimicrob Agents 2016; 48:33-40. [DOI: 10.1016/j.ijantimicag.2015.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/04/2015] [Accepted: 12/08/2015] [Indexed: 11/23/2022]
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191
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Phe K, Cadle RM, Guervil DJ, Guzman OE, Lockwood AM, Perez KK, Vuong NN, Aitken SL. Significant publications on infectious diseases pharmacotherapy in 2014. Am J Health Syst Pharm 2016; 72:1380-92. [PMID: 26246295 DOI: 10.2146/ajhp150112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The most important articles on infectious diseases (ID) pharmacotherapy published in the peer-reviewed literature in 2014, as nominated and selected by panels of pharmacists and others with ID expertise, are summarized. SUMMARY Members of the Houston Infectious Diseases Network were asked to nominate articles published in 2014 from prominent peer-reviewed journals that were felt to have a major impact in the field of ID pharmacotherapy. A list of 19 nominated articles on general ID-related topics and 9 articles specifically related to human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) was compiled. In a national online survey, members of the Society of Infectious Diseases Pharmacists (SIDP) were asked to select from the list 10 general ID articles believed to have made a significant contribution to the field of ID pharmacotherapy and 1 article contributing to HIV/AIDS pharmacotherapy. Of the 291 SIDP members surveyed, 134 (46%) and 56 (19%) participated in the selection of general ID-related articles and HIV/AIDS-related articles, respectively. The 11 highest-ranked papers (10 general ID-related articles, 1 HIV/AIDS-related article) are summarized here. CONCLUSION With the vast number of articles published each year, it is difficult to remain up-to-date on current, significant ID pharmacotherapy publications. This review of significant publications in 2014 may be helpful by lessening this burden.
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Affiliation(s)
- Kady Phe
- Kady Phe, Pharm.D., BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX. Richard M. Cadle, Pharm.D., BCPS (AQ-ID), FASHP, is Clinical Pharmacy Manager and Residency Program Director, Pharmacy Practice (Postgraduate Year 1) and Infectious Disease (Postgraduate Year 2) Programs, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston. Oscar E. Guzman, Pharm.D., BCPS, is Clinical Director, Infectious Diseases and Critical Care, Cardinal Health, Innovative Delivery Solutions, Houston. Ashley M. Lockwood, Pharm.D., is Postgraduate Year 2 Infectious Diseases Pharmacy Resident, Department of Pharmacy, Houston Methodist Hospital, Houston. Katherine K. Perez, Pharm.D., BCPS, is Clinical Specialist, Infectious Diseases, Departments of Pharmacy and Pathology and Genomic Medicine, Houston Methodist Hospital, and Assistant Professor of Health Sciences and Assistant Clinical Member, Institute for Academic Medicine, Houston Methodist Research Institute, Houston. Nancy N. Vuong, Pharm.D., MBIOT, BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy. Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Infectious Diseases, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Richard M Cadle
- Kady Phe, Pharm.D., BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX. Richard M. Cadle, Pharm.D., BCPS (AQ-ID), FASHP, is Clinical Pharmacy Manager and Residency Program Director, Pharmacy Practice (Postgraduate Year 1) and Infectious Disease (Postgraduate Year 2) Programs, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston. Oscar E. Guzman, Pharm.D., BCPS, is Clinical Director, Infectious Diseases and Critical Care, Cardinal Health, Innovative Delivery Solutions, Houston. Ashley M. Lockwood, Pharm.D., is Postgraduate Year 2 Infectious Diseases Pharmacy Resident, Department of Pharmacy, Houston Methodist Hospital, Houston. Katherine K. Perez, Pharm.D., BCPS, is Clinical Specialist, Infectious Diseases, Departments of Pharmacy and Pathology and Genomic Medicine, Houston Methodist Hospital, and Assistant Professor of Health Sciences and Assistant Clinical Member, Institute for Academic Medicine, Houston Methodist Research Institute, Houston. Nancy N. Vuong, Pharm.D., MBIOT, BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy. Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Infectious Diseases, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston
| | - David J Guervil
