Treatment options for extended-spectrum beta-lactamase (ESBL) and AmpC-producing bacteria

• Published in: Expert opinion on pharmacotherapy Vol. 17; no. 7; p. 953
• Main Authors: D'Angelo, Ryan G, Johnson, Jennifer K, Bork, Jacqueline T, Heil, Emily L
• Format: Journal Article
• Language: English
• Published: England 02.05.2016
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacterial Proteins - metabolism; beta-Lactamase Inhibitors - therapeutic use; beta-Lactamases - metabolism; beta-Lactams - therapeutic use; Cephalosporins - therapeutic use; Drug Resistance, Bacterial; Drug Therapy, Combination; Enterobacteriaceae - drug effects; Enterobacteriaceae Infections - drug therapy; Gram-Negative Aerobic Bacteria - drug effects; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - microbiology; Humans; Penicillanic Acid - analogs & derivatives; Penicillanic Acid - therapeutic use; Piperacillin - therapeutic use; AmpC; ESBL; Multidrug resistance; infectious diseases; Enterobacteriaceae
• ISSN: 1744-7666
• DOI: 10.1517/14656566.2016.1154538

Extended spectrum β-lactamases (ESBL) and AmpC β-lactamases are increasing causes of resistance in many Gram-negative pathogens of common infections. This has led to a growing utilization of broad spectrum antibiotics, most predominately the carbapenem agents. As the prevalence of ESBL and AmpC-producing isolates and carbapenem resistance has increased, interest in effective alternatives for the management of these infections has also developed. This article summarizes clinical literature evaluating the utility of carbapenem-sparing regimens for the treatment of ESBL and AmpC-producing Enterobacteriaceae, mainly β-lactam-β-lactamase inhibitor combinations and cefepime (FEP). Based on available data, the use of piperacillin-tazobactam (PTZ) and FEP in the treatment of ESBL-producing Enterobacteriaceae cannot be widely recommended. However, certain infections and patient characteristics may support for effective use of these alternative agents. In the treatment of infections caused by AmpC-producing Enterobacteriaceae, FEP has been shown to be a clinically useful carbapenem-sparing alternative. Carbapenems and FEP share many structurally similar characteristics in regards to susceptibility to AmpC β-lactamases, which further create confidence in the use FEP in these situations. Patient and infection specific characteristics should be used to employ FEP optimally.