Biology:Avibactam

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Short description: Chemical compound
Avibactam
Avibactam structure 2.svg
Avibactam ball-and-stick model.png
Clinical data
Trade namesAvycaz (formulated with ceftazidime)
License data
Pregnancy
category
  • US: B (No risk in non-human studies)
Routes of
administration
IV
ATC code
  • None
Legal status
Legal status
Pharmacokinetic data
Bioavailability100% (intravenous)
Protein binding5.7–8.2%[1]
MetabolismNil
Onset of actionIncreases in proportion to dose
ExcretionRenal (97%)
Identifiers
CAS Number
PubChem CID
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
Chemical and physical data
FormulaC7H11N3O6S
Molar mass265.24 g·mol−1
3D model (JSmol)

Avibactam is a non-β-lactam β-lactamase inhibitor[2] developed by Actavis (now Teva) jointly with AstraZeneca. A new drug application for avibactam in combination with ceftazidime (branded as Avycaz) was approved by the FDA on February 25, 2015, for treating complicated urinary tract (cUTI) and complicated intra-abdominal infections (cIAI) caused by antibiotic resistant-pathogens, including those caused by multi-drug resistant Gram-negative bacterial pathogens.[3][4][5]

Increasing resistance to cephalosporins among Gram-(−) bacterial pathogens, especially among hospital-acquired infections, results in part from the production of β-lactamase enzymes that deactivate these antibiotics. While the co-administration of a β-lactamase inhibitor can restore antibacterial activity to the cephalosporin, previously approved β-lactamase inhibitors such as tazobactam and clavulanic acid do not inhibit important classes of β-lactamases, including Klebsiella pneumoniae carbapenemases (KPCs), New Delhi metallo-β-lactamase 1 (NDM-1), and AmpC-type β-lactamases. Whilst avibactam inhibits class A (KPCs, CTX-M, TEM, SHV), class C (AmpC), and, some, class D serine β-lactamases (such as OXA-23, OXA-48), it has been reported to be a poor substrate/weak inhibitor of class B metallo-β-lactamases, such as VIM-2, VIM-4, SPM-1, BcII, NDM-1, Fez-1.[6]

For infections sustained by metallo-β-lactamases producing bacteria, a therapeutic strategy consists in administering avibactam as companion drug administered alongside aztreonam. In fact, although in theory aztreonam is not hydrolyzed by metallo-β-lactamases, many metallo-β-Lactamases-producing strains co-produce enzymes that could hydrolyze aztreonam (e.g. AmpC, ESBL), therefore avibactam is given to protect aztreonam exploiting its robust β-lactamases inhibition.[7]

See also

References

  1. "Full Prescribing Information: AVYCAZ™ (ceftazidime-avibactam) for Injection, for intravenous use". ©2015 Actavis. All rights reserved.. http://pi.actavis.com/data_stream.asp?product_group=1957&p=pi&language=E. 
  2. "The road to avibactam: the first clinically useful non-β-lactam working somewhat like a β-lactam". Future Medicinal Chemistry 8 (10): 1063–1084. June 2016. doi:10.4155/fmc-2016-0078. PMID 27327972. 
  3. "Ceftazidime-avibactam: a novel cephalosporin/β-lactamase inhibitor combination". Drugs 73 (2): 159–177. February 2013. doi:10.1007/s40265-013-0013-7. PMID 23371303. https://zenodo.org/record/1230313. 
  4. "Actavis Announces FDA Acceptance of the NDA Filing for Ceftazidime-Avibactam, a Qualified Infectious Disease Product". Actavis plc. http://www.actavis.com/news/news/thomson-reuters/actavis-announces-fda-acceptance-of-the-nda-filing. 
  5. "Kinetics of avibactam inhibition against Class A, C, and D β-lactamases". The Journal of Biological Chemistry 288 (39): 27960–27971. September 2013. doi:10.1074/jbc.M113.485979. PMID 23913691. 
  6. "Interaction of Avibactam with Class B Metallo-β-Lactamases". Antimicrobial Agents and Chemotherapy 60 (10): 5655–5662. October 2016. doi:10.1128/AAC.00897-16. PMID 27401561. 
  7. "The Revival of Aztreonam in Combination with Avibactam against Metallo-β-Lactamase-Producing Gram-Negatives: A Systematic Review of In Vitro Studies and Clinical Cases". Antibiotics 10 (8): 1012. August 2021. doi:10.3390/antibiotics10081012. PMID 34439062. 

Further reading