Xerava (eravacycline) / SOM Biotech, Ewha Womans University, PAION, Everest Medicines, Innoviva - LARVOL DELTA

Eravacycline in allogeneic stem cell transplant recipients: A real-world study of drug-drug interactions with cyclosporine/tacrolimus and anti-infective efficacy (ASH 2025) - "Eravacycline, a novel synthetic tetracycline, shares the Cytochrome P450 3A4 (CYP3A4) metabolic pathway with CNIs, yet comprehensive data on their potential pharmacokinetic interactions are scarce...Subgroup analysis revealed that when co-administered azoles and letermovir, no significant changes in C/D ratio were observed between pre-treatment and during treatment both in cyclosporine group (n=18) and tacrolimus group (n=7)... This study presented the first clinical evidence of drug-drug interaction between eravacycline with CNIs in allo-HSCT, characterized by increased CNI exposure during eravacycline administration and delayed post-cessation exposure elevation. Intensified CNI monitoring and stepwise dose adjustments are recommended throughout and after eravacycline therapy."

Clinical • Real-world • Real-world evidence • Acute Graft versus Host Disease • Bone Marrow Transplantation • Cardiovascular • Graft versus Host Disease • Hematological Disorders • Hypertension • Immunology • Infectious Disease • Transplantation • CYP3A4

Eravacycline pharmacokinetics/pharmacodynamics in the hollow fiber system model of Mycobacterium abscessus lung disease. (PubMed, Microbiol Spectr) - "The treatment guidelines include tetracyclines as part of the combination. While eravacycline MICs and static concentrations suggest great potential and even activity better than omadacycline and tigecycline, the drug only killed 0.56 log10 CFU/mL below stasis in the HFS-MAB. Monte Carlo simulation experiments suggested that optimal doses for MAB pulmonary disease are likely in the range that would not be tolerated by patients."

Journal • PK/PD data • Infectious Disease • Pulmonary Disease • Respiratory Diseases

Sphingobacterium spp. as intrinsic producers of SPI Ambler class B metallo-β-lactamases. (PubMed, J Antimicrob Chemother) - "S. spiritivorum was the most prevalent species of Sphingobacterium identified in clinical samples. All S. spiritivorum-like species produced a chromosomally encoded SPI-like MBL that might be challenging for the treatment of infections caused by this bacterial species."

Journal • Infectious Disease

Use of Aztreonam-Avibactam with Rapid Eravacycline Step-Down Therapy for a Tibial Septic Non-Union by NDM-Producing Enterobacter cloacae. (PubMed, Antibiotics (Basel)) - "Cultures grew Enterobacter cloacae complex resistant to meropenem, ceftazidime-avibactam, meropenem-vaborbactam, and cefiderocol, as well as Candida parapsilosis...The patient was treated with ATM-AVI plus micafungin, achieving clinical stability within three days...At eight-week follow-up, the patient remained clinically improved without relapse or adverse effects. This case highlights ATM-AVI as a critical therapy for NDM-producing orthopedic infections involving hardware and supports eravacycline as a feasible step-down option in outpatient management."

Journal • Infectious Disease • Musculoskeletal Diseases • Orthopedics

Eravacycline and omadacycline Rescue multidrug-resistant Elizabethkingia anophelis: Triple-Model evaluation across in Vitro, Galleria mellonella, and murine bacteremia systems. (PubMed, J Adv Res) - "These findings substantiate the robust antimicrobial efficacy of eravacycline and omadacycline against E. anophelis, offering valuable insights for optimizing clinical management. They provide compelling proof-of-concept that fluorocyclines eradicate multidrug-resistant E. anophelis in vitro and in vivo, strongly supporting clinical trial investigation."

Journal • Preclinical • Infectious Disease

New Drugs, Old Problems: A Narrative Review of Antibiotic Stewardship Program in the era of novel Gram-negative antibiotics. (PubMed, Clin Microbiol Infect) - "Effective stewardship of new Gram-negative antibiotics requires combining enablement, personalized pharmacology, and selective restriction within multidisciplinary ASPs. Strengthening real-world evidence, digital infrastructure, and standardized outcome measures is essential to guide equitable and sustainable implementation."

