Berotralstat
Severe
Database
Drug interaction classified as: excretion
Source: DDInter
Drug reference
cefiderocol
Siderophore cephalosporin (novel beta-lactam antibiotic) · Antibacterial, β-Lactam Antibiotic, Cell Wall Synthesis Inhibitor (Antipseudomonal Cephalosporin)
START
2 g IV over 3 h every 8 h
TYPICAL MAX
6 g/day (2 g q8h)
STOP IF
Severe hypersensitivity, C. difficile colitis, or seizures
WATCH
Renal function (dose-banding), C. difficile, seizures; resistance pattern
CDSCO approvedATC J01DI04
KDIGO 2024 + manufacturer label
- ONSET
- 6min · infusion start
- PEAK
- 3h · end infusion
- t½
- 2.5h · t½
- DURATION
- 8h · q8h
EXCRETION
Renal — ~99% unchanged
route + CYP
INTERACTIONS
10 major
SEVERE in our sources
PREGNANCY
Use only if benefit outweighs risk; limited data.
FDA category + note
Top interactionssee all 12 →
- BerotralstatSevereDatabaseDDInter
- BupropionSevereDatabaseDDInter
- ButorphanolSevereDatabaseDDInter
- FentanylSevereDatabaseDDInter
Mechanism
Catechol-substituted siderophore cephalosporin actively transported across the Gram-negative outer membrane via bacterial iron-uptake systems; binds PBP3 to inhibit cell-wall synthesis; stable against carbapenemases (MBL, KPC, OXA, ESBL).
Indications
Complicated urinary tract infections / pyelonephritis (resistant Gram-negatives)Hospital-acquired / ventilator-associated bacterial pneumonia (resistant Gram-negatives)
Dosing
- Adult
- 2 g IV every 8 h over 3 h.
- Pediatric
- ≥3 months (weight-band; specialist).
- Renal adjustment
- Stepwise reduction per CrCl band (e.g., 1.5 g q8h CrCl 60–89; 1 g q8h CrCl 30–59; 750 mg q12h CrCl 15–29; 750 mg q12h on HD post-dialysis).
- Hepatic adjustment
- No specific adjustment.
- Geriatric
- Adjust for renal function.
- Max dose
- 6 g/day (2 g every 8 h)
Pharmacokinetics
Onset
Bactericidal levels from infusion
Peak effect
End of infusion
Duration
Dose every 8 h
Half-life
~2–3 h
Bioavailability
IV 100%
Protein binding
~40–60%
Metabolism
Minimal
Excretion
Renal (~99% unchanged)
Contraindications
- Severe hypersensitivity to cephalosporins / beta-lactams
- Caution: history of seizures
Side effects
Common
DiarrhoeaInfusion-site reactionsConstipationRashIncreased liver enzymes
Serious
- Severe hypersensitivity / anaphylaxis
- C. difficile colitis
- Seizures (high dose, renal failure)
- Increased all-cause mortality in critically-ill HABP/VABP (CREDIBLE-CR observation)
Pregnancy & lactation
Pregnancy
Use only if benefit outweighs risk; limited data.
Lactation
Limited data; caution.
Drug interactions
Bupropion
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Butorphanol
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Fentanyl
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Hydrocodone
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Iohexol
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Iopamidol
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Oliceridine
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Oxycodone
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Tramadol
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Anticoagulants
Moderate
Database
Possible INR change (cephalosporin class)
Monitor INR
Source: Kimi deep-research + Cla
Other Beta Lactams
Moderate
Database
Class cross-reactivity
Caution in severe beta-lactam allergy history
Source: Kimi deep-research + Cla
Related guidelines
Ask House about cefiderocol
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Harrison 22e·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20