Early appropriate therapy of Gram-positive bloodstream infections: the conservative use of new drugs

International Journal of Antimicrobial Agents
Paolo A Grossi

Abstract

Among the Gram-positive organisms, meticillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecium represent the biggest therapeutic hurdles. The evolution of MRSA exemplifies the genetic adaptation of an organism into a first-class multidrug-resistant pathogen. Glycopeptides such as vancomycin have been the treatment of choice for MRSA, but poor outcomes have frequently been reported, particularly among isolates with higher minimum inhibitory concentrations (MICs) within the susceptible range (< or =2 mg/L). Further more, vancomycin's limitations as an antibacterial agent include slow bactericidal activity and relatively poor tissue penetration. Inadequate dosing may, however, contribute to vancomycin's poor performance; the standard recommendation for trough concentrations of 5-10 mg/L is inadequate for serious infections such as bacteraemia and endocarditis. Trough levels of 15-20 mg/L are probably necessary; however they are often associated with increased nephrotoxicity. Despite the recent dramatic reduction in antibiotic research by pharmaceutical companies, a few compounds have been developed to treat Gram-positive infections. Quinupristin-dalfopristin, although shown to have in vitro activity against MRSA, is...Continue Reading

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Citations

Jun 7, 2013·BMC Infectious Diseases·Carolin A KreisThomas Fuchs
Jan 25, 2013·Viruses·Marie Deghorain, Laurence Van Melderen
Nov 13, 2015·Expert Review of Anti-infective Therapy·Ana Budimir
Sep 19, 2014·The American Journal of the Medical Sciences·Justin B UseryTimothy H Self

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