Investigation of the N-Terminus Amino Function of Arg10-Teixobactin

Total Page:16

File Type:pdf, Size:1020Kb

Investigation of the N-Terminus Amino Function of Arg10-Teixobactin molecules Communication Investigation of the N-Terminus Amino Function of Arg10-Teixobactin Shimaa A. H. Abdel Monaim 1, Sikabwe Noki 1, Estelle J. Ramchuran 1, Ayman El-Faham 2,3 ID , Fernando Albericio 1,2,4,5,6,* ID and Beatriz G. de la Torre 1,7,* 1 Catalysis and Peptide Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa; [email protected] (S.A.H.A.M.); [email protected] (S.N.); [email protected] (E.J.R.) 2 Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia; [email protected] 3 Chemistry Department, Faculty of Science, Alexandria University, P.O. Box 426, Ibrahimia, Alexandria 12321, Egypt 4 School of Chemistry and Physics, University of KwaZulu-Natal, Durban 4001, South Africa 5 Department of Organic Chemistry, University of Barcelona, Barcelona 08028, Spain 6 CIBER-BBN, Networking Centre on Bioengineering, Biomaterials and Nanomedicine, Barcelona Science Park, Barcelona 08028, Spain 7 KRISP, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa * Correspondence: [email protected] (F.A.); [email protected] (B.G.d.l.T.); Tel.: +27-614-047-528 (F.A.); +27-614-009-144 (B.G.d.l.T.) Received: 28 August 2017; Accepted: 25 September 2017; Published: 28 September 2017 Abstract: Teixobactin is a recently described antimicrobial peptide that shows high activity against gram-positive bacteria as well as mycobacterium tuberculosis. Due to both its structure as a head-to-side chain cyclodepsipeptide and its activity, it has attracted the attention of several research groups. In this regard, a large number of analogs with substitutions in both the cycle and the tail has been described. Here, we report the contribution of the N-terminus residue, N-Me-D-Phe, to the activity of Arg10-teixobactin. On the basis of our findings, we conclude that the N-terminus accepts minimum changes but not the presence of long alkyl chains. The presence of a positive charge is a requirement for the activity of the peptide. Furthermore, acylation of the N-terminus leads to total loss of activity. Keywords: antimicrobial peptides; teixobactin; lipophilicity; solid-phase peptide synthesis; cyclic depsipeptides 1. Introduction The isolation of a new anti-microbial peptide (AMP) called teixobactin in 2015 by Ling et al. raised great expectations because it is one of the few new antibiotics to have been reported in recent years [1,2]. This antibiotic shows high activity against gram-positive bacteria as well as Mycobacterium tuberculosis. Teixobactin (Figure1) is a head-to-side chain cyclodepsipeptide that contains hydrophilic and hydrophobic residues [3,4]. Thus, the tail of the natural peptide contains four polar amino acids, L-allo-enduracididine, two Ser, and D-Gln, and four non-polar Ile residues, one Ala and one N-Me-D-Phe residue at the N-terminus. Finally, a D-Thr is the branching unit to form the cyclic moiety. Molecules 2017, 22, 1632; doi:10.3390/molecules22101632 www.mdpi.com/journal/molecules Molecules 2017, 22, 1632 2 of 9 Molecules 2017, 22, 1632 2 of 8 Figure 1. Chemical structure of teixobactin. Taking Arg10-teixobactin (1) as a reference, in which the unusual L-allo-Enduracididne is replaced by Taking Arg -teixobactin (1) as a reference, in which the unusual L-allo-Enduracididne is replaced L-Arg [2,5], Nowick’s10 and our group have independently confirmed the importance of maintaining a by L-Arg [2,5], Nowick’s and our group have independently confirmed the importance of maintaining balance between the hydrophobic and hydrophilic residues for keeping the activity [3,4]. The main a balance between the hydrophobic and hydrophilic residues for keeping the activity [3,4]. The main conclusions drawn from those studies are that the replacement of polar or neutral amino acids by Lys conclusions drawn from those studies are that the replacement of polar or neutral amino acids by Lys retains or improves the activity of the molecule, while replacing the non-polar amino acids by Lys