A new antibiotic designed to overcome multi-drug resistance is at least as effective as the current standard of care in complicated urinary tract infection (UTI), according to trial results published in The Lancet Infectious Diseases (25 October 2018)
The trial randomly assigned 303 people to an intravenous infusion of new antibiotic cefiderocol and 149 to the standard of care imipenem-cilastatin, three times daily for 7–14 days.
Among those who tested positive for a Gram-negative uropathogen at baseline, 73% in the cefiderocol group and 55% in the imipenem-cilastatin group were considered cured after treatment, indicating non-inferiority of cefiderocol. There were also fewer adverse events in the cefiderocol group compared with standard care.
Cefiderocol is a cephalosporin antibiotic that contains a siderophore side chain. This component helps the antibiotic overcome the resistance mechanisms evolved by Gram-negative bacteria to existing antibiotics by hijacking the bacteria’s iron transport mechanism to gain entry to the cell.
The researchers said the findings indicate the promise of the drug, which is also being trialled in lung and blood infections, including in carbapenem-resistant infections.
“As a siderophore antibiotic, cefiderocol is a novel approach that might be used to overcome Gram-negative resistance,” the authors concluded.
 Portsmouth S, van Veenhuzen D, Echols R et al. 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. Lancet Infect Dis 2018. doi: 10.1016/S1473-3099(18)30554-1