Azalide

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Azithromycin Azithromycin structure.svg
Azithromycin

Azalides such as azithromycin are a class of macrolide antibiotics that were originally manufactured in response to the poor acid stability exhibited by original macrolides (erythromycin). [1] Following the clinical overuse of macrolides and azalides, ketolides have been developed to combat surfacing macrolide-azalide resistance among streptococci species. [2] Azalides have several advantages over erythromycin such as more potent gram negative antimicrobial activity, acid stability, and side effect tolerability. [3] Although there are few drug interactions with azithromycin, it weakly inhibits the CYP4A4 enzyme. [2]

Contents

Structure

Azalides feature a nitrogen atom in their 15-membered macrolide ring resulting in improved pharmacokinetic properties and greater stability when compared to earlier generation macrolides. [2] , [3] Replacement of the ketone group in traditional macrolides with a tertiary amine group confers greater acid stability. [3] , [4] See Beckmann rearrangement.

Mechanism of action

Azalides bind to the bacterial 50S ribosomal subunit and inhibit polypeptide elongation by hindering peptidyl transfer RNA translocation. [3]

Pharmacokinetics

Applicable pharmacokinetic indexes are free azalide AUC24/MIC because of the post antibiotic effect they exhibit, and free azalide concentration/MIC. [3] , [5] Due to their large volume of distribution and lipophilic structure, azalides concentrate effectively in tissue. [3]

Related Research Articles

<span class="mw-page-title-main">Antibiotic</span> Antimicrobial substance active against bacteria

An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of such infections. They may either kill or inhibit the growth of bacteria. A limited number of antibiotics also possess antiprotozoal activity. Antibiotics are not effective against viruses such as the common cold or influenza; drugs which inhibit growth of viruses are termed antiviral drugs or antivirals rather than antibiotics. They are also not effective against fungi; drugs which inhibit growth of fungi are called antifungal drugs.

<span class="mw-page-title-main">Erythromycin</span> Chemical compound

Erythromycin is an antibiotic used for the treatment of a number of bacterial infections. This includes respiratory tract infections, skin infections, chlamydia infections, pelvic inflammatory disease, and syphilis. It may also be used during pregnancy to prevent Group B streptococcal infection in the newborn, as well as to improve delayed stomach emptying. It can be given intravenously and by mouth. An eye ointment is routinely recommended after delivery to prevent eye infections in the newborn.

<span class="mw-page-title-main">Macrolide</span> Class of natural products

The Macrolides are a class of natural products that consist of a large macrocyclic lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, may be attached. The lactone rings are usually 14-, 15-, or 16-membered. Macrolides belong to the polyketide class of natural products. Some macrolides have antibiotic or antifungal activity and are used as pharmaceutical drugs. Rapamycin is also a macrolide and was originally developed as an antifungal, but is now used as an immunosuppressant drug and is being investigated as a potential longevity therapeutic.

<span class="mw-page-title-main">Clarithromycin</span> Type of antibiotic

Clarithromycin, sold under the brand name Biaxin among others, is an antibiotic used to treat various bacterial infections. This includes strep throat, pneumonia, skin infections, H. pylori infection, and Lyme disease, among others. Clarithromycin can be taken by mouth as a pill or liquid.

This is the timeline of modern antimicrobial (anti-infective) therapy. The years show when a given drug was released onto the pharmaceutical market. This is not a timeline of the development of the antibiotics themselves.

<span class="mw-page-title-main">Clindamycin</span> Antibiotic

Clindamycin is an antibiotic medication used for the treatment of a number of bacterial infections, including osteomyelitis (bone) or joint infections, pelvic inflammatory disease, strep throat, pneumonia, acute otitis media, and endocarditis. It can also be used to treat acne, and some cases of methicillin-resistant Staphylococcus aureus (MRSA). In combination with quinine, it can be used to treat malaria. It is available by mouth, by injection into a vein, and as a cream or a gel to be applied to the skin or in the vagina.

<span class="mw-page-title-main">Azithromycin</span> Antibiotic

Azithromycin, sold under the brand names Zithromax and Azasite, is an antibiotic medication used for the treatment of a number of bacterial infections. This includes middle ear infections, strep throat, pneumonia, traveler's diarrhea, and certain other intestinal infections. Along with other medications, it may also be used for malaria. It can be taken by mouth or intravenously.

<span class="mw-page-title-main">Ketolide</span>

Ketolides are antibiotics belonging to the macrolide group. Ketolides are derived from erythromycin by substituting the cladinose sugar with a keto-group and attaching a cyclic carbamate group in the lactone ring. These modifications give ketolides much broader spectrum than other macrolides. Moreover, ketolides are effective against macrolide-resistant bacteria, due to their ability to bind at two sites at the bacterial ribosome as well as having a structural modification that makes them poor substrates for efflux-pump mediated resistance.

<span class="mw-page-title-main">Telithromycin</span> Chemical compound

Telithromycin is the first ketolide antibiotic to enter clinical use and is sold under the brand name of Ketek. It is used to treat community acquired pneumonia of mild to moderate severity. After significant safety concerns, the US Food and Drug Administration sharply curtailed the approved uses of the drug in early 2007.

<span class="mw-page-title-main">Piperacillin</span> Chemical compound

Piperacillin is a broad-spectrum β-lactam antibiotic of the ureidopenicillin class. The chemical structure of piperacillin and other ureidopenicillins incorporates a polar side chain that enhances penetration into Gram-negative bacteria and reduces susceptibility to cleavage by Gram-negative beta lactamase enzymes. These properties confer activity against the important hospital pathogen Pseudomonas aeruginosa. Thus piperacillin is sometimes referred to as an "anti-pseudomonal penicillin".