Journal • Review • Infectious Disease

Successful treatment of macrolide-resistant Mycobacterium abscessus infection using multi-drug regimens including dual β-lactams and phage therapy: case reports in two children. (PubMed, ASM Case Rep) - "Here we report two children with macrolide-resistant M. abscessus infections who achieved clinical remission and microbiologic clearance using multi-drug treatment regimens including clofazimine, bedaquiline, linezolid or eravacycline, dual β-lactam therapy with meropenem and amoxicillin, and, in one case, phage therapy. Successful treatment of macrolide-resistant M. abscessus infections in children can be achieved using multi-drug regimens including novel dual β-lactam combinations and phage therapy. Dose adjustment with therapeutic drug monitoring can ameliorate some drug-induced toxicities in children."

Journal • Infectious Disease • Pediatrics

Evaluating eravacycline's efficacy against pediatric carbapenem-resistant Klebsiella pneumoniae in China: a 6-year study. (PubMed, Microbiol Spectr) - "Therefore, we assessed the in vitro activities of ERV and tigecycline (TGC) against CRKP isolates obtained from pediatric patients in China between 2019 and 2024. However, unlike previous studies, the susceptibility rates of ERV vary considerably across different carbapenemases, sequence types, and age groups of CRKP, with the type of carbapenemase emerging as the primary determinant. These findings suggest that ERV has promising in vitro activity against CRKP isolates from pediatric patients, indicating potential clinical applicability for this demographic."

Journal • Infectious Disease • Pediatrics • Pneumonia

Integrative review on Acinetobacter baumannii as a multidrug-resistant pathogen: resistance mechanisms and therapeutic perspectives in the context of nosocomial infections. (PubMed, Rev Soc Bras Med Trop) - "Some strategies and new drugs, such as cefiderocol, eravacycline, sulbactam-darlobactam, tigecycline, and their combinations with colistin, are being tested and have shown apparent advances. This integrative review discusses the current resistance mechanisms and emerging therapeutic strategies aimed at overcoming the growing threat posed by MDR A. baumannii."

Journal • Review • Critical care • Infectious Disease

On 13 November 2025, the Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion recommending a change to the terms of the marketing authorisation for the medicinal product Xerava. (European Medicines Agency) - "Xerava is indicated in adolescents from the age of 12 years weighing at least 50 kg, and in adults, for the treatment of complicated intra-abdominal infections (cIAI)."

CHMP • Infectious Disease

Clonal dissemination of carbapenem-resistant ST477 Klebsiella michiganensis co-producing NDM-1, SFO-1, and VEB-3 in a Chinese hospital. (PubMed, Front Cell Infect Microbiol) - "Antimicrobial susceptibility testing showed high-level resistance to imipenem, meropenem, and ceftazidime-avibactam, while susceptibility was retained to amikacin, aztreonam-avibactam, eravacycline, tigecycline, and colistin. No ST477-related genomes were identified in current public datasets. This study is the first to report the clonal dissemination of ST477 K. michiganensis harboring bla NDM-1 in a Chinese hospital."

Journal • Critical care

Combating resistant pathogens: exploring the efficacy of eravacycline utilization in multidrug-resistant infections. (PubMed, Microbiol Spectr) - "Patients treated for infections due to vancomycin-resistant Enterococcus, carbapenem-resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, multidrug-resistant Enterobacterales, or Stenotrophomonas maltophilia were included. Eravacycline may serve as a valuable salvage therapy in such scenarios due to its broad-spectrum activity and lower Clostridioides difficile risk. As resistance patterns evolve, eravacycline's broad-spectrum activity may become a more used option in the management of difficult-to-treat infections, expanding therapeutic options for patients with few viable antimicrobial therapies."

Journal • Infectious Disease

A systematic review of tetracyclines for nontuberculous mycobacteria: focus on rapidly growing mycobacteria. (PubMed, Eur Respir Rev) - "There remains a significant unmet need for effective, well-tolerated therapies for the treatment of NTM, especially those that improve quality of life. Although tetracyclines have not been evaluated in RCTs, clinical evidence suggests that tetracyclines may contribute to the efficacy of combination regimens used to treat NTM disease and further RCTs are warranted."

