Consecutive Radical S-Adenosylmethionine Methylations Form the Ethyl Side Chain in Thienamycin Biosynthesis
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Essential Medicines List (EML) 2019 Application for the inclusion of imipenem/cilastatin, meropenem and amoxicillin/clavulanic acid in the WHO Model List of Essential Medicines, as reserve second-line drugs for the treatment of multidrug-resistant tuberculosis (complementary lists of anti-tuberculosis drugs for use in adults and children) General items 1. Summary statement of the proposal for inclusion, change or deletion This application concerns the updating of the forthcoming WHO Model List of Essential Medicines (EML) and WHO Model List of Essential Medicines for Children (EMLc) to include the following medicines: 1) Imipenem/cilastatin (Imp-Cln) to the main list but NOT the children’s list (it is already mentioned on both lists as an option in section 6.2.1 Beta Lactam medicines) 2) Meropenem (Mpm) to both the main and the children’s lists (it is already on the list as treatment for meningitis in section 6.2.1 Beta Lactam medicines) 3) Clavulanic acid to both the main and the children’s lists (it is already listed as amoxicillin/clavulanic acid (Amx-Clv), the only commercially available preparation of clavulanic acid, in section 6.2.1 Beta Lactam medicines) This application makes reference to amendments recommended in particular to section 6.2.4 Antituberculosis medicines in the latest editions of both the main EML (20th list) and the EMLc (6th list) released in 2017 (1),(2). On the basis of the most recent Guideline Development Group advising WHO on the revision of its guidelines for the treatment of multidrug- or rifampicin-resistant (MDR/RR-TB)(3), the applicant considers that the three agents concerned be viewed as essential medicines for these forms of TB in countries. -
In Vitro and in Vivo Study of Fosfomycin in Methicillin-Resistant Staphylococcus Aureus Septicaemia
J. Ilyg., Camb. (1980), 96, 419-423 419 Printed in Great Britain In vitro and in vivo study of fosfomycin in methicillin-resistant Staphylococcus aureus septicaemia BY W. Y. LAU, C. H. TEOH-CHAN,* S. T. FAN AND K. F. LAU* Government Surgical Unit, Queen Mary Hospital, and * Department of Microbiology, University of Hong Kong {Received 15 October 19S5; accepted 12 December 19S5) SUMMARY Five hundred strains of methicillin-resistant Staphylococcus aureus were tested against various anti-staphylococcal agents. Vancomycin, fusidic acid and fosfo- mycin were found to be the most effective. Only 1 strain out of 500 was resistant to fosfomycin. Three patients with methicillin-resistant Staphylococcus aureus septicaemia were successfully treated by fosfomycin. We conclude that fosfomycin could be the drug of choice for methicillin-resistant Staphylococcns aureus infection. INTRODUCTION Outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infection are causing increasing problems in centres all over the world (Thompson & Wenzel, 1982; Editorial, 1983). There has been a gradual increase in the incidence of MRSA in our hospital in Hong Kong from 317 in 1982 (18-7% of all S. aureus isolated) to 511 in 1983 (32-7%) and 833 in 1984 (34-9%). In vitro, resistance of MRSA is often demonstrated to many anti-staphylococcal agents including the penicillins, first-generation cephalosporins, aminoglycosides, erythromycin, clindamycin and chloramphenicol (Peacock et al. 1981). Second- and third-generation cephalosporins also have poor activity in vitro (Thompson, Fisher & Wenzel, 1982) though many MRSA strains have been found to be susceptible to rifampicin, trimethoprim- sulphamethoxazole and fusidic acid (Watanakunakorn, 1983). However, clinical experience of treating serious staphylococeal infection with rifampicin and trimethoprim-siilphamethoxazole is limited (Guenther & Wenzel, 1984) and fully resistant organisms may emerge rapidly after exposure to fusidic acid in vitro and in vivo (Watanakunakorn, 1983). -
Thienamycin (Imipenem)
