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Cefiderocol could be an effective new antibiotic…but we are not there yet – expert comment

A study in The Lancet Infectious Diseases has found a new investigational antibiotic is effective against drug-resistant bacteria in a phase 2 trial.

The findings suggest that Cefiderocol, described by the authors as ‘acting as a Trojan horse’, is as effective as the current standard-of-care antibiotic for the treatment of complicated urinary tract infections (UTIs) caused by several multidrug resistant Gram-negative bacteria.

How exciting is this development in the fight against antibiotic resistance? And how does the drug work?

Serge Mostowy, Professor of Cellular Microbiology at the London School of Hygiene & Tropical Medicine, said:

 “Antibiotic resistance is one of the greatest global health challenges we face. Infections from enterobacteria, such pathogenic E. coli, are becoming harder and harder to treat. This important study offers hope for a new antibiotic that could potentially be an alternative to treating them, but we are not there yet.

 “How cefiderocol kills bacteria is not new. From inside the bacterial cell the drug interferes with peptidoglycan, an important component of the bacterial cell wall. What is new is how the drug can enter the bacterial cell - highjacking a natural bacterial iron transport system. Exploiting this mechanism is a perfect example of modern medicine and should encourage novel research avenues aiming to fight antibiotic resistant infection.

 “This is a phase 2 clinical trial and we await information on clinical improvement and treatment durability. However, it provides proof-of-principle for a novel method of therapeutic treatment, and will be of wider interest to researchers and physicians interested in future-antibiotics.”