Ceftazidime 2g / Avibactam 500mg powder for solution for infusion vials

BackgroundCeftolozane-tazobactam and ceftazidime-avibactam are considered first-line treatment for multidrug-resistant (MDR) and/or difficult-to-treat resistant (DTR) Pseudomonas aeruginosa infections. Conflicting results in terms of clinical outcome and resistance development emerged from real-world comparative studies. We performed a systematic review with meta-analysis to compare ceftolozane-tazobactam and ceftazidime-avibactam in the treatment of MDR/DTR P. aeruginosa infections.MethodsTwo authors independently searched PubMed-MEDLINE and Scopus databases from inception to 18 November 2025 to retrieve studies comparing ceftolozane-tazobactam versus ceftazidime-avibactam in the management of MDR/DTR P. aeruginosa infections. Clinical cure was set as the primary outcome, whereas 90-day resistance development, microbiological failure, and the 30-day mortality rate were set as the secondary outcomes. Meta-analysis was performed by pooling the odds ratios (ORs) retrieved from studies providing adjustment for confounders by means of a random-effects model with the inverse variance method. The risk of bias in the included studies was independently assessed using the RoB 2.0 and the ROBINS-I tools.ResultsAmong a total of 1193 articles screened, 6 observational studies were retrieved and included (n = 1161; 644 receiving ceftolozane-tazobactam vs 517 receiving ceftazidime-avibactam). Ceftolozane-tazobactam showed a higher clinical cure rate than ceftazidime-avibactam (n = 4; OR, 1.82 [95% confidence interval, 1.10-2.99]; I2 = 25.3%). No difference emerged in terms of microbiological failure (n = 2; OR, 0.66 [95% confidence interval, .36-1.19]; I2 = 21.9%), 90-day resistance development (n = 3; OR, 1.11 [.51-2.42]; I2 = 50.0%), or 30-day mortality rate (n = 4; OR, 1.00 [.89-1.12]; I2 = 0.0%).ConclusionsOur meta-analysis showed that, after appropriate adjustment for confounders, ceftolozane-tazobactam could grant a higher clinical cure rate than ceftazidime-avibactam in the treatment of MDR/DTR P. aeruginosa infections.

Abstract licence: CC BY

BackgroundThe growing prevalence of multidrug-resistant Gram-negative bacilli poses major challenges to the management of severe paediatric infections. Ceftazidime/avibactam (CZA) and ceftolozane/tazobactam (C/T) are newer β-lactam/β-lactamase inhibitor combinations with established efficacy in adults.ObjectiveTo synthesize current evidence on the efficacy, effectiveness, and safety of CZA and C/T in hospitalized children with severe infections.MethodsWe conducted a systematic review, meta-analysis, and evidence map (PROSPERO CRD420251025715). Searches were performed in PubMed, Scopus, CENTRAL, Epistemonikos, LILACS, SciELO, and Web of Science. Eligible designs included randomized controlled trials (RCTs), cohort studies, case series, and case reports evaluating CZA or C/T for complicated intra-abdominal infections, complicated urinary tract infections (cUTI), pneumonia, or bacteraemia in patients aged 0-18 y. The primary outcome was 30-d mortality; secondary outcomes were clinical and microbiological cure and adverse events.ResultsNineteen studies (4 RCTs, 9 case series, 6 case reports) involving 472 patients were included. Sixteen studies evaluated CZA and three evaluated C/T. All RCTs were phase II, industry-sponsored, and excluded critically ill children and carbapenem-resistant infections. According to the updated RoB 2 assessment, two trials had overall low risk of bias, and two presented some concerns, mainly related to missing outcome data. No deaths occurred in RCTs, whereas observational studies reported 8% mortality. Clinical and microbiological cure exceeded 80% across study designs. Adverse events were generally infrequent; neonatal events clustered in case series, but evidence was insufficient for statistical comparison across age groups. Certainty of evidence ranged from moderate (cUTI with susceptible pathogens) to very low (pneumonia and resistant infections).ConclusionsCZA and C/T appear promising for paediatric cUTI and complicated intra-abdominal infections, but the evidence base remains narrow and largely dependent on small, industry-funded trials. Independent RCTs including critically ill children and resistant infections are urgently needed.

Abstract licence: CC BY