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Matera MG, Rinaldi B, de Novellis V, Rogliani P, Cazzola M. Current and emerging treatment modalities for bacterial rhinosinusitis in adults: A comprehensive review. Expert Opin Pharmacother 2022; 23:2013-2022. [DOI: 10.1080/14656566.2022.2147825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Barbara Rinaldi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vito de Novellis
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
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2
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Kiedrowska M, Foryś WJ, Gołębiewska A, Waśko I, Ronkiewicz P, Kuch A, Wróbel-Pawelczyk I, Wroczyński M, Hryniewicz W, Skoczyńska A. Antimicrobial resistance among Haemophilus influenzae isolates responsible for lower respiratory tract infections in Poland, 2005-2019. Eur J Clin Microbiol Infect Dis 2022; 41:961-969. [PMID: 35585442 DOI: 10.1007/s10096-022-04457-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
Haemophilus influenzae is a human-specific pathogen responsible for respiratory tract infections, meningitis, and sepsis. The study aimed to characterize antibiotic resistance in H. influenzae strains isolated from patients with lower respiratory tract infections over 15 years in Poland. The minimum inhibitory concentrations (MICs) of clinically relevant antibiotics were determined by broth microdilution method. Screening for beta-lactam resistance was performed in all isolates following EUCAST recommendation. Finally, relevant changes in penicillin-binding protein 3 (PBP3) were detected by PCR screening. Of the 1481 isolates collected between 2005 and 2019, 12.6%, 0.2%, 17.1%, and 0.2% were resistant to ampicillin, amoxicillin/clavulanate, cefuroxime, and ceftriaxone, respectively. Among them, 74.4% (1102/1481) of isolates were categorized as BLNAS (β-lactamase negative, ampicillin-susceptible), 13.0% (192/1481) as BLNAS with modified PBP3 (mutations in ftsI gene), 2.6% (39/1481) as BLNAR (β-lactamase negative, ampicillin-resistant), and 0.2% had PBP3 modifications typical for high-BLNAR. Production of β-lactamase characterized 9.7% of isolates (8.6% BLPAR-β-lactamase-positive, ampicillin-resistant, and 1.1% BLPACR-β-lactamase-positive, amoxicillin-clavulanate resistant). Three isolates with PBP3 modifications typical for high-BLNAR proved resistant to ceftriaxone (MIC > 0.125 mg/L). Resistance to ciprofloxacin, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole was observed in 0.1%, 0.5%, 1.6%, and 24.7% of isolates, respectively. This is the first report of Polish H. influenzae isolates resistant to third-generation cephalosporins. Polish H. influenzae isolates demonstrate similar susceptibility trends as in many other countries. The substantial proportion of β-lactam-resistant isolates and the emergence of those resistant to third-generation cephalosporins are of great concern and should be under surveillance.
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Affiliation(s)
- Marlena Kiedrowska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland.
| | | | - Agnieszka Gołębiewska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Izabela Waśko
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland.,Department of Biomedical Research, National Medicines Institute, Warsaw, Poland
| | - Patrycja Ronkiewicz
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Alicja Kuch
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Izabela Wróbel-Pawelczyk
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Michał Wroczyński
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland.,Faculty of Agriculture and Biology, Warsaw University of Life Sciences, Warsaw, Poland
| | - Waleria Hryniewicz
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Anna Skoczyńska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
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3
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Bassetti M, Melchio M, Giacobbe DR. Delafloxacin for the treatment of adult patients with community-acquired bacterial pneumonia. Expert Rev Anti Infect Ther 2021; 20:649-656. [PMID: 34913817 DOI: 10.1080/14787210.2021.2020098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Delafloxacin is a novel fluoroquinolone with peculiar characteristics such as a weak acid character, frequent in vitro activity against methicillin-resistant Staphylococcus aureus (MRSA), and a low potential for resistance selection compared with other fluoroquinolones. AREAS COVERED The present narrative review summarizes the available data on the use of delafloxacin for the treatment of community-acquired bacterial pneumonia (CABP). EXPERT OPINION Delafloxacin is a novel fluoroquinolone with a unique profile and some interesting characteristics for the treatment of CABP, such as its marked activity against gram-positive bacteria, including MRSA, the possible use as monotherapy (owing to anti-Gram-negative and anti-atypical bacteria activity), the retained activity against many Gram-positive organisms resistant to other fluoroquinolones, and the availability of both oral and intravenous formulations. The results of the DEFINE-CABP phase-3 randomized controlled trial have shown noninferiority of delafloxacin vs. moxifloxacin for the treatment of CABP, thereby providing a further option for this indication. Against this background, future post-marketing experiences remain of crucial importance for further refining the place in therapy of delafloxacin in the real-life management algorithms of CABP, either as first-line option or step-down/outpatient treatment.
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Affiliation(s)
- Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, San Martino Policlinico Hospital - IRCCS, Genoa, Italy
| | - Monica Melchio
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, San Martino Policlinico Hospital - IRCCS, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, San Martino Policlinico Hospital - IRCCS, Genoa, Italy
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4
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Cefotaxime-non-susceptibility of Haemophilus influenzae induced by additional amino acid substitutions of G555E and Y557H in altered penicillin-binding protein 3. J Infect Chemother 2019; 25:509-513. [PMID: 30879978 DOI: 10.1016/j.jiac.2019.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/13/2019] [Accepted: 02/18/2019] [Indexed: 11/21/2022]
Abstract
Cefotaxime-non-susceptible Haemophilus influenzae has rarely been isolated from clinical specimens. Although several reports have shown that amino acid (AA) alteration in penicillin-binding protein 3 (PBP3), encoded by the ftsI gene, reduces activity of cefotaxime, precise mechanisms conferring the non-susceptibility have been unclear. We analyzed the ftsI gene of two clinically isolated cefotaxime-non-susceptible H. influenzae strains, 16-11 and 20-07 (minimum inhibitory concentrations [MICs]: 16 and 8 μg/mL, respectively), and found that their deduced AA sequences of PBP3 included two AA substitutions of G555E and Y557H in addition to previously described AA alterations. To clarify whether the two additional substitutions are requisite for cefotaxime non-susceptibility, we produced transformants of Rd KW20 (cefotaxime MIC: ≤0.06 μg/mL) with the ftsI gene of 16-11. Cefotaxime MICs against transformants M1 and M2, of which deduced PBP3s were altered with that of 16-11 entirely and partially (only the N-terminal side up to the AA position 519), were 8 and 0.25 μg/mL, respectively. We also produced M2-555/7 through site-directed mutagenesis inducing additional substitutions of G555E and Y557H into the PBP3 of M2, against which cefotaxime MIC was 8 μg/mL. These findings show that the additional substitutions of G555E and Y557H in PBP3 with previously described alterations cause cefotaxime non-susceptibility. An additional substitution of either G555E or Y557H alone in altered PBP3 reduced cefotaxime activity but the elevation of MICs were within the category of susceptibility. To our knowledge, this is the first study clarifying a genetic factor in the PBP3 causing cefotaxime non-susceptibility among H. influenzae strains.
