Oral Antibiotics in Clinical Development for Community-Acquired Urinary Tract Infections

Veeraraghavan, Balaji; Bakthavatchalam, Yamuna Devi; Sahni, Rani Diana

doi:10.1007/s40121-021-00509-4

Cited by 29 publications

(16 citation statements)

References 62 publications

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“…Although their use was limited in the 30-day post-cUTI follow-up period, the average MS for a SNF, IRF, and LTACH encounter were $8859, $23,401, and $41,127, respectively. Fortunately, there are several pharmacokinetic and pharmacodynamic dose-optimized oral antibiotics in development with reliable activity against highly resistant common uropathogens [40] and these have the potential to lessen the financial burden of cUTIs on the Medicare program. Like all new treatments, the ability of these new agents to improve the efficiency of healthcare delivery for elderly cUTI patients will need to be demonstrated before they can be adopted in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

The 30-Day Economic Burden of Newly Diagnosed Complicated Urinary Tract Infections in Medicare Fee-for-Service Patients Who Resided in the Community

2022

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Introduction: Scant data are available on the 30-day financial burden associated with incident complicated urinary tract infections (cUTIs) in a cohort of predominately elderly patients. This study sought to examine total and cUTI-related 30-day Medicare spending (MS), a proxy for healthcare costs, among Medicare fee-for-service (FFS) beneficiaries who resided in the community with newly diagnosed cUTIs. Methods: A retrospective multicenter cohort study of adult beneficiaries in the Medicare FFS database with a cUTI between 2017 and 2018 was performed. Patients were included if they were enrolled in Medicare FFS and Medicare Part D from 2016 to 2019, had a cUTI first diagnosis in 2017–2018, no evidence of any UTI diagnoses in 2016, and residence in the community between 2016 and 2018. Results: During the study period, 723,324 cases occurred in Medicare beneficiaries who met the study criteria. Overall and cUTI-related 30-day MS were $7.6 and $4.5 billion, respectively. The average overall and cUTI-related 30-day MS per beneficiary were $10,527 and $6181, respectively. The major driver of cUTI-related 30-day MS was acute care hospitalizations ($3.2 billion) and the average overall and cUTI-related 30-day MS per hospitalizations were $16,431 and $15,438, respectively. Conclusion: Overall 30-day MS for Medicare FSS patients who resided in the community with incident cUTIs was substantial, with cUTI-related MS accounting for 59%. As the major driver of cUTI-related 30-day MS was acute care hospitalizations, healthcare systems should develop well-defined criteria for hospital admissions that aim to avert hospitalizations in clinically stable patients and expedite the transition of patients to the outpatient setting to complete their care.

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Section: Discussionmentioning

confidence: 99%

The 30-Day Economic Burden of Newly Diagnosed Complicated Urinary Tract Infections in Medicare Fee-for-Service Patients Who Resided in the Community

2022

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“…In addition to 14-day cUTI-related cost considerations with OPAT, data indicate that OPAT-related adverse events and subsequent hospital admissions/readmissions occur frequently [ 43–51 ]. There are several oral antibiotics in development with favorable susceptibility, efficacy, and safety profiles [ 52 ], and it will be important to determine if these newer oral agents can improve the quality and efficiency of health care for adult cUTI patients relative to existing OP IV cUTI treatments.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Cohort Study of the 12-Month Epidemiology, Treatment Patterns, Outcomes, and Health Care Costs Among Adult Patients With Complicated Urinary Tract Infections

Lodise

Manjelievskaia

et al. 2022

Open Forum Infectious Diseases

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Introduction Limited data are available in the United States on the 12-month epidemiology, outpatient (OP) antibiotic treatment patterns, outcomes, and costs associated with complicated urinary tract infections (cUTIs) in adult patients. Methods A retrospective observational cohort study of adult patients with incident cUTIs in IBM® MarketScan® Databases between 2017-2019 was performed. Patients were categorized as OP or inpatient (IP) based on initial setting of care for index cUTI and were stratified by age (<65 years vs ≥65 years). OP antibiotic treatment patterns, outcomes, and costs associated with cUTIs among adult patients over a 12-month follow-up period were examined. Results During study period, 95,322 patients met inclusion criteria. Most patients were OPs (84%) and aged <65 years (87%). Treatment failure (receipt of new unique OP antibiotic or cUTI-related ED visit/IP admission) occurred in 23% and 34% of OPs aged <65 years and ≥ 65 years, respectively. Treatment failure was observed in over 38% of IPs, irrespective of age. Across both cohorts and age strata, >78% received ≥2 unique OP antibiotics, >34% received ≥4 unique OP antibiotics, >16% received repeat OP antibiotics, and >23% received ≥1 intravenous (IV) OP antibiotic. The mean 12-month cUTI-related total healthcare costs were $4,697 for OPs <65 years, $8,924 for OPs >65 years, $15,401 for IPs <65 years, and $17,431 for IPs ≥ 65 years. Conclusion These findings highlight the substantial 12-month healthcare burden associated with cUTIs and underscore the need for new outpatient treatment approaches that reduce the persistent or recurrent nature of many cUTIs.

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“…However, 43 has poor oral bioavailability and is therefore only used as an injectable. A prodrug variant of 43 , ARX-1796 ( 45 ), is entering clinical trials with the companion β-lactam antibiotic Ceftibuten ( 46 ) . Notably, while leads against Class B β-lactamases such as QPX7728 ( 47 ) and aspergillomarasmine A ( 48 ) − have been discovered, a clinically useful inhibitor of this class of metalloenzymes has not yet emerged.…”

Section: The Quest For Resistance Enzyme Inhibitors That Breathe New ...mentioning

confidence: 99%

Prospects for Antibacterial Discovery and Development

et al. 2021

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The rising prevalence of multidrug-resistant bacteria is an urgent health crisis that can only be countered through renewed investment in the discovery and development of antibiotics. There is no panacea for the antibacterial resistance crisis; instead, a multifaceted approach is called for. In this Perspective we make the case that, in the face of evolving clinical needs and enabling technologies, numerous validated antibacterial targets and associated lead molecules deserve a second look. At the same time, many worthy targets lack good leads despite harboring druggable active sites. Creative and inspired techniques buoy discovery efforts; while soil screening efforts frequently lead to antibiotic rediscovery, researchers have found success searching for new antibiotic leads by studying underexplored ecological niches or by leveraging the abundance of available data from genome mining efforts. The judicious use of “polypharmacology” (i.e., the ability of a drug to alter the activities of multiple targets) can also provide new opportunities, as can the continued search for inhibitors of resistance enzymes with the capacity to breathe new life into old antibiotics. We conclude by highlighting available pharmacoeconomic models for antibacterial discovery and development while making the case for new ones.

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Oral Antibiotics in Clinical Development for Community-Acquired Urinary Tract Infections

Cited by 29 publications

References 62 publications

The 30-Day Economic Burden of Newly Diagnosed Complicated Urinary Tract Infections in Medicare Fee-for-Service Patients Who Resided in the Community

The 30-Day Economic Burden of Newly Diagnosed Complicated Urinary Tract Infections in Medicare Fee-for-Service Patients Who Resided in the Community

Retrospective Cohort Study of the 12-Month Epidemiology, Treatment Patterns, Outcomes, and Health Care Costs Among Adult Patients With Complicated Urinary Tract Infections

Prospects for Antibacterial Discovery and Development

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