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Haddad N, Carr M, Balian S, Lannin J, Kim Y, Toth C, Jarvis J. The Blood-Brain Barrier and Pharmacokinetic/Pharmacodynamic Optimization of Antibiotics for the Treatment of Central Nervous System Infections in Adults. Antibiotics (Basel) 2022; 11:antibiotics11121843. [PMID: 36551500 PMCID: PMC9774927 DOI: 10.3390/antibiotics11121843] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Bacterial central nervous system (CNS) infections are serious and carry significant morbidity and mortality. They encompass many syndromes, the most common being meningitis, which may occur spontaneously or as a consequence of neurosurgical procedures. Many classes of antimicrobials are in clinical use for therapy of CNS infections, some with established roles and indications, others with experimental reporting based on case studies or small series. This review delves into the specifics of the commonly utilized antibacterial agents, updating their therapeutic use in CNS infections from the pharmacokinetic and pharmacodynamic perspectives, with a focus on the optimization of dosing and route of administration that have been described to achieve good clinical outcomes. We also provide a concise synopsis regarding the most focused, clinically relevant information as pertains to each class and subclass of antimicrobial therapeutics. CNS infection morbidity and mortality remain high, and aggressive management is critical in ensuring favorable patient outcomes while averting toxicity and upholding patient safety.
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Affiliation(s)
- Nicholas Haddad
- College of Medicine, Central Michigan University (CMU), Mt Pleasant, MI 48859, USA
- Correspondence: ; Tel.: +1-(989)-746-7860
| | | | - Steve Balian
- CMU Medical Education Partners, Saginaw, MI 48602, USA
| | | | - Yuri Kim
- CMU Medical Education Partners, Saginaw, MI 48602, USA
| | - Courtney Toth
- Ascension St. Mary’s Hospital, Saginaw, MI 48601, USA
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Kaur R, Singh R, Kumar A, Kaur S, Priyadarshi N, Singhal NK, Singh K. 1,2,3-Triazole β-lactam conjugates as antimicrobial agents. Heliyon 2020; 6:e04241. [PMID: 32637684 PMCID: PMC7327255 DOI: 10.1016/j.heliyon.2020.e04241] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/29/2020] [Accepted: 06/15/2020] [Indexed: 01/12/2023] Open
Abstract
A convenient and efficient synthesis of new triazole β-lactam conjugates using click chemistry is described. β-lactam 15 and 16 were prepared using cycloaddition strategy and propargylated at N-1 to afford compounds 17 and 18. Cu-catalyzed click reaction of these β-lactams 17 and 18 with different aryl azides provided 1,2,3-triazole conjugates 6 and 7, respectively. The products were fully characterized spectroscopically and tested against Gram-(+) and Gram-(-) bacteria. Compound 7a and 7c were found to be most active.
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Affiliation(s)
- Rajneesh Kaur
- Department of Chemistry, MMEC, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, 133207, India
| | - Raman Singh
- Department of Chemistry, MMEC, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, 133207, India
| | - Antresh Kumar
- Department of Biotechnology, Central University of South Bihar, Panchanpur, Gaya, 824236, India
- Department of Biochemistry, Central University of Haryana, Mahendergarh, Haryana, 123031, India
| | - Satvinder Kaur
- Department of Chemistry, MMEC, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, 133207, India
| | - Nitesh Priyadarshi
- National Agri-Food Biotechnology Institute (NABI), Sector-81, S.A.S. Nagar, Mohali, Punjab, 140306, India
| | - Nitin Kumar Singhal
- National Agri-Food Biotechnology Institute (NABI), Sector-81, S.A.S. Nagar, Mohali, Punjab, 140306, India
| | - Kuldeep Singh
- Department of Chemistry, MMEC, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, 133207, India
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Abstract
Understanding the breadth of systemic antimicrobial agents available for use by the dermatologist and their associated side-effect profiles and drug interactions allows the clinician to offer patients optimal care in the management of cutaneous infectious disease.
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Affiliation(s)
- N S Sadick
- Department of Dermatology, Weill Medical College of Cornell University, New York City, New York, USA
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Epstein ME, Amodio-Groton M, Sadick NS. Antimicrobial agents for the dermatologist. I. Beta-lactam antibiotics and related compounds. J Am Acad Dermatol 1997; 37:149-65; quiz 166-8. [PMID: 9270499 DOI: 10.1016/s0190-9622(97)80118-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We review the newer antimicrobial agents that are being employed by dermatologists with increased frequency as well as some of the more commonly used older agents. Particular emphasis is based on selection factors such as causative pathogens and their resistance profiles, routes of administration, toxicity, drug interactions, and dosing requirements. Emphasis in this review is on the newer classes of antimicrobials such as third- and fourth-generation cephalosporins; beta-lactam, beta-lactamase inhibitor combination agents; monobactams; carbapenems; macrolides; and fluoroquinolones. Dermatologic indications and treatment alternatives are highlighted; this will expand the practicing clinician's therapeutic armamentarium and enable him/her to make rational decisions concerning treatment approaches to infectious disease problems encountered in daily practice.
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Affiliation(s)
- M E Epstein
- Department of Medicine, North Shore University Hospital, Manhasset, New York, USA
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Abstract
Aztreonam is a monocyclic beta-lactam antibiotic that is active exclusively against the aerobic gram-negative bacilli. It is not ototoxic or nephrotoxic and so is used as an alternative to aminoglycosides in a variety of clinical situations. In polymicrobial infections or when used for empiric therapy, aztreonam must be combined with other antimicrobial agents active against gram-positive and anaerobic species. Aztreonam is often effective against resistant strains of gram-negative organisms, which are often involved in nosocomial infections. Overuse of aztreonam should be avoided to prevent the emergence of resistant P. aeruginosa strains. Except in the treatment of P. aeruginosa infections, aztreonam should not be added to beta-lactam regimens for additional gram-negative coverage.
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Affiliation(s)
- D H Johnson
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, USA
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Abstract
Treatment of infectious diseases comprises a large part of emergency medicine practice. The management of infectious diseases in the emergency department is often different than in other settings because of the types of infectious presentations and the frequent necessity of empiric treatment decisions. This paper examines the new antimicrobials and their role for the treatment of infections in the ED.
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Affiliation(s)
- D A Talan
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar
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Abstract
Aztreonam is the first monobactam and is unique among beta-lactam antibiotics for its spectrum of activity that is exclusively active against gram-negative aerobic bacteria. Broad clinical experience with this agent supports its use in the treatment of adults with severe or complicated urologic infections. Aztreonam may be safely used in patients with penicillin allergy. With a spectrum of activity that is comparable to the aminoglycosides but without the potential for ototoxicity or nephrotoxicity, aztreonam represents a rational choice of therapy for treatment of systemic urinary tract infections due to susceptible organisms.
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Affiliation(s)
- B A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York
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Abstract
Although there are many new antimicrobial agents, many of the old antibiotics are still useful in the treatment of infections, particularly those in the community. Antimicrobial resistance patterns and special pharmacologic properties should influence the selection of newer antimicrobial agents. Change from parenteral therapy to oral therapy should increase to avoid the complications of intravenous therapy and to reduce hospital costs. Older antibiotics that are less costly should be used when the etiology and susceptibility of infecting pathogens are known. There will continue to be new antibiotics produced. Understanding the microbiologic and pharmacologic advantages of the new agents compared with older agents is essential if the new agents are to be used properly and not destroyed by inappropriate use.
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Affiliation(s)
- H C Neu
- College of Physicians & Surgeons, Columbia University, New York, NY 10032
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