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Nazli A, Tao W, You H, He X, He Y. Treatment of MRSA Infection: Where are We? Curr Med Chem 2024; 31:4425-4460. [PMID: 38310393 DOI: 10.2174/0109298673249381231130111352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/10/2023] [Accepted: 10/10/2023] [Indexed: 02/05/2024]
Abstract
Staphylococcus aureus is a leading cause of septicemia, endocarditis, pneumonia, skin and soft tissue infections, bone and joint infections, and hospital-acquired infections. In particular, methicillin-resistant Staphylococcus aureus (MRSA) is associated with high morbidity and mortality, and continues to be a major public health problem. The emergence of multidrug-resistant MRSA strains along with the wide consumption of antibiotics has made anti-MRSA treatment a huge challenge. Novel treatment strategies (e.g., novel antimicrobials and new administrations) against MRSA are urgently needed. In the past decade, pharmaceutical companies have invested more in the research and development (R&D) of new antimicrobials and strategies, spurred by favorable policies. All research articles were collected from authentic online databases, including Google Scholar, PubMed, Scopus, and Web of Science, by using different combinations of keywords, including 'anti-MRSA', 'antibiotic', 'antimicrobial', 'clinical trial', 'clinical phase', clinical studies', and 'pipeline'. The information extracted from articles was compared to information provided on the drug manufacturer's website and Clinical Trials.gov (https://clinicaltrials.gov/) to confirm the latest development phase of anti-MRSA agents. The present review focuses on the current development status of new anti-MRSA strategies concerning chemistry, pharmacological target(s), indications, route of administration, efficacy and safety, pharmacokinetics, and pharmacodynamics, and aims to discuss the challenges and opportunities in developing drugs for anti-MRSA infections.
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Affiliation(s)
- Adila Nazli
- Chongqing Key Laboratory of Natural Product Synthesis and Drug Research, School of Pharmaceutical Sciences, Chongqing University, Chongqing, 401331, China
| | - Wenlan Tao
- Chongqing School, University of Chinese Academy of Sciences (UCAS Chongqing), Chongqing, 400714, China
| | - Hengyao You
- Chongqing Key Laboratory of Natural Product Synthesis and Drug Research, School of Pharmaceutical Sciences, Chongqing University, Chongqing, 401331, China
| | - Xiaoli He
- Chongqing School, University of Chinese Academy of Sciences (UCAS Chongqing), Chongqing, 400714, China
| | - Yun He
- Chongqing Key Laboratory of Natural Product Synthesis and Drug Research, School of Pharmaceutical Sciences, Chongqing University, Chongqing, 401331, China
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Herbert R, Caddick M, Somerville T, McLean K, Herwitker S, Neal T, Czanner G, Tuft S, Kaye SB. Potential new fluoroquinolone treatments for suspected bacterial keratitis. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001002. [PMID: 36161851 PMCID: PMC9297210 DOI: 10.1136/bmjophth-2022-001002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/05/2022] [Indexed: 11/12/2022] Open
Abstract
Topical fluoroquinolones (FQs) are an established treatment for suspected microbial keratitis. An increased FQ resistance in some classes of bacterial pathogens is a concern. Some recently developed FQs have an extended spectrum of activity, making them a suitable alternative for topical ophthalmic use. For example, the new generation FQs, avarofloxacin, delafloxacin, finafloxacin, lascufloxacin, nadifloxacin, levonadifloxacin, nemonoxacin and zabofloxacin have good activity against the common ophthalmic pathogens such as Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae and several of the Enterobacteriaceae. However, because there are no published ophthalmic break-point concentrations, the susceptibility of an isolated micro-organism to a topical FQ is extrapolated from systemic break-point data and wild type susceptibility. The purpose of this review is to compare the pharmacokinetics and pharmacodynamics of the FQs licensed for topical ophthalmic use with the same parameters for new generation FQs. We performed a literature review of the FQs approved for topical treatment and the new generation FQs licensed to treat systemic infections. We then compared the minimum inhibitory concentrations (MIC) of bacterial isolates and the published concentrations that FQs achieved in the cornea and aqueous. We also considered the potential suitability of new generation FQs for topical use based on their medicinal properties. Notably, we found significant variation in the reported corneal and aqueous FQ concentrations so that reliance on the reported mean concentration may not be appropriate, and the first quartile concentration may be more clinically relevant. The provision of the MIC for the microorganism together with the achieved lower (first) quartile concentration of a FQ in the cornea could inform management decisions such as whether to continue with the prescribed antimicrobial, increase the frequency of application, use a combination of antimicrobials or change treatment.
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Affiliation(s)
- Rose Herbert
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Mary Caddick
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Tobi Somerville
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Keri McLean
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | | | - Timothy Neal
- Department of Microbiology, Royal Liverpool University Hospital, Liverpool, UK
| | - Gabriela Czanner
- Applied Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Stephen Tuft
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Stephen B Kaye
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
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3
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Selective analysis of Nadifloxacin in human plasma samples using a molecularly imprinted polymer-based solid-phase extraction proceeded by UPLC-DAD analysis. Microchem J 2020. [DOI: 10.1016/j.microc.2020.105162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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4
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Patel A, Sangle GV, Trivedi J, Shengule SA, Thorve D, Patil M, Deshmukh NJ, Choudhari B, Karade A, Gupta S, Bhagwat S, Patel M. Levonadifloxacin, a Novel Benzoquinolizine Fluoroquinolone, Modulates Lipopolysaccharide-Induced Inflammatory Responses in Human Whole-Blood Assay and Murine Acute Lung Injury Model. Antimicrob Agents Chemother 2020; 64:e00084-20. [PMID: 32152077 PMCID: PMC7179645 DOI: 10.1128/aac.00084-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Fluoroquinolones are reported to possess immunomodulatory activity; hence, a novel benzoquinolizine fluoroquinolone, levonadifloxacin, was evaluated in lipopolysaccharide-stimulated human whole-blood (HWB) and mouse acute lung injury (ALI) models. Levonadifloxacin significantly mitigated the inflammatory responses in an HWB assay through inhibition of proinflammatory cytokines and in the ALI model by lowering lung total white blood cell count, myeloperoxidase, and cytokine levels. The immunomodulatory effect of levonadifloxacin, along with promising antibacterial activity, is expected to provide clinical benefits in the treatment of infections.
