Combating carbapenem-resistant organisms with colistin-sparing regimens

The increase in carbapenem-resistant organisms (CROs) poses a public health threat and necessitates the investigation of alternative therapies to reduce colistin use. The aim of this review is to discuss sparing the use of colistin. There are many limitations to the use of colistin, including a higher risk of toxicity and the rapid development of resistance. The use of colistin-sparing combinations includes β-lactam/β-lactamase inhibitor combinations, carbapenem-aminoglycoside combinations, and carbapenem-fosfomycin combinations. In addition, monotherapy agents such as cefiderocol, a new siderophore cephalosporin with potential activity against CROs, and plazomicin, a next-generation aminoglycoside with a favourable safety profile and also some combination therapies that might spare the use of colistin. The review concludes by highlighting the urgent need to explore colistin-sparing regimens and develop new antimicrobial agents to ensure effective treatment options for multidrug-resistant infections.