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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
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🧠 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.
Introduction to S-trianam-avobactam
Speaker 1Now 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 .
True Penicillin Allergies Explained
Speaker 1These 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 .
FDA-approved Treatment Applications
Speaker 1It'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 1Now 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
Considerations and Limitations
Speaker 1with 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 .