- Kady Phe, Pharm.D., BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX. Richard M. Cadle, Pharm.D., BCPS (AQ-ID), FASHP, is Clinical Pharmacy Manager and Residency Program Director, Pharmacy Practice (Postgraduate Year 1) and Infectious Disease (Postgraduate Year 2) Programs, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston. Oscar E. Guzman, Pharm.D., BCPS, is Clinical Director, Infectious Diseases and Critical Care, Cardinal Health, Innovative Delivery Solutions, Houston. Ashley M. Lockwood, Pharm.D., is Postgraduate Year 2 Infectious Diseases Pharmacy Resident, Department of Pharmacy, Houston Methodist Hospital, Houston. Katherine K. Perez, Pharm.D., BCPS, is Clinical Specialist, Infectious Diseases, Departments of Pharmacy and Pathology and Genomic Medicine, Houston Methodist Hospital, and Assistant Professor of Health Sciences and Assistant Clinical Member, Institute for Academic Medicine, Houston Methodist Research Institute, Houston. Nancy N. Vuong, Pharm.D., MBIOT, BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy. Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Infectious Diseases, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Oscar E Guzman
- Kady Phe, Pharm.D., BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX. Richard M. Cadle, Pharm.D., BCPS (AQ-ID), FASHP, is Clinical Pharmacy Manager and Residency Program Director, Pharmacy Practice (Postgraduate Year 1) and Infectious Disease (Postgraduate Year 2) Programs, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston. Oscar E. Guzman, Pharm.D., BCPS, is Clinical Director, Infectious Diseases and Critical Care, Cardinal Health, Innovative Delivery Solutions, Houston. Ashley M. Lockwood, Pharm.D., is Postgraduate Year 2 Infectious Diseases Pharmacy Resident, Department of Pharmacy, Houston Methodist Hospital, Houston. Katherine K. Perez, Pharm.D., BCPS, is Clinical Specialist, Infectious Diseases, Departments of Pharmacy and Pathology and Genomic Medicine, Houston Methodist Hospital, and Assistant Professor of Health Sciences and Assistant Clinical Member, Institute for Academic Medicine, Houston Methodist Research Institute, Houston. Nancy N. Vuong, Pharm.D., MBIOT, BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy. Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Infectious Diseases, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Ashley M Lockwood
- Kady Phe, Pharm.D., BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX. Richard M. Cadle, Pharm.D., BCPS (AQ-ID), FASHP, is Clinical Pharmacy Manager and Residency Program Director, Pharmacy Practice (Postgraduate Year 1) and Infectious Disease (Postgraduate Year 2) Programs, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston. Oscar E. Guzman, Pharm.D., BCPS, is Clinical Director, Infectious Diseases and Critical Care, Cardinal Health, Innovative Delivery Solutions, Houston. Ashley M. Lockwood, Pharm.D., is Postgraduate Year 2 Infectious Diseases Pharmacy Resident, Department of Pharmacy, Houston Methodist Hospital, Houston. Katherine K. Perez, Pharm.D., BCPS, is Clinical Specialist, Infectious Diseases, Departments of Pharmacy and Pathology and Genomic Medicine, Houston Methodist Hospital, and Assistant Professor of Health Sciences and Assistant Clinical Member, Institute for Academic Medicine, Houston Methodist Research Institute, Houston. Nancy N. Vuong, Pharm.D., MBIOT, BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy. Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Infectious Diseases, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Katherine K Perez
- Kady Phe, Pharm.D., BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX. Richard M. Cadle, Pharm.D., BCPS (AQ-ID), FASHP, is Clinical Pharmacy Manager and Residency Program Director, Pharmacy Practice (Postgraduate Year 1) and Infectious Disease (Postgraduate Year 2) Programs, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston. Oscar E. Guzman, Pharm.D., BCPS, is Clinical Director, Infectious Diseases and Critical Care, Cardinal Health, Innovative Delivery Solutions, Houston. Ashley M. Lockwood, Pharm.D., is Postgraduate Year 2 Infectious Diseases Pharmacy Resident, Department of Pharmacy, Houston Methodist Hospital, Houston. Katherine K. Perez, Pharm.D., BCPS, is Clinical Specialist, Infectious Diseases, Departments of Pharmacy and Pathology and Genomic Medicine, Houston Methodist Hospital, and Assistant Professor of Health Sciences and Assistant Clinical Member, Institute for Academic Medicine, Houston Methodist Research Institute, Houston. Nancy N. Vuong, Pharm.D., MBIOT, BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy. Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Infectious Diseases, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Nancy N Vuong
