Older Antibiotics Still in Use for Gram-Negative Infections Despite Availability of Next-Generation Drugs
Gram-negative infections continue to pose a challenge in the field of medicine. Despite the approval of next-generation antibiotics for treating these infections, a recent study has found an increase in the use of older, generic antibiotics. The study, published in the Annals of Internal Medicine, sheds light on this concerning trend.
The study, conducted by Jeffrey R. Strich, M.D., and his colleagues from the National Institutes of Health, aimed to examine the use patterns of recently approved gram-negative antibiotics. They conducted a retrospective cohort study involving 619 U.S. hospitals. The focus was on patients suffering from gram-negative infections caused by pathogens displaying difficult-to-treat resistance (DTR).
The researchers found that between the first and second quarters of 2021, two specific antibiotics dominated new antibiotic usage. Ceftolozane-tazobactam, approved in 2014, and ceftazidime-avibactam, approved in 2015, were commonly used. However, the number of subsequent approvals for gram-negative antibiotics remained relatively low.
In their analysis of gram-negative infection hospitalizations, the researchers discovered that DTR pathogens were present in only 0.7 percent of the cases. Surprisingly, traditional antibiotics, including polymyxins, aminoglycosides, and tigecycline, were used in 41.5 percent of DTR episodes. These antibiotics are often considered reserve drugs due to their potency. The remaining 79.3 percent of cases involved the use of ceftriaxone or other ethionamide antibiotics.
The study also identified factors associated with the preferential use of newer antibiotics over traditional generic agents. The adjusted probability of receiving newer antibiotics was higher for patients with bacteremia and chronic diseases compared to patients with do-not-resuscitate status, acute liver failure, and other nonpseudomonal nonfermenter pathogens.
The authors of the study highlight the significant gap between the availability of new antibiotics and the unmet needs in pathogen research. They suggest that paradigm-changing measures should be implemented to address this issue.
This study serves as a reminder of the ongoing challenges in treating gram-negative infections. Despite advancements in antibiotic development, the use of older antibiotics persists. Further research and action are needed to ensure that patients receive the most effective treatments for these challenging infections.