Journal • Review • Nontuberculous Mycobacterial Disease • Respiratory Diseases

The impact of continuous renal replacement therapy on the pharmacokinetics of eravacycline in patients with sepsis caused by CRAB/CRE infection: a prospective observational study (ChiCTR) - P=N/A | N=20 | Not yet recruiting | Sponsor: Beijing Shijitan Hospital, Capital Medical University; Beijing Shijitan Hospital, Capital Medical University

New trial • Infectious Disease • Septic Shock

Clostridioides difficile-Induced Disseminated Intravascular Coagulation in a Patient With ESRD: A Fatal Case Report (ACG 2025) - "Initial imaging showed colitis, and empiric antibiotics (cefepime and vancomycin) were started...Antibiotics were escalated to fidaxomicin and eravacycline...Atypical presentations without initial diarrhea and complicating factors such as anticoagulation can obscure diagnosis. Clinicians should maintain vigilance for systemic manifestations like DIC, even in the absence of bowel necrosis, particularly in high-risk populations such as those with ESRD."

Case report • Clinical • Anemia • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Diabetes • Diabetic Nephropathy • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • Infectious Disease • Metabolic Disorders • Nephrology • Renal Disease • Respiratory Diseases • Type 2 Diabetes Mellitus

HYDROPNEUMOTHORAX CAUSED BY A RUPTURED MYCOBACTERIUM ABSCESSUS EMPYEMA, REQUIRING ROBOTIC VATS DECORTICATION, IN A PATIENT WITH CYSTIC FIBROSIS ON TRIKAFTA (CHEST 2025) - "Initial treatment included linezolid and piperacillin-tazobactam, later escalated to meropenem...A pigtail drain was placed and his regimen escalated to meropenem, azithromycin, amikacin, and eravacycline...Newer agents, like eravacycline and omadacycline, offer promise for treatment of multidrug-resistant infections [19]... This case underscores the complexities of M. abscessus infection in CF, requiring aggressive antimicrobial therapy and surgical intervention. Close monitoring is essential for early diagnosis. Genomic sequencing and new emerging antibiotics hold promise for future improved outcomes."

Clinical • Cystic Fibrosis • Febrile Neutropenia • Genetic Disorders • Hematological Disorders • Immunology • Infectious Disease • Neutropenia • Nontuberculous Mycobacterial Disease • Pulmonary Disease • Respiratory Diseases

An update on antimicrobial selection and duration for intra-abdominal infections. (PubMed, Expert Rev Anti Infect Ther) - "Novel antibiotics such as ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-relebactam, eravacycline, and cefiderocol have broadened treatment options for MDR pathogens. Shorter antibiotic courses, guided by source control and biomarkers, have shown to be as effective as traditional longer regimens. Future research should focus on understanding of global resistance patterns, expanding real-world evidence for novel antibiotics, refining biomarker-guided strategies, enhancing rapid diagnostics, and applying artificial intelligence for more personalized and precise management of IAIs."

Journal • Review • Infectious Disease

Stenotrophomonas maltophilia infections: Could eravacycline be a new weapon for clinicians? (PubMed, New Microbiol) - "Although minocycline and trimethoprim-ulfamethoxazole are standard treatments, recent evidence suggests that eravacycline, a novel fluorocycline, may be effective in vitro, though clinical data remain scarce. These findings suggest a potential role for eravacycline in treating S. maltophilia BSI when standard options are limited. Further clinical studies are needed to establish efficacy and appropriate therapeutic use."

Journal • Acute Myelogenous Leukemia • Biliary Cancer • Bone Marrow Transplantation • Cholangiocarcinoma • Hematological Malignancies • Infectious Disease • Leukemia • Oncology • Solid Tumor • Transplantation

No pharmacovigilance signal of intracranial hypertension associated with glycylcyclines: a FAERS-based disproportionality analysis. (PubMed, J Antimicrob Chemother) - "Although structurally related to tetracyclines, glycylcyclines are not associated with increased intracranial pressure based on current pharmacovigilance data. This may warrant re-evaluation of SmPC warnings and supports safer use in patients with suspected intracranial hypertension when no better alternatives are available."

