Bench-to-bedside review: The role of β-lactamases in antibiotic-resistant Gram-negative infections

Table 1 Common β-lactam antibiotics that may be used as monotherapy to treat infections caused by Gram-negative Bacteria

Infection type	Phenotype	Possible β-lactam antibiotics^{a, b}
Bacterial meningitis	Wild-type	Cefotaxime or ceftriaxone, cefepime, meropenem
Intra-abdominal	Wild-type	Amoxicillin-clavulanic acid^c, piperacillin-tazobactam, ticarcillin-clavulanic acid, cefoxitin, cefotetan
	ESBL-producing	Carbapenems^d
Osteomyelitis	Wild-type	Ceftazidime, cefepime
Otitis media	Wild-type	Amoxicillin ± clavulanic acid^c, cefdinir^c, cefpodoxime^c, cefprozil^c, cefuroxime axetil^c, ceftriaxone
Lower respiratory infections and pneumonia	Wild-type	Amoxicillin-clavulanic acid^c, piperacillin-tazobactam, ticarcillin-clavulanic acid, aztreonam, cefdinir^c, cefpodoxime^c, cefprozil^c, cefuroxime axetil^c, cefepime, cefotaxime, ceftriaxone, ceftazidime
	ESBL-producing	Carbapenems
Gonorrhea	Non-β-lactamase-producing	Penicillin G
	β-lactamase-producing	Cefixime^c, cefpodoxime^c, ceftriaxone, cefotaxime, cefuroxime
Skin and skin structure	Wild-type	Carbapenems Ampicillin-sulbactam, piperacillin-tazobactam, ticarcillin-clavulanic acid
Urinary tract (complicated)	Wild-type	Ampicillin-sulbactam, piperacillin-tazobactam, ticarcillin-clavulanic acid, ceftriaxone
	ESBL-producing	Carbapenems

^aAntibiotics listed are based on those recommended in the 2009 Sanford Guide [4], assuming that the causative Gram-negative bacteria are susceptible to these agents. ^bAgents are dosed intravenously unless otherwise noted. ^cOral dosing. ^dCarbapenems for infections caused by Enterobacteriaceae include doripenem, ertapenem, imipenem, and meropenem. For infections caused by Pseudomonas aeruginosa, ertapenem should not be used. ESBL, extended-spectrum β-lactamase.

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