In this bonus episode of Medication Talk, join us as we revisit our Notable New Meds of 2025 webinar and highlight two medications that didn’t make it into the main podcast—both newly approved antibiotics with important implications for clinical practice.
Listen in as our editors take a deeper look at:
- Gepotidacin (Blujepa) for uncomplicated urinary tract infections
- Aztreonam/avibactam (Emblaveo) for complicated intraabdominal‑abdominal infections
You’ll hear practical insights into where these therapies fit in current treatment approaches, what safety and interaction issues to watch for, and why they matter when resistance limits your options—giving you more confidence when either of these new meds show up in your practice.
**No CE Credit is available for this bonus episode.**
Use code mt1026b at checkout for 10% off a new or upgraded subscription.
TRC Healthcare Editors:
- Sara Klockars, PharmD, BCPS
- Stephen Small, PharmD, BCPS, BCPPS, BCCCP, CNSC
None of the speakers have anything to disclose.
This podcast is an excerpt from one of TRC’s monthly live CE webinars, the full webinar originally aired in December 2025.
The clinical resources related to this podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Chart: Urinary Tract Infections
- Chart: Aztreonam-avibactam (Emblaveo)
- Article: Keep Boosting Antibiotic Stewardship for Complicated UTIs
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Transcript:
This transcript is automatically generated.
Introduction
00:00:06 Narrator
Welcome to Medication Talk, an official podcast of TRC Healthcare, home of Pharmacist’s Letter, Prescriber Insights, and the most trusted clinical resources.
00:00:16 Narrator
On this special bonus episode, we’re revisiting our notable new meds of 2025 webinar to cover 2 medications we didn’t have time to include in the main podcast, both of which are new antibiotics.
00:00:28 Narrator
Gepotidacin (Blujepa) for uncomplicated urinary tract infections, and Aztreonam/Avibactam (Emblaveo) for complicated intra-abdominal infections.
00:00:42 Narrator
We’ll walk through where these drugs fit in therapy, key safety and interaction concerns, and practical tips so you feel more prepared when you see Blujepa or Emblaveo ordered or dispensed in your practice.
00:00:54 Narrator
And just so this bonus episode does not include continuing education credit.
00:01:00 Narrator
We still wanted to share these two additional 2025 approvals because they offer timely, real-world options for challenging infections and can help you feel more confident when you see Blujepa or Emblaveo on an order, a profile, or a prior auth request.
00:01:17 Narrator
You’ll hear from our regular hosts, two of our pharmacist editors on our team at TRC Healthcare.
00:01:23 Narrator
Associate Editor, Sara Klockars, and Assistant Editor, Stephen Small.
00:01:28 Narrator
Now, let’s take a closer look at these two new antibiotics.
Gepotidacin (Blujepa) for Uncomplicated Urinary Tract Infections
00:01:35 Steve Small
And now let’s move to some new antibiotics from 2025, starting with Gepotidacin or Blujepa for uncomplicated urinary tract infections.
00:01:46 Steve Small
Let’s first talk about what makes a urinary tract infection, or UTI, complicated versus uncomplicated, since gepotidacin can only be used for uncomplicated cases.
00:01:57 Steve Small
Uncomplicated UTIs are those that only affect the bladder.
00:02:00 Steve Small
They don’t involve other organs, and patients cannot have a fever. So pretty simple.
00:02:05 Steve Small
UTIs are considered complicated, though, if they spread from the bladder, such as to the kidney, known as pyelonephritis, or into the blood, known as bacteremia.
00:02:14 Steve Small
And if a patient has a fever, even with a bladder infection, that’s also considered complicated.
00:02:21 Steve Small
And patients with prostate infections or even urinary catheter infections also fall into this group.
00:02:26 Steve Small
So gepotidacin cannot be used for those patients.
00:02:30 Steve Small
Generally, complicated UTIs need more aggressive therapy, including possibly IV antibiotics in the hospital.
