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Pharmacologic options for CNS infections caused by resistant Gram-positive organisms

William J Peppard1, Carolyn J Johnston, Angela M Urmanski

  • 1Clinical Pharmacist, Surgical Critical Care, Froedtert Hospital, 9200 West, Wisconsin Avenue, Milwaukee, WI 53226, USA. wpeppard@fmlh.edu

Expert Review of Anti-Infective Therapy
|February 7, 2008
PubMed

Insights

Gram-positive infections of the central nervous system (CNS) are a growing concern. This review explores alternative therapies like linezolid when vancomycin fails for device-related and neurosurgical CNS infections.

Area of Science:

  • Infectious Diseases
  • Neurosurgery
  • Microbiology

Background:

  • Device-related and neurosurgical central nervous system (CNS) infections pose significant clinical challenges.
  • Gram-positive organisms are increasingly implicated in these complex infections.
  • Current treatment guidelines offer limited options when standard vancomycin therapy fails or is not tolerated.

Purpose of the Study:

  • To review and evaluate alternative antibiotic therapies for Gram-positive CNS infections.
  • To provide interpretations of existing data on alternative agents.
  • To briefly introduce emerging therapies with potent Gram-positive activity.

Main Methods:

  • Literature review of alternative therapies for CNS infections.
  • Focus on agents such as linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline.
  • Inclusion of emerging drugs like ortavancin, telavancin, dalbavancin, ceftobiprole, and iclaprim.

Main Results:

  • The review evaluates the efficacy and limitations of current alternative therapies.
  • Interpretations of available data guide clinical decision-making.
  • Emerging agents show promise for future treatment strategies.

Conclusions:

  • There is a need for effective treatment options beyond vancomycin for resistant Gram-positive CNS infections.
  • Alternative agents provide valuable options for refractory or intolerant cases.
  • Future therapies are under development to address evolving resistance patterns.

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