Evaluation Strategies for Triple-Drug Combinations against Carbapenemase-Producing Klebsiella Pneumoniae in an In Vitro Hollow-Fiber Infection Model
Clin. pharmacol. ther
; 109(4): 160-212, Apr. 2021. graf, tab
Artículo
en Inglés
| Sec. Est. Saúde SP, CONASS, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1177204
Biblioteca responsable:
BR79.1
ABSTRACT
Mounting antimicrobial resistance to carbapenemase-producing Klebsiella pneumoniae (CPKP) highlights the need to optimize currently available treatment options. The objective of this study was to explore alternative dosing strategies that limit the emergence of resistance to preserve the utility of last-line antibiotics by (i) evaluating the pharmacodynamic (PD) killing activity of simulated humanized exposures to monotherapy and two-drug and three-drug combinations against CPKP bacterial isolates with different resistance mechanisms; and (ii) optimizing polymyxin B (PMB) exposure simulated in the three-drug combination regimens to maximize the killing activity. Two CPKP clinical isolates (BAA2146 (NDM-1) and BRKP76 (KPC-2)) were evaluated over 168 hours using a hollow-fiber infection model simulating clinically relevant PMB, fosfomycin, and meropenem dosing regimens. PMB-based three-drug combinations were further optimized by varying the initial exposure (024 hours) or maintenance dose received over the duration of treatment. The area under the bacterial load-versus-time curve (AUCFU) was used to determine PD activity. Overall reductions in PMB exposure ranged from 2 to 84%. BAA2146 and BRKP76 had median (range) AUCFUs of 11.0 (10.611.6) log10 CFU hour/mL and 7.08 (7.0411.9) log10 CFU hour/mL, respectively. The PMB "front loaded" 2.5 mg/ kg/day + 0.5 mg/kg maintenance dose in combination with meropenem and fosfomycin was a promising regimen against BRKP76, with an overall reduction in PMB exposure of 56% while still eradicating the bacteria. Tailored triple combination therapy allows for the optimization of dose and treatment duration of last-line agents like PMB to achieve adequate drug exposure and appropriate PD activity while minimizing the emergence of resistance.
Texto completo:
Disponible
Colección:
Bases de datos nacionales
/
Brasil
Contexto en salud:
Enfermedades Desatendidas
Problema de salud:
Enfermedades Desatendidas
/
Zoonosis
Base de datos:
CONASS
/
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Asunto principal:
Combinación de Medicamentos
/
Klebsiella pneumoniae
Idioma:
Inglés
Revista:
Clin. pharmacol. ther
Año:
2021
Tipo del documento:
Artículo
Institución/País de afiliación:
Instituto Dante Pazzanese de Cardiologia/BR
/
Monash University/AU
/
University of Melbourne/AU
/
University of Michigan Medical School/US
/
University of North Carolina/BR
/
University of North Carolina/US