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Leone S, Pezone I, Pisaturo M, McCaffery E, Alfieri A, Fiore M. Pharmacotherapies for multidrug-resistant gram-positive infections: current options and beyond. Expert Opin Pharmacother 2024:1-11. [PMID: 38863433 DOI: 10.1080/14656566.2024.2367003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Infections due to multidrug-resistant organisms (MDRO) are a serious concern for public health with high morbidity and mortality. Though many antibiotics have been introduced to manage these infections, there are remaining concerns regarding the optimal management of Gram-positive MDROs. AREAS COVERED A literature search on the PubMed/Medline database was conducted. We applied no language and time limits for the search strategy. In this narrative review, we discuss the current options for managing Gram-positive MDROs as well as non-traditional antibacterial agents in development. EXPERT OPINION Despite their introduction more than 70 years ago, glycopeptides are still the cornerstone in treating Gram-positive infections: all registrative studies of new antibiotics have glycopeptides as control; these studies are designed as not inferior studies, therefore it is almost impossible to give recommendations other than the use of glycopeptides in the treatment of Gram-positive infections. The best evidence on treatments different from glycopeptides comes from post-hoc analysis and meta-analysis. Non-traditional antibacterial agents are being studied to aid in short and effective antibiotic therapies. The use of non-traditional antibacterial agents is not restricted to replacing traditional antibacterial agents with alternative therapies; instead, they should be used in combination with antibiotic therapies.
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Affiliation(s)
- Sebastiano Leone
- Division of Infectious Diseases, "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - Ilaria Pezone
- Department of Pediatrics, "San Giuseppe Moscati" Hospital, Aversa CE, Italy
| | - Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Eleni McCaffery
- Department of Emergency Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Aniello Alfieri
- Department of Elective Surgery, Postoperative Intensive Care Unit and Hyperbaric Oxygen Therapy, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli, Naples, Italy
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Guan D, Chen F, Shi W, Lan L, Huang W. Single Modification at the N-Terminus of Norvancomycin to Combat Drug-Resistant Gram-Positive Bacteria. ChemMedChem 2023; 18:e202200708. [PMID: 36823383 DOI: 10.1002/cmdc.202200708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 02/25/2023]
Abstract
In the arsenal of glycopeptide antibiotics, norvancomycin, which differs from vancomycin by a single methyl group, has received much less attention. Facing the risks of serious antibiotic resistance and even the collapse of last-line defenses, we designed and synthesized 40 novel norvancomycin derivatives to combat the threat. 32 compounds are single N-terminally modified derivatives generated through simple and efficient methods. Diversity at the N-terminus was greatly enriched, mainly by lipophilic attachment and strategies for the introduction of lipo-sulfonium moieties for extensive structure-activity relationship analysis. The first incorporation of a sulfonium moiety into the norvancomycin structure gave rise to compounds that exhibited 4- to 2048-fold higher activity against vancomycin-resistant bacteria VISA and VRE. This N-terminal modification for norvancomycin provides an alternatively useful and promising strategy to restore the antibacterial activity of glycopeptide antibiotics against resistant bacteria, highlighting the same importance of the N-terminal site as well as the vancosamine position, which is worth further study and development.
