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

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 beta-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.