Eravacycline for the treatment of complicated intra-abdominal infections

Expert Rev Anti Infect Ther. 2019 Nov;17(11):851-863. doi: 10.1080/14787210.2019.1681975. Epub 2019 Oct 29.


Introduction: Complicated intra-abdominal infections (cIAIs) are among the most frequent infections, contributing to significant morbidity and healthcare costs. Several medical needs remain unmet, related to the pharmacokinetic capacities of the available drugs and their limited spectrum of activity for targeting multidrug-resistant Gram-negative and Gram-positive bacteria. Eravacycline, a new synthetic fluorocycline, could have useful properties in cIAIs.Areas covered: The antimicrobial activity of eravacycline against the microorganisms most frequently cultured in cIAIs has been confirmed in worldwide panels of clinical isolates, including enterococci, ESBL-producing Enterobacteriaceae, Acinetobacter baumannii and anaerobes. Pharmacokinetic data demonstrate interesting characteristics with good tissue concentrations including biliary tract and digestive tissues. At a conventional dosage of 1 mg/kg q12h, no adjustment is required on the basis of race or gender, or in elderly (≥ 65 years old) patients, patients with renal impairment or patients undergoing hemodialysis. Phase 2 and 3 trials assessing the clinical efficacy and safety of eravacycline demonstrated non-inferiority versus carbapenems and a good safety profile.Expert opinion: Eravacycline may be particularly suitable for the treatment of cIAIs. Results from clinical trials and real-world data are now expected in specific subgroups of patients to confirm the safety profile and efficacy observed in registration trials.

Keywords: Enterobacteriaceae; Fluorocycline; complicated intra-abdominal infection; enterococci; multidrug-resistant bacteria.

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / pharmacokinetics
  • Bacteria / drug effects
  • Bacteria / isolation & purification
  • Dose-Response Relationship, Drug
  • Humans
  • Intraabdominal Infections / drug therapy*
  • Intraabdominal Infections / microbiology
  • Microbial Sensitivity Tests
  • Tetracyclines / administration & dosage*
  • Tetracyclines / adverse effects
  • Tetracyclines / pharmacokinetics


  • Anti-Bacterial Agents
  • Tetracyclines
  • eravacycline