00:02:38 Steve Small
Now, UTIs are commonly caused by gram-negative bacteria, with E.coli being the most common.
00:02:45 Steve Small
And for uncomplicated UTIs, patients typically require 3 to 14 days of antibiotics, which usually depends on several factors, such as the antibiotic used.
00:02:55 Steve Small
And we currently have several antibiotics for uncomplicated UTIs.
00:02:59 Steve Small
You’ve likely seen prescriptions for antibiotics such as nitrofurantoin or cephalexin, and even quinolones, such as levofloxacin.
00:03:06 Steve Small
But we do know that antibiotic resistance poses an increasing threat to infection treatment, making these options unusable for some patients.
00:03:14 Steve Small
Plus, we know patients may have adverse effects or even allergies to certain antibiotics, creating a need for alternatives.
00:03:23 Steve Small
Now, Gepotidacin has been approved as an antibiotic, specifically for women 12 years and up who are at least 40 kilograms, who have an uncomplicated UTI.
00:03:33 Steve Small
And gepotidacin is considered a type 2 topoisomerase inhibitor.
00:03:37 Steve Small
Let’s look at that mechanism in more detail.
00:03:41 Steve Small
So topoisomerase enzymes are used by bacteria to help unwind DNA strands, opening them up so they can be used to make proteins.
00:03:49 Steve Small
Specifically, it helps take out kinks by temporarily breaking apart the DNA strand.
00:03:55 Steve Small
And once proteins are made, topoisomerase then joins the DNA back together, zips it up, and goes off to do its job somewhere else in the DNA strand.
00:04:04 Steve Small
Now, gepotidacin stops topoisomerase from leaving the DNA strand, so the DNA stays broken, making the bacteria unable to make vital proteins, and then the bacteria die.
00:04:15 Steve Small
And this is very similar to quinolone antibiotics, which also inhibit topoisomerase enzymes, but gepotidacin binds to a different site on that enzyme.
00:04:25 Steve Small
So bacteria can have resistant quinolones, but gepotidacin’s different site may offer another route to kill those resistant bacteria.
00:04:36 Steve Small
In terms of dosing, gepotidacin comes as 750-milligram oral tablets, and patients must take 1,500 milligrams or two tablets twice a day for five days.
00:04:47 Steve Small
The manufacturer specifies doses should ideally be taken roughly 12 hours apart, such as 8 a.m.
00:04:52 Steve Small
and 8 p.m.
00:04:53 Steve Small
based on how it was given in studies.
00:04:55 Steve Small
And it’s important to take it with food to help decrease GI side effects that we’ll talk about soon.
00:05:01 Steve Small
And keep in mind that it’s cleared by the liver and kidneys, so we should avoid gepotidacin in patients with severe dysfunction of either of these organs.
00:05:11 Steve Small
Jumping back to side effects here, some of gepotidacin’s adverse effects are similar to what we’ll see with quinolones, and even antibiotics in general.
00:05:19 Steve Small
Things like joint pain and QTc prolongation are things we look out for with quinolones, and nausea and vomiting we see with many meds.
00:05:26 Steve Small
But another interesting aspect of gepotidacin is that it has cholinergic activity.
00:05:31 Steve Small
It stimulates things like salivation and sweating, and even GI motility, causing abdominal pain and diarrhea.
00:05:38 Steve Small
Now let’s talk about this cholinergic activity a little bit more because it also plays a role in drug interactions.
00:05:46 Steve Small
These cholinergic side effects likely occur because gepotidacin has been shown to inhibit acetylcholinesterase.
00:05:53 Steve Small
This enzyme breaks down acetylcholine, a neurotransmitter that stimulates receptors that make us salivate, sweat, etc.
00:06:01 Steve Small
And inhibiting that enzyme increases these bodily functions because levels of acetylcholine go up.
00:06:08 Steve Small
In terms of drug interactions, this means that it can add to the effect of other cholinesterase inhibitors, meds such as donepezil used for Alzheimer’s disease.