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Affiliation(s)
- Dongliang Guan
- CAS Key Laboratory of Receptor Research, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Pudong, Shanghai, 201203, P. R. China.,Shandong Laboratory of Yantai Drug Discovery, Bohai Rim Advanced Research Institute for Drug Discovery, Yanta, Shandong, 264117, P. R. China
| | - Feifei Chen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, P. R. China
| | - Wei Shi
- CAS Key Laboratory of Receptor Research, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Pudong, Shanghai, 201203, P. R. China.,Center for Biotherapeutics Discovery Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, P. R. China
| | - Lefu Lan
- School of Pharmaceutical Science and Technology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, 310024, P. R. China.,State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, P. R. China.,University of Chinese Academy of Sciences, No.19 A Yuquan Road, Beijing, 100049, P. R. China
| | - Wei Huang
- CAS Key Laboratory of Receptor Research, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Pudong, Shanghai, 201203, P. R. China.,School of Pharmaceutical Science and Technology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, 310024, P. R. China.,University of Chinese Academy of Sciences, No.19 A Yuquan Road, Beijing, 100049, P. R. China.,Center for Biotherapeutics Discovery Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, P. R. China
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Shoaib M, Aqib AI, Muzammil I, Majeed N, Bhutta ZA, Kulyar MFEA, Fatima M, Zaheer CNF, Muneer A, Murtaza M, Kashif M, Shafqat F, Pu W. MRSA compendium of epidemiology, transmission, pathophysiology, treatment, and prevention within one health framework. Front Microbiol 2023; 13:1067284. [PMID: 36704547 PMCID: PMC9871788 DOI: 10.3389/fmicb.2022.1067284] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Staphylococcus aureus is recognized as commensal as well as opportunistic pathogen of humans and animals. Methicillin resistant strain of S. aureus (MRSA) has emerged as a major pathogen in hospitals, community and veterinary settings that compromises the public health and livestock production. MRSA basically emerged from MSSA after acquiring SCCmec element through gene transfer containing mecA gene responsible for encoding PBP-2α. This protein renders the MRSA resistant to most of the β-lactam antibiotics. Due to the continuous increasing prevalence and transmission of MRSA in hospitals, community and veterinary settings posing a major threat to public health. Furthermore, high pathogenicity of MRSA due to a number of virulence factors produced by S. aureus along with antibiotic resistance help to breach the immunity of host and responsible for causing severe infections in humans and animals. The clinical manifestations of MRSA consist of skin and soft tissues infection to bacteremia, septicemia, toxic shock, and scalded skin syndrome. Moreover, due to the increasing resistance of MRSA to number of antibiotics, there is need to approach alternatives ways to overcome economic as well as human losses. This review is going to discuss various aspects of MRSA starting from emergence, transmission, epidemiology, pathophysiology, disease patterns in hosts, novel treatment, and control strategies.
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Affiliation(s)
- Muhammad Shoaib
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs/Lanzhou Institute of Husbandry and Pharmaceutical Sciences of the Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Amjad Islam Aqib
- Department of Medicine, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Iqra Muzammil
- Department of Medicine, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Noreen Majeed
- Institute of Microbiology, University of Agriculture, Faisalabad, Pakistan
| | - Zeeshan Ahmad Bhutta
- Laboratory of Biochemistry and Immunology, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | | | - Mahreen Fatima
- Faculty of Biosciences, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | | | - Afshan Muneer
- Department of Zoology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Maheen Murtaza
- Department of Zoology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Muhammad Kashif
- Department of Microbiology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Furqan Shafqat
- Department of Microbiology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Wanxia Pu
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs/Lanzhou Institute of Husbandry and Pharmaceutical Sciences of the Chinese Academy of Agricultural Sciences, Lanzhou, China
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Pai MP. Antimicrobial Dosing in Specific Populations and Novel Clinical Methodologies: Obesity. Clin Pharmacol Ther 2021; 109:942-951. [PMID: 33523485 DOI: 10.1002/cpt.2181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/16/2021] [Indexed: 12/17/2022]
Abstract
Obesity and its related comorbidities can negatively influence the outcomes of certain infectious diseases. Specific dosing recommendations are often lacking in the product label for patients with obesity that leads to unclear guidance in practice. Higher rates of therapeutic failure have been reported with some fixed dose antibiotics and pragmatic approaches to dose modification are limited for orally administered agents. For i.v. antimicrobials dosed on weight, alternate body size descriptors (ABSDs) have been used to reduce the risk of overdosing. These ABSDs are mathematical transformations of height and weight that represent fat-free weight and follow the same principles as body surface area (BSA)-based dosing of cancer chemotherapy. However, ABSDs are rarely studied in pivotal phase III studies and so can risk the underdosing of antimicrobials in patients with obesity when incorrectly applied in the real-world setting. Specific case examples are presented to highlight these risks. Although general principles may be considered by clinicians, a universal approach to dose modification in obesity is unlikely. Studies that can better distinguish human body phenotypes may help reduce our reliance on height and weight to define dosing. Simple and complex technologies exist to quantify individual body composition that could improve upon our current approach. Early evidence suggests that body composition parameters repurposed from medical imaging data may improve upon height and weight as covariates of drug clearance and distribution. Clinical trials that can integrate human body phenotyping may help us identify new approaches to optimal dose selection of antimicrobials in patients with obesity.