<span class="mw-page-title-main">Lincosamides</span>

Lincosamides are a class of antibiotics, which include lincomycin, clindamycin, and pirlimycin.

<span class="mw-page-title-main">Pristinamycin</span> Group of chemical compounds

Pristinamycin (INN), also spelled pristinamycine, is an antibiotic used primarily in the treatment of staphylococcal infections, and to a lesser extent streptococcal infections. It is a streptogramin group antibiotic, similar to virginiamycin, derived from the bacterium Streptomyces pristinaespiralis. It is marketed in Europe by Sanofi-Aventis under the trade name Pyostacine.

In microbiology, the minimum inhibitory concentration (MIC) is the lowest concentration of a chemical, usually a drug, which prevents visible growth of a bacterium or bacteria. MIC depends on the microorganism, the affected human being, and the antibiotic itself. It is often expressed in micrograms per milliliter (μg/mL) or milligrams per liter (mg/L).

<span class="mw-page-title-main">Miocamycin</span> Chemical compound

Miocamycin is a macrolide antibiotic. It has a spectrum activity similar to that of Erythromycin, but shows higher antimicrobial effect against certain bacteria including Legionella pneumophila, Mycoplasma hominis, and Ureaplasma urealyticum. In-vivo studies have further expounded on Miocamycin's efficacy, reporting that the medication is more effective than in-vitro data suggests.

<span class="mw-page-title-main">Oleandomycin</span> Chemical compound

Oleandomycin is a macrolide antibiotic. It is synthesized from strains of Streptomyces antibioticus. It is weaker than erythromycin.

Antimicrobial pharmacodynamics is the relationship between the concentration of an antibiotic and its ability to inhibit vital processes of endo- or ectoparasites and microbial organisms. This branch of pharmacodynamics relates the concentration of an anti-infective agent to its effect, specifically to its antimicrobial effect.

<span class="mw-page-title-main">Desosamine</span> Chemical compound

Desosamine is a 3-(dimethylamino)-3,4,6-trideoxyhexose found in certain macrolide antibiotics such as the commonly prescribed erythromycin, azithromycin, clarithroymcin, methymycin, narbomycin, oleandomycin, picromycin and roxithromycin. As the name suggests, these macrolide antibiotics contain a macrolide or lactone ring and they are attached to the ring Desosamine which is crucial for bactericidal activity. The biological action of the desosamine-based macrolide antibiotics is to inhibit the bacterial ribosomal protein synthesis. These antibiotics which contain Desosamine are widely used to cure bacterial-causing infections in human respiratory system, skin, muscle tissues, and urethra.

<span class="mw-page-title-main">Solithromycin</span> Chemical compound

Solithromycin is a ketolide antibiotic undergoing clinical development for the treatment of community-acquired pneumonia and other infections.

<span class="mw-page-title-main">Quinolone antibiotic</span> Class of antibacterial drugs, subgroup of quinolones

A quinolone antibiotic is a member of a large group of broad-spectrum bacteriocidals that share a bicyclic core structure related to the substance 4-quinolone. They are used in human and veterinary medicine to treat bacterial infections, as well as in animal husbandry, specifically poultry production.

<span class="mw-page-title-main">Ceftolozane/tazobactam</span> Antibiotic

Ceftolozane/tazobactam, sold under the brand name Zerbaxa, is a combination antibiotic medication used for the treatment of complicated urinary tract infections and complicated intra-abdominal infections in adults. Ceftolozane is a cephalosporin antibiotic, developed for the treatment of infections with gram-negative bacteria that are resistant to conventional antibiotics. It was studied for urinary tract infections, intra-abdominal infections and ventilator-associated bacterial pneumonia.

References

  1. Thibodeaux, C.J.; Liu, H.-W.; Thorson, J.S. (2007-01-01). "Complementary Routes to Natural Product Glycodiversification: Pathway Engineering and Glycorandomization". Comprehensive Glycoscience. pp. 373–396. doi:10.1016/B978-044451967-2/00040-4. ISBN   9780444519672.
  2. 1 2 3 Pai, Manjunath P. (2018), "Macrolides, Azalides, and Ketolides", Drug Interactions in Infectious Diseases: Antimicrobial Drug Interactions, Cham: Springer International Publishing, pp. 57–86, doi:10.1007/978-3-319-72416-4_2, ISBN   978-3-319-72415-7 , retrieved 2021-04-18
  3. 1 2 3 4 5 6 So, Wonhee; Nicolau, David P. (2016), "Pharmacodynamics of Macrolides, Azalides, and Ketolides", Methods in Pharmacology and Toxicology, New York, NY: Springer New York, pp. 345–366, doi:10.1007/978-1-4939-3323-5_14, ISBN   978-1-4939-3321-1 , retrieved 2021-04-18
  4. Mutak, Stjepan (February 2007). "Azalides from Azithromycin to New Azalide Derivatives". The Journal of Antibiotics. 60 (2): 85–122. doi: 10.1038/ja.2007.10 . ISSN   0021-8820. PMID   17420561.
  5. Jacobs, Michael R. (March 2003). "How can we predict bacterial eradication?". International Journal of Infectious Diseases. 7: S13–S20. doi: 10.1016/s1201-9712(03)90066-x . ISSN   1201-9712. PMID   12839703.