1520 THE JOURNAL OF ANTIBIOTICS OCT. 1989 CONVERSION OF OA-6129 B2 INTO OA-6129 B2, a fermentation carbapenem product, (5i?,6^)-6-[(i?)- l -FLUOROETHYL]-7- into optically active 88617, an 8-fluorinated OXO- 3 -[(7V,Ar,Ar-TRIM ETHYL- carbapenem derivative which improved antimicro- CARBAMIMIDOYL)METHYL]THIO- bial activity and dehydropeptidase-I stability. l -AZABICYCLO[3.2.0]HEPT-2-ENE- Treatment of OA-6129B2 sodium salt 1 with 2-CARBOXYLIC ACID (88617)t /7-nitrobenzyl (PNB) bromide or pivaloyloxymethyl chloride in DMFgave /?NB ester 2 or pivaloyl- Takeo Yoshioka, AzumaWatanabe, oxymethyl (POM) ester 3 of OA-6129 B2 (Fig. 1). Noritaka Chida and Yasuo Fukagawa The two hydroxyl groups in the pantoyl moiety of OA-6129B2 were protected by isopropylidena- Central Research Laboratories, tion for differentiation from the C-8 hydroxyl Sanraku Incorporated, 4-9-1 Johnan, Fujisawa 251, Japan group. The protected compound4 or 5 was allowed to (Received for publication May 25, 1989) react with 1.2 equiv of diethylaminosulfur trifluoride (DAST)11} at -68°C in methylene chloride for 10 minutes. After the reaction mixture was diluted with Since the epoch-making discovery of thienamy- methylene chloride and washed with a saturated cin2), a numberof extensive studies have been carried aqueous sodium bicarbonate solution, silica gel out on the development of clinically useful car- column chromatography of the organic layer pro- bapenem compounds. As a result, formimidoyl- vided the desired fluorinated compound 6 or 7 thienamycin (imipenem) has recently been put on having a fluorine atom in the R configuration at C-8 the market as a combination drug (Primaxin)3) in 43 or 49% yield, respectively. -
New Β-Lactamase Inhibitor Combinations: Options for Treatment; Challenges for Testing
MEDICAL/SCIENTIFIC AffAIRS BULLETIN New β-lactamase Inhibitor Combinations: Options for Treatment; Challenges for Testing Background The β-lactam class of antimicrobial agents has played a crucial role in the treatment of infectious diseases since the discovery of penicillin, but β–lactamases (enzymes produced by the bacteria that can hydrolyze the β-lactam core of the antibiotic) have provided an ever expanding threat to their successful use. Over a thousand β-lactamases have been described. They can be divided into classes based on their molecular structure (Classes A, B, C and D) or their function (e.g., penicillinase, oxacillinase, extended-spectrum activity, or carbapenemase activity).1 While the first approach to addressing the problem ofβ -lactamases was to develop β-lactamase stable β-lactam antibiotics, such as extended-spectrum cephalosporins, another strategy that has emerged is to combine existing β-lactam antibiotics with β-lactamase inhibitors. Key β-lactam/β-lactamase inhibitor combinations that have been used widely for over a decade include amoxicillin/clavulanic acid, ampicillin/sulbactam, and pipercillin/tazobactam. The continued use of β-lactams has been threatened by the emergence and spread of extended-spectrum β-lactamases (ESBLs) and more recently by carbapenemases. The global spread of carbapenemase-producing organisms (CPOs) including Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii, limits the use of all β-lactam agents, including extended-spectrum cephalosporins (e.g., cefotaxime, ceftriaxone, and ceftazidime) and the carbapenems (doripenem, ertapenem, imipenem, and meropenem). This has led to international concern and calls to action, including encouraging the development of new antimicrobial agents, enhancing infection prevention, and strengthening surveillance systems. -
Penicillin Allergy Guidance Document
Penicillin Allergy Guidance Document Key Points Background Careful evaluation of antibiotic allergy and prior tolerance history is essential to providing optimal treatment The true incidence of penicillin hypersensitivity amongst patients in the United States is less than 1% Alterations in antibiotic prescribing due to reported penicillin allergy has been shown to result in higher costs, increased risk of antibiotic resistance, and worse patient outcomes Cross-reactivity between truly penicillin allergic patients and later generation cephalosporins and/or carbapenems is rare Evaluation of Penicillin Allergy Obtain a detailed history of allergic reaction Classify the type and severity of the reaction paying particular attention to any IgE-mediated reactions (e.g., anaphylaxis, hives, angioedema, etc.) (Table 1) Evaluate prior tolerance of beta-lactam antibiotics utilizing patient interview or the electronic medical record Recommendations for Challenging Penicillin Allergic Patients See Figure 1 Follow-Up Document tolerance or intolerance in the patient’s allergy history Consider referring to allergy clinic for skin testing Created