Correspondence Address:
Dr. Dorairajan Suresh Kumar
Flat No. 1012, Prestige Downtwon Apartments, No. 17, Vembuliamman Koil Street, West K. K. Nagar, Chennai - 600 078, Tamil Nadu
India

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“To learn how to use antibiotics, one must first learn how not to use antibiotics.”

Antibiotic-resistant infections are becoming increasingly common, can lead to prolonged illness, increased health-care costs, and more importantly higher mortality rates worldwide. In the recent WHO list of high-level pathogens, carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacterales are duly included as critical pathogens.[1] More than 50% of Klebsiella pneumoniae isolates from patients in India were resistant to third-generation cephalosporins, and carbapenem resistance (CR) was as high as 45.7% in the some regions of India, limiting effective treatment options for common infections such as pneumonia.

Despite the bad news of raising antibiotic resistance, the good news of several new antibiotics belonging to many classes of antimicrobials such as beta-lactams-beta-lactamase inhibitors and tetracycline derivatives [Table 1] were approved in the developed world.{Table 1}

These new antibiotics show many advantages, such as active against resistant Gram-negative pathogens, good lung penetration, safety, and tolerability when compared to old antibiotics such as polymyxins. Recent western guidelines recommending these newer agents as a preferred choice for resistant Gram-negative infections including pneumonia based mostly on noninferiority trials with carbapenems or piperacillin-tazobactam as a comparator.

Based on the trials conducted in the western world, where multidrug-resistant Gram-negative infections were less common, the only available newer agent ceftazidime-avibactam is also included in the Indian treatment guidelines without any major local trials. Ceftazidime-avibactam is not active against the common CR mechanisms found in India (New Delhi metallo-beta-lactamase [NDM]-1 and NDM 1 plus OXA-beta-lactamases-48), the recommendations to add aztreonam with ceftazidime-avibactam to overcome above resistance mechanisms is also lacking evidence.

More than 20 Indian pharmaceutical companies recently started marketing generic Ceftazidime–Avibactam with cheaper price tag in India, when compared to the original molecule. The resistance rate of newer antibiotic (ceftazidime-avibactam) is already raising in the hospitals using this molecule for the last couple of years and clinical failure is also started experienced by the clinicians.[2] The use of these antibiotics should always be guided by susceptibility testing, consideration of the pharmacokinetic/pharmacodynamic (PK/PD) parameters, and lack of safer alternative treatment options rather than the cost of these antibiotics.

In conclusion, with the proper knowledge of antibiotic spectrum, PKs, PDs, and knowing the limitations of these newer antibiotics, pulmonologists in India can effectively use these newer antibiotics to manage their patients' resistant infections and reduce the raising burden of antibiotic-resistant infections in India.

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