Eravacycline as a Novel Option for Treating Multidrug-Resistant Gram-Negative and Gram-Positive Bacterial Infections: A Narrative Review.

Background: The alarming increase in the number of new bacterial defense mechanisms is exacerbating the problem of antibiotic resistance and poses a serious obstacle to the treatment of bacterial infections. Despite the approval of numerous new antibiotics by the Food and Drug Administration (FDA) and European Medicines Agency (EMA), mainly from the beta-lactam group since 2000, only some of them possess unique mechanisms of action and activity against multidrug-resistant Gram-negative bacilli (MDR GNB), including carbapenem resistance. Eravacycline (EVT), formerly known as TP-434, is a newly developed non-beta-lactam, fully synthetic tetracycline derivative, approved for the treatment of complicated intra-abdominal infections (cIAIs) in adults. Results: The analysis demonstrated significant efficacy of EVT across a wide range of in vitro and in vivo studies against MDR GNB, including carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Enterobacterales (CRE) and Gram-positive vancomycine-resistant pathogens. Conclusions: The broad spectrum of activity and favorable safety profile of EVT are well-documented in the treatment of critically ill patients. However, its efficacy against clinically relevant Gram-negative bacteria varies depending on specific species and resistance phenotypes, particularly among carbapenem-resistant and extensively drug-resistant (XDR) isolates.