1
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McSorley JC, Reyes D, Tonna I, Bateman V. Experience with dalbavancin use in various gram-positive infections within Aberdeen Royal Infirmary OPAT service. Infection 2024; 52:567-576. [PMID: 38165594 PMCID: PMC10954975 DOI: 10.1007/s15010-023-02152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/27/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE Dalbavancin, approved in 2014 for Gram-positive acute bacterial skin and skin structure infections (ABSSSI), has pharmacokinetics enabling treatment with one or two doses. Dalbavancin might be useful in outpatient parenteral antibiotic therapy (OPAT) of deep-seated infections, otherwise requiring inpatient admission. We documented our experience with pragmatic dalbavancin use to assess its effectiveness for varied indications, on- and off-label, as primary or sequential consolidation therapy. METHODS Patients prescribed dalbavancin between 1 December 2021 and 1 October 2022 were screened for demographics of age, sex, Charlson comorbidity index (CCI), allergies, pathogens, doses of dalbavancin, other antibiotics administered and surgery. Where available, infection markers were recorded. The primary outcome was a cure at the end of treatment. Secondary outcomes included any adverse events and for those with treatment failures, response to salvage antibiotics. RESULTS Sixty-seven per cent of patients were cured. Cure rates by indication were 93% for ABSSSI, 100% for bacteraemia, 90% for acute osteomyelitis, 0% for chronic osteomyelitis, 75% for native joint septic arthritis and 33% for prosthetic joint infection. Most bone and joint infections that were not cured did not have source control, and the goal of treatment was suppressive. Successful suppression rates were greater at 48% for chronic osteomyelitis and 66% for prosthetic joint infections. Adverse events occurred in 14 of 102 patients. CONCLUSION This report adds to clinical experience with dalbavancin for off-label indications whilst further validating its role in ABSSSI. Dalbavancin as primary therapy in deep-seated infections merits investigation in formal clinical trials.
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Affiliation(s)
- James C McSorley
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Darshini Reyes
- Department of Pharmacy, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ivan Tonna
- Infection Unit, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK.
| | - Vhairi Bateman
- Infection Unit, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
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2
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Retrospective Analysis of the Real-World Use of Topical Antimicrobials in the Paediatric Population with Impetigo in Italy: Focus on the Role of Ozenoxacin 1% Cream. CHILDREN 2023; 10:children10030547. [PMID: 36980105 PMCID: PMC10047292 DOI: 10.3390/children10030547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
Using electronic data from a large population-based network of Family Paediatricians (Pedianet), we aimed to describe the use of topical antimicrobials, including ozenoxacin 1% cream, in impetigo in children in Italy. We included 2929 children aged 6 months–14 years from 2016 to 2019 with at least one episode of impetigo treated with topical antimicrobials. Overall, 3051 cases of impetigo were included in the analysis. Treatment started in most cases on the same day as the impetigo diagnosis and lasted around eight days. In about 8% of the cases, a systemic antibiotic was prescribed after the topical antimicrobial, usually after 4–14 days. In this study, ozenoxacin was used in 8% of the cases. Treatment duration was significantly shorter for patients prescribed ozenoxacin compared to the whole study population (median of six vs. seven days, respectively). In contrast, the rate of treatment failure was similar. Very few adverse reactions were identified.
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3
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Salih M, Walvekar P, Omolo CA, Elrashedy AA, Devnarain N, Fasiku V, Waddad AY, Mocktar C, Govender T. A self-assembled polymer therapeutic for simultaneously enhancing solubility and antimicrobial activity and lowering serum albumin binding of fusidic acid. J Biomol Struct Dyn 2020; 39:6567-6584. [PMID: 32772814 DOI: 10.1080/07391102.2020.1803140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The global antimicrobial resistance crisis has prompted worldwide efforts to develop new and more efficient antimicrobial compounds, as well as to develop new drug delivery strategies and targeting mechanisms. This study aimed to synthesize a novel polyethylene glycol-fusidic acid (PEG-FA) conjugate for self-assembly into nano-sized structures and explore its potential for simultaneously enhancing aqueous solubility and antibacterial activity of FA. In addition, the ability of PEG-FA to bind to HSA with lower affinity than FA is also investigated. Haemolysis and in vitro cytotoxicity studies confirmed superior biosafety of the novel PEG-FA compared to FA. The water solubility of FA after PEG conjugation was increased by 25-fold compared to the bare drug. PEG-FA nanoparticles displayed particle size, polydispersity index and zeta potential of 149.3 ± 0.21 nm, 0.267 ± 0.01 and 5.97 ± 1.03 mV, respectively. Morphology studies using high-resolution transmission electron microscope revealed a homogenous spherical shape of the PEG-FA nanoparticles. In silico studies showed that Van der Waals forces facilitated PEG-FA self-assembly. HSA binding studies showed that PEG-FA had very weak or no interaction with HSA using in silico molecular docking (-2.93 kcal/mol) and microscale thermophoresis (Kd=14999 ± 1.36 µM), which may prevent bilirubin displacement. Conjugation with PEG did not inhibit the antibacterial activity of FA but rather enhanced it by 2.5-fold against Staphylococcus aureus and methicillin-resistant Staphylococcus aureus, compared to the bare FA. These results show that PEG-FA can simultaneously enhance solubility and antibacterial activity of FA, whilst also reducing binding of HSA to decrease its side effects.
