Anti-Infective Chemotherapeutic & Antibiotic Agents

CEPHALOSPORINS

Cefiderocol is a siderophore cephalosporin sharing structural similarities with both cefepime and ceftazidime but with a novel means of accessing the site of action. Cefiderocol is the only available cephalosporin without a coformulated beta lactamase inhibitor that retains activity against resistant gram negative organisms, including Pseudomonas, Acinetobacter baumannii, Stenotrophomonas maltophilia, and carbapenem resistant Enterobacteriaceae (CRE).

OTHER BETA-LACTAM MEDICATIONS

The carbapenem-beta-lactamase inhibitors, such as meropenem-vaborbactam, offer valuable options over more toxic agents, such as colistin. The adverse event profile of these combination products mimics that of the parent carbapenem antibiotic.

TETRACYCLINE DERIVATIVES

Omadacycline is active against biothreat pathogens Bacillus anthracis and Yersinia pestis.

AMINOGLYCOSIDES

In a small randomized study of patients with CRE bloodstream infections, plazomicin in combination with meropenem or tigecycline resulted in lower rates of composite mortality or disease complications compared with treatment with colistin and meropenem or tigecycline.

POLYMYXINS

Ceftolozane-tazobactam is clinically effective against multidrug-resistant Pseudomonas aeruginosa with fewer toxicities, and ceftazidime-avibactam is safer and more effective in the treatment of infection due to CRE.

LEFAMULINC

Lefamulin, the only commercially available antibiotic from the pleuromutilin class, is used in community-acquired bacterial pneumonia. Lefamulin is active against Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, atypical bacteria (eg, Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila), Staphylococcus aureus (including methicillin-resistant strains), Enterococcus faecium (including vancomycin-resistant strains), and Streptococcus pyogenes. It lacks appreciable activity against Enterobacteriaceae and Pseudomonas aeruginosa.

ALTERNATIVE MEDICATIONS IN TUBERCULOSIS TREATMENT

Bedaquiline, a mycobacterial ATP synthase inhibitor for the treatment of multidrug-resistant tuberculosis, is now considered a first-line agent, without the high mortality rates earlier predicted.