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Affiliation(s)
- Anasuya Patel
- New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Ganesh V Sangle
- Diabetes Research Lab, New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Jinal Trivedi
- New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Sushant A Shengule
- Diabetes Research Lab, New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Deepak Thorve
- New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Mohan Patil
- Diabetes Research Lab, New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Nitin J Deshmukh
- Diabetes Research Lab, New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Bhushan Choudhari
- New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Avinash Karade
- New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Sangita Gupta
- New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Sachin Bhagwat
- New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Mahesh Patel
- New Drug Discovery, Wockhardt Research Centre, Aurangabad, Maharashtra, India
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5
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Bassetti M, Del Puente F, Magnasco L, Giacobbe DR. Innovative therapies for acute bacterial skin and skin-structure infections (ABSSSI) caused by methicillin-resistant Staphylococcus aureus: advances in phase I and II trials. Expert Opin Investig Drugs 2020; 29:495-506. [PMID: 32242469 DOI: 10.1080/13543784.2020.1750595] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is among the most frequent causative agents of acute bacterial skin and skin-structure infections (ABSSSI) and has been associated with increased risks of invasive disease and of treatment failure. AREAS COVERED In this review, we focus on those novel anti-MRSA agents currently in phase I or II of clinical development that may enrich the armamentarium against ABSSSI caused by MRSA in the future. EXPERT OPINION Promising agents belonging to either old or novel antibiotic classes are currently in early phases of clinical development and may become available in the future for the effective treatment of ABSSSI caused by MRSA. In particular, the future availability of agents belonging to novel classes will be important for guaranteeing an effective treatment and for allowing outpatient treatment/early discharge, with a consequent reduced impact on healthcare resources. However, this does not mean that we can relax our efforts directed toward improving the responsible use of already available agents. Indeed, preserving their activity in the long term is crucial for optimizing the use of healthcare resources.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS , Genoa, Italy.,Department of Health Sciences, University of Genoa , Genoa, Italy
| | - Filippo Del Puente
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS , Genoa, Italy.,Department of Health Sciences, University of Genoa , Genoa, Italy
| | - Laura Magnasco
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS , Genoa, Italy.,Department of Health Sciences, University of Genoa , Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS , Genoa, Italy.,Department of Health Sciences, University of Genoa , Genoa, Italy
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Appalaraju B, Baveja S, Baliga S, Shenoy S, Bhardwaj R, Kongre V, Dattatraya GS, Dhole T, Verma B, Mukherjee DN, Gupta S, Shanmugam P, Iravane J, Mishra SR, Barman P, Chopra S, Hariharan M, Surpam R, Pratap R, Joshi P, Khande H, Mane A, Jain R, Bhagwat S. In vitro activity of a novel antibacterial agent, levonadifloxacin, against clinical isolates collected in a prospective, multicentre surveillance study in India during 2016-18. J Antimicrob Chemother 2020; 75:600-608. [PMID: 31840170 DOI: 10.1093/jac/dkz493] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/10/2019] [Accepted: 10/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Levonadifloxacin is a novel antibiotic belonging to the benzoquinolizine subclass of fluoroquinolones with potent activity against MRSA and quinolone-resistant Staphylococcus aureus. IV levonadifloxacin and its oral prodrug alalevonadifloxacin have recently been approved in India for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) including diabetic foot infections. OBJECTIVES To investigate the in vitro activity of levonadifloxacin against contemporary clinical isolates collected from multiple tertiary care hospitals across India in the Antimicrobial Susceptibility Profiling of Indian Resistotypes (ASPIRE) surveillance study. METHODS A total of 1376 clinical isolates, consisting of staphylococci (n = 677), streptococci (n = 178), Enterobacterales (n = 320), Pseudomonas aeruginosa (n = 140) and Acinetobacter baumannii (n = 61), collected (2016-18) from 16 tertiary hospitals located across 12 states in India, were included in the study. The MICs of levonadifloxacin and comparator antibiotics were determined using the reference agar dilution method and broth microdilution method. RESULTS Levonadifloxacin exhibited potent activity against MSSA (MIC50/90: 0.5/1 mg/L), MRSA (MIC50/90: 0.5/1 mg/L) and levofloxacin-resistant S. aureus (MIC50/90: 1/1 mg/L) isolates. Similarly, potent activity of levonadifloxacin was also observed against CoNS including MDR isolates (MIC50/90: 1/2 mg/L). Against Streptococcus pneumoniae, levonadifloxacin (MIC50/90: 0.5/0.5 mg/L) showed superior activity compared with levofloxacin (MIC50/90: 1/2 mg/L). Among levofloxacin-susceptible Enterobacterales, 80.6% of isolates were inhibited at ≤2 mg/L levonadifloxacin. CONCLUSIONS Levonadifloxacin displayed potent activity against contemporary MRSA and fluoroquinolone-resistant staphylococcal isolates, thus offering a valuable IV as well as an oral therapeutic option for the treatment of ABSSSIs. Furthermore, levonadifloxacin exhibited a broad-spectrum activity profile as evident from its activity against streptococci and levofloxacin-susceptible Gram-negative isolates.
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Affiliation(s)
- Boppe Appalaraju
- Department of Microbiology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
| | - Shrikala Baliga
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Suchitra Shenoy
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Renu Bhardwaj
- Department of Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon Hospitals, Pune, Maharashtra, India
| | - Vaishali Kongre
- Department of Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon Hospitals, Pune, Maharashtra, India
| | - Gogi Suresh Dattatraya
- Department of Microbiology, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala, India
| | - Tapan Dhole
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Binita Verma
- Department of Microbiology, Shree Jagannath Hospital & Research Centre, Ranchi Jharkhand, India
| | - D N Mukherjee
- Department of Microbiology, Woodlands Multispeciality Hospital Ltd, Kolkata, West Bengal, India
| | - Shalini Gupta
- Department of Microbiology, Somani Hospital, Jaipur, Rajasthan, India
| | - Priyadarshini Shanmugam
- Department of Microbiology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India
| | - Jyoti Iravane
- Department of Microbiology, Government Medical College, Aurangabad, Maharashtra, India
| | - Sudhi Ranjan Mishra
- Department of Microbiology, Aditya Care Hospital, Bhubaneswar, Odisha, India
| | - Purabi Barman
- Department of Microbiology, BLK Super Speciality Hospital, New Delhi, India
| | - Shimpi Chopra
- Department of Microbiology, BLK Super Speciality Hospital, New Delhi, India
| | | | - Rajendra Surpam
- Department of Microbiology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Rana Pratap
- Department of Microbiology, Narayan Medical College and Hospital, Jamuhar, Bihar, India
| | - Prashant Joshi
- Drug Discovery Research, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Hemant Khande
- Drug Discovery Research, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Ashish Mane
- Medical Affairs, Wockhardt Ltd, Mumbai, Maharashtra, India
| | - Rishi Jain
- Medical Affairs, Wockhardt Ltd, Mumbai, Maharashtra, India
| | - Sachin Bhagwat
- Drug Discovery Research, Wockhardt Research Centre, Aurangabad, Maharashtra, India
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7
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Koulenti D, Xu E, Song A, Sum Mok IY, Karageorgopoulos DE, Armaganidis A, Tsiodras S, Lipman J. Emerging Treatment Options for Infections by Multidrug-Resistant Gram-Positive Microorganisms. Microorganisms 2020; 8:E191. [PMID: 32019171 PMCID: PMC7074912 DOI: 10.3390/microorganisms8020191] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 12/22/2022] Open
Abstract
Antimicrobial agents are currently the mainstay of treatment for bacterial infections worldwide. However, due to the increased use of antimicrobials in both human and animal medicine, pathogens have now evolved to possess high levels of multi-drug resistance, leading to the persistence and spread of difficult-to-treat infections. Several current antibacterial agents active against Gram-positive bacteria will be rendered useless in the face of increasing resistance rates. There are several emerging antibiotics under development, some of which have been shown to be more effective with an improved safety profile than current treatment regimens against Gram-positive bacteria. We will extensively discuss these antibiotics under clinical development (phase I-III clinical trials) to combat Gram-positive bacteria, such as Staphylococcus aureus, Enterococcus faecium and Streptococcus pneumoniae. We will delve into the mechanism of actions, microbiological spectrum, and, where available, the pharmacokinetics, safety profile, and efficacy of these drugs, aiming to provide a comprehensive review to the involved stakeholders.
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Affiliation(s)
- Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (E.X.); (A.S.); (I.Y.S.M.); (J.L.)
- 2nd Critical Care Department, Attikon University Hospital, 12462 Athens, Greece;
| | - Elena Xu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (E.X.); (A.S.); (I.Y.S.M.); (J.L.)
| | - Andrew Song
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (E.X.); (A.S.); (I.Y.S.M.); (J.L.)
| | - Isaac Yin Sum Mok
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (E.X.); (A.S.); (I.Y.S.M.); (J.L.)
| | - Drosos E. Karageorgopoulos
- 4th Department of Internal Medicine, Attikon University Hospital, 12462 Athens, Greece; (D.E.K.); (S.T.)
| | | | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, 12462 Athens, Greece; (D.E.K.); (S.T.)
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (E.X.); (A.S.); (I.Y.S.M.); (J.L.)
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
- Anesthesiology and Critical Care, Centre Hospitalier Universitaire De Nîmes (CHU), University of Montpellier, 30029 Nîmes, France
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Bhagwat SS, Nandanwar M, Kansagara A, Patel A, Takalkar S, Chavan R, Periasamy H, Yeole R, Deshpande PK, Bhavsar S, Bhatia A, Ahdal J, Jain R, Patel M. Levonadifloxacin, a Novel Broad-Spectrum Anti-MRSA Benzoquinolizine Quinolone Agent: Review of Current Evidence. Drug Des Devel Ther 2019; 13:4351-4365. [PMID: 31920285 PMCID: PMC6935279 DOI: 10.2147/dddt.s229882] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/17/2019] [Indexed: 12/29/2022] Open
Abstract
Levonadifloxacin and its prodrug alalevonadifloxacin are novel broad-spectrum anti-MRSA agents belonging to the benzoquinolizine subclass of quinolone, formulated for intravenous and oral administration, respectively. Various in vitro and in vivo studies have established their antimicrobial spectrum against clinically significant Gram-positive, Gram-negative, atypical, and anaerobic pathogens. The potent activity of levonadifloxacin against MRSA, quinolone-resistant Staphylococcus aureus, and hetero-vancomycin-intermediate strains is an outcome of its well-differentiated mechanism of action involving preferential targeting to DNA gyrase. Potent anti-staphylococcal activity of levonadifloxacin was also observed in clinically relevant experimental conditions such as acidic pH, the intracellular environment, and biofilms, suggesting that the drug is bestowed with enabling features for the treatment of difficult-to-treat MRSA infections. Levonadifloxacin also retains clinically relevant activity against resistant respiratory pathogens such as macrolide- and penicillin-resistant Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, and Moraxella catarrhalis and, in conjunction with clinically established best-in-class human epithelial lung fluid concentration, has promising potential in the management of recalcitrant respiratory infections. Attractive features, such as resistance to NorA efflux, divergent mechanism of action in S. aureus, cidality against high-inoculum cultures, and low mutant prevention concentration, are likely to confer favorable resistance-suppression features to both agents. In vivo studies have shown promising efficacy in models of acute bacterial skin and skin structure infection, respiratory infections, pyelonephritis, and peritonitis at human-equivalent mouse doses. Both formulations were well tolerated in multiple phase I studies and overall showed a dose-dependent exposure. In particular, oral alalevonadifloxacin showed excellent bioavailability (~90%), almost mirroring the pharmacokinetic profile of intravenous levonadifloxacin, indicating the prodrug's seamless absorption and efficient cleavage to release the active parent drug. Hepatic impairment studies showed that clinical doses of levonadifloxacin/alalevonadifloxacin are not required to be adjusted for various degrees of hepatic impairment. With the successful completion of phase II and phase III studies for both levonadifloxacin and alalevonadifloxacin, they represent clinically attractive therapeutic options for the treatment of infections caused by multi-drug-resistant Gram-positive organisms. Herein, we review the current evidence on therapeutically appealing attributes of levonadifloxacin and alalevonadifloxacin, which are based on a range of non-clinical in vitro and in vivo investigations and clinical studies.
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Affiliation(s)
- Sachin S Bhagwat
- Department of Microbiology, Wockhardt Research Centre, Aurangabad, India
| | - Manohar Nandanwar
- Department of Toxicology, Wockhardt Research Centre, Aurangabad, India
| | - Atul Kansagara
- Department of Toxicology, Wockhardt Research Centre, Aurangabad, India
| | - Anusuya Patel
- Department of Safety Pharmacology, Wockhardt Research Centre, Aurangabad, India
| | - Swapna Takalkar
- Department of Microbiology, Wockhardt Research Centre, Aurangabad, India
| | - Rajesh Chavan
- Department of Drug Metabolism and Pharmacokinetics, Wockhardt Research Centre, Aurangabad, India
| | | | - Ravindra Yeole
- Department of Analytical Chemistry, Wockhardt Research Centre, Aurangabad, India
| | - Prasad K Deshpande
- Department of Medicinal Chemistry, Wockhardt Research Centre, Aurangabad, India
| | - Satish Bhavsar
- Department of Medicinal Chemistry, Wockhardt Research Centre, Aurangabad, India
| | - Ashima Bhatia
- Global Clinical Operations, Wockhardt Ltd, Mumbai, India
| | - Jaishid Ahdal
- Department of Medical Affairs, Wockhardt Ltd, Mumbai, India
| | - Rishi Jain
- Department of Medical Affairs, Wockhardt Ltd, Mumbai, India
| | - Mahesh Patel
- Drug Discovery Research, Wockhardt Research Centre, Aurangabad, India
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9
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Tellis M, Joseph J, Khande H, Bhagwat S, Patel M. In vitro bactericidal activity of levonadifloxacin (WCK 771) against methicillin- and quinolone-resistant Staphylococcus aureus biofilms. J Med Microbiol 2019; 68:1129-1136. [DOI: 10.1099/jmm.0.000999] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Melroy Tellis
- Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Jiji Joseph
- Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Hemant Khande
- Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Sachin Bhagwat
- Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Mahesh Patel
- Wockhardt Research Centre, Aurangabad, Maharashtra, India
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10
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In Vitro Activities of the Benzoquinolizine Fluoroquinolone Levonadifloxacin (WCK 771) and Other Antimicrobial Agents against Mycoplasmas and Ureaplasmas in Humans, Including Isolates with Defined Resistance Mechanisms. Antimicrob Agents Chemother 2018; 62:AAC.01348-18. [PMID: 30104279 DOI: 10.1128/aac.01348-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/08/2018] [Indexed: 12/28/2022] Open
Abstract
Levonadifloxacin (WCK 771) was evaluated against 68 type strains and clinical isolates of Mycoplasma genitalium, Mycoplasma hominis, Mycoplasma pneumoniae, and Ureaplasma spp. in comparison with moxifloxacin, levofloxacin, tetracycline, and azithromycin or clindamycin. Levonadifloxacin MICs were ≤0.5 μg/ml for M. genitalium MIC90s were 1 μg/ml for M. hominis, 0.125 μg/ml for M. pneumoniae, and 2 μg/ml for Ureaplasma spp. Levonadifloxacin merits further study for treating infections caused by these organisms.
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11
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Gao F, Wang P, Yang H, Miao Q, Ma L, Lu G. Recent developments of quinolone-based derivatives and their activities against Escherichia coli. Eur J Med Chem 2018; 157:1223-1248. [DOI: 10.1016/j.ejmech.2018.08.095] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 12/14/2022]
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12
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Gao C, Fan YL, Zhao F, Ren QC, Wu X, Chang L, Gao F. Quinolone derivatives and their activities against methicillin-resistant Staphylococcus aureus (MRSA). Eur J Med Chem 2018; 157:1081-1095. [PMID: 30179746 DOI: 10.1016/j.ejmech.2018.08.061] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 01/10/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is the most common pathogen both in hospital and community settings, and is capable of causing serious and even fatal infections. Several antibiotics have been approved for the treatment of infections caused by MRSA, but MRSA has already developed resistance to them. More than ever, it's imperative to develop novel, high effective and fast acting anti-MRSA agents. Quinolones are one of the most common antibiotics in clinical practice used to treat various bacterial infections, and some of them displayed excellent in vitro and in vivo anti-MRSA activities, so quinolone derivatives are one of the most promising candidates. This review summarizes the recent developments of quinolone derivatives with potential activity against MRSA, and the structure-activity relationship is also discussed.
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Affiliation(s)
- Chuan Gao
- WuXi AppTec (Wuhan), Hubei, PR China
| | - Yi-Lei Fan
- Key Laboratory of Drug Prevention and Control Technology of Zhejiang Province, Zhejiang Police College, Hangzhou, PR China
| | - Feng Zhao
- WuXi AppTec (Wuhan), Hubei, PR China
| | | | - Xiang Wu
- WuXi AppTec (Wuhan), Hubei, PR China.
| | - Le Chang
- WuXi AppTec (Wuhan), Hubei, PR China.
| | - Feng Gao
- Life Sciences Division, TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia, Canada.
