TY - JOUR
T1 - 'Old' antibiotics for emerging multidrug-resistant bacteria
AU - Bergen, Phillip John
AU - Landersdorfer, Cornelia Barbara
AU - Lee, Hee Ji
AU - Li, Jian
AU - Nation, Roger Leigh
PY - 2012
Y1 - 2012
N2 - PURPOSE OF REVIEW: Increased emergence of bacterial resistance and the decline in newly developed antibiotics have necessitated the reintroduction of previously abandoned antimicrobial agents active against multidrug-resistant bacteria. Having never been subjected to contemporary drug development procedures, these old antibiotics require redevelopment in order to optimize therapy. This review focuses on colistin as an exemplar of a successful redevelopment process and briefly discusses two other old antibiotics, fusidic acid and fosfomycin. RECENT FINDINGS: Redevelopment of colistin led to an improved understanding of its chemistry, pharmacokinetics and pharmacodynamics, enabling important steps towards optimizing its clinical use in different patient populations. A scientifically based dosing algorithm was developed for critically ill patients, including those with renal impairment. As nephrotoxicity is a dose-limiting adverse event of colistin, rational combination therapy with other antibiotics needs to be investigated. SUMMARY: The example of colistin demonstrated that state-of-the-art analytical, microbiological and pharmacokinetic/pharmacodynamic methods can facilitate optimized use of old antibiotics in the clinic. Similar methods are now being applied to fosfomycin and fusidic acid in order to optimize therapy. To improve and preserve the usefulness of these antibiotics rational approaches for redevelopment need to be followed.
AB - PURPOSE OF REVIEW: Increased emergence of bacterial resistance and the decline in newly developed antibiotics have necessitated the reintroduction of previously abandoned antimicrobial agents active against multidrug-resistant bacteria. Having never been subjected to contemporary drug development procedures, these old antibiotics require redevelopment in order to optimize therapy. This review focuses on colistin as an exemplar of a successful redevelopment process and briefly discusses two other old antibiotics, fusidic acid and fosfomycin. RECENT FINDINGS: Redevelopment of colistin led to an improved understanding of its chemistry, pharmacokinetics and pharmacodynamics, enabling important steps towards optimizing its clinical use in different patient populations. A scientifically based dosing algorithm was developed for critically ill patients, including those with renal impairment. As nephrotoxicity is a dose-limiting adverse event of colistin, rational combination therapy with other antibiotics needs to be investigated. SUMMARY: The example of colistin demonstrated that state-of-the-art analytical, microbiological and pharmacokinetic/pharmacodynamic methods can facilitate optimized use of old antibiotics in the clinic. Similar methods are now being applied to fosfomycin and fusidic acid in order to optimize therapy. To improve and preserve the usefulness of these antibiotics rational approaches for redevelopment need to be followed.
UR - http://ovidsp.tx.ovid.com/sp-3.8.0b/ovidweb.cgi?WebLinkFrameset=1&S=GNOEFPBGOGDDOOMANCOKLCGCHECHAA00&returnUrl=ovidweb.cgi%3f%26Full%2bText%3dL%257cS.
U2 - 10.1097/QCO.0b013e328358afe5
DO - 10.1097/QCO.0b013e328358afe5
M3 - Article
C2 - 23041772
SN - 0951-7375
VL - 25
SP - 626
EP - 633
JO - Current Opinion in Infectious Diseases
JF - Current Opinion in Infectious Diseases
IS - 6
ER -