ESBL

Q: which of the following group of antibiotics is a best bet against extended-spectrum beta-lactamases (ESBLs) producing organisms? 

 A) Penicillins
 B) Cephalosporins
 C) Monobactams 
 D) Carbapenems 
 E) Fluoroquinolones


Answer: D

Extended-spectrum beta-lactamases (ESBL) are enzymes that confer resistance to beta-lactam antibiotics which include penicillins, cephalosporins, and the monobactams. Carbapenems have been found to be the best treatment options in most of the studies. In case of increase risk from carbapenems such as in pregnancy or patients with underlying history of seizure, meropenem is considered as a good choice. Also, doripenem is another new promising carbapenem.


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References:

1.  Tamma PD, Han JH, Rock C, et al. Carbapenem therapy is associated with improved survival compared with piperacillin-tazobactam for patients with extended-spectrum β-lactamase bacteremia. Clin Infect Dis 2015; 60:1319.

2. Kaniga K, Flamm R, Tong SY, et al. Worldwide experience with the use of doripenem against extended-spectrum-beta-lactamase-producing and ciprofloxacin-resistant Enterobacteriaceae: analysis of six phase 3 clinical studies. Antimicrob Agents Chemother 2010; 54:2119.