retainsleads to or total improves loss of the activity. activity Only of the the molecule, replacemen whilet of replacing non-polar the Ile non-polar by cyclohexylglycine amino acids by (Chg) Lys leads has tobeen total reported loss of to activity. retain Onlyactivity the [4]. replacement In a furthe ofr step non-polar towards Ile understanding by cyclohexylglycine the contribution (Chg) has of been the reportedcationic residues to retain activityto the activity [4]. In a furtherof teixobactin, step towards our group understanding has prepared the contribution a library ofof themore cationic than residues25 teixobactin to the analogs activity in of which teixobactin, extra basic our group residues has (Lys, prepared Orn, aDap) library were of introduced more than 25into teixobactin positions analogsoccupied in by which polar/neutral extra basic amino residues acids, (Lys, without Orn, Dap)affecting were the introduced N-terminus into residue positions [6]. occupied That study by N- polar/neutralconcluded that amino the activity acids, withoutof a cationic affecting teixobac the tinterminus analog residuerequires [ 6a]. ma Thatximum study of concluded three or four that thepositive activity charges. of a cationicThus, the teixobactin introduction analog of an requires extra charge a maximum leads to oftotal three loss or of four activity positive [6]. charges. Thus,However, the introduction little attention of an extra has charge been paid leads to to the total role loss of of the activity N-terminus [6]. residue for teixobactin, However, little attention has been paid to the role of the N-terminus residue for teixobactin, N-Me-D-Phe. We and Madder-Taylor-Singh’s group have demonstrated the importance of the D- N-Me-D-Phe. We and Madder-Taylor-Singh’s group have demonstrated the importance of the D- configuration, and reported that the Me group cannot be switched for an acetyl (N-Ac-D-Phe-Arg10- configuration,teixobactin (9)) and [5,7]. reported Furthermore, that the in Me a grouptotally cannotdifferent be switchedapproach, for Nowick an acetyl et al (N. -Ac-preparedD-Phe-Arg a short10- teixobactinversion of teixobactin, (9)) [5,7]. Furthermore,namely lipobactin, in a totallywhich differentretains most approach, of its activity Nowick and et in al. which prepared the last a short five version of teixobactin, namely lipobactin, which retains most of its activity and in which the last residues (two Ile (L, and D-allo), Ser, D-Gln, and N-Me-D-Phe) are replaced by a dodecanoyl moiety [4,8]. five residuesWith the (twoaim to Ile further (L, and exploreD-allo), the Ser, contributionD-Gln, and of Nthe-Me- N-Me-D-PheD-Phe) are to replaced the activity by of a dodecanoylteixobactin, moiety [4,8]. here we synthesized a small library of Arg10-teixobactin analogs. As we previously demonstrated that With the aim to further explore the contribution of the N-Me-D-Phe to the activity of teixobactin, the replacement of N-Me-D-Phe by N-Me-D-Lys leads to total loss of activity [6], here we concentrated hereon increasing we synthesized the hydrophobicity a small library ofof Argthe10 N-teixobactin-terminus analogs.by introducing As we previouslyextra tails demonstratedto this terminus that. theLipophilicity replacement plays of N a-Me- crucialD-Phe role by Nin-Me- the Dactivity-Lys leads of all to totalpeptides, loss of as activity well as [6 ],in here their we transport concentrated and ondistribution increasing within the hydrophobicitybiological systems of [9–11]. the N-terminus However, byfor introducingAMPs, increasing extra hydrophobicity tails to this terminus. can be Lipophilicitya way to promote plays binding a crucial to bacterial role in the membranes, activity of thereby all peptides, causing as greater well as disruption. in their transport For instance, and distributionsome species within such biologicalas S. aurus systems show a [9 limited–11]. However, electrostatic for AMPs, surface increasing potential hydrophobicity with the hydrophilic can be aAMPs, way to causing promote the binding AMPs to to bind bacterial to the membranes, bacterial me therebymbrane