VOL. 7 ISSUE 4 ● APRIL 2025 By Ed Septimus, MD
EDITOR’ S CHOICE
New Perspectives
01 on Antimicrobial Agents: Omadacycline for Community-acquired Pneumonia, Skin and Soft Tissue Infections, and Nontuberculous Mycobacteria( Focus on M. abscessus)
05 Triclosan-Containing
Sutures for the Prevention of Surgical Site Infection: A Systematic Review and Meta-Analysis
12 Male-Partner
Treatment to Prevent Recurrence of Bacterial Vaginosis
Global Guideline for
19 the Diagnosis and Management of Candidiasis: An Initiative of the ECMM in Cooperation With ISHAM and ASM
EDITOR’ S CHOICE
New Perspectives on Antimicrobial Agents: Omadacycline for Community-acquired Pneumonia, Skin and Soft Tissue Infections, and Nontuberculous Mycobacteria( Focus on M. abscessus)
Antimicrob Agents Chemother 69: e01087-24. doi. org / 10.1128 / aac. 01087-24
Omadacycline is a semisynthetic aminomethylcycline antibiotic derived from minocycline. It can evade both efflux and ribosomal methylation types of resistance and therefore has an expanded spectrum compared to other tetracycline agents. Omadacycline is active against a number of multidrugresistant bacteria, including macrolide and doxycycline-resistant Streptococcus pneumoniae, MRSA, VRE, and several enteric Gram-negative bacilli. It also has activity against many nontuberculous mycobacterium( NTM) species. However, omadacycline notably lacks activity against Proteus spp., Providencia spp., Pseudomonas spp., Morganella spp., and Eikenella corrodens. Like doxycycline, omadacycline demonstrates in vitro activity against anaerobes including Clostridioides difficile, which may decrease the risk of C. difficile infections. Lastly, in vitro and in vivo evidence suggests omadacycline has activity against M. abscessus and the other rapid grower non-tuberculous mycobacterium( NTMs). Real-world clinical experience indicates that omadacycline as part of combination therapy can now be considered a first-line agent for treatment. [ BMC Infect Dis 2022; 22:874 ]
Omadacycline is available both as an oral or intravenous formulation. The bioavailability of oral omadacycline is 34.5 % following a single dose, leading to the recommended maintenance oral dose of 300 mg compared to the IV dose of 100 mg. It is recommended in the prescribing information that patients taking oral omadacycline should fast for at least 4 hours and then take with water. After oral dosing, no food or drink( except water) is to be consumed for 2 hours and no dairy products, antacids, or multivitamins for 4 hours. Omadacycline is primarily eliminated in the stool( 81.1 %). The rest of my review will concentrate on omadacycline for the treatment of CABP( community-acquired bacterial pneumonia) and ABSSTIs( acute bacterial skin and soft tissue infections).
The OPTIC trial compared omadacycline with moxifloxacin in 774 patients with CABP. Results demonstrated the noninferiority of omadacycline, with early clinical response( ECR) rates of 81 % vs 83 % for moxifloxacin and post-treatment evaluation( PTE) response rates of 88 % vs 85 %. [ N Engl J Med 2019.380:517 – 527 ] In additional OPTIC data analyses, ECR— defined as symptom improvement within 72 – 120 hours— was shown to be a reliable endpoint for evaluating CABP treatment, strongly correlating with clinical stability( vital sign normalization) and predicting positive PTE outcomes. Secondary OPTIC analyses examined omadacycline’ s efficacy in patients with varying CABP severity, comorbid conditions( e. g., COPD, asthma, and diabetes), and radiographic features. Across these variables, omadacycline’ s clinical success was comparable to that of moxifloxacin. [ Open Forum Infect Dis 2021. 8: ofab135 ] A subgroup analysis indicated slightly lower success in bacteremia cases for omadacycline, but overall, it proved effective regardless of disease severity or risk factors. Additional studies confirmed omadacycline’ s efficacy in higher-risk populations( PORT risk class III and IV), with high clinical success rates similar to those of moxifloxacin. [ Int J Infect Dis 2021.104:501 – 509 ]
Results from a second phase 3 randomized CABP trial( OPTIC-2) released in 2024 compared omadacycline with moxifloxacin in 670 adults with moderateto-severe CABP. Clinical success rates were high in both groups( ECR rates: 89.6 % for omadacycline vs 87.7 % for moxifloxacin).
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