Adverse events • Journal • Cardiovascular • CNS Disorders • Hypertension • Oncology

Successful Treatment of OXA-23 Acinetobacter baumannii Pneumonia with Sulbactam-Durlobactam in a Liver Transplant Recipient. (PubMed, Infect Drug Resist) - "Initial treatment with polymyxin B and eravacycline produced unsatisfactory results and worsened renal dysfunction during treatment. Later, administration of sulbactam-durlobactam (SUL-DUR) combined with meropenem resulted in significant clinical improvement...This case highlights the difficulty of managing OXA-23-producing Acinetobacter baumannii in liver transplant patients, especially those with kidney impairment. SUL-DUR showed effective therapy with a much lower risk of nephrotoxicity compared to previously used agents."

Journal • Infectious Disease • Nephrology • Pneumonia • Renal Disease • Respiratory Diseases • Transplantation

Eravacycline: Data Based on Real Evidence. (PubMed, New Microbiol) - "Engineered to overcome common tetracycline resistance mechanisms, eravacycline has demonstrated efficacy in vitro against MDR pathogens, including carbapenem-resistant Enterobacterales and Acinetobacter baumannii. Our findings align closely with previous case series, underscoring eravacycline's efficacy in MDR infections. However, limitations such as small sample size and retrospective design warrant further controlled studies to refine its role in complex infections beyond cIAI."

Journal • Retrospective data • Infectious Disease • Pneumonia

Antimicrobial potential of compounds from the MMV pandemic response box and COVID box against carbapenem-resistant Acinetobacter baumannii. (PubMed, Braz J Microbiol) - "Additionally, their effects on biofilm inhibition, protein leakage, and synergy with meropenem were assessed. Among the tested compounds, 10 demonstrated notable antimicrobial activity, including doxycycline, atazanavir, alexidine, eravacycline, erythromycin, gepotidacin, trimetrexate, MMV1634402 (brilacidin), MMV1580854 and MMV1578564...The present study highlights the antimicrobial activity of MMV1634402 (brilacidin) and gepotidacin, providing preliminary evidence of their potential as therapeutic candidates against CRAB. However, further studies involving a broader range of isolates and clinical validation are essential to confirm their efficacy and safety."

Journal • Infectious Disease • Malaria • Novel Coronavirus Disease

In vitro activity of meropenem-vaborbactam combinations and eravacycline against carbapenem-resistant Acinetobacter baumannii. (PubMed, Sci Rep) - "Extensively drug-resistant (XDR) CRAB isolates were selected for evaluating colistin, eravacycline and the in vitro synergy of antimicrobial combinations via gradient strips for meropenem-vaborbactam, gentamicin, and ceftazidime. All CRAB isolates were sensitive to tigecycline and were either multidrug resistant or XDR...Our findings suggest that eravacycline, as well as combination therapies involving meropenem-vaborbactam with either gentamicin or ceftazidime, may offer promising therapeutic potential for CRAB infections pending further clinical evaluation. These agents demonstrated notable in vitro activity, including potential synergistic effects, particularly against isolates harboring carbapenemase enzymes."

Journal • Preclinical • Infectious Disease

The efficacy and safety of eravacycline in the treatment of patients with pneumonia in respiratory departments: a real-world multicenter retrospective study. (PubMed, J Glob Antimicrob Resist) - "This real-world evidence confirms ERV as an effective and well-tolerated therapeutic option for managing patients in the respiratory departments, particularly those caused by MDR Gram-negative pathogens. The comparable efficacy of monotherapy and combination approaches warrants further investigation."

Journal • Real-world evidence • Retrospective data • Infectious Disease • Pneumonia • Respiratory Diseases

Development and Validation of a Rapid LC-MS/MS Method for Quantifying Eravacycline in Epithelial Lining Fluid: Application to a Prospective Pulmonary Distribution Study in HAP/VAP Patients. (PubMed, Antibiotics (Basel)) - "The corresponding urea-corrected ELF concentrations ranged from 0.570 to 1.617 μg/mL. This study described a detailed and validated method for quantifying eravacycline concentrations in ELF from patients, providing a reliable analytical approach for investigating the pulmonary distribution of eravacycline."

Journal • Infectious Disease • Pneumonia • Respiratory Diseases