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Liapikou A, Cillóniz C, Torres A. Investigational drugs in phase I and phase II clinical trials for the treatment of community-acquired pneumonia. Expert Opin Investig Drugs 2017; 26:1239-1248. [PMID: 28952384 DOI: 10.1080/13543784.2017.1385761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Community acquired pneumonia is one of the main infections, remaining as a global cause of considerable morbidity and mortality. Successful treatment hinges on expedient delivery of appropriate antibiotic therapy tailored to both the likely pathogens and the severity of disease. Although antibiotic resistance is increasing and pharmaceutical companies continue to debate the profitability of introducing new antibacterial agents, an encouraging number of new molecules have recently been unveiled which target multidrug-resistant bacteria. Areas covered: Herein, the authors summarize the actual situation of novel antibiotics for CAP in phase I & II of development. For each set of compounds, the medical significance and possible clinical placement are discussed. Current treatment options from the most important international guidelines are also reviewed. Expert opinion: Our review shows that the new antibiotics in the pipeline belong to existing antibiotic classes as β-lactams, macrolides, quinolones, oxazolidinones, tetracyclines, lipoglycopeptides, and cyclic lipopeptides and a few with a narrow spectrum of activity are novel compounds directed against novel targets. With rising outpatient antibiotic resistance in pneumonia, some of the compounds discussed are being considered for more rapid advancement in the pipeline, helping to increase the number of agents in later stages of development.
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Affiliation(s)
- Adamantia Liapikou
- a 6th Respiratory Department , Sotiria Chest Diseases Hospital , Athens , Greece
| | - Catia Cillóniz
- b Department of Pneumology , Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) , Barcelona , Spain
| | - Antoni Torres
- b Department of Pneumology , Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) , Barcelona , Spain
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The antifungal caspofungin increases fluoroquinolone activity against Staphylococcus aureus biofilms by inhibiting N-acetylglucosamine transferase. Nat Commun 2016; 7:13286. [PMID: 27808087 PMCID: PMC5097165 DOI: 10.1038/ncomms13286] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/20/2016] [Indexed: 01/04/2023] Open
Abstract
Biofilms play a major role in Staphylococcus aureus pathogenicity but respond poorly to antibiotics. Here, we show that the antifungal caspofungin improves the activity of fluoroquinolones (moxifloxacin, delafloxacin) against S. aureus biofilms grown in vitro (96-well plates or catheters) and in vivo (murine model of implanted catheters). The degree of synergy among different clinical isolates is inversely proportional to the expression level of ica operon, the products of which synthesize poly-N-acetyl-glucosamine polymers, a major constituent of biofilm matrix. In vitro, caspofungin inhibits the activity of IcaA, which shares homology with β-1-3-glucan synthase (caspofungin's pharmacological target in fungi). This inhibition destructures the matrix, reduces the concentration and polymerization of exopolysaccharides in biofilms, and increases fluoroquinolone penetration inside biofilms. Our study identifies a bacterial target for caspofungin and indicates that IcaA inhibitors could potentially be useful in the treatment of biofilm-related infections. Biofilms formed by Staphylococcus aureus are poorly responsive to antibiotics. Here, Siala et al. show that an antifungal drug (caspofungin) enhances the activity of fluoroquinolone antibiotics against S. aureus biofilms by inhibiting an enzyme involved in synthesis of the biofilm matrix.
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Gaur R, Gupta VK, Singh P, Pal A, Darokar MP, Bhakuni RS. Drug Resistance Reversal Potential of Isoliquiritigenin and Liquiritigenin Isolated fromGlycyrrhiza glabraAgainst Methicillin-ResistantStaphylococcus aureus(MRSA). Phytother Res 2016; 30:1708-1715. [DOI: 10.1002/ptr.5677] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/13/2016] [Accepted: 06/15/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Rashmi Gaur
- Medicinal Plant Chemistry Division; Central Institute of Medicinal and Aromatic Plants (CSIR); Lucknow 226015 India
| | - Vivek Kumar Gupta
- Molecular Bioprospection Department; CSIR-Central Institute of Medicinal and Aromatic Plants; Lucknow 226015 India
| | - Pooja Singh
- Medicinal Plant Chemistry Division; Central Institute of Medicinal and Aromatic Plants (CSIR); Lucknow 226015 India
| | - Anirban Pal
- Molecular Bioprospection Department; CSIR-Central Institute of Medicinal and Aromatic Plants; Lucknow 226015 India
| | - Mahendra Padurang Darokar
- Molecular Bioprospection Department; CSIR-Central Institute of Medicinal and Aromatic Plants; Lucknow 226015 India
| | - Rajendra Singh Bhakuni
- Medicinal Plant Chemistry Division; Central Institute of Medicinal and Aromatic Plants (CSIR); Lucknow 226015 India
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Gupta VK, Tiwari N, Gupta P, Verma S, Pal A, Srivastava SK, Darokar MP. A clerodane diterpene from Polyalthia longifolia as a modifying agent of the resistance of methicillin resistant Staphylococcus aureus. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:654-661. [PMID: 27161406 DOI: 10.1016/j.phymed.2016.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/27/2016] [Accepted: 03/02/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Staphylococcus aureus infections are raising serious concern across the world. The effectiveness of conventional drugs is continuously decreasing due to global emergence of multidrug resistance (MDR) and therefore, new resistance-modifying agents (RMAs) are highly needed. HYPOTHESIS Clerodane diterpene 16α-hydroxycleroda-3,13(14)-Z-dien-15,16-olide (CD) from leaves of Polyalthia longifolia (Sonn.) Thwaites (Annonaceae) as RAM will be useful in improving the current treatment strategies for staphylococcal infections. STUDY DESIGN In the present study, we determine the resistance-modifying activity of CD using clinical isolates of MRSA. Further, the influence of CD on innate immune response was also evaluated in vitro and in vivo. The nature of potential interactions was determined by fractional inhibitory concentration indices (FICIs) calculated from microdilution assays and time-kill curves. RESULTS The result of in vitro combination study showed that CD significantly reduced MIC of fluoroquinolones up to 16-folds (FICI 0.315-0.500), while in S. aureus infected Swiss albino mice model, combination of CD with norfloxacin, significantly (p<0.01, p<0.001) lowered the systemic microbial burden in blood, liver, kidney, lung and spleen tissues in comparison to CD, norfloxacin alone as well as untreated control. Flow cytometry analysis clearly showed that CD significantly inhibited EtBr efflux and extended post-antibiotic effect. In qRT-PCR analysis, CD alone as well as in combination, significantly modulated the expression of various efflux pump genes including norA up to 2-fold in clinical isolate MRSA-ST2071. Further, the in vitro combination study of the CD (10, 5, 2.5µg/ml) along with the norfloxacin (10µg/ml) depicted a significant decline in the pro-inflammatory cytokines, IL6 and TNF-α. In septic shock mice model, CD did not exhibit any significant changes in the level of pro-inflammatory cytokines. CONCLUSION This is the first report on drug resistance-modifying potential of CD through inhibition of MDR efflux pump.
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Affiliation(s)
- Vivek Kumar Gupta
- Molecular Bioprospection Department, CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow-226015, India
| | - Nimisha Tiwari
- Molecular Bioprospection Department, CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow-226015, India
| | - Priyanka Gupta
- Molecular Bioprospection Department, CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow-226015, India
| | - Surjeet Verma
- Medicinal Chemistry Division, CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow-226015, India
| | - Anirban Pal
- Molecular Bioprospection Department, CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow-226015, India
| | - Santosh Kumar Srivastava
- Medicinal Chemistry Division, CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow-226015, India
| | - Mahendra Pandurang Darokar
- Molecular Bioprospection Department, CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow-226015, India.