July 2017 by Macey Wolfe, PharmD; John Schoen, PharmD, BCPS; Scott Bergman, PharmD, BCPS; Sara May, MD; and Trevor Van Schooneveld, MD, FACP Disclaimer: This resource is intended for non-commercial educational and quality improvement purposes. Outside entities may utilize for these purposes, but must acknowledge the source. The guidance is intended to assist practitioners in managing a clinical situation but is not mandatory. The interprofessional group of authors have made considerable efforts to ensure the information upon which they are based is accurate and up to date. Any treatments have some inherent risk. Recommendations are meant to improve quality of patient care yet should not replace clinical judgment. -
Carbapenem-Resistant Acinetobacter Threat Level Urgent
CARBAPENEM-RESISTANT ACINETOBACTER THREAT LEVEL URGENT 8,500 700 $281M Estimated cases Estimated Estimated attributable in hospitalized deaths in 2017 healthcare costs in 2017 patients in 2017 Acinetobacter bacteria can survive a long time on surfaces. Nearly all carbapenem-resistant Acinetobacter infections happen in patients who recently received care in a healthcare facility. WHAT YOU NEED TO KNOW CASES OVER TIME ■ Carbapenem-resistant Acinetobacter cause pneumonia Continued infection control and appropriate antibiotic use and wound, bloodstream, and urinary tract infections. are important to maintain decreases in carbapenem-resistant These infections tend to occur in patients in intensive Acinetobacter infections. care units. ■ Carbapenem-resistant Acinetobacter can carry mobile genetic elements that are easily shared between bacteria. Some can make a carbapenemase enzyme, which makes carbapenem antibiotics ineffective and rapidly spreads resistance that destroys these important drugs. ■ Some Acinetobacter are resistant to nearly all antibiotics and few new drugs are in development. CARBAPENEM-RESISTANT ACINETOBACTER A THREAT IN HEALTHCARE TREATMENT OVER TIME Acinetobacter is a challenging threat to hospitalized Treatment options for infections caused by carbapenem- patients because it frequently contaminates healthcare resistant Acinetobacter baumannii are extremely limited. facility surfaces and shared medical equipment. If not There are few new drugs in development. addressed through infection control measures, including rigorous -
Profile Profile Profile Uses and Administration
Gramicidin/lmipenem 309 Graneodin N; Graneodin; Gripaben Caramelos; Kenacomb; t Incompatibility and stability. Intipenem is unstable at Nasomicina; Neo Coltirot; Pantometilt; Proetztotal; Tosedrin �-�P.�.�� ����---········································································· alkaline or acidic pH and the commercially available injec (details are given in Volume B) NF; Austral.: Kenacomb; Neosporint; Otocomb Otic; Otodex; ProprielaryPreparations tion of intipenem with cilastatin sodium for intravenous Sofradex; Soframycint; Austria: Volon A antibiotikahaltigt; V alpeda. use is buffered to provide, when reconstituted, a solution Belg. : Mycolog; Polyspectran Granticidinet; Braz.: Fonergin; Single-ingredient Preparations. UK: with pH 6.5 to 7.5. Licensed product information advises Londerm-Nt; Mud; Neolon D; Omcilon-A M; Oncibel; Oncileg; against mixing with other antibacterials. Onciplust; Canad.: Ak Spor; Antibiotic Cream; Antibiotic Plus; Complete Antibiotic Ointment; Diosporint; Neosporin; Opti lbafloxacin (BAN, USAN, r/NN) References. cort; Optimyxin Plus; Optimyxin; Polysporin Complete; Poly 1. Bigley FP, et al. Compatibility of imipenem-dlastatin sodium with Am Hosp Phann 1986; 43: 2803- sporin For Kids; Polysporin Plus Pain Relief; Polysporin Triple commonly used intravenous solutions. 9. J Antibiotic; Polysporin; Polytopic; ratio-Tria comb; Sofracort; 2. Smith GB, et al. Stability and kinetics of degradation of imipenem in Soframycin; Soframycin; Triple Antibiotic Ointment; Viaderm Pharm 1990; 79: 732-40. aqueous -
Radical Sam Enzymes in Thienamycin Biosynthesis
