The first US surveillance data collected after the FDA approval of ceftobiprole (Zevtera; Innoviva Specialty Therapeutics) show the advanced-generation cephalosporin retains activity against nearly all methicillin-resistant Staphylococcus aureus (MRSA). In a poster presented at IDWeek 2026, investigators with the SENTRY Antimicrobial Surveillance Program reported about 99% of MRSA isolates collected at US medical centers in 2025 were susceptible to ceftobiprole.¹
Gram-negative results were more mixed. Ceftobiprole inhibited 73% of Escherichia coli and Klebsiella pneumoniae isolates overall, compared with near-complete activity against isolates without an extended-spectrum β-lactamase (ESBL) phenotype.¹ The gap places ESBL risk at the center of empiric decisions in pneumonia and mixed infections.
The FDA approved ceftobiprole in April 2024 for 3 indications: S aureus bacteremia, including right-sided infective endocarditis, in adults; acute bacterial skin and skin structure infections in adults; and community-acquired bacterial pneumonia in adults and pediatric patients 3 months to younger than 18 years.² The bacteremia indication rested on the phase 3 ERADICATE trial, published in The New England Journal of Medicine, in which ceftobiprole was noninferior to daptomycin with or without aztreonam.³ Overall treatment success at day 70 was 69.8% (132/189) with ceftobiprole and 68.7% (136/198) with daptomycin.³
Innoviva acquired exclusive US marketing rights from Basilea Pharmaceutica in December 2024 and made the drug commercially available in May 2025.² The 2025 SENTRY collection offers clinicians the first contemporary look at susceptibility patterns since the agent entered routine use.
David Altarac, MD, chief medical officer at Innoviva Specialty Therapeutics, which markets ceftobiprole in the US, spoke with Contagion at IDWeek 2026 in Washington, DC. In the following interview, Altarac discusses the surveillance findings, empiric use when ESBL risk is present, and where ceftobiprole fits alongside ceftaroline.
Contagion: The 2025 SENTRY data show about 99% of MRSA isolates susceptible to ceftobiprole. How do these findings compare with preapproval susceptibility data?
Altarac: Ceftobiprole, or Zevtera, was approved, as you said, in 2024 based on a large randomized, controlled, double-blind study, where ceftobiprole was noninferior to the comparator in Staph bacteremia, including right-sided endocarditis, in both methicillin-susceptible Staph aureus and methicillin-resistant Staph aureus. The SENTRY findings are reassuring and consistent with the preapproval susceptibility data. We view these findings as an important continuation of the evidence rather than a new finding, and it underscores why surveillance matters. We need to know and follow contemporary isolates to monitor for the development of resistance. This is important as we move into clinical practice, to inform treatment decisions and continue to monitor for potential resistance development.