Infectious disease: how to manage Gram-positive and Gram-negative pathogen conundrums with dual beta-lactam therapy

Drugs in Context

article

Alireza FakhriRavari¹  Brenda Simiyu²  Taylor Morrisette³  Yewande Dayo⁵  Jacinda C Abdul-Mutakabbir¹ 

[1] Department of Pharmacy Practice, Loma Linda University School of Pharmacy;Department of Pharmacy Services, West Jefferson Medical Center;Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina College of Pharmacy;Department of Pharmacy Services, Medical University of South Carolina Shawn Jenkins Children’s Hospital;Department of System Pharmacy Services, Ochsner Health;Department of Basic Sciences, Loma Linda University School of Medicine

关键词: antimicrobial resistance;    beta-lactam;    combination therapy;    double carbapenem therapy;    dual therapy;    Gram-negative;    Gram-positive;   

DOI  :  10.7573/dic.2021-8-9

学科分类：社会科学、人文和艺术（综合）

来源: C S F Medical Communications Ltd.

【 摘 要 】

Antimicrobial resistance is a global public health threat due to its associated increase in mortality, and the most appropriate treatment algorithms for resistant and persistent Gram-positive and Gram-negative infections have yet to be elucidated. Whilst combination therapy has been touted as a viable method to overcome prominent resistant mechanisms represented amongst these microbes, the optimal agents to utilize remains controversial. Beta-lactams have a safe profile and are bactericidal against most Gram-positive and Gram-negative microorganisms. Thus, the use of dual beta-lactam therapy to overcome multidrug-resistant pathogens is of supreme interest. This article reviews the mechanisms of beta-lactam resistance in Gram-positive and Gram-negative bacteria, discusses the rationale for dual beta-lactam use against multidrug-resistant infections (and other scenarios in which this strategy may be most utilized in clinical practice), explores the available in vitro, in vivo and clinical data, and provides considerations for the use of dual beta-lactam therapy against Enterococcus faecalis, Listeria monocytogenes, Staphylococcus aureus, Enterobacterales, Pseudomonas aeruginosa and Acinetobacter baumannii pathogens.

【 授权许可】

CC BY-NC-ND