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Infektiologie 1. September 2008

Therapeutic options for the treatment of infections with multiresistant grampositive bacteria in onc

Infections with highly resistant grampositive bacteria are a major threat to the patients with underlying malignant diseases and due to more aggressive treatment strategies the incidence of these infections increased over the past years. For many years, glycopeptides such as vancomycin, have been the standard treatment for methicillin-resistant S. aureus (MRSA) and ampicillin-resistant enterococci. However, the clinical use of vancomycin may be limited by the adverse effects like poor tissue penetration and the emergence of vancomycin-resistant strains such as vancomycin-resistant enterococci and staphylococci. Thus, in recent years, new antimicrobial agents have been introduced into clinical praxis or are under investigation. This review summarizes current clinical data on novel therapeutics such as linezolid, tigecycline and daptomycin as well as investigational new drugs. Linezolid, an oxazolidinone derivative, has proven clinical activity only against infections with grampositive bacteria including vancomycin-resistant rods. Tigecycline is a tetracycline derivative with a very broad antimicrobial spectrum including multiresistant grampositive strains. Daptomycin, belonging to a new class of cyclic lipopeptide antibiotics, is approved for the treatment of skin and skin-structure infections, bactermia and endocarditis with grampositive bacteria. However, only limited data exist on the clinical use of tigecycline and daptomycin in oncological patients. In the near future, novel cephalosporins and carbapenems with activity against MRSA as well as new semisynthetic glycopeptides will extend our therapeutic possibilities in the treatment of infections by multiresistant grampositive bacteria.

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