The Combination of Aztreonam-Avibactam in Multidrug-Resistant Gram-Negative Infections

Aztreonam-avibactam (ATM-AVI) is used for difficult-to-treat gram-negative infections. The objective of this review is to analyze the pharmacology, safety, and clinical application of ATM-AVI. PubMed, Embase, and ClinicalTrials.gov were searched using the terms aztreonam avibactam, PF-06947387, Emblaveo, and ATM-AVI. Articles written in English and published from January 1, 1985, to June 10, 2025, that related to pharmacology, safety, clinical trials, and clinical application of ATM-AVI were reviewed. The ATM-AVI has shown similar efficacy to comparator antibiotics in complicated intra-abdominal infection (cIAI) and hospital/ventilator-acquired pneumonia (HAP/VAP). The REVISIT trial showed cIAI clinical cure rates of 76.4% and 74% for the ATM-AVI and meropenem groups, respectively (treatment difference 2.4% [95% confidence interval, CI = -7.4 to 13.0]). For HAP/VAP, clinical cure rates were 45.9% and 41.7% for the ATM-AVI and meropenem groups, respectively (treatment difference 4.3% [95% CI = -15.1 to 23.1]). The ATM-AVI was generally well tolerated, with hepatic adverse effects being the most commonly reported.Relevance to patient care and clinical practice comparison to existing drugs:The ATM-AVI has demonstrated clinical efficacy for the treatment of cIAI. However, its role needs to be further studied for other infections such as HAP/VAP, urinary tract, and other serious infections. Pharmacoeconomic analysis may be needed to assess the cost-benefit impact in the United States. The ATM-AVI may be an alternative option for the treatment of cIAI and other complicated gram-negative infections. Further studies are needed to delineate the role of ATM-AVI in clinical practice.