00:06:18 Steve Small
It can also increase the muscle relaxant effect of succinylcholine, an injectable used in the hospital for intubating patients.
00:06:26 Steve Small
It can also counteract the effect of anticholinergic meds as well.
00:06:30 Steve Small
There’s lots of examples in this class.
00:06:33 Steve Small
So you may recognize meds like hyoscyamine for irritable bowel syndrome or oxybutynin for overactive bladder.
00:06:40 Steve Small
Also avoid this antibiotic with CYP3A4 inhibitors such as itraconazole we were talking about before.
00:06:45 Steve Small
These inhibitors can actually increase the level of gepotidacin in the body.
00:06:49 Steve Small
And on the flip side, avoid using it with CYP3A4 inducers as well, meds such as rifampin.
00:06:55 Steve Small
These can increase the metabolism of gepotidacin, which can cut levels in half.
00:07:01 Steve Small
And gepotidacin can also prolong the QT interval or timing within certain sections of the heart rhythm cycle.
00:07:08 Steve Small
We also see this with quinolone antibiotics.
00:07:10 Steve Small
And QT prolongation is important to think about since it can lead to possible arrhythmias, which can potentially be fatal in some cases.
00:07:18 Steve Small
And it’s important to avoid gepotidacin in patients with existing QT prolongation, and also to weigh the potential risks in patients who are taking other QT prolonging meds.
00:07:28 Steve Small
This includes certain antiarrhythmics like amiodarone, antipsychotics such as haloperidol, and methadone.
00:07:36 Steve Small
Based on all this, don’t expect to routinely use gepotidacin for UTIs.
00:07:41 Steve Small
Instead, expect to reserve it for patients with little to no other antibiotic options, whether that’s due to prior treatment failure or resistance.
00:07:48 Steve Small
And it can be used for E.coli strains that are quinolone resistant.
00:07:53 Steve Small
Since this med is approved for women, including teens, it’s important to point out here if we don’t have pregnancy or lactation safety evidence,
00:08:01 Steve Small
and it’s reasonable to recommend contraception in those cases.
00:08:04 Steve Small
And with this medication, it’s also expensive, almost $2,000 for a five-day course.
00:08:12 Steve Small
If dispensing gepotidacin, it’s important to make sure to emphasize that 12-hour interval for patients between doses.
00:08:18 Steve Small
It’s a good idea for patients to set timers for themselves to ensure they follow this approximate spacing.
00:08:24 Steve Small
And it’s important to highlight taking it with food.
00:08:26 Steve Small
Since GI intolerance can lead to poor adherence, we want patients to get the best out of their therapy.
00:08:31 Steve Small
And in the hospital for using this medication, it’s too soon to say how gepotidacin susceptibilities will be reported by labs.
00:08:38 Steve Small
So don’t jump to extrapolating quinolone sensitivity data to this med, even though they’re related.
00:08:44 Steve Small
For example, it may be effective for quinolone-resistant E.
00:08:47 Steve Small
coli.
00:08:48 Steve Small
And it’s a good idea to consult your infectious diseases colleagues if you have questions.
00:08:53 Steve Small
Now, regardless of whether you’re in a hospital or a community pharmacy, watch for drug interactions with this med.
00:08:59 Steve Small
As we saw before, there are many potential interactions.
00:09:02 Steve Small
Ensure EHR warning pop-ups are updated to include gepotidacin to help you spot those possible interactions.
00:09:09 Steve Small
And keep in mind, gepotidacin tablets come in a 20-count bottle, which matches up with the five-day recommended duration.
00:09:18 Steve Small
And this is a great chance to mention our urinary tract infections chart online.
00:09:22 Steve Small
Use it as a helpful resource for comparing uncomplicated and complicated UTIs, along with appropriate antibiotic options to consider.
00:09:32 Sara Klockars
So Steve, we are getting an audience question about gepotidacin.
