A new study shows ceftazidime-avibactam in combination with metronidazole is non-inferior to meropenem for treating complicated intra-abdominal infections (cIAI). The finding comes as increasing incidence of multidrug resistance in extended-spectrum beta-lactamase (ESBL)-producing pathogens has cast doubt as to the long-term efficacy of existing treatment for cIAI. The current gold-standard for treatment of ESBL-producing infections is meropenem.

The study enrolled 1149 patients from two identical, prospective, randomized, multicenter, double-dummy, double-blind, comparative, global studies into one inferential database. Participants were considered eligible if they had a cIAI diagnosis requiring surgical intervention or percutaneous drainage within 24 hours before or after randomization.

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Patients received either ceftazidime-avibactam 2000mg–500mg as a 2-hour IV infusion every 8 hours, followed by metronidazole 500mg as a 60-minute IV infusion every 8 hours; or meropenem 1000mg as a 30-minute IV infusion every 8 hours. The primary endpoint for noninferiority of ceftazidime-avibactam plus metronidazole was clinical cure at the test-of-cure visit, which was 28–35 days after randomization.

In the ceftazidime-avibactam plus metronidazole group, 83.0% of patients with ceftazidime-resistant infections were classified as clinical cures. This was generally consistant with the meropenem treated group. The rate of adverse events between both treatment groups was also similar.

The new combination may help guide treatments in which patients show resistance to meropenem. The authors contend that the results from this study support the utilization of ceftazidime-avibactam plus metronidazole as a potential alternative to carbapenems in the treatment of cIAI.

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