Ceftobiprole, the active metabolite of the
prodrug ceftobiprole medocaril (
Zevtera(®)), is a new generation broad-spectrum intravenous
cephalosporin with activity against methicillin-resistant Staphylococcus aureus.
Ceftobiprole exhibits potent in vitro activity against a number of Gram-positive and Gram-negative pathogens associated with
hospital-acquired pneumonia (HAP) and community-acquired
pneumonia (CAP). It is the first
cephalosporin monotherapy approved in the EU for the treatment of both HAP (excluding
ventilator associated-pneumonia [VAP]) and CAP. In phase III trials,
ceftobiprole medocaril was noninferior, in terms of clinical cure rates at the test-of-cure visit, to
ceftazidime plus
linezolid in patients with HAP and to ceftriaxone ± linezolid in patients with CAP severe enough to require hospitalization. In patients with HAP, noninferiority of
ceftobiprole medocaril to
ceftazidime plus
linezolid was not demonstrated in a subset of patients with VAP. In patients with CAP,
ceftobiprole medocaril was effective in those at risk for poor outcomes (
pneumonia severity index ≥91,
Pneumonia Patient Outcomes Research Team score IV-V or bacteraemic
pneumonia). In the phase III trials,
ceftobiprole medocaril was generally well tolerated, with ≈10 % of patients discontinuing the treatment because of adverse events. The most common treatment-related adverse events occurring in
ceftobiprole recipients in the trials in patients with HAP or CAP included
nausea, diarrhoea,
infusion site reactions,
vomiting, hepatic
enzyme elevations and hyponatraemia. Therefore,
ceftobiprole medocaril monotherapy offers a simplified option for the initial empirical treatment of patients with HAP (excluding VAP) and in those with CAP requiring hospitalization.