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Outpatient Use of Other Antibiotics
Outpatient use of last-resort drugs sees striking growth
BACKGROUND
This category groups several unrelated classes of antibiotics considered of last resort against a variety of (mostly healthcare-associated) infections. Vancomycin is a glycopeptide drug administered intravenously to treat serious cases of MRSA and other life-threatening gram-positive infections. An important outpatient use is empiric therapy for dialysis-associated infections. Linezolid and daptomycin are new agents with similar spectra of activity to glycopeptides but significantly higher treatment costs. Nevertheless, linezolid is a cost-effective replacement to vancomycin because it can be given orally. Carbapenems are beta-lactams that are effective against a very wide number of gram-negative and gram-positive pathogens, but they are primarily reserved for the treatment of nosocomial gram-negative infections resistant to multiple drug classes. The spread of beta-lactamase encoding enzymes has rendered them ineffective in very rare but increasingly common cases. The very last resort in these cases lies in polymixins, an old drug shelved for its high kidney toxicity.
Although the data do not reflect use in hospitals, which is where the majority of use would take place, the increase in outpatient consumption of last-resort drugs is a signal that physicians are running out of treatment options in a growing number of cases.
A REGIONAL PICTURE OF ANTIBIOTIC CONSUMPTION
