1
|
Stewart AG, Harris PNA, Henderson A, Schembri MA, Paterson DL. Oral cephalosporin and β-lactamase inhibitor combinations for ESBL-producing Enterobacteriaceae urinary tract infections. J Antimicrob Chemother 2021; 75:2384-2393. [PMID: 32443141 DOI: 10.1093/jac/dkaa183] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
ESBL-producing Enterobacteriaceae as uropathogens have given rise to a sizeable amount of global morbidity. Community and hospital surveillance studies continue to report increasing proportions of these organisms as causes of urinary tract infection (UTI). Due to limited treatment options and the presence of cross-resistance amongst oral antibiotics of different classes, patients often require IV therapy, thereby increasing healthcare costs and reducing the effectiveness of delivering healthcare. Oral cephalosporin antibiotics are well known for their ability to achieve high urinary concentrations, in addition to achieving clinical success for treatment of uncomplicated UTI with a drug-susceptible pathogen. Novel cephalosporin/β-lactamase inhibitor combinations have been developed and demonstrate good in vitro activity against ESBL-producing isolates. A pooled analysis of in vitro activity of existing oral cephalosporin/clavulanate combinations in ESBL-producing Enterobacteriaceae has shown MIC50s of 0.5-1, 0.125-1 and 0.25 mg/L for cefpodoxime, ceftibuten and cefixime, respectively. A novel cyclic boronic acid β-lactamase inhibitor, QPX7728, was able to produce MIC50 values of 0.5 and ≤0.06 mg/L when paired with cefpodoxime and ceftibuten, respectively. Other novel combinations, cefpodoxime/ETX0282 and ceftibuten/VNRX7145, have also demonstrated excellent activity against ESBL producers. Clinical trials are now awaited.
Collapse
Affiliation(s)
- Adam G Stewart
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia.,Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Patrick N A Harris
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia.,Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Andrew Henderson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.,Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - David L Paterson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia.,Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Hedrick J. Cephalosporins for uncomplicated skin and skin structure infections in emerging community-acquired MRSA. Expert Opin Pharmacother 2006; 7:2019-24. [PMID: 17020429 DOI: 10.1517/14656566.7.15.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The treatment of community uncomplicated skin and skin structure infections (uSSSIs) mandates that treatment should be based on careful consideration of infection attributes and patient characteristics, particularly in this era of community-acquired MRSA as an emerging pathogen. However, as most uSSSIs in the community continue to be caused by methicillin-susceptible Staphylococcus aureus or streptococci, effective treatment against these key pathogens should aim to achieve prompt eradication, along with minimal risk of antimicrobial resistance. Cephalosporins are an effective broad-spectrum empirical treatment for uSSSIs, with considerable activity against methicillin-susceptible S. aureus. In addition, the use of antimicrobial agents in infective strains that may be resistant does not appear to be associated with adverse patient-reported outcomes, suggesting that cephalosporins may still be effective in treating community-acquired MRSA-associated SSSIs.
Collapse
Affiliation(s)
- James Hedrick
- Kentucky Pediatric/Adult Research, Bardstown, KY 40004, USA.
| |
Collapse
|