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Affiliation(s)
- Mohammed Salih
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Pavan Walvekar
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Calvin A Omolo
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Chemistry of Natural and Microbial Products, Division of Pharmaceutical and Drug Industries, National Research Centre, Cairo, Egypt
| | - Ahmed A Elrashedy
- School of Pharmacy and Health Sciences, United States International University, Nairobi, Kenya
| | - Nikita Devnarain
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Victoria Fasiku
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Ayman Y Waddad
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Chunderika Mocktar
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Thirumala Govender
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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4
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Cote CK, Blanco II, Hunter M, Shoe JL, Klimko CP, Panchal RG, Welkos SL. Combinations of early generation antibiotics and antimicrobial peptides are effective against a broad spectrum of bacterial biothreat agents. Microb Pathog 2020; 142:104050. [PMID: 32050093 DOI: 10.1016/j.micpath.2020.104050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
The misuse of infectious disease pathogens as agents of deliberate attack on civilians and military personnel is a serious national security concern, which is exacerbated by the emergence of natural or genetically engineered multidrug resistant strains. In this study, the therapeutic potential of combinations of an antibiotic and a broad-spectrum antimicrobial peptide (AMP) was evaluated against five bacterial biothreats, the etiologic agents of glanders (Burkholderia mallei), melioidosis (Burkholderia pseudomallei), plague (Yersinia pestis), tularemia (Francisella tularensis), and anthrax (Bacillus anthracis). The therapeutics included licensed early generation antibiotics which are now rarely used. Three antibiotics and one 24- amino acid AMP were selected based on MIC assay data. Combinations of the AMP and tigecycline, minocycline, or novobiocin were screened for synergistic activity by checkerboard MIC assay. The combinations each enhanced the susceptibility of several strains. The tetracycline-peptide combinations increased the sensitivities of Y. pestis, F. tularensis, B. anthracis and B. pseudomallei, and the novobiocin-AMP combination augmented the sensitivity of all five. In time-kill assays, down-selected combinations of the peptide and minocycline or tigecycline enhanced killing of B. anthracis, Y. pestis, F. tularensis, and Burkholderia mallei but not B. pseudomallei. The novobiocin-AMP pair significantly reduced viability of all strains except B. mallei, which was very sensitive to the antibiotic alone. The results suggested that antibiotic-AMP combinations are useful tools for combating diverse pathogens. Future studies employing cell culture and animal models will utilize virulent strains of the agents to investigate the in vivo availability, host cytotoxicity, and protective efficacy of these therapeutics.
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Affiliation(s)
- Christopher K Cote
- Bacteriology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Frederick, MD, 21702-5011, USA.
| | - Irma I Blanco
- Bacteriology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Frederick, MD, 21702-5011, USA
| | - Melissa Hunter
- Bacteriology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Frederick, MD, 21702-5011, USA
| | - Jennifer L Shoe
- Bacteriology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Frederick, MD, 21702-5011, USA
| | - Christopher P Klimko
- Bacteriology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Frederick, MD, 21702-5011, USA
| | | | - Susan L Welkos
- Bacteriology Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, Frederick, MD, 21702-5011, USA.
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5
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He ZF, Chen L, Zhang JP, Wang QQ. Hepatotoxicity and hematologic complications induced by fusidic acid in a patient with hepatitis B cirrhosis: A case report. Medicine (Baltimore) 2019; 98:e17852. [PMID: 31702645 PMCID: PMC6855583 DOI: 10.1097/md.0000000000017852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/27/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Fusidic acid (FA) is an active agent against gram-positive bacteria such as Staphylococcus, it is generally well tolerated and the major adverse effects are mild gastrointestinal discomfort, diarrhea, and headache. However, some rare side effects such as granulocytopenia and thrombocytopenia have also been reported. Here we report a case of FA-induced hepatotoxicity and hematologic toxicity. PATIENT CONCERNS A 54-year-old woman with hepatitis B cirrhosis was referred to us because of fever, Staphylococcus aureus was identified in the twice blood culture, and intravenous FA was given (0.5 g, q8 hours). Twelve days after FA therapy, she developed nausea and jaundice. Meanwhile, complete blood cell count showed neutropenia (white blood cell count of 1360/μL, neutrophil of 619/μL) and aggravated thrombocytopenia (platelet count of 18,000/μL). Adverse drug reaction was suspected, and FA was stopped immediately, after 1 day of discontinuation of FA, nose bleeding occurred and the platelet count declined further and reached the lowest value of 4000/μL. DIAGNOSES Hepatotoxicity and hematologic complications induced by FA were diagnosed. INTERVENTIONS AND OUTCOMES The FA was stopped immediately, and concentrated platelet transfusion was used. Five days after withdrawal of FA, jaundice resolved and the hematologic index returned to the level before the medication. LESSONS Hematologic adverse effect accompanying with hepatotoxicity may be induced by FA. Though the risk is rather low, it should not be overlooked.
