Multidrug-resistant Acinetobacter baumannii infections: current evidence on treatment options and role of PK/PD in dose optimization.
Int J Antimicrob Agents. 2019 Mar 01;:
Authors: Lim SMS, Sime FB, Roberts J
Acinetobacter baumannii remains a difficult-to-treat pathogen that poses a significant challenge to clinicians and cost to the healthcare system. There is a lack of clinical efficacy data to aid in the selection of optimal treatment for multi-drug resistant (MDR) A. baumannii infections. This paper aims to review recent literature on the treatment of MDR A. baumannii and novel agents in the pipeline and discuss the clinical data supporting their use. Colistin has been widely studied as monotherapy or as part of combination therapy, but its use is limited due to nephrotoxicity. The clinical benefit of combination therapy, whether empirical or targeted, has yet to be demonstrated, due to a lack of definitive evidence from randomized controlled trials. Most available clinical studies are retrospective and lack control groups, which offers low-grade evidence. Novel agents such as cefiderocol, plazomicin, eravacycline, and sulbactam/ETX2514 combination are promising options for the treatment of different infection pathologies caused by MDR A. baumannii, but these have yet to be evaluated in randomized controlled trials. A better understanding of the pharmacokinetics (PK)/pharmacodynamics (PD) of the "old" antibiotics is required to optimize their dosing regimens to maximize bacterial killing, minimize toxicities and improve clinical outcomes.
PMID: 30831234 [PubMed - as supplied by publisher]