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Ramasubramanian V, Murlidharan P, Nambi S, Pavithra S, Puthran S, Petigara T. Efficacy and Cost Comparison of Ertapenem as Outpatient Parenteral Antimicrobial Therapy in Acute Pyelonephritis due to Extended-spectrum Beta-lactamase-producing Enterobacteriaceae. Indian J Nephrol 2018; 28:351-357. [PMID: 30270995 PMCID: PMC6146727 DOI: 10.4103/ijn.ijn_207_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) programs are becoming an increasingly popular trend in clinical practice as they offer several benefits to both patients and health-care setups. While OPAT is an established clinical practice in the Western world, the concept itself is alien to patients in India as they prefer the security of hospitals to receive antibiotics over OPAT. We evaluated the clinical response and cost comparison of ertapenem under OPAT versus inpatient settings in patients with extended-spectrum beta-lactamase (ESBL)-positive acute pyelonephritis (APN) given the increasing importance of optimizing both hospital beds and overall cost of patient care in India. APN was chosen as the indication to be studied as it is one of the common complicated urinary tract infections treated in our OPAT unit requiring 10–14 days of parenteral therapy with an agent active against various Gram-negative bacilli and multidrug-resistant organisms. One hundred patients were retrospectively studied based on whether antibiotics were administered during hospital stay alone (hospital only), during both hospital stay, and also as OPAT post discharge (hospital/OPAT) or as OPAT alone (OPAT only). Response to ertapenem and cost of treatment in inpatient versus OPAT settings were compared using Pearson's Chi-square or Fisher's exact test for categorical variables. ANOVA (or Kruskal–Wallis) was used for continuous variables. Baseline urine cultures were ESBL positive with 98% prevalence of Gram-negative bacilli (GNB). Colony counts were ≥100,000 in 74% patients. Only ertapenem, imipenem, and meropenem showed 100% sensitivity to ESBL-positive GNB in baseline urine culture and sensitivity reports. Ertapenem showed 100% sensitivity and complete clinical resolution for 96% patients with APN due to ESBL Enterobacteriaceae. It was administered as OPAT in 90% patients and significantly reduced overall treatment costs.
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Affiliation(s)
- V Ramasubramanian
- Department of Infectious Disease & Tropical Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
| | - P Murlidharan
- Department of Nephrology, KIMS, Thiruvananthapuram, Kerala, India
| | - S Nambi
- Department of Infectious Disease & Tropical Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
| | - S Pavithra
- Apollo Research & Innovations, Chennai, Tamil Nadu, India
| | - S Puthran
- Medical Affairs, MSD Pharmaceuticals Pvt. Ltd., Mumbai, Maharashtra, India
| | - T Petigara
- Global Health Outcomes, Merck and Co., Inc., Kenilworth, NJ, USA
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Wolcott R, Sanford N, Gabrilska R, Oates J, Wilkinson J, Rumbaugh K. Microbiota is a primary cause of pathogenesis of chronic wounds. J Wound Care 2016; 25:S33-S43. [DOI: 10.12968/jowc.2016.25.sup10.s33] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R. Wolcott
- Southwest Regional Wound Care Center, Lubbock, Texas
| | - N. Sanford
- Southwest Regional Wound Care Center, Lubbock, Texas
| | - R. Gabrilska
- Texas Tech University Health Sciences Center, Lubbock, Texas
| | - J.L. Oates
- Research and Testing Laboratory, Lubbock, Texas
| | | | - K.P. Rumbaugh
- Texas Tech University Health Sciences Center, Lubbock, Texas
