Unorthodox Parenteral β-Lactam and β-Lactamase Inhibitor Combinations: Flouting Antimicrobial Stewardship and Compromising Patient Care

Antimicrob Agents Chemother. 2020 Apr 21;64(5):e00168-20. doi: 10.1128/AAC.00168-20. Print 2020 Apr 21.

Abstract

In India and China, indigenous drug manufacturers market arbitrarily combined parenteral β-lactam and β-lactamase inhibitors (BL-BLIs). In these fixed-dose combinations, sulbactam or tazobactam is indiscriminately combined with parenteral cephalosporins, with BLI doses kept in ratios similar to those for the approved BL-BLIs. Such combinations have been introduced into clinical practice without mandatory drug development studies involving pharmacokinetic/pharmacodynamic, safety, and efficacy assessments being undertaken. Such unorthodox combinations compromise clinical outcomes and also potentially contribute to resistance development.

Keywords: antimicrobial stewardship; fixed-dose antibiotic combinations; irrational combinations; unorthodox combinations; β-lactam; β-lactamase inhibitor.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acinetobacter Infections / drug therapy
  • Acinetobacter baumannii / drug effects
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship*
  • Cephalosporins / therapeutic use*
  • China
  • Drug Combinations
  • Drug Misuse*
  • Drug Resistance, Multiple, Bacterial
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae Infections / drug therapy
  • Humans
  • Inappropriate Prescribing*
  • India
  • Microbial Sensitivity Tests
  • Patient Care
  • Pseudomonas Infections / drug therapy
  • Pseudomonas aeruginosa / drug effects
  • Sulbactam / therapeutic use*
  • Tazobactam / therapeutic use*
  • beta-Lactamase Inhibitors / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • Drug Combinations
  • beta-Lactamase Inhibitors
  • Sulbactam
  • Tazobactam