A mixed methods approach (EXPANS) to assess current and future uses of antimicrobials: a case study of ceftaroline

Area of Science:

• Infectious Diseases
• Pharmacology
• Health Services Research

Background:

• Rising antibiotic resistance necessitates exploring new indications for existing antimicrobials.
• Off-label use of antibiotics is crucial for managing complex infections but requires systematic evaluation.
• Ceftaroline is an antimicrobial with limited current use in the Netherlands.

Purpose of the Study:

• To introduce and apply a mixed-methods approach, Exploratory Positioning of Antimicrobials in New Settings (EXPANS), for identifying off-label antimicrobial indications.
• To explore potential off-label uses of ceftaroline, including its application in outpatient parenteral antimicrobial therapy (OPAT).

Main Methods:

• The EXPANS approach integrated a systematic literature review, an observational study, and an expert meeting.
• The approach was applied to ceftaroline to identify its off-label indications and assess its suitability for OPAT.
• Data collection focused on clinical experiences and barriers to use.

Main Results:

• Ceftaroline was primarily used as a second-line treatment for endocarditis and bone/joint infections, often in combination with daptomycin.
• Limited use of ceftaroline in Dutch hospitals (48 patients in 5 years) was observed, with experts citing lack of evidence and reimbursement issues.
• Potential off-label uses identified include endocarditis treatment and prophylaxis for prosthetic joint revision surgery.

Conclusions:

• The EXPANS approach effectively gathered clinical data and identified barriers to antimicrobial use.
• This systematic methodology can uncover the untapped potential of existing antimicrobial agents.
• Optimizing antimicrobial use through such systematic exploration is recommended to combat resistance challenges.