Minocycline Intravenous for the Treatment of Serious Infections Due to Gram-Negative Nonpseudomonal Bacteria, Including Stenotrophomonas maltophilia, Acinetobacter baumannii, and Burkholderia cepacia

Abstract

Background Data on the role of minocycline intravenous (IV) in the treatment of serious gram-negative infections under real-world conditions are sparse. This study sought to provide evidence of real-world practices, including outcomes and safety. Methods A multicenter observational study was conducted of 71 consecutive adult inpatients enrolled at 6 geographically diverse US hospitals between May 2015 and February 2018 who were treated with minocycline IV for gram-negative infections for at least 48 hours as monotherapy or combination therapy. Results Infections included pneumonia (51%) and bacteremia (25%). The most prevalent gram-negative pathogens included Stenotrophomonas maltophilia (52%), Acinetobacter baumannii (30%), and Burkholderia complex (10%). In vitro susceptibility to minocycline was 100% for S. maltophilia. Clinical plus microbiologic response was observed in 80% of evaluable patients. Treatment of 29 evaluable patient infections due to S. maltophilia resulted in a clinical response rate of 79% and a microbiologic response rate of 72%. All patients with bacteremia due to S. maltophilia responded to minocycline IV. There were 17 (24%) in-hospital deaths of which 8 responded to minocycline. Minocycline was well tolerated. Conclusions Minocycline demonstrated that high in vitro susceptibility against problematic gram-negative pathogens and administered as an IV formulation was associated with good clinical and microbiologic outcomes alone or in combination in a seriously ill patient population.

Overcoming Stenotrophomonas maltophilia Resistance for a More Rational Therapeutic Approach

“…Finally, Sierra-Hoffman et al analyzed an observational cohort of cases from 6 geographically diverse sites from 2015 to 2018 where intravenous minocycline was used for suspected or documented gram-negative infection. They included 71 patients, of whom 35 had primary S maltophilia infections (25 pneumonia, 5 bacteremia, 3 acute bacterial skin and skin structure infections, and 2 UTIs) [ 72 ]. The included patients were severely ill as 54% received mechanical ventilation and 52% received vasopressors.…”

Minocycline‐induced hyperpigmentation in a patient on long‐term Nocardia suppressive treatment

“…Type 4 occurs over existing scars. The growing challenge of multidrug‐resistant (MDR) bacteria has renewed interest in old antibiotics, with minocycline use being explored in various clinical situations 4–6 …”

Comparison Between Efficacy of Tygecycline and Minocycline in Multi Drug Resistant Acinetobacter Baumanii Isolated From Respiratory Tract Infections

“…Both Minocycline and Tigecyclin belong to the same group of antibiotics with encouraging clinical outcome against MDR A. baumannii infections (11). Therefore, this study was designed to compare the efficacy of Tygecyclin and Minocycline against MDR A. baumanii isolated from respiratory tract infections.…”