Management of serious infections caused by metallo β-lactamases with or without OXA-48-like expressing Enterobacterales with aztreonam and ceftazidime/avibactam combination: Dosing strategy for better clinical outcome

Serious infections caused by MBLs with or without OXA-48-like expressing Enterobacterales remain challenging to treat. Since aztreonam is stable to MBLs, it can be combined with ceftazidime/avibactam to protect against concurrently expressed ESBLs and class C β-lactamases in MBL pathogens. However,...

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Veröffentlicht in:Indian journal of medical microbiology 2021-07, Vol.39 (3), p.286-288
Hauptverfasser: Veeraraghavan, Balaji, Bakthavatchalam, Yamuna Devi, Soman, Rajeev, Swaminathan, Subramanian, Manesh, Abi, Nagvekar, Vasanth, Nangia, Vivek
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Sprache:eng
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Zusammenfassung:Serious infections caused by MBLs with or without OXA-48-like expressing Enterobacterales remain challenging to treat. Since aztreonam is stable to MBLs, it can be combined with ceftazidime/avibactam to protect against concurrently expressed ESBLs and class C β-lactamases in MBL pathogens. However, in the light of dose-limiting hepatotoxicity of aztreonam, short half life of avibactam, significant protein binding of aztreonam, appropriate dosing and method of administration to optimize PK/PD and toxicodynamics for this combination is being debated. Based on in-vitro PK/PD studies, simultaneous administration of 6/1.5 g of ceftazidime/avibactam and 8 g of aztreonam per day has been recently suggested. •Management of metallo β-lactamases (MBLs) with or without OXA-48-like expressing Enterobacterales infections remain challenging.•Ceftazidime-avibactam has broad spectrum of coverage against ESBLs, ampC and carbapenemase such as KPC as well as OXA-48 like.•Since aztreonam is stable to MBLs, it can be combined with ceftazidime/avibactam to protect against concurrently expressed ESBLs and class C β-lactamases and are often considered as rescue therapy MBL infections.•The infectious disease society of America guideline recommends concurrent administration of 2/0.5 g, q8h ceftazidime/avibactam and 2 g, q8h aztreonam in 3 h infusion; this regimen is more acceptable in safety point of view.
ISSN:0255-0857
1998-3646
DOI:10.1016/j.ijmmb.2021.04.002