Lefamulin (Xenleta) is an intravenous and oral antibiotic approved for community acquired bacteria pneumonia (CABP). Similar to antibiotics like clindamycin and linezolid, lefamulin inhibits bacterial protein synthesis by acting on the 50S ribosomal subunit. What’s wonderful about this new antibiotic is that is has activity against the most common causes of CABP (pneumococcus, H. influenzae, M. catarrhalis, atypical organisms) as well as S. aureus (including MRSA!)
The LEAP-2 trial established that a five day course of oral lefamulin was noninferior to a seven day course of oral moxifloxacin (a “respiratory quinolone”); however the lefamulin group had a higher incidence of GI-related side effects like diarrhea and nausea.
Fluoroquinolones have come under fire as of late due to an increased risk of aortic aneurysm/dissection, so lefamulin offers a nice alternative; however, cost will likely limit its widespread availability and use in the short-term.
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