Fetroja® (Cefiderocol) — Novel Siderophore Cephalosporin for Drug-Resistant Gram-Negative Infections

The First Antibiotic to Use Iron Transport to Penetrate Resistant Bacteria

Fetroja® (Cefiderocol) is a novel siderophore cephalosporin antibiotic used to treat serious gram-negative infections caused by carbapenem-resistant organisms (CROs) — including carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia. Fetroja uses a unique iron-chelating mechanism to actively transport itself into resistant bacteria — overcoming the resistance mechanisms that defeat conventional antibiotics.

A.K. Pharma is a trusted medicine distributor in Delhi supplying genuine Fetroja (Cefiderocol) to hospitals, ICUs, infectious disease units, and pharmacies across India. Manufactured by Shionogi & Co., Fetroja represents a critical addition to the antibiotic arsenal against multidrug-resistant gram-negative infections that are increasingly common in Indian hospitals.

Also note — Fetroja is currently listed under “Diuretics” category on the website. This needs to be fixed.

Correct category: Anti Biotic

Go to Products → Fetroja → Edit → Categories → untick Diuretics → tick Anti Biotic → Update

What is Fetroja (Cefiderocol)?

Fetroja contains Cefiderocol — a novel catechol-substituted siderophore cephalosporin. Siderophores are small molecules that chelate (bind) iron with high affinity. Bacteria require iron for survival and have evolved sophisticated iron transport systems to capture iron from the environment.

Cefiderocol mimics bacterial siderophores by chelating ferric iron in the extracellular environment. The iron-Cefiderocol complex is then actively transported across the bacterial outer membrane through the bacteria’s own iron uptake transporters — a Trojan horse mechanism that delivers the antibiotic directly into the bacterial periplasm where it can exert its antibacterial effect.

This unique transport mechanism allows Cefiderocol to:

• Bypass outer membrane porin loss — a key resistance mechanism in gram-negative bacteria
• Achieve high periplasmic concentrations even in carbapenem-resistant organisms
• Evade efflux pump-mediated resistance
• Remain active against bacteria producing metallo-beta-lactamases (MBLs) and other carbapenemases

Full prescribing information is available at the FDA label for Cefiderocol.

Clinical Studies and Evidence

CREDIBLE-CR Trial (Cefiderocol vs Best Available Therapy in Carbapenem-Resistant Infections) Published in The Lancet Infectious Diseases (2021), the CREDIBLE-CR trial compared Cefiderocol to best available therapy (BAT) in patients with carbapenem-resistant gram-negative infections. Cefiderocol demonstrated clinical cure rates of 52.6% vs 19.6% for BAT in Acinetobacter infections and was generally comparable to BAT overall.

APEKS-NP Trial (Cefiderocol for Nosocomial Pneumonia) Published in The Lancet Infectious Diseases (2021), the APEKS-NP trial demonstrated Cefiderocol was non-inferior to high-dose extended-infusion Meropenem for the treatment of gram-negative nosocomial pneumonia including ventilator-associated pneumonia (VAP) — with all-cause mortality of 12.4% vs 11.6%.

APEKS-cUTI Trial (Cefiderocol for Complicated UTI) Published in The Lancet Infectious Diseases (2019), the APEKS-cUTI trial demonstrated Cefiderocol was superior to Imipenem-Cilastatin for microbiological eradication in complicated urinary tract infections caused by gram-negative bacteria.

Available Strengths

Fetroja is available as:

• 1g powder for concentrate for solution for infusion (vial)

The recommended dose is 2g IV every 8 hours — administered as a 3-hour extended infusion.

Indications — What Fetroja is Used For

• Hospital-Acquired and Ventilator-Associated Bacterial Pneumonia (HABP/VABP)
• Complicated Urinary Tract Infections (cUTI) with limited treatment options
• Carbapenem-resistant gram-negative infections including CRE, CRPA, CRAB, and Stenotrophomonas maltophilia

Key Benefits of Fetroja

Unique Siderophore Mechanism — The Trojan Horse Antibiotic Fetroja uses iron transport systems to actively penetrate resistant bacteria — bypassing the outer membrane permeability barriers that defeat conventional antibiotics.

Activity Against All Major Carbapenem-Resistant Pathogens Active against CRE, CRPA, CRAB, and Stenotrophomonas — the most challenging resistant gram-negative pathogens in Indian ICUs.

Stable Against All Beta-Lactamases Cefiderocol is stable against virtually all beta-lactamases including MBLs (NDM, VIM, IMP) — making it effective where Zavicefta fails.

Critical Last-Resort Option for XDR and PDR Infections For extensively drug-resistant and pan-drug-resistant gram-negative infections — Fetroja often represents the only treatment option.

How Fetroja Works

Step 1 — Iron Chelation: Cefiderocol chelates ferric iron (Fe³⁺) using its catechol siderophore moiety — forming a stable iron-Cefiderocol complex.

Step 2 — Active Transport (Trojan Horse): The iron-Cefiderocol complex is actively transported across the outer membrane via TonB-dependent iron transporters — bypassing outer membrane porins.

Step 3 — Periplasmic Accumulation: High concentrations of Cefiderocol accumulate in the bacterial periplasm.

Step 4 — PBP Inhibition: Cefiderocol binds to penicillin-binding proteins (PBPs) — inhibiting cell wall synthesis and causing bacterial cell death.

Fetroja vs Other Last-Resort Antibiotics

Dosage and Administration

• Administer as 3-hour IV infusion
• Reconstitute with sterile water, normal saline, or 5% glucose
• Duration: 7-14 days depending on indication

Storage and Handling

• Store at room temperature below 30°C or in refrigerator at 2°C-8°C
• Protect from light
• Single use vials — discard unused portion

Manufacturer Information

Fetroja (Cefiderocol) is manufactured by Shionogi & Co., Ltd.. Fetroja received FDA approval in November 2019 for cUTI and in September 2020 for HABP/VABP.

Related Antibiotic Medicines Available at A.K. Pharma

• Zavicefta (Ceftazidime-Avibactam) — for KPC and OXA-48 CRE infections
• Ambisome (Amphotericin B) — for severe fungal infections
• Browse all Anti Biotic Medicines available at A.K. Pharma