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Affiliation(s)
- Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
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Clinical Pharmacokinetics and Pharmacodynamics of Telavancin Compared with the Other Glycopeptides. Clin Pharmacokinet 2019; 57:797-816. [PMID: 29332251 PMCID: PMC5999141 DOI: 10.1007/s40262-017-0623-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Telavancin was discovered by modifying the chemical structure of vancomycin and belongs to the group of lipoglycopeptides. It employs its antimicrobial potential through two distinct mechanisms of action: inhibition of bacterial cell wall synthesis and induction of bacterial membrane depolarization and permeabilization. In this article we review the clinically relevant pharmacokinetic and pharmacodynamic data of telavancin. For comparison, the pharmacokinetic and pharmacodynamic data of the other glycopeptides are presented. Although, in contrast to the newer lipoglycopeptides, telavancin demonstrates a relatively short half-life and rapid total clearance, its apparent volume of distribution (Vd) is almost identical to that of dalbavancin. The accumulation of telavancin after repeated dosing is only marginal, whereas the pharmacokinetic values of the other glycopeptides show much greater differences after administration of multiple doses. Despite its high plasma-protein binding of 90% and relatively low Vd of approximately 11 L, telavancin shows near complete equilibration of the free fraction in plasma with soft tissue. The ratio of the area under the plasma concentration-time curve from time zero to 24 h (AUC24) of unbound plasma concentrations to the minimal inhibitory concentration (MIC) required to inhibit growth of 90% of organisms (MIC90) of Staphylococcus aureus and S. epidermidis of telavancin are sufficiently high to achieve pharmacokinetic/pharmacodynamic targets indicative for optimal bacterial killing. Considering both the AUC24/MIC ratios of telavancin and the near complete equilibration of the free fraction in plasma with soft tissue, telavancin is an appropriate antimicrobial agent to treat soft tissue infections caused by Gram-positive pathogens. Although the penetration of telavancin into epithelial lining fluid (ELF) requires further investigations, the AUC24/MIC ratio for S. aureus indicates that bactericidal activity in the ELF could be expected.
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Zhang Y, Wang Y, Van Driel ML, McGuire TM, Zhang T, Dong Y, Liu Y, Liu L, Hao R, Cao L, Xing J, Dong Y. Network meta-analysis and pharmacoeconomic evaluation of antibiotics for the treatment of patients infected with complicated skin and soft structure infection and hospital-acquired or ventilator-associated penumonia. Antimicrob Resist Infect Control 2019; 8:72. [PMID: 31080587 PMCID: PMC6501412 DOI: 10.1186/s13756-019-0518-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/04/2019] [Indexed: 01/18/2023] Open
Abstract
Background Infections due to methicillin-resistant Staphylococcus aureus (MRSA) cause serious health risks and significant economic burdens and the preferred drugs are still controversial. Methods We performed a network meta-analysis (NMA) to compare the efficacy and safety of antibiotics used to treat inpatients with complicated skin and soft structure infections (cSSSI) or hospital-acquired or ventilator-associated pneumonia (HAP/VAP). We also developed a decision tree model to assess the cost-effectiveness of antibiotics. Results Forty-nine randomized controlled trials met the inclusion criteria (34 for cSSSI, 15 for HAP/VAP) and compared the efficacy and safety of 16 antibiotics. For cSSSI, NMA indicated that for clinical cure, linezolid was superior than vancomycin (odds ratio (OR) 1.55, 95% confidence interval (CI) 1.19–2.02), while tedizolid (OR 1.39, CI 0.70–2.76) was similar to vancomycin. In terms of safety, there were no significant differences between any two interventions on total adverse events. Based on drug and hospital costs in America, the incremental cost-effectiveness ratios (ICERs) per life-year saved for linezolid and tedizolid compared with vancomycin were US$2833 and