causingin a different greater way disruption. [12]. Furthermore, For instance, the somemembrane species binding such asof suchS. aurus peptidesshow is a salt limited sensitive, electrostatic leading to surface limited potential potency withat physiological the hydrophilic ionic AMPs,strength; causing however, the increasing AMPs to bind their to hydrophobicity the bacterial membrane means reducing in a different their salt way sensitivity, [12]. Furthermore, as well as theincreasing membrane their binding bactericidal of such potency. peptides As is an salt example, sensitive, increasing leading to the limited hydrophobicity potency at physiological of the AMP ionicCNY21 strength; (CNYITELeRRQHARASHLGLAR) however, increasing their hydrophobicity improved pept meanside reducing adsorption, their led salt to sensitivity, peptide asliposome well as increasingleakage, and their enhanced bactericidal activity potency. against As Escherichia an example, coli increasing and Pseudomonas the hydrophobicity aeruginosa of[12]. the Furthermore, AMP CNY21 (CNYITELeRRQHARASHLGLAR)it has been demonstrated that the replacement improved of peptide the aliphatic adsorption, acyl moiety led to of peptide polymyxin liposome B or colistin leakage, by andaromatic enhanced or fatty activity acid substituents against Escherichia has a great coli andimpactPseudomonas on the antimicrobial aeruginosa activity[12]. Furthermore, of the analogs it has [13–17]. been demonstrated that the replacement of the aliphatic acyl moiety of polymyxin B or colistin by aromatic or fatty acid substituents has a great impact on the antimicrobial activity of the analogs [13–17]. Molecules 2017, 22, 1632 3 of 9 Molecules 2017, 22, 1632 3 of 8 2. Results Results and and Discussion Discussion 2.1. Synthetic Synthetic Strategy Strategy N 2 6 8 10 The N-terminus-terminus Arg Arg10-teixobactin-teixobactin analogs analogs (Figure (Figure 22,, 2––6,, 8––10)) were were synthesized synthesized using using strategies strategies developed by our group for the previous analogs [[2,3,7].2,3,7].
Recommended publications
  • Activity of Cefepime-Zidebactam Against Multidrug-Resistant (MDR) Gram-Negative Pathogens
    antibiotics Article Activity of Cefepime-Zidebactam against Multidrug-Resistant (MDR) Gram-Negative Pathogens Kenneth S. Thomson 1,* , Sameh AbdelGhani 1,2, James W. Snyder 1 and Gina K. Thomson 1,3 1 Department of Pathology and Laboratory Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA; [email protected] (S.A.); [email protected] (J.W.S.); [email protected] (G.K.T.) 2 Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt 3 Microbiology Department, University of Louisville Hospital, Louisville, KY 40202, USA * Correspondence: [email protected] Received: 18 February 2019; Accepted: 19 March 2019; Published: 23 March 2019 Abstract: This study compared the activity of cefepime + zidebactam (FEP-ZID) and selected currently available antibacterial agents against a panel of multidrug-resistant (MDR) clinical isolates chosen to provide an extreme challenge for antibacterial activity. FEP–ZID had a very broad and potent in vitro spectrum of activity, and was highly active against many MDR isolates of Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii. Notably, it inhibited isolates producing carbapenemases of Ambler classes A, B, and D, and P. aeruginosa isolates with multiple resistance mechanisms including combinations of upregulated efflux, diminished or non-functional OprD porins, and AmpC overproduction. Its clinical role will be determined initially by the breakpoints assigned to it, comparison studies with other investigational β-lactamase inhibitor combinations, and ultimately by the developing body of therapeutic outcome data. Keywords: carbapenemase-producing organism; carbapenemase; zidebactam; therapy 1. Introduction Gram-negative multidrug-resistant (MDR) pathogens, particularly carbapenemase-producing organisms (CPOs), cause infections of high mortality that are typically treated with antibiotic combinations that include toxic drugs such as polymyxins and aminoglycosides [1].