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Vuong C, Yeh AJ, Cheung GYC, Otto M. Investigational drugs to treat methicillin-resistant Staphylococcus aureus. Expert Opin Investig Drugs 2015; 25:73-93. [PMID: 26536498 DOI: 10.1517/13543784.2016.1109077] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Staphylococcus aureus remains one of the leading causes of morbidity and mortality worldwide. This is to a large extent due to antibiotic-resistant strains, in particular methicillin-resistant S. aureus (MRSA). While the toll of invasive MRSA infections appears to decrease in U.S. hospitals, the rate of community-associated MRSA infections remains constant and there is a surge of MRSA in many other countries, a situation that calls for continuing if not increased efforts to find novel strategies to combat MRSA infections. AREAS COVERED This review provides an overview of current investigational drugs and therapeutic antibodies against S. aureus in early clinical development (up to phase II clinical development). It includes a short description of the mechanism of action and a presentation of microbiological and clinical data. EXPERT OPINION Increased recent antibiotic development efforts and results from pathogenesis research have led to several new antibiotics and therapies, such as anti-virulence drugs, as well as a more informed selection of targets for vaccination efforts against MRSA. This developing portfolio of novel anti-staphylococcal drugs will hopefully provide us with additional and more efficient ways to combat MRSA infections in the near future and prevent us from running out of treatment options, even if new resistances arise.
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Affiliation(s)
- Cuong Vuong
- a Principal Scientist/Laboratory Head, Bacteriology , AiCuris GmbH & Co. KG, Friedrich-Ebert-Str. 475/Geb. 302, 42117 Wuppertal , Germany
| | - Anthony J Yeh
- b Post-baccalaureate IRTA, Laboratory of Bacteriology , National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bldg. 33, 1W10, 9000 Rockville Pike, Bethesda , MD 20892 , USA
| | - Gordon Y C Cheung
- c Staff Scientist, National Institute of Allergy and Infectious Diseases , National Institutes of Health, Laboratory of Bacteriology , Bldg. 33, 1W10, 9000 Rockville Pike, Bethesda , MD 20892 , USA
| | - Michael Otto
- d Senior Investigator, National Institute of Allergy and Infectious Diseases , National Institutes of Health, Laboratory of Bacteriology , Bldg. 33, 1W10, 9000 Rockville Pike, Bethesda , MD 20892 , USA
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Gaur R, Gupta VK, Pal A, Darokar MP, Bhakuni RS, Kumar B. In vitro and in vivo synergistic interaction of substituted chalcone derivatives with norfloxacin against methicillin resistant Staphylococcus aureus. RSC Adv 2015. [DOI: 10.1039/c4ra10842f] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The present investigation shows that certain substituted chalcone derivatives diminish the escalation of bacterial cellsviainhibiting bacterial efflux pump and exhibit a synergistic interaction with norfloxacin.
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Affiliation(s)
- Rashmi Gaur
- Medicinal Chemistry Division
- CSIR-Central Institute of Medicinal and Aromatic Plants
- Lucknow-226015
- India
| | - Vivek Kumar Gupta
- Molecular Bioprospection Department
- CSIR-Central Institute of Medicinal and Aromatic Plants
- Lucknow-226015
- India
| | - Anirban Pal
- Molecular Bioprospection Department
- CSIR-Central Institute of Medicinal and Aromatic Plants
- Lucknow-226015
- India
| | - Mahendra Padurang Darokar
- Molecular Bioprospection Department
- CSIR-Central Institute of Medicinal and Aromatic Plants
- Lucknow-226015
- India
| | - Rajendra Singh Bhakuni
- Medicinal Chemistry Division
- CSIR-Central Institute of Medicinal and Aromatic Plants
- Lucknow-226015
- India
| | - Brijesh Kumar
- Sophisticated Analytical Instrumentation Facility
- CSIR-Central Drug Research Institute
- Lucknow 226001
- India
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Narayanan V, Motlekar S, Kadhe G, Bhagat S. Efficacy and safety of nadifloxacin for bacterial skin infections: results from clinical and post-marketing studies. Dermatol Ther (Heidelb) 2014; 4:233-48. [PMID: 25212256 PMCID: PMC4257952 DOI: 10.1007/s13555-014-0062-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Indexed: 01/31/2023] Open
Abstract
Introduction Skin and soft tissue infections involve microbial invasion of the skin and underlying soft tissues and are estimated to affect 7–10% of hospitalized patients worldwide. Nadifloxacin, a topical fluoroquinolone, has been shown to be effective against aerobic Gram-negative, Gram-positive (including MRSA and coagulase-negative staphylococci), and anaerobic bacteria. However, there is paucity of data comparing efficacy and safety of 1% nadifloxacin with other anti-bacterials for skin infections in Indian patients. Methods This article presents the results of one post-marketing surveillance (PMS) and three randomized, open, non-blinded, multi-centric clinical studies that compared nadifloxacin with mupirocin and framycetin, and nadifloxacin with fusidic acid. Patients in India, aged from 1 to 65 years old, suffering from mild to moderate bacterial skin infections including impetigo, secondarily infected wounds, folliculitis, infected atopic dermatitis, and furunculosis were randomly allocated to three treatment groups within the studies. Efficacy was assessed by the evaluation of symptoms of erythema, exudation, swelling, pruritus, crusting, pain and tenderness in all the studies. Results A total of 272 subjects were enrolled in the study and subjects were randomly assigned to one of the three treatment groups; 92 in the nadifloxacin group, 90 in the mupirocin group, and 90 in the framycetin group. A significant reduction in the mean scores for bacterial infection symptoms in the nadifloxacin groups was observed when compared to mupirocin, framycetin and fusidic acid groups. Both physician and patients rated nadifloxacin as excellent (complete remission of symptoms) on a 4-point scale in the studies. No adverse events (AEs) were reported in the clinical studies. In the PMS, only two patients (of 329, 0.6%) reported AEs including burning and itching, one in each patient that had resolved at the time of reporting. Conclusion Nadifloxacin, a fluoroquinolone, is a new alternative topical agent in the treatment of bacterial skin infection with minimal AEs. Electronic supplementary material The online version of this article (doi:10.1007/s13555-014-0062-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Varsha Narayanan
- Wockhardt Ltd., Wockhardt Towers, Bandra Kurla Complex, Mumbai, 400051 India
| | - Salman Motlekar
- Wockhardt Ltd., Wockhardt Towers, Bandra Kurla Complex, Mumbai, 400051 India
| | - Ganesh Kadhe
- Wockhardt Ltd., Wockhardt Towers, Bandra Kurla Complex, Mumbai, 400051 India
| | - Seema Bhagat
- Wockhardt Ltd., Wockhardt Towers, Bandra Kurla Complex, Mumbai, 400051 India
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20
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Nenoff P. Acne vulgaris and bacterial skin infections: review of the topical quinolone nadifloxacin. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.1.5.643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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In vivo efficacy and synergistic interaction of 16α-hydroxycleroda-3, 13 (14) Z-dien-15, 16-olide, a clerodane diterpene from Polyalthia longifolia against methicillin-resistant Staphylococcus aureus. Appl Microbiol Biotechnol 2013; 97:9121-31. [DOI: 10.1007/s00253-013-5154-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/08/2013] [Accepted: 07/27/2013] [Indexed: 12/11/2022]
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Kumar K, Chopra S. New drugs for methicillin-resistant Staphylococcus aureus: an update. J Antimicrob Chemother 2013; 68:1465-70. [DOI: 10.1093/jac/dkt045] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Appelbaum PC. 2012 and beyond: potential for the start of a second pre-antibiotic era? J Antimicrob Chemother 2012; 67:2062-8. [DOI: 10.1093/jac/dks213] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schairer D, Martinez LR, Blecher K, Chouake J, Nacharaju P, Gialanella P, Friedman JM, Nosanchuk JD, Friedman A. Nitric oxide nanoparticles: pre-clinical utility as a therapeutic for intramuscular abscesses. Virulence 2012; 3:62-7. [PMID: 22286699 DOI: 10.4161/viru.3.1.18816] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Nitric oxide (NO) is a critical component of host defense against invading pathogens; however, its therapeutic utility is limited due to a lack of practical delivery systems. Recently, a NO-releasing nanoparticulate platform (NO-np) was shown to have in vitro broad-spectrum antimicrobial activity and in vivo pre-clinical efficacy in a dermal abscess model. To extend these findings, both topical (TP) and intralesional (IL) NO-np administration was evaluated in a MRSA intramuscular murine abscess model and compared with vancomycin. All treatment arms accelerated abscess clearance clinically, histologically, and by microbiological assays on both days 4 and 7 following infection. However, abscesses treated with NO-np via either route demonstrated a more substantial, statistically significant decrease in bacterial survival based on colony forming unit assays and histologically revealed less inflammatory cell infiltration and preserved muscular architecture. These data suggest that the NO-np may be an effective addition to our armament for deep soft tissue infections.
