eravacycline
Regulatory sources consulted
Approved indications
- Complicated intra-abdominal infections in adults and adolescents aged 12 years or older weighing ≥50 kg.
Contraindications
Absolute
- Hypersensitivity to eravacycline, tetracyclines, or excipients.
Clinical warnings
- Major warning · Do not use under age 8 because of tooth discoloration and delayed ossification. Monitor hypersensitivity reactions and pancreatitis. — CIMA/AEMPS, ficha técnica 1181312005
- Major warning · It may cause Clostridioides difficile-associated diarrhea, including after completion; stop and treat according to severity. — CIMA/AEMPS, ficha técnica 1181312005
- It may cause photosensitivity. Limit sun/UV exposure and stop for marked erythema. — CIMA/AEMPS, ficha técnica 1181312005
Drug interactions
- HighStrong CYP3A4 inducers
Mechanism: They reduce eravacycline exposure.
Recommendation: Increase to 1.5 mg/kg IV every 12 hours while they are given.
CIMA/AEMPS, ficha técnica 1181312005
- ModerateAnticoagulants
Mechanism: The class may reduce prothrombin activity.
Recommendation: Monitor INR and adjust if appropriate.
CIMA/AEMPS, ficha técnica 1181312005
Adverse events
Common (≥1%)
Nausea, vomiting, and infusion-site reactions
Rare but serious
Anaphylaxis, pancreatitis, and liver injury
Pregnancy and lactation
Avoid during pregnancy, especially from the second half, because of permanent tooth effects and delayed fetal bone growth. Consider stopping breastfeeding or treatment.
Recent literature (PubMed)
Pneumonia is frequently encountered in clinical practice, and Gram-negative bacilli constitute a significant proportion of its aetiology, especially when it is acquired in a hospital setting. With the alarming global rise in multidrug resistance in Gram-negative bacilli, antibiotic therapy for treating patients with pneumonia is challenging and must be guided by in vitro susceptibility results. In this review, we provide an overview of antibiotics newly approved for the treatment of pneumonia caused by Gram-negative bacilli. Ceftazidime-avibactam, imipenem-relebactam and meropenem-vaborbactam have potent activity against some of the carbapenem-resistant Enterobacterales, especially Klebsiella pneumoniae carbapenemase producers. Several novel antibiotics have potent activity against multidrug-resistant Pseudomonas aeruginosa, such as ceftazidime-avibactam, ceftolozane-tazobactam, imipenem-relabactam and cefiderocol. Cefiderocol may also play an important role in the management of pneumonia caused by Acinetobacter baumannii, along with plazomicin and eravacycline.
- Acinetobacter baumannii treatment strategies: a review of therapeutic challenges and considerations.
Antimicrobial resistance poses a major challenge in the treatment of Acinetobacter baumannii. Acinetobacter spp. are intrinsically resistant to a number of commonly used antibiotics. Over the past 3 years, the European and American Professional Societies have provided important guidelines on the treatment options for carbapenem-resistant A. baumannii (CRAB). Here, we review the recent literature on combination regimens for CRAB as well as carbapenem-susceptible A. baumannii infections. We discuss the strengths and weaknesses of various agents used in combination, depending on the site of infection and their pharmacokinetic properties. Consistent with the 2024 Infectious Diseases of America (IDSA) update, sulbactam-durlobactam, in combination with background carbapenem therapy, remains the combination with the greatest reduction in mortality for pulmonary infections and has promising outcomes in bloodstream infections with CRAB. Sulbactam-based combination therapy remains an ideal part of targeted strategies and has been shown to be associated with reduced mortality. Certain agents have been highlighted in the literature for suboptimal outcomes, primarily pulmonary infections treated with cefiderocol, tigecycline, and eravacycline. Studies including non-pulmonary infections, specifically bacteremia and central nervous system (CNS) infections, are overall limited to case series and subgroup analyses. Important areas for further research include breakpoint evaluations for eravacycline and minocycline as well as subclinical resistance in cefiderocol.
Klebsiella pneumoniae is a Gram-negative opportunistic pathogen responsible for a variety of community and hospital infections. Infections caused by carbapenem-resistant K. pneumoniae (CRKP) constitute a major threat for public health and are strongly associated with high rates of mortality, especially in immunocompromised and critically ill patients. Adhesive fimbriae, capsule, lipopolysaccharide (LPS), and siderophores or iron carriers constitute the main virulence factors which contribute to the pathogenicity of K. pneumoniae. Colistin and tigecycline constitute some of the last resorts for the treatment of CRKP infections. Carbapenemase production, especially K. pneumoniae carbapenemase (KPC) and metallo-β-lactamase (MBL), constitutes the basic molecular mechanism of CRKP emergence. Knowledge of the mechanism of CRKP appearance is crucial, as it can determine the selection of the most suitable antimicrobial agent among those most recently launched. Plazomicin, eravacycline, cefiderocol, temocillin, ceftolozane-tazobactam, imipenem-cilastatin/relebactam, meropenem-vaborbactam, ceftazidime-avibactam and aztreonam-avibactam constitute potent alternatives for treating CRKP infections. The aim of the current review is to highlight the virulence factors and molecular pathogenesis of CRKP and provide recent updates on the molecular epidemiology and antimicrobial treatment options. Eravacycline is a parenterally administered tetracycline-like antibiotic used to treat moderate-to-severe intraabdominal infections due to susceptible organisms. Eravacycline use has been associated with a low rate of serum enzyme elevations during therapy but has not been convincingly linked to instances of clinically apparent acute liver injury.
Carbapenem resistant Enterobacterales (CRE) are a major threat to global health and hospital-onset CRE infections have risen during the COVID-19 pandemic. Novel antimicrobials are now available for the treatment of CRE infections. There remains an urgent need for new antimicrobials for CRE, especially for those producing metallo-β-lactamases. This article discusses previously published research supporting currently available novel antimicrobials for the treatment of CRE infections. Newer compounds currently being evaluated in clinical trials are covered. A literature search was conducted in PubMed over all available dates for relevant published papers and conference abstracts with the search terms, 'CRE,' 'carbapenem-resistant Enterobacterales,' 'β-lactam-β-lactamase inhibitor,' 'KPC,' 'NDM,' 'metallo-β-lactamase,' 'ceftazidime-avibactam,' 'meropenem-vaborbactam,' 'imipenem-cilastatin-relebactam,' 'cefiderocol,' 'eravacycline,' 'plazomicin,' 'taniborbactam,' 'zidebactam,' and 'nacubactam.' Novel antimicrobials for CRE infections have been developed, most notably the β-lactam-β-lactamase inhibitor combinations, though treatment options for infections with metallo-β-lactamase producing Enterobacterales remain few and have limitations. Development of antibiotics with activity against metallo-β-lactamase producing Enterobacterales is eagerly awaited, and there are promising new compounds in clinical trials. Finally, more clinical research is needed to optimize and individualize treatment approaches, which will help guide antimicrobial stewardship initiatives aimed at reducing the spread of CRE and development of further resistance.