00:09:36 Sara Klockars
Can you use gepotidacin if patients have an allergy to quinolones, such as levofloxacin?
00:09:45 Steve Small
That’s a great thought since both meds inhibit the same bacterial enzymes we talked about.
00:09:50 Steve Small
But despite that similarity, there’s still different chemical classes at the end of the day.
00:09:55 Steve Small
So the risk of a cross reaction here is low, but it’s still important to advise patients to watch for hypersensitivity symptoms, things like hives, swelling of the lips or tongue, things like that.
00:10:07 Sara Klockars
Excellent.
00:10:07 Sara Klockars
Thank you.
00:10:08 Sara Klockars
And I have one more for you.
00:10:10 Sara Klockars
Is Blujepa also approved for gonorrhea?
00:10:15 Steve Small
Yes, gepotidacin is also approved for uncomplicated urogenital gonorrhea in patients specifically 12 years and older who weigh
00:10:22 Steve Small
at least 45 kilos or 99 pounds.
00:10:25 Steve Small
And for now, really don’t expect to see this much as it’s likely to be saved for patients who really can’t take other options that we know have a longer track record of safety and efficacy.
00:10:36 Steve Small
And on the topic of gonorrhea, another new med, zoliflodacin, was also approved for this indication in patients 12 years and older.
00:10:46 Steve Small
So stay tuned for more when this becomes available.
Aztreonam/Avibactam (Emblaveo) for Complicated Intra-Abdominal Infections
00:10:50 Steve Small
And keeping with the antibiotic theme, let’s move to a new IV antibiotic for all of our hospital colleagues in the audience.
00:10:56 Steve Small
We’ll talk about aztreonam/avibactam, or Emblaveo, for complicated intra-abdominal infections.
00:11:03 Steve Small
Similar to UTIs, abdominal infections can also be uncomplicated or complicated.
00:11:09 Steve Small
Uncomplicated cases are infections confined to the inside of a GI organ.
00:11:14 Steve Small
A good example here, a classic one, is unruptured appendicitis.
00:11:18 Steve Small
Sometimes these patients don’t need surgery and just require antibiotics, but cases can become complicated if they’re allowed time to spread, such as if appendicitis ruptures.
00:11:28 Steve Small
Complicated cases can be serious.
00:11:30 Steve Small
Plus, these patients typically need surgery to control the infection, along with using broad-spectrum antibiotics.
00:11:37 Steve Small
They have a higher risk of bacterial resistance, making outcomes potentially worse.
00:11:43 Steve Small
Diving deeper into resistance risks here,
00:11:45 Steve Small
Some bacteria can make beta-lactamase enzymes.
00:11:49 Steve Small
These enzymes chew up and deactivate beta-lactam antibiotics, which include classes such as penicillins and cephalosporins, including cephalexin.
00:11:58 Steve Small
In fact, there are four classes of different beta-lactamase enzymes, all with different ways that they work and bacteria that make them.
00:12:06 Steve Small
A concerning one right now is class B or metallo-beta-lactamases, abbreviated as MBLs.
00:12:12 Steve Small
These specifically can break down carbapenems, such as meropenem or imipenem, which are some of our go-to antibiotics for very serious infections, or if patients have resistance to typical options.
00:12:24 Steve Small
And this MBL resistance is worrisome because it leaves us with few options to otherwise help patients if they have it.
00:12:33 Steve Small
This resistance with MBL is interesting because it plays into the backstory about why aztreonam/avibactam was developed.
00:12:39 Steve Small
Some hospitals have been using aztreonam with the combo drug ceftazidime-avibactam or Avycaz to treat multidrug-resistant bacteria, especially MBLs.
00:12:49 Steve Small
This is because aztreonam and avibactam work together against all four classes of beta-lactamases.
00:12:56 Steve Small
Avibactam inhibits classes A, C, and some D lactamases, while aztreonam has a structure that isn’t affected by class Bs, so it’s in a way shielded from that.
