A 'vintage' antibiotic to fight infections caused by multi-resistant enterobacteria

A new antibiotic once considered obsolete has shown promise in treating infections caused by multidrug-resistant Enterobacteriaceae, according to a clinical trial led by researchers at the Virgen Macarena University Hospital in Seville, Spain. Published in The Lancet, the study highlights the potential of temocilina, a drug developed in the 1980s and currently unavailable in Spain, as an effective alternative to carbapenems, which are often used as last-resort treatments for resistant bacterial infections. The research, involving 29 hospitals across Spain, tested temocilina’s efficacy against infections caused by multidrug-resistant bacteria such as Escherichia coli and Salmonella. These bacteria, commonly found in the human gut, can cause severe gastrointestinal illnesses when they spread beyond the digestive system. Traditionally, these infections have been treated with cephalosporins, a broad-spectrum class of antibiotics. However, increasing resistance has forced clinicians to rely more heavily on carbapenems, which are themselves becoming less effective due to overuse. The study focused on patients whose bacteria were resistant to both cephalosporins and carbapenems. Researchers identified 334 eligible participants, each carrying bacteria with specific genetic profiles that made them particularly challenging to treat. Of these, 163 received temocilina while 165 were given carbapenems. Both groups showed similar outcomes, indicating that temocilina could serve as a viable substitute for carbapenems in certain cases. Dr. Jesús Rodríguez Bao, head of the Infectious Diseases Service at the Virgen Macarena Hospital, emphasized the significance of the findings. “We have demonstrated that an old and forgotten antibiotic, called temocilina, is active and effective against infections caused by some multidrug-resistant bacteria,” he stated. “This represents a major advancement because it will allow us to treat patients with this antibiotic, which we hope will soon be available in Spain, reviving its therapeutic value.” The project, known as Project Astarté, was coordinated by the Infectious Diseases Department of the Virgen Macarena Hospital and supported by the CIBERINFEC network, part of the Institute of Health Carlos III. It also included collaboration with the Clinical Research Group on Infectious Diseases at the IBIS center. The team sought alternatives to reduce the reliance on carbapenems, which have become increasingly ineffective due to widespread resistance. Temocilina had previously been overlooked as a treatment option, despite its historical use. Over time, newer antibiotics with broader spectra replaced it, leading to its decline in medical practice. However, the rise of antibiotic resistance has created a renewed interest in older drugs that might still hold value. This study marks the first successful clinical trial to identify an alternative to carbapenems that matches their effectiveness. Researchers noted that previous attempts to find suitable substitutes had failed. This success underscores the importance of revisiting older medications and evaluating their potential in light of evolving microbial threats. The results suggest that temocilina could play a role in managing infections caused by resistant strains, potentially reducing the need for carbapenems and slowing the development of further resistance. With the findings published, the next step involves seeking regulatory approval for temocilina’s reintroduction into Spain’s healthcare system. If approved, the drug could offer a much-needed solution in the fight against multidrug-resistant infections, offering a balance between efficacy and reduced pressure on already strained antibiotic resources.