US$5523. For HAP/VAP, there were no significant effects either for clinical cure or for safety endpoints between linezolid and vancomycin in NMA. ICERs per life-year saved for linezolid compared with vancomycin were US$2185. Conclusion In these clinical trials, considering efficacy, safety, and cost-effectivenes, linezolid and tedizolid showed their superiority in MRSA cSSSI; while linezolid might be recommended to treat MRSA pneumonia. Although vancomycin was not cost-effective in pharmacoeconomic evaluation, it is still the first-line treatment for MRSA infection in the clinical practice. This study might provide new insights of therapeutic choices for patients with MRSA infections whilst awaiting the arrival of higher quality evidence. Electronic supplementary material The online version of this article (10.1186/s13756-019-0518-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Zhang
- 1Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061 China
| | - Yan Wang
- 1Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061 China.,2School of Pharmacy, University of Queensland, Brisbane, Queensland Australia
| | - Mieke L Van Driel
- 3Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland Australia
| | - Treasure M McGuire
- 2School of Pharmacy, University of Queensland, Brisbane, Queensland Australia.,4Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland Australia.,5Mater Pharmacy Services, Mater Health Services, Brisbane, Queensland Australia
| | - Tao Zhang
- 1Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061 China
| | - Yuzhu Dong
- 1Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061 China
| | - Yang Liu
- 1Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061 China
| | - Leichao Liu
- 1Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061 China
| | - Ruifang Hao
- 1Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061 China
| | - Lu Cao
- 6Department of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061 China
| | - Jianfeng Xing
- 6Department of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061 China
| | - Yalin Dong
- 1Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061 China
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7
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Jagan NADIPELLY, Pendru R, Jyothinath K. Efficacy of Dalbavancin and Telavancin in the Treatment of Acute Bacterial Skin and Skin Structure Infections. MÆDICA 2018; 13:208-212. [PMID: 30568740 DOI: 10.26574/maedica.2018.13.3.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives Two glycopeptide analogues, such as dalbavancin and telavancin, with improved pharmacokinetic/pharmacodynamic parameters have been developed. These two glycopeptide analogues are approved by Food and Drug Administration (FDA) for treatment of various Gram-positive bacterial skin infections. Materials and methods We have conducted an open labelled prospective randomized study to compare the efficacy of these two drugs. A total of 200 patients diagnosed with acute bacterial skin and skin structure infections (ABSSSI) were recruited for the study. They were randomized to receive either a single dose of dalbavancin 1500 mg i.v (Group I) or telavancin 10 mg/kg intravenously (i.v.) every 24 hours for six days (Group II). The skin infection rating score (SIRS) was calculated on Day 0 for all patients at the time of diagnosis. Signs and symptoms of the lesions were assessed based on the following factors: blistering, exudate/pus, erythema/inflammation and itching/pain. Each factor was classified as one of the following: absent - 0, minimal - 1, moderate - 2 and severe - 3. Results Clinically successful treatment was defined as complete resolution of clinically meaningful signs and symptoms of infection, including SIRS score of 0. The outcome measure was the percentage of patients with SIRS score of 0 on day 7 (clinical success). The third most common diagnosis at baseline was impetigo (13% in both groups). Patients who received dalbavancin had a higher clinical success rate than those receiving telavancin. Conclusion Findings of the present study show that single i.v dose of dalbavancin is better than telavancin repeated doses in treatment of ABSSSI.
