Ceftolozane/tazobactam

Ceftolozane/tazobactam is indicated for the treatment of the following infections in adults caused by designated susceptible microorganisms: • Complicated intra-abdominal infections; This pharmacotechnical property supports its use in outpatient parenteral antimicrobial therapy (OPAT) programs, particularly for time-dependent β-lactam optimization and carbapenem-sparing strategies. In real-world OPAT cohorts, ceftolozane/tazobactam accounted for approximately 7.5% of antibiotics administered by continuous infusion. == Adverse drug reactions ==

The adverse-event profile of ceftolozane/tazobactam from two phase 2 trials (comparing either ceftolozane alone or in combination with tazobactam to ceftazidime or meropenem) suggests that ceftolozane/tazobactam is well tolerated. The most common AEs reported with ceftolozane/tazobactam were headache (5.8%), constipation (3.9%), hypertension (3%), nausea (2.8%), and diarrhea (1.9%). == Drug interactions ==

Based on previous trial data and ongoing clinical trials, no significant drug–drug or food–drug interactions have been associated with ceftolozane/tazobactam administration. However, drug–drug interactions similar to those observed with the cephalosporin class of antimicrobials and β-lactamase inhibitors should be considered as potential interactions until further drug–drug interactions have been completely elucidated. Moreover, as a result of drug accumulation in renal impairment, caution should be taken when coadministering ceftolozane/tazobactam with other renally eliminated medications due to possible nephrotoxicity == Pharmacology ==

Pharmacokinetics Ceftolozane–tazobactam is available as a 2:1 fixed combination (such that a 1.5 g dose of ceftolozane–tazobactam is composed of 1 g of ceftolozane and 500 mg of tazobactam). Ceftolozane-tazobactam is administered intravenously. For both ceftolozane and tazobactam, the peak plasma concentration occurs immediately after a 60 minute infusion, with a time to maximum concentration of approximately one hour. The binding of ceftolozane to human plasma proteins is approximately 16% to 21%, while the binding of tazobactam is approximately 30%. The mean steady-state volume of distribution in healthy adult males after a single 1.5 g IV dose is 13.5 L for ceftolozane and 18.2 L for tazobactam, which is similar to extracellular fluid volume. Tissue distribution of ceftalozone-tazobactam is rapid and shows good penetration into the lung, rendering it an ideal treatment for bacterial pneumonia. Tazobactam is partially metabolized to an inactive metabolite, and both drug and metabolite are excreted in the urine (80% as unchanged drug). The half-life of ceftolozane is 2.5–3.0 hours, and the half-life of tazobactam is approximately 1.0 hour; the clearance of both drugs is directly proportional to renal function. Tazobactam primarily undergoes renal excretion via active tubular secretion. Coadministration of ceftolozane with tazobactam does not result in an interaction, since ceftolozane is primarily eliminated by glomerular filtration. Tazobactam is a potent β-lactamase inhibitor of most common class A and C β-lactamases. Tazobactam has little clinically relevant in vitro activity against bacteria due to its reduced affinity to penicillin-binding proteins; however, it is an irreversible inhibitor of some β-lactamases (certain penicillinases and cephalosporinases) and can covalently bind to some chromosomal and plasmid-mediated bacterial beta-lactamases. Spectrum of activity The in vitro activity of ceftolozane–tazobactam has been examined in five surveillance studies of isolates from Europe and North America. In these studies, ceftolozane–tazobactam was notable for its activity against Pseudomonas aeruginosa, a common cause of hospital-acquired infections that is commonly multi-drug resistant. Ninety percent of Pseudomonas aeruginosa isolates were inhibited by a ceftolozane–tazobactam at a concentration of 4 μg/mL (MIC90), making it the most potent anti-pseudomonal antibiotic in clinical use. In these same studies, ceftolozane–tazobactam exhibited MIC90 values of 90 for extended spectrum beta-lactamase expressing Klebsiella pneumoniae being >32 μg/mL. == Chemistry ==

Structure Ceftolozane contains a 7-aminothiadiazole, affording increased activity against gram-negative organisms, as well as an alkoximino group, providing stability against many β-lactamases. Ceftolozane has a dimethylacetic acid moiety that contributes to enhanced activity against Pseudomonas aeruginosa. The addition of a bulky side chain (a pyrazole ring) at the 3-position prevents hydrolysis of the β-lactam ring via steric hindrance. Tazobactam is a sulfone β-lactamase inhibitor, which prevents hydrolysis of the amide bond of the β-lactam molecules by β-lactamase enzymes. Synthesis Researchers at Cubist Pharmaceuticals (prior to the acquisition of Cubist by Merck) discovered and developed a synthesis of ceftolozane sulfate based on a palladium-mediated coupling in the presence of the cephalosporin nucleus, marking a significant advancement in the chemistry of cephalosporin antibiotics. This chemistry was determined to be general to the family of cephalosporin antibiotics. Key elements of the coupling reaction were the use of a designed, electron-deficient phosphite ligand in tandem with the addition of an exogenous chloride scavenging reagent, which functioned through the in situ precipitation of potassium chloride. This work is described only in the patent literature. == History ==

The efficacy of ceftolozane/tazobactam to treat complicated intra-abdominal infections (cIAI) in combination with metronidazole was established in a clinical trial with a total of 979 adults. Participants were randomly assigned to receive ceftolozane/tazobactam plus metronidazole or meropenem. Results showed ceftolozane/tazobactam plus metronidazole was effective for the treatment of cIAI. The efficacy of ceftolozane/tazobactam to treat complicated urinary tract infections (cUTI) was established in a clinical trial where 1,068 adults were randomly assigned to receive ceftolozane/tazobactam or levofloxacin. Ceftolozane/tazobactam demonstrated it was effective in treating cUTI. Ceftolozane/tazobactam was shown to be at least as effective as other antibiotics in curing infections in three main studies. One study involved 1,083 participants who mostly had kidney infection or in some cases a complicated urinary-tract infection. Ceftolozane/tazobactam successfully treated the infection in about 85% of the cases where it was given (288 of 340), compared with 75% (266 of 353) of those given another antibiotic called levofloxacin. The second study involved 993 participants with complicated intra-abdominal infections. Ceftolozane/tazobactam was compared with another antibiotic, meropenem. Both medicines cured 94% of participants (353 out of 375 given ceftolozane/tazobactam and 375 out of 399 given meropenem). The third study involved 726 participants who were using a ventilator and who had either hospital-acquired pneumonia or ventilator-associated pneumonia. It found ceftolozane/tazobactam to be at least as effective as meropenem: the infection had resolved in 54% of participants (197 out of 362) after 7 to 14 days of treatment with ceftolozane/tazobactam compared with 53% of participants (194 out of 362) on meropenem. == References ==