    [Show full text]
  • Neomycin and Polymyxin B Sulfates and Gramicidin
    NEOMYCIN AND POLYMYXIN B SULFATES AND GRAMICIDIN- neomycin sulfate, polymyxin b sulfate and gramicidin solution/ drops A-S Medication Solutions ---------- Neomycin and Polymyxin B Sulfates and Gramicidin Ophthalmic Solution, USP (Sterile) Rx only DESCRIPTION: Neomycin and Polymyxin B Sulfates and Gramicidin Ophthalmic Solution, USP is a sterile antimicrobial solution for ophthalmic use. Each mL contains: ACTIVES: Neomycin Sulfate, (equivalent to 1.75 mg neomycin base), Polymyxin B Sulfate equal to 10,000 Polymyxin B units, Gramicidin, 0.025 mg; INACTIVES: Sodium Chloride, Alcohol (0.5%), Poloxamer 188, Propylene Glycol, Purified Water. Hydrochloric Acid and/ or Ammonium Hydroxide may be added to adjust pH (4.7-6.0). PRESERVATIVE ADDED: Thimerosal 0.001%. Neomycin Sulfate is the sulfate salt of neomycin B and C, which are produced by the growth of Streptomyces fradiae Waksman (Fam. Streptomycetaceae). It has a potency equivalent of not less than 600 micrograms of neomycin base per milligram, calculated on an anhydrous basis. The structural formulae are: Polymyxin B Sulfate is the sulfate salt of polymyxin B1 and B2 which are produced by the growth of Bacillus polymyxa (Prazmowski) Migula (Fam. Bacillaceae). It has a potency of not less than 6,000 polymyxin B units per milligram, calculated on an anhydrous basis. The structural formulae are: Gramicidin (also called gramicidin D) is a mixture of three pairs of antibacterial substances (Gramicidin A, B and C) produced by the growth of Bacillus brevis Dubos (Fam. Bacillaceae). It has a potency of not less than 900 mcg of standard gramicidin per mg. The structural formulae are: CLINICAL PHARMACOLOGY: A wide range of antibacterial action is provided by the overlapping spectra of neomycin, polymyxin B sulfate, and gramicidin.
    [Show full text]
  • Farrukh Javaid Malik
    I Farrukh Javaid Malik THESIS PRESENTED TO OBTAIN THE GRADE OF DOCTOR OF THE UNIVERSITY OF BORDEAUX Doctoral School, SP2: Society, Politic, Public Health Specialization Pharmacoepidemiology and Pharmacovigilance By Farrukh Javaid Malik “Analysis of the medicines panorama in Pakistan – The case of antimicrobials: market offer width and consumption.” Under the direction of Prof. Dr. Albert FIGUERAS Defense Date: 28th November 2019 Members of Jury M. Francesco SALVO, Maître de conférences des universités – praticien hospitalier, President Université de Bordeaux M. Albert FIGUERAS, Professeur des universités – praticien hospitalier, Director Université Autonome de Barcelone Mme Antonia AGUSTI, Professeure, Vall dʹHebron University Hospital Referee Mme Montserrat BOSCH, Praticienne hospitalière, Vall dʹHebron University Hospital Referee II Abstract A country’s medicines market is an indicator of its healthcare system, the epidemiological profile, and the prevalent practices therein. It is not only the first logical step to study the characteristics of medicines authorized for marketing, but also a requisite to set up a pharmacovigilance system, thus promoting rational drug utilization. The three medicines market studies presented in the present document were conducted in Pakistan with the aim of describing the characteristics of the pharmaceutical products available in the country as well as their consumption at a national level, with a special focus on antimicrobials. The most important cause of antimicrobial resistance is the inappropriate consumption of antimicrobials. The results of the researches conducted in Pakistan showed some market deficiencies which could be addressed as part of the national antimicrobial stewardship programmes. III Résumé Le marché du médicament d’un pays est un indicateur de son système de santé, de son profil épidémiologique et des pratiques [de prescription] qui y règnent.
