The role of carbapenems in the treatment of severe nosocomial respiratory tract infections.
The prevalence of antibiotic-resistant bacteria continues to increase, particularly in patients in the intensive care unit with nosocomial pneumonia. The intention of this review is to provide an overview of severe nosocomial pneumonia, carbapenems and the problem of bacterial resistance to antimicrobial agents. Attention was focused on the efficacy, safety and pharmacodynamics of imipenem, meropenem, ertapenem and doripenem. Issues on the impact of appropriate empiric antibiotic therapy for nosocomial pneumonia patients considered at risk for resistant pathogens are discussed. Critical decision making regarding the use of carbapenems for treating severe nosocomial pneumonia requires careful consideration of the four Ds of optimal antimicrobial therapy: right Drug, right Dose, De-escalated to pathogen-directed therapy and right Duration of therapy.
Joseph
Jomy
J
University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA.
Rodvold
Keith A
KA
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D015780:Carbapenems / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D000077726:Doripenem; D004334:Drug Administration Schedule; D024901:Drug Resistance, Multiple, Bacterial; D000077727:Ertapenem; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D000077731:Meropenem; D018579:Patient Selection; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D012720:Severity of Illness Index; D013845:Thienamycins / Q000627:therapeutic use; D016896:Treatment Outcome; D047090:beta-Lactams / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D013845:Thienamycins; D047090:beta-Lactams; D015378:Imipenem; D000077726:Doripenem; D000077731:Meropenem; D000077727:Ertapenem