Ramoplanin

Glycodepsipeptide AntibioticRx: InvestigationalCompound: Investigational

Also known as: A-16686, MDL 62,198, Ramoplanose

Educational Only — Not medical advice. Consult a qualified clinician before using any peptide.

Summary

Ramoplanin is a glycodepsipeptide antibiotic with potent activity against gram-positive bacteria, including vancomycin-resistant Enterococcus (VRE) and Clostridioides difficile. It has been investigated primarily for oral use in GI decolonization of VRE and treatment of C. difficile infections. It is not systemically absorbed when given orally, limiting its use to luminal GI indications.

Mechanism of Action

Inhibits bacterial cell wall biosynthesis by binding to lipid II (undecaprenyl-pyrophosphoryl-MurNAc-pentapeptide) and lipid I intermediates, blocking transglycosylation and preventing peptidoglycan polymerization. Also disrupts cell membrane integrity.

Routes of Administration

Oral

Goals & Uses

  • Eradication of VRE intestinal colonizationAntimicrobial / DecolonizationModerate
  • Prevention of bacteremia in immunocompromised patients colonized with VREAntimicrobial / ProphylaxisLow
  • Treatment of Clostridioides difficile infectionAntimicrobialModerate
  • Activity against MRSAAntimicrobialLow

Contraindications

  • Known hypersensitivity to ramoplanin or glycodepsipeptidesAllergyHigh

Adverse Effects

  • Injection site reactions (if parenteral)LocalUnknown
  • NauseaGastrointestinalCommonFeeling of sickness or urge to vomit
  • VomitingGastrointestinalUncommonForceful expulsion of stomach contents
  • DiarrheaGastrointestinalCommonLoose or frequent stools
  • Abdominal painGastrointestinalUncommonPain or discomfort in the abdomen

Drug Interactions

  • Oral anticoagulants (e.g., warfarin)Low

Population Constraints

  • Severe gastrointestinal mucosal damageGastrointestinalRelative
  • PregnancyReproductive SafetyRelative
  • Pediatric patientsAgeRelative

Regulatory Status

  • European UnionUnknownNo EMA approval; limited European regulatory history
  • United StatesInvestigationalFDA Orphan Drug designation for VRE decolonization; not approved; development paused
  • United KingdomUnknownNot approved by MHRA; research/investigational context only

Ramoplanin received FDA Orphan Drug designation for VRE decolonization and C. difficile infection. It has not received full FDA or EMA approval. Clinical development has been intermittent; not currently approved in any major jurisdiction.

Evidence & Sources

No sources recorded yet.

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