Xacduro
Xacduro (sulbactam / durlobactam) is a combination medication that works to treat certain types of pneumonia that's caused by bacteria called Acinetobacter baumanii-calcoaceticus complex. It's typically used for adults who are in the hospital. Xacduro (sulbactam / durlobactam) is usually given as a 3-hour infusion into the veins every 6 hours for 1 to 2 weeks. Side effects can include diarrhea and changes to liver enzyme levels in the blood.
What is Xacduro (sulbactam / durlobactam)?
What is Xacduro (sulbactam / durlobactam) used for?
- Pneumonia caused by bacteria called Acinetobacter baumanii-calcoaceticus complex that develops when you're in the hospital or on a ventilator (breathing machine)
How Xacduro (sulbactam / durlobactam) works
Xacduro (sulbactam / durlobactam) is a combination of two medications that work together to treat infections caused by certain bacteria.
- Sulbactam is a beta-lactam antibiotic. It kills bacteria by preventing them from making a covering around themselves for protection.
- Durlobactam is a beta-lactamase inhibitor. Beta-lactamases are proteins that bacteria use to break down antibiotics, like sulbactam, so that the antibiotics don't work well to kill the bacteria. Durlobactam protects sulbactam from being broken down. This allows sulbactam to work to fight the bacteria and treat the infection.
Drug facts
Side effects of Xacduro (sulbactam / durlobactam)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Changes in liver enzyme levels in the blood (19%)
- Diarrhea (17%)
- Anemia (low red blood cell count, 13%)
- Low potassium levels (12%)
- Heart rhythm problems (9%)
Less Common Side Effects
- Constipation
- Kidney problems
- Low platelet count
Xacduro (sulbactam / durlobactam) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious allergic reaction: hives, rash, blisters, skin reddening, swelling of the lips or tongue, difficulty breathing
- C. difficile-related diarrhea: foul-smelling diarrhea, frequent bowel movements (up to 15 times per day), fever, stomach pain or cramps
The following Xacduro (sulbactam / durlobactam) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Severe diarrhea, fever
- Unusual vaginal discharge, itching, or odor
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Xacduro (sulbactam / durlobactam)
Pros
- Works well to fight against a resistant and hard-to-treat form of Acinetobacter
- Can use in people with kidney or liver problems
- Safe to use in people with a latex allergy because the rubber stopper isn't made with latex
Cons
- Only approved for pneumonia caused by Acinetobacter
- Given as often as every 6 hours for most people
- Each infusion lasts for 3 hours
- Hasn't been studied in children
Pharmacist tips for Xacduro (sulbactam / durlobactam)
- Your provider might order blood tests to make sure you're not having side effects during your treatment with Xacduro (sulbactam / durlobactam). Examples of some tests include those that check your liver health, kidney health, blood potassium level, and blood cell counts. Based on your results, your provider will decide whether it's safe for you to continue Xacduro (sulbactam / durlobactam) or not.
- Xacduro (sulbactam / durlobactam) can cause diarrhea. In general, it should go away when you stop taking the antibiotic. But tell your provider if you start having watery or bloody diarrhea, fever, fatigue, or stomach cramps anytime during treatment or after stopping Xacduro (sulbactam / durlobactam). These can be signs of infectious diarrhea that can be serious and needs to be treated right away.
- Make sure your provider is aware of all the medications you're taking, especially if you're taking probenecid. Probenecid can raise the levels of Xacduro (sulbactam / durlobactam) in your blood, which can cause side effects. For this reason, Xacduro (sulbactam / durlobactam) and probenecid shouldn't be used together.
- Tell your provider if you develop other symptoms of an illness or if your symptoms become worse. You might need to be tested for an infection caused by a virus or fungus and get appropriate treatment.
Common questions about Xacduro (sulbactam / durlobactam)
Xacduro (sulbactam / durlobactam) covers (or fights off) a bacteria called Acinetobacter baumanii-calcoaceticus complex, or simply, Acinetobacter. This bacteria can cause potentially severe and life-threatening infections if they aren't properly treated. This is especially true if the infection is caused by the resistant (hard-to-treat) form of this bacteria called CRAB (carbapenem-resistant Acinetobacter). People at risk for Acinetobacter infections include those on ventilators (breathing machines), those who are in the hospital for a long time, those who have open wounds from surgery, and those with catheters. Xacduro (sulbactam / durlobactam) can be used when it's confirmed or suspected that an infection is caused by Acinetobacter and other antibiotics can't be used.
No, Xacduro (sulbactam / durlobactam) doesn't cover or fight against the Pseudomonas bacteria. It mainly works against a specific species of bacteria called Acinetobacter. Other antibiotics that can treat bacterial infections caused by Pseudomonas include meropenem (Merrem) and aztreonam (Azactam).