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Affiliation(s)
- David Schairer
- Division of Dermatology, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Fernandez J, Hilliard JJ, Morrow BJ, Melton JL, Flamm RK, Barron AM, Lynch AS. Efficacy of a new fluoroquinolone, JNJ-Q2, in murine models of Staphylococcus aureus and Streptococcus pneumoniae skin, respiratory, and systemic infections. Antimicrob Agents Chemother 2011; 55:5522-8. [PMID: 21911568 PMCID: PMC3232747 DOI: 10.1128/aac.00471-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 09/02/2011] [Indexed: 11/20/2022] Open
Abstract
The in vivo efficacy of JNJ-Q2, a new broad-spectrum fluoroquinolone (FQ), was evaluated in a murine septicemia model with methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) and in a Streptococcus pneumoniae lower respiratory tract infection model. JNJ-Q2 and comparators were also evaluated in an acute murine skin infection model using a community-acquired MRSA strain and in an established skin infection (ESI) model using a hospital-acquired strain, for which the selection of resistant mutants was also determined. JNJ-Q2 demonstrated activity in the MSSA septicemia model that was comparable to that moxifloxacin (JNJ-Q2 50% effective dose [ED(50)], 0.2 mg/kg of body weight administered subcutaneously [s.c.] and 2 mg/kg administered orally [p.o.]) and activity in the MRSA septicemia model that was superior to that of vancomycin (JNJ-Q2 ED(50), 1.6 mg/kg administered s.c.). In an S. pneumoniae lower respiratory tract infection model, JNJ-Q2 displayed activity (ED(50), 1.9 mg/kg administered s.c. and 7.4 mg/kg administered p.o.) that was comparable to that of gemifloxacin and superior to that of moxifloxacin. In both MRSA skin infection models, treatment with JNJ-Q2 resulted in dose-dependent reductions in bacterial titers in the skin, with the response to JNJ-Q2 at each dose exceeding the responses of the comparators ciprofloxacin, moxifloxacin, linezolid, and vancomycin. Additionally, in the ESI model, JNJ-Q2 showed a low or nondetectable propensity for ciprofloxacin resistance selection, in contrast to the selection of ciprofloxacin-resistant mutants observed for both ciprofloxacin and moxifloxacin. JNJ-Q2 demonstrated activity that was comparable or superior to the activity of fluoroquinolone or antistaphylococcal comparators in several local and systemic skin infection models performed with both S. aureus and S. pneumoniae and is currently being evaluated in phase II human clinical trials.
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Affiliation(s)
- Jeffrey Fernandez
- Johnson & Johnson Pharmaceutical Research and Development, LLC, 1000 Route 202 South, Raritan, NJ 08869, USA.
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Abstract
Moxifloxacin is a recent addition to the fluoroquinolone class, differing from ciprofloxacin and other older agents in having much better in vitro activity against Gram-positive aerobes while retaining potent activity against Gram-negative aerobes. It is also active against the pathogens of human and animal bite wounds and those species of atypical mycobacteria associated with dermatologic infections. Its activity against anaerobes is quite variable. Moxifloxacin penetrates well into inflammatory blister fluid and muscle and subcutaneous adipose tissues. Moxifloxacin should thus be a reasonable option for the treatment of skin and skin structure infections (SSSIs). In 3 randomized controlled trials (RCTs), oral moxifloxacin was as effective as cephalexin in the treatment of uncomplicated SSSIs in adults while in 2 RCTs, intravenous/oral moxifloxacin was as effective as intravenous/oral β-lactam/β-lactamase inhibitor therapy in the treatment of complicated SSSIs in adults. Moxifloxacin does not inhibit cytochrome P450 enzymes and thus interact with warfarin or methylxanthines. However, multivalent cations can reduce its oral bioavailability substantially. Dosage adjustment is not required in the presence of renal or hepatic impairment. The clinical relevance of its electrophysiologic effects (QTc prolongation) remains unresolved.
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Affiliation(s)
- David Rp Guay
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota Minneapolis, MN, USA
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Uramatsu M, Matsumoto T, Tateda K, Shibuya K, Miyazaki S, Horino T, Tanabe M, Sumiyama Y, Kusachi S, Yamaguchi K. Involvement of endotoxin in the mortality of mice with gut-derived sepsis due to methicillin-resistant Staphylococcus aureus. Microbiol Immunol 2010; 54:330-7. [PMID: 20536731 DOI: 10.1111/j.1348-0421.2010.00217.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
MRSA causes a wide diversity of diseases, ranging from benign skin infections to life-threatening diseases, such as sepsis. However, there have been few reports of the pathophysiology and mechanisms of sepsis resulting from the gut-derived origin of MRSA. Therefore, we established a murine model of gut-derived sepsis with MRSA and factors of MRSA sepsis that cause deterioration. We separated mice into four groups according to antibiotic treatment as follows: (i) ABPC 40 mg/kg; (ii) CAZ 80 mg/kg; (iii) CAZ 80 mg/kg + endotoxin 10 microg/mouse; and (iv) saline-treated control groups. Gut-derived sepsis was induced by i.p. injection of cyclophosphamide after colonization of MRSA strain 334 in the intestine. After the induction of sepsis, significantly more CAZ-treated mice survived compared with ABPC-treated and control groups. MRSA were detected in the blood and liver among all groups. Endotoxin levels were significantly lower in the CAZ-treated group compared to other groups. Inflammatory cytokine levels in the serum were lower in the CAZ-treated group compared to other groups. Fecal culture showed a lower level of colonization of E. coli in the CAZ-treated group compared to other groups. In conclusion, we found that CAZ-treatment ameliorates infection and suppresses endotoxin level by the elimination of E. coli from the intestinal tract of mice. However, giving endotoxin in the CAZ-treated group increased mortality to almost the same level as in the ABPC-treated group. These results suggest endotoxin released from resident E. coli in the intestine is involved in clinical deterioration resulting from gut-derived MRSA sepsis.
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Affiliation(s)
- Masashi Uramatsu
- The Third Department of Surgery, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
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In vivo activity of ceftobiprole in murine skin infections due to Staphylococcus aureus and Pseudomonas aeruginosa. Antimicrob Agents Chemother 2009; 54:116-25. [PMID: 19884364 DOI: 10.1128/aac.00642-09] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Ceftobiprole, a broad-spectrum cephalosporin with activity against methicillin-resistant Staphylococcus aureus (MRSA) (P. Hebeisen et al., Antimicrob. Agents Chemother. 45:825-836, 2001), was evaluated in a subcutaneous skin infection model with Staphylococcus aureus Smith OC 4172 (methicillin-susceptible S. aureus [MSSA]), S. aureus OC 8525 (MRSA), Pseudomonas aeruginosa OC 4351 (having an inducible AmpC beta-lactamase), and P. aeruginosa OC 4354 (overproducing AmpC beta-lactamase). In the MSSA and MRSA infection models, ceftobiprole, administered as the prodrug ceftobiprole medocaril, was more effective in reducing CFU/g skin (P < 0.001) than were cefazolin, vancomycin, or linezolid based on the dose-response profiles. Skin lesion volumes in MSSA-infected animals treated with ceftobiprole were 19 to 29% lower than those for cefazolin-, vancomycin-, or linezolid-treated animals (P < 0.001). In MRSA infections, lesion size in ceftobiprole-treated mice was 34% less than that with cefazolin or linezolid treatment (P < 0.001). Against P. aeruginosa, ceftobiprole at similar doses was as effective as meropenem-cilastatin in reductions of CFU/g skin, despite 8- and 32-fold-lower MICs for meropenem; both treatments were more effective than was cefepime (P < 0.001) against the inducible and overproducing AmpC beta-lactamase strains of P. aeruginosa. Ceftobiprole was similar to meropenem-cilastatin and 47 to 54% more effective than cefepime (P < 0.01) in reducing the size of the lesion caused by either strain of P. aeruginosa in this study. These studies indicate that ceftobiprole is effective in reducing both bacterial load and lesion volume associated with infections due to MSSA, MRSA, and P. aeruginosa in this murine model of skin and soft tissue infection.
