Lefamulin: novel pleuromutilin drug for community acquired bacterial pneumonia

Authors

  • A. P. Dubey Department of Medicine, Santhosh Medical College, Ghaziabad, Uttar Pradesh, India
  • Sachin Maggo Department of Medicine, Government Hospital, Joshimath, Uttarakhand
  • Awanish Karan Department of ENT, Government Hospital, Joshimath, Uttarakhand
  • N. K. Singh Department of Medicine, Government Hospital, Tejpur, Assam
  • Sreya Bhaskaran Department of Medicine, Government Hospital, Roorkee, Uttarakhand

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20195297

Keywords:

Lefamulin, Pleuromutilin, CABP, Multidrug resistance, Gram positive pathogens

Abstract

The advent and spread of antimicrobial resistance has led to a global public health emergency necessitating development of new antimicrobial drugs. Community acquired bacterial pneumonia (CABP) contributes a major portion of societal burden with increasing morbidity due to evolution of drug resistant strains. Lefamulin is a novel pleuromutilin antibiotic with unique mechanism of action through inhibition of protein synthesis by binding to the peptidyl transferase center of the 50s bacterial ribosome. The drug displays activity against Gram positive and atypical organisms associated with CABP (i.e., Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumonia, Legionella pneumophila, and Chlamydophila pneumoniae), with an expanded Gram-positive spectrum including Staphylococcus aureus (i.e., methicillin-resistant, vancomycin-intermediate, and heterogeneous strains). Lefamulin is available in both intravenous (IV) and per oral (PO) formulation, exhibits high nonlinear plasma protein binding with low unbound concentrations, higher concentrations in lung epithelial lining fluid (ELF) than in plasma, and a half-life of approximately 10 hour. The recommended IV dose is 150 mg twice daily over 1 hour or a PO dose of 600 mg twice daily. Most common adverse drug reactions injection site reactions, hepatic enzyme elevation, nausea, diarrhoea, hypokalemia, insomnia, and headache. Clinical trials for lefamulin have been positive and Phase 3 data suggest similar efficacy when compared to moxifloxacin with or without linezolid in CABP. Also, the documented resistance and cross-resistance with other Gram-positive antibacterials remains low. With Nabrivia Pharmaceuticals having already received US FDA approval in August 2019, lefamulin may soon be a new addition to the mounting armoury of drugs against CABP.

 

Author Biographies

A. P. Dubey, Department of Medicine, Santhosh Medical College, Ghaziabad, Uttar Pradesh, India

Dr AP Dubey

MBBS, MD, DNB (Oncology)

Asst Professor

Department of Medicine

Sachin Maggo, Department of Medicine, Government Hospital, Joshimath, Uttarakhand

Dr Sachin Maggo

MBBS, MD Internal Medicine

Department of Medicine

Awanish Karan, Department of ENT, Government Hospital, Joshimath, Uttarakhand

Dr Awanish Karan

MBBS, MS (ENT)

Professor

Department of ENT

N. K. Singh, Department of Medicine, Government Hospital, Tejpur, Assam

Dr NK Singh

MBBS, MD (Internal Medicine)

Department of Medicine

 

Sreya Bhaskaran, Department of Medicine, Government Hospital, Roorkee, Uttarakhand

Miss Sreya B

GNM Nursing

Department of Medicine 

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Published

2019-11-25

How to Cite

Dubey, A. P., Maggo, S., Karan, A., Singh, N. K., & Bhaskaran, S. (2019). Lefamulin: novel pleuromutilin drug for community acquired bacterial pneumonia. International Journal of Basic & Clinical Pharmacology, 8(12), 2783–2790. https://doi.org/10.18203/2319-2003.ijbcp20195297

Issue

Section

New Drug Update