Acinetobacter remains one of the most challenging pathogens in the field of
infectious diseases owing primarily to the uniqueness and multiplicity of its resistance mechanisms. This resistance often leads to devastatingly long delays in time to appropriate
therapy and increased mortality for patients afflicted with
Acinetobacter infections. Selecting appropriate empiric and definitive antibacterial
therapy for Acinetobacter is further complicated by the lack of reliability in commercial antimicrobial susceptibility testing devices and limited breakpoint interpretations for available agents. Existing treatment options for
infections due to Acinetobacter are limited by a lack of robust efficacy and safety data along with concerns regarding appropriate dosing, pharmacokinetic/pharmacodynamic targets, and toxicity. Antimicrobial stewardship programs are essential to combat this unpredictable pathogen through use of
infection prevention, rapid diagnostics, antibiogram-optimized treatment regimens, and avoidance of overuse of antimicrobials. The
drug development pipeline includes several agents with encouraging in vitro activity against Acinetobacter, but their place in
therapy and contribution to the armamentarium against this pathogen remain to be defined. The objective of this review is to highlight the unique challenge of treating
infections due to Acinetobacter and summarize recent literature regarding optimal antimicrobial treatment for this pathogen. The
drug development pipeline is also explored for future potentially effective treatment options.