Research progress on eravacycline: from pharmacokinetics/pharmacodynamics to the practice of individualized therapy

Eravacycline is a fully synthetic, fluorinated third-generation tetracycline with broad-spectrum antibacterial activity, approved for the treatment of complicated intra-abdominal infections(cIAI). Clinical studies have demonstrated favorable safety and predictable pharmacokinetic properties, supporting its use in diverse complicated infections. With increasing application in critically ill patients and those with significant organ dysfunction, increasing attention has been directed toward the potential alterations in pharmacokinetics caused by pathophysiological changes in these populations. Such variability may influence drug exposure and treatment outcomes; however, current dosing strategies largely follow standard recommendations, and evidence supporting dose optimization in special populations remains limited. This review provides a comprehensive overview of current evidence regarding the chemical structure, antimicrobial and pharmacological properties, pharmacokinetics, pharmacokinetic/pharmacodynamic characteristics, clinical applications, population pharmacokinetics, and therapeutic drug monitoring of eravacycline, aiming to support rational clinical use and individualized dosing strategies.