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[Pharmacology](https://durgical.com/en/pharmacology/) · [Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/)

# Cefiderocol

A siderophore cephalosporin that enters bacteria through iron transporters; active against multidrug-resistant gram-negatives.

Updated 2026-11-01

- Class: [Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/)
- Enzyme: Penicillin-binding proteins, mainly PBP3
- ATC code: J01DI04
- WHO Model List of Essential Medicines

✂**Penicillin-binding proteins, mainly PBP3**Cefiderocol

ⓘ 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.

**Target in 3D:** Penicillin-binding proteins, mainly PBP3. PDB structure 9FZ7 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/9FZ7) · Drag to rotate · pinch to zoom

## 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

### Serious (rare, important)

- Anaphylaxis
- Clostridioides difficile diarrhoea, from mild to severe colitis
- Higher mortality seen in one trial in carbapenem-resistant gram-negative infections
- Seizures: epilepsy or previous seizures are asked about before use

## 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.

## Memory aid

'Cefiderocol = an iron Trojan horse': the bacterium thinks it is importing iron and lets the enemy in through its own gate.

## 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.

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## Related drugs

- [Ceftazidime](https://durgical.com/en/pharmacology/ceftazidime/)
- [Ceftazidime + avibactam](https://durgical.com/en/pharmacology/ceftazidime-avibactam/)
- [Ceftolozane + tazobactam](https://durgical.com/en/pharmacology/ceftolozane-tazobactam/)

[← Back to the class: Beta-lactams](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a620008.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [RCSB PDB - 9FZ7: Pseudomonas aeruginosa penicillin binding protein 3 in complex with cefiderocol](https://www.rcsb.org/structure/9FZ7) (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.

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