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5
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Homma T, Kawahara T, Mikuni H, Uno T, Sato H, Fujiwara A, Uchida Y, Fukuda Y, Manabe R, Ida H, Kuwahara N, Kimura T, Hirai K, Miyata Y, Jinno M, Yamaguchi M, Kishino Y, Murata Y, Ohta S, Yamamoto M, Watanabe Y, Yamaguchi H, Kusumoto S, Suzuki S, Tanaka A, Yokoe T, Ohnishi T, Sagara H. Beneficial Effect of Early Intervention with Garenoxacin for Bacterial Infection-Induced Acute Exacerbation of Bronchial Asthma and Chronic Obstructive Pulmonary Disease. Int Arch Allergy Immunol 2019; 178:355-362. [PMID: 30759444 DOI: 10.1159/000495761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 11/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and asthma have similar clinical features and are both exacerbated by airway infection. OBJECTIVE To determine whether garenoxacin mesylate hydrate (GRNX) added to the standard care for bacterial infection-induced acute exacerbation of asthma or COPD in adults has clinical benefits. METHOD This single-arm clinical trial was conducted from January 2015 to March 2016. Adults with a history of asthma or COPD for more than 12 months were recruited within 48 h of presentation with fever and acute deterioration of asthma or COPD requiring additional intervention. Participants were administered 400 mg GRNX daily for 7 days without additional systemic corticosteroids or other antibiotics. The primary outcome was efficacy of GRNX based on clinical symptoms and blood test results after 7 days of treatment. Secondary outcomes were: (1) comparison of the blood test results, radiograph findings, and bacterial culture surveillance before and after treatment; (2) effectiveness of GRNX after 3 days of administration; (3) analyzation of patient symptoms based on patient diary; and (4) continued effectiveness of GRNX on 14th day after the treatment (visit 3). RESULTS The study included 44 febrile patients (34 asthma and 10 COPD). Frequently isolated bacteria included Moraxella catarrhalis (n = 6) and Klebsiella pneumoniae (n = 4). On visit 2, 40 patients responded, and no severe adverse events were observed. All secondary outcomes showed favorable results. CONCLUSION GRNX effectively treated asthma and COPD patients with acute bacterial infection without severe adverse events. Further research with a larger study population is needed.
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Affiliation(s)
- Tetsuya Homma
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan,
| | - Tomoko Kawahara
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hatsuko Mikuni
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tomoki Uno
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Haruna Sato
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Akiko Fujiwara
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshitaka Uchida
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yosuke Fukuda
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Ryo Manabe
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hitomi Ida
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Naota Kuwahara
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tomoyuki Kimura
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kuniaki Hirai
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshito Miyata
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Megumi Jinno
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Munehiro Yamaguchi
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yasunari Kishino
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yasunori Murata
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shin Ohta
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Mayumi Yamamoto
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshio Watanabe
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hirofumi Yamaguchi
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Sojiro Kusumoto
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shintaro Suzuki
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Tanaka
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takuya Yokoe
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tsukasa Ohnishi
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hironori Sagara
- Division of Allergology and Respiratory Medicine, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
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6
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Cho JC, Crotty MP, White BP, Worley MV. What Is Old Is New Again: Delafloxacin, a Modern Fluoroquinolone. Pharmacotherapy 2017; 38:108-121. [PMID: 29059465 DOI: 10.1002/phar.2050] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Delafloxacin is a new fluoroquinolone antimicrobial approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) in adults using dosage regimens of 300 mg intravenously every 12 hours, 450 mg orally every 12 hours, or switching from intravenous to oral regimens for a 5- to 14-day treatment duration. Dosage adjustments in patients with severe renal dysfunction (estimated glomerular filtration rate [eGFR] = 15-29 ml/min/1.73 m2 ) are not required for oral doses but should be decreased to 200 mg intravenously every 12 hours in patients requiring parenteral therapy. Due to insufficient data, use of delafloxacin is not recommended for patients on hemodialysis or with end-stage renal disease (eGFR < 15 ml/min/1.73 m2 ). Delafloxacin works through inhibition of DNA gyrase (topoisomerase II) and topoisomerase IV, which are essential enzymes for bacterial DNA transcription, replication, repair, and recombination and exhibits bactericidal activity against gram-positive and gram-negative organisms through a concentration-dependent matter. Delafloxacin has a very broad spectrum of activity against atypical, anaerobic, and resistant gram-negative and gram-positive bacteria, including methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. During phase 3 trials, the most common side effects associated with delafloxacin were gastrointestinal (nausea, diarrhea). Unlike other fluoroquinolones, there does not seem to be a risk of QTc prolongation or phototoxicity with delafloxacin. The availability of both parenteral and oral formulations for delafloxacin distinguishes it from many of the currently available agents approved for ABSSSIs. Phase 3 studies for the treatment of respiratory infections are currently under way, and future results of these studies will further help delineate the role of delafloxacin.
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Affiliation(s)
- Jonathan C Cho
- College of Pharmacy, The University of Texas at Tyler, Tyler, Texas
| | - Matthew P Crotty
- Department of Pharmacy, Methodist Dallas Medical Center, Dallas, Texas
| | - Bryan P White
- Department of Pharmacy, OU Medical Center, Oklahoma City, Oklahoma
| | - Marylee V Worley
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida
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7
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Kocsis B, Szabo D. New treatment options for lower respiratory tract infections. Expert Opin Pharmacother 2017; 18:1345-1355. [DOI: 10.1080/14656566.2017.1363179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bela Kocsis
- Institute of Medical Microbiology, Semmelweis University , Budapest, Hungary
| | - Dora Szabo
- Institute of Medical Microbiology, Semmelweis University , Budapest, Hungary
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8
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Candel FJ, Peñuelas M. Delafloxacin: design, development and potential place in therapy. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:881-891. [PMID: 28356714 PMCID: PMC5367733 DOI: 10.2147/dddt.s106071] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Delafloxacin (DLX) is a new fluoroquinolone pending approval, which has shown a good in vitro and in vivo activity against major pathogens associated with skin and soft tissue infections and community-acquired respiratory tract infections. DLX also shows good activity against a broad spectrum of microorganisms, including those resistant to other fluoroquinolones, as methicillin-resistant Staphylococcus aureus. Its pharmacokinetic properties and excellent activity in acidic environments make DLX an alternative in the treatment of these and other infections. In this manuscript, a detailed analysis of this new fluoroquinolone is performed, from its chemical structure to its in vivo activity in recently published clinical trials. Its possible place in the current antimicrobial outlook and in other infectious models is also discussed.
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Affiliation(s)
- Francisco Javier Candel
- Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Marina Peñuelas
- Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
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9
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Yoon YK, Park CS, Kim JW, Hwang K, Lee SY, Kim TH, Park DY, Kim HJ, Kim DY, Lee HJ, Shin HY, You YK, Park DA, Kim SW. Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections. Infect Chemother 2017; 49:326-352. [PMID: 29299900 PMCID: PMC5754344 DOI: 10.3947/ic.2017.49.4.326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 12/20/2022] Open
Abstract
These guidelines were developed as part of the 2016 Policy Research Servicing Project by the Korea Centers for Disease Control and Prevention. A multidisciplinary approach was taken to formulate this guideline to provide practical information about the diagnosis and treatment of adults with acute upper respiratory tract infection, with the ultimate aim to promote the appropriate use of antibiotics. The formulation of this guideline was based on a systematic literature review and analysis of the latest research findings to facilitate evidence-based practice, and focused on key questions to help clinicians obtain solutions to clinical questions that may arise during the care of a patient. These guidelines mainly cover the subjects on the assessment of antibiotic indications and appropriate selection of antibiotics for adult patients with acute pharyngotonsillitis or acute sinusitis.
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Affiliation(s)
- Young Kyung Yoon
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chan Soon Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Wook Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Kyurin Hwang
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Sei Young Lee
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Do Yang Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Hyun Jun Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Dong Young Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Hyun Jong Lee
- Korean Association of Otorhinolaryngologists, Seoul, Korea
| | - Hyun Young Shin
- Korean Association of Family Medicine, Seoul, Korea.,Department of Family Medicine, Myongji Hospital, Seonam University, College of Medicine, Goyang, Korea
| | - Yong Kyu You
- Korean Medical Practitioners Association, Seoul, Korea.,Department of Internal Medicine, Nammoon Medical Clinic, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Shin Woo Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Korean Society for Chemotherapy, Seoul, Korea.,Department of Internal Medicine, Kungpook National University, School of Medicine, Daegu, Korea.
