Review of novel β-lactams and β-lactam/β-lactamase inhibitor combinations with implications for pediatric use

Antimicrobial resistance continues to surmount increasing concern globally, and treatment of difficult-to-treat (DTR) Pseudomonas aeruginosa, carbapenem-resistant (CR) Acinetobacter baumannii (CRAB), and CR Enterobacterales (CRE) remains a challenge for clinicians. Although previously rare, the incidence of multidrug-resistant (MDR) and CR infections in pediatric patients has increased drastically in the last decade and is associated with increased morbidity and mortality. To combat this issue, 14 novel antibiotics, including three beta-lactam/novel beta-lactamase inhibitor combinations (beta L-beta LIs) and two novel beta-lactams (beta Ls), have received approval from the United States Food and Drug Administration since 2010. Improving clinician understanding of the utility of these novel therapies is imperative to improve judicious decision-making and prevent societal regression to a pre-penicillin era. In this review, we summarize the pharmacokinetic/pharmacodynamic (PK/PD) properties, clinical efficacy and safety data, dosing considerations, and subsequent role in therapy for ceftazidime-avibactam (CAZ-AVI), meropenem-vaborbactam (MER-VAB), imipenem-cilastatin-relebactam (IMI-REL), ceftolozane-tazobactam (TOL-TAZ), and cefiderocol in pediatric patients.

Automated summary

Antimicrobial resistance is a growing global concern, particularly in pediatric patients, and the approval of 14 new antibiotics since 2010 has provided potential solutions. Understanding the efficacy, safety, and dosing considerations of these novel therapies is essential for clinicians to make informed decisions and prevent regression to a pre-penicillin era.