G5: Beta-Lactam Antibiotics: Cephalosprins & Carbapenems, Monobactam

What is Ceftolozane/tazobactam (Zerbaxa) for?

• Complicated UTIs & intra-abdominal infections

• DOC for drug-resistant P. Aeruginosa

What is Ceftazidime/avibactam (Avycaz) for?

• Complicated UTIs & intra-abdominal infections

• DOC for ESBL & some carbapenemase-producing organisms

What is Cefepime/enmetazobactam (Exblifep) for?

• Complicated UTIs

• DOC for ESBLs & P. Aeruginosa

What is Cefiderocol (Fetroja) *siderophore cephalosporin for?

• Complicated UTIs & hospital-acquired pneumonia

• DOC for drug-resistant SPACE organisms & carbapenemase-producing organisms

What is Ceftobiprole (Zevtera) for?

• S. Aureus bacteremia, community-acquired pneumonia, skin & soft tissue infections

• DOC for ESBL & some carbapenemase-producing organisms

What are carbapenems?

General characteristics similar to cephalosporins, however:

• Highest seizure risk among beta-lactams

• Significant drug interaction w/ valproic acid derivatives (Depakote, Depakene)

  • Valproate levels decrease substantially, risk of breakthrough seizures

• Enterococcus coverage variable among agents (best w/ Imipenem)

• Stable against most beta-lactamases including extended-spectrum beta lactamase (ESBL)

What are the agents of carbapenems?

• Imipenem/cilastatin (Primaxin) (IV)

• Meropenem (Merrem) (IV)

• Ertapenem (Invanz) (IV)

• Doripenem (Doribax) (IV)

What are the spectrum of carbapenems?

• Broad spectrum gram (+) & (-), anaerobe CVD

• Most w/ P. Aerugonisa coverage

What are the notes of carbapenems?

• Most broad spectrum of antimicrobials

• Currently no oral formulations

• Ertapenem slightly narrower spectrum, once daily administration

• Reserved for serious infections, resistant bacteria

What test may be used for carbapenemases?

Modified-Hodge test

What is Meropenem/Vaborbactam (Vabomere) (IV)?

• First carbapenem/BLI combination

• Gram-negative focus including some carbapenemase producing organisms

• FDA approval only for cUTI

• Generally well tolerated w/ similar side effect profile to other beta-lactams

What is Imipenem-cilastatin/Relebactam (Recarbrio)?

• Gram-negative focus including some carbapenemase producing organisms & carbapenem-resistant Pseudomonas aeruginosa

• FDA approval for complicated UTI & intra-abdominal infections

• Generally well-tolerated w/ similar side effect profile to other beta-lactams

What is the agent of monobactams?

Aztreonam (Azactam) (IV)

What is the spectrum of monobactams?

Gram (-) ONLY including P. Aeruginosa

What is the notes of monobactams?

• Lower susceptibility rates for P. Aeruginosa than other antipseudomonal beta-lactams

• Use in pts w/ anaphylactic PCN allergy or combined PCN & cephalosporin allergy

What is the beta-lactamase inhibitor combination?

Sulbactam/Durlobactam (Xacduro)

• FDA approval in May 2023

What is the treatment for HAP/VAP due to Acinetobacter baumanii?

• Trial design included Imipenem & sulbactam/durlobactam vs. Imipenem & colistin

• Lower 28 day all-cause mortality in Imipenem & sulbactam/durlobactam arm

• Generally well tolerated W/ similar side effect profile to other beta-lactams