Eravacycline
Tetracyclines
Tetracyclines
IV fluorocycline, a relative of tigecycline, for complicated intra-abdominal infections, even by bacteria resistant to older tetracyclines.
Quick facts
- Group
- Tetracyclines
- Target
- Bacterial ribosome, 30S subunit (16S rRNA, A site)
- Key effects
- Nausea · Pain · Dizziness
- Monitor
- Headache or visual change · Severe abdominal pain
- ATC
- J01AA13
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows eravacycline bound to the 30S ribosomal subunit of Acinetobacter baumannii.
Eravacycline binds the 30S subunit and keeps aminoacyl-tRNA out of the A site, like the other tetracyclines. It is a structural analogue of tigecycline (a fluorocycline): its bulky substituent hinders ribosomal protection proteins and it is not a substrate of the common Tet pumps, so it keeps activity against many tetracycline-resistant strains.
- Enters the bacterium and binds the 30S
- Aminoacyl-tRNA cannot enter the A site
- Evades Tet pumps and ribosomal protection
- Protein synthesis stops
Indications
- Complicated intra-abdominal infections in adults (not used for urinary infections) Intra-abdominal abscess →
Adverse effects
Common
- Nausea, vomiting and diarrhoea
- Pain, redness or swelling at the infusion site
- Dizziness
Contraindications
- Allergy to eravacycline or other tetracyclines
Key interactions
- Strong CYP3A4 inducers (rifampicin, carbamazepine, phenytoin)
- Shorten its half-life and lower its levels.
- CYP3A4 inhibitors (itraconazole)
- Raise its levels.
What is monitored
- Headache or visual change
- Severe abdominal pain, and pancreatic enzymes if it appears
- Diarrhoea during and after treatment
- Course of the surgical wound
Administration and safety
- IV infusion, each one over about 60 minutes
- Check the medicine list for CYP3A4 inducers
Pregnancy and breastfeeding
It can harm the fetus: like the other tetracyclines, it stains teeth and affects bone growth if used in the second half of pregnancy.
Nursing care
- Ask about pregnancy and breastfeeding; breastfeeding is avoided during treatment and for 4 days after
- Watch the infusion site
- Ask the patient to report severe headache, blurred vision or abdominal pain spreading to the back
- Watch for wound-healing problems
Pharmacokinetics
- Absorption
- Poorly absorbed by mouth; IV only.
- Distribution
- Fast and wide into tissues.
- Metabolism
- CYP3A4 substrate.
- Elimination
- Mostly unchanged, with a small share of metabolites; no adjustment in kidney failure.
Test yourself
Think of the answer, then tap the question to see it.
Why does eravacycline keep activity against doxycycline-resistant bacteria?
It is not a substrate of the common Tet pumps, and its bulky substituent hinders ribosomal protection proteins.
Which infection is eravacycline approved for, and which is it not used for?
Complicated intra-abdominal infections; it is not used for urinary infections because it failed non-inferiority in trials.
Which drugs lower eravacycline levels?
Strong CYP3A4 inducers such as rifampicin, carbamazepine or phenytoin.
Connections
← Back to the class: Tetracyclines
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Eravacycline Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); A. baumannii Ribosome-Eravacycline complex: 30S (RCSB Protein Data Bank, 2026).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.