    [Show full text]
  • Rational Design and Synthesis of Modified Teixobactin Analogues: Ng, Vivian; Kuehne, Sarah A; Chan, Weng
    University of Birmingham Rational design and synthesis of modified teixobactin analogues: Ng, Vivian; Kuehne, Sarah A; Chan, Weng DOI: 10.1002/chem.201801423 License: Other (please specify with Rights Statement) Document Version Peer reviewed version Citation for published version (Harvard): Ng, V, Kuehne, SA & Chan, W 2018, 'Rational design and synthesis of modified teixobactin analogues: in vitro antibacterial activity against Staphylococcus aureus, Propionibacterium acnes and Pseudomonas aeruginosa', Chemistry: A European Journal. https://doi.org/10.1002/chem.201801423 Link to publication on Research at Birmingham portal Publisher Rights Statement: This is the peer reviewed version of the following article: Ng, V. , Kuehne, S. and Chan, W. (2018), Rational design and synthesis of modified teixobactin analogues: in vitro antibacterial activity against Staphylococcus aureus, Propionibacterium acnes and Pseudomonas aeruginosa. Chem. Eur. J.. Accepted Author Manuscript. doi:10.1002/chem.201801423, which has been published in final form at 10.1002/chem.201801423. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self- Archiving. General rights Unless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or the copyright holders. The express permission of the copyright holder must be obtained for any use of this material other than for purposes permitted by law. •Users may freely distribute the URL that is used to identify this publication. •Users may download and/or print one copy of the publication from the University of Birmingham research portal for the purpose of private study or non-commercial research.
    [Show full text]
  • Polymyxin B April 2019 Background Polymyxin B Injection Is Available
    Polymyxin B April 2019 Background . Polymyxin B injection is available for inpatient use. This product is being used by the irrigation mode of administration. The proposal is to implement the intravenous route of administration with restrictions for use. Several changes were made to the FDA drug approval process in the 1960s which is after the time (1951) when polymyxin B was originally approved by the FDA.1,2 The approval process for polymyxin B was different than medications that are approved today. Thus, there is a lack of robust clinical trials on polymyxin B’s efficacy, safety and pharmacokinetics. Efficacy Polymyxin B was FDA approved for acute infections caused by susceptible strains of Pseudomonas aeruginosa and for serious infections caused by the following organisms (if susceptible) when other less toxic drugs are ineffective or contraindicated: H. influenzae (meningeal, IT route), Escherichia coli (UTI), Aerobacter (Klebsiella) aerogenes (bacteremia), Klebsiella pneumoniae (bacteremia).3 It should be noted that this drug did not go through the modern drug development process and thus, pharmacokinetic evidence since its approval has indicated that it is not appropriate for UTIs. Guidelines indicate that polymyxin B is the preferred polymyxin therapy for systemic use in invasive infections other than UTIs.5 Safety Polymyxin B has several black box warnings (BBW): administration by the IM and IT routes should only be done in hospitalized patients, nephrotoxicity and neurotoxicity can occur, safe use in pregnancy has not been established,
    [Show full text]
  • Synthesis and Structure−Activity Relationships of Teixobactin
    Ann. N.Y. Acad. Sci. ISSN 0077-8923 ANNALS OF THE NEW YORK ACADEMY OF SCIENCES Special Issue: Antimicrobial Therapeutics Reviews REVIEW Synthesis and structure−activity relationships of teixobactin John A. Karas,1 Fan Chen,1 Elena K. Schneider-Futschik,1,2 Zhisen Kang,1 Maytham Hussein,1 James Swarbrick,1 Daniel Hoyer,1,3,4 Andrew M. Giltrap,5 Richard J. Payne,5 Jian Li,6 and Tony Velkov1 1Department of Pharmacology & Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Parkville, Victoria, Australia. 2Lung Health Research Centre, Department of Pharmacology & Therapeutics, the University of Melbourne, Parkville, Victoria, Australia. 3The Florey Institute of Neuroscience and Mental Health, the University of Melbourne, Parkville, Victoria, Australia. 4Department of Molecular Medicine, the Scripps Research Institute, La Jolla, California. 5School of Chemistry, the University of Sydney, Sydney, New South Wales, Australia. 6Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Victoria, Australia Address for correspondence: Tony Velkov and John A. Karas, Department of Pharmacology & Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Parkville, VIC 3010, Australia. [email protected] OR [email protected] The discovery of antibiotics has led to the effective treatment of bacterial infections that were otherwise fatal and has had a transformative effect on modern medicine. Teixobactin is an unusual depsipeptide natural product that was recently discovered from a previously unculturable soil bacterium and found to possess potent antibacterial activity against several Gram positive pathogens, including methicillin-resistant Staphylococcus aureus and vancomycin- resistant Enterococci.
