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Oliva A, Cogliati Dezza F, Cancelli F, Curtolo A, Falletta A, Volpicelli L, Venditti M. New Antimicrobials and New Therapy Strategies for Endocarditis: Weapons That Should Be Defended. J Clin Med 2023; 12:7693. [PMID: 38137762 PMCID: PMC10743892 DOI: 10.3390/jcm12247693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
The overall low-quality evidence concerning the clinical benefits of different antibiotic regimens for the treatment of infective endocarditis (IE), which has made it difficult to strongly support or reject any regimen of antibiotic therapy, has led to a discrepancy between the available guidelines and clinical practice. In this complex scenario, very recently published guidelines have attempted to fill this gap. Indeed, in recent years several antimicrobials have entered the market, including ceftobiprole, ceftaroline, and the long-acting lipoglycopeptides dalbavancin and oritavancin. Despite being approved for different indications, real-world data on their use for the treatment of IE, alone or in combination, has accumulated over time. Furthermore, an old antibiotic, fosfomycin, has gained renewed interest for the treatment of complicated infections such as IE. In this narrative review, we focused on new antimicrobials and therapeutic strategies that we believe may provide important contributions to the advancement of Gram-positive IE treatment, providing a summary of the current in vitro, in vivo, and clinical evidence supporting their use in clinical practice.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.C.); (A.C.); (A.F.); (L.V.); (M.V.)
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2
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New Perspectives on Antimicrobial Agents: Long-Acting Lipoglycopeptides. Antimicrob Agents Chemother 2022; 66:e0261420. [PMID: 35475634 DOI: 10.1128/aac.02614-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The long-acting lipoglycopeptides (LGPs) dalbavancin and oritavancin are semisynthetic antimicrobials with broad and potent activity against Gram-positive bacterial pathogens. While they are approved by the Food and Drug Administration for acute bacterial skin and soft tissue infections, their pharmacological properties suggest a potential role of these agents for the treatment of deep-seated and severe infections, such as bloodstream and bone and joint infections. The use of these antimicrobials is particularly appealing when prolonged therapy, early discharge, and avoidance of long-term intravascular catheter access are desirable or when multidrug-resistant bacteria are suspected. This review describes the current evidence for the use of oritavancin and dalbavancin in the treatment of invasive infections, as well as the hurdles that are preventing their optimal use. Moreover, this review discusses the current knowledge gaps that need to be filled to understand the potential role of LGPs in highly needed clinical scenarios and the ongoing clinical studies that aim to address these voids in the upcoming years.
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Efficacy of oritavancin alone and in combination against vancomycin-susceptible and -resistant enterococci in an in-vivo Galleria mellonella survival model. Int J Antimicrob Agents 2019; 54:197-201. [DOI: 10.1016/j.ijantimicag.2019.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/03/2019] [Accepted: 04/17/2019] [Indexed: 11/19/2022]
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Mercuro NJ, Davis SL, Zervos MJ, Herc ES. Combatting resistant enterococcal infections: a pharmacotherapy review. Expert Opin Pharmacother 2018; 19:979-992. [PMID: 29877755 DOI: 10.1080/14656566.2018.1479397] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The role of enterococci in infectious diseases has evolved from a gut and urinary commensal to a major pathogen of concern. Few options exist for resistant enterococci, and appropriate use of the available agents is crucial. AREAS COVERED Herein, the authors discuss antibiotics with clinically useful activity against Enterococcus faecalis and E. faecium. The article specifically discusses: antibiotics active against enterococci and their mechanism of resistance, pharmacokinetic and pharmacodynamic principles, in vitro combinations, and clinical studies which focus on urinary tract, intra-abdominal, central nervous system, and bloodstream infections due to enterococci. EXPERT OPINION Aminopenicillins are preferred over all other agents when enterococci are susceptible and patients can tolerate them. Daptomycin and linezolid have demonstrated clinical efficacy against vancomycin-resistant enterococci (VRE). Synergistic combinations are often warranted in complex infections of high inoculum and biofilms while monotherapies are generally appropriate for uncomplicated infections. Although active against resistant enterococci, the pharmacokinetics, efficacy and safety of tigecycline and quinupristin/dalfopristin can problematical for severe infections. For cystitis, amoxicillin, nitrofurantoin, or fosfomycin are ideal. Recently, approved agents such as tedizolid and oritavancin have good in vitro activity against VRE but clinical studies against other resistant enterococci are lacking.
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Affiliation(s)
- Nicholas J Mercuro
- a Pharmacy Services, Eugene Applebaum College of Pharmacy and Health Sciences , Wayne State University , Detroit , MI , USA.,b Pharmacy Services , Henry Ford Hospital , Detroit , MI , USA
| | - Susan L Davis
- a Pharmacy Services, Eugene Applebaum College of Pharmacy and Health Sciences , Wayne State University , Detroit , MI , USA.,b Pharmacy Services , Henry Ford Hospital , Detroit , MI , USA
| | - Marcus J Zervos
- c Department of Internal Medicine, Division of Infectious Diseases , Henry Ford Hospital , Detroit , MI , USA.,d Wayne State University School of Medicine , Detroit , MI , USA
| | - Erica S Herc
- c Department of Internal Medicine, Division of Infectious Diseases , Henry Ford Hospital , Detroit , MI , USA
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Comparative Pharmacodynamics of Single-Dose Oritavancin and Daily High-Dose Daptomycin Regimens against Vancomycin-Resistant Enterococcus faecium Isolates in an In Vitro Pharmacokinetic/Pharmacodynamic Model of Infection. Antimicrob Agents Chemother 2017; 61:AAC.01265-17. [PMID: 28784674 DOI: 10.1128/aac.01265-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/29/2017] [Indexed: 12/13/2022] Open
Abstract
There are limited therapeutic options to treat infections caused by vancomycin-resistant Enterococcus faecium (VREfm). The lipoglycopeptide oritavancin exhibits in vitro activity against this pathogen, although its utility against infections caused by VREfm has not been clinically established. In this study, the pharmacodynamic activity of free-drug levels associated with 12 mg/kg/day of daptomycin and a single 1,200-mg dose of oritavancin were determined against three VanA VREfm isolates in an in vitro pharmacokinetic/pharmacodynamic model.