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Affiliation(s)
- NADIPELLYa Jagan
- Faculty of Medicine, Department of Pharmacology, Texila American University, Georgetown, Guyana, South America
| | - Raghunath Pendru
- Faculty of Medicine, Department of Microbiology, Texila American University, Georgetown, Guyana, South America
| | - Kothapalli Jyothinath
- Assistant Professor, Department of Anatomy, Maheshwara Medical College and Hospital, Patancheru, Sangareddy District, Telangana, India
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Guan D, Chen F, Liu J, Li J, Lan L, Huang W. Design and Synthesis of Pyrophosphate-Targeting Vancomycin Derivatives for Combating Vancomycin-Resistant Enterococci. ChemMedChem 2018; 13:1644-1657. [PMID: 29920964 DOI: 10.1002/cmdc.201800252] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/13/2018] [Indexed: 12/12/2022]
Abstract
As the last resort for intractable Gram-positive bacterial infections, vancomycin is losing efficacy with the emergence of vancomycin-resistant bacteria, especially vancomycin-resistant Enterococci (VRE). To combat this threat, we rationally designed and synthesized 39 novel vancomycin derivatives by respective or combined modifications using metal-chelating, lipophilic, and galactose-attachment strategies for extensive structure-activity relationship (SAR) analysis. In a proposed mechanism, the conjugation of dipicolylamine on the seventh amino acid resorcinol position or C-terminus endowed the vancomycin backbone with binding capacity for the pyrophosphate moiety in lipid II while maintaining the intrinsic binding affinity for the dipeptide terminus of the bacterial cell wall peptidoglycan precursor. The in vitro antibacterial activities were evaluated, and the optimal compounds indicated 16- to 1024-fold higher activity against VRE than that of vancomycin. Compound 11 b (3',5'-bis(dipicolylaminomethyl)tyrosine [1,2,3]triazolylmethoxylethyoxyl ethylaminomethyl-N-decylvancomycin) was found to have particularly potent activity against VRE through synergistic effects brought about by combining two peripheral modifications.
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Affiliation(s)
- Dongliang Guan
- CAS Key Laboratory of Receptor Research, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Pudong, Shanghai, 201203, P.R. China
- University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049, P.R. China
| | - Feifei Chen
- CAS Key Laboratory of Receptor Research, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Pudong, Shanghai, 201203, P.R. China
| | - Junjie Liu
- CAS Key Laboratory of Receptor Research, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Pudong, Shanghai, 201203, P.R. China
- Department of Chemistry, Nanchang University, 999 Xuefu Avenue, Nanchang, 330031, P.R. China
| | - Jian Li
- CAS Key Laboratory of Receptor Research, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Pudong, Shanghai, 201203, P.R. China
- University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049, P.R. China
| | - Lefu Lan
- CAS Key Laboratory of Receptor Research, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Pudong, Shanghai, 201203, P.R. China
- University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049, P.R. China
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, P.R. China
| | - Wei Huang
- CAS Key Laboratory of Receptor Research, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zuchongzhi Road, Pudong, Shanghai, 201203, P.R. China
- University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049, P.R. China
- Center for Biotherapeutics Discovery Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, P.R. China
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Pharmacokinetics of Telavancin at Fixed Doses in Normal-Body-Weight and Obese (Classes I, II, and III) Adult Subjects. Antimicrob Agents Chemother 2018; 62:AAC.02475-17. [PMID: 29311094 DOI: 10.1128/aac.02475-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/03/2018] [Indexed: 12/22/2022] Open
Abstract
A recommended total-body-weight (TBW) dosing strategy for telavancin may not be optimal in obese patients. The primary objective of this study was to characterize and compare the pharmacokinetics (PK) of telavancin across four body size groups: normal to overweight and obese classes I, II, and III. Healthy adult subjects (n = 32) received a single, weight-stratified, fixed dose of 500 mg (n = 4), 750 mg (n = 8), or 1,000 mg (n = 20) of telavancin. Noncompartmental PK analyses revealed that subjects with a body mass index (BMI) of ≥40 kg/m2 had a higher volume of distribution (16.24 ± 2.7 liters) than subjects with a BMI of <30 kg/m2 (11.71 ± 2.6 liters). The observed area under the concentration-time curve from time zero to infinity (AUC0-∞) ranged from 338.1 to 867.3 mg · h/liter, with the lowest exposures being in subjects who received 500 mg. AUC0-∞ values were similar among obese subjects who received 1,000 mg. A two-compartment population PK model best described the plasma concentration-time profile of telavancin when adjusted body weight (ABW) was included as a predictive covariate. Fixed doses of 750 mg and 1,000 mg had similar target attainment probabilities for efficacy as doses of 10 mg/kg of body weight based on ABW and TBW, respectively. However, the probability of achieving a target area under the concentration-time curve from time zero to 24 h of ≥763 mg · h/liter in association with acute kidney injury was highest (19.7%) with TBW-simulated dosing and lowest (0.4%) at the 750-mg dose. These results suggest that a fixed dose of 750 mg is a safe and effective alternative to telavancin doses based on TBW or ABW for the treatment of obese patients with normal renal function and Staphylococcus aureus infections. (This study has been registered at ClinicalTrials.gov under identifier NCT02753855.).