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Affiliation(s)
| | - Lin Chen
- Department of Infectious Disease, First Hospital of Lanzhou University, Lanzhou
| | | | - Qing-qing Wang
- Department of Pharmacy
- Department of Pharmacy, Yanan University Affiliated Hospital, Yanan, China
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6
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Omolo CA, Kalhapure RS, Agrawal N, Rambharose S, Mocktar C, Govender T. Formulation and Molecular Dynamics Simulations of a Fusidic Acid Nanosuspension for Simultaneously Enhancing Solubility and Antibacterial Activity. Mol Pharm 2018; 15:3512-3526. [PMID: 29953816 DOI: 10.1021/acs.molpharmaceut.8b00505] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of the present study was to formulate a nanosuspension (FA-NS) of fusidic acid (FA) to enhance its aqueous solubility and antibacterial activity. The nanosuspension was characterized using various in vitro, in silico, and in vivo techniques. The size, polydispersity index, and zeta potential of the optimized FA-NS were 265 ± 2.25 nm, 0.158 ± 0.026, and -16.9 ± 0.794 mV, respectively. The molecular dynamics simulation of FA and Poloxamer-188 showed an interaction and binding energy of -74.42 kJ/mol and -49.764 ± 1.298 kJ/mol, respectively, with van der Waals interactions playing a major role in the spontaneous binding. There was an 8-fold increase in the solubility of FA in a nanosuspension compared to the bare drug. The MTT assays showed a cell viability of 75-100% confirming the nontoxic nature of FA-NS. In vitro antibacterial activity revealed a 16- and 18-fold enhanced activity against Staphylococcus aureus (SA) and methicillin-resistant SA (MRSA), respectively, when compared to bare FA. Flowcytometry showed that MRSA cells treated with FA-NS had almost twice the percentage of dead bacteria in the population, despite having an 8-fold lower MIC in comparison to the bare drug. The in vivo skin-infected mice showed a 76-fold reduction in the MRSA load for the FA-NS treated group compared to that of the bare FA. These results show that the nanosuspension of antibiotics can enhance their solubility and antibacterial activity simultaneously.
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Affiliation(s)
- Calvin A Omolo
- Discipline of Pharmaceutical Sciences , College of Health Sciences, University of KwaZulu-Natal , Private Bag , X54001 Durban , South Africa
| | - Rahul S Kalhapure
- Discipline of Pharmaceutical Sciences , College of Health Sciences, University of KwaZulu-Natal , Private Bag , X54001 Durban , South Africa.,School of Pharmacy , The University of Texas at El Paso , 500 W. University Avenue , El Paso , Texas 79968 , United States
| | - Nikhil Agrawal
- Discipline of Pharmaceutical Sciences , College of Health Sciences, University of KwaZulu-Natal , Private Bag , X54001 Durban , South Africa
| | - Sanjeev Rambharose
- Discipline of Pharmaceutical Sciences , College of Health Sciences, University of KwaZulu-Natal , Private Bag , X54001 Durban , South Africa.,Division of Emergency Medicine, Department of Surgery , University of Cape Town , Cape Town 7700 , South Africa
| | - Chunderika Mocktar
- Discipline of Pharmaceutical Sciences , College of Health Sciences, University of KwaZulu-Natal , Private Bag , X54001 Durban , South Africa
| | - Thirumala Govender
- Discipline of Pharmaceutical Sciences , College of Health Sciences, University of KwaZulu-Natal , Private Bag , X54001 Durban , South Africa
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7
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Cornet C, Calzolari S, Miñana-Prieto R, Dyballa S, van Doornmalen E, Rutjes H, Savy T, D'Amico D, Terriente J. ZeGlobalTox: An Innovative Approach to Address Organ Drug Toxicity Using Zebrafish. Int J Mol Sci 2017; 18:E864. [PMID: 28422076 PMCID: PMC5412445 DOI: 10.3390/ijms18040864] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/07/2017] [Accepted: 04/14/2017] [Indexed: 02/06/2023] Open
Abstract
Toxicity is one of the major attrition causes during the drug development process. In that line, cardio-, neuro-, and hepatotoxicities are among the main reasons behind the retirement of drugs in clinical phases and post market withdrawal. Zebrafish exploitation in high-throughput drug screening is becoming an important tool to assess the toxicity and efficacy of novel drugs. This animal model has, from early developmental stages, fully functional organs from a physiological point of view. Thus, drug-induced organ-toxicity can be detected in larval stages, allowing a high predictive power on possible human drug-induced liabilities. Hence, zebrafish can bridge the gap between preclinical in vitro safety assays and rodent models in a fast and cost-effective manner. ZeGlobalTox is an innovative assay that sequentially integrates in vivo cardio-, neuro-, and hepatotoxicity assessment in the same animal, thus impacting strongly in the 3Rs principles. It Reduces, by up to a third, the number of animals required to assess toxicity in those organs. It Refines the drug toxicity evaluation through novel physiological parameters. Finally, it might allow the Replacement of classical species, such as rodents and larger mammals, thanks to its high predictivity (Specificity: 89%, Sensitivity: 68% and Accuracy: 78%).
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Affiliation(s)
- Carles Cornet
- ZeClinics SL, PRBB (Barcelona Biomedical Research Park), 08003 Barcelona, Spain.
| | - Simone Calzolari
- ZeClinics SL, PRBB (Barcelona Biomedical Research Park), 08003 Barcelona, Spain.
| | - Rafael Miñana-Prieto
- ZeClinics SL, PRBB (Barcelona Biomedical Research Park), 08003 Barcelona, Spain.
| | - Sylvia Dyballa
- ZeClinics SL, PRBB (Barcelona Biomedical Research Park), 08003 Barcelona, Spain.
| | - Els van Doornmalen
- Pivot Park Screening Centre (PPSC), Kloosterstraat 9, 5349AB OSS, The Netherland.
| | - Helma Rutjes
- Pivot Park Screening Centre (PPSC), Kloosterstraat 9, 5349AB OSS, The Netherland.
| | - Thierry Savy
- Multilevel Dynamics in Morphogenesis Unit, USR3695 CNRS, 91190 Gif sur Yvette, France.
| | - Davide D'Amico
- ZeClinics SL, PRBB (Barcelona Biomedical Research Park), 08003 Barcelona, Spain.
| | - Javier Terriente
- ZeClinics SL, PRBB (Barcelona Biomedical Research Park), 08003 Barcelona, Spain.
