Abstract
Sulbactam/durlobactam (XACDURO®), is a co-packaged antibacterial product that has been developed by Entasis Therapeutics Inc. for the treatment of infections caused by Acinetobacter baumannii-calcoaceticus complex (ABC). Coadministration of durlobactam (a β-lactamase inhibitor with potent activity against a broad range of serine β-lactamases) with sulbactam (an established class A β-lactamase inhibitor with antibacterial activity against A. baumannii) prevents sulbactam degradation by ABC-produced β-lactamases. In May 2023, sulbactam/durlobactam was approved in the USA for use in patients 18 years of age and older for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) caused by susceptible isolates of ABC. This article summarizes the milestones in the development of sulbactam/durlobactam leading to this first approval for the treatment of infections caused by ABC.
Similar content being viewed by others
References
Castanheira M, Mendes RE, Gales AC. Global epidemiology and mechanisms of resistance of Acinetobacter baumannii-calcoaceticus complex. Clin Infect Dis. 2023;76(Suppl 2):S166–78.
US Food and Drug Administration. FDA approves new treatment for pneumonia caused by certain difficult-to-treat bacteria [media release]. 23 May 2023. https://www.fda.gov.
US Centers for Disease Control and Prevention. Carbapenem-resistant Acinetobacter baumannii (CRAB): an urgent public health threat in United States healthcare facilities. 2021. https://arpsp.cdc.gov/. Accessed 12 June 2023.
World Health Organisation. WHO publishes list of bacteria for which new antibiotics are urgently needed. 2017. https://www.who.int/. Accessed 12 June 2023.
Shields RK, Paterson DL, Tamma PD. Navigating available treatment options for carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex infections. Clin Infect Dis. 2023;76(Suppl 2):S179–93.
Vazquez-Lopez R, Solano-Galvez SG, Juarez Vignon-Whaley JJ, et al. Acinetobacter baumannii resistance: a real challenge for clinicians. Antibiotics (Basel). 2020. https://doi.org/10.3390/antibiotics9040205.
Durand-Réville TF, Guler S, Comita-Prevoir J, et al. ETX2514 is a broad-spectrum β-lactamase inhibitor for the treatment of drug-resistant Gram-negative bacteria including Acinetobacter baumannii. Nat Microbiol. 2017;2:17104.
Barnes MD, Kumar V, Bethel CR, et al. Targeting multidrug-resistant Acinetobacter spp.: sulbactam and the diazabicyclooctenone β-lactamase inhibitor ETX2514 as a novel therapeutic agent. MBio. 2019. https://doi.org/10.1128/mBio.00159-19.
El-Ghali A, Kunz Coyne AJ, Caniff K, et al. Sulbactam-durlobactam: a novel β-lactam-β-lactamase inhibitor combination targeting carbapenem-resistant Acinetobacter baumannii infections. Pharmacotherapy. 2023. https://doi.org/10.1002/phar.2802.
Watkins RR, Bonomo RA. Sulbactam-durlobactam: a step forward in treating carbapenem-resistant Acinetobacter baumannii (CRAB) infections. Clin Infect Dis. 2023;76(Suppl 2):S163–5.
Entasis Therapeutics Ltd. Sulbactam/Durlobactam (XACDURO®): US prescribing information 2023. https://www.fda.gov. Accessed 6 June 2023.
Innoviva Inc. Innoviva Specialty Therapeutics announces FDA approval for XACDURO® (sulbactam for injection; durlobactam for injection), co-packaged for intravenous use [media release]. 23 May 2023. https://investor.inva.com/.
Kaye KS, Shorr AF, Wunderink RG, et al. Efficacy and safety of sulbactam-durlobactam versus colistin for the treatment of patients with serious infections caused by Acinetobacter baumannii-calcoaceticus complex: a multicentre, randomised, active-controlled, phase 3, non-inferiority clinical trial (ATTACK). Lancet Infect Dis. 2023. https://doi.org/10.1016/S1473-3099(23)00184-6.
Innoviva Inc. Innoviva completes acquisition of Entasis Therapeutics [media release]. 11 July 2022. https://investor.inva.com/.
Innoviva Inc., Entasis Therapeutics Holdings Inc. Innoviva to acquire Entasis Therapeutics [media release]. 23 May 2022. https://investor.inva.com/.
Zai Lab Limited. Form 10-K. 2023. https://ir.zailaboratory.com/. Accessed 6 June 2023.
Entasis Therapeutics Holdings Inc. Form 10-K. 2021. https://www.sec.gov/. Accessed 6 June 2023.
