Zavicefta: A Shield Against the Surge of Antibiotic Resistant Infections

In recent years, the rise of Multidrug-resistant (MDR) infections has emerged as one of the most pressing challenges in modern medicine. Owing to various factors, bacterial infections sometimes don’t resolve with standard antibiotic therapy, some bacteria have evolved to resist standard antibiotics & spread in the body complicating illnesses. These resistant bacteria, which have developed the ability to withstand the effects of multiple antibiotic classes, complexify treatment options, prolong hospital stays, and increase mortality rates.¹ 

What are MDR infections? 

Multidrug-resistant (MDR) bacterial infections occur when bacteria evolve and develop the ability to resist the effects of several different classes of antibiotics, making them very complicated to treat. These infections are particularly concerning in healthcare settings because they can lead to prolonged illness, increased mortality, and limited treatment options.¹ 

MDR bacteria are resistant to at least one agent in three or more antibiotic classes. 

Infections caused by MDR bacteria often cannot be treated with common antibiotics, requiring the use of stronger, more potent & hence more toxic drugs or rare drugs that are difficult to access.¹  

Examples of Multidrug-Resistant Bacteria: ² 

• 1.Methicillin-resistant Staphylococcus aureus (MRSA): Resistant to beta-lactam antibiotics, including methicillin, and commonly causes skin infections, pneumonia etcetera.
• 2.Carbapenem-resistant Enterobacteriaceae (CRE): These bacteria, including Klebsiella and Escherichia coli, are resistant to carbapenems, often used as a last-line treatment for severe infections.
• 3.Vancomycin-resistant Enterococcus (VRE): Resistant to vancomycin, which is typically used to treat serious infections caused by enterococci.
• 4.Extended-spectrum beta-lactamase (ESBL)-producing bacteria: These bacteria, such as E. coli and Klebsiella, produce enzymes that break down commonly used beta-lactam antibiotics (e.g., penicillins and cephalosporins).

 Possible Causes of Multidrug Resistance: ^1,3

• 1.Overuse and Misuse of Antibiotics: One of the main causes of antibiotic resistance is the overuse and misuse of antibiotics in both humans and animals. This includes:
•    - Inappropriate prescribing: Prescribing antibiotics for viral infections (e.g., colds, flu) where they are ineffective.  
•    - Incomplete courses of treatment: Not completing the full course of antibiotics can allow some bacteria to survive and develop resistance. Patient often tend to quit eating their antibiotics when they think they are feeling fine, this is a big mistake and should be avoided. 
•    - Self-medication and over-the-counter use: Using antibiotics without a prescription, especially in countries with less stringent regulations wrongly encourages overuse of antibiotics, which in long-term causes drug resistance.    

• 2.Antibiotic Use in Agriculture: The use of antibiotics in livestock and poultry farming, often for growth promotion or disease prevention, can contribute to the development of resistant bacteria, which can be transferred to humans through consumption of contaminated meat or food.

• 3.Hospital and Healthcare Settings: MDR bacteria are often acquired in healthcare environments, where patients are exposed to invasive devices (e.g., catheters, ventilators) and are often treated with antibiotics. This increases the likelihood of resistance developing in bacteria.
•    - Prolonged hospital stays and intensive care unit (ICU) admissions increase the risk of encountering resistant organisms. 

• 4.Poor Infection Control: Inadequate hygiene, lack of proper sterilization of medical equipment, and poor infection control measures in healthcare settings can contribute to the spread of resistant bacteria.

• 5.Genetic Mutations and Horizontal Gene Transfer: Bacteria can naturally evolve resistance through genetic mutations. Additionally, they can acquire resistance genes from other bacteria via horizontal gene transfer, especially in environments with a high antibiotic pressure. This can lead to the rapid spread of resistance.

  Prevention and Management of MDR: 1 

• - Prudent use of antibiotics: Limiting unnecessary antibiotic usage, and avoiding OTC antibiotics without a doctor’s recommendation. Strictly adhering to prescribed treatments. 
• - Infection control practices: Strict hygiene, proper sterilization, and isolation protocols in healthcare settings. 
• - Surveillance: Monitoring and tracking the spread of MDR bacteria to guide treatment decisions and infection control efforts. 
• - Development of new antibiotics: Ongoing research to develop new antibiotics and alternative treatments to combat resistant infections. 

Introducing Zavicefta ⁴ 

Zavicefta (a combination of ceftazidime and avibactam) is newly developed antibiotic indicated for the treatment of multidrug resistant diseases & infections caused by certain microorganisms. It is typically used in the following scenarios: 

• 1. Complicated Intra-Abdominal Infections: It is indicated for the treatment of complicated intra-abdominal infections (cIAI), often in combination with metronidazole.⁴

• 2.Complicated Urinary Tract Infections (cUTI): It is used to treat complicated urinary tract infections, including pyelonephritis, caused by susceptible bacteria.⁴

• 3.Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP): Zavicefta is indicated for the treatment of HAP and VAP caused by susceptible microorganisms, particularly in cases involving multidrug-resistant pathogens.⁴ 

• 4.Other Serious Infections: It may be considered in cases of severe infections where multidrug-resistant organisms are suspected, including those caused by extended-spectrum beta-lactamase (ESBL)-producing or carbapenem-resistant bacteria.⁴