- Kady Phe, Pharm.D., BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX. Richard M. Cadle, Pharm.D., BCPS (AQ-ID), FASHP, is Clinical Pharmacy Manager and Residency Program Director, Pharmacy Practice (Postgraduate Year 1) and Infectious Disease (Postgraduate Year 2) Programs, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston. Oscar E. Guzman, Pharm.D., BCPS, is Clinical Director, Infectious Diseases and Critical Care, Cardinal Health, Innovative Delivery Solutions, Houston. Ashley M. Lockwood, Pharm.D., is Postgraduate Year 2 Infectious Diseases Pharmacy Resident, Department of Pharmacy, Houston Methodist Hospital, Houston. Katherine K. Perez, Pharm.D., BCPS, is Clinical Specialist, Infectious Diseases, Departments of Pharmacy and Pathology and Genomic Medicine, Houston Methodist Hospital, and Assistant Professor of Health Sciences and Assistant Clinical Member, Institute for Academic Medicine, Houston Methodist Research Institute, Houston. Nancy N. Vuong, Pharm.D., MBIOT, BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy. Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Infectious Diseases, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Samuel L Aitken
- Kady Phe, Pharm.D., BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX. Richard M. Cadle, Pharm.D., BCPS (AQ-ID), FASHP, is Clinical Pharmacy Manager and Residency Program Director, Pharmacy Practice (Postgraduate Year 1) and Infectious Disease (Postgraduate Year 2) Programs, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston. Oscar E. Guzman, Pharm.D., BCPS, is Clinical Director, Infectious Diseases and Critical Care, Cardinal Health, Innovative Delivery Solutions, Houston. Ashley M. Lockwood, Pharm.D., is Postgraduate Year 2 Infectious Diseases Pharmacy Resident, Department of Pharmacy, Houston Methodist Hospital, Houston. Katherine K. Perez, Pharm.D., BCPS, is Clinical Specialist, Infectious Diseases, Departments of Pharmacy and Pathology and Genomic Medicine, Houston Methodist Hospital, and Assistant Professor of Health Sciences and Assistant Clinical Member, Institute for Academic Medicine, Houston Methodist Research Institute, Houston. Nancy N. Vuong, Pharm.D., MBIOT, BCPS, is Infectious Diseases Pharmacotherapy Fellow, Department of Clinical Sciences and Administration, University of Houston College of Pharmacy. Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Infectious Diseases, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston.
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Pharmacokinetics, Safety and Tolerability of Single Oral or Intravenous Administration of 200 mg Tedizolid Phosphate in Adolescents. Pediatr Infect Dis J 2016; 35:628-33. [PMID: 26910588 DOI: 10.1097/inf.0000000000001096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tedizolid is a novel oxazolidinone antibacterial US FDA approved for treatment of acute bacterial skin and skin structure infections in adults. This study assessed the pharmacokinetics, safety and tolerability of tedizolid phosphate in adolescents (12-17 years old) after administration of a single intravenous (IV) or oral dose. METHODS In this multicenter, open-label study, a single IV infusion (N = 10) or oral dose (N = 10) of 200 mg tedizolid phosphate was administered to adolescents already receiving antibacterial treatment for presumed or documented infection. Blood and urine samples were collected predose and over 24 hours. RESULTS Tedizolid pharmacokinetics was generally similar after IV or oral administration of 200 mg tedizolid phosphate. Mean (standard deviation) half-life values were similar for oral and IV routes, 8.3 (2.0) and 6.6 (0.7) hours, respectively. Absolute oral bioavailability of tedizolid (90% confidence interval) was 88.8% (70.4%-112.1%). Geometric mean ratio (90% confidence interval) of area under the concentration-time curve values for adolescents relative to values previously reported for adults after 200 mg of single-dose IV or oral administration were 0.847 (0.736-0.975). Tedizolid was well tolerated. CONCLUSIONS Overall pharmacokinetics of tedizolid was similar after administration of a single oral or IV 200 mg dose, and bioavailability was high. Exposure profiles were similar to those in adults. With clinical outcomes based on area under the concentration-time curve/minimum inhibitory concentration and current susceptibility of Gram-positive pathogens, results suggest that the 200 mg daily regimen of tedizolid phosphate can be extended to adolescents for clinical trials, and that dose adjustment may not be required when switching routes.
