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The β‐Lactams Strike Back: Ceftazidime‐Avibactam
Author(s) -
Zasowski Evan J.,
Rybak Jeffrey M.,
Rybak Michael J.
Publication year - 2015
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1622
Subject(s) - ceftazidime/avibactam , ceftazidime , avibactam , klebsiella pneumoniae , medicine , meropenem , antibiotics , metronidazole , microbiology and biotechnology , pseudomonas aeruginosa , carbapenem , imipenem , beta lactamase inhibitors , pharmacology , chemistry , biology , antibiotic resistance , bacteria , escherichia coli , gene , biochemistry , genetics
Gram‐negative resistance has reached a crucial point, with emergence of pathogens resistant to most or all available antibiotics. Ceftazidime‐avibactam is a newly approved agent combining ceftazidime and a novel β‐lactamase inhibitor with activity against multidrug‐resistant gram‐negative bacteria. Avibactam has increased potency and expanded spectrum of inhibition of class A and C β‐lactamases relative to available β‐lactamase inhibitors, including extended‐spectrum β‐lactamases, AmpC, and Klebsiella pneumoniae carbapenemase ( KPC ) enzymes. Avibactam expands ceftazidime's spectrum of activity to include many ceftazidime‐ and carbapenem‐resistant Enterobacteriaceae and Pseudomonas aeruginosa . Early clinical data indicate that ceftazidime‐avibactam is effective and well tolerated in patients with complicated urinary tract infections ( cUTIs ) and complicated intraabdominal infections ( cIAI ). In a phase II trial of patients with cUTIs , ceftazidime‐avibactam produced similar rates of clinical and microbiologic success compared with imipenem‐cilastatin (70.5% and 71.4% microbiologic success rates, respectively). Likewise, patients receiving ceftazidime‐avibactam plus metronidazole in a phase II study of patients with cIAI had similar response rates to those receiving meropenem (91.2% and 93.4% clinical success rates, respectively). Based on available in vitro, in vivo, and phase II trial data, as well as preliminary phase III trial results in ceftazidime‐resistant, gram‐negative cUTI and cIAI , ceftazidime‐avibactam received U.S. Food and Drug Administration approval for treatment of cUTI , including pyelonephritis, and cIAI , in combination with metronidazole, in adult patients with limited or no alternative treatment options. The approved dosage, ceftazidime 2 g–avibactam 0.5 g administered as a 2‐hour infusion every 8 hours, was selected based on pharmacodynamic analysis and available clinical data. This dosage is under further investigation in patients with cUTI , cIAI , and nosocomial or ventilator‐associated pneumonia. The current body of evidence suggests that ceftazidime‐avibactam is a promising addition to our therapeutic armamentarium with potential to answer an urgent unmet medical need. Further data in highly resistant gram‐negative infections, particularly those caused by KPC ‐producing Enterobacteriaceae, are needed. As it is introduced into clinical use, careful stewardship and rational use are essential to preserve ceftazidime‐avibactam's potential utility.