II. Indications
- Antimicrobial Activity
- Escherichia coli
- Enterobacter cloacae complex
- KlebsiellaPneumoniae
- Proteus mirabilis
- Pseudomonas
- Conditions
- Complicated, multi-drug resistant Urinary Tract Infections including Pyelonephritis
III. Mechanism
- Structurally similar to Cefepime and Ceftazidime
- Effective against Gram Negative aerobic Bacteria (esp. complicated Pyelonephritis)
- Does NOT provide adequate Gram Positive or anaerobic activity
- Unique mechanism compared with other Cephalosporins which enter Bacterial cells via porin channels
- Cefiderocol enters the Bacterial cell via active iron transport
- As with other Cephalosporins, Cefiderocol is bactericidal, inhibiting cell wall synthesis
IV. Dosing
- Adult Dosing
- Cefiderocol 2 g IV every 8 hours for 7 to 14 days
-
Renal Dosing
- eGFR 30 to 59 ml/min: Give 1.5 g IV every 8 hours
- eGFR 15 to 29 ml/min: Give 1 g IV every 8 hours
- eGFR <15 ml/min or Hemodialysis: Give 0.75 g IV every 8 hours
V. Adverse Effects
- Reactions
- Hypersensitvity Reaction
- Infusion site reaction (inflammation, redness, Pruritus)
- Common adverse effects (>2% of patients)
- Diarrhea or Constipation
- Nausea and Vomiting
- Rash including Candidiasis
- Cough
- Increased liver enzymes
- Headache
- Hypokalemia
VI. Safety
- Unknown safety in pregnancy
- Unknown safety in Lactation
VII. Drug Interactions
- False Positive Urine Dipstick results (e.g. Urine Protein, urine blood, Urine Ketones)
VIII. Efficacy
- As effective as Imipenem-Cilastin in complicated UTI with multidrug resistant Gram Negative organisms
IX. Resources
X. References
- (2020) Presc Lett, Resource #360419, New Drug: Fetroja (Cefiderocol)
- Wu (2020) Infect Dis Ther 9:17-40 [PubMed]