Mycoplasma pneumoniae infection - Emerging treatments

Lefamulin

Lefamulin belongs to a new class of antibiotics called pleuromutilins. This class of antibiotics inhibits the 50S ribosomal subunit at the peptidyl transferase centre, and has activity against pathogens responsible for typical and atypical bacterial community-acquired pneumonia. Two phase 3 clinical trials have suggested that this antibiotic is non-inferior to moxifloxacin in the treatment of community-acquired pneumonia. One study included both intravenous and oral treatment in patients with a Pneumonia Severity Index (PSI) class above III (mainly classes III and IV).[53] The other study used oral therapy in patients within PSI classes II-IV.[54] Lefamulin is approved for use in the US and Europe; however, it has yet to be incorporated into treatment guidelines for community-acquired pneumonia.

Delafloxacin

A fluoroquinolone antibiotic approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of adults with community-acquired pneumonia caused by designated susceptible bacteria. It covers Legionella pneumophila, Chlamydia pneumoniae, and Mycoplasma pneumoniae, the most common atypical organisms that cause community-acquired pneumonia. The approval is based on results from a phase 3 study that found it was non-inferior to moxifloxacin.[55]

Omadacycline

A modernised tetracycline antibiotic (aminomethylcycline) with broad-spectrum activity, designed to overcome tetracycline resistance. It covers L pneumophila, C pneumoniae, and M pneumoniae, the most common atypical organisms that cause community-acquired pneumonia. It is available in oral and intravenous formulations. Like other antibiotics in the tetracycline class, omadacycline may cause discoloration of deciduous teeth, and inhibition of fetal bone growth when administered during pregnancy. It has been found to be non-inferior to moxifloxacin in terms of efficacy in adults with community-acquired pneumonia.[56] Omadacycline is approved by the FDA for the treatment of community-acquired pneumonia in adults; however, it is not available in Europe.

Nemonoxacin

Nemonoxacin is an oral, non-fluorinated quinolone antibiotic in clinical development for community-acquired pneumonia and other non-respiratory infections. It has already received approval in some parts of Asia for the treatment of community-acquired pneumonia.[57] Nemonoxacin has activity against Haemophilus influenzae, Moraxella catarrhalis, M pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in vitro.[57] A phase 3 randomised controlled trial in adults with community-acquired pneumonia found nemonoxacin to be equally as efficacious as levofloxacin, with a comparable safety profile.[57] Nemonoxacin is not yet approved for use in the US or Europe.