New β-Lactam/β-Lactamase Inhibitor Combination Antibiotics

Pathogens. 2025 Mar 24;14(4):307. doi: 10.3390/pathogens14040307.

Abstract

The growing problem of infections due to pathogens with antimicrobial resistance, especially Gram-negative bacteria, has led to the development of new β-lactam/β-lactamase inhibitor combination antibiotics. During the last 2 years from the writing of this article, cefepime/enmetazobactam, aztreonam/avibactam, and sulbactam/durlobactam were approved for use in clinical practice. Cefepime/enmetazobactam targets extended-spectrum β-lactamase (ESBL)-producing Pseudomonas aeruginosa and Enterobacterales. It is indicated for the treatment of patients with complicated urinary tract infections, including pyelonephritis, in Europe and the USA, and also for hospital-acquired pneumonia, ventilator-associated pneumonia, and bacteremia associated with those infections (only in Europe). The antimicrobial spectrum of aztreonam/avibactam includes carbapenem-resistant Enterobacterales. Aztreonam/avibactam is indicated for the treatment of adult patients who suffer from complicated intra-abdominal infections, complicated urinary tract infections including pyelonephritis, hospital-acquired pneumonia, and ventilator-associated pneumonia due to aerobic Gram-negative infections with limited therapeutic options. Sulbactam/durlobactam, a combination of 2 β-lactamase inhibitors, is indicated for the treatment of adult patients with hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia due to the Acinetobacter baumannii-calcoaceticus complex [including carbapenem-resistant Acinetobacter baumannii (CRAB) infections].

Keywords: antimicrobial resistance; aztreonam/avibactam; carbapenem-resistant Acinetobacter baumannii (CRAB); carbapenem-resistant Enterobacterales; cefepime/enmetazobactam; extended-spectrum β-lactamases (ESBLs); metallo-β-lactamases (MBLs); sulbactam/durlobactam; β-lactam/β-lactamase inhibitor combination agents.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents* / pharmacology
  • Anti-Bacterial Agents* / therapeutic use
  • Azabicyclo Compounds / therapeutic use
  • Drug Therapy, Combination
  • Gram-Negative Bacterial Infections / drug therapy
  • Gram-Negative Bacterial Infections / microbiology
  • Humans
  • beta-Lactamase Inhibitors* / pharmacology
  • beta-Lactamase Inhibitors* / therapeutic use
  • beta-Lactams* / pharmacology
  • beta-Lactams* / therapeutic use

Substances

  • beta-Lactamase Inhibitors
  • Anti-Bacterial Agents
  • beta-Lactams
  • Azabicyclo Compounds