Sarecycline Demonstrates Clinical Effectiveness against Staphylococcal Infections and Inflammatory Dermatoses: Evidence for Improving Antibiotic Stewardship in Dermatology

Abstract

Tetracycline class antibiotics are widely used for multiple skin diseases, including acne vulgaris, acne rosacea, cutaneous infections, inflammatory dermatoses, and autoimmune blistering disorders. Concerns about antibiotic resistance and protecting the human/host microbiome beg the question whether broad-spectrum tetracyclines such as doxycycline and minocycline should be prescribed at such a high rate by dermatologists when a narrow-spectrum tetracycline derivative, sarecycline, exists. We evaluated the clinical effectiveness of oral sarecycline against cutaneous staphylococcal infections, eyelid stye, and mucous membrane pemphigoid to determine whether sarecycline is a viable option for clinicians to practice improved antibiotic stewardship. We observed significant improvement in staphylococcal infections and inflammatory dermatoses with courses of oral sarecycline as short as 9 days, with no reported adverse events. These clinical findings are consistent with in vitro microbiological data and anti-inflammatory properties of sarecycline. Our data provides a strong rationale for clinicians to use narrow-spectrum sarecycline rather than broad-spectrum tetracyclines as a first-line agent in treating staphylococcal skin infections and inflammatory skin diseases for which tetracyclines are currently commonly employed. Such advancement in the practice paradigm in dermatology will enhance antibiotic stewardship, reduce risk of antibiotic resistance, protect the human microbiome, and provide patients with precision medicine care.

In Vitro Antimicrobial Activities of Tigecycline, Eravacycline, Omadacycline, and Sarecycline against Rapidly Growing Mycobacteria

“…Due to the dramatically reduced side effects, we deduce that OMC is promising for the treatment of RGM infections. Unfortunately, although the best safety parameters were obtained for SAC in this study and in other reports, SAC demonstrated only mild inhibitory activity against the RGM strains ( 38 , 39 ). A clinical phase II trial including 285 subjects showed that once-daily oral treatment with SAC was safe and well tolerated at a dosage of 3.0 mg/kg of body weight for 12 weeks.…”

Antibiotic Resistance Risk with Oral Tetracycline Treatment of Acne Vulgaris

“…These antibiotics can cause tinnitus, pseudotumor cerebri, or vertigo with the latter adverse event leading to restrictions on minocycline use in military aviators [ 37 , 44 ]. Minocycline can cross the blood–brain barrier, potentially explaining the increased risk for dizziness and vertigo [ 43 , 45 ]. Although topical minocycline has a low resistance claim on its label, oral minocycline does not.…”

“…Furthermore, it has been demonstrated from X-ray crystallography that the unique chemical group, the carbon 7 (C7) moiety, on sarecycline is critical for establishing biochemical properties for sarecycline that distinguish it from doxycycline and minocycline. These structural and biochemical differences are directly related to sarecycline’s decreased propensity for inducing antibiotic resistance, as illustrated by sarecycline’s increased ability to cause steric clash with the ribosomal protection protein TetM ( Figure 3 ) [ 45 , 53 ].…”

“…Despite the potential benefits of sarecycline, its significantly higher price compared to other tetracyclines such as doxycycline and minocycline, as well as lack of coverage by Medicare part D and other insurance plans, may limit its wider usage. This is a significant problem because lack of access to sarecycline hinders the ability for dermatologists and other medical providers to practice appropriate and necessary antibiotic stewardship [ 45 ]. At some point the cost of precision medicine care upfront (narrow-spectrum sarecycline) must be viewed as advantageous compared to the higher overall healthcare costs that may ensue downstream from the complications of broad-spectrum antibiotic use.…”

In vitro susceptibility testing of tetracycline‐class antibiotics against slowly growing non‐tuberculous mycobacteria

“…Although exhibiting good activity against RGM, OMC and ERC showed poor or mild activity against MAC and M. kansasii (OMC against MAC: MIC 50 = >16 μg/mL, MIC 90 = >16 μg/mL; OMC against M. kansasii : MIC 50 = 8, MIC 90 = 16 μg/mL; ERC against MAC: MIC 50 = >8 μg/mL, MIC 90 = >8 μg/mL; ERC against M. kansasii : MIC 50 = 1 μg/mL and MIC 90 = >8 μg/mL) 5,8 . SAC showed mild inhibitory activity against RGM, whereas the activity of SAC against SGM has not been reported to date 9 . In addition, SGM isolates were limited in the previously mentioned studies, and no study has been conducted on SGM isolates in China.…”