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Bishburg E, Bishburg K. Minocycline--an old drug for a new century: emphasis on methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii. Int J Antimicrob Agents 2009; 34:395-401. [PMID: 19665876 DOI: 10.1016/j.ijantimicag.2009.06.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 06/04/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
Abstract
The epidemiology of nosocomial and community-acquired infections has changed in recent years. Methicillin-resistant Staphylococcus aureus (MRSA), especially community-associated MRSA (CA-MRSA), has emerged as a gram-positive organism with an increasing impact in clinical practice. Infections with Acinetobacter baumannii have become a major cause of morbidity and mortality. Minocycline has significant in vitro activity against MRSA and A. baumannii that is comparable with agents currently used against these organisms. The absence of an intravenous (i.v.) minocycline formulation in recent years has limited its use in seriously ill patients infected with these organisms. However, minocycline i.v. has recently been reintroduced to the US market. The objective of this study was to review available information on the chemistry, mechanism of action, in vitro activity, resistance mechanisms, pharmacokinetics, tolerability and efficacy of minocycline against MRSA and A. baumannii. This article provides suggestions for future studies and potential uses of minocycline and is designed to trigger interest in systematic clinical evaluation of minocycline for patients infected with these organisms. In conclusion, minocycline is an old drug that has the potential to become an important part of the armamentarium against emerging infections such as CA-MRSA and A. baumannii. Owing to its promising profile against these clinically important pathogens as well as excellent pharmacokinetic properties, minocycline merits evaluation in serious infections.
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Affiliation(s)
- Eliahu Bishburg
- Division of Infectious Diseases, Beth Israel Medical Center, 201 Lyons Avenue G3, Newark, NJ 07112, USA.
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2
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del Carmen Carrasco-Portugal M, Luján M, Flores-Murrieta FJ. Evaluation of gender in the oral pharmacokinetics of clindamycin in humans. Biopharm Drug Dispos 2008; 29:427-30. [PMID: 18623043 DOI: 10.1002/bdd.624] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clindamycin is an antimicrobial agent metabolized by CYP3A4. Gender may influence the pharmacokinetics of drugs metabolized by this pathway, however, no information about differences in the pharmacokinetics of clindamycin in men and women is available. The purpose of this study was to evaluate gender differences in clindamycin oral pharmacokinetics. Twenty-four subjects (11 men and 13 women) received an oral 600 mg dose of clindamycin under fasting conditions and plasma concentrations were obtained at selected times during 12 h. Increased plasma levels were observed in women, but when the dose was normalized by the body weight of individuals, these differences disappeared, indicating that gender does not play an important role in the pharmacokinetics of this drug.
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Cui Y, Liao XX, Liu W, Guo RX, Wu ZZ, Zhao CM, Chen PX, Feng JQ. A novel role of minocycline: attenuating morphine antinociceptive tolerance by inhibition of p38 MAPK in the activated spinal microglia. Brain Behav Immun 2008; 22:114-23. [PMID: 17919885 DOI: 10.1016/j.bbi.2007.07.014] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 07/12/2007] [Accepted: 07/12/2007] [Indexed: 01/04/2023] Open
Abstract
We have previously demonstrated that activation of p38 mitogen-activated protein kinase (p38 MAPK) in the spinal microglia mediates morphine antinociceptive tolerance. Minocycline, a selective inhibitor of microglia activation, has been reported to attenuate peripheral inflammation-induced hyperalgesia by depressing p38 MAPK in the spinal microglia. The aim of the present study is to explore the effect of intrathecal minocycline on the development of morphine antinociceptive tolerance and p38 activation in the spinal microglia induced by chronic morphine treatment. Minocycline (20, 50 and 100 microg) was given intrathecally 30 min before each morphine (15 microg) administration for consecutive 7 days. It was shown that minocycline attenuated tolerance to morphine analgesia in a dose-dependent manner. Minocycline administration (50 microg) which was initiated on day 4 followed by another 4 days administration partially reversed the established morphine antinociceptive tolerance. However, minocycline treatment which was started on day 8 followed by its administration for 4 more days failed to reverse the established morphine tolerance. Immunohistochemical analysis showed that chronic intrathecal morphine-induced activation of p38 MAPK in the spinal microglia. Minocycline at a dose that was shown to antagonize tolerance to morphine analgesia significantly inhibited the increase in p38 MAPK activation in the spinal microglia. To our knowledge, this is the first study to demonstrate that minocycline antagonizes morphine antinociceptive tolerance, possibly due to the inhibition of p38 activation in the spinal microglia.
