Amer El Ghali, Wayne State University
Taylor Morrisette, Medical University of South Carolina
Sara Alosaimy, Wayne State University
Kristen Lucas, Wayne State University
Maria G Tupayachi-Ortiz, University of Miami
Raaga Vemula, University of Texas Health Center at Tyler
Carly Wadle, University of Texas Health Center at Tyler
Julie V Philley, University of Texas Health Center at Tyler
Carlos Mejia-Chew, Washington University School of Medicine
Yasir Hamad, Washington University School of Medicine
Ryan W Stevens, Mayo Clinic
John D Zeuli, Mayo Clinic
Andrew J Webb, Mayo Clinic
Christina T Fiske, Vanderbilt University
Anahit Simonyan, Vanderbilt University
Christo L Cimino, Vanderbilt University
Mehriban Mammadova, University of Texas Health Science Center at Houston
Virginia E Umana, University of Texas Health Science Center at Houston
Rodrigo Hasbun, University of Texas Health Science Center at Houston
Saira Butt, Indiana University Purdue University Indianapolis
Kyle C Molina, University of Colorado
Michael Thomas, University of Colorado
Emily A Kaip, University of California, San Francisco
Jeannette Bouchard, University of South Carolina
Tristan W Gore, University of South Carolina
Catessa Howard, West Virginia University
M Gabriela Cabanilla, University of New Mexico
Dana J Holger, Nova Southeastern UniversityFollow
Jeremy J Frens, Cone Health
Melissa Barger, Ventura County Medical Center
Aaron Ong, Ventura County Medical Center
Keira A Cohen, Johns Hopkins University
Michael J Rybak, Wayne State University

Document Type


Publication Date


Publication Title

Antimicrobial Agents and Chemotherapy


Mycobacterium abscessus, culture conversion, nontuberculous mycobacteria, omadacycline.



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Infections due to nontuberculous mycobacteria (NTM) continue to increase in prevalence, leading to problematic clinical outcomes. Omadacycline (OMC) is an aminomethylcycline antibiotic with FDA orphan drug and fast-track designations for pulmonary NTM infections, including Mycobacteroides abscessus (MAB). This multicenter retrospective study across 16 U.S. medical institutions from January 2020 to March 2023 examined the long-term clinical success, safety, and tolerability of OMC for NTM infections. The cohort included patients aged ≥18 yr, who were clinically evaluable, and` had been treated with OMC for ≥3 mo without a previous diagnosis of cystic fibrosis. The primary outcome was 3 mo clinical success, with secondary outcomes including clinical improvement and mortality at 6- and 12 mo, persistence or reemergence of infection, adverse effects, and reasons for OMC utilization. Seventy-five patients were included in this analysis. Most patients were female (48/75, 64.0%) or Caucasian (58/75, 77.3%), with a median (IQR) age of 59 yr (49–67). Most had NTM pulmonary disease (33/75, 44.0%), skin and soft tissue disease (19/75, 25.3%), or osteomyelitis (10/75, 13.3%), and Mycobacterium abscessus (60/75, 80%) was the most commonly isolated NTM pathogen. The median (IQR) treatment duration was 6 mo (4–14), and the most commonly co-administered antibiotic was azithromycin (33/70, 47.1%). Three-month clinical success was observed in 80.0% (60/75) of patients, and AEs attributable to OMC occurred in 32.0% (24/75) of patients, leading to drug discontinuation in 9.3% (7/75).


This work was supported by an investigator-initiated grant from Paratek Pharmaceuticals. The funders had no role in the study design, data collection and interpretation, or decision to submit the work for publication. A.E., T.M., K.L., M.G.T-O., R.V., C.W., Y.H., R.W.S., J.D.Z, A.J.W., A.S., C.L.C, M.M., V.E.U, S.B., K.C.M., M.T., E.A.K., J.B., T.W.G., C.H., M.G.C., D.J.H., J.J.F., M.L.B., A.O., J.S. have no conflicts of interest to disclose. S.A. is currently an employee of Aimmune Therapeutics, a Nestle Company. J.V.P. has been on advisory boards for Insmed, A2N, Paratek Pharmaceuticals, and Cipla Technologies, and has spoken for Insmed. M.P.V. received research funding from Paratek Pharmaceuticals, Cumberland Pharmaceuticals, Insmed, AN2, Spero, Hillrom, and Electromed. C.M-C. has consulted for HIVE Medical Inc, and has received grant funding from the CDC (CDC# 1U54CK000617-01-00). C.T.F. has spoken for Insmed. R.H. has consulted for and received research funding from Biofire Diagnostics. K.A.C. is currently employed by Janssen pharmaceutical companies of Johnson & Johnson and has received consulting fees from Insmed, Hillrom, Merck, and Microbion, and AN2, unrelated to the current investigation, and was supported by National Heart, Lung, and Blood Institute K08 HL1139994 and the Burroughs Welcome Fund Career Award for Medical Scientists. M.J.R. has received funds for research and consulting or participated in speaking bureaus for Abbvie, Baselia, Ferring, Melinta, Merck, Paratek Pharmaceuticals, Shionogi, Tetraphase, and T2 Biosystems and is partially supported by National Institute of Allergy and Infectious Diseases R21 AI163726. Conflicts that the editors considered relevant to the content of the manuscript have been disclosed. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.



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