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8
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Cluzel C, Pralong P, Logerot S, Sabatier-Vincent M, Tardieu M, Pinel N, Leccia MT. [Lethal Lyell's syndrome induced by fusidic acid]. Ann Dermatol Venereol 2016; 143:215-8. [PMID: 26831945 DOI: 10.1016/j.annder.2015.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/23/2015] [Accepted: 12/16/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Herein, we report the first case of toxic epidermal necrosis due to oral fusidic acid having a fatal outcome. PATIENTS AND METHODS An 82-year-old woman was referred to our dermatology department for generalized bullous skin eruption. Clinical examination showed fever, oral and ocular ulcerations, and epidermal detachment involving more than 70 % of her body surface area together with a positive Nikolsky sign. Lyell's syndrome was diagnosed. Cutaneous histology showed total epidermal necrosis and a normal dermis. Oral fusidic acid had been prescribed 12 days earlier for a chronic sacral pressure sore. No other treatment had been introduced during the previous two months. The outcome was fatal within 24 hours. DISCUSSION Fusidic acid is commonly used topically by dermatologists for limited staphylococcal skin infections. Oral treatment is rare and is recommended only for skin, bone or joint infections. This is the first reported case of toxic epidermal necrolysis due to oral fusidic acid. The French national drug safety monitoring register contains only one case in which fusidic acid was a possible culprit. CONCLUSION Fusidic acid must be considered a potential source of serious cutaneous adverse reactions, particularly toxic epidermal necrolysis.
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Affiliation(s)
- C Cluzel
- Clinique universitaire de dermatologie, allergologie et photobiologie, CHU de Grenoble, boulevard de la Chantourne, CS10217, 38043 Grenoble cedex 9, France
| | - P Pralong
- Clinique universitaire de dermatologie, allergologie et photobiologie, CHU de Grenoble, boulevard de la Chantourne, CS10217, 38043 Grenoble cedex 9, France.
| | - S Logerot
- Centre régional de pharmacovigilance, CHU de Grenoble, boulevard de la Chantourne, CS10217, 38043 Grenoble cedex 9, France
| | - M Sabatier-Vincent
- Clinique universitaire de dermatologie, allergologie et photobiologie, CHU de Grenoble, boulevard de la Chantourne, CS10217, 38043 Grenoble cedex 9, France
| | - M Tardieu
- Clinique universitaire de dermatologie, allergologie et photobiologie, CHU de Grenoble, boulevard de la Chantourne, CS10217, 38043 Grenoble cedex 9, France
| | - N Pinel
- Service d'anatomo-pathologie, CHU de Grenoble, boulevard de la Chantourne, CS10217, 38043 Grenoble cedex 9, France
| | - M-T Leccia
- Clinique universitaire de dermatologie, allergologie et photobiologie, CHU de Grenoble, boulevard de la Chantourne, CS10217, 38043 Grenoble cedex 9, France
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9
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Curbete MM, Salgado HRN. A Critical Review of the Properties of Fusidic Acid and Analytical Methods for Its Determination. Crit Rev Anal Chem 2015; 46:352-60. [DOI: 10.1080/10408347.2015.1084225] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Damali Amiri N, Wijenaike N. Flucloxacillin and fusidic acid-associated neutropenia in a patient with periaortic abscess: rare side effects of commonly used antibiotics. BMJ Case Rep 2015; 2015:bcr-2014-208324. [PMID: 25809430 DOI: 10.1136/bcr-2014-208324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The use of long-term antibiotics for deep-seated infections is very common, and is associated with many clinically significant side effects. In this report we describe the history of a 48-year-old man who attended West Suffolk Hospital with nausea and vomiting, and was subsequently found to have a deep-seated infection following his repeat aortic valve replacement. He completed a 7-week course of intravenous flucloxacillin and oral fusidic acid, however, prior to finishing this course a random blood test revealed a neutrophil count of zero. He was re-admitted to hospital with fever, and was treated accordingly as per the trust's neutropenic sepsis protocol with the addition of growth colony stimulating factor (GCSF). His neutrophil count recovered after 3 days and has remained within the normal range ever since.
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Affiliation(s)
| | - Nishan Wijenaike
- Department of Medicine, West Suffolk Hospital, Bury St Edmunds, UK
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11
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Kaur G, Singh K, Pavadai E, Njoroge M, Espinoza-Moraga M, De Kock C, Smith PJ, Wittlin S, Chibale K. Synthesis of fusidic acid bioisosteres as antiplasmodial agents and molecular docking studies in the binding site of elongation factor-G. MEDCHEMCOMM 2015. [DOI: 10.1039/c5md00343a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Structural modifications through bioisosteric approach yielded fusidic acid analogues with 2–35 folds increase in antiplasmodial activity as compared to fusidic acid.