Shapiro AB, Moussa SH, McLeod SM, et al. Durlobactam, a new diazabicyclooctane β-lactamase inhibitor for the treatment of Acinetobacter infections in combination with sulbactam. Front Microbiol. 2021;12:709974.
Seifert H, Müller C, Stefanik D, et al. In vitro activity of sulbactam/durlobactam against global isolates of carbapenem-resistant Acinetobacter baumannii. J Antimicrob Chemother. 2020;75(9):2616–21.
Karlowsky JA, Hackel MA, McLeod SM. In vitro activity of sulbactam-durlobactam against global isolates of Acinetobacter baumannii-calcoaceticus complex collected from 2016 to 2021. Antimicrob Agents Chemother. 2022. https://doi.org/10.1128/aac.00781-22.
Yang Q, Xu Y, Jia P, et al. In vitro activity of sulbactam/durlobactam against clinical isolates of Acinetobacter baumannii collected in China. J Antimicrob Chemother. 2020;75(7):1833–9.
McLeod S, Hackel M, Miller A. In vitro activity of sulbactam-durlobactam against Acinetobacter baumannii clinical isolates collected in 2020 from China [abstract no. 2034 plus poster]. In: ASM Microbe 2022. 2022.
Findlay J, Poirel L, Bouvier M, et al. In vitro activity of sulbactam-durlobactam against carbapenem-resistant Acinetobacter baumannii and mechanisms of resistance. J Glob Antimicrob Resist. 2022;30:445–50.
McLeod SM, Shapiro AB, Moussa SH, et al. Frequency and mechanism of spontaneous resistance to sulbactam combined with the novel β-lactamase inhibitor ETX2514 in clinical isolates of Acinetobacter baumannii. Antimicrob Agents Chemother. 2018. https://doi.org/10.1128/aac.01576-17.
Carter N, Miller A, McLeod S. Sulbactam-durlobactam is bactericidal against clinical isolates of Acinetobacter baumannii [abstract no. 2364 plus poster]. In: ASM microbe 2022. 2022.
O’Donnell JP, Bhavnani SM. The Pharmacokinetics/pharmacodynamic relationship of durlobactam in combination with sulbactam in in vitro and in vivo infection model systems versus Acinetobacter baumannii-calcoaceticus complex. Clin Infect Dis. 2023;76(Suppl 2):S202–9.
Carter N, Miller A, McLeod S. In vitro activity of sulbactam-durlobactam in combination with other antimicrobial agents [abstract no. 2365 plus poster]. In: ASM microbe 2022. 2022.
O’Donnell J, Maloney K, Steidler M, et al. A randomized, double-blind, placebo- and positive-controlled crossover study of the effects of durlobactam on cardiac repolarization in healthy subjects. Clin Transl Sci. 2021;14(4):1423–30.
Lickliter JD, Lawrence K, O’Donnell J, et al. Safety, pharmacokinetics, and drug-drug interaction potential of intravenous durlobactam, a β-lactamase inhibitor, in healthy subjects. Antimicrob Agents Chemother. 2020. https://doi.org/10.1128/aac.00071-20.
Rodvold KA, Gotfried MH, Isaacs RD, et al. Plasma and intrapulmonary concentrations of ETX2514 and sulbactam following Intravenous administration of ETX2514SUL to healthy adult subjects. Antimicrob Agents Chemother. 2018. https://doi.org/10.1128/aac.01089-18.
Sagan O, Yakubsevitch R, Yanev K, et al. Pharmacokinetics and tolerability of intravenous sulbactam-durlobactam with imipenem-cilastatin in hospitalized adults with complicated urinary tract infections, including acute pyelonephritis. Antimicrob Agents Chemother. 2020. https://doi.org/10.1128/aac.01506-19.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
The preparation of this review was not supported by any external funding.
Authorship and Conflict of interest
During the peer review process the manufacturer of the agent under review was offered an opportunity to comment on the article. Changes resulting from any comments received were made by the authors on the basis of scientific completeness and accuracy. Susan J. Keam is a contracted employee of Adis International Ltd/Springer Nature, and declares no relevant conflicts of interest. All authors contributed to the review and are responsible for the article content.
Ethics approval, Consent to participate, Consent to publish, Availability of data and material, Code availability
Not applicable.
Additional information
This profile has been extracted and modified from the AdisInsight database. AdisInsight tracks drug development worldwide through the entire development process, from discovery, through pre-clinical and clinical studies to market launch and beyond.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Keam, S.J. Sulbactam/Durlobactam: First Approval. Drugs 83, 1245–1252 (2023). https://doi.org/10.1007/s40265-023-01920-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40265-023-01920-6