Towards the Elucidation of the Mechanism of the Antibiotic Activity of Tamoxifen

Total Page:16

File Type:pdf, Size:1020Kb

Towards the Elucidation of the Mechanism of the Antibiotic Activity of Tamoxifen Towards the elucidation of the mechanism of the antibiotic activity of tamoxifen A Dissertation Presented to The Academic Faculty by Nathanael Simeon Levinson In Partial Fulfillment of the Requirements for the Degree MS in Chemistry in the College of Sciences Georgia Institute of Technology May 2017 COPYRIGHT © 2017 BY NATHANAEL SIMEON LEVINSON Towards the elucidation of the mechanism of theantibiotic activity of tamoxifen Approved by: Dr. Adegboyega Oyelere, Advisor Dr. Stefan France School of Chemistry and Biochemistry School of Chemistry and Biochemistry Georgia Institute of Technology Georgia Institute of Technology Dr. M.G. Finn, Committee Chair Dr. Thomas DiChristina School of Chemistry and Biochemistry School of Biology Georgia Institute of Technology Georgia Institute of Technology Dr. Raquel Lieberman School of Chemistry and Biochemistry Georgia Institute of Technology Date Approved: [April 20, 2017] ACKNOWLEDGEMENTS My deepest gratitude goes to my mother, Valerie, and my father, Jeffrey, who supported me emotionally, financially, intellectually, and spiritually through all the trials and tribulations I have faced not only during my graduate studies but my entire life. My undying thanks to them, without whom I would not be the man I am today. I extend heartfelt thanks to my advisor, Dr. Adegboyega Oyelere who graciously opened his lab to me and did not give up on me in the face of failing projects. I give this gratitude also to Dr. M.G. Finn, without whose support I would not have been able to complete my studies at Georgia Tech. I thank Dr. Maureen Rouhi for taking me under her wing and allowing me to write and hone my craft under her guidance. Finally, I would like to thank the administrative staff of the College of Sciences for their help and understanding during my transitionary periods at Georgia Tech, especially Dr. Cam Tyson and Dr. Kenyatta Johnson. iii TABLE OF CONTENTS ACKNOWLEDGEMENTS iii LIST OF TABLES vii LIST OF FIGURES viii SUMMARY xi CHAPTER 1. ANTIBIOTICS 1 1.1 The discovery and development of antibiotics 1 1.2 Major Antibiotic Classes 2 1.2.1 Antibiotics which target or affect the bacterial cell wall 2 1.2.1.1 Lipopeptides 2 1.2.1.2 Polymyxins 4 1.2.1.3 Glycopeptides 5 1.2.1.4 β-lactams 6 1.2.1.4.1 Penicillins 8 1.2.1.4.2 Cephalosporins 8 1.2.1.4.3 Cephamycins 9 1.2.1.4.4 Carbapenems 10 1.2.1.4.5 Monobactams 10 1.2.1.4.6 Trinems 11 1.2.1.4.7 β-lactam inhibitors 11 1.2.2 Antibiotics which target the ribosome 11 1.2.2.1 Aminoglycosides 12 1.2.2.2 Tetracyclines 13 1.2.2.3 Amphenicols 15 1.2.2.4 Macrolides 17 1.2.2.5 Streptogramins 19 1.2.2.6 Oxazolidinones 20 iv 1.2.2.7 Lincosamides 21 1.2.3 Antibiotics which have other internal targets 21 1.2.3.1 Quinolones 22 1.2.3.2 Sulfa drugs 23 CHAPTER 2. ASSAYS AND TECHNIQUES 24 2.1 Compound screening 24 2.2 Whole cell and blotting assays 29 2.2.1 Blotting to assess compound target 29 2.2.2 Minimum inhibitory concentration (MIC) 31 2.3 Cell fraction/lysate assays 32 2.3.1 RNA Footprinting 32 2.3.2 Affinity Chromatography 32 2.3.3 Thermal Shift 35 2.3.4 Radiolabeling 36 2.4 Imaging 36 2.4.1 Light microscopy 37 2.4.2 Electron microscopy 39 2.4.3 X-ray crystallography 40 CHAPTER 3. TAMOXIFEN 42 3.1 Tamoxifen: discovery, development and usage 42 3.1.1 History of tamoxifen 42 3.1.2 Tamoxifen as an antifungal 43 3.1.3 Tamoxifen as an antileishmanial agent 44 3.1.4 Tamoxifen as an antibiotic 44 CHAPTER 4. STRUCTURE-ACTIVITY RELATIONSHIP