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10
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Flamm RK, Rhomberg PR, Huband MD, Farrell DJ. In Vitro Activity of Delafloxacin Tested against Isolates of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Antimicrob Agents Chemother 2016; 60:6381-5. [PMID: 27458220 PMCID: PMC5038254 DOI: 10.1128/aac.00941-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/18/2016] [Indexed: 11/20/2022] Open
Abstract
Delafloxacin, an investigational anionic fluoroquinolone, is active against a broad range of Gram-positive and Gram-negative bacteria. In this study, 200 Streptococcus pneumoniae (plus 30 levofloxacin-resistant isolates), 200 Haemophilus influenzae, and 100 Moraxella catarrhalis isolates selected primarily from the United States (2014) were tested against delafloxacin and comparator agents. Delafloxacin was the most potent agent tested. MIC50 and MIC90 values against all S. pneumoniae isolates were 0.008 and 0.015 μg/ml. Delafloxacin susceptibility was not affected by β-lactamase status against H. influenzae and M. catarrhalis.
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11
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Van Bambeke F. Delafloxacin, a non-zwitterionic fluoroquinolone in Phase III of clinical development: evaluation of its pharmacology, pharmacokinetics, pharmacodynamics and clinical efficacy. Future Microbiol 2015; 10:1111-23. [PMID: 26119479 DOI: 10.2217/fmb.15.39] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Delafloxacin is a fluoroquinolone lacking a basic substituent in position 7. It shows MICs remarkably low against Gram-positive organisms and anaerobes and similar to those of ciprofloxacin against Gram-negative bacteria. It remains active against most fluoroquinolone-resistant strains, except enterococci. Its potency is further increased in acidic environments (found in many infection sites). Delafloxacin is active on staphylococci growing intracellularly or in biofilms. It is currently evaluated as an intravenous and intravenous/oral stepdown therapy in Phase III trials for the treatment of complicated skin/skin structure infections. It was also granted as Qualified Infectious Disease Product for the treatment of acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia, due to its high activity on pneumococci and atypical pathogens.
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Affiliation(s)
- Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Avenue E Mounier 73 B1.73.05, 1200 Brussels, Belgium
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12
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Abstract
The objective of the present work was to summarize the available literature data concerning the importance of and prospects for for the application of bacteriophages for the treatment of the most common diseases of the upper respiratory tract and the ear.
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Affiliation(s)
- E V Nosulya
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 125367
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13
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Susceptibility of clinical Moraxella catarrhalis isolates in British Columbia to six empirically prescribed antibiotic agents. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 25:155-8. [PMID: 25285112 PMCID: PMC4173978 DOI: 10.1155/2014/370964] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Moraxella catarrhalis has the ability to cause upper and lower respiratory tract infections. Typically, antibiotic susceptibility is not tested on isolation of the organism, but a reference document summarizing predicted susceptibilities is provided. The authors of this article aimed to determine the current susceptibilities of this organism in British Columbia, to update the predicted susceptibilites and ensure that appropriate antibiotic prescribing will occur. BACKGROUND: Moraxella catarrhalis is a commensal organism of the respiratory tract that has emerged as an important pathogen for a variety of upper and lower respiratory tract infections including otitis media and acute exacerbations of chronic bronchitis. Susceptibility testing of M catarrhalis is not routinely performed in most diagnostic laboratories; rather, a comment predicting susceptibility based on the literature is attached to the report. The most recent Canadian report on M catarrhalis antimicrobial susceptibility was published in 2003; therefore, a new study at this time was of interest and importance. OBJECTIVE: To determine the susceptibility of M catarrhalis isolates from British Columbia to amoxicillin-clavulanate, doxycycline, clarithromycin, cefuroxime, levofloxacin and trimethoprimsulfamethoxazole. METHODS: A total of 117 clinical M catarrhalis isolates were isolated and tested from five Interior hospitals and two private laboratory centres in British Columbia between January and December 2012. Antibiotic susceptibility of M catarrhalis isolates was characterized using the Etest (E-strip; bioMérieux, USA) according to Clinical Laboratory Standards Institute guidelines. RESULTS: All isolates were sensitive to amoxicillin-clavulanate, doxycycline, clarithromycin, levofloxacin and trimethoprimsulfamethoxazole. One isolate was intermediately resistant to cefuroxime, representing a 99.15% sensitivity rate to the cephem agent. Cefuroxime minimum inhibitory concentrations (MICs) inhibiting 50% and 90% of organisms (MIC50 and MIC90) were highest among the antibiotics tested, and the MIC90 (3 μg/mL) of cefuroxime reached the Clinical Laboratory Standards Institute breakpoint of susceptibility. DISCUSSION: The antibiotic susceptibility of M catarrhalis isolates evaluated in the present study largely confirms the findings of previous surveillance studies performed in Canada. Cefuroxime MICs are in the high end of the sensitive range and the MIC50 and MIC90 observed in the present study are the highest ever reported in Canada. CONCLUSION: Although cefuroxime MICs in M catarrhalis are high, all agents tested showed antimicrobial activity, supporting their continued therapeutic and empirical use.
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Shuel M, Whyte K, Drew T, Wylie J, Lefebvre B, Hoang L, Tsang RSW. Differential susceptibility of invasive Haemophilus influenzae serotype a and serotype b to ampicillin and other commonly prescribed antibiotics. Lett Appl Microbiol 2014; 59:193-9. [PMID: 24712310 DOI: 10.1111/lam.12265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 12/17/2022]
Abstract
UNLABELLED Haemophilus influenzae serotype a (Hia) has become an important pathogen in the post-H. influenzae serotype b (Hib) vaccine era. Antibiotic resistance in H. influenzae is a global phenomenon, but few studies have looked at antibiotic resistance profiles with regard to serotype. Invasive Hia (n = 157), noninvasive Hia (n = 2) and invasive Hib (n = 42) collected over the last two decades from three Canadian Provinces were examined for resistance to several commonly prescribed antibiotics, and sequence types (STs) were determined by MLST. Only 1·9% of Hia showed antibiotic resistance, while 31% of Hib were resistant to one or more antibiotic. Resistance to ampicillin, sulfamethoxazole-trimethoprim, chloramphenicol and tetracycline was observed, with β-lactamase-mediated ampicillin resistance being the most common. Nine STs were identified for Hia with 7 STs belonging to the same clonal complex. Ten STs were observed in Hib strains, and all of them belonged to a single clonal complex. A possible correlation between sequence type and ampicillin resistance was observed for Hib, while no correlations were observed for Hia. SIGNIFICANCE AND IMPACT OF THE STUDY Despite H. influenzae serotype b (Hib) vaccine programs, invasive disease due to Hib still exists in Canada and is either second or third most common behind nontypeable and/or serotype a (Hia). Many previous studies on antibiotic resistance have focussed on respiratory isolates, and few have looked at resistance with regard to serotype. This study analysed antibiotic resistance in invasive Hia and Hib collected over 20 years from three provinces, and results found that significantly more Hib showed resistance compared to Hia. This provides a small snapshot of H. influenzae disease in Canada and highlights the importance to continually monitor antibiotic resistance profiles.
