From the Guidelines
Eravacycline provides effective coverage against vancomycin-resistant enterococci (VRE), making it a valuable option for treating VRE infections. This synthetic fluorocycline antibiotic, similar to tigecycline, demonstrates potent activity against both Enterococcus faecalis and Enterococcus faecium, including vancomycin-resistant strains 1. The typical dosing for eravacycline is 1 mg/kg intravenously every 12 hours, with each infusion administered over 60 minutes. For patients with severe hepatic impairment (Child-Pugh C), the dose should be reduced to 1 mg/kg every 24 hours. Eravacycline works by binding to the 30S ribosomal subunit, inhibiting bacterial protein synthesis through a mechanism that overcomes many tetracycline resistance mechanisms. It maintains activity against bacteria with tetracycline-specific efflux pumps and ribosomal protection proteins.
Some key points to consider when using eravacycline for VRE infections include:
- Eravacycline is recommended for complicated intra-abdominal infections or complicated urinary tract infections where VRE is suspected or confirmed, especially in patients who cannot tolerate or have failed other therapies 1.
- The recommended treatment duration for eravacycline is 5-7 days for complicated intra-abdominal infections and 5-7 days for complicated urinary tract infections 1.
- Common side effects of eravacycline include nausea, vomiting, and infusion site reactions.
- Eravacycline has not been approved by the Taiwan Food and Drug Administration as of January 2022, but it is considered a valuable option for treating VRE infections due to its potent activity against both Enterococcus faecalis and Enterococcus faecium, including vancomycin-resistant strains 1.
It is essential to note that the evidence for eravacycline's effectiveness against VRE is based on its in vitro activity and limited clinical data, and therefore, its use should be guided by susceptibility testing and clinical judgment 1.
From the FDA Drug Label
The following in vitro data are available, but their clinical significance is unknown At least 90 percent of the following bacteria exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for eravacycline against isolates of similar genus or organism group. Aerobic bacteria Gram-positive bacteria Enterococcus faecalis Enterococcus faecium ... Antimicrobial Activity XERAVA has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections [see Indications and Usage (1)]: Aerobic bacteria Gram-positive bacteria Enterococcus faecalis Enterococcus faecium
The coverage of Eravacycline against Vancomycin-Resistant Enterococci (VRE) is not explicitly stated in the provided drug label. However, it does mention that Eravacycline has been shown to be active against Enterococcus faecalis and Enterococcus faecium, which can include VRE strains.
- Key points:
- Eravacycline is active against Enterococcus faecalis and Enterococcus faecium.
- The label does not explicitly state coverage against Vancomycin-Resistant Enterococci (VRE).
- Clinical significance of the in vitro data is unknown. Based on the information provided, it is unclear if Eravacycline is effective against VRE. 2
From the Research
Coverage of Eravaclycline against Vancomycin-Resistant Enterococci (VRE)
- Eravacycline has been shown to have potent in vitro activity against enterococcal clinical isolates, including Vancomycin-Resistant Enterococci (VRE) 3.
- The MIC50/90 values for eravacycline against Enterococcus spp. were 0.06 and 0.12 μg/ml, respectively, and were within 1 doubling dilution regardless of the vancomycin susceptibility profile 4.
- Although eravacycline has excellent in vitro activity against enterococci, including VRE, emergence of resistance is possible due to combined mechanisms (rpsJ mutations + tet genes) 3.
- Eravacycline demonstrated noninferiority to ertapenem for the treatment of patients with complicated intra-abdominal infections (cIAIs), which may include infections caused by VRE 5.
- The available evidence suggests that eravacycline may be a useful option for the treatment of infections caused by VRE, particularly in cases where other treatment options are limited 3, 6, 4.
Mechanisms of Resistance
- Resistance to eravacycline in enterococci can occur through combined mechanisms, including rpsJ mutations and tet genes 3.
- The presence of tet(M), tet(L), tet(O), and tet(S) genes can contribute to resistance to eravacycline in enterococci 3.
Clinical Significance
- Eravacycline may be a useful option for the treatment of serious infections caused by VRE, particularly in cases where other treatment options are limited 6, 4.
- The clinical significance of eravacycline for VRE therapy is supported by its potent in vitro activity and noninferiority to ertapenem for the treatment of cIAIs 3, 5, 4.