OF TAMOXIFEN 48 4.1 Purpose of study 48 4.2 Significance 48 4.3 Synthesis of tamoxifen derivatives 49 v 4.3.1 Preparation of N-desmethyl tamoxifen 49 4.3.2 Preparation of extended-alkyl derivatives 49 4.3.3 N-acetyl tamoxifen 49 4.3.4 Glycine derivative 50 4.3.5 Alanine derivative 50 4.3.6 Phenylalanine derivative 50 4.3.7 Lysine derivative 51 4.3.8 Guanidine derivative 51 4.3.9 Didesmethyl tamoxifen and 4-hydroxy tamoxifen 51 4.4 Compound Assessment 51 4.5 Results 52 4.6 Discussion 54 APPENDIX A. COLLABORATION WITH DR. DEV ARYA 57 A.1 Methods 57 A.2 Results 59 APPENDIX B. NMR AND MASS SPECTROSCOPY DATA 62 B.1 NMR 62 B.2 Mass Spectroscopy 71 APPENDIX C. MIC LINE GRAPHS 79 REFERENCES 91 vi LIST OF TABLES Table 1 – MIC results 52 Table A1 – Cell-free IC50 results 59 vii LIST OF FIGURES Figure 1 – Structure of daptomycin 3 Figure 2 – Mechanism of daptomycin 3 Figure 3 – Structure of colistin 4 Figure 4 – Mechanism of polymyxins 5 Figure 5 – Structure of vancomycin 6 Figure 6 – β-lactam cores 7 Figure 7 – Structure of streptomycin 13 Figure 8 – Structure of tetracycline 14 Figure 9 – Mechanism of tetracycline 14 Figure 10 – Structure of chloramphenicol 15 Figure 11 – Chloramphenicol interaction with peptidyl transferase cavity 16 Figure 12 – Structure of erythromycin/telithromycin 17 Figure 13 – Binding of macrolides in the ribosome 18 Figure 14 – Structure of quinupristin/dalfopristin 19 Figure 15 – Structure of linezolid 20 Figure 16 – Structure of lincomycin 21 Figure 17 – Quinolone core structure 23 Figure 18 – Sulfonamide basic structure 23 Figure 19 – The iChip 25 Figure 20 – FRET diagram 26 Figure 21 – ELISA diagram 27 Figure 22 – blotting diagram 30 Figure 23 – RNA footprinting 33 Figure 24 – Affinity chromatography 34 Figure 25 – Thermal shift diagram 35 Figure 26 – Confocal Microscope 35 viii Figure 27 – X-ray crystallography 41 Figure B1 – NMR of NL-I-43 61 Figure B2 – NMR of NL-I-44 62 Figure B3 – NMR of NL-I-45 63 Figure B4 – NMR of NL-I-69 64 Figure B5 – NMR of NL-I-70 65 Figure B6 – NMR of NL-I-71 66 Figure B7 – NMR of NL-I-72 67 Figure B8 – NMR of NL-I-97 68 Figure B9 – NMR of desmethyl tamoxifen 69 Figure B10 – Mass spec of NL-I-43 70 Figure B11 – Mass spec of NL-I-44 71 Figure B12 – Mass spec of NL-I-45 72 Figure B13 – Mass spec of NL-I-69 73 Figure B14 – Mass spec of NL-I-70 74 Figure B15 – Mass spec of NL-I-71 75 Figure B16 – Mass spec of NL-I-72 76 Figure B17 – Mass Spec of NL-I-97 77’ Figure C1 – MIC of tamoxifen in SA 79 Figure C2 – MIC of tamoxifen in MRSA 79 Figure C3 – MIC of desmethyl tamoxifen in SA 80 Figure C4 – MIC of desmethyl tamoxifen in MRSA 80 Figure C5 – MIC of didesmethyl tamoxifen in SA 81 Figure C6 – MIC of didesmethyl tamoxifen in MRSA 81 Figure C7 – MIC of NL-I-43 in SA 82 Figure C8 - MIC of NL-I-43 in MRSA 82 Figure C9 – MIC of NL-I-44 in SA 83 Figure C10 – MIC of NL-I-44 in MRSA 83 ix Figure C11 – MIC of NL-I-45 in SA 84 Figure C12 – MIC of NL-I-45 in MRSA 84 Figure C13 – MIC of NL-I-69 in SA 85 Figure C14 – MIC of NL-I-69 in MRSA 85 Figure C15 – MIC of NL-I-70 in SA 86 Figure C16 – MIC of NL-I-70 in MRSA 86 Figure C17 – MIC of NL-I-71 in SA 87 Figure C18 – MIC of NL-I-71 in MRSA 87 Figure C19 – MIC of NL-I-72 in SA 88 Figure C20 – MIC of NL-I-72 in MRSA 88 Figure C21 – MIC of NL-I-97 in SA 89 Figure C22 – MIC of NL-I-97 in MRSA 89 Figure C23 – MIC of 4-hydroxy tamoxifen in SA 90 Figure C24 – MIC of 4-hydroxy tamoxifen in MRSA 90 x SUMMARY Antibiotic resistance is increasingly a health and financial burden on the global population. Use and misuse of antibiotics has led to increased frequencies of antibiotic-resistant infections worldwide, leading to fatalities