Use hand sanitizers, cover your mouth, wash your hands, wear a mask—the byword messages of public health agencies are upon us once again as temperatures drop. In an era of increasingly drug-resistant pathogens, widespread efforts to prevent the spread of infectious disease are laudable.
Nonetheless, providers who treat severe respiratory illness say it is particularly troublesome for older people whose bout with influenza often results in community-acquired bacterial pneumonia (CABP). Depending on the bacterial strain, resistance is widespread, making the infection a tough contender to cure at any age—but especially in older people.
This season, however, providers will have a new and better choice for the treatment of CABP, a disease whose risk not only increases with age but is a significant burden of illness for about 5 million people in the U.S. each year. A study of claims data from nearly 2 million individuals 65 years and older enrolled in a Medicare Advantage Plan found that, in 2015, the CABP-related hospitalizations incurred medical costs in excess of $18,000 with an average length of stay of 5.6 days.
In August, the FDA approved XENLETA (lefamulin, Nabriva Therapeutics plc), a new antibiotic that is forecast to have a significant impact on patients with CABP and is hailed as a significant breakthrough for the treatment of antibiotic-resistant disease.
Nabriva’s chief commercial officer (CCO), Francesco Maria Lavino, PharmD, reports, “This is tremendously exciting as not only is XENLETA a new molecule, it is a new molecule in a brand-new class of IV and oral anti-infective drugs, and this has not happened in almost 20 years. And, it is also the first new-class antibiotic that has been approved in both oral and IV form which is very important because it gives physicians wider treatment options.”
XENLETA is available for oral (600 mg every 12 hours) and intravenous (150 mg every 12 hours) administration with a short 5-to-7 day course of therapy.
He explains the unique mechanism of action of this novel molecule—lefamulin.
“The drug inhibits the bacterial protein synthesis by binding the 50S ribosomal subunits through multiple interactions, and it is in the way it binds to the ribosomal site that is different from any other antibiotic. This results in a low risk of developing resistance to XENLETA as well as a low risk of developing resistance to older antibiotic classes such as the beta-lactams, fluoroquinolone, macrolide, and tetracycline antibiotic classes.
“When you have multiple binding sites it becomes more difficult for the bacteria to mutate to prevent the antibiotic from working and at the same time, retain its fitness and ability to replicate. Overcoming drug resistance is a function of inhibiting bacteria that have created already-created mechanisms to resistance to other drugs. By inhibiting the bacteria with this type of interaction, which is the hallmark of this new molecule, we achieve both effective treatment outcomes and overcome propensity toward resistance at the same time.”
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