The Use of Noncarbapenem β-Lactams for the Treatment of Extended-Spectrum β-Lactamase Infections

Clin Infect Dis. 2017 Apr 1;64(7):972-980. doi: 10.1093/cid/cix034.

Abstract

The continued rise in infections caused by extended-spectrum β-lactamase (ESBL)-producing pathogens is recognized globally as one of the most pressing concerns facing the healthcare community. Carbapenems are widely regarded as the antibiotics of choice for the treatment of ESBL-producing infections, even when in vitro activity to other β-lactams has been demonstrated. However, indiscriminant carbapenem use is not without consequence, and carbapenem overuse has contributed to the emergence of carbapenem-resistant Enterobacteriaceae. The use of non-carbapenem β-lactams for the treatment of ESBL infections has yielded conflicting results. In this review, we discuss the available data for the use of cephamycins, cefepime, piperacillin-tazobactam, ceftolozane-tazobactam, and ceftazidime-avibactam for the treatment of ESBL infections.

Keywords: ESBLs; carbapenems; cefepime; cephamycins; piperacillin-tazobactam..

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Cefepime
  • Cephalosporins / pharmacology
  • Cephalosporins / therapeutic use
  • Cephamycins / pharmacology
  • Cephamycins / therapeutic use
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae / genetics
  • Enterobacteriaceae Infections / drug therapy
  • Enterobacteriaceae Infections / microbiology
  • Humans
  • Microbial Sensitivity Tests
  • Penicillanic Acid / analogs & derivatives
  • Penicillanic Acid / pharmacology
  • Penicillanic Acid / therapeutic use
  • Piperacillin / pharmacology
  • Piperacillin / therapeutic use
  • Piperacillin, Tazobactam Drug Combination
  • Treatment Outcome
  • beta-Lactam Resistance* / drug effects
  • beta-Lactamase Inhibitors / pharmacology
  • beta-Lactamase Inhibitors / therapeutic use*
  • beta-Lactamases / genetics*
  • beta-Lactamases / metabolism*

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • Cephamycins
  • beta-Lactamase Inhibitors
  • Piperacillin, Tazobactam Drug Combination
  • Cefepime
  • Penicillanic Acid
  • beta-Lactamases
  • Piperacillin