00:13:06 Steve Small
And you may be wondering, what about ceftazidime here?
00:13:09 Steve Small
Well, it sort of frankly just sits on the sidelines since aztreonam and avibactam pretty much have it covered.
00:13:15 Steve Small
And the question then became, why can’t aztreonam and avibactam just be combined together in that case?
00:13:22 Steve Small
And that is how we now have aztreonam/avibactam.
00:13:25 Steve Small
It’s specifically for complicated intra-abdominal infections in adults when they have no other options due to resistance, adverse effects, or other factors.
00:13:34 Steve Small
And it must be combined with metronidazole in these cases to cover anaerobic bacteria in the gut or Bacteroides as a common example, which can occur in intra-abdominal infections.
00:13:45 Steve Small
You may notice that the labeling for Emblaveo points out that approval for this indication is based on limited clinical safety and efficacy data.
00:13:54 Steve Small
Now, the study evidence we have is pretty minimal for these meds as a combined single product.
00:14:00 Steve Small
Instead, in this case, the FDA mostly relied on data we have for avibactam alone and aztreonam alone to really justify this approval.
00:14:09 Steve Small
In terms of how it works, we said earlier that some bacteria may have beta-lactamase enzymes that can chew up aztreonam, making it ineffective.
00:14:17 Steve Small
But thankfully, avibactam can bind to and inhibit these enzymes, preventing aztreonam from breaking down.
00:14:23 Steve Small
So you can think of avibactam as being aztreonam’s bodyguard in a way, protecting it from being damaged by these beta-lactamase enzymes.
00:14:30 Steve Small
And this protection allows aztreonam to then bind to penicillin-binding proteins in bacteria, which then stops bacterial cell wall production, which eventually then kills bacteria.
00:14:42 Steve Small
Now, this medication is only available IV, and it comes in 2 gram vials.
00:14:47 Steve Small
Keep in mind that each vial has 1.5 grams of aztreonam, along with 0.5 grams of avibactam.
00:14:53 Steve Small
And for patients with normal kidney function, so creatinine clearance above 50 mils per minute,
00:14:58 Steve Small
It’s recommended to give 2.67 grams as a loading dose, followed by 2 grams IV every six hours.
00:15:04 Steve Small
Now, patients with poor kidney function need their doses adjusted.
00:15:09 Steve Small
And this medication is infused over 3 hours.
00:15:13 Steve Small
That’s longer than we typically see for most antibiotics.
00:15:15 Steve Small
And what’s also interesting is that each dose can be diluted in at least 50 mLs or up to a max of 250 mLs of diluent.
00:15:24 Steve Small
Now, this can be a bag of normal saline, dextrose 5%, or even lactated Ringer’s.
00:15:29 Steve Small
But at 250 mL per dose, this means that a patient could get an extra 1 liter of fluid per day from this med alone.
00:15:37 Steve Small
Now, that could be a lot of fluid, especially for a seriously ill patient.
00:15:43 Steve Small
Some other unique side effects to think about are liver injury, anemia, and low potassium levels with this antibiotic.
00:15:50 Steve Small
And in general, patients getting this medication in the hospital are likely ill enough that they’ll be getting these labs checked regularly anyways.
00:16:00 Steve Small
Now, similar to gepotidacin, don’t expect to commonly see this medication in practice.
00:16:05 Steve Small
Where this antibiotic can come in handy is to treat MBL-resistant infections in the hospital when we would otherwise turn to carbapenems like meropenem or imipenem.
00:16:14 Steve Small
Now, some experts expect that aztreonam/avibactam might be used off-label outside of just intra-abdominal infections because of its unique niche.
00:16:23 Steve Small
And it’s more convenient than combining aztreonam with ceftazidime plus avibactam.
00:16:28 Steve Small
But expect hospitals to likely have restrictions for using this antibiotic, if they even carry it at all.