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193
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Obaitan I, Dwyer R, Lipworth AD, Kupper TS, Camargo CA, Hooper DC, Murphy GF, Pallin DJ. Failure of antibiotics in cellulitis trials: a systematic review and meta-analysis. Am J Emerg Med 2016; 34:1645-52. [PMID: 27344098 DOI: 10.1016/j.ajem.2016.05.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/21/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The objectives of the study are to quantify trial-to-trial variability in antibiotic failure rates, in randomized clinical trials of cellulitis treatment and to provide a point estimate for the treatment failure rate across trials. METHODS We conducted a structured search for clinical trials evaluating antibiotic treatment of cellulitis, indexed in PubMed by August 2015. We included studies published in English and excluded studies conducted wholly outside of developed countries because the pathophysiology of cellulitis is likely to be different in such settings. Two authors reviewed all abstracts identified for possible inclusion. Of studies identified initially, 5% met the selection criteria. Two reviewers extracted data independently, and data were pooled using the Freeman-Tukey transformation under a random-effects model. Our primary outcome was the summary estimate of treatment failure across intent-to-treat and clinically evaluable participants. RESULTS We included 19 articles reporting data from 20 studies, for a total of 3935 patients. Treatment failure was reported in 6% to 37% of participants in the 9 trials reporting intent-to-treat results, with a summary point estimate of 18% failing treatment (95% confidence interval, 15%-21%). In the 15 articles evaluating clinically evaluable participants, treatment failure rates ranged from 3% to 42%, and overall, 12% (95% confidence interval, 10%-14%) were designated treatment failures. CONCLUSIONS Treatment failure rates vary widely across cellulitis trials, from 6% to 37%. This may be due to confusion of cellulitis with its mimics and perhaps problems with construct validity of the diagnosis of cellulitis. Such factors bias trials toward equivalence and, in routine clinical care, impair quality and antibiotic stewardship. Objective diagnostic tools are needed.
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Affiliation(s)
- Itegbemie Obaitan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Richard Dwyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Adam D Lipworth
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA
| | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - David C Hooper
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | - George F Murphy
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
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Kaku N, Morinaga Y, Takeda K, Kosai K, Uno N, Hasegawa H, Miyazaki T, Izumikawa K, Mukae H, Yanagihara K. Antimicrobial and immunomodulatory effects of tedizolid against methicillin-resistant Staphylococcus aureus in a murine model of hematogenous pulmonary infection. Int J Med Microbiol 2016; 306:421-8. [PMID: 27259840 DOI: 10.1016/j.ijmm.2016.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/09/2016] [Accepted: 05/12/2016] [Indexed: 02/07/2023] Open
Abstract
Tedizolid (TZD) is a second-generation oxazolidinone and demonstrates potent in-vitro activity against multidrug-resistant Gram-positive bacteria. Phase III studies in patients with acute bacterial skin and skin structure infections (ABSSSI) have demonstrated the non-inferiority of TZD to linezolid (LZD). However, there are only a few studies that show the effect of TZD in pulmonary infections. In this study, we investigated the effect of TZD in a murine model of hematogenous pulmonary infection caused by methicillin-resistant Staphylococcus aureus (MRSA). The mice were treated either twice daily with saline (control), 25mg/kg of vancomycin (low-VAN), 110mg/kg of vancomycin (high-VAN), 120mg/kg of LZD or once daily with 20mg/kg of TZD. As compared to the control, the low- and high-VAN treatment groups, LZD and TZD significantly improved the survival rate, reduced the bacterial count in the lungs. Furthermore, TZD decreased the area of central bacterial colony zone (CBCZ) at 36h post-inoculation, compared with the control. In addition, we investigated the immunomodulatory effect of TZD by evaluating the plasma concentrations of the inflammatory cytokines. Although there were no significant differences in the bacterial count in the lungs amongst the drugs at 26h post-inoculation, TZD and LZD significantly improved the plasma concentrations of TNF-alpha, IL-6 and MIP-2, in comparison with the control. In this study, both TZD and LZD demonstrated antimicrobial and immunomodulatory efficacy in a murine model of hematogenous pulmonary infection caused by MRSA.