as well as greatly increasing healthcare costs. To combat this, researchers have done much work to expand to the field of antibiotics, delving back into old compounds and testing massive libraries of compounds with rapid screening techniques. Tamoxifen is one such compound that is primarily used as an anticancer agent, but displays many useful other characteristic, including antibacterial effects. However, the mechanism of the antibacterial effects of tamoxifen are poorly documented. My research was aimed at both improving the effectivity of tamoxifen as an antibacterial and elucidating the mechanism of action of tamoxifen. xi CHAPTER 1. ANTIBIOTICS Antibiotics have a relatively short history, with development beginning in the 1930’s, slowly as the idea was adopted, exploding in the 1960’s, and decelerating significantly to the present day as many natural sources of novel antibiotics are exhausted. A brief history of antibiotics, along with a survey of the majority of relevant antibiotic classes, their histories, mechanisms, and uses are presented in this chapter. 1.1 The discovery and development of antibiotics In 1928, Alexander Fleming took a vacation from his work at St. Mary’s, leaving behind Petri dishes with bacterial cultures. Upon his return, he found the plates a mess of contamination. As he sorted through and discarded the ruined cultures, he noticed that one plate had mold growing along the edge. Furthermore, there was a clear zone between the mold and the nearest bacterial colony.
Recommended publications
  • A TWO-YEAR RETROSPECTIVE ANALYSIS of ADVERSE DRUG REACTIONS with 5PSQ-031 FLUOROQUINOLONE and QUINOLONE ANTIBIOTICS 24Th Congress Of
    A TWO-YEAR RETROSPECTIVE ANALYSIS OF ADVERSE DRUG REACTIONS WITH 5PSQ-031 FLUOROQUINOLONE AND QUINOLONE ANTIBIOTICS 24th Congress of V. Borsi1, M. Del Lungo2, L. Giovannetti1, M.G. Lai1, M. Parrilli1 1 Azienda USL Toscana Centro, Pharmacovigilance Centre, Florence, Italy 2 Dept. of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), 27-29 March 2019 Section of Pharmacology and Toxicology , University of Florence, Italy BACKGROUND PURPOSE On 9 February 2017, the Pharmacovigilance Risk Assessment Committee (PRAC) initiated a review1 of disabling To review the adverse drugs and potentially long-lasting side effects reported with systemic and inhaled quinolone and fluoroquinolone reactions (ADRs) of antibiotics at the request of the German medicines authority (BfArM) following reports of long-lasting side effects systemic and inhaled in the national safety database and the published literature. fluoroquinolone and quinolone antibiotics that MATERIAL AND METHODS involved peripheral and central nervous system, Retrospective analysis of ADRs reported in our APVD involving ciprofloxacin, flumequine, levofloxacin, tendons, muscles and joints lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, pefloxacin, prulifloxacin, rufloxacin, cinoxacin, nalidixic acid, reported from our pipemidic given systemically (by mouth or injection). The period considered is September 2016 to September Pharmacovigilance 2018. Department (PVD). RESULTS 22 ADRs were reported in our PVD involving fluoroquinolone and quinolone antibiotics in the period considered and that affected peripheral or central nervous system, tendons, muscles and joints. The mean patient age was 67,3 years (range: 17-92 years). 63,7% of the ADRs reported were serious, of which 22,7% caused hospitalization and 4,5% caused persistent/severe disability. 81,8% of the ADRs were reported by a healthcare professional (physician, pharmacist or other) and 18,2% by patient or a non-healthcare professional.
