New Antibiotics for the Treatment of multidrug-resistant gram-negative Bacteria

Zusammenfassung Die stetige Zunahme an bakteriellen Resistenzen und von multiresistenten Erregern (MRE) - vor allem im gramnegativen Bereich - ist ein weltweites Problem. Die Entwicklung neuer Wirkstoffe gegen Infektionen mit multiresistenten gramnegativen Erregern (MRGN) besitzt daher hochste Prioritat. Im Folgenden werden kurzlich zugelassene oder in der fortgeschrittenen klinischen Prufung befindliche Antibiotika mit Wirksamkeit gegen MRGN vorgestellt. Abstract New -lactam/-lactamase inhibitor (BLI) combinations (ceftolozan/tazobactam, ceftazidim/avibactam, meropenem/vaborbactam, imipenem/relebactam, aztreonam/avibactam) are the focus of newly approved antibiotics or those currently in advanced clinical testing. In contrast to the BLI currently available, the new inhibitors avibactam, vaborbactam and relebactam are not structurally -lactams. The combination with a BLI protects -lactam from degradation by broad-spectrum -lactamases from gram-negative pathogens. The main indications for the new substances are therefore infections with multi-resistant gram-negative bacteria. In clinical use, it should be noted that the BLI does not close efficacy gaps in the -lactam/BLI combination (e.g. no effect of cephalosporin/BLI combinations on anaerobes or enterococci). Cefiderocol is the first representative of the siderophore cephalosporin antibiotic group to enter phase II clinical testing. Eravacyclin (tetracycline derivative) and plazomicin (aminoglycoside) are new non--lactam antibiotics in advanced clinical testing (phase III). In order to maintain the efficacy of new reserve antibiotics for as long as possible, a prescription should only be made if an additional benefit in comparison to established substances has been proven, e.g. by a resistance test.