    [Show full text]
  • Emergence of Third-Generation Cephalosporin-Resistant Morganella Morganii in a Captive Breeding Dolphin in South Korea
    animals Brief Report Emergence of Third-Generation Cephalosporin-Resistant Morganella morganii in a Captive Breeding Dolphin in South Korea 1,2, 3, 3 1 1 Seon Young Park y , Kyunglee Lee y, Yuna Cho , Se Ra Lim , Hyemin Kwon , Jee Eun Han 4,* and Ji Hyung Kim 1,* 1 Infectious Disease Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon 34141, Korea; [email protected] (S.Y.P.); [email protected] (S.R.L.); [email protected] (H.K.) 2 Division of Animal and Dairy Sciences, College of Agriculture and Life Science, Chungnam National University, Daejeon 34134, Korea 3 Cetacean Research Institute, National Institute of Fisheries Science, Ulsan 44780, Korea; [email protected] (K.L.); tnvlfl[email protected] (Y.C.) 4 Laboratory of Aquatic Biomedicine, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea * Correspondence: [email protected] (J.E.H.); [email protected] (J.H.K.) These authors equally contributed to this work. y Received: 9 July 2020; Accepted: 28 October 2020; Published: 6 November 2020 Simple Summary: The emergence of antimicrobial resistance (AMR) has become an important consideration in animal health, including marine mammals, and several potential zoonotic AMR bacterial strains have been isolated from wild cetacean species. Although the emergence of AMR bacteria can be assumed to be much more plausible in captive than in free-ranging cetaceans owing to their frequent contact with humans and antibiotic treatments, the spread and its impacts of AMR bacteria in captive animals have not been adequately investigated yet. Here in this study, we present evidence on the presence of multidrug-resistant potential zoonotic bacteria which caused fatal infection in a captive dolphin bred at a dolphinarium in South Korea.
    [Show full text]
  • Polymyxin B* Class: Polymyxins Overview Polymyxin B Is a Polypeptide Bactericidal Antibiotic. the Polymyxins Were Discovered In
    Polymyxin B* Class: Polymyxins Overview Polymyxin B is a polypeptide bactericidal antibiotic. The polymyxins were discovered in 1947 and introduced to the medical community in the 1950s. Colistin, also called polymyxin E and its parenteral form, colistimethate, are related polymyxins. Polymyxins can be administered orally, topically or parenterally, including intrathecally and intraperitoneally. However parenteral administration is primarily used in life threatening infections caused by Gram-negative bacilli or Pseudomonas species that are resistant to other drugs. Polymyxins exert their effect on the bacterial cell membrane by affecting phospholipids and interfering with membrane function and permeability, which results in cell death. Polymyxins are more effective against Gram-negative than Gram- positive bacteria and are effective against all Gram-negative bacteria except Proteus species. These antibiotics act synergistically with potentiated sulfonamides, tetracyclines and certain other antimicrobials. Polymyxins also limit activity of endotoxins in body fluids and therefore, may be beneficial in therapy for endotoxemia. Polymyxins are not well absorbed into the blood after either oral or topical administration. Polymyxins bind to cell membranes, purulent exudates and tissue debris. The drugs are eliminated from the kidneys with approximately sixty percent of polymyxin B and ninety percent of colistin excreted unchanged. Polymyxins are considered nephrotoxic and neurotoxic and neuromuscular blockade is seen at higher concentrations. In reality, the potential for nephrotoxicity is minimal when the drugs are utilized properly, especially colistin. Polymyxin B is a potent releaser of histamines and hypersensitivity reactions can occur. Parenteral polymyxins are often characterized by intense pain at the injection site. Divalent cations, unsaturated fatty acids and quaternary ammonium compounds inhibit the activity of polymyxins.