    [Show full text]
  • AMEG Categorisation of Antibiotics
    12 December 2019 EMA/CVMP/CHMP/682198/2017 Committee for Medicinal Products for Veterinary use (CVMP) Committee for Medicinal Products for Human Use (CHMP) Categorisation of antibiotics in the European Union Answer to the request from the European Commission for updating the scientific advice on the impact on public health and animal health of the use of antibiotics in animals Agreed by the Antimicrobial Advice ad hoc Expert Group (AMEG) 29 October 2018 Adopted by the CVMP for release for consultation 24 January 2019 Adopted by the CHMP for release for consultation 31 January 2019 Start of public consultation 5 February 2019 End of consultation (deadline for comments) 30 April 2019 Agreed by the Antimicrobial Advice ad hoc Expert Group (AMEG) 19 November 2019 Adopted by the CVMP 5 December 2019 Adopted by the CHMP 12 December 2019 Official address Domenico Scarlattilaan 6 ● 1083 HS Amsterdam ● The Netherlands Address for visits and deliveries Refer to www.ema.europa.eu/how-to-find-us Send us a question Go to www.ema.europa.eu/contact Telephone +31 (0)88 781 6000 An agency of the European Union © European Medicines Agency, 2020. Reproduction is authorised provided the source is acknowledged. Categorisation of antibiotics in the European Union Table of Contents 1. Summary assessment and recommendations .......................................... 3 2. Introduction ............................................................................................ 7 2.1. Background ........................................................................................................
    [Show full text]
  • FLUOROQUINOLONES: from Structure to Activity and Toxicity
    FLUOROQUINOLONES: from structure to activity and toxicity F. Van Bambeke, Pharm. D. & P. M. Tulkens, MD, PhD Unité de Pharmacologie Cellulaire et Moléculaire Université Catholique de Louvain, Brussels, Belgium SBIMC / BVIKM www.sbimc.org - www.bvikm.org www.md.ucl.ac.be/facm www.isap.org soon... Mechanism of action of fluoroquinolones: the basics... PORIN DNA Topo DNA gyrase isomerase Gram (-) Gram (+) 2 key enzymes in DNA replication: DNA gyrase topoisomerase IV bacterial DNA is supercoiled Ternary complex DNA - enzyme - fluoroquinolone DNA GYRASE catalytic subunits COVALENTLY CLOSED CIRCULAR DNA FLUOROQUINOLONES: DNA GYRASE ATP binding subunits 4 stacked molecules (Shen, in Quinolone Antimicrobial Agents, 1993) Resistance to fluoroquinolones: the basics decreased efflux pump permeability DNA mutation of DNA gyrase Topo isomerase the enzymes Gram (-) Gram (+) Fluoroquinolones are the first entirely man-made antibiotics: do we understand our molecule ? R5 O R COOH 6 R7 X8 N R1 Don’t panic, we will travel together…. Chemistry and Activity This is where all begins... The pharmacophore common to all fluoroquinolones BINDING TO DNA R5 O O R C 6 - BINDING TO O BINDING TO THE ENZYME THE ENZYME R7 X8 N R1 AUTO-ASSEMBLING DOMAIN (for stacking) From chloroquine to nalidixic acid... nalidixic acid N CH3 O O HN CH 3 C - O chloroquine CH N N Cl N 3 C2H5 1939 O O C O- 1962 Cl N 1958 C2H5 7-chloroquinoline (synthesis intermediate found to display antibacterial activity) Nalidixic acid * a • typical chemical features of O O fluoroquinolones (a, b, c) BUT a naphthridone C - O- b (N at position 8: ) H C N N 3 • limited usefulness as drug C H 2 5 • narrow antibacterial spectrum c (Enterobacteriaceae only) • short half-life (1.5h) • high protein binding (90%) * Belg.
