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Combination therapy for carbapenem-resistant Enterobacteriaceae: increasing evidence, unanswered questions, potential solutions

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Abstract

Carbapenem-resistant Enterobacteriaceae (CRE) are associated with a high mortality rate and are an increasing problem worldwide. In this mini-review, we consider the growing number of observational studies in favour of combination therapy but highlight the absence of randomised control trials. We discuss the importance of data on minimum inhibitory concentrations (MICs), both for surveillance and for individual patient management. We examine the issues surrounding the use of carbapenems, polymyxins and tigecycline in the treatment of CRE. When and how should we be using carbapenems? Which polymyxin is best? Is tigecycline much maligned? Further studies are urgently needed to validate drug combinations, doses and ratios to maximise efficacy whilst reducing drug exposure and adverse effects.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Public Health England, London, UK

    L. E. B. Nabarro

  2. Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India

    L. E. B. Nabarro & B. Veeraraghavan

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  1. L. E. B. Nabarro
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  2. B. Veeraraghavan
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Correspondence to L. E. B. Nabarro.

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Nabarro, L.E.B., Veeraraghavan, B. Combination therapy for carbapenem-resistant Enterobacteriaceae: increasing evidence, unanswered questions, potential solutions. Eur J Clin Microbiol Infect Dis 34, 2307–2311 (2015). https://doi.org/10.1007/s10096-015-2486-7

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  • DOI: https://doi.org/10.1007/s10096-015-2486-7

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