Treatment Options for Pan Drug Resistant Gram Negative Bugs

 



 

What is a Pan Drug Resistant (PDR) bug?

This is not easy to define. Pan is a Greek word meaning all. Therefore, Pandrug Resistant simply means resistant to all the antibiotics. But no microbiology lab reports sensitivity to all the antibiotics. Therefore, Pandrug Resistance is an arbitrary situation.

 

We can however simply define Pandrug Resistant bugs when all reported sensitivity is of resistant pattern or when at least all the class has shown resistance.

 

Susceptibility testing for which sensitivity is sometimes not reported:

Fosfomycin

Older and newer antibiotics such as Tetracyclines (such as Minocycline)

Aminoglycosides (missing at least one aminoglycoside)

Cotrimoxazole etc

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Proven treatment regimens examples:

 

PDR K. pneumoniae

1.       Double Carbapenem

2.       Double Carbapenem + Colistin

3.       Ceftazidime/Avibactam

4.       High dose Tigecycline (200mg once daily) combined with colistin and Amikacin

 

PDR P. aeruginosa

1.       Ceftolozane/tazobactam (C/T)

2.       High-dose intravenous (IV) Amikacin (25-50mg/kg)

3.       Amikacin (1g/day) with Meropenem (2g q8h infused over 3 hours)

 

PDR A. baumannii

1.       IV colistin, high-dose IV Tigecycline (200 mg loading dose followed after 12 h by 100 mg q12h),

2.       High-dose IV Ampicillin/Sulbactam (6/3g q8h) and inhaled colistin with empirical MRSA coverage

 

Other PDR GNB

1.       PDR Burkholderia cepacia - Ceftazidime/Avibactam plus Meropenem plus high doses of nebulized colistin for

2.       PDR Providencia stuartii- Piperacillin/tazobactam (4.5 g q8h) plus Amikacin (1 g q24h)

 

In vitro activity of newer agents

1.       Ceftolozane/tazobactam

2.       Aztreonam/Avibactam

3.       Ceftazidime/Avibactam

 

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Ref:

Karakonstantis S et al. Pandrug-resistant Gram-negative bacteria. A systematic review of current

Epidemiology, prognosis and treatment options. Journal of Antimicrobial Chemotherapy 2019

https://www.ncbi.nlm.nih.gov/pubmed/31586417

==

 

--

Dr. Prashant Kumar (@homeprashant)

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