Old antibiotics for infections in critically ill patients.
OBJECTIVE
The alarming epidemic of multidrug-resistant bacteria and the reluctance of the pharmaceutical industry to invest in the development of new antibiotics have forced clinicians to reintroduce forgotten antibiotics into their practice. This review highlights the effectiveness and safety of older antibiotics when used in the treatment of infections of critically ill patients.


RESULTS
Polymyxins emerged as useful antibiotics for the treatment of infections due to multidrug-resistant Gram-negative bacteria, in particular Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae. The nephrotoxicity and neurotoxicity associated with their use are less frequent and serious than previously reported. In addition, aerosolized polymyxins may be a useful weapon in the treatment of hospital-acquired pneumonia. Fosfomycin and chloramphenicol have a wide antimicrobial spectrum, are used extensively in Europe and Africa, respectively, and may have an expanded role in our antimicrobial arsenal. Fusidic acid remains active against various staphylococcal strains, while isepamicin (an aminoglycoside used in some European countries) is slightly more effective than amikacin against some Gram-negative bacteria.


CONCLUSIONS
The declining investment of the pharmaceutical industry in the development of new antibiotics and the increasing antimicrobial resistance create a fertile ground for the study and, probably, revival of older antibiotics for use, especially in critically ill patients.
Falagas
Matthew E
ME
Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece. m.falagas@aibs.gr
Kopterides
Petros
P
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002701:Chloramphenicol / Q000627:therapeutic use; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D005578:Fosfomycin / Q000627:therapeutic use; D005672:Fusidic Acid / Q000627:therapeutic use; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D011113:Polymyxins / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D011113:Polymyxins; D005578:Fosfomycin; D005672:Fusidic Acid; D002701:Chloramphenicol; C016927:isepamicin