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Kepplinger B, Morton-Laing S, Seistrup KH, Marrs ECL, Hopkins AP, Perry JD, Strahl H, Hall MJ, Errington J, Allenby NEE. Mode of Action and Heterologous Expression of the Natural Product Antibiotic Vancoresmycin. ACS Chem Biol 2018; 13:207-214. [PMID: 29185696 DOI: 10.1021/acschembio.7b00733] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Antibiotics that interfere with the bacterial cytoplasmic membrane have long-term potential for the treatment of infectious diseases as this mode of action is anticipated to result in low resistance frequency. Vancoresmycin is an understudied natural product antibiotic consisting of a terminal tetramic acid moiety fused to a linear, highly oxygenated, stereochemically complex polyketide chain. Vancoresmycin shows minimum inhibitory concentrations (MICs) from 0.125 to 2 μg/mL against a range of clinically relevant, antibiotic-resistant Gram-positive bacteria. Through a comprehensive mode-of-action study, utilizing Bacillus subtilis reporter strains, DiSC3(5) depolarization assays, and fluorescence microscopy, we have shown that vancoresmycin selectively targets the cytoplasmic membrane of Gram-positive bacteria via a non-pore-forming, concentration-dependent depolarization mechanism. Whole genome sequencing of the producing strain allowed identification of the 141 kbp gene cluster encoding for vancoresmycin biosynthesis and a preliminary model for its biosynthesis. The size and complex structure of vancoresmycin could confound attempts to generate synthetic analogues. To overcome this problem and facilitate future studies, we identified, cloned, and expressed the 141 kbp biosynthetic gene cluster in Streptomyces coelicolor M1152. Elucidation of the mode-of-action of vancoresmycin, together with the heterologous expression system, will greatly facilitate further studies of this and related molecules.
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Affiliation(s)
- Bernhard Kepplinger
- Centre for Bacterial Cell Biology, Newcastle University
, Newcastle upon Tyne NE2 4BN, United Kingdom
- Demuris Limited , Newcastle Biomedicine Bio-Incubators
, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Stephanie Morton-Laing
- Demuris Limited , Newcastle Biomedicine Bio-Incubators
, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Kenneth Holst Seistrup
- Centre for Bacterial Cell Biology, Newcastle University
, Newcastle upon Tyne NE2 4BN, United Kingdom
| | | | - Adam Paul Hopkins
- Demuris Limited , Newcastle Biomedicine Bio-Incubators
, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - John David Perry
- Microbiology Department, Freeman Hospital
, Newcastle upon Tyne NE7 7DN, United Kingdom
| | - Henrik Strahl
- Centre for Bacterial Cell Biology, Newcastle University
, Newcastle upon Tyne NE2 4BN, United Kingdom
| | - Michael John Hall
- School of Chemistry, Newcastle University
, Newcastle upon Tyne NE1 7RU, United Kingdom
| | - Jeff Errington
- Centre for Bacterial Cell Biology, Newcastle University
, Newcastle upon Tyne NE2 4BN, United Kingdom
- Demuris Limited , Newcastle Biomedicine Bio-Incubators
, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Nicholas Edward Ellis Allenby
- Demuris Limited , Newcastle Biomedicine Bio-Incubators
, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom
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Alihodžić S, Bukvić M, Elenkov IJ, Hutinec A, Koštrun S, Pešić D, Saxty G, Tomašković L, Žiher D. Current Trends in Macrocyclic Drug Discovery and beyond -Ro5. PROGRESS IN MEDICINAL CHEMISTRY 2018; 57:113-233. [DOI: 10.1016/bs.pmch.2018.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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Duncan LR, Sader HS, Smart JI, Flamm RK, Mendes RE. Telavancin activity in vitro tested against a worldwide collection of Gram-positive clinical isolates (2014). J Glob Antimicrob Resist 2017; 10:271-276. [DOI: 10.1016/j.jgar.2017.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022] Open
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13
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Bal AM, David MZ, Garau J, Gottlieb T, Mazzei T, Scaglione F, Tattevin P, Gould IM. Future trends in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection: An in-depth review of newer antibiotics active against an enduring pathogen. J Glob Antimicrob Resist 2017; 10:295-303. [PMID: 28732783 DOI: 10.1016/j.jgar.2017.05.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/20/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major public health problem. Vancomycin and teicoplanin have been in clinical use for several decades but their drawbacks are well described. In the last 10 years, several antibiotics have been made available for clinical use. Daptomycin and linezolid have been extensively used during this period. Other agents such as ceftaroline, ceftobiprole, dalbavancin, oritavancin, tedizolid and telavancin have been approved by regulatory agencies since 2009. Many others, such as the newer tetracyclines, fluoroquinolones, oxazolidinones and pleuromutilins, are in various stages of development. In addition, an ongoing multicentre trial is investigating the role of combination of vancomycin or daptomycin with β-lactam antibiotics. This review discusses the role of the newer antibiotics, reflecting the views of the 6th MRSA Consensus Conference meeting of the International Society of Chemotherapy MRSA Working Group that took place in 2016.
