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Antibiotic Dereplication Using the Antibiotic Resistance Platform
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Shifting Gears: The Future of Polymyxin Antibiotics

Justin R Lenhard1, Zackery P Bulman2, Brian T Tsuji3

  • 1Department of Clinical and Administrative Sciences, California Northstate University College of Pharmacy, Elk Grove, CA 95757, USA. Justin.lenhard@cnsu.edu.

Antibiotics (Basel, Switzerland)
|April 25, 2019
PubMed

Insights

Polymyxin antibiotics are regaining use against resistant bacteria but face competition from new drugs. Future use may focus on specific infections like carbapenem-resistant Acinetobacter baumannii, with personalized dosing and new analogs offering promise.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Polymyxin antibiotics, once sidelined due to nephrotoxicity, have seen a resurgence for treating multidrug-resistant pathogens.
  • The evolving landscape of antimicrobial agents necessitates a re-evaluation of polymyxins' role.

Purpose of the Study:

  • To review the current status and future prospects of polymyxin antibiotics.
  • To evaluate treatment options for difficult-to-treat bacterial infections in light of new antimicrobial developments.

Main Methods:

  • Review of current literature and highlights from the 3rd International Polymyxin Conference.
  • Analysis of the impact of newly introduced antibiotics on polymyxin utilization.

Main Results:

  • New agents like ceftazidime-avibactam and ceftolozane-tazobactam are expected to reduce polymyxin use against Enterobacteriaceae and Pseudomonas aeruginosa.
  • Polymyxins remain crucial for carbapenem-resistant Acinetobacter baumannii infections pending alternative treatments.
  • Inhaled polymyxins show potential as adjunctive therapy for pulmonary infections, requiring further clinical validation.

Conclusions:

  • The niche for polymyxins is narrowing due to newer, safer antibiotics.
  • Personalized dosing and development of safer polymyxin analogs are key strategies for optimizing future use.
  • Polymyxins will likely retain importance for specific resistant infections, particularly Acinetobacter baumannii.
Keywords:
Acinetobacter baumanniiKlebsiella pneumoniaePseudomonas aeruginosaavibactamcarbapenem resistancecefiderocolceftolozaneinhaled antibioticspolymyxinsβ-lactamase inhibitors

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