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Affiliation(s)
- M Shuel
- Vaccine Preventable Bacterial Diseases Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
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15
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Kaplan A. Canadian guidelines for acute bacterial rhinosinusitis: clinical summary. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:227-34. [PMID: 24627376 PMCID: PMC3952756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To provide a clinical summary of the Canadian clinical practice guidelines for acute bacterial rhinosinusitis (ABRS) that includes relevant considerations for family physicians. QUALITY OF EVIDENCE Guideline authors performed a systematic literature search and drafted recommendations. Recommendations received both strength of evidence and strength of recommendation ratings. Input from external content experts was sought, as was endorsement from Canadian medical societies (Association of Medical Microbiology and Infectious Disease Canada, Canadian Society of Allergy and Clinical Immunology, Canadian Society of Otolaryngology-Head and Neck Surgery, Canadian Association of Emergency Physicians, and the Family Physicians Airways Group of Canada). MAIN MESSAGE Diagnosis of ABRS is based on the presence of specific symptoms and their duration; imaging or culture are not needed in uncomplicated cases. Treatment is dependent on symptom severity, with intranasal corticosteroids (INCSs) recommended as monotherapy for mild and moderate cases, although the benefit might be modest. Use of INCSs plus antibiotics is reserved for patients who fail to respond to INCSs after 72 hours, and for initial treatment of patients with severe symptoms. Antibiotic selection must account for the suspected pathogen, the risk of resistance, comorbid conditions, and local antimicrobial resistance trends. Adjunct therapies such as nasal saline irrigation are recommended. Failure to respond to treatment, recurrent episodes, and signs of complications should prompt referral to an otolaryngologist. The guidelines address situations unique to the Canadian health care environment, including actions to take during prolonged wait periods for specialist referral or imaging. CONCLUSION The Canadian guidelines provide up-to-date recommendations for diagnosis and treatment of ABRS that reflect an evolving understanding of the disease. In addition, the guidelines offer useful tools to help clinicians discern viral from bacterial episodes, as well as optimally manage their patients with ABRS.
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Affiliation(s)
- Alan Kaplan
- 17 Bedford Park Ave, Richmond Hill, ON L4C 2N9.
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16
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Tillotson GS. Role of gemifloxacin in community-acquired pneumonia. Expert Rev Anti Infect Ther 2014; 6:405-18. [DOI: 10.1586/14787210.6.4.405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhanel GG, Karlowsky JA, Rubinstein E, Hoban DJ. Tigecycline: a novel glycylcycline antibiotic. Expert Rev Anti Infect Ther 2014; 4:9-25. [PMID: 16441206 DOI: 10.1586/14787210.4.1.9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tigecycline, the first-in-class glycylcycline, was developed to recapture the broad spectrum of activity of the tetracycline class and to treat patients with difficult-to-treat bacterial infections. Tigecycline's in vitro spectrum of activity encompasses aerobic, facultative and anaerobic Gram-positive and -negative bacteria, including antimicrobial-resistant bacteria such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis and Enterococcus faecium, and extended-spectrum beta-lactamase-producing Enterobacteriaceae. Clinical trials involving patients with complicated skin and skin-structure infections and complicated intra-abdominal infections, including patients infected with methicillin-resistant S. aureus, demonstrated that tigecycline was bacteriologically and clinically effective with mild-to-moderate gastrointestinal adverse events (i.e., nausea, vomiting and diarrhea) the most commonly reported. Tigecycline is a promising new broad-spectrum parenteral monotherapy for the treatment of patients with Gram-positive and -negative bacterial infections.
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Affiliation(s)
- George G Zhanel
- Department of Medical Microbiology, Faculty of Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
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Teras J, Gardovskis J, Vaasna T, Kupcs U, Pupelis G, Dukart G, Dartois N, Jouve S, Cooper A. Overview of Tigecycline Efficacy and Safety in the Treatment of Complicated Skin and Skin Structure Infections - A European Perspective. J Chemother 2013; 20 Suppl 1:20-7. [DOI: 10.1179/joc.2008.20.supplement-1.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kilic S, Dizbay M, Cabadak H. In VitroActivity of Tigecycline, Tetracycline and Fluoroquinolones againstBrucella melitensis. J Chemother 2013; 20:33-7. [DOI: 10.1179/joc.2008.20.1.33] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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20
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Moran GJ, Rothman RE, Volturo GA. Emergency management of community-acquired bacterial pneumonia: what is new since the 2007 Infectious Diseases Society of America/American Thoracic Society guidelines. Am J Emerg Med 2013; 31:602-12. [PMID: 23380120 DOI: 10.1016/j.ajem.2012.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/30/2012] [Accepted: 12/02/2012] [Indexed: 01/02/2023] Open
Abstract
Community-acquired pneumonia (CAP) is a major health problem in the United States and is associated with substantial morbidity, mortality, and health care costs. Patients with CAP commonly present to emergency departments where physicians must make critical decisions regarding diagnosis and management of pneumonia in a timely fashion, with emphasis on efficient and cost-effective diagnostic choices, consideration of emerging antimicrobial resistance, timely initiation of antibiotics, and appropriate site-of-care decisions. In light of the burden that pneumonia places on health care systems and the emergency department in particular, this article reviews significant developments in the management of CAP in the United States 5 years since the publication of the 2007 Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of CAP in adults, focusing on recent studies and recommendations for managing CAP, the primary bacterial pathogens responsible for CAP, and trends in resistance, new diagnostic technologies, and newer antimicrobials approved for the treatment of CAP. These new data and additional guidelines pertaining to the treatment of CAP further our knowledge and understanding of this challenging infection. Furthermore, appreciation of the availability of new diagnostic testing and therapeutic options will help meet the demand for improved management of CAP.
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Affiliation(s)
- Gregory J Moran
- Olive View-UCLA Medical Center, North Annex, Sylmar, CA 91342, USA.
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Macrolide and tetracycline resistance among Moraxella catarrhalis isolates from 2009 to 2011. Diagn Microbiol Infect Dis 2012; 74:198-200. [DOI: 10.1016/j.diagmicrobio.2012.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 06/08/2012] [Indexed: 11/21/2022]
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Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJC, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis 2012. [DOI: 10.1093/cid/cis370] [Citation(s) in RCA: 367] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.
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Affiliation(s)
- Anthony W. Chow
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington, D.C
| | - Jan L. Brozek
- Department of Clinical Epidemiology and Biostatistics
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ellie J. C. Goldstein
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles
- R. M. Alden Research Laboratory, Santa Monica, California
| | - Lauri A. Hicks
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - George A. Pankey
- Department of Infectious Disease Research, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Mitchel Seleznick
- Division of General Internal Medicine, University of South Florida College of Medicine, Tampa
| | - Gregory Volturo
- Department of Emergency Medicine, University of Massachusetts, Worcester
| | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Thomas M. File
- Department of Infectious Diseases, Northeast Ohio Medical University, Rootstown
- Summa Health System, Akron, Ohio
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Aerosol-Based Efficient Delivery of Clarithromycin, a Macrolide Antimicrobial Agent, to Lung Epithelial Lining Fluid and Alveolar Macrophages for Treatment of Respiratory Infections. J Aerosol Med Pulm Drug Deliv 2012; 25:110-5. [DOI: 10.1089/jamp.2011.0894] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Wang H, Chen M, Xu Y, Sun H, Yang Q, Hu Y, Cao B, Chu Y, Liu Y, Zhang R, Yu Y, Sun Z, Zhuo C, Ni Y, Hu B, Tan TY, Hsueh PR, Wang JH, Ko WC, Chen YH, Wahjono H. Antimicrobial susceptibility of bacterial pathogens associated with community-acquired respiratory tract infections in Asia: report from the Community-Acquired Respiratory Tract Infection Pathogen Surveillance (CARTIPS) study, 2009–2010. Int J Antimicrob Agents 2011; 38:376-83. [DOI: 10.1016/j.ijantimicag.2011.06.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/29/2011] [Accepted: 06/30/2011] [Indexed: 11/27/2022]
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Optimal dose finding of garenoxacin based on population pharmacokinetics/pharmacodynamics and Monte Carlo simulation. Eur J Clin Pharmacol 2011; 68:39-53. [PMID: 21796376 PMCID: PMC3249185 DOI: 10.1007/s00228-011-1095-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 06/28/2011] [Indexed: 12/04/2022]
Abstract
Purpose Garenoxacin, a novel des-F(6)-quinolone, possesses potent antibacterial activity against infectious pathogens in the respiratory tract. Population pharmacokinetic/pharmacodynamic (PK/PD) modeling and Monte Carlo simulations were used to optimize garenoxacin dosage regimens. Methods At the end of phase II stage, the clinical dose of garenoxacin was predicted to be 400 mg once daily by the interim PK/PD analysis using phase I and phase II clinical data. The criteria used to determine an optimal dose were (1) the target attainment of the area under the unbound concentration–time curve divided by the minimum inhibitory concentration (fAUC0−24/MIC ratio) and (2) the maintenance of a trough concentration above the mutant prevention concentration. In a confirmatory phase III study, garenoxacin was administered 400 mg once daily to 136 patients infected with mild or moderate chronic respiratory diseases. Results Logistic regression analysis showed that fAUC0−24/MIC ratio was a significant variable that predicted clinical response (p = 0.0164). Of all subjects, 92.4% reached the target value of fAUC0−24/MIC ratio > 30 h, and the clinical efficacy rate of this population was 91.8%. On the other hand, there was no significant relationship between exposure values (AUC0−24 and maximum concentration) and the incidence of adverse events by the Mann–Whitney test. Conclusions The antimicrobial efficacy of the actual phase III study was consistent with the expectation from the Monte Carlo PD simulation. We were able to show that the optimal garenoxacin dosage regimens were successfully determined using prospective population PK/PD analysis and clinical trial simulations. Electronic supplementary material The online version of this article (doi:10.1007/s00228-011-1095-3) contains supplementary material, which is available to authorized users.
