ceftobiprole medocaril
Sources réglementaires consultées
Indications approuvées
- Pneumonie communautaire et nosocomiale, hors pneumonie associée à la ventilation, et infections bactériennes aiguës de la peau et des structures cutanées dues à des germes sensibles.
Contre-indications
Absolues
- Hypersensibilité au ceftobiprole médocaril, au ceftobiprole ou à d’autres céphalosporines.
Mises en garde cliniques
- Mise en garde majeure · Une hypersensibilité sévère ou une anaphylaxie peut survenir ; rechercher les antécédents d’allergie aux bêta-lactamines et arrêter en cas de réaction allergique. — CIMA/AEMPS, ficha técnica 78691
- Mise en garde majeure · Une diarrhée et une colite à Clostridioides difficile peuvent survenir pendant ou après le traitement ; évaluer toute diarrhée importante. — CIMA/AEMPS, ficha técnica 78691
- Mise en garde majeure · L’accumulation, notamment en cas d’insuffisance rénale ou de dose non ajustée, peut provoquer encéphalopathie, myoclonies ou convulsions ; adapter à la fonction rénale et surveiller l’état neurologique. — CIMA/AEMPS, ficha técnica 78691
Effets indésirables
Communs (≥1%)
Nausées, diarrhée et éruption cutanée
Rares mais graves
Anaphylaxie, colite à C. difficile et cytopénies sévères
Grossesse et allaitement
Pendant la grossesse, utiliser uniquement en cas d’indication clinique. Évaluer l’allaitement selon l’exposition dans le lait et l’état du nourrisson décrits dans le résumé des caractéristiques du produit.
Bibliographie récente (PubMed)
Ceftobiprole medocaril is a broad-spectrum 5th-generation cephalosporin with activity against Gram-positives such as methicillin-resistant Staphylococcus aureus and penicillin-resistant Streptococcus pneumoniae, and against Gram-negatives such as Pseudomonas aeruginosa. The recommended dose is 500 mg every 8 h in 2-hour infusions. Various clinical trials have demonstrated its usefulness in the treatment of community-acquired pneumonia and nosocomial pneumonia, with the exception of ventilator-associated pneumonia. In summary, it is a very useful antibiotic for the treatment of pneumonia.
Drug discovery campaigns often face biopharmaceutical challenges, some of which can be solved by a prodrug approach. Prodrugs are enzymatically or chemically transformed in vivo to produce active drugs. Among these, medoxomil promoieties have been judiciously employed in multiple drug discovery campaigns, leading to three prodrugs gaining FDA approval: azilsartan medoxomil (6), olmesartan medoxomil (20), and ceftobiprole medocaril (29), and one approval in Japan: prulifloxacin (35). The promoiety can be easily appended to mask carboxylic acids, amines, zwitterionic compounds, and other polar groups, imparting lipophilicity to the parent compound. The promoiety has the added advantage of rapid and complete conversion to the parent drug by multiple enzymatic pathways across different tissues. The approach has been used for drugs spanning multiple classes to improve oral bioavailability, solubility, tissue localization, efflux, and side effect profiles. This Perspective analyzes the history and application of medoxomil prodrugs and discusses their potential for drug development.
The objective was to review the pharmacology, efficacy, and safety of intravenous ceftobiprole in the treatment of bloodstream infections, acute bacterial skin and skin structure infections (ABSSSIs), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP), or ventilator-associated pneumonia (VAP). PubMed and ClinicalTrials.gov were searched using the following terms: ceftobiprole, ceftobiprole medocaril, ceftobiprole medocaril sodium, Zevtera, and BAL5788. Articles published in English between January 1985 and August 15, 2024, related to pharmacology, safety, efficacy, and clinical trials were reviewed. Ceftobiprole has shown similar efficacy to comparator antibiotics in CAP, ABSSSIs, and bloodstream infections. Overall treatment success in patients with bacteremia was 69.8% and 68.7%; 91.3% and 88.1% with ABSSSIs and 86.6% and 87.4% with CAP in ceftobiprole and comparator groups, respectively. Finally, in the management of HAP and VAP, ceftobiprole was inferior in the VAP population. Ceftobiprole had a favorable safety profile with gastrointestinal adverse effects occurring more frequently than comparators.Relevance to Patient Care and Clinical Practice in Comparison to Existing Drugs:Clinicians have limited options to treat multidrug-resistant infections. Ceftobiprole has demonstrated efficacy against causative pathogens in specific infections including methicillin-resistant Staphylococcus aureus bacteremia (SAB), ABSSSI, and CAP and may be considered a viable alternative. However, ceftobiprole's impact on HAP, VAP, and febrile neutropenia needs to be further delineated. Ceftobiprole's broad-spectrum activity makes it a viable option for treating patients hospitalized with CAP, ABSSSI, and SAB. Further studies are needed in severely ill HAP or VAP, febrile neutropenia, and pediatric patients.