Treatment challenges in the management of difficult-to-treat gram-positive infections: A consensus view apropos therapeutic role of novel anti-MRSA antibiotics, levonadifloxacin (IV) and alalevonadifloxacin (oral).

Autor: Saseedharan S; Department of Critical Care, S. L. Raheja Hospital, Mumbai, India., Dubey D; Department of Critical Care, Medanta Hospital, Lucknow, India., Singh RK; Department of Emergency Medicine, SGPGIMS, Lucknow, India., Zirpe K; Department of Neuro Critical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, India. Electronic address: drkapilzirpe@gmail.com., Choudhuri AH; Department of Anesthesia & Critical Care, GB Pant Hospital, New Delhi, India., Mukherjee DN; Department of Clinical Microbiology & ID, Woodlands, CMRI Hospitals and Belluview Clinic, Kolkata, India., Gupta N; Department of Infectious Diseases, Medanta-The Medicity & Fortis Memorial Research Institute, Gurgaon, India., Sahasrabudhe S; Department of Pulmonology and Critical Care Medicine, Medicover Hospitals, Aurangabad, India., Soni S; Department of Nephrology, Dialysis and Kidney Transplantation, Medicover Hospitals, Aurangabad, India., Kulkarni S; Department of Nephrology, MGM Medical College, Aurangabad, India., Walse P; Department of Critical Care, Asian Hospital, Aurangabad, India., Vora AC; Department of Pulmonology, Vora Clinic, Mumbai, India., Thomas J; Department of Paediatrics, L H Hiranandani Hospital, Mumbai, India., Tayade A; Department of Infectious Diseases, Kingsway Hospital, Nagpur, India., Bhadarke G; Department of Haematology, Sankalp Specialty Hospital, Nashik, India., Kishore K; Department of Pulmonary & Critical Care, Yashoda Super Speciality Hospital Kaushambi, Ghaziabad, India., Paliwal Y; Department of Critical Care, Fortis Hospital Kolkata, India., Patil P; Department of Infectious Diseases, KIMS, Secunderabad, Telangana, India., Reddy PK; Department of Critical Care Medicine, Care Hospitals, Banjara Hills, Hyderabad, India., Nagvekar V; Department of Internal Medicine, Infectious Diseases, Lilavati Hospital & Research Centre, Bandra (W), Mumbai, India., Veeraraghavan B; Department of Clinical Microbiology, Christian Medical College, Vellore, India.
Jazyk: angličtina
Zdroj: Indian journal of medical microbiology [Indian J Med Microbiol] 2024 Jan-Feb; Vol. 47, pp. 100528. Date of Electronic Publication: 2024 Jan 21.
DOI: 10.1016/j.ijmmb.2024.100528
Abstrakt: Purpose: Treatment of antibiotic-resistant Gram-positive infections (GPIs), including methicillin-resistant Staphylococcus aureus (MRSA) is becoming increasingly difficult, particularly in patients with multiple co-morbidities who require antibiotics with greater safety and a consistent pharmacokinetic/pharmacodynamic (PK/PD) profile. Such difficult-to-treat GPIs are often associated with poor outcomes, extended hospital stay and increased expenditure. This can be partly attributed to the limited safety and aberrant PK/PD profile of existing anti-MRSA antibiotics. In this context, intravenous levonadifloxacin and its oral prodrug alalevonadifloxacin are novel anti-MRSA antibiotics that have significant advantages over conventional anti-Gram-positive antibiotics. The purpose of this paper was to generate a consensus on the optimal use of levonadifloxacin and alalevonadifloxacin for tackling resistant Gram-positive infections in patients with multiple co-morbidities.
Method: Using a modified Delphi approach that combines critical appraisal of evidence and expert opinion, therapeutic use of levonadifloxacin and alalevonadifloxacin in various clinical scenarios and specific unmet conditions was deliberated. Fifteen expert members from medicine, critical-care, emergency, microbiology, and intensive-care disciplines participated and voted on 11 pre-conceived statements. When there was at least 70 % agreement, a consensus was reached.
Results: Following the voting, agreements were reached on 10 out of the 11 statements. Broadly, a consensus was reached in defining the therapeutic role of levonadifloxacin and alalevonadifloxacin in the treatment of various clinical indications involving resistant Gram-positive pathogens, including MRSA, in patients with co-morbidities, such as co-existing or increased risk for kidney dysfunction or hepatic disease and/or immunosuppression; also, in therapeutically challenging conditions caused by Gram-positive bacteria such as bacteraemia, bone and joint infection, diabetic foot infection, febrile neutropenia, and hospital-acquired pneumonia.
Conclusions: This consensus supports the therapeutic use of levonadifloxacin and alalevonadifloxacin in the treatment of antibiotic-resistant GPIs, including those caused by MRSA and certain polymicrobial infections, in patients with multiple co-morbidities requiring drug with adequate safety and consistent efficacy.
Competing Interests: Declaration of competing interest None
(Copyright © 2024 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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