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Townsend ML, Pound MW, Drew RH. Potential role of tigecycline in the treatment of community-acquired bacterial pneumonia. Infect Drug Resist 2011; 4:77-86. [PMID: 21694911 PMCID: PMC3108749 DOI: 10.2147/idr.s6030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Indexed: 12/13/2022] Open
Abstract
Tigecycline is a member of the glycylcycline class of antimicrobials, which is structurally similar to the tetracycline class. It demonstrates potent in vitro activity against causative pathogens that are most frequently isolated in patients with community-acquired bacterial pneumonia (CABP), including (but not limited to) Streptococcus pneumoniae (both penicillin-sensitive and -resistant strains), Haemophilus influenzae and Moraxella catarrhalis (including β-lactamase-producing strains), Klebsiella pneumoniae, and ‘atypical organisms’ (namely Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila). Comparative randomized clinical trials to date performed in hospitalized patients receiving tigecycline 100 mg intravenous (IV) × 1 and then 50 mg IV twice daily thereafter have demonstrated efficacy and safety comparable to the comparator agent. Major adverse effects were primarily gastrointestinal in nature. Tigecycline represents a parenteral monotherapy option in hospitalized patients with CABP (especially in patients unable to receive respiratory fluoroquinolones). However, alternate and/or additional therapies should be considered in patients with more severe forms of CABP in light of recent data of increased mortality in patients receiving tigecycline for other types of severe infection.
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Affiliation(s)
- Mary L Townsend
- Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
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Desrosiers M, Evans GA, Keith PK, Wright ED, Kaplan A, Bouchard J, Ciavarella A, Doyle PW, Javer AR, Leith ES, Mukherji A, Schellenberg RR, Small P, Witterick IJ. Canadian clinical practice guidelines for acute and chronic rhinosinusitis. Allergy Asthma Clin Immunol 2011; 7:2. [PMID: 21310056 PMCID: PMC3055847 DOI: 10.1186/1710-1492-7-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 02/10/2011] [Indexed: 01/26/2023] Open
Abstract
This document provides healthcare practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS) and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in guidelines development, and do not address the particulars of the Canadian healthcare environment. Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg, increased use of corticosteroids). The role of bacteria in the persistence of chronic infections, and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused. Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on readability rather than completeness, yet covers relevant information, offers summaries of areas where considerable evidence exists, and provides recommendations with an assessment of strength of the evidence base and degree of endorsement by the multidisciplinary expert group preparing the document. These guidelines have been copublished in both Allergy, Asthma & Clinical Immunology and the Journal of Otolaryngology-Head and Neck Surgery.
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Affiliation(s)
- Martin Desrosiers
- Division of Otolaryngology - Head and Neck Surgery Centre Hospitalier de l'Université de Montréal, Université de Montréal Hotel-Dieu de Montreal, and Department of Otolaryngology - Head and Neck Surgery and Allergy, Montreal General Hospital, McGill University, Montreal, QC, Canada.
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Tempera G, Furneri PM, Carlone NA, Cocuzza C, Rigoli R, Musumeci R, Pilloni AP, Prenna M, Tufano MA, Tullio V, Vitali LA, Nicoletti G. Antibiotic susceptibility of respiratory pathogens recently isolated in Italy: focus on cefditoren. J Chemother 2010; 22:153-9. [PMID: 20566418 DOI: 10.1179/joc.2010.22.3.153] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aim of this study was to evaluate the in vitro antibiotic susceptibility of respiratory pathogens recently isolated in Italy to commonly used antibiotics including cefditoren. Six clinical microbiological laboratories collected, between January and September 2009, a total of 2,510 respiratory pathogens from subjects with community-acquired respiratory tract infections (CARTI). Ceftditoren, out of all the beta-lactams studied, had the lowest MIC(90 )against 965 strains of Streptococcus pneumoniae examined, followed by cefotaxime and ceftriaxone (2% resistance in penicillin-resistant S. pneumoniae (PRSP)). Against 470 Haemophilus influenzae , independently of their production of beta-lactamases or ampicillin resistance, cefditoren was the oral cephalosporin with the best in vitro activity, comparable to that of the injectable cephalosporins and levofloxacin. Higher MIC(90)s were found for the macrolides (4 - 16 mg/l) and cefaclor (4 - 32 mg/l). As was foreseeable, Streptococcus pyogenes (225 strains) was uniformly sensitive to all the beta-lactam antibiotics, but the elevated MIC(90 )values reduced (<75%) susceptibility of this pathogen to macrolides. Beta-lactamase-negative Moraxella catarrhalis (100 strains) had reduced susceptibility only to the macrolides, while the 250 beta-lactamase-producing strains also had reduced susceptibility to cefuroxime. Levofloxacin showed the lowest MIC(50)/MIC(90 )values in the producing strains, whereas cefditoren, cefotaxime and ceftriaxone in the non-producers. As regards the enterobacteriaceae, cefditoren and levofloxacin had the lowest MIC(90)s against Klebsiella pneumoniae. Cefditoren and the third-generation injectable cephalosporins had the lowest MIC(90)s against Escherichia coli (100% susceptibility) while levofloxacin was less active (86% susceptibility).In conclusion, cefditoren's wide spectrum and high intrinsic activity, as well as its capacity to overcome most of the resistance that has become consolidated in some classes of antibiotics widely used as empiric therapy for CARTI, allows us to suggest that cefditoren might be included in the european guidelines as one of the first-choice antibiotics in the treatment of CARTI.
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Affiliation(s)
- G Tempera
- Department of Microbiological and Gynecological Sciences, University of Catania, Italy.
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Pingault NM, Bowman JM, Lehmann D, Riley TV. Antimicrobial susceptibility of Moraxella catarrhalis isolated from children in Kalgoorlie–Boulder, Western Australia. Pathology 2010; 42:273-9. [DOI: 10.3109/00313021003631270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shuel M, Law D, Skinner S, Wylie J, Karlowsky J, Tsang RS. Characterization of nontypeableHaemophilus influenzaecollected from respiratory infections and invasive disease cases in Manitoba, Canada. ACTA ACUST UNITED AC 2010; 58:277-84. [DOI: 10.1111/j.1574-695x.2009.00634.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Forgie S, Zhanel G, Robinson J. Management of acute otitis media. Paediatr Child Health 2009; 14:457-64. [PMID: 20808476 PMCID: PMC2786953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- S Forgie
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee
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Forgie S, Zhanel G, Robinson J. La prise en charge de l'otite moyenne aiguë. Paediatr Child Health 2009. [DOI: 10.1093/pch/14.7.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Tigecycline derived from minocycline. It is part of a new class of antibiotics called glycylcyclines. Tigecycline is given intravenously and has activity against a variety of gram-positive and gram-negative bacterial pathogens, many of which are resistant to existing antibiotics. Tigecycline successfully completed phase III trials in which it was at least equal to intravenous vancomycin and aztreonam to treat complicated skin and skin structure infections (cSSSI), and to intravenous imipenem and cilastatin to treat complicated intra-abdominal infections (cIAI). Tigecycline side effects are primarily digestive upset. It should be a valuable addition to the armamentarium to treat even the most resistant pathogens.