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Affiliation(s)
- A M Bal
- Department of Microbiology, University Hospital Crosshouse, Kilmarnock KA2 0BE, UK.
| | - M Z David
- Departments of Medicine, Paediatrics, and Public Health Sciences, University of Chicago, Chicago, IL 60637, USA
| | - J Garau
- Department of Medicine, Hospital Universitari Mútua de Terrassa, Plaza Dr Robert 5, Barcelona 08221, Spain
| | - T Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW 2139, Australia
| | - T Mazzei
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Firenze, Firenze, Italy
| | - F Scaglione
- Department of Oncology and Onco-Haematology, University of Milan, Via Vanvitelli 32, 20129 Milan, Italy
| | - P Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 35033 Rennes, France
| | - I M Gould
- Department of Microbiology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
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15
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Enabling techniques in the search for new antibiotics: Combinatorial biosynthesis of sugar-containing antibiotics. Biochem Pharmacol 2017; 134:56-73. [DOI: 10.1016/j.bcp.2016.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/24/2016] [Indexed: 12/12/2022]
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16
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Hall RG, Thatcher M, Wei W, Varghese S, Varughese L, Ndiulor M, Payne KD. Dosing strategies to optimize currently available anti-MRSA treatment options (Part 1: IV options). Expert Rev Clin Pharmacol 2017; 10:493-508. [PMID: 28293964 DOI: 10.1080/17512433.2017.1300527] [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] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a predominant pathogen resulting in significant morbidity and mortality. Optimal dosing of anti-MRSA agents is needed to help prevent the development of antimicrobial resistance and to increase the likelihood of a favorable clinical outcome. Areas covered: This review summarizes the available data for antimicrobials routinely used for MRSA infections that are not administered orally or topically. We make recommendations and highlight the current gaps in the literature. A PubMed (1966 - Present) search was performed to identify relevant literature for this review. Expert commentary: Improvements in MIC determination and therapeutic drug monitoring are needed to fully implement individualized dosing that optimizes antimicrobial pharmacodynamics.Additional data will become available for these agents in regards to effectiveness for severe MRSA infections and pharmacokinetic data for special patient populations.