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Xu ZR, Ran XW, Xian Y, Yan XD, Yuan GY, Mu SM, Shen JF, Zhang BS, Gan WJ, Wang J. Ertapenem versus piperacillin/tazobactam for diabetic foot infections in China: a Phase 3, multicentre, randomized, double-blind, active-controlled, non-inferiority trial. J Antimicrob Chemother 2016; 71:1688-96. [PMID: 26888908 DOI: 10.1093/jac/dkw004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/04/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Few randomized controlled studies have compared antibiotic regimens against diabetic foot infections (DFIs) in Chinese patients. We evaluated the efficacy and safety of ertapenem versus piperacillin/tazobactam for the treatment of DFIs in Chinese patients. METHODS Patients with moderate to severe DFIs requiring parenteral antibiotics were randomized in a 1 : 1 ratio to receive ertapenem (1.0 g once daily) or piperacillin/tazobactam (4.5 g every 8 h) by 30 min intravenous (iv) infusions for ≥5 days. The primary outcome was favourable clinical response at discontinuation of iv therapy (DCIV). An evaluable-patient population was identified for primary analysis of non-inferiority at -15%. Safety was assessed. ClinicalTrials.gov: NCT01370616. RESULTS Of 565 patients randomized, 443 patients (ertapenem = 219 and piperacillin/tazobactam = 224) were clinically evaluable for primary analysis. In the clinically evaluable population, the proportions of patients with favourable clinical response at DCIV were 93.6% (205/219) and 97.3% (218/224) in the ertapenem and piperacillin/tazobactam groups, respectively (difference: -3.8%, 95% CI: -8.3%, 0.0%). Ertapenem had a significantly lower favourable clinical response rate (91.5% versus 97.2%, 95% CI for difference: -12.1%, -0.3%) at DCIV in severe DFI patients. In the modified ITT population, 88.8% (237/267) and 90.6% (241/266) of patients in the ertapenem and piperacillin/tazobactam groups, respectively, had favourable clinical responses at DCIV (difference: -1.9%, 95% CI: -7.3%, 3.3%). Microbiological eradications of causative pathogens and adverse events were similar between treatment groups. CONCLUSIONS Treatment with ertapenem was non-inferior to piperacillin/tazobactam in Chinese patients with DFIs. Ertapenem treatment resulted in a markedly lower rate of clinical resolution in severe DFIs.
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Affiliation(s)
| | - Xing-Wu Ran
- West China Hospital, Sichuan University, Chengdu, China
| | - Yang Xian
- Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiao-Dong Yan
- The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Guo-Yue Yuan
- Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | | | | | | | - Wei-Jin Gan
- Biostatistics, PAREXEL International, Shanghai, China
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Walker SE. Stability of Ertapenem 100 mg/mL in Manufacturer's Glass Vials or Syringes at 4°C and 23°C. Can J Hosp Pharm 2015; 68:121-6. [PMID: 25964683 PMCID: PMC4414073 DOI: 10.4212/cjhp.v68i2.1437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Prophylactic administration of ertapenem as a single 1-g IV dose has been shown to reduce sepsis after prostate biopsy. OBJECTIVE To evaluate the stability of ertapenem after reconstitution with 0.9% sodium chloride to a final concentration of 100 mg/mL and storage in the manufacturer's original glass vials or polypropylene syringes. METHODS On study day 0, 100 mg/mL solutions of ertapenem were retained in the manufacturer's glass vials or packaged in polypropylene syringes and stored at 4°C or 23°C without protection from fluorescent room light. Samples were assayed periodically over 18 days using a validated, stability-indicating liquid chromatographic method with ultra-violet detection. A beyond-use date was determined as the time for the concentration to decline to 90% of the initial (day 0) concentration, based on the fastest degradation rate, with 95% confidence. RESULTS Reconstituted solutions stored in the manufacturer's glass vials or polypropylene syringes exhibited a first-order degradation rate, such that 10% of the initial concentration was lost in the first 2.5 days when stored at 4°C or within the first 6.75 h when stored at room temperature (23°C). Analysis of variance showed differences in the percentage remaining due to temperature (p < 0.001) and study day (p < 0.001) but not type of container (p = 0.98). When a 95% CI for the degradation rate was calculated and used to determine a beyond-use date, it was established that more than 90% of the initial concentration would remain for 2.35 days at 4°C and for 0.23 day (about 5 h, 30 min) at room temperature. CONCLUSIONS A 100 mg/mL ertapenem solution stored in the manufacturer's glass vial or a polypropylene syringe will retain more than 90.5% of the initial concentration when stored for 48 h at 4°C and for an additional 1 h at 23°C.
