Monobactams update on Aztreonam and prospects for development of new drugs

Abstract

Introduction: Monobactams belong to the beta-lactam group and are drugs indicated for the treatment of infections caused by aerobic Gram-negative bacteria. Aztreonam is currently the only available representative of the group and, due to its clinical safety profile, efforts have been directed towards the development of new antibacterials in this class. Methodology: This is a narrative literature review that examines articles, books, and documents from various sources in Portuguese, English, and Spanish. The analysis focuses on relevant data regarding aztreonam and related compounds, addressing the main aspects of aztreonam
– brief history, chemical structure, mechanism of action, pharmacokinetics, pharmacodynamics, spectrum of action, resistance mechanisms, drug interactions, clinical indications, dosage, use in special situations, and adverse effects – as well as presenting the potential of the aztreonam-avibactam combination and the development of new monobactams. Results and Discussion: Aztreonam
has a unique chemical structure, containing a monocyclic beta-lactam ring. Its bactericidal action occurs through the inhibition of penicillin-binding protein-3 (PBP-3), affecting the cell wall synthesis of Gram-negative bacteria. In general, the drug is well-tolerated and causes mild adverse effects. Combinations like aztreonam-avibactam are promising for treating infections caused by multidrug-resistant bacteria. Studies highlight the need for new compounds, such as LYS228 and BAL30072, which expand the spectrum of action and overcome resistance mechanisms. Conclusion: Aztreonam remains relevant in antimicrobial therapy against Gram-negative infections. The development of new monobactams is a strategy to address increasing bacterial resistance and improve the treatment of complex infections.