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Affiliation(s)
- Gurminder Kaur
- Department of Chemistry
- University of Cape Town
- Rondebosch 7701
- South Africa
- South African Medical Research Council Drug Discovery and Development Research Unit
| | - Kawaljit Singh
- Department of Chemistry
- University of Cape Town
- Rondebosch 7701
- South Africa
- South African Medical Research Council Drug Discovery and Development Research Unit
| | - Elumalai Pavadai
- Department of Chemistry
- University of Cape Town
- Rondebosch 7701
- South Africa
- South African Medical Research Council Drug Discovery and Development Research Unit
| | - Mathew Njoroge
- Department of Chemistry
- University of Cape Town
- Rondebosch 7701
- South Africa
- South African Medical Research Council Drug Discovery and Development Research Unit
| | - Marlene Espinoza-Moraga
- Department of Chemistry
- University of Cape Town
- Rondebosch 7701
- South Africa
- South African Medical Research Council Drug Discovery and Development Research Unit
| | - Carmen De Kock
- Division of Clinical Pharmacology
- Department of Medicine
- University of Cape Town
- Groote Schuur Hospital
- Observatory
| | - Peter J. Smith
- Division of Clinical Pharmacology
- Department of Medicine
- University of Cape Town
- Groote Schuur Hospital
- Observatory
| | - Sergio Wittlin
- University of Basel
- 4002 Basel
- Switzerland
- Swiss Tropical and Public Health Institute
- Socinstrasse 57
| | - Kelly Chibale
- Department of Chemistry
- University of Cape Town
- Rondebosch 7701
- South Africa
- South African Medical Research Council Drug Discovery and Development Research Unit
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12
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Liang RM, Yong XL, Duan YQ, Tan YH, Zeng P, Zhou ZY, Jiang Y, Wang SH, Jiang YP, Huang XC, Dong ZH, Hu TT, Shi HQ, Li N. Potent in vitro synergism of fusidic acid (FA) and berberine chloride (BBR) against clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA). World J Microbiol Biotechnol 2014; 30:2861-9. [DOI: 10.1007/s11274-014-1712-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 07/25/2014] [Indexed: 12/01/2022]
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13
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Kigondu EM, Wasuna A, Warner DF, Chibale K. Pharmacologically active metabolites, combination screening and target identification-driven drug repositioning in antituberculosis drug discovery. Bioorg Med Chem 2014; 22:4453-61. [PMID: 24997576 DOI: 10.1016/j.bmc.2014.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 01/14/2023]
Abstract
There has been renewed interest in alternative strategies to address bottlenecks in antibiotic development. These include the repurposing of approved drugs for use as novel anti-infective agents, or their exploitation as leads in drug repositioning. Such approaches are especially attractive for tuberculosis (TB), a disease which remains a leading cause of morbidity and mortality globally and, increasingly, is associated with the emergence of drug-resistance. In this review article, we introduce a refinement of traditional drug repositioning and repurposing strategies involving the development of drugs that are based on the active metabolite(s) of parental compounds with demonstrated efficacy. In addition, we describe an approach to repositioning the natural product antibiotic, fusidic acid, for use against Mycobacterium tuberculosis. Finally, we consider the potential to exploit the chemical matter arising from these activities in combination screens and permeation assays which are designed to confirm mechanism of action (MoA), elucidate potential synergies in polypharmacy, and to develop rules for drug permeability in an organism that poses a special challenge to new drug development.
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Affiliation(s)
- Elizabeth M Kigondu
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa; South African Medical Research Council Drug Discovery and Development Research Unit, University of Cape Town, Rondebosch 7701, South Africa
| | - Antonina Wasuna
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa; South African Medical Research Council Drug Discovery and Development Research Unit, University of Cape Town, Rondebosch 7701, South Africa
| | - Digby F Warner
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa; MRC/NHLS/UCT Molecular Mycobacteriology Research Unit and DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Rondebosch 7701, South Africa.
| | - Kelly Chibale
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa; South African Medical Research Council Drug Discovery and Development Research Unit, University of Cape Town, Rondebosch 7701, South Africa; Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa.
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14
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Park MR, Kim DS, Kim J, Ahn K. Anaphylaxis to topically applied sodium fusidate. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 5:110-2. [PMID: 23450038 PMCID: PMC3579090 DOI: 10.4168/aair.2013.5.2.110] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/19/2012] [Indexed: 11/20/2022]
Abstract
Fusidic acid is a bacteriostatic antibiotic that is effective primarily on gram-positive bacteria, such as Staphylococcus and Corynebacterium species. It is often topically applied to the skin, but is also given systemically as a tablet or injection. Allergic contact dermatitis, or urticaria, has been reported as a side effect of fusidic acid treatment, whereas anaphylaxis to topically administered fusidic acid has not been reported previously. A 16-year-old boy visited an outpatient clinic for further evaluation of anaphylaxis. He suffered abrasions on his arms during exercise, which were treated with a topical ointment containing sodium fusidate. Within 30 minutes, he developed urticaria and eyelid swelling, followed by a cough and respiratory difficulty. His symptoms were relieved by emergency treatment in a nearby hospital. To investigate the etiology, oral provocation with fusidate was performed. After 125 mg (1/2 tablet) of sodium fusidate was administered, he developed a cough and itching of the throat within 30 minutes, which was followed by chest discomfort and urticaria. Forced expiratory volume in 1 second (FEV1) dropped from 4.09 L at baseline to 3.50 L after challenge, although wheezing was not heard in his chest. After management with an inhaled bronchodilator using a nebulizer, chest discomfort was relieved and FEV1 rose to 3.86 L. The patient was directed not to use fusidate, especially on abrasions. Here we report the first case of anaphylaxis resulting from topical fusidic acid application to abrasions.