    [Show full text]
  • Applications
    APPLICATIONS Zeshan Aqeel Senior Application Scientist A Screen of 22 Common Antibiotics that Demonstrates Zeshan loves to collect watches and the Back to the the Unique Reversed Phase Selectivity and Improved Future Trilogy. He has twin boys who drive him crazy! He Chromatographic Performance for Bases using a is an Apple Fanboy for life and ® he likes being in the lab more Kinetex PS C18 HPLC/UHPLC Column than anywhere else. Zeshan Aqeel, Jeff Layne, and Ryan Splitstone Phenomenex, Inc., 411 Madrid Ave, Torrance CA 90501 USA Overview Ciprofloxacin The Kinetex PS C18 is a USP classified L1 column, that provides Molecular Formula: C17H19FN3O3 both a unique polar/hydrophobic selectivity, and is 100 % aqueous Basic pKa: 8.77 stable. The column demonstrates enhanced selectivity and peak Acidic pKa: 5.56 shape for basic compounds under typical reversed phase condi- LogP: -0.86 tions. In addition, the solid support is a Kinetex core-shell (superfi- CH3 cially porous) particle morphology that provides ultra-high column + O S O 1 NH efficiency on any HPLC or UHPLC system. CH3 2 N N + O S O The mobile phase program chosen was a routine gradientNH of Acetonitrile with 0.1 % Formic Acid as the strong organic solvent2 and Water with 0.1 % Formic Acid as Nthe weak solvent.N The flow O F rate of 0.5 mL/min was used, and the column heater was set to ambient temperature (25 °C).O OH O F F OH Introduction OH O HO N In this application, 22 antibiotics were analyzed to demonstrate the F OH Kinetex PS C18 HPLC/UHPLC column’s unique multi-modal selec- F tivity and improved chromatographic performance for polar bases.
    [Show full text]
  • Disabling and Potentially Permanent Side Effects Lead to Suspension Or Restrictions of Quinolone and Fluoroquinolone Antibiotics
    16 November 2018 EMA/795349/2018 Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics EMA has reviewed serious, disabling and potentially permanent side effects with quinolone and fluoroquinolone antibiotics given by mouth, injection or inhalation. The review incorporated the views of patients, healthcare professionals and academics presented at EMA’s public hearing on fluoroquinolone and quinolone antibiotics in June 2018. EMA’s human medicines committee (CHMP) has endorsed the recommendations of EMA’s safety committee (PRAC) and concluded that the marketing authorisation of medicines containing cinoxacin, flumequine, nalidixic acid, and pipemidic acid should be suspended. The CHMP confirmed that the use of the remaining fluoroquinolone antibiotics should be restricted. In addition, the prescribing information for healthcare professionals and information for patients will describe the disabling and potentially permanent side effects and advise patients to stop treatment with a fluoroquinolone antibiotic at the first sign of a side effect involving muscles, tendons or joints and the nervous system. Restrictions on the use of fluoroquinolone antibiotics will mean that they should not be used: • to treat infections that might get better without treatment or are not severe (such as throat infections); • to treat non-bacterial infections, e.g. non-bacterial (chronic) prostatitis; • for preventing traveller’s diarrhoea or recurring lower urinary tract infections (urine infections that do not extend beyond the bladder); • to treat mild or moderate bacterial infections unless other antibacterial medicines commonly recommended for these infections cannot be used. Importantly, fluoroquinolones should generally be avoided in patients who have previously had serious side effects with a fluoroquinolone or quinolone antibiotic.