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Arhin FF, Seguin DL, Belley A, Moeck G. In vitro stepwise selection of reduced susceptibility to lipoglycopeptides in enterococci. Diagn Microbiol Infect Dis 2017; 89:168-171. [PMID: 28733126 DOI: 10.1016/j.diagmicrobio.2017.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
The propensity of oritavancin to select for stably elevated oritavancin minimum inhibitory concentrations (MICs) was studied by serial passaging of strains in broth containing oritavancin for 20days. Seven clinical strains of Enterococcus faecalis and E. faecium were studied; they included vancomycin-susceptible and both VanA and VanB vancomycin-resistant isolates. Stepwise oritavancin selection yielded stably elevated oritavancin MICs in six of the seven strains, with MIC increases ranging from 4-32-fold. By comparison, stepwise selection with comparator agents dalbavancin (4- to >128-fold MIC increases), telavancin (4-8-fold MIC increases) and daptomycin (4-32-fold MIC increases) also yielded selectants with elevated MICs of the respective agents. Oritavancin selectants retained parental MICs of vancomycin, daptomycin, linezolid and rifampicin. Some, but not all of the oritavancin selectants also showed MIC increases to the lipoglycopeptides telavancin, dalbavancin and teicoplanin, suggesting that within the lipoglycopeptide class, different mechanisms of action may be elucidated.
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Affiliation(s)
- Francis F Arhin
- The Medicines Company, 7170 Frederick Banting, St. Laurent, Quebec, Canada, H4S 2A1.
| | - David Lalonde Seguin
- The Medicines Company, 7170 Frederick Banting, St. Laurent, Quebec, Canada, H4S 2A1
| | - Adam Belley
- The Medicines Company, 7170 Frederick Banting, St. Laurent, Quebec, Canada, H4S 2A1
| | - Gregory Moeck
- The Medicines Company, 7170 Frederick Banting, St. Laurent, Quebec, Canada, H4S 2A1
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7
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Kaasch AJ, Seifert H. Oritavancin: a long-acting antibacterial lipoglycopeptide. Future Microbiol 2016; 11:843-55. [DOI: 10.2217/fmb-2016-0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Oritavancin is a new lipoglycopeptide antibacterial agent with an exceptionally long terminal half-life and a rapid bactericidal effect. Multiple mechanisms of action lead to a broad activity against Gram-positive bacteria, such as staphylococci, streptococci and enterococci, including methicillin-resistant Staphylococcus aureus. Its long terminal half-life allows for single-dose treatment of acute bacterial skin and skin structure infections. Oritavancin was found to be safe and effective in treating acute bacterial skin and skin structure infections in adults and it is currently approved in the USA and in Europe for this indication. Unfortunately, data for other indications are lacking. Here, we review chemistry, microbiology, pharmacology, efficacy and tolerability of oritavancin.
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Affiliation(s)
- Achim J Kaasch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19–21, 50935 Cologne, Germany
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University-Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19–21, 50935 Cologne, Germany
- German Centre for Infection Research (DZIF), Bonn-Cologne, University of Cologne, Albertus-Magnus-Platz, 50923 Cologne, Germany
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Combination antibiotic therapy for the treatment of infective endocarditis due to enterococci. Infection 2015; 44:273-81. [PMID: 26324294 DOI: 10.1007/s15010-015-0836-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/22/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Enterococci are common causes of infective endocarditis (IE) in both health care and community-based setting. Enterococcal IE requires bactericidal therapy for an optimal outcome. For decades, cell-wall-active antimicrobial agents (penicillins or vancomycin) in combination with aminoglycosides were the cornerstone of the treatment; however, the emergence of antibiotic resistance has significantly reduced the efficacy of these regimens. MATERIALS AND METHODS Data for this review were identified by searches of MEDLINE and references from relevant articles on antibiotic combination regimens for the treatment of enterococcal IE. Abstracts presented in scientific conferences were not searched for. CONCLUSION New effective and safe combination treatments, including double-β-lactam and daptomycin/β-lactam combination, are proving useful for the management of IE due to enterococci.
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9
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Oritavancin Pharmacokinetics and Bone Penetration in Rabbits. Antimicrob Agents Chemother 2015; 59:6501-5. [PMID: 26239977 DOI: 10.1128/aac.00981-15] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/30/2015] [Indexed: 11/20/2022] Open
Abstract
The pharmacokinetics and bone concentrations of oritavancin were investigated after a single intravenous dose was administered to rabbits. The pharmacokinetic profile of oritavancin in rabbits showed that it is rapidly distributed to bone tissues, with concentrations remaining stable for up to 168 h, the last measured time point. Based on these findings, further evaluation of oritavancin for the treatment of infections in bone tissues is warranted.
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O'Driscoll T, Crank CW. Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management. Infect Drug Resist 2015; 8:217-30. [PMID: 26244026 PMCID: PMC4521680 DOI: 10.2147/idr.s54125] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Since its discovery in England and France in 1986, vancomycin-resistant Enterococcus has increasingly become a major nosocomial pathogen worldwide. Enterococci are prolific colonizers, with tremendous genome plasticity and a propensity for persistence in hospital environments, allowing for increased transmission and the dissemination of resistance elements. Infections typically present in immunosuppressed patients who have received multiple courses of antibiotics in the past. Virulence is variable, and typical clinical manifestations include bacteremia, endocarditis, intra-abdominal and pelvic infections, urinary tract infections, skin and skin structure infections, and, rarely, central nervous system infections. As enterococci are common colonizers, careful consideration is needed before initiating targeted therapy, and source control is first priority. Current treatment options including linezolid, daptomycin, quinupristin/dalfopristin, and tigecycline have shown favorable activity against various vancomycin-resistant Enterococcus infections, but there is a lack of randomized controlled trials assessing their efficacy. Clearer distinctions in preferred therapies can be made based on adverse effects, drug interactions, and pharmacokinetic profiles. Although combination therapies and newer agents such as tedizolid, telavancin, dalbavancin, and oritavancin hold promise for the future treatment of vancomycin-resistant Enterococcus infections, further studies are needed to assess their possible clinical impact, especially in the treatment of serious infections.
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Affiliation(s)
- Tristan O'Driscoll
- Department of Pharmacy Practice, Chicago College of Pharmacy, Downers Grove, IL, USA
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11
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Mitra S, Saeed U, Havlichek DH, Stein GE. Profile of oritavancin and its potential in the treatment of acute bacterial skin structure infections. Infect Drug Resist 2015; 8:189-97. [PMID: 26185459 PMCID: PMC4500617 DOI: 10.2147/idr.s69412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Oritavancin, a semisynthetic derivative of the glycopeptide antibiotic chloroeremomycin, received the US Food and Drug Administration approval for the treatment of acute bacterial skin and skin structure infections caused by susceptible Gram-positive bacteria in adults in August 2014. This novel second-generation semisynthetic lipoglycopeptide antibiotic has activity against a broad spectrum of Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate S. aureus (VISA), and vancomycin-resistant Enterococcus. Oritavancin inhibits bacterial cell wall synthesis and is rapidly bactericidal against many Gram-positive pathogens. The long half-life of this drug enables a single-dose administration. Oritavancin is not metabolized in the body, and the unchanged drug is slowly excreted by the kidneys. In two large Phase III randomized, double-blind, clinical trials, oritavancin was found to be non-inferior to vancomycin in achieving the primary composite end point in the treatment of acute Gram-positive skin and skin structure infections. Adverse effects noted were mostly mild with nausea, headache, and vomiting being the most common reported side effects. Oritavancin has emerged as another useful antimicrobial agent for treatment of acute Gram-positive skin and skin structure infections, including those caused by MRSA and VISA.
