Question of the Week – 2017

By

Dr Mahen Kothalawala

Can  “Beta lactam – Beta lactamase inhibitirs(BL_BLIs) ”   combinations such as ” ampicillin/sulbactam “, “amoxcillin/clavulanic acid “and “piperacillin/tazobactam ” be used to treat blood culture isolates known to produce ESBLs ?
Are above drugs active against CREs?

2 thoughts on “Question of the Week – 2017”

  1. Can be used according to sensitivity although most do not attempt. Newer combinations are used for the treatment of CRE infections too.

  2. Theoretically we can treat ESBL infection with BL/BLI combination as ESBLs are Class A betalactamases which are inhibited by BLI. However, there is some concern that clinical outcomes in sepsis are not so good with BL/BLI when compared to carbapenems.

    As far as CRE, carbapenemases come in Class A, B and D forms and therefore BL/BLI cannot be recommended. However newer combinations such as ceftazidime-avibactam may be useful.

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