    [Show full text]
  • Β-Lactam/Β-Lactamase Inhibitors for the Treatment of Infections Caused by Extended-Spectrum Β-Lactamase (ESBL)-Producing Enterobacteriaceae
    β-lactam/β-lactamase Inhibitors for the Treatment of Infections Caused by Extended-Spectrum β-Lactamase (ESBL)-producing Enterobacteriaceae Alireza FakhriRavari, Pharm.D. PGY-2 Pharmacotherapy Resident Controversies in Clinical Therapeutics University of the Incarnate Word Feik School of Pharmacy San Antonio, Texas November 13, 2015 Learning Objectives At the completion of this activity, the participant will be able to: 1. Describe different classes of β-lactamases produced by gram-negative bacteria. 2. Identify β-lactamase inhibitors and their spectrum of inhibition of β-lactamases. 3. Evaluate the evidence for use of β-lactam/β-lactamase inhibitors compared to carbapenems for treatment of ESBL infections. β-lactam/β-lactamase inhibitors for the treatment of infections caused by ESBL-producing Enterobacteriaceae 1 1. A Brief History of the Universe A. Timeline: 1940s a. β-lactams and β-lactamases i. Sir Alexander Fleming discovered penicillin from Penicillium notatum (now Penicillium chrysogenum) in 1928.1,2 ii. Chain, Florey, et al isolated penicillin in 1940, leading to its commercial production.3 iii. First β-lactamase was described as a penicillinase in Escherichia coli in 1940.4 iv. Giuseppe Brotzu discovered cephalosporin C from the mold Cephalosporin acremonium (now Acremonium chrysogenum) in 1945, but cephalosporins were not clinically used for another 2 decades.2,5 b. What are β-lactamases? i. β-lactamases are enzymes that hydrolyze the amide bond of the β-lactam ring, thereby inactivating them.6 Figure 1: Mechanism of action of β-lactamases ii. β-lactamase production is the principal mechanism by which gram-negative bacteria resist β-lactam antibiotics.6 iii.
    [Show full text]
  • Trend Analysis of Antibiotics Consumption Using WHO Aware Classification in Tertiary Care Hospital
    International Journal of Basic & Clinical Pharmacology Bhardwaj A et al. Int J Basic Clin Pharmacol. 2020 Nov;9(11):1675-1680 http:// www.ijbcp.com pISSN 2319-2003 | eISSN 2279-0780 DOI: https://dx.doi.org/10.18203/2319-2003.ijbcp20204493 Original Research Article Trend analysis of antibiotics consumption using WHO AWaRe classification in tertiary care hospital Ankit Bhardwaj*, Kaveri Kapoor, Vivek Singh Saraswathi institute of Medical Sciences, Pilakhuwa, Hapur, Uttar Pradesh, India Received: 21 August 2020 Accepted: 21 September 2020 *Correspondence: Dr. Ankit Bhardwaj, Email: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Aim of the study was to assess trend in antibiotics consumption pattern from 2016 to 2019 using AWaRe classification, ATC and Defined daily dose methodology (DDD) in a tertiary care hospital. Antibiotics are crucial for treating infectious diseases and have significantly improved the prognosis of patients with infectious diseases, reducing morbidity and mortality. The aim of the study is to classify the antibiotic based on WHO AWaRe classification and compare their four-year consumption trends. The study was conducted at a tertiary care center, Pilakhuwa, Hapur. Antibiotic procurement data for a period of 4 years (2016-2019) was collected from the Central medical store. Methods: This is a retrospective time series analysis of systemic antibiotics with no intervention at patient level. Antibiotic procurement was taken as proxy for consumption assuming that same has been used.
