From the Guidelines
Fetroja (cefiderocol) is a potential alternative for the treatment of invasive infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa, according to the latest guidelines. This is based on the most recent study from 2022, published in the International Journal of Antimicrobial Agents 1. The study recommends novel β-lactam agents such as ceftolozane/tazobactam and ceftazidime/avibactam as first-line options for targeted treatment, but also suggests that imipenem/cilastatin–relebactam, cefiderocol (Fetroja), and colistin-based therapy may be potential alternatives.
Some key points to consider when using Fetroja for MDR Pseudomonas infections include:
- The unique mechanism of action of Fetroja, which allows it to bypass many resistance mechanisms that affect other antibiotics
- The importance of confirming susceptibility through appropriate testing, as resistance can still develop
- The typical dosing and treatment duration for Fetroja, which is 2 grams administered intravenously every 8 hours, with adjustments needed for patients with renal impairment, and treatment duration typically ranging from 7-14 days depending on the site and severity of infection.
It's worth noting that the strength of recommendation for Fetroja as an alternative treatment option is strong, but the certainty of evidence is moderate, as stated in the guideline 1. However, in the context of real-life clinical medicine, Fetroja represents an important option for serious infections caused by MDR gram-negative pathogens when other treatment options are limited.
From the FDA Drug Label
Cefiderocol has shown in vitro activity against isolates of S. maltophilia and a subset of isolates of Enterobacterales and P aeruginosa that are resistant to meropenem, ciprofloxacin, amikacin, cefepime, ceftazidime-avibactam, and ceftolozane/tazobactam. Cefiderocol demonstrated in vitro activity against a subgroup of Enterobacterales genetically confirmed to contain the following: ESBLs (TEM, SHV, CTX-M, oxacillinase [OXA]), AmpC, AmpC-type ESBL (CMY), serine-carbapenemases (such as KPC, OXA-48), and metallo-carbapenemases (such as NDM and VIM). Cefiderocol demonstrated in vitro activity against a subgroup of P aeruginosa genetically confirmed to contain VIM, IMP, GES, AmpC, and a subgroup of A. baumannii containing OXA-23, OXA-24/40, OXA-51, OXA-58, and AmpC.
Fetroja (cefiderocol) has in vitro activity against MDR Pseudomonas aeruginosa, including those with certain resistance mechanisms such as VIM, IMP, GES, and AmpC.
- Key points:
- In vitro activity against MDR P. aeruginosa
- Activity against isolates with certain resistance mechanisms
- Cefiderocol may be effective against MDR Pseudomonas 2
From the Research
Fetroja (Cefiderocol) Coverage for MDR Pseudomonas
- Cefiderocol, also known as Fetroja, is a siderophore cephalosporin antibiotic that has shown potent activity against multidrug-resistant (MDR) Gram-negative bacteria, including Pseudomonas aeruginosa 3, 4, 5, 6.
- Studies have demonstrated that cefiderocol has high susceptibility rates against MDR P. aeruginosa, with a susceptibility rate of 97.3% reported in one study 4.
- Cefiderocol has been shown to be effective against P. aeruginosa isolates with various resistance mechanisms, including those producing carbapenemases such as VIM and GES 4.
- The antibiotic has a unique mechanism of action, utilizing its siderophore-like property to enter the bacterial periplasmic space and inhibit cell wall synthesis 6.
- Cefiderocol has been approved for the treatment of complicated urinary tract infections (cUTIs) caused by Gram-negative bacteria, including P. aeruginosa, and has been shown to be non-inferior to other antibiotics such as imipenem-cilastatin and meropenem in clinical trials 3, 5, 7.
Key Findings
- Cefiderocol has been shown to be highly effective against MDR P. aeruginosa, with high susceptibility rates and potent activity against various resistance mechanisms 4, 6.
- The antibiotic has a unique mechanism of action and has been approved for the treatment of cUTIs caused by Gram-negative bacteria, including P. aeruginosa 3, 5, 6.
- Cefiderocol has been shown to be non-inferior to other antibiotics in clinical trials, including imipenem-cilastatin and meropenem 3, 5, 7.