Eravacycline for the treatment of complicated intra‐abdominal infections

Abstract

Eravacycline is a novel fluorocycline antibiotic in the tetracycline class, with activities against multidrugresistant organisms, extended-spectrum β-lactamaseproducing (ESBL) bacteria, and carbapenem-resistant Enterobacteriaceae. The approval of eravacycline by the U.S. Food and Drug Administration for the treatment of complicated intra-abdominal infection (cIAIs) was based on the success of two-Phase III clinical trials: IGNITE 1 and IGNITE 4. Two other Phase III trials, IGNITE 2 and IGNITE 3, have been conducted to assess efficacy and safety of eravacycline vs levofloxacin and ertapenem, respectively, for the treatment of complicated urinary tract infection, however, did not prove eravacycline's noninferiority. Therefore, eravacycline is approved for the treatment of cIAIs caused by gram-positive organisms, gram-negative organisms, and anaerobic pathogens in hospitalized patients aged 18 or older. Eravacycline has become a valuable medication to clinicians due to its unique coverage. Eravacycline is a great alternative in replacing carbapenems for patients with beta-lactam allergy due to its ESBL coverage. In addition, eravacycline covers atypical organisms and Methicillin-resistant Staphylococcus aureus, which carbapenems cannot. This article is a review of eravacycline's pharmacology, efficacy, safety profile, and potential clinical application.

Pseudomonas aeruginosa: Infections, Animal Modeling, and Therapeutics

“…Generally, tetracycline antibiotics are not very effective against P. aeruginosa infections and may even enhance its virulence by stimulating its T3SS virulence function [264]. However, eravacycline (a novel fully synthetic fluorocycline) is different in that it exhibits potent activity against a broad spectrum of clinically relevant Gram-positive and Gramnegative aerobic and anaerobic bacteria, including P. aeruginosa, and has been recently approved in several countries for the treatment of complicated intra-abdominal infections in adult patients [265][266][267]. It owes its potency to 2 modifications in the tetracyclic D ring at position C7 (fluorine atom addition) and C9 (pyrrolidinoacetamo group addition) [268], which allow it to be effective even in pathogens that express tetracycline-specific efflux and ribosomal protection mechanisms in clinical isolates [269].…”

Emergence of eravacycline heteroresistance in carbapenem-resistant Acinetobacter baumannii isolates in China

“…Notably, eravacycline is four times more effective than tigecycline against multidrug-resistant A. baumannii ( Zhanel et al., 2016 ). Eravacycline was approved for the treatment of complicated intra-abdominal infections in adults based on the success of two phase III clinical trials, IGNITE 1 and IGNITE 4, by the U.S. Food and Drug Administration (FDA) in 2018 ( Wang et al., 2021a ). Eravacycline is an intravenous and oral medication with the potential to treat CRAB infections.…”