Which newly approved or experimental antibiotics (omadacycline, lefamulin, solithromycin, ceftaroline, nemonoxacin, delafloxacinat) are used to treat community-acquired pneumonia (CAP)?

Updated: Oct 31, 2019
  • Author: Stephanie L Baer, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Newer agents approved or under investigation for treatment of CAP include omadacycline, lefamulin, solithromycin, ceftaroline, nemonoxacin, and delafloxacin. Omadacycline is a tetracycline designed to overcome tetracycline resistance, and it was shown to be noninferior to moxifloxacin. [71, 72] Lefamulin, a pleuromutilin antibiotic, was found to be noninferior to moxifloxacin in a 2019 phase 3 trial. [73] Lefamulin is indicated for the treatment of bacterial CAP due to S pneumoniae, S aureus (methicillin-susceptible isolates), H influenzae, Legionella pneumophila, M pneumoniae, or C pneumoniae in adults. It is administered twice daily as either an intravenous infusion or an oral tablet. Solithromycin, a new macrolide, was compared to moxifloxacin as an IV-to-PO option and was found to be noninferior. [74]  Ceftaroline has been shown noninferior and possibly superior to ceftriaxone for CAP in randomized, controlled, double-blind, international trials based in the United States and Asia. [75, 76] Nemonoxacin has been reported to yield clinical cure rates similar to those of levofloxacin in 3 trials, primarily in Asia and Russia. [77] Delafloxacin, a novel fluoroquinolone, has the advantage of activity against both MRSA and Pseudomonas and gained approval in October 2019 for the treatment of bacterial CAP in adults. Approval was based on a phase 3 randomized, double-blind study (n = 859) that compared delafloxacin to moxifloxacin. Results showed that IV-to-oral delafloxacin was noninferior at 96 hours compared with moxifloxacin. [78, 79]

Baloxavir is a promising agent that was recently globally approved for influenza. It is a selective inhibitor of influenza cap-dependent endonuclease and is active against both influenza A and B. It has activity against resistant strains and was superior to placebo in alleviating symptoms and superior to oseltamivir for rapid reduction of viral load. [80]


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