Zavicefta is effective against a broad spectrum of Gram-negative bacteria, including Enterobacteriaceae and Pseudomonas aeruginosa, as well as some Gram-positive organisms, though the exact use depends on susceptibility testing. Always consult a healthcare provider for specific recommendations based on individual infection types and susceptibility patterns.⁴ 

 So, why is Zavicefta not a primary treatment? ⁴ 

• 1.Reserved for Multidrug-Resistant Organisms (MDROs): Zavicefta is generally reserved for situations where infections are caused by multidrug-resistant (MDR) bacteria, such as carbapenem-resistant Enterobacteriaceae (CRE) or extended-spectrum beta-lactamase (ESBL)-producing organisms. These pathogens are less likely to be susceptible to first-line or standard antibiotics, making Zavicefta an important option in severe or resistant infections.⁴ 

• 2.Narrower Spectrum for General Use: Although it has a broad spectrum, especially against Gram-negative bacteria, Zavicefta is not effective against some common pathogens like methicillin-resistant Staphylococcus aureus (MRSA), Enterococcus, and other pathogens that may be more common in uncomplicated infections. This makes it less suitable as a first-line treatment for most routine infections. In most cases, it is used in combination with an antibiotic that IS effective against gram-positive bacteria.⁴  

Let’s have a look at the common and serious adverse effects of Zavicefta (ceftazidime/avibactam) ⁴ 

 Common Side Effects:⁴ 

• -Diarrhea: Often mild to moderate.
• -Nausea: Can occur in some patients.
• -Headache: A frequent side effect in some individuals.
• -Increased liver enzymes: Such as ALT (alanine aminotransferase) or AST (aspartate aminotransferase), indicating liver stress.

Serious Adverse Effects:⁴  

• 1.Allergic Reactions: These may include rashes, pruritus (itching), or more severe reactions like anaphylaxis (rare but possible). There have been reports of allergic reactions progressing to Kounis syndrome- which is rare but can be fatal.
• 2.Clostridium difficile-Associated Diarrhea (CDAD): As with many antibiotics, there is a risk of C. difficile infection, which can cause abdominal discomfort, moderate-severe diarrhea as well as colitis.
• 3.Seizures: In patients with renal impairment, tremors, seizures & even encephalopathy have been reported and are a risk, especially with prolonged use or high doses. Patients with kidney problems should be monitored for these neurological issues.
• 4.Kidney Issues: Including renal impairment or failure, particularly in those with pre-existing kidney disease or conditions. Patients with a kidney disease is to be evaluated and given an adjusted dosage of Zavicefta by the doctor.

 Other Considerations:⁴ 

• - Hematologic Effects: There may be effects on blood counts, including eosinophilia (elevated eosinophils) or thrombocytosis (increased platelet count). 

• - Superinfections: Like any other antibiotic, Zavicefta can also lead to overgrowth of non-susceptible organisms. 
   

Usage: Zavicefta, manufactured by Pfizer, is supplied as a single-dose vial and is administered by intravenous infusion over 120 minutes in an appropriate infusion volume.4  

It’s important to monitor for adverse effects during treatment, especially for patients with pre-existing kidney conditions or those on other medications.  

Always stay in touch with your doctor & communicate with them about any and all unusual symptoms or side effects that you may be experiencing. 

In conclusion:  As common antibiotics become less effective, the need for innovative solutions has become more urgent than ever. In this battle against the evolving superbugs, Zavicefta (a combination of ceftazidime and avibactam) stands out as a crucial tool. This advanced antibiotic, designed specifically to tackle infections caused by resistant Gram-negative bacteria, offers hope in the fight against MDR infections. 

 By targeting multidrug-resistant pathogens such as Carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum beta-lactamase (ESBL)-producing bacteria, Zavicefta provides an essential option when other antibiotics fail. 

 As resistance continues to spread, Zavicefta plays an integral role in preserving the effectiveness of antibiotics and shaping the future of infection treatment. 

Accessing Zavicefta through Rx4u 

While Zavicefta emerges as an innovative solution against ever-evolving superbugs, patients can access this medication through the Rx4U platform which makes this process easier by adhering to their Named Patient Programs (NPP), ensuring access to rare disease therapies.   

Rx4U serves as a support system for patients battling rare diseases. With its global supply network, Rx4U enables timely access to life-saving medications, empowering patients with the most advanced treatments available.   

For more information, visit http://www.rx4u.in/   

Note: 

The information provided is for education purpose only and is subjected to prescribing information of the drug and the guidance of your treating physician. Always consult your health care provider before making any medical decision for starting your treatment. 

Refernce links: 

1.https://portal.ct.gov/dph/hai/multidrugresistant-organisms-mdros-what-are-they#:~:text=Multidrug%2Dresistant%20organisms%20are%20bacteria,pathogens%20associated%20with%20antimicrobial%20resistance.  
2.https://www.mskcc.org/cancer-care/patient-education/multidrug-resistant-organisms-mdros 
3.https://www.niaid.nih.gov/research/antimicrobial-resistance-causes 
4.https://www.ema.europa.eu/en/documents/product-information/zavicefta-epar-product-information_en.pdf