Strongly Bactericidal All-Oral beta-Lactam Combinations for the Treatment of Mycobacterium abscessus Lung Disease

Bioactive forms of oral beta-lactams were screened in vitro against Mycobacterium abscessus with and without the bioactive form of the oral beta-lactamase inhibitor avibactam ARX1796. Sulopenem was equally active without avibactam, while tebipenem, cefuroxime, and amoxicillin required avibactam for optimal activity. Systematic pairwise combination of the four beta-lactams revealed strong bactericidal synergy for each of sulopenem, tebipenem, and cefuroxime combined with amoxicillin in the presence of avibactam. These all-oral beta-lactam combinations warrant clinical evaluation.