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Pleuromutilin

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Pleuromutilin, Xenleta, Lefamulin

  • Background
  1. Xenleta is first in a new Antibiotic class (Pleuromutilin), costing $280/day
  • Indications
  1. Community Acquired Pneumonia with Antibiotic Resistance
  2. May have activity against STDs (multi-drug resistant Gonorrhea, Mycoplasma Genitalium)
  • 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
  • Adverse Effects
  1. QT Prolongation
  2. Liver Function Test increases
  3. Nausea (2-3%)
  4. Diarrhea (12%)
  • Drug Interactions
  1. Strong and moderate CYP3A4 inducers
  2. P-Glycoprotein Inducers
  • 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)
  • Safety
  1. Do not use in pregnancy in Lactation (use reliable Contraception when taking)
  • References
  1. (2019) presc lett 26(10): 59
  2. Lovecchio (2019) Crit Dec Emerg Med 33(10): 24