1 Recommendations

1.1 Cefiderocol is recommended, within its marketing authorisation, as an option for treating severe drug-resistant infections caused by gram-negative bacteria. This includes, but is not limited to, infections caused by metallo-beta-lactamase-producing Enterobacterales, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Clinicians should follow advice from specialists in microbiology or infectious disease and offer cefiderocol only if there are no suitable alternative treatment options.

The decision to offer cefiderocol should be guided by results from tests for microbiological susceptibility and mechanisms of resistance that confirm that the infection is susceptible to cefiderocol, and not susceptible to other suitable antibiotics. If these results are not yet available, cefiderocol may be offered, but only if the infection:

  • needs urgent treatment, and

  • is expected to be susceptible to cefiderocol and not to other suitable antibiotics.

    As well as considering susceptibility, judgements about whether an alternative treatment is suitable may take account of concerns about its toxicity, availability or interactions with other drugs, and its spectrum of activity.

    Prescribers should follow the recommendations on new antimicrobials in the NICE guideline on antimicrobial stewardship.

1.2 Because of the uncertainty in the estimates of the value of cefiderocol to the NHS in England, NICE encourages research to further develop best practice in the health economic evaluation of antimicrobials (see sections 5 and 6).