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Affiliation(s)
- Norihito Kaku
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan.
| | - Yoshitomo Morinaga
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Kazuaki Takeda
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan; Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Kosuke Kosai
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Naoki Uno
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Hiroo Hasegawa
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Taiga Miyazaki
- Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Hiroshi Mukae
- Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Japan
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195
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Vincent JL, Bassetti M, François B, Karam G, Chastre J, Torres A, Roberts JA, Taccone FS, Rello J, Calandra T, De Backer D, Welte T, Antonelli M. Advances in antibiotic therapy in the critically ill. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:133. [PMID: 27184564 PMCID: PMC4869332 DOI: 10.1186/s13054-016-1285-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Infections occur frequently in critically ill patients and their management can be challenging for various reasons, including delayed diagnosis, difficulties identifying causative microorganisms, and the high prevalence of antibiotic-resistant strains. In this review, we briefly discuss the importance of early infection diagnosis, before considering in more detail some of the key issues related to antibiotic management in these patients, including controversies surrounding use of combination or monotherapy, duration of therapy, and de-escalation. Antibiotic pharmacodynamics and pharmacokinetics, notably volumes of distribution and clearance, can be altered by critical illness and can influence dosing regimens. Dosing decisions in different subgroups of patients, e.g., the obese, are also covered. We also briefly consider ventilator-associated pneumonia and the role of inhaled antibiotics. Finally, we mention antibiotics that are currently being developed and show promise for the future.
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 1070, Brussels, Belgium.
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, 33100, Udine, Italy
| | - Bruno François
- Service de Réanimation Polyvalente, CHU de Dupuytren, 87042, Limoges, France
| | - George Karam
- Infectious Disease Section, Louisiana State University School of Medicine, 70112, New Orleans, LA, USA
| | - Jean Chastre
- Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Antoni Torres
- Department of Pulmonary Medicine, Hospital Clinic of Barcelona, IDIBAPS-Ciberes, 08036, Barcelona, Spain
| | - Jason A Roberts
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, Royal Brisbane and Women's Hospital, 4029 Herston, Brisbane, Australia
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, 1070, Brussels, Belgium
| | - Jordi Rello
- Department of Intensive care, CIBERES, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, 08035, Barcelona, Spain
| | - Thierry Calandra
- Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois, University of Lausanne, 1011, Lausanne, Switzerland
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospital, Université Libre de Bruxelles, 1420, Braine L'Alleud, Belgium
| | - Tobias Welte
- Department of Respiratory Medicine, Medizinische Hochschule, 30625, Hannover, Germany
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Rome, Italy
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196
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Esposito S, Bassetti M, Bonnet E, Bouza E, Chan M, De Simone G, Dryden M, Gould I, Lye DC, Saeed K, Segreti J, Unal S, Yalcin AN. Hot topics in the diagnosis and management of skin and soft-tissue infections. Int J Antimicrob Agents 2016; 48:19-26. [PMID: 27216380 DOI: 10.1016/j.ijantimicag.2016.04.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 12/16/2022]
Abstract
Eighteen hot topics regarding the diagnosis and management of skin and soft-tissue infections (SSTIs) were selected and reviewed by members of the SSTI Working Group of the International Society of Chemotherapy (ISC). Despite the large amount of literature available on the issue selected, there are still many unknowns with regard to many of them and further studies are required to answer these challenging issues that face clinicians on a daily basis.