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Affiliation(s)
- Noah Scheinfeld
- Department of Dermatology, St Lukes Roosevelt Hospital, New York, USA.
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New semiphysiological absorption model to assess the pharmacodynamic profile of cefuroxime axetil using nonparametric and parametric population pharmacokinetics. Antimicrob Agents Chemother 2009; 53:3462-71. [PMID: 19528278 DOI: 10.1128/aac.00054-09] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cefuroxime axetil is widely used to treat respiratory tract infections. We are not aware of a population pharmacokinetic (PK) model for cefuroxime axetil. Our objectives were to develop a semiphysiological population PK model and evaluate the pharmacodynamic profile for cefuroxime axetil. Twenty-four healthy volunteers received 250 mg oral cefuroxime as a suspension after a standardized breakfast. Liquid chromatography-tandem mass spectrometry was used for drug analysis, NONMEM and S-ADAPT (results reported) were used for parametric population PK modeling, and NPAG was used for nonparametric population PK modeling. Monte Carlo simulations were used to predict the duration for which the non-protein-bound-plasma concentration was above the MIC (fT(>MIC)). A model with one disposition compartment, a saturable and time-dependent drug release from the stomach, and fast drug absorption from the intestine yielded precise (r > 0.992) and unbiased curve fits and an excellent predictive performance. The apparent clearance was 21.7 liters/h (19.8% coefficient of variation [CV]) and the volume of distribution 38.7 liters (18.3% CV). Robust (>or=90%) probabilities of target attainment (PTAs) were achieved by 250 mg cefuroxime given every 12 h (q12h) or q8h for MICs of <or=0.375 mg/liter or <or=0.5 mg/liter, respectively, for the bacteriostasis target fT(>MIC) of >or=40% and for MICs of <or=0.094 mg/liter or <or=0.375 mg/liter, respectively, for the near-maximal-killing target fT(>MIC) of >or=65%. For the >or=40% fT(>MIC) target, the PTAs for 250 mg cefuroxime q12h were >or=97.8% for Streptococcus pyogenes and penicillin-susceptible Streptococcus pneumoniae. Cefuroxime at 250 mg q12h or q8h achieved PTAs below 73% or 92%, respectively, for Haemophilus influenzae, Moraxella catarrhalis, and penicillin-intermediate S. pneumoniae for susceptibility data from various countries. Depending on the MIC distribution, 250 mg oral cefuroxime q8h instead of q12h should be considered, especially for more-severe infections that require near-maximal killing by cefuroxime.
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Gergova R, Markovska R, Mitov I. Antimicrobial resistance and production of beta-lactamases in Bulgarian clinical isolatesMoraxella catarrhalis. ANN MICROBIOL 2009. [DOI: 10.1007/bf03175616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Shuel ML, Tsang RSW. Canadian beta-lactamase-negative Haemophilus influenzae isolates showing decreased susceptibility toward ampicillin have significant penicillin binding protein 3 mutations. Diagn Microbiol Infect Dis 2009; 63:379-83. [PMID: 19249177 DOI: 10.1016/j.diagmicrobio.2008.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 12/08/2008] [Accepted: 12/18/2008] [Indexed: 11/26/2022]
Abstract
Nineteen beta-lactamase-negative ampicillin-resistant (BLNAR) and 2 beta-lactamase-positive amoxicillin-clavulanic acid-resistant Canadian Haemophilus influenzae strains were characterized. All 21 isolates were found to have the N526K mutations in their ftsI genes, and their ampicillin MIC(50) values were 4-8 times that of beta-lactamase-negative ampicillin-susceptible strains. The difficulty in detection of BLNAR strains was discussed.
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Affiliation(s)
- Michelle L Shuel
- Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
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Qin L, Masaki H, Gotoh K, Furumoto A, Terada M, Watanabe K, Watanabe H. Molecular epidemiological study of Moraxella catarrhalis isolated from nosocomial respiratory infection patients in a community hospital in Japan. Intern Med 2009; 48:797-803. [PMID: 19443974 DOI: 10.2169/internalmedicine.48.2036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Moraxella catarrhalis, occasionally, plays the essential role in nosocomial respiratory infection (NRI). Few studies have reported the route by which this organism spreads in a nosocomial infection outbreak. We identified characteristics of the strains isolated from NRI and attempted to reveal the potential nosocomial transmission routes. METHODS A follow-up study has been performed in a Japanese community hospital between July 2002 and January 2003. M. catarrhalis clinical isolates were identified and beta-lactamase production test as well as the minimal inhibitory concentrations (MICs) have been examined. Pulsed-field gel electrophoresis (PFGE) and the multi locus sequence typing method (MLST) have been introduced as the effective "fingerprinting" methods. RESULTS A total of 29 strains were isolated from 17 participants; 7 independent DNA fragment patterns were detected by PFGE. Pattern B (defined in this study) was dominant, and was detected both in strains from a health care worker (HCW) and inpatients. In the 9 selected strains analyzed by MLST, 7 unique MLST types were identified, which showed the congruence with the results of PFGE results. CONCLUSION Epidemiological analysis proved the transmission route from patient to patient, and suggested that more studies should be focused on identifying the possible transmission route between HCWs and inpatients.
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Affiliation(s)
- Liang Qin
- Division of Infectious Diseases, Department of Infectious Medicine, Kurume University School of Medicine, Kurume.
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Wang A, Yu S, Yao K, Zhang W, Yuan L, Wang Y, Wei J, Shen X, Yang Y. Antimicrobial susceptibility of Haemophilus influenzae strains and antibiotics usage patterns in pediatric outpatients: results from a children's hospital in China (2000-2004). Pediatr Pulmonol 2008; 43:457-62. [PMID: 18360841 DOI: 10.1002/ppul.20789] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the nasopharyngeal carriage and antimicrobial susceptibility of H. influenzae among children younger than 5 years old and to assess antibiotics usage patterns in the outpatient department of Beijing Children's Hospital from 2000 to 2004. MATERIALS AND METHODS From 2000 to 2004, At least 100 strains of H. influenzae were isolated from the pediatric patients who were younger than 5 years and who presented with symptoms of acute upper respiratory tract infections during February to May in each of the study years. Antimicrobial susceptibilities were determined; and antibiotics usage was expressed as defined daily dose (DDD)/100 patient days. RESULTS The overall nasopharyngeal carriage rate of H. influenzae is 26.3% (562/2,137) in children younger than 5 years old with acute upper respiratory tract infection. The percentage of ampicillin-resistant isolates ranges from 4.0% (4/100) to 14.3% (17/119) from 2000 to 2004. All the ampicillin-resistant isolates are beta-lactamase producers. More than 80% of the isolates are susceptible to amoxicillin, cefaclor, and chloramphenicol; whereas, almost all (99-100%) of the isolates are sensitive to amoxicillin/clavulanic acid, ceftriaxone, and cefuroxime. For antibiotics utilization, macrolides are the predominantly used antibiotics, followed by cephalosporins and penicillins among pediatric patients in the outpatient department during the study period. CONCLUSION All amoxicillin-resistant isolates of H. influenzae are producing beta-Lactamase; and the rates of amoxicillin-resistant isolates are increasing over time. Amoxicillin/clavulanic acid and cephalosporins are highly sensitive to H. influenzae isolated from Chinese pediatric patients. Macrolides are the most used antibiotics in the outpatient department during the study period.
