Journal
ANNALS OF PHARMACOTHERAPY
Volume 49, Issue 1, Pages 86-98Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1060028014556652
Keywords
bacterial resistance; -lactamase; carbapenemase; -lactamase inhibitor; clavulanate; tazobactam; sulbactam; avibactam; MK-7655; relebactam; RPX7009
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Funding
- Merck
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Objective: To review the available evidence regarding the utility of the currently available -lactam/-lactamase inhibitor combinations (BLICs) as well as the emerging body of data for the novel agents in the pipeline. Data Sources: A MEDLINE literature search (1960-August 2014) was performed using the search terms -lactamase, -lactamase inhibitor, clavulanate, sulbactam, tazobactam, avibactam, NXL104, MK-7655, and RPX7009. Current studies focusing on new agents were obtained from clinicaltrials.gov. Additional references were identified from a review of literature citations and meeting abstracts. Study Selection and Data Extraction: All English-language studies pertaining to BLICs were evaluated. Data Synthesis: Historical clinical and in vitro data focusing on the characteristics of the conventional BLICs are reviewed. Avibactam, relebactam (formerly MK-7655), and RPX7009 are new -lactamase inhibitors that are being studied in combination with -lactams. Clinical and in vitro data that provide support for their use for multidrug-resistant organisms are reviewed. -Lactam antibiotics are a mainstay for the treatment of many infections. The addition of -lactamase inhibitors enhances their activity against organisms that produce -lactamases; however, organisms that produce extended-spectrum -lactamases, AmpC -lactamases, and carbapenemases are proliferating. The BLICs (amoxicillin/clavulanate, ticarcillin/clavulanate, ampicillin/sulbactam, and piperacillin/tazobactam) lack activity against some of these enzymes, presenting a critical need for new antibiotics. Conclusions: The historical BLICs are useful for many infections; however, evolving resistance limits their use. The new BLICs (combinations with avibactam, relebactam, and RPX7009) may be valuable options for patients infected with multidrug-resistant organisms.
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