Emblaveo (aztreonam/avibactam) / Pfizer, AstraZeneca, AbbVie - LARVOL DELTA

Aztreonam-avibactam pharmacokinetics during extracorporeal membrane oxygenation support: first insights from a case report. (PubMed, Int J Antimicrob Agents) - No abstract available

Journal • PK/PD data

Activity of aztreonam-avibactam, cefiderocol, and cefepime-taniborbactam against a global collection of genetically characterized metallo-β-lactamase-producing Enterobacterales. (PubMed, Antimicrob Agents Chemother) - "Tigecycline and colistin inhibited 94.1% and 76.6% of the isolates (FDA and EUCAST breakpoints, respectively). MBL-producing organisms are still considered an unmet medical need. Aztreonam-avibactam was active against this large collection of MBL-producing isolates that had elevated MIC values for many comparator agents."

Journal

Evaluation of aztreonam/avibactam gradient test strip and aztreonam-ceftazidime/avibactam broth disk elution method for susceptibility testing of metallo-β-lactamase positive carbapenemase-producing bacteria. (PubMed, Diagn Microbiol Infect Dis) - "Whole-genome sequencing was used for discrepancy analysis. Based on accuracy, reproducibility, and ease of use, the ATM/AVI gradient strip was selected as the preferred method for clinical laboratory testing."

Journal

Susceptibilities of cefiderocol, meropenem-xeruborbactam, cefepime-taniborbactam, aztreonam-avibactam, and sulbactam-durlobactam against imipenem-non-susceptible Gram-negative bacilli in Taiwan. (PubMed, Int J Infect Dis) - " Cefiderocol was highly effective, whereas novel β-lactam/β-lactamase inhibitors activity varied by species and carbapenemase types. PBP3 alterations reduced FTB and AZA activity in INS-EC."

Journal • Infectious Disease • Pneumonia

AWARE: Real-World Effectiveness of Aztreonam-Avibactam Against MBL-Producing CRE (clinicaltrials.gov) - P=N/A | N=100 | Not yet recruiting | Sponsor: Sir Run Run Shaw Hospital

New trial • Real-world evidence • Infectious Disease • Pneumonia • Respiratory Diseases

Reducing aztreonam/avibactam waste: insights from Monte Carlo simulations. (PubMed, J Antimicrob Chemother) - "Lowering the LD in patients with preserved renal function had only a short-lived impact on early exposure and did not compromise PK/PD performance. These results support dose adaptation to reduce unnecessary drug waste."

Journal

Antimicrobial Activity of Aztreonam-Avibactam and Other β-Lactamase Inhibitor Combinations Tested Against Enterobacterales Isolates from Pediatric Patients from United States Medical Centers (2019-2023). (PubMed, Antibiotics (Basel)) - "Susceptibility to imipenem-relebactam varied from 97.1% (ceftriaxone-nonsusceptible) to 100.0% (ESBL producers). Ceftolozane-tazobactam showed good activity against ESBL producers (91.8% susceptible), but limited activity against ceftriaxone-nonsusceptible (75.8% susceptible) and MDR isolates (80.9% susceptible)...ESBL-producing Enterobacterales, mainly CTX-M, remain an important cause of infection in children. Aztreonam-avibactam, ceftazidime-avibactam, and meropenem-vaborbactam were highly active against isolates from both pediatric and adult population."

Journal • Infectious Disease • Nephrology • Pediatrics • Pneumonia • Respiratory Diseases

Use of Aztreonam-Avibactam with Rapid Eravacycline Step-Down Therapy for a Tibial Septic Non-Union by NDM-Producing Enterobacter cloacae. (PubMed, Antibiotics (Basel)) - "Cultures grew Enterobacter cloacae complex resistant to meropenem, ceftazidime-avibactam, meropenem-vaborbactam, and cefiderocol, as well as Candida parapsilosis...The patient was treated with ATM-AVI plus micafungin, achieving clinical stability within three days...At eight-week follow-up, the patient remained clinically improved without relapse or adverse effects. This case highlights ATM-AVI as a critical therapy for NDM-producing orthopedic infections involving hardware and supports eravacycline as a feasible step-down option in outpatient management."