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Affiliation(s)
- Scott E Walker
- Scott E Walker, MScPhm, is Director of Pharmacy, Sunnybrook Health Sciences Centre, and Associate Professor, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Wiskirchen DE, Housman ST, Quintiliani R, Nicolau DP, Kuti JL. Comparative pharmacokinetics, pharmacodynamics, and tolerability of ertapenem 1 gram/day administered as a rapid 5-minute infusion versus the standard 30-minute infusion in healthy adult volunteers. Pharmacotherapy 2013; 33:266-74. [PMID: 23400916 DOI: 10.1002/phar.1197] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
STUDY OBJECTIVE To compare ertapenem pharmacokinetics, pharmacodynamics, and tolerability when administered as a rapid 5-minute infusion to the standard 30-minute infusion. DESIGN Prospective, randomized, crossover pharmacokinetic study. SETTING Clinical research center. SUBJECTS Twelve healthy adult volunteers. INTERVENTION Each subject received ertapenem 1 g intravenously, administered either as a rapid 5-minute infusion or the standard 30-minute infusion, every 24 hours for 3 days (first phase); after a 4-day washout period, each subject then received the other infusion every 24 hours for 3 days (second phase). MEASUREMENTS AND MAIN RESULTS Plasma samples were collected after the first and third (steady-state) doses of each study phase, and protein binding was assessed by use of ultrafiltration. Pharmacokinetic analyses were conducted using noncompartmental and compartmental methods. A 5000-subject Monte Carlo simulation was used to assess the probability of target attainment for free drug concentration remaining above the minimum inhibitory concentration (MIC) for 40% or greater of the dosing interval (40% fT > MIC) over an MIC range. Ertapenem was well tolerated and adverse events were similar for both infusions. The ertapenem steady-state mean ± SD maximum concentrations were 193.3 ± 43.3 and 165.7 ± 20.4 mg/L for the 5- and 30-minute infusions, respectively; the mean ± SD areas under the concentration-time curves from 0-24 hours were 561.2 ± 77.0 and 531.3 ± 56.9 μg · hr/ml (geometric mean ratio 1.008, 90% confidence interval 0.999-1.017), respectively. Protein binding was concentration dependent (range 87.9-98.9%). A two-compartment model best described ertapenem pharmacokinetics with the following parameter estimates: clearance 1.89 ± 0.19 L/hr, volume of central compartment 5.04 ± 0.56 L, and transfer constants k12 0.43 ± 0.08/hr and k21 0.44 ± 0.07/hr. The probabilities of target attainment for 5- and 30-minute infusions were 97.0% and 97.9% at an MIC of 0.25 mg/L and 1.7% and 2.8% at an MIC of 0.5 mg/L, respectively. CONCLUSION Ertapenem administered as a rapid 5-minute infusion provides a well tolerated, bioequivalent, and pharmacodynamically equivalent regimen to the 30-minute infusion at clinically relevant MICs.
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Affiliation(s)
- Dora E Wiskirchen
- Center for Anti-Infective Research and Development , Hartford Hospital, Hartford, CT 06102, USA
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Efficacy of ertapenem for treatment of bloodstream infections caused by extended-spectrum-β-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 2012; 56:2173-7. [PMID: 22290982 DOI: 10.1128/aac.05913-11] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ertapenem is active against extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae organisms but inactive against Pseudomonas aeruginosa and Acinetobacter baumannii. Due to a lack of therapeutic data for ertapenem in the treatment of ESBL bloodstream infections (BSIs), group 2 carbapenems (e.g., imipenem or meropenem) are often preferred for treatment of ESBL-producing Enterobacteriaceae, although their antipseudomonal activity is unnecessary. From 2005 to 2010, 261 patients with ESBL BSIs were analyzed. Outcomes were equivalent between patients treated with ertapenem and those treated with group 2 carbapenems (mortality rates of 6% and 18%, respectively; P = 0.18).
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Ertapenem for treatment of osteomyelitis: a case series. BMC Res Notes 2011; 4:478. [PMID: 22047594 PMCID: PMC3219740 DOI: 10.1186/1756-0500-4-478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 11/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ertapenem is a once-daily broad spectrum carbapenem that is increasingly used to treat polymicrobial osteomyelitis due to diabetic foot and traumatic wound infections. However, limited data exists on ertapenem use for osteomyelitis. This study aimed to characterize outcomes and adverse effects with empiric use of ertapenem for osteomyelitis. FINDINGS A total of 112 patients presenting to Duke, Durham Regional or Durham VA Medical Centers with a suspected diagnosis of osteomyelitis and ertapenem use from 11/2001 to 8/2009 were screened, and 12 subjects met inclusion criteria for the study. Mean age was 60 ± 16 years, 68% were female, 75% were Caucasian, and the most common comorbidities included diabetes (58%), peripheral vascular disease (42%), and history of tobacco use (75%). Over half of the patients presented to a primary care clinic or emergency room greater than six months after the onset of clinical symptoms. Bone culture was obtained for diagnostic guidance in only two cases; and surgical intervention was pursued in three cases. Patients received a mean duration of 34.6 ± 7.8 days of therapy, and in three cases, subsequent suppressive oral antibiotics were given. Six (50%) patients met criteria for clinical success, defined as resolution of clinical signs and symptoms of infection such that discontinuation of antibiotics was deemed appropriate at end of ertapenem therapy, without recurrence at one year follow-up. No adverse drug effects were noted. CONCLUSIONS In this case series of mostly community-acquired, lower extremity osteomyelitis, bone biopsy was infrequent, and an average six-week course of empiric ertapenem was well-tolerated with curative rates of 50% at one year.
