Siderophore cephalosporin Pregnancy: There are no or limited data from use in pregnant women; animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. As a precautionary measure, it is preferable to avoid use during pregnancy. It is unknown whether cefiderocol/metabolites are excreted in human milk; a decision must be made whether to discontinue breast-feeding or the therapy.

Cefiderocol

Brand names: Fetcroja

Cefiderocol is an intravenous siderophore cephalosporin antibiotic reserved for serious infections due to aerobic Gram-negative organisms with limited treatment options.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 2 g every 8 hours (normal renal function, CrCL 90 to 120 mL/min)

Route: Intravenous infusion (over 3 hours)

Frequency: Every 8 hours

Product: Fetcroja (cefiderocol). Should be used to treat patients with limited treatment options only, after consultation with a physician experienced in the management of infectious diseases. To be used in combination with antibacterial agents active against anaerobic and/or Gram-positive pathogens when these are known or suspected to be contributing. Augmented renal clearance (CrCL 120 mL/min or greater): 2 g every 6 hours. Duration in accordance with the site of infection: complicated UTI including pyelonephritis and complicated intra-abdominal infections 5 to 10 days; hospital-acquired/ventilator-associated pneumonia 7 to 14 days (treatment up to 21 days may be required). CrCL calculated using the Cockcroft-Gault formula.

Dose adjustments

Renal

Mild renal impairment (CrCL 60 to 90 mL/min): 2 g every 8 hours. Moderate (CrCL 30 to 60 mL/min): 1.5 g every 8 hours. Severe (CrCL 15 to 30 mL/min): 1 g every 8 hours. End stage renal disease (CrCL <15 mL/min) and intermittent haemodialysis: 0.75 g every 12 hours (administer at the earliest possible time after completion of haemodialysis on haemodialysis days). Augmented renal clearance (CrCL 120 mL/min or greater): 2 g every 6 hours.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Hypersensitivity to any cephalosporin antibacterial medicinal product
Severe hypersensitivity (e.g. anaphylactic reaction, severe skin reaction) to any other type of beta-lactam antibacterial agent (e.g. penicillins, monobactams or carbapenems)

Side effects

Diarrhoea (8.2%)
Vomiting (3.6%)
Nausea (3.3%)
Cough (2%)
Rash; hypersensitivity including skin reactions and pruritus; elevations in liver tests (ALT, GGT, AST); infusion site reactions

Interactions

Drug/laboratory test interactions — may cause false-positive results in dipstick tests (urine protein, ketones, or occult blood); use alternate laboratory methods to confirm positive tests

Clinical monograph

How it works

It binds iron and is actively transported into bacteria through iron-uptake channels (a 'Trojan horse' mechanism), then inhibits cell-wall synthesis while remaining stable to many beta-lactamases, including some carbapenemases.

Prescribing in practice

It should be reserved for multidrug-resistant Gram-negative infections where alternatives are inadequate, ideally under specialist microbiology or infection advice, to preserve its activity.
Avoid in patients with known severe hypersensitivity to cephalosporins or other beta-lactams.
Susceptibility testing is important as resistance can emerge, and dosing must be adjusted for renal function including in patients on renal replacement therapy.

Monitoring

Monitor renal function to guide dosing, the clinical and microbiological response, and for hypersensitivity reactions.

Counselling the patient

This is a reserve antibiotic given by drip for difficult-to-treat infections.
Tell the team about any previous penicillin or cephalosporin allergy.
Report any rash, swelling or breathing difficulty during treatment.

Evidence & guidelines

Use is informed by the CREDIBLE-CR and APEKS-NP trials in carbapenem-resistant and Gram-negative nosocomial infections.

Reference: NICE TA763; BSAC; UKHSA AMR; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways