In vitro antibacterial activity of AM-715, a new nalidixic acid analog

Gyrase and Topoisomerase IV: Recycling Old Targets for New Antibacterials to Combat Fluoroquinolone Resistance

Beyond their requisite functions in many critical DNA processes, the bacterial type II topoisomerases, gyrase and topoisomerase IV, are the targets of fluoroquinolone antibacterials. These drugs act by stabilizing gyrase/topoisomerase IV-generated DNA strand breaks and by robbing the cell of the catalytic activities of these essential enzymes. Since their clinical approval in the mid-1980s, fluoroquinolones have been used to treat a broad spectrum of infectious diseases and are listed among the five "highest priority" critically important antimicrobial classes by the World Health Organization. Unfortunately, the widespread use of fluoroquinolones has been accompanied by a rise in target-mediated resistance caused by specific mutations in gyrase and topoisomerase IV, which has curtailed the medical efficacy of this drug class. As a result, efforts are underway to identify novel antibacterials that target the bacterial type II topoisomerases. Several new classes of gyrase/topoisomerase IV-targeted antibacterials have emerged, including novel bacterial topoisomerase inhibitors, Mycobacterium tuberculosis gyrase inhibitors, triazaacenaphthylenes, spiropyrimidinetriones, and thiophenes. Phase III clinical trials that utilized two members of these classes, gepotidacin (triazaacenaphthylene) and zoliflodacin (spiropyrimidinetrione), have been completed with positive outcomes, underscoring the potential of these compounds to become the first new classes of antibacterials introduced into the clinic in decades. Because gyrase and topoisomerase IV are validated targets for established and emerging antibacterials, this review will describe the catalytic mechanism and cellular activities of the bacterial type II topoisomerases, their interactions with fluoroquinolones, the mechanism of target-mediated fluoroquinolone resistance, and the actions of novel antibacterials against wild-type and fluoroquinolone-resistant gyrase and topoisomerase IV.

Bicarbonate modulates delafloxacin activity against MDR Staphylococcus aureus and Pseudomonas aeruginosa

OBJECTIVES

To investigate the utility of recently approved delafloxacin and other fluoroquinolones against leading MDR bacterial pathogens under physiologically relevant conditions.

METHODS

MIC and MBC assays were conducted for MDR strains of Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae in the standard antibiotic susceptibility testing medium CAMHB, amended Roswell-Park Memorial Institute tissue culture medium (RPMI+) or 20% fresh human whole blood. In vivo correlation of in vitro findings was performed in a murine P. aeruginosa pneumonia model. Mechanistic bases for the findings were explored by altering media conditions and with established fluoroquinolone accumulation assays.

RESULTS

Fluoroquinolone MICs were increased in RPMI+ compared with CAMHB for all four MDR pathogens. Specifically, delafloxacin MICs were increased 32-fold versus MDR S. aureus and 8-fold versus MDR P. aeruginosa. MBC assays in 20% human whole blood and a murine MDR P. aeruginosa pneumonia model both confirmed that delafloxacin activity was reduced under physiological conditions. Bicarbonate (HCO3-), a key component of host physiology found in RPMI+ but absent from CAMHB, dictated delafloxacin susceptibility in CAMHB and RPMI+ by impairing its intracellular accumulation.

CONCLUSIONS

Standard in vitro antibiotic susceptibility testing conditions overpredicted the effectiveness of delafloxacin against MDR pathogens by failing to capture the role of the biological buffer HCO3- to impair delafloxacin accumulation. This work showcases limitations of our current antibiotic susceptibility testing paradigm and highlights the importance of understanding host microenvironmental conditions that impact true clinical efficacy.

Quinolones: Mechanism, Lethality and Their Contributions to Antibiotic Resistance

Fluoroquinolones (FQs) are arguably among the most successful antibiotics of recent times. They have enjoyed over 30 years of clinical usage and become essential tools in the armoury of clinical treatments. FQs target the bacterial enzymes DNA gyrase and DNA topoisomerase IV, where they stabilise a covalent enzyme-DNA complex in which the DNA is cleaved in both strands. This leads to cell death and turns out to be a very effective way of killing bacteria. However, resistance to FQs is increasingly problematic, and alternative compounds are urgently needed. Here, we review the mechanisms of action of FQs and discuss the potential pathways leading to cell death. We also discuss quinolone resistance and how quinolone treatment can lead to resistance to non-quinolone antibiotics.

Identifying Small Molecules That Promote Quasipalindrome-Associated Template-Switch Mutations in Escherichia coli

DNA can assemble into non-B form structures that stall replication and cause genomic instability. One such secondary structure results from an inverted DNA repeat that can assemble into hairpin and cruciform structures during DNA replication. Quasipalindromes (QP), imperfect inverted repeats, are sites of mutational hotspots. Quasipalindrome-associated mutations (QPMs) occur through a template-switch mechanism in which the replicative polymerase stalls at a QP site and uses the nascent strand as a template instead of the correct template strand. This mutational event causes the QP to become a perfect or more perfect inverted repeat. Since it is not fully understood how template-switch events are stimulated or repressed, we designed a high-throughput screen to discover drugs that affect these events. QP reporters were engineered in the Escherichia coli lacZ gene to allow us to study template-switch events specifically. We tested 700 compounds from the NIH Clinical Collection through a disk diffusion assay and identified 11 positive hits. One of the hits was azidothymidine (zidovudine, AZT), a thymidine analog and DNA chain terminator. The other ten were found to be fluoroquinolone antibiotics, which induce DNA-protein crosslinks. This work shows that our screen is useful in identifying small molecules that affect quasipalindrome-associated template-switch mutations. We are currently assessing more small molecule libraries and applying this method to study other types of mutations.

In vitro and in vivo efficacy study of cefepime, doripenem, tigecycline, and tetracycline against extended-spectrum beta-lactamases Escherichia coli in chickens

BACKGROUND AND AIM

At present, there are no data about the efficacy of some recent antibiotics on Escherichia coli in broiler chickens in the study area. This study was designed to evaluate the in vitro and in vivo efficacy of cefepime, doripenem, tigecycline, and tetracycline against multidrug-resistant-extended-spectrum beta-lactamases (MDR-ESBLs) producing E. coli in broiler chicks.

MATERIALS AND METHODS

A total of 34 MDR-ESBLs E. coli isolates were used in this study. In vitro evaluation of the antibacterial efficacy of cefepime, doripenem, tigecycline, and tetracycline were performed using disk diffusion and minimum inhibitory concentration (MIC) assays. In vivo evaluation of the efficacy of the antibiotics was perfumed using 180, 2-week-old chicks challenged with MDR-ESBL-producing E. coli strain O78. Chicks were divided into six groups (30 chicks each) according to the treatment regimen. Treatment was administered to chicks in Groups 3-6 intravenously, twice per day for 1 week using one antibiotic per group at concentration 10 times the determined MIC. Chicks in the positive control (Group 1) were challenged and received 0.2 ml of sterile Tryptone Soy Broth (TSB), while those in the negative control (Group 2) were not challenged and received 0.2 ml of sterile TSB. The severity of clinical signs, gross lesions, and mortality rate was scored and compared between groups.

RESULTS

All E. coli isolates were sensitive to doripenem and tigecycline, while 88% were sensitive to cefepime and only 23% were sensitive to tetracycline. In vivo antibiotic efficacy evaluation in challenged chicks revealed a significant reduction in the severity of clinical signs, gross lesions, and mortality (3%) in chicks treated with cefepime compared to non-treated chicks (55%). There was no significant effect on the severity of clinical signs, gross lesions, and mortality in chicks treated with doripenem, tigecycline, and tetracycline compared to non-treated chicks. The mortality rates of chicks treated with doripenem, tigecycline, and tetracycline were 57%, 50%, and 90%, respectively.

CONCLUSION

The results of this study indicate that most MDR-ESBLs producing E. coli isolates were sensitive to doripenem, tigecycline, and cefepime. However, in vivo study indicated that only cefepime was effective and resulted in a significant reduction in clinical signs, gross lesions, and mortality in infected chicks. Therefore, cefepime could be used to treat naturally infected chickens with MDR-ESBLs producing strains of E. coli.

Abundance of mobile genetic elements in an Acinetobacter lwoffii strain isolated from Transylvanian honey sample

Based on phylogenetic analyses, strain M2a isolated from honey, an unexpected source of acinetobacters, was classified as Acinetobacter lwoffii. The genome of this strain is strikingly crowded with mobile genetic elements. It harbours more than 250 IS elements of 15 IS-families, several unit and compound transposons and 15 different plasmids. These IS elements, including 30 newly identified ones, could be classified into at least 53 IS species. Regarding the plasmids, 13 of the 15 belong to the Rep-3 superfamily and only one plasmid, belonging to the “Low-GC” family, possesses a seemingly complete conjugative system. The other plasmids, with one exception, have a mobilization region of common pattern, consisting of the divergent mobA/mobL-family and mobS-, mobC- or traD-like genes separated by an oriT-like sequence. Although two plasmids of M2a are almost identical to those of A. lwoffi strains isolated from gold mine or Pleistocene sediments, most of them have no close relatives. The presence of numerous plasmid-borne and chromosomal metal resistance determinants suggests that M2a previously has also evolved in a metal-polluted environment. The numerous, possibly transferable, plasmids and the outstanding number of transposable elements may reflect the high potential of M2a for rapid evolution.

Microbiological Air Quality and Drug Resistance in Airborne Bacteria Isolated from a Waste Sorting Plant Located in Poland-A Case Study

International interests in biological air pollutants have increased rapidly to broaden the pool of knowledge on their identification and health impacts (e.g., infectious, respiratory diseases and allergies). Antibiotic resistance and its wider implications present us with a growing healthcare crisis, and an increased understanding of antibiotic-resistant bacteria populations should enable better interpretation of bioaerosol exposure found in the air. Waste sorting plant (WSP) activities are a source of occupational bacterial exposures that are associated with many health disorders. The objectives of this study were (a) to assess bacterial air quality (BAQ) in two cabins of a WSP: preliminary manual sorting cabin (PSP) and purification manual sorting cabin (quality control) (QCSP), (b) determine the particle size distribution (PSD) of bacterial aerosol (BA) in PSP, QCSP, and in the outdoor air (OUT), and (c) determine the antibiotic resistance of isolated strains of bacteria. Bacterial strains were identified on a Biolog GEN III (Biolog, Hayward, CA, USA), and disc diffusion method for antimicrobial susceptibility testing was carried out according to the Kirby-Bauer Disk Diffusion Susceptibility Test Protocol. A large share of fecal bacteria, Enterococcus faecalis and Alcaligenes faecalis spp. feacalis, was found in the tested indoor air, which is a potential health hazard to the workers of the monitored WSP. Our results demonstrate the necessity to take into account fecal air pollution levels to avoid making erroneous assumptions regarding the environmental selection of antibiotic resistance. Total elimination of many anthropogenic sources is not possible, but important findings of this study can be used to develop realistic management policies methods to improve BAQ.

Transferable Mechanisms of Quinolone Resistance from 1998 Onward

While the description of resistance to quinolones is almost as old as these antimicrobial agents themselves, transferable mechanisms of quinolone resistance (TMQR) remained absent from the scenario for more than 36 years, appearing first as sporadic events and afterward as epidemics. In 1998, the first TMQR was soundly described, that is, QnrA. The presence of QnrA was almost anecdotal for years, but in the middle of the first decade of the 21st century, there was an explosion of TMQR descriptions, which definitively changed the epidemiology of quinolone resistance. Currently, 3 different clinically relevant mechanisms of quinolone resistance are encoded within mobile elements: (i) target protection, which is mediated by 7 different families of Qnr (QnrA, QnrB, QnrC, QnrD, QnrE, QnrS, and QnrVC), which overall account for more than 100 recognized alleles; (ii) antibiotic efflux, which is mediated by 2 main transferable efflux pumps (QepA and OqxAB), which together account for more than 30 alleles, and a series of other efflux pumps (e.g., QacBIII), which at present have been sporadically described; and (iii) antibiotic modification, which is mediated by the enzymes AAC(6')Ib-cr, from which different alleles have been claimed, as well as CrpP, a newly described phosphorylase.

Efficacy of Norfloxacin in Bacterial Conjunctivitis

We investigated the efficacy and safety of norfloxacin 0.3% ophthalmic solution in 120 patients with bacterial conjunctivitis or blepharitis. Patients were selected for the study if they showed conjunctival hyperemia and at least three of the following criteria: a) symptoms of a surface ocular infection; b) a purulent discharge; c) crusting of the eyelids, and d) thickened, red lid margins. After taking a specimen for culture from the conjunctiva or skin-lash margin, the test drug was administered to the infected eye every two hours for one day, then 4 times daily for one week. Of the 120 patients who entered the study, 84.1% were cured. No serious adverse reactions occurred.

DNA Topoisomerases as Targets for Antibacterial Agents

DNA topoisomerases are proven therapeutic targets of antibacterial agents. Quinolones, especially fluoroquinolones, are the most successful topoisomerase-targeting antibacterial drugs. These drugs target type IIA topoisomerases in bacteria. Recent structural and biochemical studies on fluoroquinolones have provided the molecular basis for both their mechanism of action, as well as the molecular basis of bacterial resistance. Due to the development of drug resistance, including fluoroquinolone resistance, among bacterial pathogens, there is an urgent need to discover novel antibacterial agents. Recent advances in topoisomerase inhibitors may lead to the development of novel antibacterial drugs that are effective against fluoroquinolone-resistant pathogens. They include type IIA topoisomerase inhibitors that either interact with the GyrB/ParE subunit or form nick-containing ternary complexes. In addition, several topoisomerase I inhibitors have recently been identified. Thus, DNA topoisomerases remain important targets of antibacterial agents.

Heterocycles [h]-fused onto 4-oxoquinoline-3-carboxylic acid. Part XII: synthesis of 5-fluoro-7-oxodihydo[1,3,4]thiadiazino [5,6-h]quinoline-8-carboxylic acid and ester

Direct interaction of dithizone with 7-chloro-6- fluoro-8-nitro-4-oxoquinoline-3-carboxylic acid or with its ester delivered the corresponding novel 1,3,4-thiadiazino [5,6-h]quinoline 3-carboxylic acid, or its ester which was then hydrolyzed to the respective acid. Structures of the latter tricyclic hybrids were deduced from analytical and spectral data and confirmed by single crystal X-ray structure determination of the ester derivative. The free acid showed moderate activity against Staphylococcus aureus with a MIC value of 25 μg mL−1.

New antituberculous drugs derived from natural products: current perspectives and issues in antituberculous drug development

Tuberculosis is one of the most common and challenging infectious diseases worldwide. Especially, the lack of effective chemotherapeutic drugs for tuberculosis/human immunodeficiency virus co-infection and prevalence of multidrug-resistant and extensively drug-resistant tuberculosis remain to be serious clinical problems. Development of new drugs is a potential solution to fight tuberculosis. In this decade, the development status of new antituberculous drugs has been greatly advanced by the leading role of international organizations such as the Global Alliance for Tuberculosis Drug Development, Stop Tuberculosis Partnership and Global Health Innovative Technology Fund. In this review, we introduce the development status of new drugs for tuberculosis, focusing on those derived from natural products.The Journal of Antibiotics advance online publication, 1 November 2017; doi:10.1038/ja.2017.126.

One-pot and step-wise synthesis of thieno[3,2-c]pyridin-4-ones

Both one pot and step wise synthesis of methyl 3,5-diaminothieno[3,2-c]pyridin-4-one-2-carboxylates6have been delineated by the reaction of 6-aryl-4-methylthio-2H-pyran-2-one-3-carbonitriles3, methyl mercaptoacetate and hydrazine hydrate.

A "Double-Edged" Scaffold: Antitumor Power within the Antibacterial Quinolone

In the late 1980s, reports emerged describing experimental antibacterial quinolones having significant potency against eukaryotic Type II topoisomerases (topo II) and showing cytotoxic activity against tumor cell lines. As a result, several pharmaceutical companies initiated quinolone anticancer programs to explore the potential of this class in comparison to conventional human topo II inhibiting antitumor drugs such as doxorubicin and etoposide. In this review, we present a modern re-evaluation of the anticancer potential of the quinolone class in the context of today's predominantly pathway-based (rather than cytotoxicity-based) oncology drug R&D environment. The quinolone eukaryotic SAR is comprehensively discussed, contrasted with the corresponding prokaryotic data, and merged with recent structural biology information which is now beginning to help explain the basis for that SAR. Quinolone topo II inhibitors appear to be much less susceptible to efflux-mediated resistance, a current limitation of therapy with conventional agents. Recent advances in the biological understanding of human topo II isoforms suggest that significant progress might now be made in overcoming two other treatment-limiting disadvantages of conventional topo II inhibitors, namely cardiotoxicity and drug-induced secondary leukemias. We propose that quinolone class topo II inhibitors could have a useful future therapeutic role due to the continued need for effective topo II drugs in many cancer treatment settings, and due to the recent biological and structural advances which can now provide, for the first time, specific guidance for the design of a new class of inhibitors potentially superior to existing agents.

Synthesis and antibacterial activity of some novel 4-oxopyrido[2,3-a]phenothiazines

A series of substituted 4-oxopyrido[2,3-a]phenothiazine-3-carboxylic acids (6a-d) were prepared via cyclization of the corresponding ethyl 7-(arylthioxy)-8-nitro(or azido)-4-oxoquinoline-3-carboxylates (3a-d/4a-d), followed by hydrolysis of the resultant esters (5a-d). Among these tetracyclics, compound 6a with unsubstituted terminal benzo-ring D was the most active against representative Gram-positive and Gram-negative bacterial strains. These compounds were also active against methicillin-resistant Staphylococcus aureus (MRSA), with very low toxicity to normal cells. Virtual screening using ligand-protein docking modeling predicted that the compounds 6a-d are potential inhibitors of the topoisomerase IV enzyme and that hydrophobic interactions and hydrogen bonds are the major molecular interactions between these compounds and the residues of the active site of topoisomerase IV.

Synthesis and biological evaluation of tetracyclic thienopyridones as antibacterial and antitumor agents

A facile synthesis of model 4-oxopyrido[3',2':4,5]thieno[3,2-b]indole-3-carboxylic acids 9a-e was achieved via Stille arylation of 2-chloro-3-nitro-4-oxothieno[2,3-b]pyridine-5-carboxylate and a subsequent microwave-assisted phosphite-mediated Cadogan reaction. The new compounds were tested for their in vitro antimicrobial and antiproliferative activity. Compounds 9a-c and 9e exhibited very high potency against Gram positive Bacillus subtilis and Bacillus megaterium at concentrations 0.000015-0.007 μg/mL. They also displayed excellent activity towards other Gram positive bacilli and staphylococci and Gram negative Haemophilus influenzae, being in most cases superior or equal to commercial fluoroquinolones. Both 9a and 9c were inhibitors of the DNA gyrase activity. As concerns antitumor properties, compounds 9b-e showed growth inhibition of MCF-7 breast tumor and A549 non-small cell lung cancer cells with IC(50) 1.6-2.8 μM and 2.6-6.9 μM, respectively, coupled with absence of cytotoxicity towards normal cells. These compounds are promising as dual acting chemotherapeutics.

Biofilm inhibition and drug-eluting properties of novel DMAEMA-modified polyethylene and silicone rubber surfaces

Poly(2-(dimethylaminoethyl) methacrylate) (pDMAEMA) was grafted to low density polyethylene (LDPE) and silicone rubber (SR) in order to make them less susceptible to microbial biofilm formation. The direct grafting of DMAEMA using γ-rays was an efficient and fast procedure for obtaining modified materials, which could be quaternized in a second step using methyl iodide. Raman spectroscopy showed that the grafting occurred only at the surface of the LDPE, but both at the surface and in the bulk of the SR. Consequently, the grafted chains caused changes in the surface-related features of the LDPE (water contact angle and viscoelastic behavior in the dry state) and in the bulk-related properties of the SR (swelling and viscoelasticity in the swollen state). The microbiological assays revealed that the grafted DMAEMA reduced Candida albicans biofilm formation (almost no biofilm on SR), while the quaternized surfaces inhibited C. albicans and Staphylococcus aureus biofilm by more than 99% compared to pristine materials. Modified LDPE and SR were capable of holding considerable amounts of nalidixic acid, an anionic antimicrobial drug, and sustained the release for several hours. In addition, the grafted materials were cytocompatible (fibroblast cell survival > 70%). In conclusion, these materials have the ability to inhibit microbial biofilm formation and at the same time act as drug-eluting systems, and for that reason may hold great promise for anti-biofouling applications.

High-performance liquid chromatographic analysis of norfloxacin in human tissues and plasma with fluorescence detection

A high-performance liquid chromatographic analysis with fluorimetric detection is described for the quantitative determination of norfloxacin in renal, prostatic tissues and in plasma. The analytical procedure in the tissue pretreatment, consists of purification of the obtained sample by a solid state extraction and quantitation by HPLC. The samples were chromatographed on a C(8) reversed-phase column. Analytical recoveries ranged from 95.2 to 97.6%. Within and between day precision were assessed by analysing serum containing 50 and 500 ng/ml norfloxacin. At each concentration, within day precision was < or = 3.6% (relative standard deviation, n = 10) and day-to-day precision was < or = 5.3% (n = 10). Limit of detection was ca 1 ng/ml.

Kinetic modelling of the intestinal transport of sarafloxacin. Studies in situ in rat and in vitro in Caco-2 cells

The absorption kinetics of sarafloxacin, as a model of fluoroquinolone structure, were studied in the rat small intestine and in Caco-2 cells. The objective of the study was to investigate the mechanistic basis of the drug's intestinal transport in comparison with other members of the fluoroquinolone family and to apply a mathematical modelling approach to the transport process. In the rat small intestine, sarafloxacin showed dual mechanisms of intestinal absorption with a passive diffusional component and an absorptive carrier-mediated component. The characteristics of the animal study design made it suitable for population analysis, thus allowing the accurate estimation of transport parameters and their inter and intra-individual variances. The transport system in the rat model was ATP-dependent, as sodium azide was able to decrease the absorption rate constant in a concentration-dependent fashion. The inhibition mechanism of sodium azide was modelled based on its ATP depletion capacity. The rationale of this approach was to consider the inhibitor-carrier interaction as a concentration- dependent response. This interaction was accurately described by a non-competitive mechanism. In Caco-2 cells, sarafloxacin showed a concentration dependent permeability in both directions apical to basal, and basal to apical. The permeability values and ratios of permeability values at different concentrations suggested the presence of two carriers (absorption and efflux carriers). The passive diffusion component in both systems was compared to that predicted by the absorption-partition correlation, previously established for two series of fluoroquinolones. The discrepancy between the experimental and predicted value suggested the presence of an efflux mechanism similar to that already described for other fluoroquinolones. The differences and similarities of the in situ and the in vitro results are discussed as well as the usefulness of the modelling approach.

Quinolones in 2005: an update

Quinolones are one of the largest classes of antimicrobial agents used worldwide. This review considers the quinolones that are available currently and used widely in Europe (norfoxacin, ciprofloxacin, ofloxacin, levofloxacin and moxifloxacin) within their historical perspective, while trying to position them in the context of recent and possible future advances based on an understanding of: (1) their chemical structures and how these impact on activity and toxicity; (2) resistance mechanisms (mutations in target genes, efflux pumps); (3) their pharmacodynamic properties (AUC/MIC and Cmax/MIC ratios; mutant prevention concentration and mutant selection window); and (4) epidemiological considerations (risk of emergence of resistance, clonal spread). Their main indications are examined in relation to their advantages and drawbacks. Overall, it is concluded that these important agents should be used in an educated fashion, based on a careful balance between their ease of use and efficacy vs. the risk of emerging resistance and toxicity. However, there is now substantial evidence to support use of the most potent drug at the appropriate dose whenever this is required.

Spectrofluorimetry and chemometrics for investigation of norfloxacin distribution in multilamellar liposomes

Norfloxacin (NFX), a fluoroquinolone, was encapsulated in multilamellar liposomes (MLV) of soy-bean phosphatidylcholine at pH 7.0. The observed affinity of this class of drugs for hydrophobic environments, such as phospholipid bilayers, could lead to a better understanding of the mechanism of uptake in bacteria. The fluorescent properties of NFX were examined both free in solution and in MLV, using anisotropy and fluorescence quenching measurements. The latter data was treated with a chemometric method to deconvolute the overlapped spectra of zwitterionic and neutral species of NFX in equilibrium at this pH. The results show that NFX incorporates into the lipidic bilayers with two different distributions of species: the zwitterionic form in the lipid/aqueous interface, and the neutral one, more towards the center of the bilayer.

A study on the micelle-sensitized Ce(IV)-Na2S2O3-norfloxacin chemiluminescence system and its applications

A new chemiluminescence (CL) flow-injection method was developed for the determination of norfloxacin. The method is based on the CL reaction of norfloxacin with sodium thiosulphate and Ce(IV) in sulphuric acid medium sensitized by sodium dodecylsulphate. Under optimum conditions, the CL intensity is proportional to the concentration of the norfloxacin in the range 3.89 x 10(-8)-7.18 x 10(-6) g/mL. The detection limit (3 s/k) was 2.21 x 10(-9) g/mL for norfloxacin. The method has been applied successfully to the determination of norfloxacin in pharmaceutical formulations and human urine. The mechanism for this chemiluminescence system is discussed.

Fluoroquinolones: mechanism of action, classification, and development of resistance

The fluoroquinolones represent an evolving class of broad-spectrum antimicrobial agents used in the prevention and treatment of a variety of ocular infections; however, resistance to currently available agents in the class has been emerging among ocular pathogens. This article reviews the mechanism of action of existing and new fluoroquinolones and discusses the structure-activity relationship of the fluoroquinolones as it relates to the classification of these compounds. This article also highlights the mechanism of resistance among common ocular pathogens and discusses the potential need for newer fluoroquinolones in ophthalmology.

A review of clinical trials with fluoroquinolones with an emphasis on new agents

This review aims to provide a comparison between the antimicrobial spectra, pharmacokinetics and clinical efficacy of the newer fluoroquinolones with older agents in this class, as well as other antibiotics used to treat lower respiratory and urinary tract infections (LRTIs and UTIs) respectively. Increasing antimicrobial resistance among common uro- and respiratory pathogens has focused attention on the development of fluoroquinolones, which have a broad spectrum of activity and improved tissue penetration. The new and developmental quinolones can be administered on a once-daily basis and exhibit high oral bioavailability, which reduces the need for parenteral therapy in hospitalised patients and may therefore potentially reduce the need for hospitalisation. These attributes, coupled with their expanded spectrum suggest that the newer fluoroquinolones are so far the most ideal agents for the empirical treatment of many common infections.

Characterization of quinolone antibacterial-induced convulsions and increases in nuclear AP-1 DNA- and CRE-binding activities in mouse brain

The quinolone antibacterials enoxacin and norfloxacin (2.5 mg/kg, i.v.) provoked clonic convulsions in mice treated concomitantly with biphenylacetic acid (BPAA, 100 mg/kg, i.p.), a major metabolite of the nonsteroidal anti-inflammatory drug fenbufen. Gel-shift assays showed that enoxacin-induced convulsions resulted in increases in nuclear activator protein 1 (AP-1) DNA- and cyclic AMP responsive element (CRE)-binding activities in the cerebral cortex and hippocampus, but not in other regions, such as the cerebellum and thalamus. In contrast, ofloxacin and levofloxacin, at the same doses, in the presence of BPAA did not evoke convulsions or increase these DNA-binding activities. Administration of these quinolones and BPAA alone elicited neither convulsions nor increases in these DNA-binding activities. These results suggest that the increased nuclear AP-1 DNA- and CRE-binding activities in the cerebral cortex and hippocampus induced by quinolones with BPAA correlated with seizure activities and that these brain regions play pivotal roles in quinolone-induced convulsions.

Activity of trovafloxacin against blood isolates of Streptococcus pneumoniae in Sweden

The in vitro activity of the fluoroquinolone trovafloxacin (CP-99,219) against 257 blood isolates of Streptococcus pneumoniae obtained from Swedish hospitals was compared with those of commonly prescribed oral antibiotics and also with those of ciprofloxacin and ofloxacin against a collection of strains resistant (n = 6) or intermediately resistant (n = 22) to penicillin (Pc-R). The MICs of trovafloxacin for Pc-R strains of pneumococci ranged from 0.032 to 0.25 mg/l. No difference was seen between the clinical isolates and the Pc-R strains (MIC50 = 0.064 mg/l and MIC90 = 0.125 mg/l for both collections). For the Pc-R strains, the MIC50 and MIC90 values of ciprofloxacin were 0.5 and 1 mg/l, and those of ofloxacin 2 and 4 mg/l. The incidence of resistance in the two collections (clinical isolates/Pc-R strains) was 3%/39% for tetracycline, 1%/18% for macrolides, and 3%/57% for trimethoprim/sulfamethoxazole. The results of the current study suggest that the clinical efficacy of trovafloxacin in the treatment of pneumococcal infections should be investigated.

In vitro and in vivo antibacterial activities of CS-940, a new 6-fluoro-8-difluoromethoxy quinolone

The in vitro and in vivo activities of CS-940, a new 6-fluoro-8-difluoromethoxy quinolone, were compared with those of ciprofloxacin, tosufloxacin, sparfloxacin, and levofloxacin. The in vitro activity of CS-940 against gram-positive bacteria was nearly equal to or greater than those of the other quinolones tested. In particular, CS-940 was two to eight times more active against methicillin-resistant Staphylococcus aureus than the other quinolones, at the MIC at which 90% of the clinical isolates are inhibited. Against gram-negative bacteria, the activity of CS-940 was comparable to or greater than those of tosufloxacin, sparfloxacin, and levofloxacin, while it was lower than that of ciprofloxacin. The activity of CS-940 was largely unaffected by medium, inoculum size, or the addition of horse serum, but it was decreased under acidic conditions, as was also seen with the other quinolones tested. CS-940 showed potent bactericidal activity against S. aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. In oral treatment of mouse systemic infections caused by S. aureus, Streptococcus pneumoniae, Streptococcus pyogenes, E. coli, K. pneumoniae, Serratia marcescens, and P. aeruginosa, CS-940 was more effective than ciprofloxacin, sparfloxacin, and levofloxacin against all strains tested. Against experimental pneumonia with K. pneumoniae in mice, CS-940 was the most effective of all the quinolones tested. These results suggest that CS-940 may be effective in the therapy of various bacterial infections.

Evidence that a hybrid molecule of norfloxacin and biphenylacetic acid is a potent antagonist at the GABAA receptor

The combination of some fluorinated quinolone antimicrobials and certain non-steroidal anti-inflammatory drugs (NSAIDs), such as fenbufen, has been reported to elicit serious convulsions in humans. Fluoroquinolones, including norfloxacin (NFLX) and NSAIDs synergistically inhibit GABAA receptors. The mechanism(s) of the synergism, however, at present remains unclear. In the present study, the hypothesis that NFLX and biphenylacetic acid (BPA), an active metabolite of fenbufen, undergo an intermolecular interaction to produce a more potent GABAA antagonist, was investigated by examining the effects of two hybrid molecules of NFLX linked with BPA on GABA-evoked whole cell currents, recorded from rat hippocampal neurons using the perforated-patch clamp technique. Hybrid-1, with a -CONH(CH2)3- chain between NFLX and BPA, inhibited the GABA response more potently than co-treatment with NFLX and BPA. In contrast, hybrid-2 with a -CONH- chain between NFLX and BPA, exhibited only a weak inhibition of the GABA response. The characterization of the inhibition of the GABA response in the presence of hybrid-1 was similar to that of the combination of NFLX and BPA regarding the following: (1) there was a rightward parallel shift of the concentration-response curve of GABA at lower concentrations and a suppression of the maximal response to GABA at higher concentrations; (2) it was voltage-independent; and (3) there was no influence on the reversal potential of the GABA response. These results therefore suggest that NFLX and BPA interact with the GABAA receptor at nearby sites and thus suppress the GABA response.

Inhibition of GABAA receptor chloride channel by quinolones and norfloxacin-biphenylacetic acid hybrid compounds

Receptor binding studies have shown that the combination of some new quinolone antibacterial agents with 4-biphenylacetic acid (BPAA), a metabolite of fenbufen, inhibits GABAA receptors. In order to elucidate further the mechanism of these drug interactions, the effect of quinolone antibacterial agents on muscimol-stimulated 36Cl- uptake in rat cerebral cortical synaptoneurosomes was investigated in the absence or presence of BPAA. In the absence of BPAA, quinolones such as norfloxacin (NFLX) and enoxacin attenuated muscimol-stimulated 36Cl- uptake at 10 microM and above. In combination with 10 microM BPAA, the inhibitory effect of these drugs was potentiated and there was a parallel shift of the inhibition curves to the left for these drugs. BPAA alone (1 and 10 microM) did not affect basal or muscimol-stimulated 36Cl- uptake. Hybrid molecules of NFLX and BPAA were synthesized and their inhibitory potency was also investigated. Inhibition curves of muscimol-stimulated 36Cl- uptake revealed that a hybrid with a -CONH(CH2)3- chain between NFLX and BPAA (flexible structure) (1 nM-20 microM) inhibited muscimol-stimulated 36Cl- uptake more potently than did the combination of NFLX (10 nm-100 microM) and 10 microM BPAA. In contrast, another hybrid linked by -CONH-(stretched structure) exhibited a weak inhibitory effect at 10 microM. These results suggest that quinolones in combination with BPAA bind to GABAA receptors, thus inhibiting Cl- channel activity, and that the inhibitory potency of quinolones may be enhanced by an intermolecular interaction with BPAA.

Attenuated inhibition by levofloxacin, l-isomer of ofloxacin, on GABA response in the dissociated rat hippocampal neurons

The effects of ofloxacin (OFLX) and its isomers, levofloxacin (LVFX) and DR-3354, on the gamma-aminobutyric acid (GABA)-induced Cl- current in acutely dissociated rat hippocampal CA1 neurons were investigated using nystatin perforated patch recording configuration under voltage-clamp conditions. At 10(-5) M these 3 compounds themselves did not affect the GABA response. Biphenylacetic acid (BPA) at 10(-5) M also had no effect on the GABA response, but BPA greatly suppressed the GABA response in combination with these 3 compounds without affecting the reversal potential of GABA response. The inhibitory effects of OFLX and DR-3354 on the GABA response were stronger than that of LVFX. LVFX inhibited the response in a competitive and voltage-independent manner. The results suggest that LVFX has lower CNS adverse effects, such as convulsions, compared to OFLX.

Pharmacokinetics and tissue residues of norfloxacin and its N-desethyl- and oxo-metabolites in healthy pigs

The pharmacokinetic properties of norfloxacin were determined in healthy pigs after single intramuscular (i.m.) and intravenous (i.v.) dosage of 8 mg/kg body weight. After i.m. and i.v. administration, the plasma concentration-time graph was characteristic of a two-compartment open model. After single i.m. administration, norfloxacin was absorbed rapidly, with a tmax of 1.46 +/- 0.06 h. The elimination half-life (t1/2 beta) and the mean residence time of norfloxacin in plasma were 4.99 +/- 0.28 and 6.05 +/- 0.22 h, respectively, after i.m. administration and 3.65 +/- 0.16 and 3.34 +/- 0.16 h, respectively, after i.v. administration. Intramuscular bioavailability was found to be 53.7 +/- 4.4%. Plasma concentrations greater than 0.2 microgram/mL were achieved at 20 min and persisted up to 8 h post-administration. Maximal plasma concentration was 1.11 +/- 0.03 micrograms/mL. Statistically significant differences between the two routes of administration were found for the half-lives of both distribution and elimination phases (t1/2 alpha, t1/2 beta) and apparent volume of distribution (Vd(area)). In pigs, norfloxacin was mainly converted to desethylenenorfloxacin and oxonorfloxacin. Considerable tissue concentrations of norfloxacin, desethylenenorfloxacin, and oxonorfloxacin were found when norfloxacin was administered intramuscularly (8 mg/kg on 4 consecutive days). The concentration of the parent fluoroquinolone in liver and kidney ranged between 0.015 and 0.017 microgram/g on day 12 after the end of dosing.

