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Xacduro
sulbactam and durlobactam
Adult Dosing .
Dosage forms: INJ
pneumonia, hospital-acquired or ventilator-associated
- [1 dose IV q6h x7 days]
- Info: due to Acinetobacter baumannii-calcoaceticus complex; 1 dose = sulbactam 1 g + durlobactam 1 g; may extend duration based on clinical response; refer to IDSA guidelines; give 1 dose IV q4h if CrCl >130
renal dosing
- [see below]
- CrCl >130: 1 dose q4h; CrCl 45-129: 1 dose q6h; CrCl 30-44: 1 dose q8h; CrCl 15-29: 1 dose q12h; CrCl <15: 1 dose q24h, start 1 dose q12h x3 doses
- HD: 1 dose q24h, start 1 dose q12h x3 doses, on dialysis days administer after dialysis; consider supplement if next maintenance dose not due right after dialysis; PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- caution: hypersensitivity to beta-lactams
- caution: CrCl >130
- caution: renal impairment
- caution: antibiotic-associated colitis history, recent
Drug Interactions .
Overview
durlobactam
beta-lactamase inhibitor
-
None
sulbactam
beta-lactam antibiotic; beta-lactamase inhibitor
- OAT1 substrate
- alters GI flora
- impairs immunomodulatory bacterial infective agent
Avoid/Use Alternative
- BCG live intravesical
- cabotegravir
- cholera vaccine, live
- dichlorphenamide
- fecal microbiota, live
- fexinidazole
- methotrexate
- nitisinone
- probenecid
- trimethoprim
- typhoid vaccine, live
Monitor/Modify Tx
- warfarin
Caution Advised
- lactulose
- sodium picosulfate
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- C. difficile-associated diarrhea
Common Reactions
- LFTs incr.
- diarrhea
- anemia
- hypokalemia
- thrombocytopenia
- constipation
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; CBC, LFTs if prolonged tx
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no known risk of fetal harm based on human data with sulbactam; no human data available with durlobactam; possible risk of skeletal variations based on animal data at 2x and 4x MRHD with durlobactam
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no known risk of infant harm based on limited human data with sulbactam; no human data available to assess risk of infant harm with durlobactam; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for sulbactam and durlobactam: minimal; CYP450: none
Excretion: for sulbactam: for sulbactam: urine (75-85% unchanged); Half-life: 2.2h; for durlobactam: urine (78% unchanged); Half-life: 2.5h
Subclass: Beta-Lactamase Inhibitors ; Beta-Lactams
Mechanism of Action
for sulbactam: binds to peptidoglycan, inhibiting cell wall synthesis in Acinetobacter baumannii-calcoaceticus complex; for durlobactam: inhibits beta-lactamases, preventing beta-lactam degradation
Formulary .
No Formulary Selected
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