Eravacycline for treatment of complicated intra-abdominal infections: the fire is not ignited!

The worldwide surge of multi-drug resistant (MDR) Gram-negative infections has become a real threat in postsurgical and critically ill patients. Among the most dreaded MDR Gram-negatives are extended-spectrum β-lactamase (ESBL) and carbapenemase producing Enterobacteriaceae and MDR Pseudomonas species (1,2). Carbapenem-resistant Enterobacteriaceae (CRE), in particular, are a steadily growing plague associated with increased morbidity and high mortality rates (3). Against this MDR Gram-negative epidemic stands a long period of antibiotic “starvation”, interrupted only by the market introduction of tigecycline and doripenem (4). This often left clinicians with no other option than choosing for “older” polymyxins and/or aminoglycosides as primary treatment of complicated urinary, abdominal, pulmonary, and blood infections caused by MDR Gram-negative bacteria (5,6). Unfortunately, these two antibiotic classes have no well-defined or an unpredictable pharmacokinetic and pharmacodynamic profile which hampers their efficacy whilst enhancing the risk for adverse effects and toxicity.