Strongly bactericidal all-oral β-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.