Shifting Gears: The Future of Polymyxin Antibiotics
The manuscripts contained in this special edition of Antibiotics represent a current review of the polymyxins as well as highlights from the 3rd International Polymyxin Conference, which was held in Madrid, Spain, 25 to 26 April 2018. The role of the polymyxin antibiotics has evolved over time based...
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| Format: | Article |
| Language: | English |
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MDPI AG
2019-04-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/8/2/42 |
| _version_ | 1819079347138461696 |
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| author | Justin R. Lenhard Zackery P. Bulman Brian T. Tsuji Keith S. Kaye |
| author_facet | Justin R. Lenhard Zackery P. Bulman Brian T. Tsuji Keith S. Kaye |
| author_sort | Justin R. Lenhard |
| collection | DOAJ |
| description | The manuscripts contained in this special edition of Antibiotics represent a current review of the polymyxins as well as highlights from the 3rd International Polymyxin Conference, which was held in Madrid, Spain, 25 to 26 April 2018. The role of the polymyxin antibiotics has evolved over time based on the availability of alternative agents. After high rates of nephrotoxicity caused the drug class to fall out of favor, polymyxins were once against utilized in the 21st century to combat drug-resistant pathogens. However, the introduction of safer agents with activity against drug-resistant organisms has brought the future utility of polymyxins into question. The present review investigates the future niche of polymyxins by evaluating currently available and future treatment options for difficult-to-treat pathogens. The introduction of ceftazidime-avibactam, meropenem-vaborbactam and plazomicin are likely to decrease polymyxin utilization for infections caused by <i>Enterobacteriaceae</i>. Similarly, the availability of ceftolozane-tazobactam will reduce the use of polymyxins to counter multidrug-resistant <i>Pseudomonas aeruginosa</i>. In contrast, polymyxins will likely continue be an important option for combatting carbapenem-resistant <i>Acinetobacter baumannii</i> until better options become commercially available. Measuring polymyxin concentrations in patients and individualizing therapy may be a future strategy to optimize clinical outcomes while minimizing nephrotoxicity. Inhaled polymyxins will continue to be an adjunctive option for pulmonary infections but further clinical trials are needed to clarify the efficacy of inhaled polymyxins. Lastly, safer polymyxin analogs will potentially be an important addition to the antimicrobial armamentarium. |
| first_indexed | 2024-12-21T19:27:32Z |
| format | Article |
| id | doaj.art-6fea8da9903249819e4fd5be6dc52b88 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-12-21T19:27:32Z |
| publishDate | 2019-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-6fea8da9903249819e4fd5be6dc52b882022-12-21T18:52:47ZengMDPI AGAntibiotics2079-63822019-04-01824210.3390/antibiotics8020042antibiotics8020042Shifting Gears: The Future of Polymyxin AntibioticsJustin R. Lenhard0Zackery P. Bulman1Brian T. Tsuji2Keith S. Kaye3Department of Clinical and Administrative Sciences, California Northstate University College of Pharmacy, Elk Grove, CA 95757, USADepartment of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USALaboratory for Antimicrobial Dynamics, NYS Center of Excellence in Bioinformatics and Life Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, New York, NY 14215, USADepartment of Internal Medicine; Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI 48109, USAThe manuscripts contained in this special edition of Antibiotics represent a current review of the polymyxins as well as highlights from the 3rd International Polymyxin Conference, which was held in Madrid, Spain, 25 to 26 April 2018. The role of the polymyxin antibiotics has evolved over time based on the availability of alternative agents. After high rates of nephrotoxicity caused the drug class to fall out of favor, polymyxins were once against utilized in the 21st century to combat drug-resistant pathogens. However, the introduction of safer agents with activity against drug-resistant organisms has brought the future utility of polymyxins into question. The present review investigates the future niche of polymyxins by evaluating currently available and future treatment options for difficult-to-treat pathogens. The introduction of ceftazidime-avibactam, meropenem-vaborbactam and plazomicin are likely to decrease polymyxin utilization for infections caused by <i>Enterobacteriaceae</i>. Similarly, the availability of ceftolozane-tazobactam will reduce the use of polymyxins to counter multidrug-resistant <i>Pseudomonas aeruginosa</i>. In contrast, polymyxins will likely continue be an important option for combatting carbapenem-resistant <i>Acinetobacter baumannii</i> until better options become commercially available. Measuring polymyxin concentrations in patients and individualizing therapy may be a future strategy to optimize clinical outcomes while minimizing nephrotoxicity. Inhaled polymyxins will continue to be an adjunctive option for pulmonary infections but further clinical trials are needed to clarify the efficacy of inhaled polymyxins. Lastly, safer polymyxin analogs will potentially be an important addition to the antimicrobial armamentarium.https://www.mdpi.com/2079-6382/8/2/42polymyxins<i>Acinetobacter baumannii</i><i>Klebsiella pneumoniae</i><i>Pseudomonas aeruginosa</i>carbapenem resistanceβ-lactamase inhibitorsavibactamceftolozanecefiderocolinhaled antibiotics |
| spellingShingle | Justin R. Lenhard Zackery P. Bulman Brian T. Tsuji Keith S. Kaye Shifting Gears: The Future of Polymyxin Antibiotics Antibiotics polymyxins <i>Acinetobacter baumannii</i> <i>Klebsiella pneumoniae</i> <i>Pseudomonas aeruginosa</i> carbapenem resistance β-lactamase inhibitors avibactam ceftolozane cefiderocol inhaled antibiotics |
| title | Shifting Gears: The Future of Polymyxin Antibiotics |
| title_full | Shifting Gears: The Future of Polymyxin Antibiotics |
| title_fullStr | Shifting Gears: The Future of Polymyxin Antibiotics |
| title_full_unstemmed | Shifting Gears: The Future of Polymyxin Antibiotics |
| title_short | Shifting Gears: The Future of Polymyxin Antibiotics |
| title_sort | shifting gears the future of polymyxin antibiotics |
| topic | polymyxins <i>Acinetobacter baumannii</i> <i>Klebsiella pneumoniae</i> <i>Pseudomonas aeruginosa</i> carbapenem resistance β-lactamase inhibitors avibactam ceftolozane cefiderocol inhaled antibiotics |
| url | https://www.mdpi.com/2079-6382/8/2/42 |
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