title: Current and future treatment options for infections caused by multidrug-resistant Gram-negative pathogens.
abstract: The spread of multidrug-resistant, extensively drug-resistant and pan-drug-resistant pathogens is causing an unprecedented public health crisis. The limited current therapeutic options led to the revival of two 'old' antibiotics - colistin and fosfomycin - for which a better understanding of their pharmacokinetics in the critically ill patient and in specific body compartments is required. Tigecycline's use in clinical practice for nonapproved indication based on its in vitro activity against problematic pathogens requires caution and probably higher doses. Furthermore, all three antibiotics should be used as part of combination regimens in order to prevent resistance and optimize outcomes. The development of new antibacterials in the near future, namely combinations of avibactam, ceftolozane/tazobactam and plazomicin, seems promising; however, they will only partially address current mechanisms of resistance.
authors.affiliation: 4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, 1 Rimini Street, Athens 12462, Greece.
authors.forename: Garyphallia
authors.initials: G
authors.lastname: Poulakou
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.forename: Elda
authors.initials: E
authors.lastname: Righi
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
mesh_terms: D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D003091:Colistin / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D016638:Critical Illness / Q000628:therapy; D024901:Drug Resistance, Multiple, Bacterial; D005578:Fosfomycin / Q000493:pharmacokinetics / Q000627:therapeutic use; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008911:Minocycline / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D000078304:Tigecycline
chemical_list: D000900:Anti-Bacterial Agents; D005578:Fosfomycin; D000078304:Tigecycline; D008911:Minocycline; D003091:Colistin
keywords: aerosolized antibiotics; avibactam; carbapenemase; colistin; critically ill; fosfomycin; multidrug resistance; plazomicin; tigecycline