Exblifep, a new antibacterial for the treatment of urinary tract infections and pyelonephritis

Antibiotic resistance is an ever-present threat that demands constant innovations in order to treat urinary tract infections and pyelonephritis. Bacteria are known to develop various adaptations in order to evade eradication by antibiotic agents. In this project we have reviewed, Exblifep, one of the newer drugs that have been developed to target resistant bacteria. Exblifep, a combination of cefepime with enmetazobactam. Cefepime is a fourth-generation cephalosporin that contains a cephem nucleus and a side chain with a quaternary amine. It is considered a broad-spectrum antibiotic whose coverage includes most gram-negative bacteria and some gram positives, including MSSA and streptococcus spp. Enmetazobactam is a derivative of Tazobactam, which protects beta-lactam antibiotics from being broken down by many species of ESBLs, but does not contain any antibacterial properties on its own. The Enmetazobactam has a high binding affinity towards ESBLs due to the presence of N-methyl substitution in Enmetazobactam. Exblifep has received FDA approval (2024) to treat complicated urinary tract infections and pyelonephritis. Both components are largely excreted unchanged through the kidneys. In addition, Exblifep also carries a warning for an increased INR, neurotoxicity, and a risk of superinfection if used for an extended period of time. Thus, the appropriate clinical use, monitoring for adverse effects, and dose adjustments are required in patients with renal impairment to ensure both safety and long-term effectiveness of Exblifep.