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Mackintosh CL, White HA, Seaton RA. Outpatient parenteral antibiotic therapy (OPAT) for bone and joint infections: experience from a UK teaching hospital-based service. J Antimicrob Chemother 2010; 66:408-15. [DOI: 10.1093/jac/dkq445] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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How much money can be saved by applying intravenous antibiotics once instead of several times a day? Infection 2010; 38:479-82. [PMID: 20981469 DOI: 10.1007/s15010-010-0060-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The preparation, administration and monitoring of intravenous (IV) applications are time consuming and require human resources. We estimated the potential time and cost savings by replacing antibiotics given 3-4 times daily with antibiotics with similar spectrum and efficacy given once daily. METHODS The savings of indirect costs were estimated based on the antibiotic consumption data of a two-year period (i.e. 2007 and 2008), a nurse's mean workload per application and the average nurse's salary in Switzerland. RESULTS The consumption of IV antibiotics in 2007 and 2008 at the University Hospital of Basel was 29.0 and 32.2 defined daily doses (DDD) per 100 patient days, respectively. Nurses spent an estimated 13,786 h on the application of the estimated 82,715 does of IV antibiotics. A total of 56,404 applications or nursing staff time costs of 338,436 Swiss Francs (CHF; 236,669 <euro>), equal to 16% of the overall costs spent on purchasing antibiotics in the year 2008, may have been saved by switching multiple-dose antibiotics to a hypothetical once-daily antibiotic. Including disposable materials, 21% or 456,884 CHF (319,499 <euro>) could be saved annually (purchase costs not taken into account). CONCLUSION We found a potential cost saving of 21% of the purchase costs in a 750-bed institution. Hence, indirect costs should be included in the calculation of the total cost for the application of broad-spectrum IV antibiotics. Switching from a 3-4 times daily application to a once-daily antibiotic should be considered if a once-daily antibiotic is deemed equally effective and has a similar spectrum.
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Hitchcock J, Jepson AP, Main J, Wickens HJ. Establishment of an outpatient and home parenteral antimicrobial therapy service at a London teaching hospital: a case series. J Antimicrob Chemother 2009; 64:630-4. [DOI: 10.1093/jac/dkp212] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nielsen MD, Mendicino RW, Catanzariti AR. The use of ertapenem for the treatment of lower extremity infections. J Foot Ankle Surg 2009; 48:135-41. [PMID: 19232964 DOI: 10.1053/j.jfas.2008.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Indexed: 02/03/2023]
Abstract
UNLABELLED Lower extremity infections are a growing challenge. Moderate to severe infections are frequently polymicrobial in nature and require appropriate parenteral antibiotic therapy. Ideally, empiric treatment should be broad spectrum in coverage, simplistic in use, and economically reasonable for the patient and the health care system. This article retrospectively reviewed the outcomes of 230 patients, 159 (69.13%) of whom were diabetic, who were admitted with lower extremity infections and who were empirically treated with ertapenem. Ertapenem was well tolerated with a low adverse effect profile. We found a 79.13% rate (182 of 230 patients) of favorable outcome with this regimen, which is comparable to other published studies that have looked at the use of this agent. Ertapenem is a once-daily, broad-spectrum carbapenem antibiotic indicated for the treatment of complicated skin and skin-structure infections (cSSSI). Ertapenem is an appropriate choice for empiric antibiotic therapy of lower extremity infections. LEVEL OF CLINICAL EVIDENCE 2.
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Affiliation(s)
- Matthew D Nielsen
- Department of Foot and Ankle Surgery, The Western Pennsylvania Hospital, Pittsburgh, USA
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Berg ML, Crank CW, Philbrick AH, Hayden MK. Efficacy of Ertapenem for Consolidation Therapy of Extended-Spectrum β-lactamase-Producing Gram-Negative Infections: A Case Series Report. Ann Pharmacother 2008; 42:207-12. [DOI: 10.1345/aph.1k365] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Infections caused by extended-spectrum β-lactamase (ESBL)-producing gram-negative organisms are becoming increasingly common and present significant challenges in terms of treatment. Carbapenems is the antibiotic class of choice for treatment of these types of infections. Ertapenem is the newest carbapenem, capable of being dosed once daily, and has some in vitro but little in vivo evidence supporting its use for the treatment ol these resistant infections. Objective: To examine the clinical and microbiologic outcomes associated with ertapenem therapy of ESBL-producing Escherichia coli, Klebsiella pneumoniae. and Proteus mirabilis infections. Methods: This was a retrospective case series that examined the clinical and microbiologic outcomes of 22 patients who received ertapenem for treatment of an ESBL infection at Rush University Medical Center in Chicago. IL, during 2003–2005. Results: The majority (16/22) of patients received ertapenem (or consolidation rather than initial therapy. Different antibiotics most commonly used were other carbapenems, piperacillin/tazobactam, and aminoglycosides. The most common infections treated were lower urinary tract infections and osteomyelitis. Clinical efficacy was determined in all 22 patients, with 20 (91%) patients having a positive outcome, defined as either clinical improvement or clinical cure. The best clinical cure rate was seen with wound infections, where all 3 patients examined were found to be clinically cured. Microbiologic efficacy was determined in 7 patients, with 6 {85.7%) defined as microbiologic cure. One patient was found to be both a clinical and microbiologic failure and was also found to have developed an ertapenem-resistant strain of E. coli. Conclusions: These results demonstrate potential microbiologic and clinical efficacy of ertapenem for treatment of ESBL-producing infections and the need for a prospective, randomized study examining its efficacy versus that of other carbapenems.
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Affiliation(s)
- Melody L Berg
- Pharmacotherapy Specialty Resident, Midwestern University Chicago College of Pharmacy, Downers Grove, IL; now, Clinical Assistant Professor, University of Illinois-Chicago; Internal Medicine Clinical Pharmacy Specialist, Department of Pharmacy, Edward Hospital, Naperville, IL
| | | | | | - Mary K Hayden
- Associate Attending Physician in Infectious Diseases, Rush University Medical Center
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Stein GE. New drugs to treat skin and soft tissue infections. Curr Infect Dis Rep 2007; 9:408-14. [PMID: 17880852 DOI: 10.1007/s11908-007-0063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Due to increasing antimicrobial resistance, a pressing need exists for new antibiotics to treat skin and soft tissue infections. Several newer agents such as tigecycline, daptomycin, and linezolid have been important additions for the treatment of multidrug-resistant pathogens. New drugs in development such as dalbavancin and ceftobiprole will further enhance our ability to treat mixed infections and improve patient compliance. These promising new antimicrobials will likely grow in importance as resistant bacterial strains increase in community-acquired infections.
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Affiliation(s)
- Gary E Stein
- Department of Medicine, Michigan State University, B320 Life Sciences, East Lansing, MI 48824, USA.
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Steinberg JS, Kim PJ, Abbruzzese MR. An infectious disease update on antibiotics: emerging resistance. Clin Podiatr Med Surg 2007; 24:285-309. [PMID: 17430771 DOI: 10.1016/j.cpm.2007.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Podiatric physicians often encounter infectious processes in the lower extremity in inpatient and outpatient settings. Bacterial resistance to antibiotics is a growing concern for clinicians treating these infections, especially in complex patients who have immune compromise such as diabetes. Although a number of antibiotic options are available for the treatment of lower-extremity soft tissue and bone infections, a careful examination of bacterial susceptibilities, drug resistance, and treatment efficacy can result in better patient care and limb salvage.
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Affiliation(s)
- John S Steinberg
- Department of Plastic Surgery, Georgetown University School of Medicine, 3800 Reservoir Road NW, Main Bldg. 1st Floor, Limb Center, Washington, DC 20007-2113, USA.
