CMI highlight: Optimising antibiotic prescribing: Collective approaches to managing a common-pool
Piperaki et al. the review provides a brief overview of the important pharmacokinetic / pharmacocodynamic parameters of relevant antimicrobial agents, a critical evaluation of randomized controlled trials and observational studies, suggestions for increasing the strength of observational studies, and instructions to select treatment regimens according to the severity of the infection and the status of the host.
The authors aim: i) to assist physicians to adapt therapeutic approaches in CRAB infections by considering all potentially available antimicrobials and ii) to present directions for future investigations that emerge through treatment efforts in endemic settings.
Carbapenem-resistant Acinetobacter baumannii (CRAB) has gained global notoriety as a critically important nosocomial pathogen. It mostly affects debilitated patients causing pneumonia and bloodstream infections with high mortality rates. Difficulties in treating CRAB infections stem from a formidable resistance profile that leaves available a few antibiotics of uncertain efficacy such as colistin and tigecycline. Despite the relentless attempts to improve therapeutic approaches (as depicted in colistin-oriented randomized clinical trials and the numerous observational studies), progress is still limited.
Articles and reviews from PubMed and Scopus databases; studies from ClinicalTrials.gov; presentations from ECCMID congresses and IDWeek meetings.
The lack of an optimal therapeutic regimen for CRAB thus far, as shown in this review, suggests the need to thoroughly investigate alternative approaches through carefully designed trials that should include all relevant drugs. Some of these alternative directions are indicated in the present review.
The absence of an optimal treatment regimen for CRAB so far, as this review shows, suggests the need to thoroughly investigate alternative approaches through carefully designed trials, which should include all relevant drugs. Some of these alternative orientations are indicated in Piperaki et al. review.