From the Guidelines
Ceftazidime/avibactam and meropenem/vaborbactam are the recommended first-line treatment options for infections caused by carbapenem-resistant Klebsiella pneumoniae (K. pneumoniae). The choice between these two antibiotics should be based on the site of infection, local epidemiology, and the emergence of resistance [ 1 ]. For example, meropenem/vaborbactam may be considered as the first choice in specific types of infections, such as pneumonia, due to its high epithelial lining fluid (ELF) concentrations [ 1 ]. Key considerations for treatment include:
- Ceftazidime/avibactam has been shown to have a higher clinical cure rate and lower risk of nephrotoxicity compared to traditional antibiotic regimens [ 1 ]
- Meropenem/vaborbactam has been associated with a higher clinical cure rate, decreased mortality, and reduced nephrotoxicity compared to the best available therapy [ 1 ]
- Imipenem/relebactam and cefiderocol may also be considered as potential alternatives for the treatment of infections involving KPC-producing CRE, although clinical studies of their efficacy in these patients are limited [ 1 ]
- Antibiotic selection should always be guided by susceptibility testing, as resistance patterns vary [ 1 ]
- Treatment duration is typically 7-14 days based on infection severity and response, and these infections often require infectious disease consultation, close monitoring for toxicity, and source control measures [ 1 ]
From the FDA Drug Label
AVYCAZ demonstrated in vitro activity against Enterobacteriaceae in the presence of some beta-lactamases and extended-spectrum beta-lactamases (ESBLs) of the following groups: TEM, SHV, CTX-M, Klebsiella pneumoniae carbapenemase (KPCs), AmpC, and certain oxacillinases (OXA). RECARBRIO is a combination of imipenem/cilastatin and relebactam. ... Relebactam protects imipenem from degradation by certain serine beta-lactamases such as ... Klebsiella-pneumoniae carbapenemase (KPC)
The antibiotics avibactam (in combination with ceftazidime) and relebactam (in combination with imipenem/cilastatin) are effective against carbapenem-resistant Klebsiella pneumoniae (K. pneumoniae) 2 3.
- AVYCAZ (ceftazidime-avibactam) has been shown to be active against K. pneumoniae in the presence of KPCs.
- RECARBRIO (imipenem/cilastatin-relebactam) has also demonstrated activity against K. pneumoniae isolates that produce KPCs.
From the Research
Effective Antibiotics Against Carbapenem-Resistant K. pneumoniae
- Ceftazidime-avibactam has been shown to be effective against carbapenem-resistant K. pneumoniae, with a study demonstrating its in vitro activity against 65 CR-hvKp isolates 4.
- Colistin and tigecycline have also been found to be highly active in vitro against CR-hvKp isolates 4.
- Aztreonam-avibactam has been shown to have antibacterial activity against bloodstream infections caused by carbapenem-resistant K. pneumoniae, with a study demonstrating its effectiveness in achieving a cumulative fraction of response (CFR) of above 96% 5.
- Meropenem-vaborbactam has been successfully used in treating patients infected with K. pneumoniae resistant to ceftazidime/avibactam and susceptible to carbapenems 6.
- A double carbapenem regimen (ertapenem plus meropenem) has been presented as a potential treatment option for carbapenem-resistant K. pneumoniae infections, with a case report demonstrating its effectiveness in achieving bactericidal activity against pan drug-resistant K. pneumoniae isolates 7.
Clinical Use of Ceftazidime-Avibactam
- Ceftazidime-avibactam has been used as a salvage treatment for infections due to carbapenem-resistant K. pneumoniae in liver transplantation recipients, with a study demonstrating its promising results in achieving clinical response and low mortality rates 8.
- The use of ceftazidime-avibactam in combination with other antibiotics, such as aztreonam, has been recommended for treating patients infected with K. pneumoniae resistant to ceftazidime/avibactam and susceptible to carbapenems 6.