Cefiderocol

Cefiderocol, sold under the brand name Fetroja, is an antibiotic used to treat complicated urinary tract infections when no other options are available.[2] It is indicated for the treatment of multi-drug-resistant Gram-negative bacteria including Pseudomonas aeruginosa.[3][4][5] It is given by injection into a vein.[6]

Cefiderocol
Clinical data
Trade namesFetroja
Routes of
administration		Intravenous infusion
ATC code
  • none
Legal status
Legal status
Pharmacokinetic data
Protein binding56–58%[1]
Elimination half-life2.8 hours
Excretionmainly renal (60–70% unchanged)
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
Chemical and physical data
FormulaC30H34ClN7O10S2
Molar mass752.21 g·mol−1
3D model (JSmol)

It is in the cephalosporin family of medications.[2][7] Cefiderocol was approved for medical use in the United States on November 14, 2019.[2][8]

Medical uses

Cefiderocol is used to treat adults with complicated urinary tract infections, including kidney infections caused by susceptible Gram-negative microorganisms, who have limited or no alternative treatment options.[2][7]

Mechanism of action

Its mechanism of entry into bacterial cells is by binding to iron, which is actively transported into the bacterial cells along with the cefiderocol.[9][10][11][12][6] It is in a medication class known as siderophores,[6][7] and was the first siderophore antibiotic to be approved by the U.S. Food and Drug Administration (FDA).[13] It bypasses the bacterial porin channels by using the bacteria's own iron-transport system for being transported in.[14]

History

In 2019, cefiderocol was approved in the United States as an antibacterial drug for treatment of adults 18 years of age or older with complicated urinary tract infections (cUTI), including kidney infections caused by susceptible Gram-negative microorganisms, who have limited or no alternative treatment options.[2][8]

The safety and effectiveness of cefiderocol was demonstrated in a study of 448 patients with cUTIs.[2] Of the patients who were administered cefiderocol, 72.6% had resolution of symptoms and eradication of the bacteria approximately seven days after completing treatment, compared with 54.6% in patients who received an alternative antibiotic.[2] The clinical response rates were similar between the two treatment groups.[2]

Labeling for cefiderocol includes a warning regarding the higher all-cause mortality rate observed in cefiderocol-treated patients compared to those treated with other antibiotics in a trial in critically ill patients with multidrug-resistant Gram-negative bacterial infections.[2] The cause of the increase in mortality has not been established.[2] Some of the deaths were a result of worsening or complications of infection, or underlying co-morbidities.[2] The higher all-cause mortality rate was observed in patients treated for hospital-acquired/ventilator-associated pneumonia (i.e.nosocomial pneumonia), bloodstream infections, or sepsis.[2] The safety and efficacy of cefiderocol has not been established for the treatment of these types of infections.[2]

Cefiderocol received a Qualified Infectious Disease Product designation from the U.S. Food and Drug Administration (FDA) and was granted priority review.[2] The FDA granted approval of Fetroja, on November 14, 2019, to Shionogi & Co., Ltd.[2]

References
  1. Katsube, T.; Echols, R.; Arjona Ferreira, J. C.; et al. (2017). "Cefiderocol, a Siderophore Cephalosporin for Gram‐Negative Bacterial Infections: Pharmacokinetics and Safety in Subjects With Renal Impairment". Journal of Clinical Pharmacology. 57 (5): 584–591. doi:10.1002/jcph.841. PMC 5412848. PMID 27874971.
  2. "FDA approves new antibacterial drug to treat complicated urinary tract infections as part of ongoing efforts to address antimicrobial resistance". U.S. Food and Drug Administration (FDA) (Press release). 14 November 2019. Archived from the original on 16 November 2019. Retrieved 15 November 2019. This article incorporates text from this source, which is in the public domain.
  3. Choi, Justin J; McCarthy, Matthew W. (24 January 2018). "Cefiderocol: a novel siderophore cephalosporin". Expert Opinion on Investigational Drugs. 27 (2): 193–197. doi:10.1080/13543784.2018.1426745. PMID 29318906.
  4. Aoki, Toshiaki; Yoshizawa, Hidenori; Yamawaki, Kenji; et al. (15 July 2018). "Cefiderocol (S-649266), A new siderophore cephalosporin exhibiting potent activities against Pseudomonas aeruginosa and other gram-negative pathogens including multi-drug resistant bacteria: Structure activity relationship". European Journal of Medicinal Chemistry. 155: 847–868. doi:10.1016/j.ejmech.2018.06.014. ISSN 1768-3254. PMID 29960205.
  5. Portsmouth, Simon; van Veenhuyzen, David; Echols, Roger; et al. (25 October 2018). "Cefiderocol versus imipenem-cilastatin for the treatment of complicated urinary tract infections caused by Gram-negative uropathogens: a phase 2, randomised, double-blind, non-inferiority trial". The Lancet Infectious Diseases. 0 (12): 1319–1328. doi:10.1016/S1473-3099(18)30554-1. ISSN 1473-3099. PMID 30509675.
  6. "Fetroja (cefiderocol) for injection, for intravenous use full prescribing information" (PDF). November 2019. Retrieved 17 November 2019. This article incorporates text from this source, which is in the public domain.
  7. Zhanel GG, Golden AR, Zelenitsky S, et al. (February 2019). "Cefiderocol: A Siderophore Cephalosporin with Activity Against Carbapenem-Resistant and Multidrug-Resistant Gram-Negative Bacilli". Drugs. 79 (3): 271–289. doi:10.1007/s40265-019-1055-2. PMID 30712199.
  8. "Cefiderocol New Drug Application". U.S. Food and Drug Administration (FDA). Archived from the original on 4 December 2019. Retrieved 22 November 2019. This article incorporates text from this source, which is in the public domain.
  9. Sato T, Yamawaki K (November 2019). "Cefiderocol: Discovery, Chemistry, and In Vivo Profiles of a Novel Siderophore Cephalosporin". Clin. Infect. Dis. 69 (Supplement_7): S538–S543. doi:10.1093/cid/ciz826. PMC 6853759. PMID 31724047.
  10. Matthews-King A (26 October 2018). "Antibiotic 'Trojan horse' could defeat superbugs causing global medical crisis, trial finds". The Independent. Retrieved 26 October 2018.
  11. Newey S (26 October 2018). "New 'Trojan horse' drug proves effective against antibiotic resistant bacteria". The Telegraph. ISSN 0307-1235. Retrieved 26 October 2018.
  12. Simpson DH, Scott P (2017). "Antimicrobial Metallodrugs". In Lo K (ed.). Inorganic and Organometallic Transition Metal Complexes with Biological Molecules and Living Cells. Elsevier. ISBN 9780128038871.
  13. Saisho, Yutaka; Katsube, Takayuki; White, Scott; et al. (March 2018). "Pharmacokinetics, Safety, and Tolerability of Cefiderocol, a Novel Siderophore Cephalosporin for Gram-Negative Bacteria, in Healthy Subjects" (PDF). Antimicrobial Agents and Chemotherapy. 62 (3): 1–12. doi:10.1128/AAC.02163-17. PMC 5826143. PMID 29311072. Retrieved 22 November 2019.
  14. Ito A, Nishikawa T, Matsumoto S, et al. (December 2016). "Siderophore Cephalosporin Cefiderocol Utilizes Ferric Iron Transporter Systems for Antibacterial Activity against Pseudomonas aeruginosa". Antimicrobial Agents and Chemotherapy. 60 (12): 7396–7401. doi:10.1128/AAC.01405-16. PMC 5119021. PMID 27736756.
  • "Cefiderocol". Drug Information Portal. U.S. National Library of Medicine.


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