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In vitro activity of the quinolone WCK 771 against recent U.S. hospital and community-acquired Staphylococcus aureus pathogens with various resistance types. Antimicrob Agents Chemother 2008; 53:811-3. [PMID: 19029326 DOI: 10.1128/aac.01150-08] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
WCK 771 demonstrated MIC(50) and MIC(90)s of 0.03 and 1 microg/ml, respectively, against 297 recent U.S. community-acquired and hospital strains of Staphylococcus aureus, irrespective of quinolone or glycopeptide resistance. Against quinolone-resistant strains, MIC(90)s of WCK 771 and moxifloxacin were 1 and 16 microg/ml, respectively.
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30
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Robertson GT, Doyle TB, Du Q, Duncan L, Mdluli KE, Lynch AS. A Novel indole compound that inhibits Pseudomonas aeruginosa growth by targeting MreB is a substrate for MexAB-OprM. J Bacteriol 2007; 189:6870-81. [PMID: 17644596 PMCID: PMC2045200 DOI: 10.1128/jb.00805-07] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Drug efflux systems contribute to the intrinsic resistance of Pseudomonas aeruginosa to many antibiotics and biocides and hamper research focused on the discovery and development of new antimicrobial agents targeted against this important opportunistic pathogen. Using a P. aeruginosa PAO1 derivative bearing deletions of opmH, encoding an outer membrane channel for efflux substrates, and four efflux pumps belonging to the resistance nodulation/cell division class including mexAB-oprM, we identified a small-molecule indole-class compound (CBR-4830) that is inhibitory to growth of this efflux-compromised strain. Genetic studies established MexAB-OprM as the principal pump for CBR-4830 and revealed MreB, a prokaryotic actin homolog, as the proximal cellular target of CBR-4830. Additional studies establish MreB as an essential protein in P. aeruginosa, and efflux-compromised strains treated with CBR-4830 transition to coccoid shape, consistent with MreB inhibition or depletion. Resistance genetics further suggest that CBR-4830 interacts with the putative ATP-binding pocket in MreB and demonstrate significant cross-resistance with A22, a structurally unrelated compound that has been shown to promote rapid dispersion of MreB filaments in vivo. Interestingly, however, ATP-dependent polymerization of purified recombinant P. aeruginosa MreB is blocked in vitro in a dose-dependent manner by CBR-4830 but not by A22. Neither compound exhibits significant inhibitory activity against mutant forms of MreB protein that bear mutations identified in CBR-4830-resistant strains. Finally, employing the strains and reagents prepared and characterized during the course of these studies, we have begun to investigate the ability of analogues of CBR-4830 to inhibit the growth of both efflux-proficient and efflux-compromised P. aeruginosa through specific inhibition of MreB function.
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Affiliation(s)
- Gregory T Robertson
- Cumbre Pharmaceuticals, Inc., 1502 Viceroy Drive, Dallas, TX 75235-2304, USA
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31
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Yeole RD, Kulkarni VL, Latad SB, Chavan RP, Chugh Y, Patel MV, Khorakiwala HF. Simple liquid chromatography–tandem mass spectrometry method for determination of novel anti-methicillin-resistant Staphylococcus aureus fluoroquinolone WCK 771 in human serum. J Chromatogr B Analyt Technol Biomed Life Sci 2007; 846:306-12. [PMID: 17027349 DOI: 10.1016/j.jchromb.2006.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 08/23/2006] [Accepted: 09/10/2006] [Indexed: 11/18/2022]
Abstract
A simple, rapid, specific, precise, accurate and sensitive method for determination of WCK 771 in human serum has been developed. The method uses high performance liquid chromatography with tandem mass spectrometric detection. Sample preparation involves protein precipitation method by addition of acetonitrile. Gatifloxacin was used as internal standard. The response was found to be linear from 0.312 to 40 microg/ml of serum with correlation coefficient greater than 0.99. Limit of detection and lower limit of quantification for WCK 771 was found to be 0.078 microg/ml and 0.312 microg/ml, respectively. The intra-day precision and accuracy from analysis of quality control (QC) samples at four concentrations was in the range of 2.36-2.58% and from 96.71 to 103.2%, respectively. The inter-day precision and accuracy from analysis of quality control samples at four concentrations was in the range of 3.14-6.82% and from 96.84 to 105.76%, respectively. WCK 771 was found to be stable for 24 h at auto-injector environment. WCK 771 was also found to be stable for 2h in serum at 25+/-3 degrees C and for 3 months at -20 degrees C. Mean absolute recovery at four different concentrations was 86.92% with standard deviation of 1.79. Throughput of the method is approximately one sample every 4 min. The method was also reproduced with monkey serum. The method was employed for estimation of drug serum levels during pre-clinical and clinical trials.
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Affiliation(s)
- R D Yeole
- Wockhardt Limited, Wockhardt Research Center, D-4, MIDC, Chikalthana, Aurangabad 431210, India.
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Jacobs MR, Appelbaum PC. Nadifloxacin: a quinolone for topical treatment of skin infections and potential for systemic use of its active isomer, WCK 771. Expert Opin Pharmacother 2006; 7:1957-66. [PMID: 17020421 DOI: 10.1517/14656566.7.14.1957] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Nadifloxacin is a potent, broad-spectrum, quinolone agent approved for topical use in acne vulgaris and skin infections in Japan. As exposure of pathogenic and colonising bacteria to antibiotics results in drug resistance, it is not desirable to use an important, broad-spectrum antibiotic, which belongs to a class of agents widely used systemically to treat a wide variety of infections, as a topically applied preparation. On this basis, nadifloxacin is not a good option for topical treatment of acne when other effective non-antibiotic treatments are available. Nadifloxacin has potential as a topical agent for short-term treatment of skin infections. The arginine salt of its (-)-(S)-isomer is being developed as a parenteral agent based on its potency against methicillin and quinolone-resistant Staphylococcus aureus.
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Affiliation(s)
- Michael R Jacobs
- Department of Pathology, Case Western Reserve University and University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA.
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33
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Bhagwat SS, Mundkur LA, Gupte SV, Patel MV, Khorakiwala HF. The anti-methicillin-resistant Staphylococcus aureus quinolone WCK 771 has potent activity against sequentially selected mutants, has a narrow mutant selection window against quinolone-resistant Staphylococcus aureus, and preferentially targets DNA gyrase. Antimicrob Agents Chemother 2006; 50:3568-79. [PMID: 16940059 PMCID: PMC1635177 DOI: 10.1128/aac.00641-06] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
WCK 771 is a broad-spectrum fluoroquinolone with enhanced activity against quinolone-resistant staphylococci. To understand the impact of the target-level interactions of WCK 771 on its antistaphylococcal pharmacodynamic properties, we determined the MICs for genetically defined mutants and studied the mutant prevention concentrations (MPCs), the frequency of mutation, and the cidality against the wild type and double mutants. There was a twofold increase in the MICs of WCK 771 for single gyrA mutants, indicating that DNA gyrase is its primary target. All first- and second-step mutants selected by WCK 771 revealed gyrA and grlA mutations, respectively. The MICs of WCK 771 and clinafloxacin were found to be superior to those of other quinolones against strains with double and triple mutations. WCK 771 was also cidal for high-density double mutants at low concentrations. WCK 771 and clinafloxacin showed narrow mutant selection windows compared to those of the other quinolones. Against a panel of 50 high-level quinolone-resistant clinical isolates of staphylococci (ciprofloxacin MIC > or = 16 microg/ml), the WCK 771 MPCs were < or =2 microg/ml for 68% of the strains and < or =4 microg/ml for 28% of the strains. Our results demonstrate that gyrA is the primary target of WCK 771 and that it has pharmacodynamic properties remarkably different from those of quinolones with dual targets (garenoxacin and moxifloxacin) and topoisomerase IV-specific quinolones (trovafloxacin). WCK 771 displayed an activity profile comparable to that of clinafloxacin, a dual-acting quinolone with a high affinity to DNA gyrase. Overall, the findings signify the key role of DNA gyrase in determining the optimal antistaphylococcal features of quinolones.
