Use Last-Resort Antibiotics Wisely Against Superbugs
Journal name: The Malaysian Journal of Medical Sciences
Original article title: The Multidrug-Resistant Gram-negative Superbugs Threat Require Intelligent Use of the Last Weapon
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Zakuan Zainy Deris
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: The Multidrug-Resistant Gram-negative Superbugs Threat Require Intelligent Use of the Last Weapon
Year: 2015
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
The rise of multidrug-resistant Gram-negative bacteria, particularly Acinetobacter baumannii and Klebsiella pneumoniae, poses a significant challenge in treating nosocomial infections. As resistance to commonly used antibiotics escalates, polymyxins, including polymyxin B and colistin (polymyxin E), have emerged as last-resort therapeutic options. These drugs were developed before stringent drug regulations were implemented, resulting in a prevalence of unreliable information regarding their use. Recent studies emphasize the need for careful management of polymyxin therapies to maintain their efficacy against resistant pathogens.
Pharmacokinetics and Dosing of Polymyxins
A critical aspect of utilizing polymyxins effectively lies in understanding their pharmacokinetics. Current evidence suggests that polymyxin B dosing should be based on total body weight instead of renal function adjustments, countering the recommendations made by manufacturers. Additionally, colistin is administered as an inactive prodrug (colistin methanesulfonate), which has different pharmacokinetic dynamics compared to polymyxin B. The necessity for a precise loading dose for colistin, adjusted for body weight, followed by maintenance doses according to kidney function, is paramount for achieving optimal therapeutic outcomes. Combination therapies with polymyxins are also recommended to combat sub-therapeutic concentrations and the emergence of hetero-resistance in various Gram-negative species, enhancing the potential for successful treatment in critically ill patients.
Conclusion
The increasing prevalence of resistant Gram-negative superbugs necessitates urgent attention and strategic use of polymyxins in clinical settings. Given the limited antibiotic alternatives, polymyxins must be judiciously reserved for instances where they can be effectively employed based on current pharmacokinetic and pharmacodynamic data. The responsible usage of these last-line antibiotics is essential not only for immediate patient care but also for preserving their effectiveness against the growing threat of resistance, ultimately safeguarding future therapeutic options against multidrug-resistant infections.
FAQ section (important questions/answers):
What are polymyxins used for in clinical practice?
Polymyxins, specifically polymyxin B and colistin, are used as a last resort to treat infections caused by multidrug-resistant Gram-negative bacteria, such as Acinetobacter baumannii and Klebsiella pneumoniae.
Why is there a concern about polymyxin use?
There is concern about the rise of polymyxin hetero-resistance and the potential for inappropriate antibiotic therapy, which can lead to treatment failures and increased mortality due to infections.
How should polymyxin B be dosed in patients?
Polymyxin B should be dosed based on total body weight, up to 2.5 mg/kg/day, without renal dose adjustments, which have been found ineffective in critically ill patients.
What are the differences between polymyxin B and colistin?
Polymyxin B is in its active form for administration, while colistin is administered as an inactive prodrug, colistin methanesulfonate (CMS), which requires conversion to the active form in the body.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Use Last-Resort Antibiotics Wisely Against Superbugs”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Antibiotic (Antibacterial):
Antibiotics are crucial in medical treatment to combat bacterial infections. Their efficacy is increasingly threatened by resistance mechanisms in bacteria, such as multidrug-resistant strains. Understanding the pharmacodynamics and pharmacokinetics of antibiotics, like polymyxins, helps clinicians choose the appropriate treatment regimens, ensuring that these vital drugs retain effectiveness against resistant bacteria.
2) Drug:
In the context of medicine, a drug refers to any substance used to diagnose, cure, or alleviate symptoms of a disease. The development of new drugs to combat drug-resistant bacteria is essential. Existing drugs must be used judiciously to prevent the emergence of further resistance, particularly in critical care settings.
3) Activity:
Activity in this context refers to the effectiveness of microorganisms against antibiotics. Monitoring bacterial activity helps clinicians understand which treatments will be most successful. Determining the activity levels of agents like polymyxins against resistant strains is vital for guiding effective antibiotic therapy, thereby improving patient outcomes and reducing mortality rates.
4) Delhi:
Delhi is relevant in the discussion of antibiotic resistance as the emergence of strains like New Delhi metallo-beta-lactamase (NDM)-producing bacteria has sparked global public health concerns. NDM-1 is particularly associated with high resistance to multiple antibiotics, making infected patients difficult to treat and illustrating a growing challenge for healthcare systems.
5) Beta:
Beta, in the antibiotic context, often relates to beta-lactam antibiotics, which include penicillins and cephalosporins. These antibiotics have historically been vital in treating various infections. However, resistance mechanisms, such as the production of metallobeta-lactamases by certain bacteria, complicate treatment options, necessitating the use of last-resort antibiotics like polymyxins.
6) Teri:
Deri in this context may refer to derivatives or related compounds in pharmacology or therapeutic agents. Understanding the variances between different derivatives of similar antibiotics can help delineate their efficacy and side effects. Research into novel derivatives of antibiotics could present new options against resistant pathogens while minimizing toxicity.
7) Table:
In scientific literature, a table is often used to summarize and present data clearly and concisely. Tables can depict results from studies examining antibiotic susceptibility, resistance patterns, or pharmacokinetic profiles, enabling researchers and clinicians to compare data easily, thereby supporting evidence-based decision-making in clinical settings.
