Plazomicin was noninferior to meropenem, a carbapenem for
the treatment of complicated urinary tract antibiotics (UTIs) and acute pyelonephritis
caused by Enterobacteriaceae, including multidrug-resistant strains in a study
published February 21, 2019 in the New England Journal of Medicine.
Plazomicin is a new aminoglycoside antibiotic.
In the study, more than 600 patients with complicated
UTIs were randomized in a 1:1 ratio to receive intravenous plazomicin (15 mg/kg
once daily) or meropenem (1 g every 8 hours), with optional oral step-down
therapy after at least 4 days of IV therapy, for 7-10 days.
Plazomicin was noninferior to meropenem with respect to
the primary efficacy end points of the study.
·
Composite cure (clinical cure
and microbiologic eradication) at day 5 was observed in 88% of patients in
the plazomicin group vs 91.4% in the meropenem group.
·
At the test-of-cure visit (15
to 19 days after initiation of therapy), composite cure was observed in 81.7%
and 70.1%, respectively
·
Microbiologic eradication,
including eradication of Enterobacteriaceae that were not susceptible to
aminoglycosides was higher in the plazomicin group vs meropenem group; 78.8%
vs. 68.6%, respectively) and Enterobacteriaceae that produce extended-spectrum
β-lactamases (ESBL); 82.4% vs. 75.0%, respectively.
·
Fewer patients in the
plazomicin group had microbiologic recurrence (3.7% vs. 8.1%) or clinical
relapse (1.6% vs. 7.1%) vs meropenem group.
Both plazomicin and meropenem were well-tolerated;
increase in serum creatinine levels was uncommon but higher with plazomicin.
These findings suggest plazomicin as a short
duration intravenous alternative for outpatients who cannot take ertapenem
for complicated UTI when there is risk of ESBL-producing organisms
Dr KK Aggarwal
Padma Shri
Awardee
President Elect Confederation of
Medical Associations in Asia and Oceania
(CMAAO)
Group
Editor-in-Chief IJCP Publications
President Heart
Care Foundation of India
Past National President
IMA
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