Eravacycline Associated Hypofibrinogenemia: A Case Series of Transplant Patients With Mycobacterium Abscessus Infections and Review of Literature

Safety profiles of Tetracycline-class drugs: a pharmacovigilance analysis of the FAERS database

BACKGROUND

As synthesis technology advances, novel and efficient derivatives of tetracyclines are found. Three new antibiotics, tigecycline, omadacycline, and eravacycline, approved within the past 18 years, and represent a new era in the use of tetracyclines. To gain further insight into adverse events linked to tetracyclines and better protect pediatric patients, ongoing monitoring of safety data is crucial.

METHODS

The FAERS data from the first quarter of 2004 to the third quarter of 2023 in the AERSMine were extracted to conduct disproportionality analysis. The association between five tetracyclines and adverse events was evaluated using reporting odds ratio, and their risk factors were explored by multivariate logistic regression analysis.

RESULTS

Our study showed that endocrine disorders had the strongest signal in children, especially thyroid gland disorders. Patients aged 12-18 and treatment with minocycline are risk factors for thyroid adverse events(12-18: OR = 10.727 [7.113-16.177], p < 0.0001; minocycline: OR = 17.025 [10.475-27.678], p < 0.0001).Second-generation tetracycline and third-generation tetracycline ADR patterns differed. Blood fibrinogen decreased and hypofibrinogenaemia were primarily reported with tigecycline and eravacycline.

CONCLUSION

The potential effect of minocycline on thyroid function in adolescents should be of concern. This study investigated adverse events highly associated with tetracyclines treatment, which provided basic evidence for further research on tetracyclines-related adverse events for children. However, the safety of third-generation tetracycline in children requires additional validation through a large-scale prospective study.

Reviewing novel treatment options for carbapenem-resistant Enterobacterales

INTRODUCTION

Carbapenem resistant Enterobacterales (CRE) are a major threat to global health and hospital-onset CRE infections have risen during the COVID-19 pandemic. Novel antimicrobials are now available for the treatment of CRE infections. There remains an urgent need for new antimicrobials for CRE, especially for those producing metallo-β-lactamases.

AREAS COVERED

This article discusses previously published research supporting currently available novel antimicrobials for the treatment of CRE infections. Newer compounds currently being evaluated in clinical trials are covered. A literature search was conducted in PubMed over all available dates for relevant published papers and conference abstracts with the search terms, 'CRE,' 'carbapenem-resistant Enterobacterales,' 'β-lactam-β-lactamase inhibitor,' 'KPC,' 'NDM,' 'metallo-β-lactamase,' 'ceftazidime-avibactam,' 'meropenem-vaborbactam,' 'imipenem-cilastatin-relebactam,' 'cefiderocol,' 'eravacycline,' 'plazomicin,' 'taniborbactam,' 'zidebactam,' and 'nacubactam.'

EXPERT OPINION

Novel antimicrobials for CRE infections have been developed, most notably the β-lactam-β-lactamase inhibitor combinations, though treatment options for infections with metallo-β-lactamase producing Enterobacterales remain few and have limitations. Development of antibiotics with activity against metallo-β-lactamase producing Enterobacterales is eagerly awaited, and there are promising new compounds in clinical trials. Finally, more clinical research is needed to optimize and individualize treatment approaches, which will help guide antimicrobial stewardship initiatives aimed at reducing the spread of CRE and development of further resistance.