Journal • Infectious Disease • Musculoskeletal Diseases • Orthopedics

Treatment Options for Critically Ill Patients with Infections Caused by Metallo-Beta-Lactamase-Producing Klebsiella pneumoniae. (PubMed, Antibiotics (Basel)) - "The emergence of metallo-beta-lactamases (MBLs) has contributed to the protection of pathogens against all current beta-lactam/beta-lactamase inhibitors (BL/BLIs), including the newer ceftazidime-avibactam (CAZ-AVI), meropenem-vaborbactam, and imipenem-relebactam...In vitro and clinical data suggest that combinations of CAZ-AVI with aztreonam (ATM) and the use of two different carbapenems (double carbapenem therapy, DCT) may be an option for MBL-producing pathogens... Treatment with CAZ-AVI + ATM or DCT presented similar efficacy with appropriate antibiotic therapy for infections caused by MBL-producing K. pneumoniae strains. Larger studies are required to confirm the findings."

Journal • Critical care • Infectious Disease • Pneumonia

β-Lactam/β-Lactamase Inhibitor Combinations in Sepsis-Associated Acute Kidney Injury and Renal Replacement Therapy. (PubMed, Antibiotics (Basel)) - "This review summarizes PK/PD features, extracorporeal clearance, and practical dosing considerations about ceftolozane-tazobactam, ceftazidime-avibactam, aztreonam-avibactam, cefiderocol, meropenem-vaborbactam, imipenem-relebactam, and newer agents including sulbactam-durlobactam, cefepime-enmetazobactam, and cefepime-taniborbactam. Full-dose initiation during the first 24-48 h, followed by careful adjustment, appears prudent. Therapeutic drug monitoring should be used when available, and institution-specific protocols should be integrated into stewardship programs to improve efficacy and minimize resistance."

Journal • Review • Acute Kidney Injury • Infectious Disease • Nephrology • Pediatrics • Renal Disease • Septic Shock

Cost-Effectiveness Analysis of Aztreonam-Avibactam Compared with Colistin Plus Meropenem in Treating Metallo-Beta-Lactamase-Producing Enterobacterales Infections in Spain. (PubMed, Infect Dis Ther) - "ATM-AVI is a highly cost-effective antibiotic versus COL+MER in the management of patients with serious infections caused by MBL-Enterobacterales."

HEOR • Journal • Infectious Disease • Pneumonia • Respiratory Diseases

New Drugs, Old Problems: A Narrative Review of Antibiotic Stewardship Program in the era of novel Gram-negative antibiotics. (PubMed, Clin Microbiol Infect) - "Effective stewardship of new Gram-negative antibiotics requires combining enablement, personalized pharmacology, and selective restriction within multidisciplinary ASPs. Strengthening real-world evidence, digital infrastructure, and standardized outcome measures is essential to guide equitable and sustainable implementation."

Journal • Review • Infectious Disease

Microbiological, Clinical, and Pharmacokinetic/Pharmacodynamic Data to Support EUCAST Aztreonam-Avibactam Minimum Inhibitory Concentration Susceptibility Breakpoints Against Enterobacterales. (PubMed, Infect Dis Ther) - P3 | "MIC distributions and JPTA simulations supported a susceptible MIC breakpoint for aztreonam-avibactam against Enterobacterales of ≤ 8 mg/l. However, limited clinical outcomes data for Enterobacterales with aztreonam-avibactam MIC ≥ 4 mg/l justified the more conservative breakpoints established by EUCAST."