00:16:34 Steve Small
For example, we’ll likely need approval from your infectious diseases consult service first before dispensing it for a patient.
00:16:40 Steve Small
And keep in mind that this antibiotic is still not effective against some bacteria, including gram-positive bacteria, such as Staphylococcus.
00:16:48 Steve Small
And like we said earlier, it’s not effective against anaerobes, so it must be combined with metronidazole to give that coverage for intra-abdominal infections.
00:16:58 Steve Small
And pharmacists can play a role in ensuring that metronidazole is ordered with this med.
00:17:02 Steve Small
They should also be prepared for compatibility questions.
00:17:05 Steve Small
That three-hour infusion time can really tie up an IV line.
00:17:09 Steve Small
And since we don’t have a lot of compatibility data yet, nurses will be calling for recommendations.
00:17:14 Steve Small
So for example, adjust med timing or recommend adding more IV sites to run aztreonam/avibactam alone.
00:17:21 Steve Small
Clarify beyond-use dating in the admin instructions for nurses, this med should be refrigerated for up to 24 hours after prep, but after that, it’s a bit unique.
00:17:31 Steve Small
Bags can then be stored at room temp for a limited time, depending on their diluent.
00:17:35 Steve Small
So for example, a dose diluted in normal saline can be stored at room temp for up to 12 hours after being in the fridge for 24 hours.
00:17:43 Steve Small
But that timing is different for, let’s say, dextrose 5%. And this can be confusing.
00:17:49 Steve Small
So ideally, work with your IT colleagues to include automatic text in the order that explains this beyond-use dating info for nurses.
00:17:57 Steve Small
Also watch for pulmonary edema or other fluid overload symptoms if using those large diluent volumes we discussed.
00:18:03 Steve Small
And when appropriate, advocate diluting this antibiotic in the smallest volume needed to really avoid this issue.
00:18:09 Steve Small
And it’s good stewardship to have stop times on any antibiotic orders to make sure they aren’t used longer than needed.
00:18:15 Steve Small
For this antibiotic, generally limit the duration to 5 to 14 days of therapy.
00:18:21 Steve Small
For technicians, watch for possible confusion between aztreonam/avibactam and ceftazidime/avibactam.
00:18:29 Steve Small
They sound very similar, but they are not the same.
00:18:32 Steve Small
Keep in mind that the aztreonam version is refrigerated, whereas the ceftazidime vials are stored at room temp.
00:18:38 Steve Small
Diluents can also be confusing here.
00:18:40 Steve Small
Aztreonam/avibactam must be reconstituted with sterile water and then mixed in normal saline, dextrose 5%, or lactated Ringer’s.
00:18:49 Steve Small
And the clock is ticking here.
00:18:51 Steve Small
Once you reconstitute a vial with sterile water, you’ll need to transfer that to the diluent bag within one hour.
00:18:57 Steve Small
Don’t let vials sit down in the IV room hood.
00:19:00 Steve Small
And I’ll admit, the loading dose for this med is a bit unique, 2.67 grams.
00:19:05 Steve Small
So expect to use 2 vials for that dose, and you will have some drug left over.
00:19:12 Steve Small
There’s lots to know about this interesting antibiotic, so check out our aztreonam/avibactam new drug info sheet online as a quick guide on dosing, preparation, and more.
Conclusion
00:19:24 Narrator
We hope you enjoyed and gained practical insights from listening to this discussion.
00:19:29 Narrator
Now that you’ve listened, you can log in to your Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights account and access and print out additional materials on this topic, like charts and other quick reference tools.
00:19:42 Narrator
We’ve linked directly to a few relevant ones right in the show notes.
00:19:47 Narrator
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00:19:53 Narrator
Sign up today to stay ahead with trusted, unbiased insights and continuing education.
00:19:59 Narrator
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00:20:09 Narrator
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00:20:14 Narrator
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00:20:20 Narrator
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00:20:29 Narrator
Thanks for listening to Medication Talk!
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