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Affiliation(s)
- Subhashis Mitra
- Department of Infectious Diseases, Michigan State University, East Lansing, MI, USA
| | - Usman Saeed
- Department of Infectious Diseases, Michigan State University, East Lansing, MI, USA
| | - Daniel H Havlichek
- Department of Infectious Diseases, Michigan State University, East Lansing, MI, USA
| | - Gary E Stein
- Department of Infectious Diseases, Michigan State University, East Lansing, MI, USA
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12
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Pericás JM, Zboromyrska Y, Cervera C, Castañeda X, Almela M, Garcia-de-la-Maria C, Mestres C, Falces C, Quintana E, Ninot S, Llopis J, Marco F, Moreno A, Miró JM. Enterococcal endocarditis revisited. Future Microbiol 2015; 10:1215-40. [PMID: 26118390 DOI: 10.2217/fmb.15.46] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The Enterococcus species is the third main cause of infective endocarditis (IE) worldwide, and it is gaining relevance, especially among healthcare-associated cases. Patients with enterococcal IE are older and have more comorbidities than other types of IE. Classical treatment options are limited due to the emergence of high-level aminoglycosides resistance (HLAR), vancomycin resistance and multidrug resistance in some cases. Besides, few new antimicrobial alternatives have shown real efficacy, despite some of them being recommended by major guidelines (including linezolid and daptomycin). Ampicillin plus ceftriaxone 2 g iv./12 h is a good option for Enterococcus faecalis IE caused by HLAR strains, but randomized clinical trials are essential to demonstrate its efficacy for non-HLAR EFIE and to compare it with ampicillin plus short-course gentamicin. The main mechanisms of resistance and treatment options are also reviewed for other enterococcal species.
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Affiliation(s)
- J M Pericás
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - Y Zboromyrska
- Clinical Microbiology Service, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - C Cervera
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - X Castañeda
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - M Almela
- Clinical Microbiology Service, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - C Garcia-de-la-Maria
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - C Mestres
- Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Falces
- Cardiology Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E Quintana
- Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - S Ninot
- Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J Llopis
- Department of Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - F Marco
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Microbiology Service, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
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13
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Saravolatz LD, Stein GE. Oritavancin: A Long-Half-Life Lipoglycopeptide. Clin Infect Dis 2015; 61:627-32. [PMID: 25900171 DOI: 10.1093/cid/civ311] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/08/2015] [Indexed: 01/28/2023] Open
Abstract
Oritavancin is a lipoglycopeptide antibiotic that has been shown to be effective for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). This antibiotic has multiple mechanisms of action including inhibiting peptidoglycan cell wall synthesis and disrupting bacterial cell membrane, leading to cell death. Oritavancin is highly active against common gram-positive pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-intermediate S. aureus, vancomycin-resistant S. aureus, and vancomycin-resistant enterococci. The drug is administered as a single intravenous dose of 1200 mg over 3 hours in adult patients, and because of its terminal half-life of 393 hours, repeat dosing is not required in the treatment of ABSSIs. There is a very slow elimination from tissue sites, and no dosing adjustments are required for renal or hepatic insufficiency. Two clinical trials have demonstrated noninferiority compared with vancomycin in the treatment of ABSSSIs. Other than liver enzyme elevation and the occurrence of osteomyelitis, oritavancin has been associated with adverse events similar to those of vancomycin in follow-up for up to 60 days. Patients should be monitored for osteomyelitis and alternate therapy given in the case of confirmed or suspected osteomyelitis. Although oritavancin is an attractive antibiotic to consider in the outpatient area, its efficacy and safety in the treatment of other sites of infection are yet to be established.
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Affiliation(s)
- Louis D Saravolatz
- St John Hospital and Medical Center, Grosse Pointe Woods Michigan State University, East Lansing
| | - Gary E Stein
- St John Hospital and Medical Center, Grosse Pointe Woods Michigan State University, East Lansing
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Messina JA, Fowler VG, Corey GR. Oritavancin for acute bacterial skin and skin structure infections. Expert Opin Pharmacother 2015; 16:1091-8. [PMID: 25803197 DOI: 10.1517/14656566.2015.1026256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Inpatient treatment of acute bacterial skin and skin structure infections (ABSSSIs) exerts a significant economic burden on the healthcare system. Oritavancin is a concentration-dependent, rapid bactericidal agent approved for the treatment of ABSSSIs. Its prolonged half-life with one-time intravenous (i.v.) dosing offers a potential solution to this burden. In addition, oritavancin represents an alternative therapy for Streptococci and multidrug-resistant Gram-positive bacteria including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. Animal models have also shown promising results with oritavancin for other disease states including those that require long courses of i.v. THERAPY AREAS COVERED This review covers oritavancin's basic chemistry, spectrum of activity, pharmacodynamics/pharmacokinetics and efficacy in clinical trials, and provides expert opinion on future directions. To compose this review, a search of PubMed was performed, and articles written in the English language were selected based on full text availability. EXPERT OPINION If oritavancin is proven to be a cost-effective strategy for outpatient treatment and prevents complications of prolonged i.v. therapy, it will be sought as an alternative antibiotic therapy for ABSSSIs. In addition, further clinical data demonstrating efficacy in Gram-positive infections requiring prolonged therapy such as endocarditis and osteomyelitis could support oritavancin's success in the current market.
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Affiliation(s)
- Julia A Messina
- Infectious Disease Fellow, Duke University, Department of Medicine , Durham, NC , USA
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Abstract
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, call The Formulary at 800-322-4349. The December 2014 monograph topics are olodaterol, peginterferon beta-1a, testosterone nasal gel, ferric citrate corredination complex, and safinamide. The Safety MUE is on olodaterol.
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Affiliation(s)
- Dennis J Cada
- Founder and Contributing Editor, The Formulary , Washington State University , Spokane, Washington
| | - Danial E Baker
- Director, Drug Information Center, and Professor of Pharmacy Practice, College of Pharmacy , Washington State University Spokane, PO Box 1495, Spokane, Washington 99210-1495 . The authors indicate no relationships that could be perceived as a conflict of interest
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16
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Abstract
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, call The Formulary at 800-322-4349. The December 2014 monograph topics are olodaterol, peginterferon beta-1a, testosterone nasal gel, ferric citrate corredination complex, and safinamide. The Safety MUE is on olodaterol.
