Real-World Safety and Efficacy Data Comparing Dosing Strategies of Eravacycline: A Retrospective Cohort Study

Background: Limited data exists to assess the efficacy and safety outcomes of alternative eravacycline dosing strategies. Methods: We conducted a single center, retrospective, cohort study to compare the outcomes of 2 different eravacycline dosing regimens for various eravacycline-susceptible non-mycobacterial infections between September 2019 and June 2024. Main Point Summary: Eravacycline 1.5 mg/kg q24h demonstrated no worse odds of clinical success and a statistically significant reduction in mortality compared to 1 mg/kg q12h. The once-daily regimen may increase healthcare convenience; however, it likely results in higher rates of nausea. Results: The study analyzed 133 patients who received eravacycline for at least 50% of the recommended indication-based duration of therapy, comparing 2 groups: 24 patients on eravacycline 1.5 mg/kg q24hrs and 109 on eravacycline 1 mg/kg q12hrs. The patients who received once-daily dosing were older (64.5 vs 53 years old) with more comorbidities. Both groups showed similar clinical success rates (54% once-daily dosing vs 46% twice-daily dosing), however, the once-daily dosing of eravacycline had lower mortality (4% vs 26%). Once-daily dosing was associated with an increased incidence of nausea and a trend toward fewer infection-related readmissions. Conclusion: The use of eravacycline 1.5 mg/kg q24h demonstrated similar odds of clinical success compared with the 1 mg/kg q12h regimen and may result in a reduction in 30-day mortality but resulted in higher rates of adverse effects. However, further studies are needed to confirm these findings.