It depends on your reaction to penicillin. Both Xacduro (sulbactam / durlobactam) and penicillin are categorized as beta-lactam antibiotics. Since they're in the same drug class and have similar chemical structures, it's possible to have an allergic reaction to Xacduro (sulbactam / durlobactam) if you're allergic to penicillin. Your provider will decide to use Xacduro (sulbactam / durlobactam) to treat your infection based on how severe your reaction to penicillin was in the past. For example, it's probable that your provider will treat you with Xacduro (sulbactam / durlobactam) if you had a mild reaction (like rash or itchiness); they'll closely watch for allergic reactions while you get treated. But your provider might decide to use a different kind of antibiotic if you had a severe reaction (like facial swelling, closing of the throat, or anaphylaxis).
No. Xacduro (sulbactam / durlobactam) is only available as an injection; your healthcare team will inject the medication into your vein. Currently, there isn't an available antibiotic that you can take by mouth that's on the market and considered equivalent to Xacduro (sulbactam / durlobactam).
It takes about 10 to 12 hours for most of Xacduro (sulbactam / durlobactam) to leave the body after one dose for people with healthy kidneys. This time frame is based on an estimate of the medication's half-life, which is a measure of how long it takes the body to remove the medication from its system. The kidneys help the body get rid of the medication. So when the kidneys aren't working as well as they should like in people with kidney problems, it can take longer for the body to remove Xacduro (sulbactam / durlobactam).
It's not known how safe Xacduro (sulbactam / durlobactam) is for pregnant people because it hasn't been studied. Be sure your healthcare team knows that you're pregnant before you start treatment with Xacduro (sulbactam / durlobactam). Your provider will weigh the risks and benefits of using this medication before starting treatment.
It's not completely clear whether it's safe to breastfeed while you're taking Xacduro (sulbactam / durlobactam), but it's thought to be generally acceptable. It's expected for Xacduro (sulbactam / durlobactam) to reach low levels in breast milk that probably won't cause harm to babies. Let your provider know if your baby is having diarrhea after feeding. Your provider might ask you to switch to using formula for your baby while you're getting treated.
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Risks and warnings for Xacduro (sulbactam / durlobactam)
Xacduro (sulbactam / durlobactam) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Allergic reactions
- Risk factors: Allergy to other beta-lactam antibiotics (e.g., penicillins, cephalosporins, carbapenems)
Allergic reactions to Xacduro (sulbactam / durlobactam) are possible. These reactions can include serious skin reactions and life-threatening reactions like facial swelling, shock, and anaphylaxis (closing of the throat). Let your provider know if you have an allergy to antibiotics. Get medical attention right away if you notice hives, rash, red skin, swelling of the lips or tongue, or difficulty breathing during or after treatment with Xacduro (sulbactam / durlobactam).
Diarrhea from Clostridioides difficile infection
Antibiotics, including Xacduro (sulbactam / durlobactam), raise your risk of getting infected with a bacteria called Clostridioides difficile (C. diff). This infection can cause diarrhea that can sometimes be life-threatening. Antibiotics change the amount of normal bacteria in your stomach and intestines. This can cause C. diff to overgrow in your gut and lead to an infection. This type of infectious diarrhea is different from the diarrhea you might have as a possible side effect of Xacduro (sulbactam / durlobactam). C. diff-related diarrhea can cause rapid heart rate, fever, nausea, foul-smelling diarrhea, bloody stools, or frequent bowel movements (even up to 15 times per day). This type of diarrhea is a medical emergency, so call for help as soon as possible if you experience any of these symptoms. You'll get tested for C. diff infection and receive treatment, if needed.
Low blood cell counts
Xacduro (sulbactam / durlobactam) can lower the number of red blood cells and platelets in your body. This can put you at risk for anemia and bleeding. During treatment, your provider might order blood draws to check your blood cell counts. Tell your provider if you experience symptoms of anemia (e.g., tiredness, headache, pale skin, fast heart rate) or bleeding (e.g., dizziness, feeling faint, bruising, bleeding that lasts a long time).
Xacduro (sulbactam / durlobactam) dosage
Typical dosage for Xacduro (sulbactam / durlobactam)
The typical dose is 1 gram of sulbactam and 1 gram of durlobactam given as an intravenous (IV) infusion into the veins every 6 hours for 7 to 14 days.
The dose might differ based on whether you have kidney problems. And the length of your treatment depends on how serious your infection is and how well Xacduro (sulbactam / durlobactam) is working to fight the infection. Your provider will determine the right dose and length of treatment for you.
Xacduro (sulbactam / durlobactam) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Xacduro (sulbactam / durlobactam) will not be safe for you to take.
- Allergy to other beta-lactam antibiotics (e.g., penicillins, cephalosporins, carbapenems)
What are alternatives to Xacduro (sulbactam / durlobactam)?
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