As antimicrobial resistance grows and clinicians encounter increasingly complex infections, experts are being forced to reconsider not only which antimicrobials to use, but how they are delivered.
“The escalating crisis of antimicrobial resistance, coupled with the inherent difficulties in achieving therapeutic drug concentrations at the site of infection for some of our most challenging disease states, has created a pressing need for innovative and, increasingly, off-label antimicrobial delivery methods,” said Kellie Goodlet, PharmD, BCIDP, BCPS, BCTXP, FCCP, FIDSA, associate professor at Midwestern University College of Pharmacy. “There is increasing interest in thinking outside the box to optimize how we deliver antimicrobials, not just which antimicrobial we choose.”
Those challenges and emerging solutions will be the focus of “You Want to Put the Antibiotic WHERE?! (Part 1) Access to the Cisterna Magna,” Thursday, Oct. 22, at 3:15 p.m. ET.
Dr. Goodlet, who will moderate the session with David Cluck, PharmD, FIDSA, professor of pharmacy practice at East Tennessee State University’s Bill Gatton College of Pharmacy, said the session was designed to take a practical look at delivery strategies that are already being used in clinical practice despite limited evidence and substantial variation in implementation.
“These approaches can become necessary when barriers such as poor tissue penetration, the blood-brain and blood-CSF barriers, biofilms and limited vascular access make achieving effective drug concentrations particularly difficult with conventional systemic therapy,” she said.
The symposium will feature presentations from Michael Nailor, PharmD, clinical pharmacy specialist in infectious diseases at St. Joseph’s Hospital & Medical Center; Kris Smith, MD, fellowship director at the Barrow Neurological Institute; and Ashley Levack, MD, associate professor of orthopedic surgery and rehabilitation at Loyola University Chicago.
Intrathecal Antifungals
Dr. Nailor will open the session with “Intrathecal Antifungals in CNS Infections: Evidence, Dosing and Clinical Considerations,” a presentation focused on one of ID’s most difficult treatment scenarios, Dr. Goodlet said.
Dr. Goodlet noted that intrathecal amphotericin B is most commonly used as a salvage therapy for coccidioidal meningitis but may become increasingly relevant as fungal pathogens expand geographically and antifungal resistance concerns grow.
Dr. Smith will focus on direct cisternal access and how the location and technique of CNS drug delivery can influence outcomes.
Dr. Goodlet said clinicians often think of intrathecal therapy as a single concept, but “intrathecal” can include intralumbar, intraventricular and intracisternal administration, as well as reservoir-based approaches.
The presentation will highlight how advances in neurosurgical techniques have shaped treatment options for difficult central nervous system infections and why the route of administration can significantly affect drug distribution, efficacy and toxicity. Understanding those distinctions is critical when attempting to achieve effective antifungal concentrations in the central nervous system, she said.
Topical Antibiotics
Topical antibiotics in orthopedic trauma and surgery will also be covered in the session. Local antibiotic delivery methods, such as antibiotic-loaded beads, spacers, cement and powders, can achieve extremely high concentrations at sites of infection, particularly in poorly vascularized tissue or around implanted devices. However, Dr. Goodlet emphasized that local therapy should not be assumed to be harmless.
The presentation will examine both the potential benefits and limitations of these approaches, including concerns about prolonged antimicrobial exposure, safety, resistance and the quality of existing evidence.
Dr. Goodlet hopes attendees leave with a broader understanding of how antimicrobial delivery strategies can influence patient outcomes.
“Ultimately, this session is about thinking strategically about how to use our antimicrobial toolbox most effectively without losing sight of evidence-based practice,” Dr. Goodlet said. “Attendees will gain practical considerations they can apply when conventional routes fall short, along with a framework for determining when an innovative delivery strategy may truly add value for the patient.”
Don’t miss a related IDWeek session, “You Want to Put the Antibiotic WHERE?!" (Part 2) Exploring Off-Label Routes of Administration and Novel Delivery Methods for Challenging Infections,” Friday, Oct. 23, 10:30-11:45 a.m. ET.