Ceftazidime-avibactam induced renal disorders: past and present

• Published in: Frontiers in pharmacology Vol. 15; p. 1329307
• Main Authors: Shi, Yanrong, Wu, Jichao, Mi, Wei, Zhang, Xusheng, Ren, Xiuli, Shen, Chengwu, Lu, Cuicui
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 2024
• Subjects: acute kidney injury; ceftazidime-avibactam; clinical trials; pharmacokinetic/pharmacodynamic; Pharmacology; real-world studies; pharmacokinetic/pharmacodynamic; acute kidney injury; clinical trials; ceftazidime-avibactam; real-world studies
• ISSN: 1663-9812; 1663-9812
• DOI: 10.3389/fphar.2024.1329307

With the increasing prevalence of multidrug-resistant Gram-negative bacterial pathogens worldwide, antimicrobial resistance has become a significant public health concern. Ceftazidime-avibactam (CAZ-AVI) exhibited excellent activity against many carbapenemase-producing pathogens, and was widely used for the treatment of various complicated infections. CAZ-AVI is well tolerated across all dosing regimens, and its associated acute kidney injury (AKI) in phase II/III clinical trials is rare. However, recent real-world studies have demonstrated that CAZ-AVI associated AKI was more frequent in real-world than in phase II and III clinical trials, particularly in patients receiving concomitant nephrotoxic agents, with critically ill patients being at a higher risk. Herein, we reviewed the safety data related to renal impairment of CAZ-AVI, and discussed its pharmacokinetic/pharmacodynamic targets and dosage adjustment in patients with impaired renal function. This review aimed to emphasize the importance for healthcare professionals to be aware of this adverse event of CAZ-AVI and provide practical insights into the dosage optimization in critically ill patients with renal dysfunction.