    [Show full text]
  • Prescribing Information Including Patient Medication Information
    PRESCRIBING INFORMATION INCLUDING PATIENT MEDICATION INFORMATION OPTIMYXIN PLUS Gramicidin, Neomycin and Polymyxin B Sulfate Each mL of solution contains Gramicidin 0.025 mg Neomycin 1.75 mg (as neomycin sulfate) and Polymyxin B Sulfate 10 000 units Ophthalmic/Otic USP Antibiotic Sandoz Canada Inc. Date of Preparation: July 1989 110 Rue de Lauzon Date of Revision: March 27, 2019 Boucherville, QC, Canada J4B 1E6 Submission Control Number: 217599 Optimyxin Plus Eye/Ear Solution (Neomycin and Polymyxin B Sulfate and Gramicidin Ophthalmic Solution USP) Antibiotic INDICATIONS Optimyxin Plus is used for the prophylaxis and treatment of eye and ear infections. To reduce the development of drug-resistant bacteria and maintain the effectiveness of OPTIMYXIN PLUS and other antibacterial drugs, OPTIMYXIN PLUS should be used only to treat infections that are proven or strongly suspected to be caused by bacteria. CONTRAINDICATIONS Hypersensitivity to any of the components. The presence of preexisting nerve deafness is a contraindication to the use of any topical aminoglycoside in circumstances where significant systemic absorption could occur. WARNINGS AND PRECAUTIONS The manifestations of sensitization to neomycin are usually itching, reddening and edema of the conjunctiva and eyelid. It may be manifest simply as a failure to heal. During long-term use of neomycin-containing products, periodic examination for such signs is advisable, and the patient should be told to discontinue the product if they are observed. These symptoms subside quickly on withdrawing the medication. Neomycin-containing applications should be avoided for the patient thereafter. Susceptibility/Resistance Development of Drug Resistant Bacteria Prescribing OPTIMYXIN PLUS in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and risks the development of drug- resistant bacteria.
    [Show full text]
  • Colistin (Polymyxin E Or Colistimethate)
    ColistinColistin (Polymyxin (Polymyxin E or Colistimethate) E or Colistimethate) IV Only Use requires formal ID Consult Colistin (also known as Polymyxin E or Colistimethate) and Polymyxin B are the two different polymyxin antibiotics. Colistin is a prodrug (Colistimethate sodium). The product vials may be labeled as International Units (IU) of prodrug, or mg of the active product: colistin base activity (CBA). To avoid major dosing errors, carefully read vial labels. Recommend that all doses be converted to mg of CBA. Conversion: 1,000,000 units of Colistimethate (prodrug) = 80 mg of Colistimethate (prodrug) = 30 mg of colistin base activity (CBA) Activity: Coverage against most gram-negatives, including many multi-drug resistant (MDR) Enterobacteriaceae (such as E. coli, Klebsiella spp.; including ESBL-producing and carbapenem-resistant Enterobacteriaceae), Pseudomonas spp., and Acinetobacter spp. NOT ACTIVE against Proteus spp., Serratia spp., Providencia spp, Burkholderia spp, Stenotrophomonas spp, gram-negative cocci, gram-positive organisms, or anaerobes Criteria for Use: Treatment of infections due to MDR Enterobacteriaceae, Pseudomonas spp., and Acinetobacter spp. with no other treatment options Treatment of UTI. Colistin preferred over polymyxin B for UTIs Unacceptable Uses: Empiric treatment of suspected gram-negative infections Use as monotherapy due to rapid resistance development Dosing in Adults: Optimal dosing regimens are not well established Standard dose: 5 mg CBA/kg ONCE (load), then 2.5 mg CBA/kg Q12H Renal dose
    [Show full text]