title: beta-Lactams without a suicide inhibitor.
abstract: Existing clinical studies concerning the impact of therapy with third-generation cephalosporins or cefepime on infections caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are retrospective, non-randomised, and have been carried out with a small number of patients and low-dosage schedules that lack PK-PD correlations with clinical efficacy. Rates of clinical failure and mortality are higher than those in studies with non-ESBL- producing Enterobacteriaceae. Therefore, in settings with a high prevalence of ESBL-producing Enterobacteriaceae, empirical therapy with advanced cephalosporins should be avoided. Temocillin, an old beta-lactam that is stable in the presence of both ESBLs and AmpC beta-lactamases, seems to deserve revival, although clinical data are limited.
authors.affiliation: 4th Department of Internal Medicine, Athens University Hospital ATTIKON, Athens, Greece. hgiama@ath.forthnet.gr
authors.forename: H
authors.initials: H
authors.lastname: Giamarellou
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D010406:Penicillins / Q000494:pharmacology / Q000627:therapeutic use; D013845:Thienamycins / Q000494:pharmacology / Q000627:therapeutic use; D047090:beta-Lactams / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D013845:Thienamycins; D047090:beta-Lactams; C031367:temocillin; D000077731:Meropenem