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Tebipenem HBr

Oral Carbapenem in Development for Treatment of Complicated Urinary Tract Infections (cUTIs)

Antibiotic resistance is a growing global health threat, and one troubling concern is the rise in resistant strains of E. coli, the bacteria that cause most UTIs.

UTIs are among the most common bacterial diseases worldwide and have significant clinical and economic burden. cUTIs are UTIs that are associated with the presence of underlying risk factors in patients, such as anatomical or functional abnormalities of the urinary tract. Patients with cUTI have a higher risk of recurrence and progression to severe infection, as well as a greater risk of morbidity and mortality when compared to uncomplicated UTI.

With an estimated three million cases each year in the United States, cUTI is a leading cause of infection-related hospitalization. According to Simmering et al., there has been a concerning 52% (population-adjusted) increase in the incidence of hospital admission for UTI over the course of a decade (1998-2011) which is associated with additional costs. In a nationwide cohort study, the total median 30-day post-index all-cause total healthcare costs for cUTI care ranged from $1,531 for patients initially identified in the outpatient setting to $13,028 for patients initially identified in the inpatient setting.

While drugs such as trimethoprim/sulfamethoxazole and fluoroquinolones (levofloxacin, ciprofloxacin) have been the primary oral options for treatment of UTIs caused by gram-negative organisms, nearly 30% to 35% of UTIs are resistant, which has led to increased use of IV-administered therapeutics such as carbapenems. Carbapenems have been utilized for more than 30 years and are considered the standard of care for many serious MDR gram-negative bacterial infections but have only been available as IV-administered formulations. Currently, there are no commercially available oral carbapenems for use in adults.

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Tebipenem HBr

Spero is developing Tebipenem HBr (tebipenem pivoxil hydrobromide; formerly SPR994) as a potential oral antibiotic for the treatment of cUTI and AP to help patients avoid hospitalizations (stay at home) and/or transition patients home after IV therapy (get home) if approved.

Carbapenems are an important subclass of antibiotics for the treatment of drug-resistant gram-negative bacterial infections. To date, carbapenems have emerged as the standard-of-care for many MDR gram-negative bacterial infections, but today they are only available as IV therapeutics for such indications.[6]

A Substantial Burden and Our Motivation to Succeed

Antibiotic resistance is a growing global health threat, and one particularly troubling concern is the rise in resistant strains of E. coli, which cause the majority of urinary tract infections (UTIs).[1,2,3] In a recent surveillance study conducted in the USA in 2022, 20.2% and 26.5% of isolates were resistant to levofloxacin and trimethoprim/sulfamethoxazole (TMP/SMX), respectively.[SENTRY 2022] Of note, the nationwide prevalence of extended-spectrum β-lactamase (ESBL) phenotype amongst E. coli was 12.0% among UTI isolates and 14.6% among E. coli from all specimen sources in 2022. [SENTRY 2022]

ESBL-Phenotype and Carbapenemase-Production Among Enterobacterales Isolates (USA 1997-2022)
Incidence Change Among Hospitalized Patients in the USA (2012 — 2017)
MRSA, methicillin-resistant Staphylococcus aureus; ESBL-E, extended-spectrum beta-lactamase producing Enterobacterales; VRE, vancomycin resistant Enterococcus spp.; MDR P. aeruginosa, multidrug-resistant Pseudomonas aeruginosa; CRE, carbapenem-resistant Enterobacter ales; CRAB, carbapenem-resistant Acinetobacter baumannnii. 

Incidence Change Among Hospitalized Patients in the USA (2012 — 2017)[4]

ESBL-producing Enterobacterales infections were the only major MDR pathogens in the United States with an observed increase in incidence for hospitalized patients between 2012-2017, driven by the 64% increase in community-onset cases and primarily from E. coli.[4]

In vitro activity of oral antibiotics against non-ESBL- and ESBL-phenotype E. coli from urinary tract isolates (USA 2022)

This is concerning, as approximately 80% of cUTI cases initially seek care in the outpatient setting.[5] Recent Infectious Diseases Society of America guidance for the treatment of cUTI or pyelonephritis due to ESBL-producing Enterobacterales recommend treatment with an intravenous carbapenem, a fluoroquinolone, or TMP/SMX.[6] Unfortunately, high co-resistance among the currently available oral treatment options may limit the ability to treat some patients in an outpatient setting.[3,7,8,9]

In vitro activity of oral antibiotics against non-ESBL- and ESBL-phenotype E. coli from urinary tract isolates (USA 2022)
AMOX/CLAV, amoxicillin/clavulanate; TMP-SMX, trimethoprim/sulfamethoxazole In vitro susceptibility determined using 2019 CLSI Interpretive criteria. Oral breakpoints used for cefuroxime. Dataset provided by JMI Laboratories and the SENTRY Antimicrobial Surveillance Program, available at sentry-mvp.jmilabs.com.

