Cefiderokol

Cefiderokol appears to be a misspelling of cefiderocol, a siderophore cephalosporin antibiotic developed by Shionogi and marketed in some regions under the brand name Fetroja. The standard spelling in medical literature is cefiderocol. The following summarizes cefiderocol’s characteristics.

Cefiderocol works by inhibiting bacterial cell wall synthesis through binding to penicillin-binding proteins. Its distinctive feature is a catechol-containing siderophore moiety that chelates iron and uses bacterial iron-uptake systems to enter Gram-negative bacteria, a mechanism described as the “Trojan horse.” Once inside, it remains stable against many beta-lactamases, including some carbapenemases, contributing to activity against multidrug-resistant organisms.

The drug is primarily active against Gram-negative bacteria, including Enterobacterales, Pseudomonas aeruginosa, and certain carbapenem-resistant strains. Activity against Gram-positive bacteria and anaerobes is limited, and resistance can emerge through various mechanisms such as alterations in iron transport or beta-lactamase production.

Indications and administration: cefiderocol has been approved for adults with complicated urinary tract infections, including pyelonephritis. It is administered intravenously, with dosing and administration tailored to renal function and patient factors. As with other antibiotics, infection control considerations and local resistance patterns influence use.

Safety and regulatory considerations: clinical trials raised concerns about higher all-cause mortality in some carbapenem-non-susceptible infections treated with cefiderocol, prompting safety communications and cautious use in certain settings. Common adverse effects include gastrointestinal symptoms, infusion-related reactions, and rash. Cefiderocol’s availability varies by country, and it is typically reserved for difficult-to-treat Gram-negative infections when other options are limited.