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Affiliation(s)
- Mi-Ran Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
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15
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Lemaire S, Van Bambeke F, Pierard D, Appelbaum PC, Tulkens PM. Activity of fusidic acid against extracellular and intracellular Staphylococcus aureus: influence of pH and comparison with linezolid and clindamycin. Clin Infect Dis 2011; 52 Suppl 7:S493-503. [PMID: 21546626 DOI: 10.1093/cid/cir165] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Emergence of multidrug-resistant Staphylococcus aureus has triggered a reassessment of fusidic acid (CEM-102, sodium fusidate). METHODS Fusidic acid was examined for (1) activity against recent methicillin-resistant S. aureus (MRSA) isolates; (2) modulation of activity by acidic pH; and (3) accumulation by phagocytic cells and intracellular activity against methicillin-susceptible S. aureus (MSSA) and MRSA. RESULTS About 96% of strains (N = 94) were susceptible (European Committee on Antimicrobial Susceptibility Testing breakpoint [≤ 1 mg/L]). Activity was enhanced at pH 5.5 (6 dilutions decrease for minimum inhibitory concentration) in parallel with an increase of drug bacterial accumulation (opposite effects for clindamycin; linezolid remained unaffected). Fusidic acid accumulated in THP-1 cells (about 5.5 fold), with further accumulation at pH 5.5 vs pH 7.4. The intracellular activity of Fusidic acid was similar to that of clindamycin and linezolid (maximal relative activity, 0.4-0.6 log(10) colony-forming unit decrease). No cross-resistance to vancomycin or daptomycin was observed. CONCLUSIONS Fusidic acid is active against S. aureus in broth as well as intracellularly, with no cross-resistance to other antibiotics.
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Affiliation(s)
- Sandrine Lemaire
- Cellular and Molecular Pharmacology, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
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16
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Mendoza N, Tyring SK. Emerging drugs for complicated skin and skin-structure infections. Expert Opin Emerg Drugs 2010; 15:509-20. [PMID: 20557269 DOI: 10.1517/14728214.2010.497486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED IMPORTANCE OF THE FILED: With the worldwide surge of MRSA, skin and skin-structure infection (SSTI) treatment has become a challenge for physicians. Cultures and antibiotic susceptibility tests for SSTIs are the rule due to the implication in morbidity and mortality rates associated with MRSA infections. The need for new antibiotics is evident and the effort to decrease antibiotic resistance is a world priority. AREAS COVERED IN THIS REVIEW This manuscript accesses the actual treatments and the developing of antibiotics for MRSA SSTIs. WHAT THE READER WILL GAIN This is a review of the data on the available and emerging treatments for MRSA SSTIs. TAKE HOME MESSAGE There is an unmet medical need for new antibiotics in the new millennium. As physicians, we must assure all appropriate procedures are completed in order to reduce the bacterial resistance, especially for MRSA.
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Affiliation(s)
- Natalia Mendoza
- Center for Clinical Studies, 6655 Travis Suite 120, Houston, TX 77030, USA.
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17
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Bouza E. New therapeutic choices for infections caused by methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2010; 15 Suppl 7:44-52. [PMID: 19951334 DOI: 10.1111/j.1469-0691.2009.03091.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In recent years, a marked increase in the incidence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) has occurred in many countries. This review addresses the effectiveness and limitations of drugs classically used for the treatment of MRSA, e.g. vancomycin, and also newer anti-MRSA antimicrobials, e.g. second-generation glycolipopeptides, tigecycline, and beta-lactams.
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Affiliation(s)
- E Bouza
- Servicio de Microbiología Clínica y E. Infecciosas, Hospital General Universitario Gregorio Marañón, Universidad Complutenste, Madrid, and Ciber de Enfermedades Respiratories (CIBERES), Spain.
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18
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Koomanachai P, Crandon JL, Nicolau DP. Newer developments in the treatment of Gram-positive infections. Expert Opin Pharmacother 2010; 10:2829-43. [PMID: 19929705 DOI: 10.1517/14656560903357491] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Gram-positive organisms are continually a major cause of infection. These organisms are ever-evolving and exhibit resistance to nearly all available agents. Historically, vancomycin was crowned the drug of choice for many of these organisms including methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, and penicillin-resistant Enterococcus spp. Many of these organisms have exhibited reduced susceptibility or frank resistance to vancomycin which has resulted in treatment failure. For this reason, new strategies in treating Gram-positive infections are a hot topic. There are two general approaches to waging this war: i) development of new antimicrobial agents; and ii) reinvigorating old antibiotics that still retain appreciable activity against Gram-positives. We review both antibiotic groupings with a focus on S. aureus, S. pneumoniae and Enterococcus spp.
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Affiliation(s)
- Pornpan Koomanachai
- Hartford Hospital, Center for Anti-Infective Research and Development, 80 Seymour Street, Hartford, CT 06102, USA
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19
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Leitner JM, Graninger W, Thalhammer F. Hepatotoxicity of antibacterials: Pathomechanisms and clinical. Infection 2010; 38:3-11. [PMID: 20107858 DOI: 10.1007/s15010-009-9179-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 10/13/2009] [Indexed: 12/16/2022]
Abstract
Drug-induced hepatotoxicity is a frequent cause of liver disease and acute liver failure, particularly in patients treated with multiple drugs. Several antibacterial drugs have the potential to cause severe liver injury and failure. This article aims to increase the awareness and understanding of drug induced liver injury (DILI) due to antibacterial drugs. It reviews the pattern of antibacterial DILI and provides details on molecular mechanisms and toxicogenomics, as well as clinical data based on epidemiology studies. Certain antibacterial drugs are more frequently linked to hepatotoxicity than others. Therefore, the hepatotoxic potential of tetracyclines,sulfonamides, tuberculostatic agents, macrolides, quinolones,and beta-lactams are discussed in more detail. Efforts to improve the early detection of DILI and the acquisition of high-quality epidemiological data are pivotal for increased patient safety.