    [Show full text]
  • The Grohe Method and Quinolone Antibiotics
    The Grohe method and quinolone antibiotics Antibiotics are medicines that are used to treat bacterial for modern fluoroquinolones. The Grohe process and the infections. They contain active ingredients belonging to var- synthesis of ciprofloxacin sparked Bayer AG’s extensive ious substance classes, with modern fluoroquinolones one research on fluoroquinolones and the global competition of the most important and an indispensable part of both that produced additional potent antibiotics. human and veterinary medicine. It is largely thanks to Klaus Grohe – the “father of Bayer quinolones” – that this entirely In chemical terms, the antibiotics referred to for simplicity synthetic class of antibiotics now plays such a vital role for as quinolones are derived from 1,4-dihydro-4-oxo-3-quin- medical practitioners. From 1965 to 1997, Grohe worked oline carboxylic acid (1) substituted in position 1. as a chemist, carrying out basic research at Bayer AG’s Fluoroquinolones possess a fluorine atom in position 6. In main research laboratory (WHL) in Leverkusen. During this addition, ciprofloxacin (2) has a cyclopropyl group in posi- period, in 1975, he developed the Grohe process – a new tion 1 and also a piperazine group in position 7 (Figure A). multi-stage synthesis method for quinolones. It was this This substituent pattern plays a key role in its excellent achievement that first enabled him to synthesize active an- antibacterial efficacy. tibacterial substances such as ciprofloxacin – the prototype O 5 O 4 3 6 COOH F COOH 7 2 N N N 8 1 H N R (1) (2) Figure A: Basic structure of quinolone (1) (R = various substituents) and ciprofloxacin (2) Quinolones owe their antibacterial efficacy to their inhibition This unique mode of action also makes fluoroquinolones of essential bacterial enzymes – DNA gyrase (topoisomer- highly effective against a large number of pathogenic ase II) and topoisomerase IV.
    [Show full text]
  • Investigation of the Correlation Between the Use of Antibiotics In
    Supplementary Materials Investigation of the Correlation between the Use of Antibiotics in Aquaculture Systems and their Detection in Aquatic Environments: A Case Study of the Nera River Aquafarms in Italy Marta Sargenti 1,*, Silvia Bartolacci 2, Aurora Luciani 3, Katiuscia Di Biagio 2, Marco Baldini 2, Roberta Galarini 1, Danilo Giusepponi 1 and Marinella Capuccella 1 Table S1. Summary of information on sampling points and related aquafarms with specification of quantity and type of production. Sampling Coordinates (N, Upstream Aquafarms1 Fattening Aquafarms1 Prefattening Aquafarms1 Juvenile Aquafarms1 No-Prescription Aquafarms1 Points E) (n°) (n°) (n°) (n°) (n°) P1 42.90717, 13.03294 4 3 – 1 1 P2 42.87999, 12.99158 5 3 1 1 1 P3 42.81428, 12.91549 4 – – – 1 P4 42.71214, 12.82946 2 2 – – 1 P5 42.58246, 12.75803 – – – – – P1: Molini; P2: Pontechiusita; P3: Borgo Cerreto; P4: Scheggino; P5: Casteldilago. 1All the farms' information were extracted from the italian national database (Banca Dati Nazionale—BDN). Accesible at: https://www.vetinfo.it/. Table S2. List of antibiotics and their abbreviations with the relevant limits of detection (LODs) included in the method developed for river waters (64 compounds) and for sediments (56 compounds). LOD LOD Analyte Abbreviation Class Waters (ng/L) Sediments (ng/g) Florfenicol amine (florfenicol metabolite) FFA 1 1 Florfenicol FF Amphenicols (3) 1 1 Thiamfenicol TMF 1 1 Amoxicillin AMX 100 - Ampicillin AMP 10 10 Cefacetrile CEF 10 - Cefalexin LEX 1 10 Cefalonium CLM 10 - Cefapirin CFP 1 10 Cefazoline
    [Show full text]
  • Customs Tariff - Schedule
    CUSTOMS TARIFF - SCHEDULE 99 - i Chapter 99 SPECIAL CLASSIFICATION PROVISIONS - COMMERCIAL Notes. 1. The provisions of this Chapter are not subject to the rule of specificity in General Interpretative Rule 3 (a). 2. Goods which may be classified under the provisions of Chapter 99, if also eligible for classification under the provisions of Chapter 98, shall be classified in Chapter 98. 