Alternative therapies for Carbapenem-Resistant Enterobacteriaceae (CRE)

Background: Increasing antibiotic resistance is a global concern for human health. Carbapenem antibiotics have high sensitivity and are among the last line of antibiotics for treating infections caused by Gram-negative bacteria that are resistant to various classes of drugs. Over 70% were caused by Carbapenem-Resistant Enterobacteriaceae (CRE) infections, a threat in the clinical field. Objective: To find alternative antibiotic therapy options for Carbapenem-Resistant Enterobacteriaceae (CRE) infections. Method: A narrative review method was used in this study. Articles from several journals with the keyword "Therapy Alternative of Carbapenem-Resistant Enterobacteriaceae" in PubMed, Elsevier Article, Cochrane and Indonesian literature from Google Scholar databases were reviewed. Results: Recommended alternative therapy options for CRE infections include combinations of carbapenem-containing antibiotics with other antibiotic classes as anti-CRE treatments, ceftazidime/avibactam for KPC and OXA-48-producing infections, in vitro efficacy of eravacycline, and prolonged high-dose carbapenem therapy. Additionally, several drugs in the development stages include the combination of new beta-lactamase inhibitor IMI/REL and the novel cephalosporin siderophore cefiderocol, zidebactam, and nacubactam. Conclusion: New strategies against CRE, such as the reutilization of older antibiotic classes, higher anti-CRE doses, and combination approaches, have demonstrated clinically effective and improved outcomes and have also gained approval from the FDA.