Solithromycin commentary

Abstract

The collective commentaries by José, Meterskey and Huang, Mandal and Sahi, and Menéndez and Méndez (1-4) emphasize the significant disease burden of community-acquired pneumonia (CAP) and the unmet need for alternative antimicrobials for the management of this potentially life-threatening infection. Present guideline recommendations list two options of antimicrobial therapy for serious infections: monotherapy with a fluoroquinolone and combination therapy with a beta-lactam and a macrolide (5). There are disadvantages to both of these treatment regimens. With fluoroquinolones, there are concerns for collateral damage in the form of several adverse effects, including an adverse effect on the gastrointestinal microbiome. For combination therapy, there is the inconvenience of two drugs and the dilemma of de-escalation from IV to oral therapy (i.e., does the patient need to step down to two oral agents). Thus, a monotherapy agent which has efficacy against the likely pathogens of CAP and is available as once-daily dosing in both IV and oral formulations would be a welcome addition to our antimicrobial armamentarium.