Special Report

Treatment options for infections caused by multidrug-resistant Gram-negative bacteria: a guide to good clinical practice

Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, 1417614411, Iran

‡Both authors contributed equally

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Maryam Alaei‡

Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, 1417614411, Iran

‡Both authors contributed equally

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Hossein Khalili

*Author for correspondence: Tel.: +98 216 695 4709;

E-mail Address: Khalilih@sina.tums.ac.ir

https://orcid.org/0000-0002-1590-6396

Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, 1417614411, Iran

Research Center for Antibiotic Stewardship & Antimicrobial Resistance, Imam Khomeini Hospital, Tehran, 1417614411, Iran

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Published Online:4 May 2023https://doi.org/10.2217/fmb-2022-0160

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Abstract

The rapid emergence of multidrug-resistant Gram-negative bacterial infections necessitates the development of new treatments or the repurposing of available antibiotics. Here, treatment options for treatment of these infections, recent guidelines and evidence are reviewed. Studies that included treatment options for infections caused by multidrug-resistant Gram-negative bacteria (Enterobacterales and nonfermenters), as well as extended-spectrum β-lactamase-producing and carbapenem-resistant bacteria, were considered. Potential agents for the treatment of these infections, considering type of microorganism, mechanism of resistant, source and severity of infection as well as pharmacotherapy considerations, are summarized.

Plain language summary

Gram-negative bacteria (GNB) are one of the most important causes of infection in humans. GNB can evolve to neutralize the effects of antibiotics by producing proteins called enzymes that break down the antibiotics or through mechanisms that discharge antibiotics from bacteria. The antibiotic can therefore no longer kill the bacteria, so they are considered antibiotic-resistant. For the treatment of resistant GNB infections, smart consideration and selection of potential combinations of available antibiotics or the development of new drugs are needed. In this review, we summarized and collected the recent guidelines and literature reports and present the pharmacological considerations for treatment of resistant GNB infections.

Tweetable abstract

The rapid spread of antimicrobial resistance is a serious concern worldwide. There are limited options for the treatment of infections due to multidrug-resistant Gram-negative bacteria, therefore optimizing the use of available antibiotics is essential.

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Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 18, No. 5

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History

Received 14 July 2022

Accepted 21 February 2023

Published online 4 May 2023

Published in print March 2023

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Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/fmb-2022-0160

Author contributions

Literature review and preparation of first draft of manuscript: K Delroba and M Alaei. Presentation and selection of the data and final editing of the manuscript: H Khalili.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

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