Cefiderocol (Fetroja)
Efficacy
Cefiderocol is a cephalosporin derived antibiotic with a novel mechanism of action that utilizes a siderophore iron uptake mechanism into bacteria. The spectrum of activity is very broad against Gram-negative organisms, and it has activity against extensively drug-resistant bacteria including organisms that produce carbapenemases. It has activity against multidrug-resistant (MDR) Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and other nonfermenting Gram-negative organisms. It is currently FDA approved for complicated urinary tract infection (cUTI) and nosocomial pneumonia, with noninferiority shown in both clinical trials against a carbapenem comparator. Infectious Diseases Society of America (IDSA) guidelines support use of cefiderocol for infections caused by carbapenemase producing organisms.
Safety
The clinical trials performed for FDA approval of cefiderocol showed it was well tolerated and discontinuation due to adverse side effects were low in both clinical trials. The side effect profile aligns with other cephalosporins, with the most frequently reported side effects in clinical trials being diarrhea, altered liver function tests, infusion site reactions, and hypokalemia.
Uniqueness
Cefiderocol has a novel mechanism of action and is one of few beta lactam antibiotics with activity against organisms that produce metallo-β-lactamases. It has very broad activity against a variety of the most drug-resistant Gram-negative organisms and is stable against most β-lactamases. Dosing regimens and infusion times are similar to other beta lactams. It is well tolerated and has been shown to be effective in infections caused by highly resistant pathogens where treatment options are limited.