Carbapenem-sparing cUTI treatment shows superiority to piperacillin-tazobactam
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Cefepime-enmetazobactam demonstrated superiority compared with piperacillin-tazobactam in a phase 3 trial involving more than 1,000 adults with complicated UTIs and acute pyelonephritis, according to results presented at IDWeek.
The findings shows that cefepime-enmetazobactam (FPE) “represents a potential improved empiric treatment option,” Infectious Disease News Editorial Board Member Keith S. Kaye, MD, MPH, professor of internal medicine and director of research in the division of infectious diseases at the University of Michigan Medical School, told Healio. “FPE is carbapenem sparing and therefore is desirable as a replacement to carbapenems for patients with UTIs caused by extended-spectrum beta-lactamase (ESBL)-producing pathogens.”
Kaye and colleagues conducted a randomized, double-blind, multicenter trial that included 1,034 patients with complicated UTIs/acute pyelonephritis (cUTI/AP). They randomly assigned patients to receive either an FPE or PTZ regimen via 2-hour infusion for 7 to 14 days. The researchers also performed subgroup analyses on patients with ESBL-baseline uropathogens (BU) that were not resistant to FPE and PTZ and a group that included ESBL-BU resistant to either agent.
Among the microbiological modified intent-to-treat population (mMITT), FPE was superior to PTZ at test of cure (79.1% vs. 58.9%), they reported. Additionally, the prevalence rate of ESBL-BU was 20.9%.
“The microbiological eradication rates of PTZ observed in this study were similar to rates observed in other cUTI/AP trials — for example, the Tango I trial,” Kaye said. “However, unlike recently approved agents that target carbapenem-resistant pathogens, cefepime-enmetazobactam targets ESBL-producing gram-negative organisms.”
Kaye said that the researchers were surprised by the percentage of difference in treatment outcomes between the mMITT group (21.2%) and ESBL-producing pathogens (30.2%).
“This trial was limited to cUTI/AP, and comparative efficacy data in other indications — for example, complicated intra-abdominal infections or nosocomial pneumonia — would be of value,” he said.
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Kaye KS, et al. Late Breaker 4. Presented at: IDWeek; Oct. 21-25, 2020 (virtual meeting).
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