Journal • PK/PD data • Infectious Disease

Aztreonam-Avibactam: A Review in the Treatment of Serious Bacterial Infections Caused by Aerobic Gram-Negative Organisms. (PubMed, Drugs) - "Based on all available data, aztreonam-avibactam is a valuable addition to the treatment options for adults with serious bacterial infections caused by aerobic Gram-negative organisms. Furthermore, with in vitro data showing that the drug combination retains potent activity against metallo-β-lactamase (MBL)-producing Enterobacterales and Stenotrophomonas maltophilia, and noting the limited effective treatment options available for infections caused by such bacteria, aztreonam-avibactam is likely to be particularly useful in regions with a high prevalence of MBLs."

Journal • Review • Infectious Disease • Nephrology • Pneumonia • Respiratory Diseases

Ceftazidime-Avibactam in the Treatment of Bacteremia Due to Carbapenem-Resistant Gram-Negative Bacteria in Hematological Patients: Experience in a Single Center (ASH 2023) - "Ceftazidime did not influence the activity of aztreonam-avibactam against MBL-CRE in-vitro. CAZ-AVI is highly effective for bacteremia due to CRPA and serine-beta-lactamase CRE. Avibactam in combination with aztreonam is highly active for bacteremia due to aztreonam-resistant MBL producers."

Clinical • Gram negative • Hematological Disorders • Infectious Disease • Neutropenia

In vivo evolution of resistance to novel β-lactam/β-lactamase inhibitor combinations through overproduction of the horizontally acquired extended-spectrum AmpC β-lactamase FOX-14 and porin disruption in Serratia marcescens. (PubMed, Eur J Clin Microbiol Infect Dis) - "We tested the susceptibility of the isolates to ceftazidime/avibactam, aztreonam/avibactam, imipenem/relebactam and meropenem/vaborbactam. Purified FOX-14 displayed marked cephalosporinase activity against ceftazidime and cefepime, with low Km values, while negligible turnover for aztreonam and ertapenem and a low avibactam IC50. In S. marcescens, in vivo resistance in clinical isolates emerged from FOX-14 overproduction combined with reduced outer-membrane permeability, predominantly due to OmpF disruption. These findings elucidate resistance to newer β-lactam/β-lactamase inhibitor combinations and warrant close monitoring of antimicrobial activity during carbapenem-based therapy for S. marcescens infections."

Journal • Preclinical • Infectious Disease

Clonal dissemination of carbapenem-resistant ST477 Klebsiella michiganensis co-producing NDM-1, SFO-1, and VEB-3 in a Chinese hospital. (PubMed, Front Cell Infect Microbiol) - "Antimicrobial susceptibility testing showed high-level resistance to imipenem, meropenem, and ceftazidime-avibactam, while susceptibility was retained to amikacin, aztreonam-avibactam, eravacycline, tigecycline, and colistin. No ST477-related genomes were identified in current public datasets. This study is the first to report the clonal dissemination of ST477 K. michiganensis harboring bla NDM-1 in a Chinese hospital."

Journal • Critical care

Estimating the Clinical and Economic Value of Aztreonam-Avibactam for the Treatment of Metallo-Beta-Lactamase–Producing Carbapenem- Resistant Enterobacterales Infections in China: Adopting the STEDI Value Framework (ISPOR-EU 2025) - "ATM-AVI was assessed as a first-line treatment, within the existing two-line treatment strategy (colistin + meropenem and colistin + aminoglycoside). The introduction of ATM-AVI as an additional treatment option for MBL-CRE HAP/VAP and cIAI, in China, offers significant benefits to the healthcare system, providing cost savings and improved population health. Methods to quantify the full value of antimicrobials within the context of AMR should be considered within health technology assessments to address the AMR threat."

Clinical • Infectious Disease • Pneumonia • Respiratory Diseases

Turbitest: an innovative rapid test for determining in vitro susceptibility to ceftazidime-avibactam plus aztreonam in Enterobacterales. (PubMed, Eur J Clin Microbiol Infect Dis) - "The combination aztreonam-avibactam (AZA) was developed in an attempt to overcome this challenge, as avibactam inhibits KPC and other serine-β-lactamases, enabling aztreonam (ATM) to act against MBL. TurbiTest is an inexpensive test that demonstrated a promising performance with considerably reduced turnaround time to results (less than 5 h). Interlaboratory reproducibility, as well as the performance with other bacterial population remain to be explored."

