Nya antibiotika med aktivitet mot multiresistenta tarmbakterier. Kombinationspreparat prövas nu kliniskt
Sammanfattning
Increasing prevalence of ESBL-producing Enterobacteriaceae, including ESBLCARBA, has been reported in Sweden during the last five years. This increase of multidrug resistant bacteria (including Acinetobacter spp and Pseudomonas aeruginosa) poses a challenge for physicians due to the few effective antibiotics available. Some new antibiotics are in the process of clinical trials and they could be used as treatment alternatives pending their approval. Four combinations of beta-lactam plus beta-lactamase inhibitor are being reviewed in this article. Ceftolozane plus tazobactam is effective against ESBLA but not against ESBLCARBA-producing Gram-negative bacilli. It also has good activity against multidrug resistant Pseudomonas. Ceftazidime plus avibactam has a very similar activity spectrum, but it is also effective against ESBLCARBA except for metallo-beta-lactamases (MBL). Biapenem plus ME1071, a selective MBL inhibitor, can be used against Gram-negative bacilli producing such enzymes. BAL30072 plus meropenem has a broad spectrum of activity including ESBLA, multidrug resistant Pseudomonas and Acinetobacter, and ESBLCARBA except for Klebsiella pneumoniae carbapenemase (KPC). New antibiotics provide treatment solutions in specific cases but in the battle against multidrug resistant bacteria there are other equally important aspects that should be considered, like adherence to infection control in health-care settings and antimicrobial stewardship.