9-aminomethyl minocycline compounds and use thereof in treating community-acquired bacterial pneumonia (CABP)

1. A method of treating Community-Acquired Bacterial Pneumonia (CABP) in a subject in need of treatment thereof, comprising administering to said subject 9-[(2,2-dimethyl-propyl amino)-methyl]-minocycline or a salt thereof according to the following dosing regimen:

(1) three intravenous doses of about 100 mg each, administered 12 hours apart, followed by,

(2) one or more intravenous doses of about 100 mg each, each administered 24 hours following the immediate preceding intravenous dose, followed by,

(3) optionally, one oral dose of about 300 mg, administered in the morning and 12-24 hrs after the immediate preceding intravenous dose, followed by,

(4) optionally, one or more oral doses of about 300 mg each, each administered 24 hours following the immediate preceding oral dose,

such that said subject is treated.

2. A method of treating Community-Acquired Bacterial Pneumonia (CABP) in a subject in need of treatment thereof, comprising administering to said subject 9-[(2,2-dimethyl-propyl amino)-methyl]-minocycline or a salt thereof according to the following dosing regimen:

(1) three intravenous doses of about 100 mg each, administered 12 hours apart, followed by,

(2) one or more intravenous doses of about 100 mg each, each administered 24 hours following the immediate preceding intravenous dose, followed by,

(3) one or more oral doses of about 300 mg each, each administered 24 hours following the immediate preceding dose,

such that said subject is treated.

3. The method of claim 2 , wherein step (2) consists of one intravenous dose of about 100 mg of said subject 9-[(2,2-dimethyl-propyl amino)-methyl]-minocycline or salt thereof.

4. A method of treating Community-Acquired Bacterial Pneumonia (CABP) in a subject in need of treatment thereof, comprising administering to said subject 9-[(2,2-dimethyl-propyl amino)-methyl]-minocycline or a salt thereof according to the following dosing regimen:

(1) three intravenous doses of about 100 mg each, administered 12 hours apart, followed by,

(2) one or more intravenous doses of about 100 mg each, each administered 24 hours following the immediate preceding intravenous dose,

such that said subject is treated.

5. The method of claim 1 , wherein the steps are completed within 7 days, 8 days, 9 days, 10 days, 11 days, 12 days, 13 days, 14 days, 15 days, 16 days, 17 days, 18 days, 19 days, or 20 days.

6. The method of claim 1 , wherein the number of days of IV dosing is 3-10 days, 3-6 days, 7-10 days, or 5 days.

7. The method of claim 1 , comprising one or more oral doses, and wherein the number of days of IV dosing is 4-7 days, 4-5 days, 6-7 days, or 5 days.

8. The method of claim 7 , wherein the number of days of oral dosing is 1-7 days, 1-4 days, 5-7 days, or 5 days.

9. The method of claim 7 , wherein the number of days of IV dosing is 5 days, and the number of days of oral dosing is 5 days.

10. The method of claim 1 , wherein said CABP is caused by Staphylococcus aureus including methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus pneumoniae including penicillin-resistant Streptococcus pneumoniae (PRSP), Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, Legionella pneumophila, Chlamydophila pneumoniae, Mycoplasma pneumoniae, Chlamydophila psittaci, Coxiella burnetii, Escherichia coli , or a combination thereof.

11. The method of claim 1 , wherein said subject is a human.

12. The method of claim 1 , wherein each of said oral dose is administered independently as two 150-mg tablets.

13. The method of claim 1 , wherein each of said intravenous dose is administered continuously over about 30 minutes.

14. The method of claim 1 , wherein said dosing regimen has a clinical success rate that is within 10% (or 12.5%) margin of non-inferiority compared to moxifloxacin administered as 400 mg intravenous dose once every 24 hours for three or more days, followed by one or more doses of 400 mg oral doses of moxifloxacin once every 24 hours.

15. The method of claim 1 , wherein said subject experience improvement, at day 3 to day 5 after step (1), in at least two symptoms selected from: chest pain, frequency or severity of cough, amount of productive sputum, and difficulty breathing, wherein said symptoms are evaluated on a four-point scale of absent, mild, moderate, and severe, and wherein improvement is at least a one-point improvement from baseline to the assessment at said day 3 to day 5.

16. The method of claim 1 , wherein said subject, at day 3 to day 5 after step (1), experience improvement in at least two symptoms and no worsening in any of the symptoms selected from: chest pain, frequency or severity of cough, amount of productive sputum, and difficulty breathing, and improvement in at least one vital sign selected from: body temperature, blood pressure, heart rate, and respiratory rate.

17. The method of claim 1 , wherein the subject undergoes fasting overnight, with no food or drink except water for at least 6 hours, just before step (3) dosing (if present), and wherein the subject continues fasting after step (3) dosing, with no food for 2 hours, and no dairy products for 4 hours.

18. The method of claim 1 , wherein said salt is a tosylate salt.

19. The method of claim 1 , which method has a clinical success rate of about 70%-100%; about 75-95%, about 80-95%, about 75-90%, about 80-90%, about 75-85%, about 80-85%, about 85-90%, about 90-95%, about 80-82%, or about 81%; or about 75-85%, observed at about 72-120 hours after the administration of the first intravenous dose.

20. The method of claim 1 , wherein said subject has CABP categorized as PORT Risk Class III or IV.

21. The method of claim 1 , wherein gastrointestinal (GI) adverse events (AEs) associated with treatment of said subject are mild, or do not result in discontinuation of therapy with said method.

22. The method of claim 1 , wherein treatment of said subject (1) does not result in increased risk of C. difficile (e.g., C. difficile colitis and Pseudomembranous colitis) infection in said subject, or (2) does not substantially disrupting gut microbiome in said subject.