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Affiliation(s)
- Silvano Esposito
- Department of Infectious Diseases, University of Salerno, Salerno, Italy.
| | - Matteo Bassetti
- Department of Infectious Diseases, Santa Maria Misericordia Hospital, Udine, Italy
| | - Eric Bonnet
- Department of Infectious Diseases, Hôpital Joseph Ducuing, Toulouse, France
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Monica Chan
- Department of Infectious Diseases, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore
| | - Giuseppe De Simone
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Matthew Dryden
- Hampshire Hospitals Foundation Trust, Winchester, UK; Southampton University School of Medicine, Southampton, UK; Rare and Imported Pathogens Department, Public Health England, UK
| | - Ian Gould
- Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - David Chien Lye
- Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kordo Saeed
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK; Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Basingstoke, UK; University of Southampton Medical School, Southampton, UK
| | - John Segreti
- Department of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Serhat Unal
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ata Nevzat Yalcin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Dou JL, Jiang YW, Xie JQ, Zhang XG. New Is Old, and Old Is New: Recent Advances in Antibiotic-Based, Antibiotic-Free and Ethnomedical Treatments against Methicillin-Resistant Staphylococcus aureus Wound Infections. Int J Mol Sci 2016; 17:E617. [PMID: 27120596 PMCID: PMC4881443 DOI: 10.3390/ijms17050617] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 12/26/2022] Open
Abstract
Staphylococcus aureus is the most common pathogen of wound infections. Thus far, methicillin-resistant S. aureus (MRSA) has become the major causative agent in wound infections, especially for nosocomial infections. MRSA infections are seldom eradicated by routine antimicrobial therapies. More concerning, some strains have become resistant to the newest antibiotics of last resort. Furthermore, horizontal transfer of a polymyxin resistance gene, mcr-1, has been identified in Enterobacteriaceae, by which resistance to the last group of antibiotics will likely spread rapidly. The worst-case scenario, "a return to the pre-antibiotic era", is likely in sight. A perpetual goal for antibiotic research is the discovery of an antibiotic that lacks resistance potential, such as the recent discovery of teixobactin. However, when considering the issue from an ecological and evolutionary standpoint, it is evident that it is insufficient to solve the antibiotic dilemma through the use of antibiotics themselves. In this review, we summarized recent advances in antibiotic-based, antibiotic-free and ethnomedical treatments against MRSA wound infections to identify new clues to solve the antibiotic dilemma. One potential solution is to use ethnomedical drugs topically. Some ethnomedical drugs have been demonstrated to be effective antimicrobials against MRSA. A decline in antibiotic resistance can therefore be expected, as has been demonstrated when antibiotic-free treatments were used to limit the use of antibiotics. It is also anticipated that these drugs will have low resistance potential, although there is only minimal evidence to support this claim to date. More clinical trials and animal tests should be conducted on this topic.
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Affiliation(s)
- Jian-Lin Dou
- Institute of Pathogenic Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.
| | - Yi-Wei Jiang
- Spinal Surgery Department, Affiliated Hospital of Gansu University of Chinese Medicines, Lanzhou 730020, China.
| | - Jun-Qiu Xie
- Institute of Pathogenic Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.
| | - Xiao-Gang Zhang
- Spinal Surgery Department, Affiliated Hospital of Gansu University of Chinese Medicines, Lanzhou 730020, China.