3. Goods may be classified under a tariff item in this Chapter and be entitled to the Most-Favoured-Nation Tariff or a preferential tariff rate of customs duty under this Chapter that applies to those goods according to the tariff treatment applicable to their country of origin only after classification under a tariff item in Chapters 1 to 97 has been determined and the conditions of any Chapter 99 provision and any applicable regulations or orders in relation thereto have been met. 4. The words and expressions used in this Chapter have the same meaning as in Chapters 1 to 97. Issued January 1, 2019 99 - 1 CUSTOMS TARIFF - SCHEDULE Tariff Unit of MFN Applicable SS Description of Goods Item Meas. Tariff Preferential Tariffs 9901.00.00 Articles and materials for use in the manufacture or repair of the Free CCCT, LDCT, GPT, UST, following to be employed in commercial fishing or the commercial MT, MUST, CIAT, CT, harvesting of marine plants: CRT, IT, NT, SLT, PT, COLT, JT, PAT, HNT, Artificial bait; KRT, CEUT, UAT, CPTPT: Free Carapace measures; Cordage, fishing lines (including marlines), rope and twine, of a circumference not exceeding 38 mm; Devices for keeping nets open; Fish hooks; Fishing nets and netting; Jiggers; Line floats; Lobster traps; Lures; Marker buoys of any material excluding wood; Net floats; Scallop drag nets; Spat collectors and collector holders; Swivels.
    [Show full text]
  • Alphabetical Listing of ATC Drugs & Codes
    Alphabetical Listing of ATC drugs & codes. Introduction This file is an alphabetical listing of ATC codes as supplied to us in November 1999. It is supplied free as a service to those who care about good medicine use by mSupply support. To get an overview of the ATC system, use the “ATC categories.pdf” document also alvailable from www.msupply.org.nz Thanks to the WHO collaborating centre for Drug Statistics & Methodology, Norway, for supplying the raw data. I have intentionally supplied these files as PDFs so that they are not quite so easily manipulated and redistributed. I am told there is no copyright on the files, but it still seems polite to ask before using other people’s work, so please contact <[email protected]> for permission before asking us for text files. mSupply support also distributes mSupply software for inventory control, which has an inbuilt system for reporting on medicine usage using the ATC system You can download a full working version from www.msupply.org.nz Craig Drown, mSupply Support <[email protected]> April 2000 A (2-benzhydryloxyethyl)diethyl-methylammonium iodide A03AB16 0.3 g O 2-(4-chlorphenoxy)-ethanol D01AE06 4-dimethylaminophenol V03AB27 Abciximab B01AC13 25 mg P Absorbable gelatin sponge B02BC01 Acadesine C01EB13 Acamprosate V03AA03 2 g O Acarbose A10BF01 0.3 g O Acebutolol C07AB04 0.4 g O,P Acebutolol and thiazides C07BB04 Aceclidine S01EB08 Aceclidine, combinations S01EB58 Aceclofenac M01AB16 0.2 g O Acefylline piperazine R03DA09 Acemetacin M01AB11 Acenocoumarol B01AA07 5 mg O Acepromazine N05AA04
    [Show full text]
  • Fluoroquinolone and Quinolone Antibiotics: PRAC Recommends Restrictions on Use New Restrictions Follow Review of Disabling and Potentially Long-Lasting Side Effects
    5 October 2018 EMA/668915/2018 Fluoroquinolone and quinolone antibiotics: PRAC recommends restrictions on use New restrictions follow review of disabling and potentially long-lasting side effects EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) has recommended restricting the use of fluoroquinolone and quinolone antibiotics (used by mouth, injection or inhalation) following a review of disabling and potentially long-lasting side effects reported with these medicines. The review incorporated the views of patients, healthcare professionals and academics presented at EMA’s public hearing on fluoroquinolone and quinolone antibiotics in June 2018. Very rarely, patients treated with fluoroquinolone or quinolone antibiotics have suffered long-lasting and disabling side effects, mainly involving muscles, tendons and bones and the nervous system. Following its evaluation of these side effects, the PRAC has recommended that some medicines, including all those that contain a quinolone antibiotic, should be removed from the market. This is because they are authorised only for infections that should no longer be treated with this class of antibiotics. The PRAC recommended that the remaining fluoroquinolone antibiotics should: • not be used − to treat infections that might get better without treatment or are not severe (such as throat infections); − for preventing traveller’s diarrhoea or recurring lower urinary tract infections (urine infections that do not extend beyond the bladder); − to treat patients who have previously had serious side effects with a fluoroquinolone or quinolone antibiotic; − to treat mild or moderately severe infections unless other antibacterial medicines commonly recommended for these infections cannot be used; • be used with caution especially for the elderly, patients with kidney problems, patients who have had an organ transplantation or those who are being treated with a systemic corticosteroid.
