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Antibiotic pipeline remains limited for pediatrics
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NEW YORK — There is an ongoing need to develop new medications with potent gram-negative activity, particularly in the pediatric population, according to a presenter here at the 25th Annual Infectious Diseases in Children Symposium.
George McCracken Jr., MD, of UT Southwestern Medical Center, said there are a few newer drugs in the pipeline, including tigecycline (Tygacil, Pfizer), telavancin (Vibativ, Astellas Pharma), ceftobiprole, ceftaroline (Teflaro, Forest Laboratories) and doripenem (Doribax, Johnson and Johnson), but only a select few of these — ceftaroline and doripenem — hold promise in the shorter term for use in children.
McCracken said ceftaroline is a newer-generation, broad-spectrum cephalosporin approved for use in complicated skin and skin structure infections and community-acquired pneumonia in adults. Data indicate this medication is active against methicillin-resistant Staphylococcus aureus, resistant pneumococci and many gram-positive and gram-negative organisms. The current dosage for adults is 600 mg every 12 hours by IV, and pharmacokinetic studies, which should help determine optimal doses in children, are under way.
“This is a promising therapy for pediatric community-acquired pneumonia and possibly meningitis, although more data are needed related to [cerebrospinal fluid] penetration,” McCracken said.
Doripenem is a carbapenem with broad activity in adults and is used in this population for intra-abdominal infections, hospital-associated pneumonia and complicated urinary tract infection, he said. Although this medication has not yet been evaluated in pediatric patients, some surgeons are using it in younger patients. However, he noted, more data in pediatrics are required.
In adults, McCracken said both tigecycline and telavancin have been used for complicated skin and skin structure infections. Tigecycline is also used in patients with complicated intra-abdominal infections and community-acquired pneumonia.
He said common adverse events that have been reported with this medication include gastrointestinal issues, headache and photosensitivity. The dosage for this medication is 100 mg (slow IV infusion) followed by 50 mg every 12 hours, but this medication has not been evaluated in children.
Telavancin, McCracken said, is showing “modest activity against vancomycin-resistant Enterococcus,” but this medication has not been tested in children. Common adverse reactions include taste disturbance, nausea, vomiting and foamy urine.
Looking further into the pipeline, he said there will likely be more research into newer fluoroquinolones, oxazolidinones, carbapenems, macrolides, beta-lactamase inhibitors and aerosols.
The number of drug companies with antibiotic research and development programs has shrunk in recent years, from about 20 in 1990 to only about three today. This shrinkage has been attributed to a combination of economic, scientific and regulatory challenges.
For more information:
McCracken G. Antibiotic therapy in pediatrics. Presented at: 25th Annual Infectious Diseases in Children Symposium; Nov. 17-18; New York.
Disclosure: McCracken reports no relevant financial disclosures.