RADICAL SAM ENZYMES IN THIENAMYCIN BIOSYNTHESIS by Daniel Roe Marous A dissertation submitted to The Johns Hopkins University in conformity with the requirements for the degree of Doctor of Philosophy Baltimore, Maryland December, 2015 ©Daniel Roe Marous 2015 All rights reserved Abstract Despite its broad anti-infective activity, the biosynthesis of the paradigm carbapenem antibiotic, thienamycin, remains largely unknown. Apart from the first two biosynthetic steps shared with a simple carbapenem, the pathway sharply diverges to the more structurally complex members of this class of β-lactam antibiotics like thienamycin. Existing evidence points to three putative cobalamin-dependent, radical S- adenosylmethionine (RS) enzymes, ThnK, ThnL and ThnP, potentially being responsible for assembly of the ethyl side chain at C6, bridgehead epimerization at C5, installation of the C2-thioether side chain and C2/3-desaturation. The C2 substituent has been demonstrated to be derived from stepwise truncation of coenzyme A, but the timing of these events with respect to C2—S bond formation is not known. Using in vitro reactions with synthetically-accessed substrates, we show that ThnK of the three apparent cobalamin-dependent RS enzymes performs sequential methylations to build out the C6- ethyl side chain in a stereocontrolled manner. This enzymatic reaction produced the expected RS methylase coproducts S-adenosylhomocysteine (SAH) and 5’- deoxyadenosine (5’-dA) by LC-MS and was also found to require cobalamin. For double methylation to occur, the carbapenam substrate must bear a coenzyme A-derived C2- thioether side chain, implying the activity of a prior sulfur insertion by an unidentified enzyme. Heterologous expression of thienamycin biosynthetic enzymes in Streptomyces combined with a competition bioassay now implicates ThnL in attachment of the thioether. -
Computational Antibiotics Book
Andrew V DeLong, Jared C Harris, Brittany S Larcart, Chandler B Massey, Chelsie D Northcutt, Somuayiro N Nwokike, Oscar A Otieno, Harsh M Patel, Mehulkumar P Patel, Pratik Pravin Patel, Eugene I Rowell, Brandon M Rush, Marc-Edwin G Saint-Louis, Amy M Vardeman, Felicia N Woods, Giso Abadi, Thomas J. Manning Computational Antibiotics Valdosta State University is located in South Georgia. Computational Antibiotics Index • Computational Details and Website Access (p. 8) • Acknowledgements (p. 9) • Dedications (p. 11) • Antibiotic Historical Introduction (p. 13) Introduction to Antibiotic groups • Penicillin’s (p. 21) • Carbapenems (p. 22) • Oxazolidines (p. 23) • Rifamycin (p. 24) • Lincosamides (p. 25) • Quinolones (p. 26) • Polypeptides antibiotics (p. 27) • Glycopeptide Antibiotics (p. 28) • Sulfonamides (p. 29) • Lipoglycopeptides (p. 30) • First Generation Cephalosporins (p. 31) • Cephalosporin Third Generation (p. 32) • Fourth-Generation Cephalosporins (p. 33) • Fifth Generation Cephalosporin’s (p. 34) • Tetracycline antibiotics (p. 35) Computational Antibiotics Antibiotics Covered (in alphabetical order) Amikacin (p. 36) Cefempidone (p. 98) Ceftizoxime (p. 159) Amoxicillin (p. 38) Cefepime (p. 100) Ceftobiprole (p. 161) Ampicillin (p. 40) Cefetamet (p. 102) Ceftoxide (p. 163) Arsphenamine (p. 42) Cefetrizole (p. 104) Ceftriaxone (p. 165) Azithromycin (p.44) Cefivitril (p. 106) Cefuracetime (p. 167) Aziocillin (p. 46) Cefixime (p. 108) Cefuroxime (p. 169) Aztreonam (p.48) Cefmatilen ( p. 110) Cefuzonam (p. 171) Bacampicillin (p. 50) Cefmetazole (p. 112) Cefalexin (p. 173) Bacitracin (p. 52) Cefodizime (p. 114) Chloramphenicol (p.175) Balofloxacin (p. 54) Cefonicid (p. 116) Cilastatin (p. 177) Carbenicillin (p. 56) Cefoperazone (p. 118) Ciprofloxacin (p. 179) Cefacetrile (p. 58) Cefoselis (p. 120) Clarithromycin (p. 181) Cefaclor (p. -
PRIMAXIN (Imipenem and Cilastatin)
• Known hypersensitivity to any component of PRIMAXIN (4) HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use ----------------------- WARNINGS AND PRECAUTIONS ---------------------- PRIMAXIN safely and effectively. See full prescribing information • Hypersensitivity Reactions: Serious and occasionally fatal for PRIMAXIN. hypersensitivity (anaphylactic) reactions have been reported in patients receiving therapy with beta-lactams. If an allergic reaction PRIMAXIN® (imipenem and cilastatin) for Injection, for to PRIMAXIN occurs, discontinue the drug immediately (5.1). intravenous use • Seizure Potential: Seizures and other CNS adverse reactions, such Initial U.S. Approval: 1985 as confusional states and myoclonic activity, have been reported during treatment with PRIMAXIN. If focal tremors, myoclonus, or --------------------------- RECENT MAJOR CHANGES -------------------------- seizures occur, patients should be evaluated neurologically, placed Indications and Usage (1.9) 12/2016 on anticonvulsant