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Antibiotic Resistence

New Guidelines for the Most Common Drug-Resistant Pathogens

12/02/2021

The Infectious Diseases Society of America (IDSA) has published treatment guidance on 3 of the most common drug-resistant pathogens: AmpC b-lactamase producing Enterobacterales (AmpC-E), Carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia.1

“Published data on optimal treatment of AmpC-E, CRAB and S maltophilia infections are limited,” the IDSA stated in a press release.2 “As such, guidance in this document is provided as ‘suggested approaches’ based on clinical experience, expert opinion and a review of the available literature.”

For AmpC-E cystitis, the following agents and doses are recommended for adults:

  • Amikacin, 15 mg/kg/dose intravenously once
  • Cefepime, 1 g intravenously every 8 hours
  • Ciprofloxacin, 400 mg intravenously every 8 hours or 500 to 700 mg orally every 12 hours
  • Ertapenem, 1 g intravenously over 30 mins every 24 hours
  • Gentamicin, 5 mg/kg/dose intravenously once
  • Imipenem-cilastatin, 500 mg intravenously over 30 mins every 6 hours
  • Levofloxacin, 750 mg intravenously or orally every 24 hours
  • Meropenem, 1 g intravenously every 8 hours
  • Nitrofuranotoin, 100 mg orally every 12 hours
  • Plazomicin, 15 mg/kg intravenously once
  • Tobramycin, 5 mg/kg/dose intravenously once
  • Trimetoprim, 160 mg/sulfamethoxazole intravenously or orally every 12 hours

 

For CRAB, the following agents and doses are recommended for adults:

  • Ampicillin-sulbactam, 9 g intravenously over 4 hours or 27 g intravenously every 24 hours as a continuous infusion
  • Cefiderocol, 2 g intravenously over 3 hours
  • Eravacycline, 1 mg/kg/dose intravenously every 12 hours
  • Imipenem-cilastatin, 500 mg intravenously over 30 mins every 6 hours
  • Meropenem, 2 g intravenously over 3 hours every 8 hours
  • Minocycline, 200 mg intravenously or orally every 12 hours
  • Tigencycline, 200 mg intravenously as one dose, then 100 mg intravenously every 12 hours

 

For S maltophilia infections, the following agents and doses are recommended for adults:

  • Cefiderocol, 2 g intravenously over 3 hours every 8 hours
  • Cefazidime-avibactam, 2.5 g intravenously over 3 hours every 8 hours and coadministration of aztreonam, 2 g intravenously over 3 hours every 8 hours
  • Eravacycline, 1 mg/kg/dose intravenously every 12 hours
  • Levofloxacin, 750 mg intravenously or orally every 24 hours
  • Minocycline, 200 mg intravenously or orally every 12 hours
  • Tigencycline, 200 mg intravenously as one dose, then 100 mg intravenously every 12 hours
  • Trimetoprim, 160 mg/sulfamethoxazole intravenously or orally every 12 hours

 

“Developing comprehensive clinical guidance is a lengthy process that aims to keep pace with constantly evolving scientific research,” said Cornelius J. Clancy, MD, FIDSA, professor of medicine at the University of Pittsburgh and senior author of the new guidance.2 “By focusing on a small handful of pathogens, this guidance provides clinicians with up-to-date information needed to address the most urgent threats.”

—Amanda Balbi

References

1. Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. IDSA Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections: Version 2.0. The Infectious Diseases Society of America. Published online November 22, 2021. Accessed December 2, 2021. https://www.idsociety.org/practice-guideline/amr-guidance-2.0/

2. New Guidance for Treating Antimicrobial-Resistant Infections Released. News Release. The Infectious Diseases Society of America; November 22, 2021. Accessed December 2, 2021. https://www.idsociety.org/news--publications-new/articles/2021/new-guidance-for-treating-antimicrobial-resistant-infections-released/