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Oritavancin and Tigecycline: Investigational Antimicrobials for Multidrug‐Resistant Bacteria
Author(s) -
Guay David R. P.
Publication year - 2004
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.24.1.58.34808
Subject(s) - tigecycline , linezolid , quinupristin , antimicrobial , multiple drug resistance , medicine , dalfopristin , microbiology and biotechnology , antibiotics , tolerability , vancomycin , staphylococcus aureus , biology , pharmacology , adverse effect , bacteria , genetics
The advent of multidrug‐resistant gram‐positive aerobes such as Staphylococcus aureus, Streptococcus pneumoniae , and the enterococci, which are resistant to β‐lactams, vancomycin, and a host of other commonly used antimicrobials, has complicated our approach to antibiotic therapy. Despite marketing of the first oxazolidinone, linezolid, and the streptogramin combination, quinupristin‐dalfopristin, an urgent need exists for more agents to combat these pathogens. Two such agents, the glycopeptide oritavancin (LY333328) and the glycylcycline tigecycline (GAR‐936), are in phase III clinical trials. These agents, which require parenteral administration, exhibit substantial in vitro activity against a variety of gram‐positive aerobes and anaerobes, including the multidrug‐resistant organisms listed previously. Only tigecycline demonstrates useful activity against gram‐negative organisms. Combination therapy of these agents with ampicillin or aminoglycosides frequently leads to synergistic in vitro activity against multidrug‐resistant staphylococci and streptococci. These agents are also active in a variety of animal models of systemic and localized infections. Few published efficacy and tolerability data are available in humans. If controlled clinical trial data verify these agents' efficacy and tolerability, both drugs should become welcome additions to the available antimicrobials. However, restricting their use to the treatment of infections caused by bacteria resistant to other antimicrobials, especially multidrug‐resistant staphylococci and streptococci, may prolong their clinical utility by retarding the development of resistance. Careful surveillance of bacterial sensitivity to these agents should be undertaken to assist clinicians in the decision whether or not to use these agents empirically to treat infections caused by suspected multidrug‐resistant gram‐positive pathogens.