Effects of norfloxacin on the retina in rabbits

BACKGROUND

Fluoroquinolones have a strong affinity with melanin, and their ocular effects have been reevaluated. Norfloxacin, one of the fluoroquinolones, has broad-spectrum activity against aerobic gram-positive and gram-negative bacteria. We examined the retinal toxicity and intraocular pharmacokinetics of intravitreal norfloxacin in rabbits.

METHODS

Twenty-three albino and 23 pigmented rabbits were divided into three groups to evaluate retinal toxicity and two groups to investigate the intraocular pharmacokinetics. Each of these five groups was further divided into two subgroups (albino rabbits and pigmented rabbits).

RESULTS

With 500 micrograms norfloxacin, the oscillatory potential of the electroretinogram was transiently and selectively deteriorated in albino and pigmented rabbits, whereas the electroretinogram remained unchanged with 50 micrograms in pigmented rabbits. No changes were observed in the visual evoked potential or on histology of the retina 7 days after an intravitreal injection of 50 or 500 micrograms norfloxacin. The electroretinogram and the retinal histology became abnormal 7 days after four intravitreal injections of 500 micrograms norfloxacin at 7-day intervals. As regards the intraocular pharmacokinetics after an intravitreal injection, the norfloxacin concentration in the chorioretina was as high as that in the vitreous 3 h after injection and was much higher than that in the vitreous 7 days after injection. Similar results were obtained after multiple injections.

CONCLUSIONS

These results indicate a high concentration of norfloxacin in the melanin-containing ocular tissues.

Prediction of brain delivery of ofloxacin, a new quinolone, in the human from animal data

We attempted to predict the delivery of ofloxacin (OFLX), a new quinolone antibacterial agent (NQ), into cerebrospinal fluid (CSF) in the human based on the physiological properties and pharmacokinetic parameters of NQs in various animals. Physiological properties for evaluation of drug delivery into CSF such as volume and the bulk flow rate of CSF and weight of choroid plexus, were compared among the rat, rabbit, cat, dog, and human. Statistically significant correlations with power values of 0.82-0.89 in the linear regression were observed on log-log plots between brain weight and those properties of each species. Delivery of OFLX into CSF from blood was analyzed by "diffusion and flow model" with unidirectional efflux process from CSF to blood. The blood-CSF diffusion clearance and the efflux clearance of OFLX in the human were extrapolated from animal data based on the allometric correlations between brain weight and these parameters in the rat, rabbit, and dog. The apparent volume of distribution and the total body clearance of NQs in the human could also be predicted from animal data based on the classical Adolph-Dedrick approach. To simulate the CSF concentration-time profile of OFLX in the human by using these predicted parameters, it was necessary to consider both the lumbar CSF compartment and the ventricular CSF compartment. Both plasma and CSF concentration-time profiles of OFLX predicted from only animal experimental data were in good agreement with those observed clinically.

Comparative activities of eight quinolones against members of the Bacteroides fragilis group

The in vitro activities of five new quinolones (clinafloxacin [CI-960 or PD-127391], BAY Y 3118, E-4868, E-5065, and E-5068) against 100 Bacteroides fragilis group bacterial isolates were compared with those of ciprofloxacin, ofloxacin, and sparfloxacin. Overall, E-5068 was the most active in vitro (MIC for 90% of isolates tested [MIC90], 0.25 microgram/ml); this was followed by clinafloxacin and BAY Y 3118 (MIC90, 0.5 microgram/ml). Ciprofloxacin, sparfloxacin, and ofloxacin were the least active (MIC90s, 64, 16, and 16 micrograms/ml, respectively). B. fragilis and Bacteroides caccae were more susceptible than the other members of the B. fragilis group to all of the quinolones tested.

DNA topoisomerases from Streptomyces noursei: influence of coumarins and quinolones on the enzymic activity

DNA topoisomerases have been purified from Streptomyces noursei. DNA gyrase and topoisomerase I show a differential sensitivity against quinolones and coumarins compared to the E. coli enzymes. Streptomyces gyrase is resistant to much higher levels of various drugs than is the E. coli enzyme. The observed differences between the gyrases from streptomycetes and E. coli are discussed in the light of present literature data.

In vitro antibacterial activity of AM-1155, a novel 6-fluoro-8-methoxy quinolone

The in vitro antibacterial activity of AM-1155 against a wide variety of clinical isolates was compared with those of other fluoroquinolones. The MICs of AM-1155 for 90% of Staphylococcus aureus, Streptococcus pneumoniae, and Enterococcus faecalis isolates tested were 0.10, 0.39, and 0.78 microgram/ml, respectively. The antibacterial activity of AM-1155 against gram-positive bacteria and anaerobes was comparable to those of sparfloxacin and tosufloxacin. AM-1155 inhibited 90% of most species of the family Enterobacteriaceae at a concentration of 0.39 microgram/ml. AM-1155 generally had activity comparable to that of sparfloxacin against gram-negative bacteria. AM-1155 showed moderate activity against methicillin- and quinolone-resistant S. aureus. AM-1155 demonstrated bactericidal activity at the MIC. The frequency of occurrence of spontaneous mutants resistant to four times the MIC of AM-1155 was < 1 x 10(9) for S. aureus, Escherichia coli, and Pseudomonas aeruginosa. AM-1155 strongly inhibited the supercoiling activities of DNA gyrases purified from E. coli and S. aureus.