Journal • Preclinical

Cost-Effectiveness Analysis of Aztreonam Avibactam (ATMAVI) ± Metronidazole (MTZ) for the Treatment of Complicated Intra-Abdominal Infections (cIAIs) and Ventilator-Associated Hospital-Acquired Pneumonia (HAP/VAP) Caused by Suspected MBL-Producing... (ISPOR-EU 2025) - "This analysis assesses the cost-effectiveness of ATM-AVI for complicated intra-abdominal infections (cIAI) and hospital- or ventilator-associated pneumonia (HAP/VAP). This study used a 38-day decision tree followed by a Markov model over a 5-year horizon to evaluate the medical costs and clinical outcomes of ATM-AVI ± metronidazole versus meropenem ± colistin (for cIAI) or meropenem-based therapy (for HAP/VAP) from a payer perspective. For patients with cIAI and HAP/VAP, and assuming a cost-effectiveness threshold of NTD 1150478 per QALY, treatment with ATM-AVI is considered a highly cost-effective use of healthcare resources in Taiwan."

Clinical • Cost effectiveness • HEOR • Infectious Disease • Pneumonia • Respiratory Diseases

Evaluation of the efficacy of aztreonam-avibactam (ChiCTR) - P4 | N=100 | Not yet recruiting | Sponsor: Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University; Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University

New P4 trial • Real-world evidence • Infectious Disease • Pneumonia • Respiratory Diseases

Therapeutic challenges in treating ESBL- and/or AmpC-producing non-carbapenemase-producing Enterobacterales: an in vitro evaluation of novel β-lactam/β-lactamase inhibitor combinations and cefiderocol. (PubMed, J Antimicrob Chemother) - "CR non-CPE exhibit heterogeneous resistance profiles, especially in ESBL/AmpC co-producers and CTX-M-33-producing isolates. While cefepime-zidebactam, imipenem-relebactam, and cefiderocol were the most active agents, susceptibility testing remains essential to guide therapy in this emerging and neglected bacterial group."

Journal • Preclinical

Therapeutic optimization against bacteria carrying metalloenzymes: the battle for class B. (PubMed, Rev Esp Quimioter) - "Currently, the antimicrobial cornerstones against these pathogens are aztreonam/avibactam and cefiderocol. Successful therapy requires the early and adequate initiation of antibiotic treatment, optimisation of its pharmacokinetics/pharmacodynamics, and appropriate control of the infection source."

Journal • Review • Infectious Disease

"Evaluating the susceptibility of MBL carbapenemase-producing Enterobacteriaceae and Pseudomonas spp. to ceftazidime/avibactam plus aztreonam and Cefiderocol: A synergy study and susceptibility profile". (PubMed, J Microbiol Methods) - "This study assessed the in vitro susceptibility of aztreonam/avibactam (ATM/AVI) and the synergy analyses against 38 clinical carbapenemase-producing strains (31 Enterobacterales and 7 Pseudomonas spp.) collected over two years. MBL-type carbapenemases producers is still uncertain. Cefiderocol remains highly effective against MBL-producing Enterobacterales and Pseudomonas spp."

Journal

Efficacy of human-simulated aztreonam-avibactam against Stenotrophomonas maltophilia in the neutropenic murine thigh infection model. (PubMed, J Antimicrob Chemother) - "Aztreonam-avibactam HSR demonstrated in vivo efficacy against the majority of S. maltophilia isolates with MIC ≤4/4 mg/L in a neutropenic murine thigh infection model. These results provide decision support to standards development organizations for determination of susceptibility breakpoints for aztreonam-avibactam against S. maltophilia."

Journal • Preclinical • Infectious Disease