The Latest

In July 2023, Spero announced that it received written agreement from the U.S. Food and Drug Administration (FDA), under a Special Protocol Assessment (SPA), on the design and size of PIVOT-PO. PIVOT-PO is a global, randomized, double-blind, pivotal Phase 3 clinical trial. The trial compares oral tebipenem HBr with intravenous imipenem cilastatin, in hospitalized adult patients with cUTI/AP. The primary efficacy endpoint is overall response, which is a combination of clinical cure and favorable microbiological response, at the Test-of-Cure (TOC) visit. On January 2, 2024, Spero announced the first patient and the first visit for PIVOT-PO and commenced enrollment. The trial is expected to enroll approximately 2,648 patients, with enrollment completion targeted for 2H 2025. For more information on PIVOT-PO, refer to ClinicalTrials.gov ID NCT06059846.

Tebipenem HBr represents a promising step in helping to combat antibiotic-resistant infections.

Check out the latest posters and publications on tebipenem HBr:

Resources

World Health Organization (WHO)– antimicrobial resistance

The World Health Organization, an agency of the United Nations, was established in 1948 to promote health and control communicable diseases.

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The Centers for Disease Control and Prevention (CDC)

The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency under the Department of Health and Human Services, and is headquartered in Atlanta, Georgia.[2][3] The agency's main goal is the protection of public health and safety through the control and prevention of disease, injury, and disability in the US and worldwide.[4] The CDC focuses national attention on developing and applying disease control and prevention. It especially focuses its attention on infectious disease, food borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention, and educational activities designed to improve the health of United States citizens.

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American Society for Microbiology

Established in 1899, ASM is the home for microbial scientists from around the globe to connect, learn, discover, and prepare for the future.

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ClinicalTrials.gov

ClinicalTrials.gov is a database of clinical studies conducted worldwide. The community can follow the progress of tebipenem HBr as the candidate moves through clinical trials.ClinicalTrials.gov ID NCT06059846.

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References for Tebipenem HBr
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  1. Flores-Mierles AL, et al.  Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015; 13(5):269-84.
  2. Castanheira M, et al. Variations in the occurrence of resistance phenotypes and carbapenemase genes Among Enterobacteriaceae in 20 years of the SENTRY Antimicrobial Surveillance Program. Open Forum Infect Dis. 2019; 6(Suppl 1):S23-S33.
  3. Critchley IA, et al. The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017. PLoS One. 2019; 14(12):e0220265.
  4. Jernigan JA, et al. Multidrug-resistant bacterial infections in U.S. hospitalized patients, 2012-2017. N Engl J Med. 2020; 382(14):1309-1319.
  5. Carreno JJ, et al.  Longitudinal, nationwide, cohort study to assess incidence, outcomes, and costs associated with complicated urinary tract infection. Open Forum Infect Dis. 2020; 7(1):ofz536.
  6. Tamma PD, et al. Infectious Diseases Society of America Guidance on the treatment of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Clin Infect Dis. 2021; 72(7):1109-1116.
  7. Simmering J, et al. The increase in hospitalizations for urinary tract infections and the associated costs in the United States, 1998–2011. Open Forum Infec Dis. 2017; 4(1):ofw281.
  8. Talan D, et al. Emergence of extended-spectrum β-lactamase urinary tract infections among hospitalized emergency department patients in the United States. Ann Emerg Med. 2021; 77(1):32-43.
  9. Lodise TP, et al. Hospital admission patterns of adult patients with complicated urinary tract infections who present to the hospital by disease acuity and comorbid conditions: How many admissions are potentially avoidable? Am J Infect Control. 2021; S0196-6553(21)00382-5.

[Last updated July 2024]