An overview of sulbactam‐durlobactam approval and implications in advancing therapeutics for hospital‐acquired and ventilator‐associated pneumonia by acinetobacter baumannii‐calcoaceticus complex: A narrative review

Abstract

Abstract Purpose Infections caused by Acinetobacter baumannii, particularly those resistant to antibiotics such as carbapenem, have become a global health crisis with a significant mortality rate. Hospital‐acquired pneumonia (HAP) and ventilator‐associated pneumonia (VAP) resulting from the A. baumannii‐calcoaceticus (ABC) complex represent a major clinical challenge. This review aimed to understand the approval process, mechanism of action, therapeutic potential, and future implications of sulbactam‐durlobactam therapy (SUL‐DUR). Methods PubMed, Web of Science, EMBASE, Clinical trials. gov, ICTRP, and CENTRAL were searched for studies on SUL‐DUR for the treatment of hospital‐acquired pneumonia and ventilator‐associated pneumonia. Also, World Health Organization, U.S. Food and Drug Administration, and Centers for Disease Control and Prevention websites were searched for relevant information. Results SUL‐DUR, marketed as Xacduro, is a novel pharmaceutical combination that functions as a narrow‐spectrum parenterally administered antibiotic. Sulbactam acts as a β‐lactamase inhibitor, whereas durlobactam protects against degradation by A. baumannii enzymes. A phase 1 trial successfully established the safety and tolerability of SUL‐DUR in patients with normal and mild renal impairment. A phase 2 trial demonstrated the safety and tolerability of SUL‐DUR in a larger population with urinary tract infections. A phase 3 trial showed that SUL‐DUR was non‐inferior to colistin in terms of mortality in A. baumannii‐related VAP, HAP, and bacteremia. Conclusion The combination of sulbactam and durlobactam is a promising treatment option for HAP and VAP caused by ABC complex.

Keywords

• acinetobacter
• durlobactam
• hospital acquired pneumonia
• sulbactam
• ventilator associated pneumonia
• Xacduro