New Antibiotics for Healthcare-Associated Pneumonia

Elizabeth A. Neuner, Pharm.D.; David J. Ritchie, Pharm.D.; Scott T. Micek, Pharm.D.

Disclosures

Semin Respir Crit Care Med. 2009;30(1):92-101. 

In This Article

Conclusions

With the addition of these investigational and newly approved compounds to the antimicrobial armamentarium (Table 1), deciding the optimal role of each agent in the treatment of HCAP is important. With its broad spectrum of activity and supportive clinical trial results doripenem will likely become a new option for the treatment of HCAP. The optimal dose and role as an empirical agent or definitive therapy for resistant gram-negative organisms is debatable. Ceftobiprole is the first cephalosporin to possess MRSA activity in addition to antipseudomonal activity, affording it the potential for empirical monotherapy for HCAP. Clinical trials for the treatment of both CAP and HAP have recently been completed, and full publication of the results, including details regarding the subgroup analysis of patients with VAP, are eagerly anticipated. Although ceftaroline possesses anti-MRSA activity, its narrow gram-negative spectrum and lack of pseudomonal coverage will limit its use. The DHFR inhibitor iclaprim is currently being investigated for HAP, VAP, and HCAP due to gram-positive pathogens, including MRSA, because of its in vitro activity and pharmacokinetic profile. These early clinical studies will help determine the safety and efficacy of iclaprim and its future role. Many questions regarding the lung penetration, safety, and efficacy of the long-acting dalbavancin remain unanswered, and no conclusion regarding its role in the treatment of HCAP can be made at this time. Telavancin is a lipoglycopeptide with more promising potential for HCAP. The potent activity and noninferiority clinical trial data suggest telavancin may potentially be an alternative to vancomycin or linezolid as empirical treatment for gram-positive HCAP. Oritavancin has the infrastructure of intrapulmonary distribution and potent MRSA activity for future study for the treatment of respiratory tract infections.

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