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Affiliation(s)
- Dennis J Cada
- Founder and Contributing Editor, The Formulary , Washington State University , Spokane, Washington
| | - Danial E Baker
- Director, Drug Information Center, and Professor of Pharmacy Practice, College of Pharmacy , Washington State University Spokane, PO Box 1495, Spokane, Washington 99210-1495 . The authors indicate no relationships that could be perceived as a conflict of interest
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Mercier RC, Hrebickova L. Oritavancin: a new avenue for resistant Gram-positive bacteria. Expert Rev Anti Infect Ther 2014; 3:325-32. [PMID: 15954849 DOI: 10.1586/14787210.3.3.325] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oritavancin, a new semisynthetic glycopeptide has a spectrum of activity similar to vancomycin, although it exhibits potent antimicrobial activity against vancomycin-resistant staphylococci and enterococci species. It has a long-terminal half-life of 360 h, is highly protein bound and has been dosed once-daily in clinical trials. Oritavancin has been studied in complicated skin and skin structure infections where it was noninferior to the comparator group of vancomycin/cephalexin. Thus far, oritavancin has a favorable side-effect profile and appears promising in the treatment of multidrug resistant Gram-positive bacteria.
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Affiliation(s)
- Renee-Claude Mercier
- University of New Mexico, College of Pharmacy, MSC09 5360, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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18
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Arias CA, Murray BE. Emergence and management of drug-resistant enterococcal infections. Expert Rev Anti Infect Ther 2014; 6:637-55. [DOI: 10.1586/14787210.6.5.637] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Arias CA, Mendes RE, Stilwell MG, Jones RN, Murray BE. Unmet needs and prospects for oritavancin in the management of vancomycin-resistant enterococcal infections. Clin Infect Dis 2012; 54 Suppl 3:S233-8. [PMID: 22431854 DOI: 10.1093/cid/cir924] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The treatment of infections caused by vancomycin-resistant enterococci (VRE) has become an important clinical challenge and compromises the care of critically ill patients. A striking increase in the frequency of nosocomial isolation of multidrug-resistant Enterococcus faecium has dramatically reduced the therapeutic alternatives because the majority of E. faecium isolates are resistant to ampicillin and vancomycin. Only 2 agents have US Food and Drug Administration approval for the treatment of VRE (E. faecium) infections, namely, linezolid and quinupristin/dalfopristin (Q/D). However, the use of these compounds in severe VRE infections is hampered by the lack of in vivo bactericidal activity, reports of therapeutic failures with monotherapy, a requirement for central venous access for administration (Q/D), and adverse-effect profile. The lipopeptide antimicrobial daptomycin has in vitro bactericidal activity against VRE; however, clinical use of this compound for VRE has not been well studied, and the reports of resistance emerging during therapy at the approved doses are worrisome. Tigecycline has in vitro bacteriostatic activity against VRE, but its clinical use for serious enterococcal infections is unclear due to low serum levels and static effect. Thus, current reliable therapies for VRE appear to be limited, and clinical data that use the above compounds are certainly scant. Oritavancin is an investigational semisynthetic glycopeptide with potent in vitro activity against VRE (both VanA and VanB phenotypes). Although review of the available preclinical data indicates that this compound used as a single agent is likely to have important limitations for the treatment of a severe VRE infection (ie, endocarditis), combination of oritavancin with other agents such as aminoglycosides may offer promise and deserves further investigation, as does use of oritavancin for less serious infections as monotherapy for vancomycin-susceptible and multidrug-resistant enterococci.
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Affiliation(s)
- Cesar A Arias
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical School, 6431 Fannin St, Houston, TX 77030, USA
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20
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Ambrose PG, Drusano GL, Craig WA. In Vivo Activity of Oritavancin in Animal Infection Models and Rationale for a New Dosing Regimen in Humans. Clin Infect Dis 2012; 54 Suppl 3:S220-8. [DOI: 10.1093/cid/cis001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Swaminathan S, Alangaden GJ. Treatment of resistant enterococcal urinary tract infections. Curr Infect Dis Rep 2011; 12:455-64. [PMID: 21308555 DOI: 10.1007/s11908-010-0138-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Enterococcus spp have emerged as important pathogens in urinary tract infection (UTI), especially in hospitalized patients. Resistance to multiple antibiotics, including vancomycin, has become common, particularly in infections involving Enterococcus faecium. The management of UTIs caused by Enterococcus spp has become challenging given the presence of underlying comorbidities in these patients and the limited therapeutic options available to treat multidrug-resistant (MDR) Enterococcus. Routine therapy for asymptomatic bacteriuria with MDR-Enterococcus is not recommended. Removal of indwelling urinary catheters should be considered. Appropriate antibiotic therapy selection should be guided by urine culture and susceptibility results. Data are limited on the treatment of UTIs caused by MDR-Enterococcus. Potential oral agents active against MDR-Enterococcus that may be considered for acute uncomplicated UTI include nitrofurantoin, fosfomycin, and fluoroquinolones. Potential parenteral agents for the treatment of pyelonephritis and complicated UTIs caused by MDR-Enterococcus include daptomycin, linezolid, and quinipristin-dalfopristin. Aminoglycosides or rifampin may be considered as adjunctive therapy in serious infections.
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Affiliation(s)
- Subramanian Swaminathan
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI, USA,
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22
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Arias CA, Contreras GA, Murray BE. Management of multidrug-resistant enterococcal infections. Clin Microbiol Infect 2011; 16:555-62. [PMID: 20569266 DOI: 10.1111/j.1469-0691.2010.03214.x] [Citation(s) in RCA: 268] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Enterococci are organisms with a remarkable ability to adapt to the environment and acquire antibiotic resistance determinants. The evolution of antimicrobial resistance in these organisms poses enormous challenges for clinicians when faced with patients affected with severe infections. The increased prevalence and dissemination of multidrug-resistant Enterococcus faecium worldwide has resulted in a major decrease in therapeutic options because the majority of E. faecium isolates are now resistant to ampicillin and vancomycin, and exhibit high-level resistance to aminoglycosides, which are three of the traditionally most useful anti-enterococcal antibiotics. Newer antibiotics such as linezolid, daptomycin and tigecycline have good in vitro activity against enterococcal isolates, although their clinical use may be limited in certain clinical scenarios as a result of reduced rates of success, possible underdosing for enterococci and low serum levels, respectively, and also by the emergence of resistance. The experimental agent oritavancin may offer some hope for the treatment of vancomycin-resistant enterococci but clinical data are still lacking. Thus, optimal therapies for the treatment of multidrug-resistant enterococcal infections continue to be based on empirical observations and extrapolations from in vitro and animal data. Clinical studies evaluating new strategies, including combination therapies, to treat severe vancomycin-resistant E. faecium infections are urgently needed.