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Affiliation(s)
- Aihua Wang
- Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Antibiotic susceptibility of invasive Haemophilus influenzae strains in Canada. Antimicrob Agents Chemother 2008; 52:1551-2. [PMID: 18227189 DOI: 10.1128/aac.01580-07] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Canadian invasive Haemophilus influenzae isolates from 1990 to 2006 were examined for antibiotic susceptibility: 42 strains (17.8%) were resistant to ampicillin by beta-lactamase production, 5.5% were beta-lactamase negative ampicillin intermediate, and 2.5% were intermediate to only the 2-microg ampicillin disk. An increase in beta-lactamase-negative ampicillin-intermediate strains has been found.
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Swainston Harrison T, Keam SJ. Azithromycin extended release: a review of its use in the treatment of acute bacterial sinusitis and community-acquired pneumonia in the US. Drugs 2007; 67:773-92. [PMID: 17385947 DOI: 10.2165/00003495-200767050-00010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Azithromycin is a macrolide antibacterial agent. The novel microspheres oral extended-release formulation (Zmax) is the first antibacterial drug approved in the US for administration as a single dose in adult patients with mild to moderate acute bacterial sinusitis (ABS) or community-acquired pneumonia (CAP). It has a broad spectrum of in vitro antibacterial activity against Gram-positive, Gram-negative and atypical pathogens that cause ABS and CAP infections (including Streptococcus pneumoniae), and achieves good tissue penetration. Azithromycin extended release is an effective and generally well tolerated treatment in patients with ABS or CAP. The clinical cure rates of a single 2.0 g dose of azithromycin extended release were noninferior to those obtained with a 10-day regimen of levofloxacin in patients with ABS, and with 7-day regimens of clarithromycin extended release or levofloxacin in patients with CAP. With a pharmacodynamic and pharmacokinetic profile well suited to administration as a single-dose regimen that may offer the advantage of improved compliance and convenience compared with once-daily longer-course regimens, azithromycin extended release is a new option in the empirical treatment of adult patients with mild or moderate ABS or CAP in the US.
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Penetration of garenoxacin into lung tissues and bone in subjects undergoing lung biopsy or resection. Curr Med Res Opin 2007; 23:1841-7. [PMID: 17601364 DOI: 10.1185/030079907x210480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Concentrations of garenoxacin in plasma and samples of lung parenchyma, bronchial mucosa, and bone were determined following single-dose administration. RESEARCH DESIGN AND METHODS Open-label, non-randomized study in which subjects undergoing invasive lung biopsy or resection were given a single 600-mg oral dose of garenoxacin. Lung parenchyma, and, if possible, bronchial mucosa and bone (i.e., flat bone with sinus mucosa or long bone from the lower legs) samples and corresponding plasma samples were obtained 2-4, 4-6, 10-12, or 20-24 h post-dose. Garenoxacin concentrations were measured using validated liquid chromatography with dual mass spectrometry. Safety was also assessed. RESULTS Twenty-seven subjects enrolled and completed the study. Garenoxacin plasma concentrations (mean +/- standard deviation) during the 24-h period ranged from 1.9 +/- 1 to 7.4 +/- 3 mug/mL. Garenoxacin concentrations in lung tissue (15.2 +/- 9 mug/g) peaked at 4-6 h and decreased to 3.7 +/- 3 mug/g at 20-24 h. Mean ratios between bronchial mucosa and plasma ranged from 0.82 to 0.99 over a 24-h period. At 12 h, the mean ratio between bone and plasma was 0.56. Garenoxacin concentrations in lung tissue exceeded the MIC(90) for common respiratory pathogens by at least 61-fold. Garenoxacin was safe and well tolerated. Forty-five adverse events were reported by 26 subjects; none were determined to be attributable to garenoxacin by the investigators. Most of the adverse events were mild to moderate in severity. CONCLUSIONS Garenoxacin achieved 24-h concentrations in pulmonary tissues that exceeded the MIC(90) for common respiratory pathogens. A controlled study involving a larger number of lung and bone tissue samples is needed to further confirm these findings.
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Skoczyńska A, Kadłubowski M, Waśko I, Fiett J, Hryniewicz W. Resistance patterns of selected respiratory tract pathogens in Poland. Clin Microbiol Infect 2007; 13:377-83. [PMID: 17359321 DOI: 10.1111/j.1469-0691.2007.01664.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study presents the results of a survey of the in-vitro susceptibility to antimicrobial agents of major pathogens responsible for community-acquired respiratory tract infections in Poland during 2002-2004. The collection of 1184 bacterial isolates comprised 398 Streptococcus pneumoniae, 344 Haemophilus influenzae, 302 Streptococcus pyogenes and 140 Moraxella catarrhalis. Among the pneumococcal isolates, 16.8% were penicillin-non-susceptible (PNSP), of which 80.6% were identified as multidrug-resistant. Overall, 9.0% of H. influenzae isolates were beta-lactamase-positive, although this percentage increased noticeably in the third year of the study. Based on PCR results, 12.8% of H. influenzae isolates were identified as low-level beta-lactamase-negative, ampicillin-resistant (BLNAR), and one isolate as low-level beta-lactamase-positive, amoxycillin-clavulanic acid-resistant (BLPACR). Pulsed-field gel electrophoresis (PFGE) classified 45 H. influenzae isolates with altered penicillin-binding proteins into 15 PFGE types, including two predominant types (with four and six sub-types) containing 15 and ten isolates, respectively. Resistance to tetracycline, erythromycin and clindamycin was found in 20.9%, 8.9% and 4.6% of S. pyogenes isolates, respectively. The production of beta-lactamase characterised 91.4% of M. catarrhalis isolates. In summary, the overall occurrence of PNSP in Poland remains stable, although there was a noticeable increase in the proportion of fully-resistant isolates. A rising trend in the prevalence of beta-lactamase producers and low-level BLNAR isolates was observed among Polish isolates of H. influenzae.
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Affiliation(s)
- A Skoczyńska
- Department of Epidemiology and Clinical Microbiology, National Institute of Public Health, Warsaw, Poland
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Noskin GA. Tigecycline: a new glycylcycline for treatment of serious infections. Clin Infect Dis 2006; 41 Suppl 5:S303-14. [PMID: 16080069 DOI: 10.1086/431672] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tigecycline is a new semisynthetic glycylcycline for the treatment of serious infections. Of the glycylcyclines, tigecycline is the most studied and appears to hold promise as a new antimicrobial agent that can be administered as monotherapy to patients with many types of serious bacterial infections. For patients with serious infections, the initial choice for empirical therapy with broad-spectrum antibiotics is crucial, and, if the choice is inappropriate, it may have adverse consequences for the patient. Tigecycline has been designed to overcome many existing mechanisms of resistance among bacteria and confers broad antibiotic coverage against vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and many species of multidrug-resistant gram-negative bacteria. Tigecycline has been efficacious and well tolerated in human clinical phase 2 studies, which warranted further evaluation of tigecycline in larger studies for treatment of many indications, including complicated skin and skin-structure infections, complicated intra-abdominal infections, and infections of the lower respiratory tract.
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Affiliation(s)
- Gary A Noskin
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA.
