Cefiderocol !
A siderophore cephalosporin that enters bacteria through iron transporters; active against multidrug-resistant gram-negatives.
Updated 2026-11-01
The figure shows Pseudomonas aeruginosa PBP3 acylated by cefiderocol. On binding, cefiderocol loses its catechol group at position 3, and the form left in the crystal is the same one ceftazidime leaves (ligand CAZ), with which it shares its side chain.
Mechanism of action
Cefiderocol binds the PBPs and inhibits wall synthesis like other cephalosporins. The difference is how it gets in: a catechol group chelates iron, and the bacterium's iron transporters actively pump it inside at high concentration, besides entry through porins. It is stable to all types of β-lactamases, including metallo-β-lactamases, and is active against resistant Enterobacterales, Pseudomonas aeruginosa and Acinetobacter baumannii.
- Cefiderocol's catechol binds free iron
- The bacterium takes it up through its iron transporters
- Once inside, it resists β-lactamases and acylates PBP3
- The wall fails and the bacterium lyses
Pharmacokinetics
- Absorption
- Intravenous only.
- Elimination
- By the kidney; adjusted to kidney function.
Indications
- Urinary tract infections due to gram-negatives with few treatment options.
- Hospital-acquired and ventilator-associated pneumonia due to resistant gram-negatives.
Adverse effects
Common
- Nausea, vomiting, diarrhoea, constipation
- Pain, redness or swelling at the infusion site
- Oral or genital candidiasis
Contraindications
- Serious hypersensitivity to any component or to other β-lactams
Key interactions
- Other drugs and supplements
- The label asks for a full medication review; dose changes or monitoring may be needed.
What is monitored
- Clinical response and cultures
- Kidney function
- Neurological status in epilepsy or kidney failure
Administration and safety
- Intravenous infusion only.
- Use restricted to infections with few alternatives, under the antimicrobial stewardship programme.
Nursing care
- Before the first dose: ask about allergy to penicillins, cephalosporins and other β-lactams, and what the reaction was.
- Ask about epilepsy or previous seizures.
- Check the infusion site.
- Teach the patient to report watery or bloody diarrhoea, even weeks after the course ends.
Pregnancy and breastfeeding
Data in pregnant women are limited; it is used only if the benefit justifies the risk, and the team is told about any pregnancy.
Test yourself
Think of the answer, then tap the question to see it.
How does cefiderocol enter gram-negatives besides the porins?
Its catechol group chelates iron and the bacterium pumps it in through its active iron transporters, as if it were a siderophore.
Does cefiderocol resist metallo-β-lactamases?
Yes; it is stable to all types of β-lactamases, including metallo-β-lactamases, unlike ceftazidime + avibactam.
Which warning comes with cefiderocol?
A clinical trial showed higher mortality in patients with carbapenem-resistant gram-negative infections.
Related drugs
← Back to the class: Beta-lactams
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Cefiderocol Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); RCSB PDB - 9FZ7: Pseudomonas aeruginosa penicillin binding protein 3 in complex with cefiderocol (RCSB Protein Data Bank, 2026); Farmacología básica y clínica (Katzung), cap. 43 (McGraw Hill, 2025).
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Representative model, for educational purposes only.