8) Jacob:
Jacob refers to a common surname but may relate to authorship of pertinent studies or clinical guidelines. Understanding the contributions of researchers like Jacob in pharmacotherapy emphasizes the collaborative nature of medicine in tackling issues like antibiotic resistance. Their insights can improve treatment outcomes through enhanced understanding of pharmacological principles.
9) New Delhi:
New Delhi is the birthplace of significant antibiotic-resistant bacterial strains, most notably New Delhi metallo-beta-lactamase (NDM). The rapid global spread of NDM-producing bacteria highlights the challenges faced in controlling infectious diseases worldwide. This phenomenon underscores the urgency for developing treatments that are effective against such resistant organisms.
10) Teaching:
Teaching in this context highlights the importance of educating healthcare professionals about antimicrobial resistance and effective treatment strategies. Educational initiatives can improve clinicians' knowledge on dosing regimens, resistance mechanisms, and new antibiotic therapies, which is vital for combating the growing threat of multidrug-resistant Gram-negative infections.
11) Species:
In microbiology, species refer to a group of organisms capable of interbreeding. Understanding the diversity of bacterial species and their susceptibility to different antibiotics aids researchers in developing targeted therapies. Identifying resistant species is critical for implementing effective treatment protocols and preventing the spread of infections in healthcare settings.
12) Blood:
Blood is often the medium studied when evaluating infections, particularly sepsis caused by resistant bacteria. Understanding the role of bloodstream infections in patient morbidity and mortality drives antibiotic research. Monitoring blood cultures for resistant pathogens allows clinicians to adjust treatments appropriately, enhancing patient care and outcomes in severe infections.
13) Study (Studying):
Study refers to a formal investigation conducted to understand particular phenomena, such as antimicrobial resistance or the efficacy of specific drugs like polymyxins. Studying these topics underpins advancements in medical protocols, helping healthcare providers adopt strategies to combat rising resistance levels and optimize treatment regimens for critically ill patients.
14) Pharmacotherapy:
Pharmacotherapy is the use of drugs to treat disease and is especially important in managing infections. Understanding pharmacotherapy principles for resistant pathogens enables clinicians to select the most effective treatment plans, ensuring that effective antibiotics are utilized while minimizing the risk of resistance development and adverse effects for patients.
15) Practising (Practicing):
Practicing refers to the application of medical knowledge and skills in real-life situations. Practicing clinicians are on the front lines of dealing with antibiotic resistance. Continuous education and adherence to best practices in the realm of antibiotic stewardship are crucial for managing infections in the clinical setting and improving patient outcomes.
16) Disease:
Disease refers to a pathological condition resulting from various factors, including infections. In the context of antibiotic resistance, understanding disease mechanisms allows healthcare professionals to develop effective treatment plans. Addressing diseases caused by multidrug-resistant organisms is essential for safeguarding public health and ensuring the effective use of existing antibiotics.
17) Cancer:
Cancer poses complex challenges for antibiotic use, especially among immunocompromised patients. Antibiotic resistance in this population can lead to complications, increasing morbidity and mortality. Effective management of infections in cancer patients requires targeted antibiotic therapy to prevent potential treatment delays due to bacterial infections that could worsen their condition.
18) Indian:
Indian references contextually indicate the geographical and biological specificity related to antibiotic resistance patterns and microbial characteristics in India. This highlights the need for tailored antimicrobial strategies in the region, considering local resistance trends that can significantly differ from global paradigms, impacting treatment choices and patient care.
19) Pharmacology:
Pharmacology is the study of drugs and their effects on the body. Knowledge in pharmacology is vital for understanding the actions of antibiotics like polymyxins. It informs dosing strategies and guides clinicians in leveraging the pharmacokinetic and pharmacodynamic principles to optimize antibiotic effectiveness while minimizing side effects.
20) Line:
Line indicates a metaphorical boundary or precedence in medicine, such as a 'line of last defense' in treating infections. In antibiotic therapy, polymyxins are often considered the last line due to their reserved use against resistant infections. This highlights the importance of prudent prescribing to prevent the emergence of further resistance.
21) Post:
Post pertains to the aftermath or following events, often related to patient care transitions. In antibiotic resistance, post-treatment monitoring is crucial to evaluate the effectiveness of prescribed therapies, assess any emerging resistance patterns post-treatment, and adjust future interventions to maintain effective patient outcomes and minimize infection recurrence.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Use Last-Resort Antibiotics Wisely Against Superbugs’. Further sources in the context of Science might help you critically compare this page with similair documents:
New Delhi, Active agent, Adverse effect, Hospital admission, Antibiotic treatment, Pharmacodynamics, Antimicrobial activity, Inhibitory concentration, Combination therapy, Antimicrobial agent, Antimicrobial Resistance, Synergistic effect, Body weight, Clinical success, In vitro studies, Gram negative bacteria, Antibiotic resistance, Klebsiella pneumoniae, Pharmacokinetics and pharmacodynamics, Clinical use, Gram negative, Loading dose, Creatinine clearance, Treatment failure, Serum concentration, Multidrug-resistant, Monotherapy, Synergy, Nosocomial infection, Acinetobacter baumannii, Minimal inhibitory concentration, Prodrug, Maintenance dose, Clinical Specimen, Beta-Lactamase, Imipenem resistance, Pharmacokinetic profile, Pharmacokinetic Data, Parenteral administration, MIC, Carbapenem resistant, MDR pathogens, New antibiotic, Drug regulation, Nephrotoxicity concerns, Research grant, Multidrug resistant pathogen.
Concepts being referred in other categories, contexts and sources.
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