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Sulbactam + avibactam is an experimental, non-commercial antibacterial combination consisting of two small-molecule beta-lactamase inhibitors. Sulbactam is a first-generation beta-lactamase inhibitor that also possesses intrinsic antibacterial activity against Acinetobacter species by targeting penicillin-binding proteins (PBP1a, PBP1b, and PBP3). Avibactam is a diazabicyclooctane (DBO) beta-lactamase inhibitor added to protect sulbactam from enzymatic degradation by beta-lactamases. In vitro studies have shown that the addition of avibactam restores sulbactam's activity against carbapenem-resistant Acinetobacter baumannii (CRAB) isolates, including those producing OXA-type carbapenemases and, in some studies, metallo-beta-lactamases like NDM. The combination is investigated as an off-label or research-use approach for multidrug-resistant or carbapenem-resistant A. baumannii infections, often administered clinically via the co-administration of ampicillin-sulbactam and ceftazidime-avibactam.
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