Cefiderocol Is Approved for Complicated UTI and Pyelonephritis

In November 2019, the U.S. Food and Drug Administration (FDA) approved cefiderocol for the treatment of complicated urinary tract infections (cUTI) and pyelonephritis. Cefiderocol is a siderophore cephalosporin resistant to hydrolysis by many β-lactamases, including some serine and metallo-carbapenemases. As a siderophore, it binds to ferric iron and is actively transported into bacterial cells via the bacterial iron transporters, which incorporate this essential cation. Thus, cefiderocol acts as a sort of Trojan horse whereby the vital process of iron acquisition is used to disguise cefiderocol, allowing it to achieve high concentrations in the periplasmic space, where it can inhibit the cell wall synthesis machinery of bacteria.

The safety…