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Affiliation(s)
- Sachin S Bhagwat
- Wockhardt Research Centre, D-4, Chikalthana, MIDC Area, 431210, Aurangabad (MS), India
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Yeole RD, Jadhav AS, Patil KR, Rane VP, Kubal ML, Singh S, Patel MV, Khorakiwala HF. Validated chiral high-performance liquid chromatography method for a novel anti-methicillin-resistant staphylococcus aureus fluoroquinolone WCK 771. J Chromatogr A 2006; 1108:38-42. [PMID: 16426621 DOI: 10.1016/j.chroma.2005.12.085] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2005] [Revised: 12/14/2005] [Accepted: 12/23/2005] [Indexed: 10/25/2022]
Abstract
A sensitive, simple, specific, precise, accurate and rugged method for the assay and determination of enantiomeric purity of S-(-)-9-fluoro-6,7-dihydro-8-(4-hydroxypiperidin-1-yl)-5-methyl-1-oxo-1H,5H-benzo[i,j]quinolizine-2-carboxylic acid L-arginine salt tetrahydrate (WCK 771) in bulk drug has been developed. The method is RP-HPLC using endcapped C-18 stationary phase and chiral mobile phase. Chirality to the mobile phase was imparted with addition of beta-cyclodextrin. The UV-vis detector was operated at 290 nm. The flow rate of mobile phase was 2 ml/min. The method offers excellent separation of two enantiomers with resolution more than 2 and tailing factor less than 1.5. The method was validated for the assay of WCK 771 and quantification of R-(+)-enantiomer impurity in bulk drug. The calibration curves showed excellent linearity over the concentration range of 0.05-0.15 mg/ml for WCK 771 and 0.5-7.5 microg/ml for R-(+)-enantiomer. The precision (RSD) of the assay was 0.23%. The limit of detection and limit of quantitation of the method for WCK 771 were 0.015 and 0.06 microg/ml, respectively. The limit of detection and limit of quantitation for R-(+)-enantiomer were 0.025 and 0.09 microg/ml, respectively. The average recovery of the R-(+)-enantiomer was 100.5%. Same method was applied for the assay and determination of enantiomeric purity of WCK 771 in the intravenous formulation.
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Affiliation(s)
- R D Yeole
- Wockhardt Limited, Wockhardt Research Center, Analytical, Drug Discovery, D-4, MIDC Area, Chikalthana, Aurangabad, Maharashtra 431210, India.
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Lynch AS. Efflux systems in bacterial pathogens: An opportunity for therapeutic intervention? An industry view. Biochem Pharmacol 2006; 71:949-56. [PMID: 16290174 DOI: 10.1016/j.bcp.2005.10.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 10/05/2005] [Accepted: 10/11/2005] [Indexed: 11/19/2022]
Abstract
The efflux systems of bacteria protect cells from antibiotics and biocides by actively transporting compounds out of the cytoplasm and/or periplasm and thereby limit their steady-state accumulation at their site(s) of action. The impact of efflux systems on the efficacy of antibiotics used in human medicine and animal husbandry is becoming increasingly apparent from the characterization of drug-resistant strains with altered drug efflux properties. In most instances, efflux-mediated antibiotic resistance arises from mutational events that result in their elevated expression and, in the case of efflux pumps with broad substrate specificity, can confer multi-drug resistance (MDR) to structurally unrelated antibiotics. Knowledge of the role of efflux systems in conferring antibiotic resistance has now been successfully exploited in the pharmaceutical industry and contributed, in part, to the development of new members of the macrolide and tetracycline classes of antibiotics that circumvent the efflux-based resistance mechanisms that have limited the clinical utility of their progenitors. The therapeutic utility of compounds that inhibit bacterial drug efflux pumps and therein potentiate the activity of a co-administered antibiotic agent remains to be validated in the clinical setting, but the approach holds promise for the future in improving the efficacy and/or extending the clinical utility of existing antibiotics. This review discusses the potential of further exploiting the knowledge of efflux-mediated antibiotic resistance in bacteria toward the discovery and development of new chemotherapeutic agents.
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Affiliation(s)
- A Simon Lynch
- Cumbre Inc., 1502 Viceroy Drive, Dallas, TX 75235-2304, USA.
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de Souza NJ, Gupte SV, Deshpande PK, Desai VN, Bhawsar SB, Yeole RD, Shukla MC, Strahilevitz J, Hooper DC, Bozdogan B, Appelbaum PC, Jacobs MR, Shetty N, Patel MV, Jha R, Khorakiwala HF. A Chiral Benzoquinolizine-2-carboxylic Acid Arginine Salt Active against Vancomycin-Resistant Staphylococcus aureus. J Med Chem 2005; 48:5232-42. [PMID: 16078842 DOI: 10.1021/jm050035f] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is an urgent medical need for novel antibacterial agents to treat hospital infections, specially those caused by multidrug-resistant Gram-positive pathogens. The need may also be fulfilled by either exploring antibacterial agents having new mechanism of action or expanding known classes of antibacterial drugs. The paper describes a new chemical entity, compound 21, derived from hitherto little known "floxacin". The choice of the entity was made from a series of synthesized prodrugs and salts of the active chiral benzoquinolizine carboxylic acid, S-(-)-nadifloxacin. The chemistry, physicochemical characteristics, and essential bioprofile of 21 qualifies it for serious consideration as a novel drug entity against hospital infections of multi-drug-resistant Staphylococcus aureus, and its progress up to clinical phase I trials in humans is described.
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Affiliation(s)
- Noel J de Souza
- Wockhardt Limited, Wockhardt Research Centre, D-4, MIDC, Chikalthana, Aurangabad-431 210, India
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Abstract
Antibiotic resistance continues to plague antimicrobial chemotherapy of infectious disease. And while true biocide resistance is as yet unrealized, in vitro and in vivo episodes of reduced biocide susceptibility are common and the history of antibiotic resistance should not be ignored in the development and use of biocidal agents. Efflux mechanisms of resistance, both drug specific and multidrug, are important determinants of intrinsic and/or acquired resistance to these antimicrobials, with some accommodating both antibiotics and biocides. This latter raises the spectre (as yet generally unrealized) of biocide selection of multiple antibiotic-resistant organisms. Multidrug efflux mechanisms are broadly conserved in bacteria, are almost invariably chromosome-encoded and their expression in many instances results from mutations in regulatory genes. In contrast, drug-specific efflux mechanisms are generally encoded by plasmids and/or other mobile genetic elements (transposons, integrons) that carry additional resistance genes, and so their ready acquisition is compounded by their association with multidrug resistance. While there is some support for the latter efflux systems arising from efflux determinants of self-protection in antibiotic-producing Streptomyces spp. and, thus, intended as drug exporters, increasingly, chromosomal multidrug efflux determinants, at least in Gram-negative bacteria, appear not to be intended as drug exporters but as exporters with, perhaps, a variety of other roles in bacterial cells. Still, given the clinical significance of multidrug (and drug-specific) exporters, efflux must be considered in formulating strategies/approaches to treating drug-resistant infections, both in the development of new agents, for example, less impacted by efflux and in targeting efflux directly with efflux inhibitors.
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Affiliation(s)
- Keith Poole
- Department of Microbiology & Immunology, Queen's University, Kingston, ON, Canada.
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