Current Perspectives on Treatment of Gram-Positive Infections in India: What Is the Way Forward?

Table 3

Some new drugs recently approved and in pipeline for treatment of gram-positive infections.

Name of the drug	Class	Mechanism of action	Important GP organisms covered	Dose and Route^†	Phase of testing^‡	Serious Adverse effects
Delafloxacin	Fluoro-quinolone	Inhibit DNA gyrase and Topoisomerase IV	MRSA, MSSA, St. pyogenes, E. faecalis	300 mg IV/ 450 mg oral	USFDA approved in June 2017	Tendinitis and tendon rupture, peripheral neuropathy, Central nervous system effects
Nemonoxacin			MRSA, VRSA	250-750 mg, oral, IV	Phase III	None reported
Levonadifloxacin			MRSA, VRSA	1000 mg oral, 800 mg IV	Phase III	None reported
Alalevonadifloxacin			MRSA, VRSA	1000 mg oral	Phase III	None reported
Solithromycin	Fluoro-ketolide	Inhibits protein synthesis by binding to 50s ribosome subunit and blocking peptide chain elongation	S. aureus, St. pneumoniae	800 mg oral	Phase III	Possible hepatotoxicity
Omadacycline	Tetracycline	Inhibits protein synthesis by binding to 30s ribosome subunit and blocking binding of aminoacid-tRNA with mRNA	S. aureus (MSSA), St. pneumoniae	100-200 mg IV; 300-450 mg oral	USFDA approved in October 2018	Similar to other tetracyclines
Eravacycline			E faecalis, E faecium, S. Aureus, St anginosus group	1 mg/kg IV infusion	USFDA approved in August 2018	Similar to other tetracyclines
Tedizolid	Oxazolidinone	Inhibits protein synthesis by binding to the 50S ribosome subunit	MRSA, MSSA, St. pyogenes, St. agalactiae, S. anginosus, E. faecalis	200 mg oral or IV infusion	USFDA approved in June 2014	Similar to linezolid
Lanopepden (GSK’322)	Peptidyl deformylase inhibitor	Inhibits bacterial protein synthesis	St. pneumoniae, St. pyogenes, S. aureus	1500 mg oral	Phase II	None reported
AFN-1252	Fabl (enoyl ACP reductase) inhibitor	Interferes with essential bacterial fatty acid biosynthetic pathway	S. aureus, S. epidermidis, other staphylococci	200 mg oral	Phase II	None reported

Note: this list is not exhaustive; ^†these are suggested doses; detailed dosing and regimens may vary according to indication; ^‡as on December 2018.