Eravacycline, the First and Unique Fluorocycline Antibacterial Agent

Abstract

Fluorocycline has been approved for the treatment of complicated intra-abdominal infections (cIAIs) caused by gram-positive and gram-negative bacteria in noso-comial infections. Especially, eravacycline is a unique synthetic fluorocycline anti-bacterial agent that belongs to the tetracycline class. It acts against multidrug-resistant microorganisms such as carbapenem-resistant Enterobacteriaceae and extended-spectrum β-lactamase-generating bacteria. Representing the most advanced class of tetracyclines, eravacycline demonstrates broad-spectrum anti-bacterial activity against aerobic and anaerobic microorganisms. It can be an excellent replacement for carbapenem in treating β-lactam-induced allergic patients owing to its activity against extended-spectrum β-lactamase-producing strains. Furthermore, it exhibits efficacy against methicillin-resistant Staphylococcus aureus and many atypical pathogens for which carbapenems have shown a dispiriting effect. In vitro, eravacycline was effective against a broad spectrum of clinically related gram-positive and gram-negative bacteria that express acquired resistance mechanisms toward the standard tetracycline classes. The intravenous dosage form of eravacycline has been used in many countries, including the USA and the EU, for treating cIAIs with severe complications in hospitalized patients (aged ≥ 18). Its greater efficacy and superior tolerability index compared with other tetracycline-class drugs (such as tigecycline) make it the best option for treating cIAIs. Its broad-spectrum activity against the most common clinically related pathogens makes it unique compared with its other analogs. Thus, it has become a practical choice as an empirical therapy for the treatment of pathogens. In this review, we address the possibility of employing eravacycline to treat bacterial infections, focusing on its chemistry, mode of action, pharmacokinetics, treatment indications, adverse effects, and safety profiles.