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Affiliation(s)
- J M Leitner
- Dept. of Internal Medicine I, Medical University of Vienna, General Hospital of Vienna, Austria.
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20
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Bobadilla-González P, García-Menaya JM, Cordobés-Durán C, Pérez-Rangel I, Sánchez-Vega S. Generalized urticaria to fusidic acid. Allergy 2009; 64:817-8. [PMID: 19187392 DOI: 10.1111/j.1398-9995.2009.01977.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P Bobadilla-González
- Allergy Department, Hospital Infanta Cristina, Badajoz, Spain and Caser Policlinic, Badajoz, Spain.
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21
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PLGA and PHBV Microsphere Formulations and Solid-State Characterization: Possible Implications for Local Delivery of Fusidic Acid for the Treatment and Prevention of Orthopaedic Infections. Pharm Res 2009; 26:1644-56. [DOI: 10.1007/s11095-009-9875-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
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22
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Cevher E, Orhan Z, Sensoy D, Ahiskali R, Kan PL, Sağirli O, Mülazimoğlu L. Sodium fusidate-poly(D,L-lactide-co-glycolide) microspheres: Preparation, characterisation andin vivoevaluation of their effectiveness in the treatment of chronic osteomyelitis. J Microencapsul 2008; 24:577-95. [PMID: 17654177 DOI: 10.1080/02652040701472584] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to prepare poly(D,L-lactide-co-glycolide) (PLGA) microspheres containing sodium fusidate (SF) using a double emulsion solvent evaporation method with varying polymer:drug ratios (1:1, 2.5:1, 5:1) and to evaluate its efficiency for the local treatment of chronic osteomyelitis. METHODS The particle size and distribution, morphological characteristics, thermal behaviour, drug content, encapsulation efficiency and in vitro release assessments of the formulations had been carried out. Sterilized SF-PLGA microspheres were implanted in the proximal tibia of rats with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis. After 3 weeks of treatment, bone samples were analysed with a microbiological assay. RESULTS PLGA microspheres between the size ranges of 2.16-4.12 microm were obtained. Production yield of all formulations was found to be higher than 79% and encapsulation efficiencies of 19.8-34.3% were obtained. DSC thermogram showed that the SF was in an amorphous state in the microspheres and the glass transition temperature (T(g)) of PLGA was not influenced by the preparation procedure. In vitro drug release studies had indicated that these microspheres had significant burst release and their drug release rates were decreased upon increasing the polymer:drug ratio (p < 0.05). Based on the in vivo data, rats implanted with SF-PLGA microspheres and empty microspheres showed 1987 +/- 1196 and 55526 +/- 49086 colony forming unit of MRSA in 1 g bone samples (CFU/g), respectively (p < 0.01). CONCLUSION The in vitro and in vivo studies had shown that the implanted SF loaded microspheres were found to be effective for the treatment of chronic osteomyelitis in an animal experimental model. Hence, these microspheres may be potentially useful in the clinical setting.
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Affiliation(s)
- Erdal Cevher
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey.
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23
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Krzek J, Hubicka U, Szczepańczyk J, Kwiecień A, Rzeszutko W. Simultaneous Determination of Fusidic Acid, m‐ and p‐Hydroxybenzoates and Butylhydroxyanisole by TLC with Densitometric Detection in UV. J LIQ CHROMATOGR R T 2007. [DOI: 10.1080/10826070600760023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jan Krzek
- a Department of Inorganic and Analytical Chemistry , Jagiellonian University, Collegium Medicum , Kraków, Poland
| | - Urszula Hubicka
- a Department of Inorganic and Analytical Chemistry , Jagiellonian University, Collegium Medicum , Kraków, Poland
| | - Justyna Szczepańczyk
- a Department of Inorganic and Analytical Chemistry , Jagiellonian University, Collegium Medicum , Kraków, Poland
| | - Anna Kwiecień
- a Department of Inorganic and Analytical Chemistry , Jagiellonian University, Collegium Medicum , Kraków, Poland
| | - Włodzimierz Rzeszutko
- a Department of Inorganic and Analytical Chemistry , Jagiellonian University, Collegium Medicum , Kraków, Poland
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Abstract
Thrombocytopenia can have several causes, including the use of certain drugs. The mechanism behind drug-induced thrombocytopenia is either a decrease in platelet production (bone marrow toxicity) or an increased destruction (immune-mediated thrombocytopenia). In addition, pseudothrombocytopenia, an in vitro effect, has to be distinguished from true drug-induced thrombocytopenia. This article reviews literature on drug-induced immune thrombocytopenia, with the exception of thrombo-haemorrhagic disorders such as thrombotic thrombocytopenic purpura and heparin-induced thrombocytopenia and thrombosis. A literature search in PubMed combined with a check of the reference lists of all the retrieved articles resulted in 108 articles relevant to the subject. The drug classes that are most often associated with drug-induced immune thrombocytopenia are cinchona alkaloid derivatives (quinine, quinidine), sulfonamides, NSAIDs, anticonvulsants, disease modifying antirheumatic drugs and diuretics. Several other drugs are occasionally described in case reports of thrombocytopenia; an updated review of these case reports can be found on the internet. A small number of epidemiological studies, differing largely in the methodology used, describe incidences in the magnitude of 10 cases per 1 000 000 inhabitants per year. No clear risk factors could be identified from these studies. The underlying mechanism of drug-induced immune thrombocytopenia is not completely clarified, but at least three different types of antibodies appear to play a role (hapten-dependent antibodies, drug-induced, platelet-reactive auto-antibodies and drug-dependent antibodies). Targets for drug-dependent antibodies are glycoproteins on the cell membrane of the platelets, such as glycoprotein (GP) Ib/IX and GPIIb/IIIa. Diagnosis of drug-induced immune thrombocytopenia may consist of identifying clinical symptoms (bruising, petechiae, bleeding), a careful evaluation of the causal relationship of the suspected causative drug, general laboratory investigation, such as total blood count and peripheral blood smear (to rule out pseudothrombocytopenia), and platelet serology tests. The sensitivity of these tests is dependent on factors such as the concentration of the drug in the test and the potential sensitisation of the patient by metabolites instead of the parent drug. Drug-induced immune thrombocytopenia can be treated by withholding the causative drug and, in severe cases associated with bleeding, by platelet transfusion. Although drug-induced thrombocytopenia is a relatively rare adverse drug reaction, its consequences may be severe. Therefore it is important to extend our knowledge on this subject. Future research should focus on the identification of potential risk factors, as well as the exact mechanism underlying drug-induced thrombocytopenia.
