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Increasing resistance to important antibiotics of last resort – But the reserve of those drugs also often does not work

Antibiotic Pills reserve
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Germs with resistance to important antibiotics of last resort are detected in a growing number of hospital patients in Germany. This shows the data from a report of the National Reference Center for Gram-negative Pathogens (NRZ) of the Ruhr-University Bochum, recently published by the Robert Koch Institute in Berlin. We interviewed Dr. Niels Pfennigwerth about this issue.

The article reports that in certain cases physicians have to resort to the “reserve of the reserve “. Which medications we are speaking about and what are their side effects?
Normally these are colistin and tigecycline. Both substances are controversial with regards to their effectiveness. Colistin is also highly nephro- and neurotoxic. Tigecyclin has no extreme side effects but is even more controversial in its efficacy than colistin.

Are these reserve-of-reserve antibiotics effective in any case, or do exist cases where they also do not work?
Unfortunately, there are an increasing number of cases with resistance also to these antibiotics. Representative figures are not yet available.

What would you do if even they would not work anymore? Which of the recurring approaches seems to be the most promising one?
Often, in this case, it is referred to a combination therapy, that means to several antibiotics from different classes of drugs. Also, there are a few “new” antibiotics, e.g. the combination ceftazidime / avibactam, which sometimes still have an effect. However, there are also cases in which no treatment of the infection is possible.

If I take a look on the last page of the bulletin (S 270; comparing weeks 1-25 2017/2018) I see – relating to MRSA and clostridium difficile – declining numbers. What is the reason for this positive development?
At the peak of the MRSA epidemic, numerous hospital hygiene procedures have been optimized or rebuilt, so that MRSA numbers are on the decline. There is now an increased awareness in relation to MRSA among all who are involved, so that the hygiene rules are better respected.

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