Polymyxins: To Combine or Not to Combine?
Polymyxins have been a mainstay for the treatment of extensively drug resistant (XDR) Gram-negative bacteria for the past two decades. Many questions regarding the clinical use of polymyxins have been answered, but whether the administration of polymyxins in combination with other antibiotics leads...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2019-04-01
|
| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/8/2/38 |
| _version_ | 1818057386656530432 |
|---|---|
| author | Federico Perez Nadim G. El Chakhtoura Mohamad Yasmin Robert A. Bonomo |
| author_facet | Federico Perez Nadim G. El Chakhtoura Mohamad Yasmin Robert A. Bonomo |
| author_sort | Federico Perez |
| collection | DOAJ |
| description | Polymyxins have been a mainstay for the treatment of extensively drug resistant (XDR) Gram-negative bacteria for the past two decades. Many questions regarding the clinical use of polymyxins have been answered, but whether the administration of polymyxins in combination with other antibiotics leads to better outcomes remains unknown. This review discusses the limitations of observational studies that suggest a benefit of combinations of colistin and carbapenems to treat infections caused by carbapenem-resistant Enterobacteriaceae (CRE), especially <i>Klebsiella pneumoniae</i> carbapenemase (KPC)-producing <i>K. pneumoniae</i>, and summarizes the results of randomized controlled trials in which treatment with colistin in combination with meropenem or rifampin does not lead to better clinical outcomes than colisitn monotherapy in infections caused by carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB). Although the introduction of new antibiotics makes it possible to treat certain strains of CRE and carbapenem-resistant <i>P. aeruginosa</i> (CRPA) with polymyxin-sparing regimens, the use of polymyxins is, for now, still necessary in CRAB and in CRE and CRPA harboring metallo-beta-lactamases. Therefore, strategies must be developed to optimize polymyxin-based treatments, informed by in vitro hollow fiber models, careful clinical observations, and high-quality evidence from appropriately designed trials. |
| first_indexed | 2024-12-10T12:43:55Z |
| format | Article |
| id | doaj.art-e65bc47328ee40ea85845d1527de1f5b |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-12-10T12:43:55Z |
| publishDate | 2019-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-e65bc47328ee40ea85845d1527de1f5b2022-12-22T01:48:27ZengMDPI AGAntibiotics2079-63822019-04-01823810.3390/antibiotics8020038antibiotics8020038Polymyxins: To Combine or Not to Combine?Federico Perez0Nadim G. El Chakhtoura1Mohamad Yasmin2Robert A. Bonomo3Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USAMedicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USAMedicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USAMedicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USAPolymyxins have been a mainstay for the treatment of extensively drug resistant (XDR) Gram-negative bacteria for the past two decades. Many questions regarding the clinical use of polymyxins have been answered, but whether the administration of polymyxins in combination with other antibiotics leads to better outcomes remains unknown. This review discusses the limitations of observational studies that suggest a benefit of combinations of colistin and carbapenems to treat infections caused by carbapenem-resistant Enterobacteriaceae (CRE), especially <i>Klebsiella pneumoniae</i> carbapenemase (KPC)-producing <i>K. pneumoniae</i>, and summarizes the results of randomized controlled trials in which treatment with colistin in combination with meropenem or rifampin does not lead to better clinical outcomes than colisitn monotherapy in infections caused by carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB). Although the introduction of new antibiotics makes it possible to treat certain strains of CRE and carbapenem-resistant <i>P. aeruginosa</i> (CRPA) with polymyxin-sparing regimens, the use of polymyxins is, for now, still necessary in CRAB and in CRE and CRPA harboring metallo-beta-lactamases. Therefore, strategies must be developed to optimize polymyxin-based treatments, informed by in vitro hollow fiber models, careful clinical observations, and high-quality evidence from appropriately designed trials.https://www.mdpi.com/2079-6382/8/2/38polymyxin Bcolistinantibiotic-combinationsCRE |
| spellingShingle | Federico Perez Nadim G. El Chakhtoura Mohamad Yasmin Robert A. Bonomo Polymyxins: To Combine or Not to Combine? Antibiotics polymyxin B colistin antibiotic-combinations CRE |
| title | Polymyxins: To Combine or Not to Combine? |
| title_full | Polymyxins: To Combine or Not to Combine? |
| title_fullStr | Polymyxins: To Combine or Not to Combine? |
| title_full_unstemmed | Polymyxins: To Combine or Not to Combine? |
| title_short | Polymyxins: To Combine or Not to Combine? |
| title_sort | polymyxins to combine or not to combine |
| topic | polymyxin B colistin antibiotic-combinations CRE |
| url | https://www.mdpi.com/2079-6382/8/2/38 |
| work_keys_str_mv | AT federicoperez polymyxinstocombineornottocombine AT nadimgelchakhtoura polymyxinstocombineornottocombine AT mohamadyasmin polymyxinstocombineornottocombine AT robertabonomo polymyxinstocombineornottocombine |