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Fluorocycline antibiotic (tetracycline class) Pregnancy: US labelling §8.1: like other tetracycline-class antibacterials, eravacycline may cause discoloration of deciduous teeth and reversible inhibition of bone growth when given during the second and third trimester of pregnancy. The limited available data in pregnant women are insufficient to inform a drug-associated risk of major birth defects or miscarriage. Animal studies indicate that eravacycline crosses the placenta and is found in fetal plasma; doses greater than approximately 3 times (rats) and 2.8 times (rabbits) the clinical exposure by AUC, given during organogenesis, were associated with decreased ossification, decreased fetal body weight and/or increased post-implantation loss.

Eravacycline

Brand names: Xerava

Eravacycline is a fluorocycline (tetracycline-class) intravenous antibacterial used for complicated intra-abdominal infections in adults.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1 mg/kg every 12 hours
Route: Intravenous infusion over approximately 60 minutes. Reconstitute each vial with 5 mL sterile water for injection or 0.9% sodium chloride, then dilute in a 0.9% sodium chloride infusion bag to a target concentration of 0.3 mg/mL (range 0.2 to 0.6 mg/mL)
Frequency: Every 12 hours
US prescribing information §2.1 (XERAVA for injection). No UK SPC was captured in this bundle, so this is US labelling and must be verified against the UK SPC. DURATION: 4 to 14 days for complicated intra-abdominal infection, guided by the severity and location of infection and the patient's clinical response. The dose is calculated on ACTUAL body weight (1 mg/kg actual body weight). SEVERE HEPATIC IMPAIRMENT (Child-Pugh C): 1 mg/kg every 12 hours on Day 1, then 1 mg/kg every 24 hours starting on Day 2, for a total duration of 4 to 14 days; no adjustment is warranted in mild to moderate hepatic impairment (Child-Pugh A and B). CONCOMITANT STRONG CYP3A INDUCER: 1.5 mg/kg every 12 hours for a total duration of 4 to 14 days; no adjustment is warranted with weak or moderate CYP3A inducers. ADMINISTRATION: for intravenous infusion only; each vial is single-dose; reconstituted vial content must be diluted within 1 hour or discarded; diluted solutions must be infused within 12 hours at room temperature or within 8 days if refrigerated at 2 to 8 degrees C; do not freeze. May be given through a dedicated line or a Y-site; if the same line is used for sequential infusions, flush before and after with 0.9% sodium chloride. XERAVA is compatible with 0.9% sodium chloride only and should not be mixed with other drugs or added to solutions containing other drugs. PAEDIATRIC: safety and effectiveness in paediatric patients have not been established, and because of tetracycline-class effects on tooth development and bone growth, use in paediatric patients less than 8 years of age is not recommended - verify any paediatric use against a children's formulary. ELDERLY: no overall differences in safety or efficacy were observed in patients 65 years and over, and no clinically relevant pharmacokinetic differences with respect to age.

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.