New drugs in infectious diseases. Which place for tedizolid, ceftaroline, and ceftobiprole in the ICU?
Nouvelles molécules anti-infectieuses. Quelle place en médecine intensive réanimation pour le tédizolide, la ceftaroline et le ceftobiprole ?
Résumé
Although decreasing in the past years, severe infections caused by Gram-positive bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and penicillin-resistant pneumococci, remain a matter of concern. Indeed, there is a need for new antibiotics given the issues raised by the use of glycopeptides. Accordingly, in addition to possible loss of efficiency against MRSA and safety concerns, vancomycin-resistant enterococci are regularly responsible for significant outbreaks among hospitalized patients. In this context, the Oxazolidinone family has grown since tedizolid, the spectrum of which includes the above-mentioned resistant pathogens, has been successfully developed. Current data suggest that tedizolid could be more efficient and less toxic than linezolid, thus allowing longer durations of treatment. Indeed, although the drug is licensed only for the treatment of acute bacterial skin and skin structure infections (ABSSSIs), several clinical trials are currently ongoing. New cephalosporins owing antibacterial activity against MRSA have also appeared recently. In addition to a strong bactericidal activity and a favourable safety profile, these drugs have proven efficient for the treatment of infections involving Gram-positive agents, that is, community-acquired pneumonia (ceftaroline), health care-associated pneumonia (ceftobiprole), as well as ABSSSIs. In spite of a broad spectrum of activity covering Gram-negative bacteria including Pseudomonas aeruginosa (ceftobiprole only), clinical data are mandatory before expanding their use to the critically ill patients with pneumonia, given pharmacokinetic issues in this setting. Administration of these drugs should actually be optimized in order to make use of their whole efficiency.