Eravacycline
Brand names: Xerava
Eravacycline is a fluorocycline (tetracycline-class) intravenous antibacterial used for complicated intra-abdominal infections in adults.
Adult dose
Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.
Contraindications
- Known hypersensitivity to eravacycline, to tetracycline-class antibacterial drugs, or to any of the excipients (US labelling §4)
Side effects
- Infusion site reactions - among the most common reactions (incidence 3% or greater)
- Nausea - among the most common reactions (incidence 3% or greater)
- Vomiting - among the most common reactions (incidence 3% or greater)
- Life-threatening hypersensitivity (anaphylactic) reactions have been reported; discontinue if an allergic reaction occurs
- Tetracycline-class effects: permanent tooth discoloration (yellow-grey-brown) and enamel hypoplasia, and reversible inhibition of bone growth, when used during tooth development (last half of pregnancy, infancy and childhood up to 8 years); also Clostridioides difficile-associated diarrhoea - evaluate if diarrhoea occurs
Interactions
- Strong CYP3A inducers (US §7.1) - decrease eravacycline exposure and may reduce efficacy; increase the dose to 1.5 mg/kg every 12 hours. No adjustment is needed with weak or moderate CYP3A inducers
- Anticoagulant drugs (US §7.2) - because tetracyclines depress plasma prothrombin activity, patients on anticoagulant therapy may require a downward adjustment of their anticoagulant dosage
Clinical monograph
How it works
It binds to the bacterial 30S ribosomal subunit and inhibits protein synthesis, with activity against many Gram-positive, Gram-negative and anaerobic organisms including some multidrug-resistant strains.
Prescribing in practice
- As a tetracycline-class agent it can cause permanent tooth discolouration and affect skeletal development, so it is avoided in pregnancy and in young children.
- Infusion-related reactions and gastrointestinal upset (nausea, vomiting) are common.
- It should be used in line with antimicrobial stewardship and local microbiology advice to preserve activity against resistant organisms.
Monitoring
Monitor clinical response, infusion-site and hypersensitivity reactions, and gastrointestinal tolerability.
Counselling the patient
- Report any severe or watery diarrhoea, which may indicate a bowel infection.
- Tell the team if you are or might be pregnant.
- Report any rash, swelling or difficulty breathing during the infusion.
Evidence & guidelines
Eravacycline's efficacy in complicated intra-abdominal infection was demonstrated in the IGNITE programme of non-inferiority trials.
Reference: BSAC; UKHSA AMR guidance; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.
- NYHA Heart Failure Classification · Heart Failure
- GRACE ACS Risk Score · Acute Coronary Syndrome
- MAGGIC Heart Failure Risk Score · Heart Failure
- WHO Functional Classification (Pulmonary Hypertension) · Pulmonary Hypertension
- Centor / McIsaac Score for Strep Pharyngitis · Throat
- FeverPAIN Score for Strep Throat · Throat
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023