Actinomycosis is a chronic localized or hematogenous anaerobic infection caused by Actinomyces israelii. Which of the following is the most common portal of entry for this organism?

Abscess resulting from periodontal disease
Break in the mucosa from abdominal trauma
Complications from an intrauterine device
Pulmonary disease resulting from aspiration of oral secretions

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By

Brian J. Werth

, PharmD, University of Washington School of Pharmacy

Last full review/revision May 2020| Content last modified May 2020

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Lefamulin is a pleuromutilin antibiotic that inhibits bacterial protein synthesis by binding to the peptidyl transferase center of the 50S bacterial ribosome, thus preventing the binding of transfer RNA.

Oral bioavailability is about 25%, and consequently the oral dose is 4 times higher (600 mg every 12 hours) than the IV dose (150 mg every 12 hours). Lefamulin has minimal renal clearance and does not require dose adjustment in patients with kidney disease.

Lefamulin is indicated for the treatment of community-acquired bacterial pneumonia (CABP) caused by the following susceptible microorganisms:

Streptococcus pneumoniae
Staphylococcus aureus (methicillin-susceptible isolates
Haemophilus influenzae
Legionella pneumophila
Mycoplasma pneumoniae
Chlamydophila pneumoniae

Use of lefamulin with CYP3A4 substrates that prolong the QT interval, such as tacrolimus, dofetilide, and quetiapine, is contraindicated.

Animal reproduction studies with lefamulin show some risk, and no adequate, well-controlled studies have been done in pregnant women. Alternatives to lefamulin should be considered in pregnant women until better safety data are available. Females with reproductive potential should use contraception while on therapy and for 2 days after the last dose.

Animal lactation studies suggest that lefamulin concentrates in breast milk. It is advised that lactating women taking lefamulin pump and discard while taking lefamulin and for 2 days after the last dose.

Lefamulin may cause QT prolongation especially if combined with other drugs that prolong the QT interval.

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