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van den Boom J, Kristiansen JB, Voss LM, Stott NS. Flucloxacillin associated neutropenia in children treated for bone and joint infections. J Paediatr Child Health 2005; 41:48-51. [PMID: 15670224 DOI: 10.1111/j.1440-1754.2005.00535.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This report describes episodes of acute neutropenia associated with flucloxacillin use in children treated for bone and joint infections. METHODS A retrospective chart audit was performed on eight children who developed neutropenia when treated with flucloxacillin. RESULTS Eight children (aged 1 month to 13 years) had a diagnosis of neutropenia attributed to treatment with flucloxacillin, seven of whom received parenteral therapy. The time to onset of neutropenia averaged 27 days, with neutrophil counts returning to normal limits in all patients after 2 to 9 days. Two children were asymptomatic when the neutropenia was detected. The average flucloxacillin dose used was 65% (range 20-100%) of the recommended maximum dose. CONCLUSIONS These cases suggest that flucloxacillin should be used with greater caution and guidelines for dosing and clinical monitoring (regular neutrophil counts) need to be reassessed, despite none of these patients experiencing serious sequelae.
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Affiliation(s)
- J van den Boom
- Starship Children's Health, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
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26
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Vial T, Grignon M, Daumont M, Guy C, Zenut M, Germain ML, Jaubert J, Ruivard M, Guyotat D, Descotes J. Sideroblastic anaemia during fusidic acid treatment. Eur J Haematol 2004; 72:358-60. [PMID: 15059072 DOI: 10.1111/j.1600-0609.2004.00217.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES AND METHODS To describe cases of fusidic acid-associated sideroblastic anaemia from the French Pharmacovigilance database. RESULTS Six cases of sideroblastic anaemia associated with oral fusidic acid treatment were retrieved. Four females and two males (mean age 65.3 yr) developed severe anaemia (mean haemoglobin level: 6.9 g/dL) within 32-190 d (mean: 81 d) of treatment. Bone marrow aspirates showed dyserythropoiesis and ringed sideroblasts in all patients. Four patients required repeated blood transfusions. After fusidic acid discontinuation in five patients, complete recovery was obtained. In one patient, rechallenge with fusidic acid resulted in recurrence of anaemia that resolved after definitive discontinuation of the drug. CONCLUSION Our data indicate that fusidic acid should be added to the list of drugs that can cause sideroblastic anaemia.
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Affiliation(s)
- T Vial
- Centre Antipoison-Centre de Pharmacovigilance de Lyon, 162 avenue Lacassagne, 69424 Lyon, France.
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Jover A, Budal RM, Al-Soufi W, Meijide F, Vázquez Tato J, Yunes RA. Spectra and structure of complexes formed by sodium fusidate and potassium helvolate with beta- and gamma-cyclodextrin. Steroids 2003; 68:55-64. [PMID: 12475723 DOI: 10.1016/s0039-128x(02)00115-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The complexation of two steroid antibiotics of the fusidane family, sodium fusidate and potassium helvolate, by beta-CD and gamma-CD has been studied by using 1D and 2D-NMR techniques. Both guests form 1:1 complexes with gamma-CD and 1:2 (guest:cyclodextrin) complexes with beta-CD. Thus, both antibiotics behave as monotopic and ditopic guests when they are complexed by gamma-CD and beta-CD, respectively. Both steroids enter into the cavity of the gamma-CD by the side chain, reaching the central region of the steroid (rings C and D), whereas the A and B (partially) rings remain outside. For beta-CD complexes, ROESY spectra show a remarkable absence of interactions of the protons of the C and D rings, whereas clear interactions corresponding to the side chain, and A and B rings are observed. The obtained equilibrium constants (see previous paper) are discussed in terms of the structures proposed for the complexes. NMR spectra of sodium fusidate are revised, and a full assignment of the 1H and 13C NMR spectra is presented for potassium helvolate.
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Affiliation(s)
- Aida Jover
- Facultad de Ciencias, Departamento de Química Física, Universidad de Santiago de Compostela, Campus de Lugo, Spain
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Affiliation(s)
- M Biswas
- Department of Medicine, Singleton Hospital, Swansea SA2 8QA, Wales, UK.
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Affiliation(s)
- M Biswas
- Department of Medicine, Singleton Hospital, Swansea SA2 8QA, Wales, UK.
| | - K Owen
- Centre for Molecular Genetics, University of Exeter, Exeter EX2 5AX
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