Ceftolozane/tazobactam: place in therapy

ABSTRACT

Introduction: Ceftolozane/tazobactam (C/T) is a new antibiotic resulting from the combination of a novel cephalosporin, structurally similar to ceftazidime, with tazobactam, a well-known beta-lactamase inhibitor. C/T remains active against extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and multi-drug resistant (MDR) P. aeruginosa, and has been recently approved for the treatment of complicated intra-abdominal infections (cIAI) and complicated urinary tract infections (cUTI). A trial on hospital-acquired pneumonia is ongoing.

Areas covered: The place in therapy of C/T is delineated by addressing the following main topics: (i) antimicrobial properties; (ii) pharmacological properties; (iii) results of clinical studies.

Expert commentary: C/T is approved for cIAI and cUTI. However, the drug has a special value for clinicians in any kind of infectious localization for two main reasons. The first is that C/T is especially valuable in suspected or documented severe infections due to MDR P. aeruginosa, which is not a rare occurrence in many countries. The second is that C/T may provide an alternative to carbapenems for the treatment of infections caused by ESBL-producers, thus allowing a carbapenem-sparing strategy. Reporting of off-label use is mandatory to increase the body of evidence and the clinicians’ confidence in using it for indications other than cIAI and cUTI.

KEYWORDS:

• Antimicrobial resistance
• MDR
• ceftolozane
• tazobactam
• carbapenem-sparing
• ESBL
• Pseudomonas
• Enterobacteriaceae

Declaration of interest

DR Giacobbe received an unconditioned grant from MSD Italy. M Bassetti participated in advisory boards and/or received speaker honoraria from Achaogen, Angelini, Astellas, AstraZeneca, Bayer, Basilea, Cidara, Gilead, Menarini, MSD, Paratek, Pfizer, The Medicine Company, Tetraphase, and Vifor. FG De Rosa received speaker fees and participated in advisory boards for MSD. V Del Bono received speaker fees from Pfizer, MSD, Basilea, Astellas, Gilead, and Sanofi. PA Grossi acted as consultant and member of speakers’ bureau for MSD, Gilead, BD, Angelini, Paratek, and Novartis. F Menichetti participated in advisory boards and/or received speaker honoraria from Pfizer, Gilead, Angelini, and MSD. F Pea participated in speaker bureau for Angelini, Basilea Pharmaceutica, Gilead, Hikma, Merck Sharp & Dohme, Nordic Pharma, Pfizer, and Sanofi Aventis, and in advisory board for Angelini, Basilea Pharmaceutica, Gilead, Merck Sharp & Dohme, Nordic Pharma, and Pfizer. GM Rossolini has served as a consultant to and/or received congress lecture fees and/or research grants and/or travel grants from Accelerate, Achaogen, Alifax, Angelini, Arrow, AstraZeneca, Basilea, Beckman Coulter, Becton Dickinson, bioMérieux, Biotest, Cepheid, Checkpoints, Elitech, Estor, Liofilchem, Merck, Nordic Pharma, Novartis, Pfizer, Rempex, Roche, Seegene, ThermoFisher, Zambon. M Tumbarello received speaker fees and participated in advisory boards for MSD.

PL Viale acted as consultant to Pfizer, Cepheid, and Merck Sharp & Dohme, received research grants from Gilead Sciences and Pfizer, honoraria for lectures from Gilead Sciences, Merck Sharp & Dohme and Pfizer, and travel grants from Merck Sharp & Dohme, Pfizer, and Gilead Sciences. C Viscoli reports personal fees from MSD Int, Gilead, Forrest Italia, Angelini, and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work, including travel and meeting expenses, was funded by an unrestricted grant by MSD Italia Srl. The sponsor had no role in selecting the participants, reviewing the literature, defining recommendations, drafting or reviewing the paper, or in the decision to submit the manuscript for publication. All views expressed are solely those of the authors.