Infectious Disease Book

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Pleuromutilin

Aka: Pleuromutilin, Xenleta, Lefamulin
  1. Background
    1. Xenleta is first in a new antibiotic class (Pleuromutilin), costing $280/day
  2. Indications
    1. Community Acquired Pneumonia with Antibiotic Resistance
    2. May have activity against STDs (multi-drug resistant Gonorrhea, Mycoplasma genitalium)
  3. Mechanism
    1. Inhibits peptide transfer and protein synthesis
      1. Binds peptidyl transferase center of 50s Bacterial ribosome
    2. Activity against organisms seen in community-acquired Bacterial organisms
      1. Streptococcus Pneumoniae
      2. HaemophilusInfluenzae
      3. Mycoplasma pneumoniae
      4. Legionella pneumophila
      5. Chlamydophila pneumoniae
      6. Staphylococcus aureus (including MRSA)
      7. Vancomycin-Resistant Enterococcus (VRE)
    3. Activity against organisms seen in STDs (not FDA approved)
      1. Multi-drug resistant NeisseriaGonorrhea
      2. Mycoplasma genitalium
  4. Adverse Effects
    1. QT Prolongation
    2. Liver Function Test increases
    3. Nausea (2-3%)
    4. Diarrhea (12%)
  5. Drug Interactions
    1. Strong and moderate CYP3A4 inducers
    2. P-Glycoprotein Inducers
  6. Dosing
    1. IV
      1. 150 mg IV every 12 hours over 60 minutes for 5 to 7 days
    2. Oral
      1. 600 mg tablet orally every 12 hours for 5 days (at least 1 hour before or 2 hours after a meal)
  7. Safety
    1. Do not use in pregnancy in Lactation (use reliable Contraception when taking)
  8. References
    1. (2019) presc lett 26(10): 59
    2. Lovecchio (2019) Crit Dec Emerg Med 33(10): 24

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