Featured Article| Volume 19, ISSUE 3, 104518, March 2023

Treatment for Multidrug Resistant Gram-Negative Infections With Cefiderocol (Fetroja)

Published:February 07, 2023DOI:


      • Cefiderocol is the first intravenous siderophore cephalosporin antimicrobial that was approved by the FDA.
      • Cefiderocol's innovative mechanism of action retains activity against highly resistant aerobic gram-negative microorganisms which threaten clinical practice.
      • Cefiderocol is indicated in susceptible gram-negative infections attributed to complicated urinary tract infection cUTI including pyelonephritis, hospital acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP).
      • Cefiderocol's utility requires judicious considerations in the presence of antimicrobial resistance to maximize benefit clinically while minimizing the development of future antimicrobial resistance.


      Global concern regarding antimicrobial resistance has allowed for innovative antimicrobials to emerge specifically in the presence of infections caused by resistant gram-negative microorganisms. The outer membrane of gram-negative microorganisms can hinder antimicrobial penetration. A novel approach to infiltrate gram-negative microorganisms would be to use their own transport systems. Cefiderocol is the first approved intravenous siderophore cephalosporin to treat resistant gram-negative infections. Cefiderocol achieves direct entry into the bacteria’s periplasmic space, avoiding mechanisms of resistance encountered with antimicrobials in clinical practice. Cefiderocol can revolutionize clinical practice with its original mechanism of action and sustainable activity against resistant gram-negative microorganisms.


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      Nino Marzella, PharmD, BCPS, is an Associate Professor of Pharmacy Practice, Long Island University Pharmacy, Arnold and Marie Schwartz College of Pharmacy, and Clinical Pharmacy Specialist, New York Harbor Healthcare System, Department of Veterans Affairs, Brooklyn Campus, Brooklyn, and can be contacted at [email protected]