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Affiliation(s)
- C A Arias
- Department of Internal Medicine, Division of Infectious Diseases and Center for the Study of Emerging and Reemerging Pathogens, University of Texas Medical School at Houston, Houston, TX, USA
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23
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The in vitro contribution of autolysins to bacterial killing elicited by amoxicillin increases with inoculum size in Enterococcus faecalis. Antimicrob Agents Chemother 2010; 55:910-2. [PMID: 21098238 DOI: 10.1128/aac.01230-10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The mechanisms of antibiotic-induced cell death are poorly understood despite the critical role of the bactericidal activities of antibiotics for successful treatment of severe infections. These mechanisms include irreversible damaging of macromolecules by reactive oxygen species and bacteriolysis mediated by peptidoglycan hydrolases (autolysins). We have assessed the contribution of the second mechanism by using an autolysin-deficient mutant of Enterococcus faecalis and shown that it contributes to amoxicillin-induced cell lysis only at a high bacterial density.
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24
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Bouza E, Burillo A. Oritavancin: a novel lipoglycopeptide active against Gram-positive pathogens including multiresistant strains. Int J Antimicrob Agents 2010; 36:401-7. [PMID: 20729040 DOI: 10.1016/j.ijantimicag.2010.06.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
Abstract
Oritavancin is a lipoglycopeptide antibiotic under investigation for the treatment of serious infections caused by Gram-positive bacteria. Oritavancin has demonstrated rapid dose-dependent bactericidal activity towards vancomycin-susceptible and -resistant enterococci, meticillin-susceptible and -resistant Staphylococcus aureus, vancomycin-intermediate S. aureus (VISA), heteroresistant VISA (hVISA), vancomycin-resistant S. aureus (VRSA) and small-colony variants of S. aureus. It is also active against Clostridium difficile. Upon intravenous administration, oritavancin displays a three-compartment pharmacokinetic model, dose proportionality, a distribution volume of ca. 110 L, a terminal elimination half-life in excess of 2 weeks and it is not metabolised. Its pharmacodynamic properties make it an ideal antibiotic for a once-daily or even single-dose regimen. Oritavancin is currently under review by the US Food and Drug Administration. So far, oritavancin has demonstrated efficacy in two pivotal Phase III trials conducted in patients with complicated skin and skin-structure infections in which oritavancin was compared with vancomycin plus cefalexin. In both trials, the primary endpoint (clinical cure in clinically evaluable patients at first follow-up with a 10% non-inferiority margin) was met, with the advantages of shorter duration of therapy and fewer adverse events. Further results indicating its activity against bacteria growing in biofilms as well as stationary-phase bacteria open the way for its use to treat prosthetic device infections, which is to be investigated in upcoming trials.
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Affiliation(s)
- Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
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25
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Zhanel GG, Calic D, Schweizer F, Zelenitsky S, Adam H, Lagacé-Wiens PR, Rubinstein E, Gin AS, Hoban DJ, Karlowsky JA. New Lipoglycopeptides. Drugs 2010; 70:859-86. [DOI: 10.2165/11534440-000000000-00000] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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26
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Guskey MT, Tsuji BT. A Comparative Review of the Lipoglycopeptides: Oritavancin, Dalbavancin, and Telavancin. Pharmacotherapy 2010; 30:80-94. [DOI: 10.1592/phco.30.1.80] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Abstract
Timely provision of adequate antimicrobial coverage in an initial anti-infective treatment regimen results in optimal outcomes for bacterial and fungal infections. However, selection of appropriate antimicrobial regimens for treatment of infections in the intensive care unit (ICU) can be challenging due to expansion of resistance, which typically requires use of multidrug anti-infective regimens to provide adequate coverage of important pathogens commonly seen in the ICU setting. Indeed, a recent additional call to action by the Infectious Diseases Society of America (IDSA) has enforced the impact that antimicrobial-resistant pathogens can have on patient care. The term ESKAPE has been coined by this IDSA group to refer to Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacter species, the etiologic causes of the majority of hospital-acquired infections in the United States that are able to effectively "escape" our antibiotic arsenal and that also mandate discovery of new antimicrobial agents. This article reviews select antibacterial agents and an antifungal agent in late stages of clinical development that appear to have potential for treatment of infections in the ICU.
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28
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Oritavancin kills stationary-phase and biofilm Staphylococcus aureus cells in vitro. Antimicrob Agents Chemother 2008; 53:918-25. [PMID: 19104027 DOI: 10.1128/aac.00766-08] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Slow-growing bacteria and biofilms are notoriously tolerant to antibiotics. Oritavancin is a lipoglycopeptide with multiple mechanisms of action that contribute to its bactericidal action against exponentially growing gram-positive pathogens, including the inhibition of cell wall synthesis and perturbation of membrane barrier function. We sought to determine whether oritavancin could eradicate cells known to be tolerant to many antimicrobial agents, that is, stationary-phase and biofilm cultures of Staphylococcus aureus in vitro. Oritavancin exhibited concentration-dependent bactericidal activity against stationary-phase inocula of methicillin-susceptible S. aureus (MSSA) ATCC 29213, methicillin-resistant S. aureus (MRSA) ATCC 33591, and vancomycin-resistant S. aureus (VRSA) VRS5 inoculated into nutrient-depleted cation-adjusted Mueller-Hinton broth. As has been described for exponential-phase cells, oritavancin induced membrane depolarization, increased membrane permeability, and caused ultrastructural defects including a loss of nascent septal cross walls in stationary-phase MSSA. Furthermore, oritavancin sterilized biofilms of MSSA, MRSA, and VRSA at minimal biofilm eradication concentrations (MBECs) of between 0.5 and 8 mug/ml. Importantly, MBECs for oritavancin were within 1 doubling dilution of their respective planktonic broth MICs, highlighting the potency of oritavancin against biofilms. These results demonstrate a significant activity of oritavancin against S. aureus in phases of growth that exhibit tolerance to other antimicrobial agents.
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29
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Lortholary O, Lefort A, Tod M, Chomat AM, Darras-Joly C, Cordonnier C. Pharmacodynamics and pharmacokinetics of antibacterial drugs in the management of febrile neutropenia. THE LANCET. INFECTIOUS DISEASES 2008; 8:612-20. [DOI: 10.1016/s1473-3099(08)70228-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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30
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Assessment by time-kill methodology of the synergistic effects of oritavancin in combination with other antimicrobial agents against Staphylococcus aureus. Antimicrob Agents Chemother 2008; 52:3820-2. [PMID: 18644953 DOI: 10.1128/aac.00361-08] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Oritavancin is a semisynthetic lipoglycopeptide in clinical development for serious gram-positive infections. This study describes the synergistic activity of oritavancin in combination with gentamicin, linezolid, moxifloxacin, or rifampin in time-kill studies against methicillin-susceptible, vancomycin-intermediate, and vancomycin-resistant Staphylococcus aureus.
