**Advancing in the Direction of Right Solutions: Treating Multidrug-Resistant Pneumonia Multidrug-Resistant Pneumonia**

**Advancing in the Direction of Right Solutions: Treating** 

DOI: 10.5772/intechopen.69979

Manu Chaudhary, Gazalla Ayub and Anurag Payasi Payasi

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

Manu Chaudhary, Gazalla Ayub and Anurag

http://dx.doi.org/10.5772/intechopen.69979

#### **Abstract**

[65] Potron A, Poirel L, Nordmann P. Emerging broad-spectrum resistance in Pseudomonas aeruginosa and *Acinetobacter baumannii*: Mechanisms and epidemiology. International Journal of Antimicrobial Agents. 2015;**45**(6):568-585. DOI: 10.1016/j.ijantimicag.2015.03.001

[66] Paczosa MK, Mecsas J. *Klebsiella pneumoniae*: Going on the offense with a strong defense. Microbiology and Molecular Biology Reviews. 2016;**80**(3):629-661. DOI: 10.1128/MMBR.

[67] Guillamet CV, Vazquez R, Noe J, Micek ST, Kollef MH. A cohort study of bacteremic pneumonia: The importance of antibiotic resistance and appropriate initial therapy?

[68] Blot F, Raynard B, Chachaty E, Tancrede C, Antoun S, Nitenberg G. Value of Gram stain examination of lower respiratory tract secretions for early diagnosis of nosocomial pneumonia. American Journal of Respiratory and Critical Care Medicine. 2000;**162**(5):1731-

[69] O'Horo JC, Thompson D, Safdar N. Is the gram stain useful in the microbiologic diagnosis of VAP? A meta-analysis. Clinical Infectious Diseases. 2012;**55**(4):551-561. DOI:

[70] Lung M, Codina G. Molecular diagnosis in HAP/VAP. Current Opinion in Critical Care.

[71] Mothershed EA, Whitney AM. Nucleic acid-based methods for the detection of bacterial pathogens: Present and future considerations for the clinical laboratory. Clinica Chimica

[72] Tenover FC. Developing molecular amplification methods for rapid diagnosis of respiratory tract infections caused by bacterial pathogens. Clinical Infectious Diseases.

[73] Beale DJ, Jones OA, Karpe AV, Dayalan S, Oh DY, Kouremenos KA, et al. A review of analytical techniques and their application in disease diagnosis in breathomics and sal-

[74] Motta A, Paris D, Melck D, De Laurentiis G, Maniscalco M, Sofia M, et al. Nuclear magnetic resonance-based metabolomics of exhaled breath condensate: Methodological

[75] Ibrahim B, Basanta M, Cadden P, Singh D, Douce D, Woodcock A, et al. noninvasive phenotyping using exhaled volatile organic compounds in asthma. Thorax. 2011;**66**:

[76] Filipiak W, Beer R, Sponring A, Filipiak A, Ager C, Schiefecker A, et al. Breath analysis for in vivo detection of pathogens related to ventilator-associated pneumonia in intensive care patients: A prospective pilot study. Journal of Breath Research. 2015;**9**(1):016004

[77] Fowler SJ, Basanta-Sanchez M, Xu Y, Goodacre R, Dark PM. Surveillance for lower airway pathogens in mechanically ventilated patients by metabolomic analysis of exhaled

ivaomics research. International Journal of Molecular Sciences. 2016;**18**(1):24

Medicine (Baltimore). 2016;**95**(35):e4708. DOI: 10.1097/MD.0000000000004708

00078-15

124 Contemporary Topics of Pneumonia

10.1093/cid/cis512

1737. DOI: 10.1164/ajrccm.162.5.9908088

2012;**18**(5):487-494. DOI: 10.1097/MCC.0b013e3283577d37

Acta. 2006;**363**(1-2):206-220. DOI: 10.1016/j.cccn.2005.05.050

aspects. European Respiratory Journal. 2012;**39**(2):498-500

breath: A case-control study. Thorax. 2015;**70**(4):320-325

804-809. DOI: 10.1136/thx.2010.156695

2011;**52**(Suppl 4):S338-S345. DOI: 10.1093/cid/cir049

Worldwide, antibiotic resistance is a major contemporary public health threat due to rapid emergence of resistant bacteria and endangering the efficacy of antibiotics. There are significant number of reports on clinical failure of β-lactam and β-lactamase inhibitor combination and even carbapenems due to various carbapenem resistance mechanisms. The increasing rate of the antibiotic resistance and its impact on treatment failure encouraged us to study newly reported concept of antibiotic adjuvant entities (AAEs) by which the increasing failure rate of antibiotics can be controlled. These AAEs have been developed for both Gram-positive and Gram-negative multidrug-resistant (MDR) infections. Elores (ceftriaxone + sulbactam with adjuvant ethylenediaminetetraacetic acid (EDTA)) and Potentox (cefepime + amikacin with adjuvant potassium chloride) are the AAEs for Gram-negative MDR pathogens each catering to a different type of resistance and Vancoplus (ceftriaxone + vancomycin with adjuvant L-arginine), another AAE, can help us to last longer in the war against antibiotic-resistant Gram-positive bugs particularly which cause complicated lower respiratory tract infection (LRTI) leading to pneumonia. These new antibiotic additions (Elores, Potentox, and Vancoplus) to the current armamentarium to treat MDR infections, including pneumonia, can help us combat against antimicrobial resistance more efficiently.

**Keywords:** antibiotic resistance, pneumonia, Elores, Potentox, Vancoplus