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Affiliation(s)
- Yu Cui
- Department of Physiology, Zhongshan Medical College, Sun Yat-Sen University, Guangzhou 510080, PR China
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Guay D. Update on clindamycin in the management of bacterial, fungal and protozoal infections. Expert Opin Pharmacother 2007; 8:2401-44. [PMID: 17927492 DOI: 10.1517/14656566.8.14.2401] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lincomycin and clindamycin are the only members of the relatively small lincosamide antimicrobial class marketed for use in humans. This paper only reviews data regarding clindamycin, with an emphasis on data published over the last decade. Clindamycin exhibits a broad spectrum of antimicrobial activity, including Gram-positive aerobes/anaerobes, Gram-negative anaerobes and select protozoa (Toxoplasma gondii, Plasmodium falciparum, Babesia spp.) and fungi (Pneumocystis jiroveci). It still enjoys use in the therapy and prophylaxis of a large number of bacterial, protozoal and fungal infections, despite > 40 years of clinical use. However, the spectre of resistance by an increasing number of microorganisms is beginning to cast a shadow over the future use of this valuable agent. With the emergence and spread of infections due to community-acquired methicillin-resistant Staphylococci (for which clindamycin is a first-line agent), it is hoped that the issues of resistance can be mitigated and the use of clindamycin extended for at least the foreseeable future.
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Affiliation(s)
- David Guay
- University of Minnesota, College of Pharmacy, Weaver-Densford Hall 7-148, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
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Stieger K, Mendes-Madeira A, Meur GL, Weber M, Deschamps JY, Nivard D, Provost N, Moullier P, Rolling F. Oral administration of doxycycline allows tight control of transgene expression: a key step towards gene therapy of retinal diseases. Gene Ther 2007; 14:1668-73. [PMID: 17914405 DOI: 10.1038/sj.gt.3303034] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Gene transfer of neurotrophic or antiangiogenic factors has been shown to improve photoreceptor survival in retinal degenerative disorders (that is retinitis pigmentosa) and to prevent neovascularization in retinal vascular diseases (that is age-related macular degeneration, diabetic retinopathy). Expression of such neurotrophic or antiangiogenic factors after gene transfer requires the use of a regulatory system to control transgene expression to avoid unwanted side effects in cases of overexpression. In a previous study, we demonstrated that rAAV-mediated gene transfer of the tetracycline-regulatable (tetR) system allows transgene regulation in the retina of nonhuman primates after intravenous administration of doxycycline (Dox). The purpose of this study was to evaluate oral administration of Dox to control transgene expression in the retina, since the pharmacokinetics after oral administration of the inducer drug represent a key factor when considering advancing to clinical trials. We report on the outcome of this evaluation and demonstrate that oral administration of Dox at a dose that is clinically used in humans (5 mg kg(-1) per day) is capable to continuously induce transgene expression in all macaques tested for 6 months. Moreover, control of transgene expression persists up to 4 years post-subretinal injection, with maximal induced levels of transgene product remaining stable over time.
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Affiliation(s)
- K Stieger
- INSERM UMR U649, CHU-Hotel Dieu, Nantes, France
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Sabet NS, Subramaniam G, Navaratnam P, Sekaran SD. Detection of mecA and ermA genes and simultaneous identification of Staphylococcus aureus using triplex real-time PCR from Malaysian S. aureus strain collections. Int J Antimicrob Agents 2007; 29:582-5. [PMID: 17314034 DOI: 10.1016/j.ijantimicag.2006.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 11/28/2006] [Accepted: 12/18/2006] [Indexed: 10/23/2022]
Abstract
A triplex real-time polymerase chain reaction (PCR) assay was used for the simultaneous detection of mecA (methicillin resistance), ermA (erythromycin resistance) and femA (Staphylococcus aureus identification) genes in a single assay. Among 93 clinical S. aureus hospital isolates, there were 48 methicillin-resistant S. aureus (MRSA) and 45 methicillin-sensitive S. aureus (MSSA) isolates. Screening the isolates using the triplex real-time PCR assay, the mecA, ermA and femA genes were detected in all MRSA isolates. The triplex real-time PCR assay was completed within 3h and is a useful genotypic method for detecting the resistance determinants as well as for the identification of S. aureus isolates. These findings will assist the clinical laboratory in identifying these resistance genes and S. aureus rapidly, thus benefiting patient therapy. This study represents a valuable source of information for researchers to study the local antibiotic resistance pattern, which can increase our knowledge of the antibiotic resistance profile, using real-time PCR technology.
