Published data were available for the use of ceftazidime/avibactam for complicated intra‑abdominal infections and complicated urinary tract infections in adults. There were no published randomised controlled trial (RCT) data for using ceftazidime/avibactam to treat hospital-acquired pneumonia or to treat aerobic gram‑negative infections with limited treatment options and so the likely place of therapy for these 2 indications is unclear.
Local decision makers need to take safety, efficacy, cost and patient factors into account when considering the likely place in therapy of ceftazidime/avibactam for its licensed indications. The European Public Assessment Report [EPAR]: ceftazidime/avibactam states that ceftazidime/avibactam is active against ceftazidime-resistant and many carbapenem-resistant clinical isolates of Enterobacteriaceae and Pseudomonas aeruginosa when assessed in vitro and in vivo. However, there is limited evidence that ceftazidime/avibactam is effective in treating people with ceftazidime‑resistant pathogens. The EPAR also states that very few pathogens expressing serine carbapenemases have been treated with ceftazidime/avibactam. Specialists involved in reviewing this evidence summary have suggested that ceftazidime/avibactam is likely to be a treatment option for complicated intra‑abdominal infections and complicated urinary tract infections if a person's infection does not respond to commonly used antimicrobials and when there is known resistance to other antimicrobials. Use of ceftazidime/avibactam will need to be informed by understanding the mechanisms by which pathogens evolve to develop resistance.
Commissioners and local decision makers will need to consider where ceftazidime/avibactam fits within local hospital antimicrobial policies and guidelines for managing complicated intra-abdominal infections, complicated urinary tract infections, hospital‑acquired pneumonia and treating infections due to aerobic gram‑negative organisms in adults with limited treatment options, taking account of the principles of antimicrobial stewardship.