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Table of Contents
LETTERS TO EDITOR
Year : 2018  |  Volume : 34  |  Issue : 1  |  Page : 140-141

Minocycline: The second important antimicrobial in multidrug-resistant Acinetobacter baumanii infections


Department of Anesthesiology and Pain Management, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India

Date of Web Publication15-Mar-2018

Correspondence Address:
Abhijit S Nair
Department of Anesthesiology and Pain Management Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad - 500 034, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_156_17

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How to cite this article:
Nair AS. Minocycline: The second important antimicrobial in multidrug-resistant Acinetobacter baumanii infections. J Anaesthesiol Clin Pharmacol 2018;34:140-1

How to cite this URL:
Nair AS. Minocycline: The second important antimicrobial in multidrug-resistant Acinetobacter baumanii infections. J Anaesthesiol Clin Pharmacol [serial online] 2018 [cited 2019 Oct 16];34:140-1. Available from: http://www.joacp.org/text.asp?2018/34/1/140/227558



Multidrug resistant (MDR) Acinetobacter baumanii infections have the propensity to increase the hospital stay, cost of treatment, morbidity, mortality, and above all remain very difficult to treat.[1] Independent risk factors for colonization or infection with resistant strains of Acinetobacter are prior methicillin-resistant Staphylococcus aureus colonies, previous use of carbapenem and fluoroquinolone, immobilization, previous admission in intensive care unit for major surgery or mechanical ventilation, having a central venous catheter in situ, hemodialysis, or malignancy.

A. baumanii are member of the ESKAPE group of pathogens which also includes Enterococcus faecium, S.aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterobacter spp.[2] At present, the recommendations are to treat MDR A. baumanii infection with two antimicrobials one of which should essentially be colistin. The purpose of using combination antimicrobials is to reduce drug resistance by effectively treating the infection, and to have better outcomes.[3] Colistin resistance is also emerging possibly due to mutation in genes encoding Pmr A and B proteins. In A. baumanii sensitive only to colistin, antimicrobials such as carbapenems, quinolones, aminoglycosides, and tigecycline have been used with variable efficacy.

Minocycline is a semi-synthetic, second-generation drug belonging to the tetracycline family. It is effective against gram positive, gram negative, and many atypical bacteria including Mycobacterium species Bacillus anthracis. Earlier it was used for treating sexually transmitted diseases and acne vulgaris.[4] It is a bacteriostatic and acts by inhibiting protein synthesis. US-FDA has recently approved the use of intravenous (IV) minocycline in hospitalized patients who have positive cultures for MDR Acinetobacter species. This approval is a Qualified Infectious Disease Product (QIDP) designation under the GAIN act i.e., Generating Antibiotic Incentives Now Act. When used in A. baumanii infections, IV minocycline exhibits bactericidal activity and synergistic bactericidal effects when combined with colistin or other susceptible antimicrobials.[5] The recommended dose is 100–200 mg twice daily for IV use.

Castanheira et al. found that minocycline was highly susceptible to A.baumanii strains along with colistin when compared to doxycycline, tetracycline, and other broad-spectrum antimicrobials (minocycline 79.1% and colistin 98.8%). The authors tested the efficacy of minocycline against 5477 A. baumanii and other gram-negative pathogens to arrive at the above conclusion.

Minocycline works effectively when used for Acinetobacter colonies in lung, meninges, soft tissue, and blood. However, due to its limited solubility in urine, it might not be effective in urinary pathogens. The most common adverse events with minocycline are nausea, anorexia, diarrhoea, dizziness, light headedness, vertigo, tinnitus, and reducedhearing. It should be used with caution in patients with hepatic dysfunction. Dose adjustment is suggested in patients with azotemia, renal dysfunction, and hyperphosphatemia. Monitoring of blood urea nitrogen and creatinine is required in these patients.

In the present scenario MDR A. baumanii infections are very difficult to treat. With colistin-resistant strains also emerging from several units, options are limited. Minocycline appears promising but should be used judiciously by clinicians for treating A. Baumanii infections.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Castanheira M, Mendes RE, Jones RN. Update on Acinetobacter species: Mechanisms of antimicrobial resistance and contemporary in vitro activity of minocycline and other treatment options. Clin Infect Dis 2014;59(Suppl 6):S367-73.  Back to cited text no. 1
    
2.
Pendleton JN, Gorman SP, Gilmore BF. Clinical relevance of the ESKAPE pathogens. Expert Rev Anti Infect Ther 2013;11:297-308.  Back to cited text no. 2
    
3.
Tuon FF, Rocha JL, Merlini AB. Combined therapy for multi-drug-resistant Acinetobacter baumanii infection--is there evidence outside the laboratory? L Med Microbiol 2015;64:951-9.  Back to cited text no. 3
    
4.
Garrido-Mesa N, Zarzuelo A, Galvez J. Minocycline: Far beyond an antibiotic. Br J Pharmacol 2013;169:337-52.  Back to cited text no. 4
    
5.
Greig SL, Scott LJ. Intravenous Minocycline: A Review in Acinetobacter Infections. Drugs 2016;76:1467-76.  Back to cited text no. 5
    




 

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