Aztreonam-avibactam (Emblaveo) photo pending
KEY POINTS
- Aztreonam-avibactam (Emblaveo) is the combination of a monobactam (aztreonam) that interferes with bacterial cell wall synthesis and avibactam (a β-lactamase inhibitor) that neutralizes β-lactamase enzymes
- There are few options for metallo-β-lactamase (MBL) producing gram negative bacteria, but aztreonam-avibactam can be effective
- MBLs do not hydrolyze aztreonam so it can be used for MBLs, however bacteria that produce MBLs often co-produce other β-lactamases that hydrolyze aztreonam. Avibactam protects aztreonam from these other co-produced β-lactamases.
- Ceftazidime-avibactam (Avycaz) has been combined with aztreonam in many instances to enable using aztreonam with avibactam, because no aztreonam-avibactam product as a single entity has been available. This is still done today in the United States where Emblavio is not FDA approved (as of April 2024).
- Aztreonam-avibactam was approved by the European Commission on 22 April 2024 for patients with multi-drug resistant infections and limited treatment options, cited to be able to be used for:
- Complicated intra-abdominal infections (cIAI)
- Hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP),
- Complicated urinary tract infections (cUTI), including pyelonephritis.
- Aztreonam-avibactam has gram negative activity only
- Primary role is in treatment of infections caused by MBL-producing gram negative bacteria
- Has activity versus many gram negative bacteria, including Pseudomonas aeruginosa, E. coli, Citrobacter freundii complex, Stenotrophomonas maltophilia, Klebsiella aerogenes, and Klebsiella pneumoniae
- Not expected to work for Acinetobacter species, gram positive bacteria, or anaerobic organisms
- For adults with normal renal function, requires a 3-hour infusion administered every 6 hours
- Requires dose and/or frequency adjustments for renal function
- Beware cross-hypersensitivity reaction between aztreonam and ceftazidime (i.e., if a patient has an allergy to one, they may have an allergy to the other b/c of their similar chemical structure)
- Provided as a powder for reconstitution in a 30mL vial, supplied in packs of 10
- Vial should be used within 30 minutes to make the dose, but diluted dose can be good for 24 hours when refrigerated and 12 hours at room temperature
RESOURCES
- Aztreonam-Avibactam (Emblaveo) European Package Insert
- Pfizer release on aztreonam-avibactam (Emblaveo) European approval
- Metallo-β-Lactamases: Structure, Function, Epidemiology, Treatment Options, and the Development Pipeline (AAC 2020)
- Dose selection for aztreonam-avibactam, including adjustments for renal impairment, for Phase IIa and Phase III evaluation (EJCP 2024)
- Phase 3 Studies of Pfizer’s Novel Antibiotic Combination Offer New Treatment Hope for Patients with Multidrug-Resistant Infections and Limited Treatment Options (Pfizer 2023)
- Pharmacokinetics and safety of aztreonam/avibactam for the treatment of complicated intra-abdominal infections in hospitalized adults: results from the REJUVENATE study (JAC 2020)
- 2893 A. Efficacy and Safety of Aztreonam-Avibactam for the Treatment of Serious Infections Due to Gram-Negative Bacteria, Including Metallo-β-Lactamase-Producing Pathogens: Phase 3 REVISIT Study (OFID 2023)
- In vitro activity of aztreonam/avibactam against isolates of Enterobacterales collected globally from ATLAS in 2019 (JGAR 2022)