Siderophore Cephalosporin (Pan-Drug Resistant Gram-Negatives) Pregnancy: No or limited data (fewer than 300 pregnancy outcomes). Animal studies do not indicate reproductive toxicity. As a precautionary measure, it is preferable to avoid use during pregnancy.

Cefiderocol

Brand names: Fetcroja

Cefiderocol is a siderophore cephalosporin given intravenously for serious aerobic Gram-negative infections, including carbapenem-resistant organisms, where alternative treatment options are limited.

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

Route: Intravenous infusion over 3 hours

Frequency: Every 8 hours (normal renal function, CrCL 90 to 120 mL/min)

For patients with CrCL >=90 mL/min: normal renal function (CrCL >=90 to 120 mL/min) 2 g every 8 hours; augmented renal clearance (CrCL >=120 mL/min) 2 g every 6 hours. To be used in combination with antibacterial agents active against anaerobic and/or Gram-positive pathogens when these are contributing to the infection. Duration according to site of infection (e.g. complicated UTI/complicated intra-abdominal 5 to 10 days; hospital-acquired/ventilator-associated pneumonia 7 to 14 days; up to 21 days may be required). Recommended for patients with limited treatment options only, after specialist infectious-disease consultation. CrCL calculated using the Cockcroft-Gault formula.

Dose adjustments

Renal

Dose reduced by renal function: mild impairment (CrCL >=60 to 90 mL/min) 2 g every 8 h; moderate (CrCL >=30 to 60) 1.5 g every 8 h; severe (CrCL >=15 to 30) 1 g every 8 h; end-stage renal disease (CrCL <15) 0.75 g every 12 h; intermittent haemodialysis 0.75 g every 12 h (administer at the earliest possible time after completion of haemodialysis on dialysis days). No dose adjustment for hepatic impairment or in the elderly.

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%)
Candidiasis (including oral and vulvovaginal candidiasis, candiduria)

Interactions

May cause false-positive results in dipstick tests (urine protein, ketones, or occult blood); use alternate laboratory methods to confirm positive results (from US labelling)

Clinical monograph

How it works

It binds ferric iron and is actively transported into the bacterial periplasm via iron-uptake systems (a Trojan-horse mechanism), then inhibits cell-wall synthesis by binding penicillin-binding proteins; this entry route and its stability confer activity against many carbapenemase-producing organisms.

Prescribing in practice

Reserve for confirmed or strongly suspected multidrug-resistant Gram-negative infection with limited options, used under specialist microbiology advice, as some trial data showed higher mortality in certain critically ill subgroups.
Contraindicated in patients with hypersensitivity to cefiderocol or other cephalosporins, with caution in broader beta-lactam allergy.
Renally cleared, so dose adjustment is required across the range of renal function, including augmented renal clearance.

Monitoring

Monitor renal function, clinical and microbiological response, and consider susceptibility testing as activity is organism-specific.

Counselling the patient

This is a last-line hospital antibiotic for highly resistant infections.
Report any rash, diarrhoea, or breathing difficulty to the team.

Evidence & guidelines

The APEKS-NP and CREDIBLE-CR trials informed its use against carbapenem-resistant Gram-negative infections, the latter prompting caution in some critically ill patients.

Reference: Wunderink et al. NEJM 2021 (APEKS-NP); MHRA Drug Safety Update 2020; EMA assessment report Fetcroja; 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.

Calculators

Pathways