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31
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Crandon J, Nicolau DP. Oritavancin: a potential weapon in the battle against serious Gram-positive pathogens. Future Microbiol 2008; 3:251-63. [DOI: 10.2217/17460913.3.3.251] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Oritavancin is a lipoglycopeptide antibiotic with activity against aerobic and anaerobic Gram-positive bacteria. Oritavancin separates itself from other glycopeptides through its potent in vitro activity against resistant isolates of Staphylococcus aureus, Enterococcus spp. and Streptococcus spp. Oritavancin possesses a long half-life that should allow, at maximum, once-daily dosing. Currently, oritavancin has completed two Phase III trials and one Phase II trial for the treatment of complicated skin and skin structure infections, and two Phase II trials for the treatment of Gram-positive bacteremia. In all instances, oritavancin displayed favorable outcomes and was noninferior to comparator agents (vancomycin followed by oral cephalexin) when a comparison was made. Further studies are necessary to fully characterize dose and clinical role.
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Affiliation(s)
- Jared Crandon
- Center for Anti-Infective Research & Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - David P Nicolau
- Center for Anti-Infective Research & Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA and, Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA
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32
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Aksoy D, Unal S. New antimicrobial agents for the treatment of Gram-positive bacterial infections. Clin Microbiol Infect 2008; 14:411-20. [DOI: 10.1111/j.1469-0691.2007.01933.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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33
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Van Bambeke F, Mingeot-Leclercq MP, Struelens MJ, Tulkens PM. The bacterial envelope as a target for novel anti-MRSA antibiotics. Trends Pharmacol Sci 2008; 29:124-34. [DOI: 10.1016/j.tips.2007.12.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Revised: 12/18/2007] [Accepted: 12/20/2007] [Indexed: 10/22/2022]
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34
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Technetium 99m–Labeled Annexin V Scintigraphy of Platelet Activation in Vegetations of Experimental Endocarditis. Circulation 2008; 117:781-9. [DOI: 10.1161/circulationaha.107.718114] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The pathophysiology of infective endocarditis involves a pathogen/host tissue interaction, leading to formation of infected thrombotic vegetations. Annexin V is a ligand of phosphatidylserines exposed by activated platelets and apoptotic cells. Because vegetations are platelet-fibrin clots in which platelet proaggregant activity is enhanced by bacterial colonization, we investigated the ability of annexin V labeled with technetium Tc 99m (
99m
Tc-ANX) to provide functional imaging of these vegetations in experimental models of infective endocarditis. This ability was assessed in rabbits and rats because of the different interest of these 2 species in preclinical analysis.
Methods and Results—
Nonbacterial thrombotic endocarditis was induced with the use of a catheter left indwelling through the aortic or tricuspid valve, and animals were injected with either a bacterial inoculum or saline. Scintigraphic investigations were performed 5 days later and showed a higher
99m
Tc-ANX uptake by vegetations in infected versus noninfected animals (ratio, 1.3 for in vivo acquisitions and 2 for autoradiography;
P
<0.0001 for all), whereas no significant uptake was present in controls. Right-sided endocarditis was associated with pulmonary uptake foci corresponding to emboli. Histological analysis of vegetations showed a specific uptake of
99m
Tc-ANX at the interface between circulating blood and vegetation. In parallel, underlying myocardial tissue showed myocyte apoptosis and mucoid degeneration, without extracellular matrix degradation at this stage.
Conclusions—
99m
Tc-ANX is suitable for functional imaging of platelet-fibrin vegetations in endocarditis, as well as embolic events.
99m
Tc-ANX uptake reflects mainly platelet activation in the luminal layer of vegetations. This uptake is enhanced by bacterial colonization.
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35
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Poulakou G, Giamarellou H. Oritavancin: a new promising agent in the treatment of infections due to Gram-positive pathogens. Expert Opin Investig Drugs 2008; 17:225-43. [DOI: 10.1517/13543784.17.2.225] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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36
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Tacconelli E, Cataldo MA. Antimicrobial therapy ofStaphylococcus aureusbloodstream infection. Expert Opin Pharmacother 2007; 8:2505-18. [DOI: 10.1517/14656566.8.15.2505] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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37
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Ward KE, Mersfelder TL, LaPlante KL. Oritavancin – an investigational glycopeptide antibiotic. Expert Opin Investig Drugs 2006; 15:417-29. [PMID: 16548791 DOI: 10.1517/13543784.15.4.417] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antibiotics save countless lives each year; however, increasing rates of drug-resistant bacteria have limited antibiotic selection. Currently, there are few available options for treating resistant Gram-positive organisms. Oritavancin, a novel glycopeptide antibiotic with bactericidal activity, has been developed and recently completed the first round of Phase III clinical trials for the treatment of complicated skin and skin structure infections. Investigations into oritavancin's efficacy will be explored in catheter-related bacteraemia and nosocomial pneumonia. Oritavancin demonstrates similar activity to vancomycin but possesses extended activity against vancomycin-resistant Staphylococcus and Enterococcus. The pharmacokinetics and pharmacodynamics of oritavancin appear to be favourable and once-daily dosing is likely. The incidence of multi-drug resistant bacteria is increasing and explorations into additional treatment options are essential. Further development of oritavancin is necessary to determine clinical efficacy.
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Affiliation(s)
- Kristina E Ward
- Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI, USA
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38
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Pace JL, Yang G. Glycopeptides: Update on an old successful antibiotic class. Biochem Pharmacol 2006; 71:968-80. [PMID: 16412985 DOI: 10.1016/j.bcp.2005.12.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 12/04/2005] [Accepted: 12/07/2005] [Indexed: 11/21/2022]
Abstract
The natural product glycopeptides vancomycin and teicoplanin have come to play a significant role in the therapy for Gram-positive bacterial infections. In particular vancomycin is the choice for empiric therapy of these infections primarily due to its activity against and the significance of methicillin-resistant Staphylococcus aureus. While high-level problematic glycopeptide resistance among enterococci was observed initially and continues to increase, the slow creep of vancomycin intermediate susceptibility and the fear of frank resistance among the staphylococci have precipitated increasing work leading to creation of new semisynthetic analogs. These new agents, including dalbavancin and telavancin, are within 1-2 years availability in the clinic. Interestingly, chemical modifications resulting in these second-generation analogs and additional characterization have revealed new mechanisms of antibacterial action, and plasticity regarding additional properties including pharmacokinetics for the drug candidates. The unique beneficial properties of the near term vancomycin replacements, semisynthesis of additional important analogs, and advances in metabolic engineering resulting in novel scaffolds signal a new era for the glycopeptide antibiotics.
