Eravacycline (Xerava): A Comprehensive Pharmacological and Clinical Monograph

1.0 Executive Summary

Eravacycline, marketed under the brand name Xerava, is a fully synthetic, parenterally administered fluorocycline antibiotic, representing a novel advancement within the tetracycline class of antimicrobials.[1] Developed by Tetraphase Pharmaceuticals, its creation was a direct response to the escalating global health crisis of antimicrobial resistance, particularly among Gram-negative pathogens.[3] The drug's primary approved indication is for the treatment of complicated intra-abdominal infections (cIAI) in adult patients.[1]

The mechanism of action of Eravacycline is consistent with its parent class, involving the inhibition of bacterial protein synthesis through high-affinity binding to the 30S ribosomal subunit.[1] This action prevents the incorporation of aminoacyl-tRNA, thereby halting the elongation of peptide chains.[6] A key feature of Eravacycline is its molecular structure, which has been specifically engineered to circumvent two major mechanisms of tetracycline resistance: active drug efflux and ribosomal protection.[6] This rational drug design confers a potent and broad spectrum of activity.

Eravacycline exhibits robust in vitro activity against a wide array of clinically significant pathogens. This includes Gram-positive organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE), as well as a range of Gram-negative organisms, including extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Enterobacteriaceae (CRE).[8] It is also active against many anaerobic bacteria. A notable limitation in its spectrum is its lack of clinically relevant activity against Pseudomonas aeruginosa.[8]