New Antibiotics Offer Hope, But Stewardship Challenges Remain

Pharmacists face critical need to rethink deployment of beta-lactam/beta-lactamase inhibitor combinations in Gram-negative infections

Published on Mar. 10, 2026

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The emergence of new beta-lactam/beta-lactamase inhibitor (BL/BLI) antibiotic combinations is reshaping the treatment of multidrug-resistant Gram-negative infections, but innovation alone is not enough. Hospital pharmacists are facing a critical need to rethink when and how these agents are deployed, moving beyond traditional restriction-based stewardship to a more nuanced, evidence-driven approach.

Why it matters

Antimicrobial resistance (AMR) is a growing global threat, linked to 1.14 million deaths worldwide in 2021. Gram-negative bacteria, particularly Enterobacterales like E. coli and Klebsiella pneumoniae, are driving this rise in drug-resistant infections. While new BL/BLI combinations offer promise, optimizing their use is crucial to preserving their effectiveness.

The details

The new BL/BLI combinations, such as cefepime/enmetazobactam, avibactam/aztreonam, and meropenem/vaborbactam, have shown improved activity against certain resistant Gram-negative pathogens. However, simply having these agents available is not enough. Pharmacists must balance timely access to these life-saving drugs with the need to preserve their effectiveness through strategic deployment. This includes considering factors like optimal drug exposure, evolving resistance patterns, and the unique challenges posed by pathogens like Pseudomonas aeruginosa.

  • In 2021, antimicrobial resistance was linked to 1.14 million deaths globally.
  • Between 2019 and 2024, drug-resistant bacteraemia increased by 13.1% in the UK.

The players

Professor Andrew Seaton

President of the British Society for Antimicrobial Chemotherapy (BSAC), who has described antimicrobial resistance as a 'supreme global threat'.

Dr. Ryan Shields

A researcher at the University of Pittsburgh Medical Center who has highlighted the 'stewardship dilemma' of balancing timely access to new antibiotics with the need to preserve their effectiveness.

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What they’re saying

“Antimicrobial resistance is a 'supreme global threat'.”

— Professor Andrew Seaton, President, British Society for Antimicrobial Chemotherapy (newsy-today.com)

“There is a 'stewardship dilemma': balancing timely access to life-saving drugs with the need to preserve their effectiveness.”

— Dr. Ryan Shields, Researcher, University of Pittsburgh Medical Center (newsy-today.com)

What’s next

Experts emphasize the need for a more proactive, evidence-based approach to antimicrobial stewardship, including earlier treatment selection and adjusting strategies based on evolving resistance patterns.

The takeaway

The success of new antibiotics like BL/BLI combinations depends on factors like early pathogen detection, optimized drug exposure, and strategic integration into treatment pathways. Pharmacists play a crucial role in ensuring appropriate antibiotic use and minimizing the development of resistance.