Cefiderocol (Fetroja) is a newly approved cephalosporin antibiotic for adults with complicated urinary tract infections (cUTI), including pyelonephritis, caused by susceptible gram-negative microorganisms when there are limited or no alternative treatments.

The safety and effectiveness of cefiderocol were demonstrated in a multinational, double-blind clinical trial of 448 patients with cUTI that compared cefiderocol 2g IV every eight hours (infused over one hour) with imipenem-cilastatin (Primaxin) 1g IV every eight hours (infused over one hour) for seven to 14 days. Of the patients taking cefiderocol, 72.6% experienced a resolution of symptoms and eradication of bacteria within seven days of completing treatment compared with 54.6% of those who received imipenem-cilastatin.

Cefiderocol's labeling carries a warning that an increase in all-cause mortality was seen in patients treated with cefiderocol, compared with those treated with other antibiotics, in a clinical trial of critically ill patients with carbapenem-resistant gram-negative infections. The reason for this has not been determined. Cefiderocol also carries warnings that hypersensitivity reactions, including anaphylaxis, may occur and can be fatal, and that seizures and other central nervous system adverse effects are also possible. Like almost all antibiotics, cefiderocol may induce Clostridioides difficile-associated diarrhea.

The most common adverse effects of cefiderocol include diarrhea, constipation, nausea, vomiting, elevations in liver function tests, rash, infusion site reactions, candidiasis, cough, headache, and hypokalemia. Cefiderocol is contraindicated when there is a known history of severe hypersensitivity to [beta]-lactam antibacterial drugs.

Nurses should confirm the patient's creatinine clearance, as patients with low creatinine clearance will need a lower cefiderocol dose. After reconstitution and further dilution, the drug is stable for four hours at room temperature. Nurses should administer IV cefiderocol slowly (over three hours) every eight hours. The duration of treatment is seven to 14 days.

For complete prescribing information for cefiderocol, see http://www.accessdata.fda.gov/drugsatfda_docs/label/2019/209445s000lbl.pdf.