    [Show full text]
  • Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DIX to the HTSUS—Continued
    20558 Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DEPARMENT OF THE TREASURY Services, U.S. Customs Service, 1301 TABLE 1.ÐPHARMACEUTICAL APPEN- Constitution Avenue NW, Washington, DIX TO THE HTSUSÐContinued Customs Service D.C. 20229 at (202) 927±1060. CAS No. Pharmaceutical [T.D. 95±33] Dated: April 14, 1995. 52±78±8 ..................... NORETHANDROLONE. A. W. Tennant, 52±86±8 ..................... HALOPERIDOL. Pharmaceutical Tables 1 and 3 of the Director, Office of Laboratories and Scientific 52±88±0 ..................... ATROPINE METHONITRATE. HTSUS 52±90±4 ..................... CYSTEINE. Services. 53±03±2 ..................... PREDNISONE. 53±06±5 ..................... CORTISONE. AGENCY: Customs Service, Department TABLE 1.ÐPHARMACEUTICAL 53±10±1 ..................... HYDROXYDIONE SODIUM SUCCI- of the Treasury. NATE. APPENDIX TO THE HTSUS 53±16±7 ..................... ESTRONE. ACTION: Listing of the products found in 53±18±9 ..................... BIETASERPINE. Table 1 and Table 3 of the CAS No. Pharmaceutical 53±19±0 ..................... MITOTANE. 53±31±6 ..................... MEDIBAZINE. Pharmaceutical Appendix to the N/A ............................. ACTAGARDIN. 53±33±8 ..................... PARAMETHASONE. Harmonized Tariff Schedule of the N/A ............................. ARDACIN. 53±34±9 ..................... FLUPREDNISOLONE. N/A ............................. BICIROMAB. 53±39±4 ..................... OXANDROLONE. United States of America in Chemical N/A ............................. CELUCLORAL. 53±43±0
    [Show full text]
  • Refer to Annex I at the End of This Document
    ____________________________________________________________________________ PRAC recommends restriction use of quinolones and fluoroquinolones ____________________________________________________________________________ 24.10.18 | Circular Number P18/2018 Information on quinolones and fluoroquinolones • Fluoroquinolones and quinolones are a class of broad-spectrum antibiotics that are active against bacteria of both Gram-negative and Gram-positive classes. • The review covered the following medicines: ciprofloxacin, flumequine, levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, pefloxacin, prulifloxacin and rufloxacin (fluoroquinolone antibiotics); cinoxacin, nalidixic acid, pipemidic acid (quinolone antibiotics). • The review concerned only medicines given systemically (by mouth or injection) and inhaled medicines. In Malta four different fluoroquinolone antibiotics are authorised through national procedures. These are ciprofloxacin, levofloxacin, moxifloxacin and norfloxacin. For more details on fluoroquinolone containing products authorised in Malta refer to Annex I at the end of this document. Information from the EMA about long-lasting side effects of quinolones and fluoroquinolones In February 2017, the Pharmacovigilance Risk Assessment Committee (PRAC) started a review on fluoroquinolone and quinolone antibiotics (used by mouth, injection or inhalation) under Article 31 of Directive 2001/83/EC. The review was carried out due to the disabling and potentially long-lasting side effects reported with these medicines.
    [Show full text]