Synthesis and antimicrobial spectrum of FCE 22101 and its orally available ester FCE 22891

[New orally active penem antibiotic: Farom]

An orally active penem antibiotic, Farom (generic name: faropenem), was designed by the conformational analysis of active and inactive penem derivatives. Faropenem showed potent activity against a wide variety of bacteria including extended-spectrum beta-lactamase (ESBL)-producing ones. The mechanism of the stability against ESBL was elucidated by modeling the Michaelis complex of faropenem and Toho-1, an ESBL. Modeling of a complex of faropenem at the active site of a penicillin-binding protein 2 (PBP2) model suggested the characteristic affinity for faropenem with PBP2 of Escherichia coli. Faropenem has been totally synthesized from (R)-1,3-butanediol. The synthetic intermediate, a 3-hydroxyethyl-4-acetoxyazetidinone derivative, was efficiently prepared by the 2 + 2 coupling of a optically active vinylsulfide derivative and chlorosulfonyl isocyanate, followed by the substitution of the acetoxy group for the thiophenyl group at the C-4 position.

Potent bacteriolytic activity of ritipenem associated with a characteristic profile of affinities for penicillin-binding proteins of Haemophilus influenzae

Ritipenem is highly bacteriolytic against Haemophilus influenzae. Bacterial lysis was shown after treatments with ritipenem and cefsulodin at their MICs and after treatments with fropenem and cefdinir at four times their MICs, indicated by decreases in the culture turbidities and by morphological changes of the destroyed cells. These beta-lactams were preferentially bound to penicillin-binding protein (PBP) 1b. Ritipenem, fropenem, and cefsulodin exhibited poor affinities to PBPs 3a and 3b, but cefdinir showed high affinities to these PBPs. Microscopic examinations revealed that selective PBP 3 inhibitors, such as aztreonam and cefotaxime, inhibited lysis induced by ritipenem. These results suggest that the preferential inactivation of PBP 1b could be essential to induce the lysis of H. influenzae cells and that binding to PBPs 3a and 3b may interfere with lysis.

Simultaneous determination of an active metabolite and open-ring metabolites by high performance liquid chromatography and pharmacokinetic studies of a penem antibiotic, FCE22891, in dogs

A sensitive high performance liquid chromatographic method for the simultaneous determination of an active metabolite (FCE22101) and open-ring metabolites (P1, P2) of a penem antibiotic, FCE22891, in dog plasma was developed. Plasma samples were pretreated only by ultrafiltration for the determination of the metabolites. The filtrates were directly analyzed by a reversed-phase high-performance liquid chromatographic system using a two-sided bracketing injection technique. The quantitation limits of FCE22101, P1 and P2 were 0.03, 0.1 and 0.15 microgram ml-1, respectively. Analysis of the spiked plasma samples demonstrated the good accuracy and precision of the method. The proposed method was applied to the pharmacokinetic studies of an active metabolite and open-ring metabolites after oral administration of a penem antibiotic, FCE22891, in dogs. In addition, the plasma levels of unchanged FCE22891 and the possible changes of formaldehyde and acyl-L-carnitine levels in plasma, which will be generated from the ester group of FCE22891, were also investigated.

Survey of in vitro susceptibilities of Vibrio cholerae O1 and O139 to antimicrobial agents

Vibrio cholerae O139 (173 strains) and O1 (221 strains) were tested for their in vitro susceptibilities to 39 antimicrobial agents. Both O139 and O1 strains were highly susceptible to azithromycin, cephems, minocycline, penems, and newer fluoroquinolones. O139 strains (94.8%), O1 Indian El Tor strains (97%), and Bangladeshi El Tor strains (50%) were highly resistant to streptomycin, sulfamethoxazole, and trimethoprim and moderately resistant to chloramphenicol and furazolidone, in sharp contrast to O1 Peruvian El Tor and O1 classical strains. Some Bangladeshi El Tor strains (43.3%) showed tetracycline resistance as well.

The in vitro activity of FCE 22101 against gram-negative aerobic isolates resistant to third generation cephalosporins

The in vitro activity of FCE 22101 against 97 Gram-negative aerobic nosocomial isolates was compared with that of ceftriaxone using the agar dilution method. Thirty-four (79%) of the 43 ceftriaxone resistant (MIC > 16 mg/l) isolates were found to be FCE 22101 susceptible (MIC < or = 8 mg/l), while of the ceftriaxone susceptible isolates, only seven Enterobacter cloacae and one Serratia spp strain were FCE 22101 resistant. The new penem may offer an alternative for treating nosocomial infections due to aerobic Gram-negative strains resistant to third generation cephalosporins, provided that clinical studies confirm its clinical usefulness.

Pharmacokinetics of [14C]FCE 22891, a penem antibiotic, following oral administration to healthy volunteers

FCE 22891 is a prodrug of the penem antibiotic FCE 22101 and is suitable for oral administration. The pharmacokinetics of FCE 22891 were investigated in four healthy male volunteers following the oral administration of 500 mg of [14C]FCE 22891. Levels of radioactivity in plasma were always higher and persisted for longer than those of FCE 22101. The time to the maximum concentration of radioactivity in plasma generally coincided with that of FCE 22101. The respective values for the maximum concentrations of radioactivity in plasma were, on average, 8.57 +/- 2.95 micrograms equivalent/ml and 2.97 +/- 2.05 micrograms/ml. Over a 5-day period, mean urinary and fecal recovery of radioactivity accounted for 53.2 and 41.0% of the dose, respectively. The average amount of FCE 22101 excreted in urine and feces corresponded to 9.0 and 1.6% of the dose, respectively. The urinary recovery of the open-ring metabolite P1 and of its 5-S epimer P2 accounted for about 6.5 and 1.2% of the dose, respectively. Other chromatographic peaks corresponding to nonidentified compounds accounted for about 14.0% (polar metabolite fraction; peak P), 3.7% (less polar fraction; peak X), and 15.4% (least polar fraction) of the dose. Elimination of radioactivity and FCE 22101 in urine was rapid. Intersubject variability in the kinetics of total radioactivity in plasma was far less than that observed for FCE 22101. The results of the present study support suggestions that presystemic metabolism of FCE 22101 and/or transformation of the prodrug to compounds other than FCE 22101 are the main cause of intersubject variability in the kinetics of FCE 22101 produced in plasma following oral administration of its prodrug.

Current trends and new perspectives in antibiotic therapy

During the last ten years, limitless numbers of antimicrobials were produced by the pharmaceutical industry and some have been marketed. The main objectives of new drugs are to overcome the expanding problems of resistant bacteria, to fill the gaps of spectrum of previous agents. These objectives are progressively reached by new beta-lactams, penems, fluoroquinolones; in general practice, new oral cephalosporins are becoming available. To overcome toxicity problems new concepts in antibiotic usage such as intermittent aminoglycoside regimens are suggested. Research in antibiotics, the discovery of new molecules or the re-evaluation of older drugs constitute dynamic trends in antibiotic therapy.