Novel agents in development for multidrug-resistant Gram-negative infections: potential new options facing multiple challenges

Purpose of reviewTo review novel antiinfective agents in development for multidrug-resistant (MDR) Gram-negative bacterial infections.Recent findingsFour novel agents are in various phases of development (tebipenem, durlobactam-sulbactam, cefepime-taniborbactam, and xeruborbactam). Tebpipenem is an oral carbapenem with a recently completed phase III trial for complicated urinary tract infections while durlobactam-sulbactam represents a potential alternative for drug-resistant Acinetobacter baumannii. Cefepime-taniborbactam possesses in-vitro potency against a range of troubling pathogens and we await further information on a recently completed study on complicated urinary tract infection. Finally, xeruborbactam is an ultrabroad beta-lactamase inhibitor that can be paired with a range of intravenous and oral agents. It exhibits enhanced in-vitro activity against many MDR pathogens, including those resistant to newer, broader spectrum options. Data in humans with xeruborbactam are limited.Each of the newer options reviewed possesses a unique range of in-vitro activity against select, challenging pathogens with some narrowly tailored and other broader in activity. Several have both oral and intravenous formulations. Two agents have presented data from recent phase III trials, whereas two are not as advanced in their clinical programs.