Emerging treatments
Eravacycline
Eravacycline, a tetracycline derivative antibiotic, has been approved in the US and Europe for the treatment of complicated intra-abdominal infections in adults. It has shown activity against multidrug-resistant (MDR) species, including extended spectrum beta-lactamase (ESBL)-producing species, and has been used to treat SBP.[140]
New beta-lactam/beta-lactamase inhibitors
Numerous beta-lactam/beta-lactamase inhibitor combinations have been developed to treat infections from MDR pathogens, particularly carbapenem-resistant Enterobacteriaceae (CRE). As these drugs were developed for the treatment of the most difficult-to-treat CRE and ESBL-producing organisms, they should be used only in patients with culture-confirmed diagnosis or who are very ill at high likelihood for infection with resistant organisms. Options include meropenem/vaborbactam, imipenem/cilastatin/relebactam, and ceftazidime/avibactam. Each of these combinations has been approved for use in the US and Europe. Aztreonam/avibactam has also been approved in Europe, but not currently the US, for the treatment of complicated intra-abdominal infections.
Granulocyte-macrophage colony-stimulating factor (GM-CSF)
In a randomized controlled trial in which difficult to treat SBP (defined as nosocomial infection with inadequate response to antibiotics within 48 hours) patients were randomized to receive meropenem (a carbapenem antibiotic) plus placebo or meropenem plus GM-CSF. The meropenem plus GM-CSF group had better resolution rates (30% vs. 60%, respectively).[141]
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