Expert Opinion on the Prescription Practice of Carbapenem Antibiotics for the Treatment of Drug-Resistant Bacterial Infections in Indian Settings

Manjula S *

Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.

Krishna Kumar M

Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.

*Author to whom correspondence should be addressed.


Abstract

Objective: The current survey-based study aims to gather expert opinions on the prescription practice of carbapenem antibiotics for the treatment of drug-resistant bacterial infections in Indian clinical settings.

Methods: The cross-sectional, multiple-response questionnaire-based survey involving professionals with expertise in treating pathogenic illnesses was carried out between 2022 and 2023. The questionnaire comprised 25 questions, the majority of which dealt with the use of antibiotics as monotherapy and in various combinations to treat pathogenic illnesses.

Results: Out of 302 survey participants, 83% of them preferred meropenem medications more frequently than imipenem, biapenem, doripenem, and other antibiotics to treat pathogenic infections. For the management of multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant (PDR) infections, approximately 54% of the respondents preferred the administration of 1 gm of IV meropenem in 2 to 3 divided doses. About 61% of the responders suggested using IV meropenem together with colistin to treat infections. The combination of IV meropenem with β-lactams, aminoglycosides, tigecycline, colistin, and others was preferred by 91% of the respondents for the treatment of MDR, XDR, and PDR infections. For treating difficult intra-abdominal infections, meningitis, and urinary tract infections (UTIs), almost 43% of the respondents preferred meropenem in combination with sulbactam.

Conclusion: The survey findings emphasize the prominent role of meropenem, either as a standalone treatment or in combination with other antibiotics in the management of challenging infections caused by MDR, XDR, or PDR pathogens. In specific scenarios involving difficult intra-abdominal infections, meningitis, and UTIs, clinicians recommended meropenem in combination with sulbactam antibiotics.

Keywords: Multi-drug resistance, antibiotics, carbapenems, meropenem, sepsis


How to Cite

S, M., & M , K. K. (2024). Expert Opinion on the Prescription Practice of Carbapenem Antibiotics for the Treatment of Drug-Resistant Bacterial Infections in Indian Settings. Asian Journal of Research in Infectious Diseases, 15(3), 26–32. https://doi.org/10.9734/ajrid/2024/v15i3335

Downloads

Download data is not yet available.

References

Bassetti M, Welte T, Wunderink RG. Treatment of Gram-negative pneumonia in the critical care setting: is the beta-lactam antibiotic backbone broken beyond repair? Critical Care. 2016;20(1):19.

Munoz-Price LS, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. The Lancet Infectious Diseases. 2013;13(9):785–96.

Mancuso G, Midiri A, Gerace E, Biondo C. Bacterial Antibiotic Resistance: The Most Critical Pathogens. Pathogens. 2021;10(10):1310.

Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infectious Diseases. 2014;14(1):13.

Hagihara M, Crandon JL, Nicolau DP. The efficacy and safety of antibiotic combination therapy for infections caused by Gram-positive and Gram-negative organisms. Expert Opinion on Drug Safety. 2012;11(2):221–33.

Sun D, Rubio-Aparicio D, Nelson K, Dudley MN, Lomovskaya O. Meropenem-Vaborbactam Resistance Selection, Resistance Prevention, and Molecular Mechanisms in Mutants of KPC-Producing Klebsiella pneumoniae. Antimicrobial Agents and Chemotherapy. 2017;61(12): e01694-17.

Shields RK, Chen L, Cheng S, Chavda KD, Press EG, Snyder A et al. Emergence of Ceftazidime-Avibactam Resistance Due to Plasmid-Borne blaKPC-3 Mutations during Treatment of Carbapenem-Resistant Klebsiella pneumoniae Infections. Antimicrobial Agents and Chemotherapy. 2017;61(3):e02097-16.

Zhanel GG, Wiebe R, Dilay L, Thomson K, Rubinstein E, Hoban DJ, et al. Comparative Review of the Carbapenems. Drugs. 2007;67(7):1027–52.

Lowe MN, Lamb HM. Meropenem. Drugs. 2000;60(3):619–46.

Hurst M, Lamb HM. Meropenem: A review of its use in patients in intensive care. Drugs. 2000;59(3):653–80.

Meronem IV 500mg Powder for solution for injection or infusion - Summary of Product Characteristics (SmPC) - (emc) [Internet]. [cited 2023 Sep 26].

Available:https://www.medicines.org.uk/emc/product/6731/smpc#gref

Pattnaik D, Panda SS, Singh N, Sahoo S, Mohapatra I, Jena J. Multidrug resistant, extensively drug resistant and pan drug resistant gram negative bacteria at a tertiary care centre in Bhubaneswar. International Journal of Community Medicine and Public Health. 2019; 6(2):567–72.

Mulani MS, Kamble EE, Kumkar SN, Tawre MS, Pardesi KR. Emerging strategies to combat ESKAPE pathogens in the era of antimicrobial resistance: a review. Frontiers in microbiology. 2019;10:539.

Breijyeh Z, Jubeh B, Karaman R. Resistance of Gram-Negative Bacteria to Current Antibacterial Agents and Approaches to Resolve It. Molecules. 2020;25(6):1340.

Indian Pediatrics - Editorial [Internet]. [cited 2023 Sep 26].

Available:https://www.indianpediatrics.net/may2005/may-443-450.htm

Baldwin CM, Lyseng-Williamson KA, Keam SJ. Meropenem: A review of its use in the treatment of serious bacterial infections. Drugs. 2008;68(6):803–38.

Wang X, Zhang X, Zong Z, Yu R, Lv X, Xin J et al. Biapenem versus meropenem in the treatment of bacterial infections: A multicenter, randomized, controlled clinical trial. Indian J Med Res. 2013;138(6):995–1002.

Fish DN. Meropenem in the treatment of complicated skin and soft tissue infections. Ther Clin Risk Manag. 2006;2(4):401- 15.

Colardyn F, Faulkner KL, on behalf of the Meropenem Serious Infection Study Group. Intravenous meropenem versus imipenem/cilastatin in the treatment of serious bacterial infections in hospitalized patients. J Antimicrob Chemother. 1996;38(3):523-37.

Abdelsalam MFA, Abdalla MS, El-Abhar HSED. Prospective, comparative clinical study between high-dose colistin monotherapy and colistin–meropenem combination therapy for treatment of hospital-acquired pneumonia and ventilator- associated pneumonia caused by multidrug- resistant Klebsiella pneumoniae. J Glob Antimicrob Resist. 2018;15:127–35.