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Affiliation(s)
- Negar Shafiei Sabet
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Cunha BA. New uses for older antibiotics: nitrofurantoin, amikacin, colistin, polymyxin B, doxycycline, and minocycline revisited. Med Clin North Am 2006; 90:1089-107. [PMID: 17116438 DOI: 10.1016/j.mcna.2006.07.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nitrofurantoin, amikacin, colistin, polymyxin B, doxycycline, and minocycline are antibiotics with proven effectiveness against selected pathogens. These antibiotics have not developed resistance over time. As "low-resistance potential antibiotics" that are effective against an increasing number of infections due to resistant gram-positive or gram-negative pathogens, these antimicrobials remain an important part of the antibiotic armamentarium. They will be used increasingly in the future, as highly resistant organisms continue to be important clinically and therapeutic options remain limited.
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Affiliation(s)
- Burke A Cunha
- State University of New York School of Medicine, Stony Brook, NY, USA
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Fanning GC, Symonds G. Gene-expressed RNA as a therapeutic: issues to consider, using ribozymes and small hairpin RNA as specific examples. Handb Exp Pharmacol 2006:289-303. [PMID: 16594621 DOI: 10.1007/3-540-27262-3_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
In recent years there has been a greater appreciation of both the role of RNA in intracellular gene regulation and the potential to use RNA in therapeutic modalities. In the latter case, RNA can be used as a therapeutic target or a drug. The chapters in this volume cover the varied and potent actions of RNA as antisense, ribozymes, aptamers, microRNA and small hairpin RNA in gene regulation, as well as their use as potential therapeutics for metabolic and infectious diseases. Our group has been involved in the development of anti-HIV gene expression constructs to treat HIV. In this chapter, we address the relevant scientific and some of the commercial issues in the use of RNA as a therapeutic. Specifically, the chapter discusses delivery, expression, potency, toxicity and commercial development using, as examples, hammerhead ribozymes and small hairpin RNA.
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Affiliation(s)
- G C Fanning
- Johnson Johnson Research, The Australian Technology Park, Strawberry Hills, Locked Bag 4555, 2012 Sydney NSW, Australia
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Abstract
BACKGROUND CONTEXT Recent advances in our understanding of the biologic makeup and environment of the intervertebral disc (IVD) have led to increased interest in the development of novel treatments for disc degeneration. Certain genes found to alter rates of matrix synthesis and catabolism within the disc have provided targets for scientists seeking to alter the balance between the two. To this end, gene therapy has emerged as a potential therapeutic option, and recent research efforts have yielded very promising results. PURPOSE To update and consolidate information regarding the recent advances in gene therapy and its application to IVD degeneration. STUDY DESIGN/SETTING Review of recent and ongoing research in the field of gene therapy, particularly regarding its application to the treatment of IVD degeneration. METHODS Literature review. RESULTS With its unique ability to provide sustained delivery of potentially therapeutic agents, gene therapy has shown much promise with regard to the treatment of IVD degeneration. There have been many exciting developments such as safer and more reliable vector constructs, favorable results using therapeutic transgenes in disc cells both in vitro and in vivo, and improvement in transgene regulation, and investigators continue to explore ways in which gene therapy can become a powerful tool in the future treatment of disc degeneration. CONCLUSIONS With continued perseverance and dedication, many advances have been made in the application of gene therapy to the IVD, and it continues to demonstrate great potential to become a powerful tool in the future treatment of disc degeneration.
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Affiliation(s)
- Eric A Levicoff
- Ferguson Laboratory for Orthopaedic Research, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Rm C-313, Presbyterian University Hospital, 200 Lothrop St., Pittsburgh, PA 15213, USA
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Jiang SX, Lertvorachon J, Hou ST, Konishi Y, Webster J, Mealing G, Brunette E, Tauskela J, Preston E. Chlortetracycline and Demeclocycline Inhibit Calpains and Protect Mouse Neurons against Glutamate Toxicity and Cerebral Ischemia. J Biol Chem 2005; 280:33811-8. [PMID: 16091365 DOI: 10.1074/jbc.m503113200] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Minocycline is a potent neuroprotective tetracycline in animal models of cerebral ischemia. We examined the protective properties of chlortetracycline (CTC) and demeclocycline (DMC) and showed that these two tetracyclines were also potent neuroprotective against glutamate-induced neuronal death in vitro and cerebral ischemia in vivo. However, CTC and DMC appeared to confer neuroprotection through a unique mechanism compared with minocycline. Rather than inhibiting microglial activation and caspase, CTC and DMC suppressed calpain activities. In addition, CTC and DMC only weakly antagonized N-methyl-D-aspartate (NMDA) receptor activities causing 16 and 14%, respectively, inhibition of NMDA-induced whole cell currents and partially blocked NMDA-induced Ca2+ influx, commonly regarded as the major trigger of neuronal death. In vitro and in vivo experiments demonstrated that the two compounds selectively inhibited the activities of calpain I and II activated following glutamate treatment and cerebral ischemia. In contrast, minocycline did not significantly inhibit calpain activity. Taken together, these results suggested that CTC and DMC provide neuroprotection through suppression of a rise in intracellular Ca2+ and inhibition of calpains.
