Dr. A. Lenore Ackerman on sulopenem and the UTI treatment landscape

In this video, A. Lenore Ackerman, MD, PhD, discusses sulopenem etzadroxil/probenecid (oral sulopenem) for the proposed indication of adult patients with uncomplicated urinary tract infection (UTI) caused by designated susceptible bacteria along with the UTI treatment landscape. Ackerman is an assistant professor in the department of surgery, division of urology at the University of California, Los Angeles. She is an advisor for GlaxoSmithKline.

Transcription:

It's not super well defined, because...there hasn't been an oral option in the carbapenem family. So we don't really know how, if it was introduced to the greater population with uncomplicated UTIs, how that's going to impact multi-drug resistance? And I am a little nervous, because these are our big guns. These are the ones that we need to have available when people are coming in with complicated infections that are drug resistant, and so it's a little bit scary, but I think that there is kind of a clear hierarchy of how we should go through what order we should use [antibiotics] in. We've got our first-line antibiotics, and then you've got some second-line ones, and then you reserve your fluoroquinolones for when you've got no other options. And then probably after that, you're going to see your carbapenems orally, if that's available. And I think what that may end up doing for sort of the possibility of outpatient prescriptions, on the good side, I think there are those patients with those highly resistant infections who probably don't need hospitalization that you could now keep out of the hospital. That's a really, really big bonus. I think the hard part is knowing who those people are. I have to say, this is a little bit of a sideways move here, but one of the things I think that's really interesting is we're seeing the development of a lot of AI predictive models of who might progress to urosepsis and who might be at higher risk for progression of their infection to have greater health consequences. Maybe the combination of those tools with better diagnostic stewardship and a little bit better education of both physicians and patients about whether you really even need aggressive antibiotics for most infections can help us both use that to its greatest efficacy, but also prevent it from being used or overused in situations in which you don't need it...We don't really go into this very much with patients anymore, but what happens for most uncomplicated UTIs when they're not treated, they resolve spontaneously without antibiotics. You may be miserable for a couple days—and ask any woman who's had a UTI; it can be a very unpleasant couple of day—but there's, I think, this pervasive attitude, both among physicians and patients, that leaving a UTI untreated is going to kill somebody. And I think that the more we can get away from that as a concept and just treat it like, if you get the flu, most of the time we're not treating that with aggressive antiviral medications. Most people can recuperate and recover on their own. And there are some people who are higher risk for whom they need maybe more aggressive treatment. And if we could view UTI a little bit more like that, where we treat people for symptomatic resolution, we treat people to keep them more comfortable, and we reserve our big guns for thosepeople that are higher risk, I think that's going to be the most productive way to preserve our big-gun antibiotics for those situations in which they're really needed. So I think if there are AI models that can help us out, if there are better guidelines that can help us out, all these things will be really, really helpful moving forward.

This transcript was edited for clarity.