The efficacy of apramycin use in animals: A scoping review

Apramycin is an aminoglycoside antimicrobial that is used in livestock but interest has emerged in repurposing it for use in humans with multidrug resistant Gram negative bacterial infections. A scoping review was performed to identify available evidence pertaining to the efficacy of apramycin in animals, as part of assessment of its use in animals and potential issues that might emerge with re-purposing the drug for use in humans. Thirty eligible studies were identified, reporting data from 44 trials (1-3 trials/study, median 1). Studies were predominantly from before 1990. Most studies involved pigs, cattle and poultry, and assessed apramycin for prevention or treatment of enteric disease caused by E. coli. When studies of growth promotion (n = 6), parenteral administration (which is no longer used as an injectable version is not available, n = 9) and experimental infection (n = 1) are removed, only 28 trials from 18 studies reported evaluation of clinical outcomes with currently available formulations. Study design was often poorly described and statistical analyses were often superficially reported or not reported. Overall, a statistically significant beneficial effect of apramycin vs one or more comparisons was reported for 17/44 (39%) trials. No statistically significant effect was reported in two (4.5%) trials. The remaining inferred effects, either without a comparison group (uncontrolled studies) or without statistical analysis between groups. Data suggest that apramycin can be effective for the treatment and prevention of enteric disease in calves, piglets, poultry and rabbits, at least under certain production systems, predominantly against disease caused by E. coli, but more robust data and studies involving current production systems are needed.