Pharmacotherapies for multidrug-resistant gram-positive infections: current options and beyond

ABSTRACT

Introduction

Infections due to multidrug-resistant organisms (MDRO) are a serious concern for public health with high morbidity and mortality. Though many antibiotics have been introduced to manage these infections, there are remaining concerns regarding the optimal management of Gram-positive MDROs.

Areas covered

A literature search on the PubMed/Medline database was conducted. We applied no language and time limits for the search strategy. In this narrative review, we discuss the current options for managing Gram-positive MDROs as well as non-traditional antibacterial agents in development.

Expert opinion

Despite their introduction more than 70 years ago, glycopeptides are still the cornerstone in treating Gram-positive infections: all registrative studies of new antibiotics have glycopeptides as control; these studies are designed as not inferior studies, therefore it is almost impossible to give recommendations other than the use of glycopeptides in the treatment of Gram-positive infections. The best evidence on treatments different from glycopeptides comes from post-hoc analysis and meta-analysis. Non-traditional antibacterial agents are being studied to aid in short and effective antibiotic therapies. The use of non-traditional antibacterial agents is not restricted to replacing traditional antibacterial agents with alternative therapies; instead, they should be used in combination with antibiotic therapies.

KEYWORDS:

• Multidrug-resistant organisms
• methicillin-resistant-staphylococcus aureus
• vancomycin-resistant enterococcus faecium
• penicillin-non-susceptible streptococcus pneumoniae
• anti-Gram-positive antibiotics

Article highlights

• MDROs are one of the most critical public health concerns.

• MRSA, VRE, and PNSP are the Gram-positive bacteria included in the WHO Global priority organisms list.

• Many antibiotics have been introduced to manage infections due to Gram-positive MDROs.

• Prudent use of old and new antibiotics is needed.

• Non-traditional antibacterial agents are in clinical development.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.