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Brilliant Board Review & CME
🎙️ Brilliant Medicine: Your Internal Medicine Edge
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Brilliant Board Review & CME
🎙️ Episode 21: The Nuclear Option: Aztreonam-Avibactam vs MDR Gram-Negs
🧠 Context:
Rising rates of carbapenem-resistant gram-negatives, especially those producing MBLs like NDM, VIM.
💊 Drug Combo:
Aztreonam + Avibactam = a lifeline for metallo-beta-lactamase (MBL) producers.
FDA-approved for:
Complicated intra-abdominal infections (with metronidazole).
Hospital-acquired and ventilator-associated pneumonias (HAP/VAP).
🧩 Clinical Takeaway:
Reserved for pan-resistant infections; not a first-line agent.
ID consult required in most hospitals due to high cost and restricted use.
This is your last-resort ammo — know when to reach for it.
Now let's talk about a newer drug multidrug-resistant gram-negative bacteria and this is S-trianam-avobactam, so it's a combination and now S-trianam you may be very familiar with it. This is what you have to use for people who have severe penicillin allergy. Now, remember, only 1% of patients truly have a true penicillin allergy. These are things we need to be very careful about before they're actually listed as an allergy. It's highly suggested that, if there even is a question of it, there's different workups that can be done, including getting them to an allergist, because once we see penicillin as an allergy, it really takes out whole classes of medication, especially if it's not true, and it can hurt the patients in the long run. So this is for metallo-B-lactamase-producing enterobacterioles and then stanotrophormonous multifilia. It's FDA-approved with metronidazole for treatment of complicated inner abdominal infections, basically when everything else has failed. These are the super Also for hospital-acquired bacterial pneumonia, basically, when everything else has failed. These are the super Also for hospital-acquired bacterial pneumonia and this is the big one VAP venular-associated bacterial pneumonia. So this is a new tool.
Speaker 1:Now will you be using this often? Probably not, unless you're working in the ID world. It's going to be restricted and it's important it's restricted because this is going to be one of those last line drugs, but it's nice to know what is available. These are things you can discuss, and even discuss with your ID department, if this is available for these very sick patients, and should the trigger be pulled for this Now, what's going to be the big setback on this one Cost? Now, estrinum is well tolerated. Is it the greatest antibiotic by itself? Probably not, but with this combination it seems very good in the studies. So this is a new tool, maybe not that we can use in our tool ball, but we can get assistance for from RID fellows and attendings.