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Affiliation(s)
- Susan X Jiang
- Neurophysiology Group, National Research Council Institute for Biological Sciences, National Research Council Canada, Ottawa, Ontario K1A 0R6, Canada
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Abstract
Postoperative infections in joint prostheses and fracture-fixation devices commonly involve both MRSA and methicillin resistant coagulase-negative staphylococcus. In addition, community-acquired MRSA has also become an important consideration when infected patients are admitted to the hospital from the community. Preoperative colonization with MRSA and methicillin resistant coagulase-negative staphylococcus increases the risk of postoperative surgical site infections in orthopedic patients. Up to 5.3% of orthopedic patients are colonized with these organisms on hospital admission. Screening and decolonization of methicillin resistant staphylococci decrease the incidence of postoperative surgical site infections in the orthopedic patient. This may be particularly important in orthopedic implants given the difficulty encountered in treating infected prosthesis. Current US guidelines advocate screening for methicillin resistant staphylococci only when risk factors are present. Growing evidence suggests that screening and decolinization of all patients having elective orthopedic procedures, especially those including prosthetic implants, will decrease the incidence of postoperative infections. The infected prosthesis may be potentially salvaged if the clinical manifestations of infection have been present for < or = 10 days, the implant is stable, and the etiologic organisms are susceptible to oral antibiotics.
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Affiliation(s)
- Wael E Shams
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky School of Medicine, Lexington, KY, USA
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Toniatti C, Bujard H, Cortese R, Ciliberto G. Gene therapy progress and prospects: transcription regulatory systems. Gene Ther 2004; 11:649-57. [PMID: 14985790 DOI: 10.1038/sj.gt.3302251] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The clinical efficacy and safety as well as the application range of gene therapy will be broadened by developing systems capable of finely modulating the expression of therapeutic genes. Transgene regulation will be crucial for maintaining appropriate levels of a gene product within the therapeutic range, thus preventing toxicity. Moreover, the possibility to modulate, stop or resume transgene expression in response to disease evolution would facilitate the combination of gene therapy with more conventional therapeutic modalities. The development of ligand-dependent transcription regulatory systems is thus of great importance. Here, we summarize the most recent progress in the field.
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Affiliation(s)
- C Toniatti
- 1I.R.B.M.-P. Angeletti, Via Pontina Km. 30.600, 00040 Pomezia, Rome, Italy
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Affiliation(s)
- Kamal M F Itani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Houston Veterans Administration Medical Center (112A), 2002 Holcombe Boulevard, Houston, Texas 77030, USA.
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Strommenger B, Kettlitz C, Werner G, Witte W. Multiplex PCR assay for simultaneous detection of nine clinically relevant antibiotic resistance genes in Staphylococcus aureus. J Clin Microbiol 2003; 41:4089-94. [PMID: 12958230 PMCID: PMC193808 DOI: 10.1128/jcm.41.9.4089-4094.2003] [Citation(s) in RCA: 372] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this study we describe a multiplex PCR assay for the detection of nine clinically relevant antibiotic resistance genes of Staphylococcus aureus. Conditions were optimized to amplify fragments of mecA (encoding methicillin resistance), aacA-aphD (aminoglycoside resistance), tetK, tetM (tetracycline resistance), erm(A), erm(C) (macrolide-lincosamide-streptogramin B resistance), vat(A), vat(B), and vat(C) (streptogramin A resistance) simultaneously in one PCR amplification. An additional primer pair for the amplification of a fragment of the staphylococcal 16S rDNA was included as a positive control. The multiplex PCR assay was evaluated on 30 different S. aureus isolates, and the PCR results correlated with the phenotypic antibiotic resistance data obtained by the broth microdilution assay. The multiplex PCR assay offers a rapid, simple, and accurate identification of antibiotic resistance profiles and could be used in clinical diagnosis as well as for the surveillance of the spread of antibiotic resistance determinants in epidemiological studies.
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Abstract
Leptospirosis is a worldwide disease. In this time of globalization knowledge about leptospirosis is important. Although pulmonary involvement has an incidence varying from 20% to 70% and its exteriorization may vary from mild to severe, The severe form appears to be becoming more prevalent (at least in Brazil) and may be associated with higher mortality.
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Affiliation(s)
- Carlos Roberto Ribeiro Carvalho
- Division of Respiratory Diseases, Heart Institute (InCor), University of São Paulo Medical School, Rua Maria Figueiredo 396, Apt. 141, CEP 04002-002, São Paulo, Brazil
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Affiliation(s)
- Avinash K Shetty
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27517, USA
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