Ashlan J. Kunz Coyne, PharmD, MPH, sat down with us write after MAD-ID 2025 to discuss some of the new antibiotics that were approved for ESBL-producing Enterobacterales.
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Transcript. This transcript was transcribed by Temi AI.
I'm Meg Callaghan with Infectious Disease Special Edition. If you want to introduce yourself.
So I'm Ashlan J. Kunz Coyne, PharmD, MPH, an an assistant professor at the University of Kentucky College of Pharmacy.
Thank you so much for taking the time to talk to us. So we just got through MAD-ID 2025, and I think you had more than one thing that you were talking about. Yes.
But today we wanted to talk specifically about new things coming in the pipeline. So let's start off with like an elevator pitch of what your talk was about? Yeah, absolutely. So my talk was a combination of myself talking about ESBL-producing Enterobacterales and Pranita D. Tamma, MD, MHS, talking about agents for MBL producers. So, the goal is to really highlight the agents that have been approved, that we have limited data for both clinically as well as in vitro and in vivo data to really help our ID community see, this is the data we have, but compared to our practice and daily decisions that we make, this is the data that we still need.
So when you're looking through all this new data, what are you most looking forward to? Yeah, so I mean, just in general it's very exciting being infectious diseases and seeing that we have multiple new agents as well as agents in the pipeline for ESBL-producing Enterobacterales infections because I mean, this is a type of infection that ESBL presence in Enterobacterales has been continually increasing for multiple decades. So what that results in is we end up having to use, you know, IV carbapenems where that's because we have cross resistance to some of the other first line options being, you know, quinolones or Bactrim.
So we've been kind of siloed into using just the IV carbapenem. So it's exciting to have these new agents specifically the agents that have already been FDA approved are sulopenem and then cefepime and enmetazobactam, both of which are available in IV formulation. But then sulopenem also has the oral formulation available. And so the other thing is that, when this new data comes out with these new agents, you're always trying to really look into, okay, how did they study them? What was the trial design? What were the comparator agents? And then from that, comparing it to how we practice to determine, okay, is this realistic compared to what we actually do? Or how do we need to conduct additional studies to really get, be better insight into their impact in practice?
Well, let me just go right off of that. So what were the studies, is it comparable to how you're practicing or is it more like this is we need a lot more study before we can do that in the real world?
Yeah, so I interestingly the, the allium trial, so the trial with Cefepime and enmetazobactam that compared, you know, that new agent to piperacillin tazobactam. So not all of the infections were ESBL-producing isolates, but about 20% were, and all the patients either had complicated UTI or pyelonephritis. So I mean, that's a very, very common infection that we see in clinical practice. The one thing that kind of makes it a challenge on drawing conclusions from this trial is the comparator agent being piperacillin-tazobactam, which we know has multiple concerns when it comes to using it for ESBL infection. So, you know, maybe unreliable susceptibility testing, you know, we're seeing microbiological failure because when you're exposing these isolates to piperacillin-tazobactam backend, you're getting this upregulation of resistance enzymes leading to, you know, drug resistance. And fortunately there is an ongoing trial looking at piperacillin-tazobactam for ESBL.
So hopefully we'll get some more information on can we use it, can we not use it? But I would say that was the one thing that I do wish the trial with Cefepime and enmetazobactam. I kind of wish the comparator would've been an IV carbapenem, but I see where they were coming from as far as like comparing it head-to-head with another fatal lactam beta-lactamase inhibitor combination.
Well thank you so much for taking the time to talk to us. I really appreciate it.
Absolutely. Thank you for having me. It was great to see everyone in sunny Florida at MAD-ID.