Plazomicin: a new aminoglycoside in the fight against antimicrobial resistance.

OBJECTIVE

To review the mechanism of action, mechanisms of resistance, activity, pharmacokinetics, pharmacodynamics, and clinical data for a novel aminoglycoside.

DATA SOURCES

A PubMed search was performed from January 2006 to August 2019 using the following search terms: plazomicin and ACHN-490. Another search was conducted on clinicaltrials.gov for published clinical data. References from selected studies were also used to find additional literature.

STUDY SELECTION AND DATA EXTRACTION

All English-language studies presenting original research (, pharmacokinetic, and clinical) were evaluated.

DATA SYNTHESIS

Plazomicin has activity against several multi-drug-resistant organisms, including carbapenem-resistant . It was Food and Drug Administration (FDA) approved to treat complicated urinary tract infections (cUTIs), including acute pyelonephritis, following phase II and III trials compared with levofloxacin and meropenem, respectively. Despite the FDA Black Box Warning for aminoglycoside class effects (nephrotoxicity, ototoxicity, neuromuscular blockade, and pregnancy risk), it exhibited a favorable safety profile with the most common adverse effects being decreased renal function (3.7%), diarrhea (2.3%), hypertension (2.3%), headache (1.3%), nausea (1.3%), vomiting (1.3%), and hypotension (1.0%) in the largest in-human trial.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

Plazomicin will likely be used in the treatment of multi-drug-resistant cUTIs or in combination to treat serious carbapenem-resistant infections.

CONCLUSIONS

Plazomicin appears poised to help fill the need for new agents to treat infections caused by multi-drug-resistant .