Which antibiotics should be stocked in your arsenal to combat bacteria with increasing antibiotic resistance?

What we're up against: extended-spectrum- beta-lactamase (ESBL) producing strains of E. coli and Klebsiella, multidrug resistant Pseudomonas aeruginosa and Acinetobacter baumannii, MRSA, VRE

Drugs that may be helpful:

• Linezolid - good for VRE, MRSA


• Daptomycin - good for VRE, MRSA. Poor lung penetration however.


• Colistin - good for multidrug resistant strains of Pseudomonas, Acinetobacter; however is last line treatment given potential nephro and neurotoxicity


• Tigecycline - a tetracycline antibiotic; this thing kills almost everything with exception of Pseudomonas; good for MRSA, VRE, ESBLs


• Carbapenems (meropenem, imipenem, ertapenem, doripenem) - a betalactam antibiotic; has broadest spectrum of antimicrobial activity of all the drug classes; good for multidrug resistant Pseudomonas aeruginosa and Acinetobacter baumannii, ESBLs; no good for MRSA

These are some general rules. Refer to most up to date guidelines and hospital specific antibiograms for additional information.

Source

Volles, D Pharm D and Branan, T Pharm D. "Antibiotics in the Intensive Care Unit: Focus on Agents for Resistant Pathogens." Emerg Med Clin N Am 26 (2008) 813 - 834.