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Fraise AP. Tigecycline: The answer to beta-lactam and fluoroquinolone resistance? J Infect 2006; 53:293-300. [PMID: 16876253 DOI: 10.1016/j.jinf.2006.05.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 05/26/2006] [Accepted: 05/26/2006] [Indexed: 10/24/2022]
Abstract
Patients with serious bacterial infections such as intra-abdominal infections and complicated skin and soft tissue infections are often treated empirically because a delay in appropriate initial antimicrobial therapy has been shown to significantly increase morbidity and mortality. Furthermore, pathogens that have developed resistance to mainstay therapeutic options are increasing in prevalence making these infections a challenge for physicians. Treatment guidelines for surgical and intra-abdominal infections recommend selection of an agent or a combination of agents with activity to cover both Gram-positive, Gram-negative organisms and anaerobes. Recommended agents include second-generation cephalosporins with anaerobic coverage, beta-lactam/beta-lactamase inhibitor agents, fluoroquinolone/metronidazole combinations and carbapenems. However, the effectiveness of these agents has come into question as once susceptible organisms are now showing signs of resistance to such antimicrobial therapies. Alternative agents specifically designed to overcome mechanisms of microbial resistance have been sought. The result of that search has been the development of a new class of antimicrobials termed glycylcyclines. The first of these novel antibacterials is tigecycline, with a broad spectrum of activity that includes coverage against vancomycin-resistant enterococci, methicillin-resistant S. aureus, and many species of multidrug-resistant Gram-negative bacteria. Tigecycline also has activity against most penicillin-susceptible and resistant Gram-positive organisms. Clinical trial experience with tigecycline has shown it to be at least as effective as current recommended regimens for the treatment of intra-abdominal infections and complicated skin and soft tissue infections. This new agent thus holds promise as an alternative to the beta-lactams and fluoroquinolones for the initial empiric treatment of serious bacterial infections.
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Affiliation(s)
- Adam P Fraise
- Microbiology Department, Sandwell & West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham B18 7QH, UK.
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Wierzbowski AK, Hoban DJ, Hisanaga T, DeCorby M, Zhanel GG. The use of macrolides in treatment of upper respiratory tract infections. Curr Allergy Asthma Rep 2006; 6:171-81. [PMID: 16566868 DOI: 10.1007/s11882-006-0056-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Antimicrobial resistance is a growing problem among upper respiratory tract pathogens. Resistance to beta-lactam drugs among Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes is increasing. As safe and well-tolerated antibiotics, macrolides play a key role in the treatment of community-acquired upper respiratory tract infections (RTIs). Their broad spectrum of activity against gram-positive cocci, such as S. pneumoniae and S. pyogenes, atypical pathogens, H. influenzae (azithromycin and clarithromycin), and Moraxella catarrhalis, has led to the widespread use of macrolides for empiric treatment of upper RTIs and as alternatives for patients allergic to beta-lactams. Macrolide resistance is increasing among pneumococci and recently among S. pyogenes, and is associated with increasing use of the newer macrolides, such as azithromycin. Ribosomal target modification mediated by erm(A) and erm(B) genes and active efflux due to mef(A) and mef(E) are the principal mechanisms of resistance in both S. pneumoniae and S. pyogenes. Recently, ribosomal protein and RNA mutations have been found to be responsible for acquired resistance to macrolides in S. pneumoniae, S. pyogenes, and H. influenzae. Although macrolides are only weakly active against macrolide-resistant streptococci species, producing an efflux pump (mef), and are inactive against pathogens with ribosomal target modification (erm), treatment failures are uncommon. Therefore, macrolide therapy, for now, remains a good alternative for treatment of upper RTIs; however, continuous monitoring of the local resistance patterns is essential.
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Varon E, Houssaye S. [Resistance of infectious agents involved in low respiratory tract infections in France]. Med Mal Infect 2006; 36:555-69. [PMID: 16962730 DOI: 10.1016/j.medmal.2006.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 05/19/2006] [Indexed: 11/21/2022]
Abstract
This review concerning the major lower respiratory tract pathogens in France has for aim to describe the epidemiology of resistance to beta-lactams, macrolides, ketolides, and fluoroquinolones especially in Streptococcus pneumoniae and Haemophilus influenzae. It should also provide new insights on the mechanisms of acquired resistance and the level of resistance conferred, highlighting the related ecological impact. In the context of this XVth consensus conference, this review should contribute to the elaboration of guidelines for the treatment of lower respiratory tract infections in adults.
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Affiliation(s)
- E Varon
- Laboratoire de microbiologie, centre national de référence des pneumocoques, APHP, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75908 Paris cedex 15, France.
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Ko KS, Song JH, Lee MY, Park S, Kwon KT, Heo ST, Ryu SY, Oh WS, Peck KR, Lee NY. Antimicrobial activity of tigecycline against recent isolates of respiratory pathogens from Asian countries. Diagn Microbiol Infect Dis 2006; 55:337-41. [PMID: 16631337 DOI: 10.1016/j.diagmicrobio.2006.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 02/01/2006] [Accepted: 02/02/2006] [Indexed: 10/24/2022]
Abstract
In vitro activities of tigecycline were compared with 15 other comparator agents against recent clinical isolates of respiratory pathogens (623 Streptococcus pneumoniae, 105 Staphylococcus aureus, 92 Klebsiella pneumoniae, and 84 Haemophilus influenzae isolates) collected from 11 Asian countries. All isolates of S. pneumoniae from Asian countries were susceptible to tigecycline regardless of penicillin susceptibility with MIC90 of <or=0.06 mg/L. Both methicillin-resistant and methicillin-susceptible S. aureus isolates were susceptible to tigecycline with very low MIC90 values (0.25 and 0.12 mg/L, respectively). Tigecycline was also active against K. pneumoniae (98.9% susceptible; MIC50, 1 mg/L; MIC90, 2 mg/L) including 10 extended-spectrum beta-lactamase-producing isolates and H. influenzae (100% susceptible; MIC50 and MIC90, 0.12 mg/L) from Korea. Data confirmed that tigecycline has an excellent in vitro activity against drug-resistant clinical isolates of respiratory pathogens from Asian countries.
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Affiliation(s)
- Kwan Soo Ko
- Asian-Pacific Research Foundation for Infectious Diseases (ARFID), Seoul, South Korea
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Appropriate Use of Antibiotics. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2006. [DOI: 10.1097/01.idc.0000230542.09713.45] [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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Lau YJ, Hsueh PR, Liu YC, Shyr JM, Huang WK, Teng LJ, Liu CY, Luh KT. Comparison of In Vitro Activities of Tigecycline with Other Antimicrobial Agents against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in Taiwan. Microb Drug Resist 2006; 12:130-5. [PMID: 16922631 DOI: 10.1089/mdr.2006.12.130] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We compared the in vitro activities of tigecycline to those of other agents against 300 nonduplicate isolates of Streptococcus pneumoniae (194 isolates), Haemophilus influenzae (60 isolates), and Moraxella catarrhalis (46 isolates) recovered from patients treated in three major hospitals in Taiwan from August through December, 2003. All of these isolates were inhibited at 0.5 mg/L of tigecycline. For S. pneumoniae isolates, 72% were not susceptible to penicillin (69% intermediate and 3% resistant) and 96% were not susceptible to azithromycin. Among the 178 isolates resistant to azithromycin, 53 isolates (30%) had the M phenotype and 70% had the cMLSB phenotype. The rate of nonsusceptibility to ertapenem, telithromycin, moxifloxacin, and quinupristindalfopristin in S. pneumoniae was 3%, 2%, 1%, and 57%, respectively. For H. influenzae, 36 (60%) were not susceptible to ampicillin, among which 31 possessed beta-lactamase. A high rate (8.3%) of H. influenzae isolates with beta-lactamase-negative and ampicillin-resistant phenotype was found. All H. influenzae isolates were susceptible to azithromycin, but 40% of them were not susceptible to clarithromycin. Ninety-eight percent (44 isolates) of M. catarrhalis possessed beta-lactamase. All three fluoroquinolones tested were highly active (MIC90 < or =0.12 mg/L) against H. influenzae and M. catarrhalis.
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Affiliation(s)
- Yeu-Jun Lau
- Department of Internal Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
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