An overview of lefamulin for the treatment of community acquired bacterial pneumonia

ABSTRACT

Introduction

Lefamulin is a novel antibiotic that belongs to the pleuromutilin class with excellent activity against all microorganisms, including atypical pathogens, that cause community-acquired pneumonia (CAP).

Areas covered

This article reviews the spectrum of activity, the main pharmacokinetic and pharmacodynamic characteristics of lefamulin as well as its clinical efficacy and safety in the treatment of CAP in adult patients.

Expert opinion

The clinical efficacy of lefamulin in patients with non severe CAP has been demonstrated in 2 randomized clinical trials. Precisely one of the limitations of the phase 3 trials is that the proportion of severe CAP cases is very low. Its particular mechanism of action, affecting ribosomal protein synthesis, provides a low probability of cross-resistance to other commonly used antibiotics in CAP. These findings, together with the antimicrobial activity of lefamulin, its pharmacokinetic parameters and safety profile make it a good alternative for outpatient treatment of CAP. In patients hospitalized with CAP, lefamulin can be used as a potential oral step-down agent after an intravenous regimen with beta-lactams, or as a therapeutic alternative in patients with β-lactam allergies.

KEYWORDS:

• Lefamulin
• community-acquired pneumonia
• pleuromutilin

Declaration of interest

V Falco has received honoraria for speaking at educational events for Janssen Pharmaceuticals, Merck Sharp and Dohme (MSD), ViiV Healthcare and has received research funding from Gilead Sciences, MSD and ViiV Healthcare. J Burgos has received honoraria for speaking at educational events from Janssen, MSD and ViiV Healthcare and has received research funding from MSD. B Almirante has received honoraria for s peaking at educational events from MSD, Pfizer Inc, Gilead Sciences and Angellini and has received research funding from Gilead Sciences, MSD and Pfizer Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors are supported by Plan Nacional de I+D+I 2013–2016. They are also supported by the Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, the Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0003], which is co-financed by European Development Regional Fund ‘A way to achieve Europe’ and Operative program Intelligent Growth 2014–2020.