Omadacycline as a promising new agent for the treatment of infections with Mycobacterium abscessus

Background Despite intensive treatment regimens, the outcome of Mycobacterium abscessus infections is extremely poor and thus novel treatment regimens are needed. Although tigecycline seems to be one of the best options currently available, its long-term use is hampered by severe toxic side effects as well as the need for intravenous administration and the relatively high concentrations required for efficacy. Objectives To assess the in vitro activity of omadacycline against M. abscessus and compare it with the activity of tigecycline. Methods The concentration- and time-dependent killing capacities of omadacycline and tigecycline against M. abscessus subspecies abscessus were determined using a time-kill kinetics assay. Time-kill curves as well as concentration-effect curves were generated. Results Time-kill curves showed strong concentration-dependent antimicrobial activity for both omadacycline and tigecycline. Omadacycline showed inhibition of mycobacterial growth at 4mg/L and mycobacterial killing at concentrations >= 16mg/L. Tigecycline showed mycobacterial killing at concentrations >= 4mg/L, achieving elimination at concentrations >= 16mg/L. The concentration-effect curves after 7days of exposure showed stasis, 1log mycobacterial killing and 2log mycobacterial killing at 3.3, 4.0 and 4.8mg/L for omadacycline and 2.2, 2.7 and 3.4mg/L for tigecycline, respectively. Conclusions The results of this in vitro study on omadacycline activity, together with its favourable (pharmacokinetic) properties, suggest that omadacycline is a potential new agent for the treatment of M. abscessus infections.