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Behra-Miellet J, Dubreuil L, Calvet L. Evaluation of the in vitro activity of ertapenem and nine other comparator agents against 337 anaerobic bacteria. Int J Antimicrob Agents 2006; 28:25-35. [PMID: 16757152 DOI: 10.1016/j.ijantimicag.2006.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
Ertapenem activity in vitro was compared with that of nine reference antibiotics against 337 anaerobes by determining minimal inhibition concentrations (MICs). Amongst 246 Gram-negative anaerobes, 4, 8, 3, 4, 7, 2 and 52 strains showed resistance to ertapenem, amoxicillin/clavulanic acid, ticarcillin/clavulanic acid, piperacillin/tazobactam, cefoxitin, imipenem and clindamycin, respectively, and all strains were inhibited by metronidazole. Ertapenem MIC(50) values were 0.5, 0.25, 0.06 and <or=0.03mg/L for the Bacteroides fragilis group, Prevotella spp., fusobacteria and Gram-positive cocci, respectively. Overall resistance rates were 2.1%, 51.3%, 2.4%, 1.2%, 1.5%, 7.1%, 0.6%, 22% and 1.5% for ertapenem, amoxicillin, amoxicillin/clavulanic acid, ticarcillin/clavulanic acid, piperacillin/tazobactam, cefoxitin, imipenem, clindamycin and metronidazole, respectively. Ertapenem showed a broad spectrum and good activity against anaerobes.
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Affiliation(s)
- J Behra-Miellet
- Faculté de Pharmacie, 3 rue du Professeur Laguesse, BP83, 59006 Lille Cedex, France
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Abstract
The Group 1, 1 beta-methyl carbapenem ertapenem (Invanz) is approved for parenteral use in patients with complicated intra-abdominal infection (cIAI), community-acquired pneumonia (CAP) and acute pelvic infection caused by susceptible strains of certain designated organisms in both the US and the EU. Additional approved indications in the US include complicated skin and skin structure infection (cSSSI) and complicated urinary tract infection (cUTI). Ertapenem is approved for use in adults in both the US and the EU and in paediatric patients aged >or=3 months in the US. Ertapenem has a broad spectrum of in vitro activity against Gram-negative pathogens, including extended-spectrum beta-lactamase (ESBL)- and AmpC-producing Enterobacteriaceae, Gram-positive pathogens and anaerobic pathogens. It has similar efficacy to comparator antibacterials such as piperacillin/tazobactam in cSSSI (including diabetic foot infection), cIAI and acute pelvic infection and ceftriaxone with or without metronidazole in cIAI, cUTI and CAP. The drug has also shown efficacy in the treatment of paediatric patients with complicated community-acquired bacterial infections. Ertapenem has a convenient once-daily administration schedule and is generally well tolerated. Thus, ertapenem is an important option for the empirical treatment of complicated community-acquired bacterial infections in hospitalised patients.
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Bhattacharya S. ESBL- FROM PETRI DISH TO THE PATIENT. Indian J Med Microbiol 2006. [DOI: 10.1016/s0255-0857(21)02465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zhanel GG, Johanson C, Embil JM, Noreddin A, Gin A, Vercaigne L, Hoban DJ. Ertapenem: review of a new carbapenem. Expert Rev Anti Infect Ther 2005; 3:23-39. [PMID: 15757455 DOI: 10.1586/14787210.3.1.23] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The carbapenems are beta-lactam-type antibiotics with an exceptionally broad spectrum of activity. Ertapenem is a new carbapenem developed to address the pharmacokinetic shortcomings (short half-life) of imipenem and meropenem. Ertapenem shares similar structural features with meropenem, including its stability to dehydropeptidase-1, allowing it to be administered without a dehydropeptidase-1 inhibitor. Ertapenem, like imipenem and meropenem, demonstrates broad-spectrum antimicrobial activity against many Gram-positive and -negative aerobes and anaerobes and is resistant to nearly all beta-lactamases, including extended-spectrum beta-lactamases and AmpCs. However, it differs from both imipenem and meropenem in demonstrating limited activity against Enterococcusspp., Pseudomonasaeruginosa and other nonfermentative Gram-negative bacteria commonly associated with nosocomial infections. The extensive protein binding of ertapenem extends the half-life and allows for once-daily dosing. Prospective, multicenter, randomized, double-blind, comparative clinical studies demonstrate similar clinical efficacy of ertapenem compared with other agents. Clinical trials of complicated intra-abdominal infection, acute pelvic infection, complicated skin and soft-structure infection, community-acquired pneumonia and complicated urinary tract infections demonstrated that ertapenem has equivalent efficacy and safety compared with ceftriaxone and piperacillin/tazobactam. Ertapenem is a promising new carbapenem with excellent efficacy and safety for the treatment of a variety of community-acquired infections. It also appears to be of great value as an outpatient parenteral antimicrobial therapy.
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Affiliation(s)
- George G Zhanel
- Health Sciences Center, Clinical Microbiology, MS673-820, Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada.
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