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Affiliation(s)
- John L Pace
- Protez Pharmaceuticals Inc., 30 Spring Mill Drive, Malvern, PA 19355, USA.
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39
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Scapellato PG, Ormazabal C, Scapellato JL, Bottaro EG. Meningitis due to vancomycin-resistant Enterococcus faecium successfully treated with combined intravenous and intraventricular chloramphenicol. J Clin Microbiol 2005; 43:3578-9. [PMID: 16000513 PMCID: PMC1169172 DOI: 10.1128/jcm.43.7.3578-3579.2005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Kaye KS, Engemann JJ, Fraimow HS, Abrutyn E. Pathogens resistant to antimicrobial agents: epidemiology, molecular mechanisms, and clinical management. Infect Dis Clin North Am 2004; 18:467-511, viii. [PMID: 15308273 DOI: 10.1016/j.idc.2004.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Resistance to antimicrobial drugs is increasing at an alarming rate among both gram-positive and gram-negative bacteria. Traditionally, bacteria resistant to multiple antimicrobial agents have been restricted to the nosocomial environment. A disturbing trend has been the recent emergence and spread of resistant pathogens and resistance traits in nursing homes, the community, as well as in hospitals. This article reviews the epidemiology, molecular mechanisms of resistance, and treatment options for pathogens resistant to antimicrobial drugs.
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Affiliation(s)
- Keith S Kaye
- Department of Medicine, Duke University Medical Center, Box 3152, Durham, NC 27710, USA.
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41
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Bhavnani SM, Owen JS, Loutit JS, Porter SB, Ambrose PG. Pharmacokinetics, safety, and tolerability of ascending single intravenous doses of oritavancin administered to healthy human subjects. Diagn Microbiol Infect Dis 2004; 50:95-102. [PMID: 15474317 DOI: 10.1016/j.diagmicrobio.2004.06.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Accepted: 06/21/2004] [Indexed: 10/26/2022]
Abstract
Oritavancin (LY333328 diphosphate) is a novel glycopeptide antimicrobial agent with potent microbiological activity in vitro against Gram-positive bacteria. A single-dose, open-label, noncontrolled, dose-escalation study in 11 healthy human subjects was carried out to evaluate the safety and pharmacokinetics of oritavancin. One subject at each dose level received a single intravenous dose of 0.02, 0.03, 0.05, 0.08, 0.125, 0.20, and 0.325 mg/kg infused over 1 hour and four subjects each received a single-dose of 0.5 mg/kg. Safety and tolerability were evaluated by monitoring adverse events and laboratory parameters. Oritavancin pharmacokinetics were assessed by blood, urine, and fecal sampling. The plasma concentrations of oritavancin after the end of infusion followed a multiexponential decline over a 2-week period. Median (range) C(max) for the 0.5 mg/kg dose group was 6.5 (4.7-7.6) microg/mL. In every subject, plasma concentrations declined to < or =10% of the C(max) within 24 hours. Following a short, constant-rate infusion, the pharmacokinetics of oritavancin were linear across a total dose range from 3.66-44.6 mg. Renal clearance was approximately 0.457 mL/min. The mean (range) plasma terminal half-life of oritavancin was 195.4 (135.8-273.8) hours across all dose levels from 0.05-0.5 mg/kg. Less than 5% and 1% of administered drug were recovered in the urine and feces, respectively, after 7 days. This first time in man evaluation of oritavancin revealed that single doses of oritavancin of up to and including 0.5 mg/kg were safe and well tolerated. Although no clinically relevant changes in renal, hepatic and hematologic indices from baseline were observed, five subjects did manifest asymptomatic and transient elevations of hepatic transaminase concentrations. Because this study was not placebo-controlled and enrolled a small number of subjects, the safety and pharmacokinetic profiles of oritavancin need to be confirmed in additional studies.
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Guay DRP. Oritavancin and Tigecycline: Investigational Antimicrobials for Multidrug-Resistant Bacteria. Pharmacotherapy 2004; 24:58-68. [PMID: 14740788 DOI: 10.1592/phco.24.1.58.34808] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The advent of multidrug-resistant gram-positive aerobes such as Staphylococcus aureus, Streptococcus pneumoniae, and the enterococci, which are resistant to beta-lactams, vancomycin, and a host of other commonly used antimicrobials, has complicated our approach to antibiotic therapy. Despite marketing of the first oxazolidinone, linezolid, and the streptogramin combination, quinupristin-dalfopristin, an urgent need exists for more agents to combat these pathogens. Two such agents, the glycopeptide oritavancin (LY333328) and the glycylcycline tigecycline (GAR-936), are in phase III clinical trials. These agents, which require parenteral administration, exhibit substantial in vitro activity against a variety of gram-positive aerobes and anaerobes, including the multidrug-resistant organisms listed previously. Only tigecycline demonstrates useful activity against gram-negative organisms. Combination therapy of these agents with ampicillin or aminoglycosides frequently leads to synergistic in vitro activity against multidrug-resistant staphylococci and streptococci. These agents are also active in a variety of animal models of systemic and localized infections. Few published efficacy and tolerability data are available in humans. If controlled clinical trial data verify these agents' efficacy and tolerability, both drugs should become welcome additions to the available antimicrobials. However, restricting their use to the treatment of infections caused by bacteria resistant to other antimicrobials, especially multidrug-resistant staphylococci and streptococci, may prolong their clinical utility by retarding the development of resistance. Careful surveillance of bacterial sensitivity to these agents should be undertaken to assist clinicians in the decision whether or not to use these agents empirically to treat infections caused by suspected multidrug-resistant gram-positive pathogens.
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Affiliation(s)
- David R P Guay
- Institute for the Study of Geriatric Pharmacotherapy, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.