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198
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VanEperen AS, Segreti J. Empirical therapy in Methicillin-resistant Staphylococcus Aureus infections: An Up-To-Date approach. J Infect Chemother 2016; 22:351-9. [PMID: 27066882 DOI: 10.1016/j.jiac.2016.02.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) continues to be an important pathogen worldwide, with high prevalence of infection in both community and hospital settings. Timely and appropriate choice of empirical therapy in the setting of MRSA infection is imperative due to the high rate of associated morbidity and mortality with MRSA infections. Initial choices should be made based on the site and severity of the infection, most notably moderate skin and soft tissue infections which may be treated with oral antibiotics (trimethoprim-sulfamethoxazole, clindamycin, doxycycline/minocycline, linezolid) in the outpatient setting, versus choice of parenteral therapy in the inpatient setting of more invasive or severe disease. Though the current recommendations continue to strongly rely on vancomycin as a standard empiric choice in the setting of severe/invasive infections, alternative therapies exist with studies supporting their non-inferiority. This includes the use of linezolid in pneumonia and severe skin and skin structure infections (SSSI) and daptomycin for MRSA bacteremia, endocarditis, SSSIs and bone/joint infections. Additionally, concerns continue to arise in regards to vancomycin, such as increasing isolate MICs, and relatively high rates of clinical failures with vancomycin. Thus, the growing interest in vanomycin alternatives, such as ceftaroline, ceftobribole, dalbavancin, oritavancin, and tedizolid, and their potential role in treating MRSA infections.
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Affiliation(s)
- Alison S VanEperen
- Section of Infectious Diseases, Rush University Medical Center, 600 South Paulina, Suite 143 Armour Academic Facility, Chicago, IL 60612, USA
| | - John Segreti
- Section of Infectious Diseases, Rush University Medical Center, 600 South Paulina, Suite 143 Armour Academic Facility, Chicago, IL 60612, USA.
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Falcó V, Burgos J, Papiol E, Ferrer R, Almirante B. Investigational drugs in phase I and phase II clincial trials for the treatment of hospital-acquired pneumonia. Expert Opin Investig Drugs 2016; 25:653-65. [PMID: 26998623 DOI: 10.1517/13543784.2016.1168803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hospital acquired pneumonia (HAP) is one of the main infections acquired by patients during a stay in hospital. The main issue when dealing with patients with HAP and ventilator associated pneumonia (VAP) is the increasing role of multi-drug resistant organisms (MDROs). AREAS COVERED In this review the authors summarize the actual situation of MDROs as a cause of HAP and VAP. They also review the current treatment options stated in the most important international guidelines. Finally, they focus on the investigational drugs that have reached the phase III stage of development and the novel compounds that are being studied in phase I and II clinical trials. EXPERT OPINION Thanks to their excellent activity against MDROs, drugs in development for the treatment of HAP and VAP can significantly improve the therapeutic options available. In selected patients, the possibility to administer directed therapy with monoclonal antibodies to specific pathogens is an exciting strategy in the fight against widespread resistance.
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Affiliation(s)
- Vicenç Falcó
- a Infectious Diseases Department, University Hospital Vall d'Hebron , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Joaquin Burgos
- a Infectious Diseases Department, University Hospital Vall d'Hebron , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Elisabeth Papiol
- b Intensive Care Department, University Hospital Vall d'Hebron , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Ricard Ferrer
- b Intensive Care Department, University Hospital Vall d'Hebron , Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Benito Almirante
- a Infectious Diseases Department, University Hospital Vall d'Hebron , Universitat Autònoma de Barcelona , Barcelona , Spain
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200
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New Gram-Positive Agents: the Next Generation of Oxazolidinones and Lipoglycopeptides. J Clin Microbiol 2016; 54:2225-32. [PMID: 26962092 DOI: 10.1128/jcm.03395-15] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The growing problem of antimicrobial resistance among bacterial pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), has reached a critical state. Tedizolid phosphate, dalbavancin, and oritavancin have recently been approved by the U.S. Food and Drug Administration (FDA) for the treatment of acute bacterial skin and skin structure infections (ABSSSI) and represent the next generation of oxazolidinones and lipoglycopeptides. All three agents exhibit in vitro activity and clinical efficacy against MRSA. Tedizolid phosphate and oritavancin demonstrate in vitro activity against VRE. These new Gram-positive agents are reviewed here.
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