New treatment options for lower respiratory tract infections

ABSTRACT

Introduction: Community-acquired pneumonia (CAP) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are among the most frequent lower respiratory tract infections (LRTIs). They represent an increased morbidity and mortality rate in adults.

Areas covered: This review describes recent advances regarding solithromycin, zabofloxacin and delafoxacin antibacterial agents that have been recently developed for treatment of CAP and in AECOPD. All of them have been introduced into phase III clinical trials. We will be summarising chemical structures, pharmacokinetics, antibacterial efficacy and toxicity of these agents. The manuscript has been prepared based on available scientific publications.

Expert opinion: Novel agents of known antimicrobial classes have been developed that demonstrate treatment options in CAP and in AECOPD. Antimicrobials discussed in this review showed bactericide effect against major respiratory tract pathogens. Each has multiple targets in bacteria, thus enabling them for more potency, even against strains exhibiting resistance to commonly used antibiotics. Solithromycin, delafloxacin and zabofloxcian demonstrate broad-spectrum antibacterial activity together with other beneficial features like intracellular accumulation, anti-inflammatory effect and inhibition of biofilm production. These agents showed moderately severe or mild adverse events and demonstrated favourable tissue penetration. These features can make solithromycin, zabofloxacin and delafloxacin treatment options in LRTIs.

KEYWORDS:

• Clinical trials
• fluoroquinolones
• macrolides
• respiratory tract infections

Article highlights

• This review features three antibacterial agents namely, solithromycin, zabofloxacin and delafloxcin.

• Oral solithromycin has demonstrated to be clinically effective, in a once daily dosing for a 5-day treatment in CAP.

• Solithromycin was clinically effective against penicillin-, macrolide-, and fluoroquinolone-resistant isolates of S. pneumoniae.

• Zabofloxacin demonstrates a treatment option in acute exacerbation COPD, as it was found to be non-inferior to moxifloxacin during clinical trials.

• A phase II study concluded that the antibacterial effectiveness of delafloxacin (200 mg each day for 5 days) was equivalent to that of levofloxacin (500 mg daily for 7 days) in the treatment of acute exacerbation of COPD.

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Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

The authors received funding for research from the OTKA Hungarian Research Fund (Grant: 108481).