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43
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Abstract
Vancomycin and teicoplanin are still the only glycopeptide antibiotics available for use in humans. Emergence of resistance in enterococci and staphylococci has led to restriction of their use to severe infections caused by Gram-positive bacteria for which no other alternative is acceptable (because of resistance or allergy). In parallel, considerable efforts have been made to produce semisynthetic glycopeptides with improved pharmacokinetic and pharmacodynamic properties, and with activity towards resistant strains. Several molecules have now been obtained, helping to better delineate structure-activity relationships. Two are being currently evaluated for skin and soft tissue infections and are in phases II/III. The first, oritavancin (LY333328), is the 4'-chlorobiphenylmethyl derivative of chloroeremomycin, an analogue to vancomycin. It is characterised by: i) a spectrum covering vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and to some extent glycopeptide-intermediate S. aureus (GISA); ii) rapid bactericidal activity including against the intracellular forms of enterococci and staphylococci; and iii) a prolonged half-life, allowing for daily administration. The second molecule is dalbavancin (BI397), a derivative of the teicoplanin analogue A40926. Dalbavancin has a spectrum of activity similar to that of oritavancin against vancomycin-sensitive strains, but is not active against VRE. It can be administered once a week, based on its prolonged retention in the organism. Despite these remarkable properties, the use of these potent agents should be restricted to severe infections, as should the older glycopeptides, with an extension towards resistant or poorly sensitive bacteria, to limit the risk of potential selection of resistance.
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Affiliation(s)
- Françoise Van Bambeke
- Unité de Pharmacologie Cellulaire et Moléculaire, Université Catholique de Louvain, 73.70 avenue Mounier 73, Brussels 1200, Belgium.
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44
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Boylan CJ, Campanale K, Iversen PW, Phillips DL, Zeckel ML, Parr TR. Pharmacodynamics of oritavancin (LY333328) in a neutropenic-mouse thigh model of Staphylococcus aureus infection. Antimicrob Agents Chemother 2003; 47:1700-6. [PMID: 12709343 PMCID: PMC153305 DOI: 10.1128/aac.47.5.1700-1706.2003] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The pharmacokinetics and pharmacodynamics of oritavancin (LY333328), a glycopeptide antibiotic with concentration-dependent bactericidal activity against gram-positive pathogens, in a neutropenic-mouse thigh model of Staphylococcus aureus infection were studied. Plasma radioequivalent concentrations of oritavancin were determined by using [(14)C]oritavancin at doses ranging from 0.5 to 20 mg/kg of body weight. Peak plasma radioequivalent concentrations after an intravenous dose were 7.27, 12.56, 69.29, and 228.83 micro g/ml for doses of 0.5, 1, 5, and 20 mg/kg, respectively. The maximum concentration of drug in serum (C(max)) and the area under the concentration-time curve (AUC) increased linearly in proportion to the dose. Neither infection nor neutropenia was seen to affect the pharmacokinetics of oritavancin. Intravenous administration resulted in much higher concentrations in plasma than the concentrations obtained with subcutaneous administration. Single-dose dose-ranging studies suggested a sigmoid maximum effect (E(max)) dose-response relationship, with a maximal effect evident at single doses exceeding 2 mg/kg. The oritavancin dose (stasis dose) that resulted in a 24-h colony count similar to the pretreatment count was 1.53 (standard error [SE], 0.35) mg/kg. The single oritavancin dose that resulted in 50% of maximal bacterial killing (ED(50)) was 0.95 (SE, 0.20) mg/kg. Dose fractionation studies suggested that single doses of 0.5, 1, 2, 4, and 16 mg/kg appeared to have greater bactericidal efficacy than the same total dose subdivided and administered multiple times during the 24-h treatment period. When using an inhibitory E(max) model, C(max) appears to correlate better with bactericidal activity than do the time during which the concentration in plasma exceeds the MIC (T>MIC) and AUC. These data suggest that optimal oritavancin dosing strategies will require regimens that favor high C(max) concentrations rather than long periods during which unbound concentrations in plasma exceed the MIC.
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Affiliation(s)
- Carole J Boylan
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA.
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45
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Hoen B. Special issues in the management of infective endocarditis caused by gram-positive cocci. Infect Dis Clin North Am 2002; 16:437-52, xi. [PMID: 12092481 DOI: 10.1016/s0891-5520(01)00004-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Gram-positive cocci, mainly streptococci and staphylococci, continue to cause the majority of cases of infective endocarditis. Among the streptococci causing IE, the long-standing predominance of oral or viridans-group streptococci has progressively faded, while the number of cases caused by "enteric streptococci" (Streptococcus bovis and enterococci) has increased. While most oral streptococci and S. bovis strains remain fully sensitive to penicillin, nutritionally variant streptococci--now renamed Abiotrophia--and enterococci can exhibit resistance to penicillin and/or glycopeptides that makes endocarditis more difficult to treat. Among the staphylococci causing endocarditis, the increasing proportion of coagulase-negative and methicillin-resistant strains observed in recent years has changed the approach to choice of antibiotic therapy. The purpose of this paper is to focus on some new aspects of the management of antibiotic therapy of IE due to streptococci and staphylococci, including recent developments such as once-daily aminoglycoside administration in IE, outpatient antibiotic therapy, and the evaluation of new antibiotics.
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Affiliation(s)
- Bruno Hoen
- Service de Maladies Infectieuses et Tropicales, University of Besançon Medical Center, F-25030 Besançon, France.
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46
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Delahaye F, Hoen B, McFadden E, Roth O, de Gevigney G. Treatment and prevention of infective endocarditis. Expert Opin Pharmacother 2002; 3:131-45. [PMID: 11829727 DOI: 10.1517/14656566.3.2.131] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The paper presents the most recent recommendations for the treatment and prevention of infective endocarditis (IE). The treatment of IE is complex and requires close collaboration among specialists in infectious diseases, cardiology, cardiac surgery and microbiology. The mainstay of medical treatment is antibiotic therapy. Theoretical considerations regarding vegetations and antibiotics have practical consequences on the route and modalities of administration of antibiotics and on the techniques used to monitor treatment. The choice of antibiotics depends on the microorganism (streptococci, enterococci, staphylococci, HACEK group [Haemophilus sp., Actinobacillus sp., Cardiobacterium sp., Eikenella sp. and Kingella sp.], Coxiella, Brucella, Legionella, Bartonella, fungi) and on whether IE occurs on native or prosthetic valves. Treatment of IE with negative blood cultures is particularly difficult. Cardiac surgery is often needed during the bacteriologically active period (in ~50% of patients). The decision to intervene and the optimal timing of the intervention requires careful consideration of multiple potential risks: the haemodynamic risk, the infectious risk, the risk due to cardiac lesions, the risk due to extracardiac complications and the risk due to the location of infective endocarditis. Even though the efficacy of antibiotic prophylaxis of IE is not completely proven, it is recommended for selected patients who undergo an at-risk procedure. Lists of cardiac conditions and of medical procedures at risk are presented; specific antibiotic prophylactic regimens for dental and upper respiratory tract procedures in out-patients, procedures under general anaesthesia and urological and GI procedures are outlined.
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Affiliation(s)
- François Delahaye
- Hôpital Louis Pradel, BP Lyon Montchat, 69394 Lyon Cedex 03, France.
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