This eBook release, titled "PART III" is part of the "PROFESSIONALISM IN CLINICAL PRACTICE SERIES." It specifically addresses the optimisation of antibiotic efficacy and safety for infections caused by multi-drug resistant bacteria. The eBook covers a total of twenty distinct topics. Each topic is divided into two parts: Keypoints and their references. Each topic typically consists of an average of 12 key points that encompass the relevant subject matter. The following topics are entitled as:

1 CEFIDEROCOL AND SULBACTAM-DURLOBACTAM SHOW STRONG ACTIVITY AGAINST A WIDE RANGE OF ISOLATES. BUT UNRESOLVED QUESTIONS REMAIN ABOUT USING THESE AGENTS ALONGSIDE OTHER MEDICATIONS

2 PREVIOUS POLYMYXIN FAILURE FOR INVASIVE INFECTIONS CAUSED BY CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII, A THREE-DRUG COMBINATION OF AMPICILLIN-SULBACTAM, CARBAPENEMS, AND POLYMYXINS MAY BE NECESSARY

3 THE HYPOTHESIS THAT AMPICILLIN-SULBACTAM IS BETTER THAN COLISTIN FOR TREATING CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII INFECTIONS, ESPECIALLY PNEUMONIA, HAS LITTLE CLINICAL EVIDENCE

4 TETRACYCLINE-BASED REGIMENS AND ALTERNATIVE TREATMENTS FOR CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII INFECTIONS ARE LIMITED, WITH MOST CLINICAL DATA ON TIGECYCLINE. MINOCYCLINE AND ERAVACYCLINE LACK DEFINED CLINICAL BREAKPOINTS

5 AMPICILLIN / SULBACTAM DOSING FOR CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII INFECTIONS IS VARYING, BUT CLINICAL EVIDENCE SUPPORTS HIGH-DOSE OPTIMISATION

6 COMBINED WITH A Β-LACTAMASE INHIBITOR, SULBACTAM IS MOST EFFECTIVE AGAINST CARBAPENEM-RESISTANT ACINETOBACTER BAUMANII INFECTIONS. TIGECYCLINE IS PROMISING BUT UNCERTAIN AS A STANDALONE THERAPY

7 MINOCYCLINE, A COMBINATION DRUG, HAS SHOWN PROMISE IN TREATING CARBAPENEM-RESISTANT ACINETOBACTER BAUMANII INFECTIONS, DURLOBACTAM, A NOVEL Β-LACTAMASE INHIBITOR, ENHANCES SULBACTAM'S EFFECTIVENESS

8 IMIPENEM-CILASTATIN'S EFFECT ON SULBACTAM-DURLOBACTAM NEEDS FURTHER STUDY. DEPENDING ON FACTORS, FUTURE TREATMENTS SHOULD INCLUDE SULBACTAM

9 THE GUIDELINE DEVELOPMENT GROUP DEVELOPED CLINICAL PRACTICE GUIDELINES TO ASSESS THE EFFICACY OF MANAGING CARBAPENEM-RESISTANT ACINETOBACTER BAUMANII INFECTIONS USING THE GRADE APPROACH

10 THE GLOBAL GUIDELINES GROUP RECOMMENDS USING MINIMUM INHIBITOR CONCENTRATION VALUES, PHENOTYPIC AND GENOTYPIC TESTS, AND ANTIMICROBIAL SYNERGY TESTING FOR TREATING CARBAPENEM-RESISTANT ACINETOBACTER BAUMANII INFECTION

11 COMBINING POLYMYXIN AND CARBAPENEM TO TREAT CARBAPENEM-RESISTANT GRAM-NEGATIVE BACTERIA IS CONTROVERSIAL. GUIDELINES RECOMMEND THIS COMBINATION FOR MEROPENEM MICS UNDER 8 MG/

12 TIGECYCLINE-BASED AND POLYMYXIN-BASED COMBINATION THERAPIES HAVE ADVANTAGES AND DISADVANTAGES. AMIKACIN OR INTRAVENOUS FOSFOMYCIN MAY BE RECOMMENDED FOR CARBAPENEM-RESISTANT GRAM-NEGATIVE BACTERIA INFECTIONS

13 THERAPEUTIC DRUG MONITORING ENHANCING TREATMENT EFFECTIVENESS. SCREENING AND INTESTINAL DECOLONIZATION FOR CARBAPENEM-RESISTANT ENTEROBACTERIACEAE ARE EFFECTIVE, REDUCING ALL-CAUSE DEATHS AND INCREASING SUCCESSFUL ERADICATION

14 IMPLEMENTING INTERVENTIONS LIKE SINK REMOVAL, WATER-SAFE POLICIES, AND STAFF HAND HYGIENE MAY REDUCE THE ANNUAL INCIDENCE RATE OF MULTI-DRUG RESISTANT GRAM-NEGATIVE BACTERIA

15 COMBINATION THERAPY FOR LONG-TERM RESPIRATORY TRACT INFECTIONS SHOWS CLINICAL RECOVERY AND COMPLETE ELIMINATION AND CEFTAZIDIME/AVIBACTAM IS SUPERIOR IN TREATING COMPLICATED INFECTIONS

16 MEROPENEM / VABORBACTAM IS USED AS A LAST-RESORT TREATMENT FOR CEFTAZIDIME / AVIBACTAM-RESISTANT K BACTERIA AND CEFIDEROCOL IS EFFECTIVE AGAINST MULTIDRUG-RESISTANT GRAM-NEGATIVE BACTERI

17 CLINICAL TRIALS ON ERAVACYCLINE IN LIVER TRANSPLANTATION HAVE LIMITED DATA, WITH FEW POSITIVE OUTCOMES. FIXED-DOSE COMBINATION MAY CAUSE RENAL IMPAIRMEN

18 BETA-LACTAM ANTIBIOTICS KILL TIME-DEPENDENTLY, DEPENDING ON UNBOUND DRUG CONCENTRATION ABOVE THE MINIMUM INHIBITORY CONCENTRATION. UNFORTUNATELY, INFECTIOUS DISEASE SPECIALISTS DO NOT REDUCE CARBAPENEM-RESISTANT ENTEROBACTERIACEAE INFECTION MORTALITY

19 TREATMENTS FOR CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII INCLUDE SULBACTAM, POLYMYXINS, TIGECYCLINE, CEFIDEROCOL, AND FOSFOMYCIN. DIAZABICYCLOOCTANE DURLOBACTAM WORKS, BUT SULBACTAM IMPROVES CLINICALLY

20 CEFIDEROCOL, AN IRON-CONTAINING CEPHALOSPORIN, MAY TREAT BACTERIAL RESISTANCE, BUT CLINICAL DATA IS SCARCE. MULTIPLE TREATMENT REGIMENS MAKE CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII NFECTION COMBINATION THERAPY DIFFICULT. NEBULIZED COLISTIN MAY PREVENT TOXICITY

Authors

Clinical Pharmacy Specialist; MOH’D NOUR BANI YOUNES, MSc in Clinical Pharmacy, BCPS, BCCCP, BCNSP, BCACP, and BCIDP

Pharm D: Kariman Hatem Al Ghweiri