NDM-Producing Enterobacterales, Formulary Decisions, and the Next Wave of Agents

Body:For NDM-producing Enterobacterales, the guidance names aztreonam-avibactam and cefiderocol as preferred treatment options, with ceftazidime-avibactam plus aztreonam as an alternative when aztreonam-avibactam is unavailable. The panel considers either aztreonam-avibactam or ceftazidime-avibactam plus aztreonam reasonable, with a slight preference for the coformulated aztreonam-avibactam.

“We would encourage hospitals to start thinking about how you’ll test susceptibility with this drug, and then, very importantly, what kinds of stewardship restrictions you’ll place so it’s not just the one go-to drug for every carbapenem-resistant organism,” said Pranita D. Tamma, MD, MHS, of the Department of Pediatrics at the University of Pennsylvania School of Medicine.

In this episode, Emily L. Heil, PharmD, MS, FIDP, BCIDP, AAHIVP, professor in the Department of Practice, Sciences, and Health Outcomes Research at the University of Maryland School of Pharmacy and pharmacy director of the Antimicrobial Stewardship Program at the University of Maryland Medical Center, and Tamma explain why the coformulated product earned its edge despite limited clinical data, why NDM-5–producing E coli with PBP3 insertions raise concern for both preferred agents, and how hospitals can prepare to use newer agents responsibly.