Long-term evaluation of clinical success and safety of omadacycline in nontuberculous mycobacteria infections: a retrospective, multicenter cohort of real-world health outcomes.

Infections due to nontuberculous mycobacteria (NTM) continue to increase in prevalence, leading to problematic clinical outcomes. Omadacycline (OMC) is an aminomethylcycline antibiotic with FDA orphan drug and fast-track designations for pulmonary NTM infections, including Mycobacteroides abscessus (MAB). This multicenter retrospective study across 16 U.S. medical institutions from January 2020 to March 2023 examined the long-term clinical success, safety, and tolerability of OMC for NTM infections. The cohort included patients aged ≥18 yr, who were clinically evaluable, and` had been treated with OMC for ≥3 mo without a previous diagnosis of cystic fibrosis. The primary outcome was 3 mo clinical success, with secondary outcomes including clinical improvement and mortality at 6- and 12 mo, persistence or reemergence of infection, adverse effects, and reasons for OMC utilization. Seventy-five patients were included in this analysis. Most patients were female (48/75, 64.0%) or Caucasian (58/75, 77.3%), with a median (IQR) age of 59 yr (49-67). Most had NTM pulmonary disease (33/75, 44.0%), skin and soft tissue disease (19/75, 25.3%), or osteomyelitis (10/75, 13.3%), and Mycobacterium abscessus (60/75, 80%) was the most commonly isolated NTM pathogen. The median (IQR) treatment duration was 6 mo (4 - 14), and the most commonly co-administered antibiotic was azithromycin (33/70, 47.1%). Three-month clinical success was observed in 80.0% (60/75) of patients, and AEs attributable to OMC occurred in 32.0% (24/75) of patients, leading to drug discontinuation in 9.3% (7/75).

Impact of clinical pharmacist discharge prescription review on the appropriateness of antibiotic therapy: a retrospective comparison.

BACKGROUND: Inappropriate antibiotic prescribing upon hospital discharge has been identified as a significant problem. Despite high rates of antibiotic prescription errors, there is no widely accepted antimicrobial stewardship initiative to prevent such errors. AIM: The primary objective of this study was to determine the impact of hospital-based clinical pharmacist discharge prescription review on the appropriateness of antibiotic prescriptions. METHOD: This was an observational study comparing the appropriateness of hospital discharge antibiotic prescriptions between two similar internal medicine services. One cohort of patients was admitted to medicine services where rounding clinical pharmacists performed routine antibiotic discharge assessment, and the comparator cohort was admitted to hospitalist services without routine pharmacist discharge antibiotic review. RESULTS: Our study included 150 cases per cohort. Baseline characteristics were similar between groups, except for increased age (p = 0.025) and fewer cases of acute bacterial skin & skin structure infections (p = 0.001) in the hospitalist cohort. Antibiotic appropriateness was considerably greater in the medicine (pharmacist) group versus hospitalist group [(83% versus 54%, respectively (p < 0.00001)]. The difference in appropriateness was mainly driven by pneumonia and urinary tract infection prescriptions. CONCLUSION: Appropriateness of antibiotic prescriptions significantly improved in the setting of pharmacist discharge review. This initiative highlights the important role of clinical pharmacists in outpatient antimicrobial stewardship.

Preliminary, Real-world, Multicenter Experience With Omadacycline for Mycobacterium abscessus Infections.

Twelve patients were treated with omadacycline (OMC) as part of a multidrug regimen for Mycobacterium abscessus. The majority of infections were of pulmonary origin (7/12; 58.3%). The median (interquartile range) duration of OMC was 6.2 (4.2-11.0) months. Clinical success occurred in 9/12 (75.0%) patients. Three patients experienced a possible adverse effect while on therapy.