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Affiliation(s)
- Ronald G Hall
- a Texas Tech University Health Sciences Center , Dallas , TX , USA.,b Dose Optimization and Outcomes Research (DOOR) program
| | - Michael Thatcher
- a Texas Tech University Health Sciences Center , Dallas , TX , USA
| | - Wei Wei
- a Texas Tech University Health Sciences Center , Dallas , TX , USA
| | - Shibin Varghese
- a Texas Tech University Health Sciences Center , Dallas , TX , USA
| | - Lincy Varughese
- a Texas Tech University Health Sciences Center , Dallas , TX , USA
| | - Michelle Ndiulor
- a Texas Tech University Health Sciences Center , Dallas , TX , USA
| | - Kenna D Payne
- a Texas Tech University Health Sciences Center , Dallas , TX , USA
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17
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Zeng D, Debabov D, Hartsell TL, Cano RJ, Adams S, Schuyler JA, McMillan R, Pace JL. Approved Glycopeptide Antibacterial Drugs: Mechanism of Action and Resistance. Cold Spring Harb Perspect Med 2016; 6:cshperspect.a026989. [PMID: 27663982 DOI: 10.1101/cshperspect.a026989] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The glycopeptide antimicrobials are a group of natural product and semisynthetic glycosylated peptides that show antibacterial activity against Gram-positive organisms through inhibition of cell-wall synthesis. This is achieved primarily through binding to the d-alanyl-d-alanine terminus of the lipid II bacterial cell-wall precursor, preventing cross-linking of the peptidoglycan layer. Vancomycin is the foundational member of the class, showing both clinical longevity and a still preferential role in the therapy of methicillin-resistant Staphylococcus aureus and of susceptible Enterococcus spp. Newer lipoglycopeptide derivatives (telavancin, dalbavancin, and oritavancin) were designed in a targeted fashion to increase antibacterial activity, in some cases through secondary mechanisms of action. Resistance to the glycopeptides emerged in delayed fashion and occurs via a spectrum of chromosome- and plasmid-associated elements that lead to structural alteration of the bacterial cell-wall precursor substrates.
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Affiliation(s)
- Daina Zeng
- Agile Sciences, Raleigh, North Carolina 27606
| | | | - Theresa L Hartsell
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins School of Medicine and Nursing, Baltimore, Maryland 21287
| | - Raul J Cano
- ATCC Center for Translational Microbiology, Union, New Jersey 07083.,Biological Sciences Department, California Polytechnic State University, San Luis Obispo, California 93407
| | - Stacy Adams
- Center for Skin Biology, GlaxoSmithKline, Durham, North Carolina 27703
| | | | - Ronald McMillan
- ATCC Center for Translational Microbiology, Union, New Jersey 07083
| | - John L Pace
- ATCC Center for Translational Microbiology, Union, New Jersey 07083.,STEM Program, Kean University, Union, New Jersey 07083.,Biomanufacturing Research Institute and Technology Enterprise, North Carolina Central University, Durham, North Carolina 27707
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Liapikou A, Dimakou K, Toumbis M. Telavancin in the treatment of Staphylococcus aureus hospital-acquired and ventilator-associated pneumonia: clinical evidence and experience. Ther Adv Respir Dis 2016; 10:368-78. [PMID: 27340253 DOI: 10.1177/1753465816651594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Telavancin (TLV) is a lipoglycopeptide derivative of vancomycin (VAN), which has activity against Gram-positive aerobic bacteria, and is especially effective against methicillin-resistant Staphylococcus aureus (MRSA) and Gram-positive bacteria resistant to VAN. Comparative clinical studies of TLV have demonstrated noninferiority compared with VAN in the treatment of hospital-acquired Gram-positive pneumonia, with high cure rates for TLV-treated patients with monomicrobial S. aureus infection, including isolates with reduced VAN susceptibility. The results based on the patients' clinical response were supported by supplemental post-hoc analyses of 28-day mortality. In Europe and the USA, TLV is approved as a useful alternative for patients with difficult-to-treat, hospital-acquired MRSA pneumonia when there are very few alternatives. The present article reviews TLV's pharmacological characteristics and clinical efficacy resulting from clinical trials giving a detailed picture of its properties and position in the management of hospital-acquired pneumonia.
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Adamantia L, Antoni T. Pharmacodynamics, pharmacokinetics and clinical efficacy of telavancin in the treatment of pneumonia. Expert Opin Drug Metab Toxicol 2016; 12:803-12. [DOI: 10.1080/17425255.2016.1187599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Torres Antoni
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
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Van Bambeke F. Lipoglycopeptide Antibacterial Agents in Gram-Positive Infections: A Comparative Review. Drugs 2015; 75:2073-95. [DOI: 10.1007/s40265-015-0505-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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21
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Rodvold KA. Telavancin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis 2015; 61 Suppl 2:S35-7. [PMID: 26316556 DOI: 10.1093/cid/civ524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keith A Rodvold
- Colleges of Pharmacy and Medicine, University of Illinois at Chicago
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Sandrock CE, Shorr AF. The Role of Telavancin in Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia. Clin Infect Dis 2015; 61 Suppl 2:S79-86. [DOI: 10.1093/cid/civ535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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