therapy if not already instituted, and the dosage of Dosage and Administration (2) 12/2016 PRIMAXIN re-examined to determine whether it should be decreased or the antibacterial drug discontinued (5.2). ----------------------------INDICATIONS AND USAGE --------------------------- • Increased Seizure Potential Due to Interaction with Valproic Acid: PRIMAXIN for intravenous use is a combination of imipenem, a penem Co-administration of PRIMAXIN, to patients receiving valproic acid antibacterial, and cilastatin, a renal dehydropeptidase inhibitor, or divalproex sodium results in a reduction in valproic acid indicated for the treatment of the following serious infections caused by concentrations. The valproic acid concentrations may drop below designated susceptible bacteria: the therapeutic range as a result of this interaction, therefore • Lower respiratory tract infections. (1.1) increasing the risk of breakthrough seizures. The concomitant use of • Urinary tract infections. -
Management of Penicillin and Beta-Lactam Allergy
Management of Penicillin and Beta-Lactam Allergy (NB Provincial Health Authorities Anti-Infective Stewardship Committee, September 2017) Key Points • Beta-lactams are generally safe; allergic and adverse drug reactions are over diagnosed and over reported • Nonpruritic, nonurticarial rashes occur in up to 10% of patients receiving penicillins. These rashes are usually not allergic and are not a contraindication to the use of a different beta-lactam • The frequently cited risk of 8 to 10% cross-reactivity between penicillins and cephalosporins is an overestimate based on studies from the 1970’s that are now considered flawed • Expect new intolerances (i.e. any allergy or adverse reaction reported in a drug allergy field) to be reported after 0.5 to 4% of all antimicrobial courses depending on the gender and specific antimicrobial. Expect a higher incidence of new intolerances in patients with three or more prior medication intolerances1 • For type-1 immediate hypersensitivity reactions (IgE-mediated), cross-reactivity among penicillins (table 1) is expected due to similar core structure and/or major/minor antigenic determinants, use not recommended without desensitization • For type-1 immediate hypersensitivity reactions, cross-reactivity between penicillins (table 1) and cephalosporins is due to similarities in the side chains; risk of cross-reactivity will only be significant between penicillins and cephalosporins with similar side chains • Only type-1 immediate hypersensitivity to a penicillin manifesting as anaphylaxis, bronchospasm, -
The Use of Natural Product Substrates for the Synthesis of Libraries of Biologically Active, New Chemical Entities
University of Montana ScholarWorks at University of Montana Graduate Student Theses, Dissertations, & Graduate School Professional Papers 2010 The seU of Natural Product Substrates for the Synthesis of Libraries of Biologically Active, New Chemical Entities Joshua Bryant Phillips The University of Montana Let us know how access to this document benefits ouy . Follow this and additional works at: https://scholarworks.umt.edu/etd Recommended Citation Phillips, Joshua Bryant, "The sU e of Natural Product Substrates for the Synthesis of Libraries of Biologically Active, New Chemical Entities" (2010). Graduate Student Theses, Dissertations, & Professional Papers. 1100. https://scholarworks.umt.edu/etd/1100 This Dissertation is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact [email protected]. THE USE OF NATURAL PRODUCT SUBSTRATES FOR THE SYNTHESIS OF LIBRARIES OF BIOLOGICALLY ACTIVE, NEW CHEMICAL ENTITIES by Joshua Bryant Phillips B.S. Chemistry, Northern Arizona University, 2002 B.S. Microbiology (health pre-professional), Northern Arizona University, 2002 Presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy Chemistry The University of Montana June 2010 Phillips, Joshua Bryant Ph.D., June 2010 Chemistry THE USE OF NATURAL PRODUCT SUBSTRATES FOR THE SYNTHESIS OF LIBRARIES OF BIOLOGICALLY ACTIVE, NEW CHEMICAL ENTITIES Advisor: Dr. Nigel D. Priestley Chairperson: Dr. Bruce Bowler ABSTRACT Since Alexander Fleming first noted the killing of a bacterial culture by a mold, antibiotics have revolutionized medicine, being able to treat, and often cure life-threatening illnesses and making surgical procedures possible by eliminating the possibility of opportunistic infection.