Omadacycline in treating community-based infections: a review and expert perspective

ABSTRACT

Introduction

Omadacycline is approved for the treatment of community-acquired bacterial pneumonia (CABP) and acute bacterial skin and soft tissue infection (ABSSSI). The integration of newer agents into clinical use involves understanding the nuances of clinical decision-making. This review will provide an in-depth focus on omadacycline in clinical practice.

Areas covered

Literature review of omadacycline utilizing PubMed was performed to provide a comprehensive evaluation of omadacycline pharmacology, microbiology, registrational Phase 3 clinical trials, and post-marketing clinical studies. In addition, the immunomodulatory and other attributes of tetracycline class of antibiotics, of which omadacycline is a member, are reviewed, introducing the concept of antibiotic selection with attention to the bacterial pathogen and human host relationship.

Expert opinion

Omadacycline builds upon the favorable attributes of tetracycline antibiotics and provides very reliable empiric coverage for both Staphylococcus aureus and Streptococcus spp. Clinicians require a more robust understanding of antibiotics, including omadacycline, in order to optimize patient outcomes, streamline care, and reduce medical costs.

KEYWORDS:

• Omadacycline
• tetracyclines
• fluoroquinolones
• community acquired bacterial pneumonia (CABP)
• acute bacterial skin and soft tissue infection (ABSSSI)

Article highlights

• In treating CABP, generic tetracyclines (eg. doxycycline) are recommended as single agents only for patients with few comorbidities or low illness severity, due to their less reliable coverage against S. pneumoniae.

• IDSA-ATS treatment guidelines recommend cephalosporins or fluoroquinolones in higher-risk older CABP patients, which come at an increased risk for Clostridioides difficile, significant drug interactions, and aortic rupture.

• Adding generic doxycycline to cephalosporins has been shown to improve outcomes in CABP.

• When treating CABP, omadacycline essentially provides the reliable coverage against S. pneumoniae and other community respiratory pathogens as the fluoroquinolones without the risks posed by that class.

• While the reasons remain to be determined, omadacycline statistically outperformed linezolid among patients with diabetes mellitus in a post-hoc analysis of the OASIS-1 and OASIS-2 trials.

• Real-world data are desperately needed in high-risk patients with CABP and ABSSSI where the costs of omadacycline compared to generics are justified, particularly in older patients.

Acknowledgments

After the manuscript was written and submitted for publication and during the peer review period, author M. Nowak joined and became employed by Paratek pharmaceuticals. Paratek played no role in the design and writing of this manuscript.

Declaration of interest

G Sakoulas has consulted for Octapharma, Abbvie, and Paratek Pharmaceuticals and is on the speakers bureau for Abbvie and Paratek Pharmaceuticals. 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 material 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

This work was not funded.