Antibiotics Methicillin

The bacterium Staphylococcus aureus, which is a major cause of infection in the developed countries, is now resistant to most antibiotics. It is usually present on the skin, where it causes no problems, but it can invade the body through cuts and wounds, including those caused by surgery. These bacteria are now prevalent in many hospitals, so that infection is a major problem for the medical staff in hospitals. The resistant bacterium is known as methicillin-resistant Staphylococcus aureus (MRSA). It is also known in the mass media as the super bug . Penicillin kiUs bacteria because the P-lactam group in the antibiotic inhibits a reaction that is essential for bacterial ceU wall production. Consequently, the bacteria cannot proliferate. Resistance to penicillin in many bacteria is due to production of an enzyme, p-lactamase, that degrades P-lactams. The antibiotic methicillin is one of a group of semisynthetic penicillins in which the P-lactam group is not... 

Staphylococcal skin infections can usually be diagnosed by their appearance without laboratory testing. Serious staphylococcal infections require samples of blood or infected fluid for culture and diagnosis of which antibiotics should be used. Some strains are resistant to many antibiotics. Methicillin-resistant S. aureus is resistant to nearly all antibiotics and is increasingly common. 

Dimethoxybenzoic acid was needed for a synthesis of the (3-lactann antibiotic methicillin. Show how this carboxylic acid could be synthesized from 2-bromo-l,3-benzenediol. 

As recently as 1970, only about 30 naturally occurring organohalogen compounds were known. It was simply assumed that chloroform, halogenated phenols, chlorinated aromatic compounds called PCBs, and other such substances found in the environment were industrial pollutants. Now, only a third of a century later, the situation js quite different. More than 5000 organohalogen compounds have been found to occur naturally, and tens of thousands more surely exist. From a simple compound like chloromethane to an extremely complex one like vancomycin, a remarkably diverse range of organohalogen compounds exists in plants, bacteria, and animals. Many even have valuable physiological activity. Vancomycin, for instance, is a powerful antibiotic produced by the bacterium Amycolatopsis orientalis and used clinically to treat methicillin-resistant Staphylococcus aureus (MRSA). 

Methicillin-resistent staphylococci are strains of staphylococci, which show resistance to a wide variety of antibiotics. They are named for their resistance to methicillin, a (3 -lactamase-resistant penicillin. Methicil-lin-resistante Staphylococcus aureus (MRSA) has become a serious problem particularly in hospitals. 

The sodium and potassium salts are veiy soluble in water but they are hydrolysed in solution, at a temperature-dependent rate, to the corresponding penicilloic acid (Fig. 5.3 A see also Fig. 9.3), which is not antibacterial. Penicilloic acid is produced at alkaline pH or (via penieillenic acid Fig. 5.3B) at neutral pH, but at acid pH a molecular rearrangement oeeurs, giving penillic acid (Fig. 5.3C). Instability in acid medium logically precludes oral administration, since the antibiotic may be destroyed in the stomach for example at pH 1.3 and 35°C methicillin has a half-life of only 2-3 minutes and is therefore not administered orally, whereas ampicillin, with a half-life of 600 minutes, is obviously suitable for oral use. 

The antibiotics of choice for treating methicillin-sensitive S. aureus (MSSA) infections are penicillinase-stable penicillins and first-generation cephalosporins. 

Another important advance has been the application of PyMS with ANNs to discriminate between methicillin-resistant and methicillin-sensitive Staphylococcus aureusIn this study DFA and HCA showed that the major source of variation between the pyrolysis mass spectra of 15 methicillin-resistant (MRSA) and 22 methicillin-sensitive Staphylococcus aureus (MSSA) strains resulted from the phage group of the bacteria, rather than from their resistance or sensitivity to methicillin. By contrast, ANNs could recognize those aspects of the pyrolysis mass spectra that differentiated MRSA and MSSA strains. These results gave the first demonstration that the combination of PyMS with ANNs could provide a rapid and accurate antibiotic-susceptibility testing technique. 

Acute drug-related hypersensitivity reactions (allergic responses) may cause tubulointerstitial nephritis, which will damage the tubules and interstitium. These reactions are most commonly observed with administration of methicillin and other synthetic antibiotics as well as furosemide and the thiazide diuretics. The onset of symptoms occurs in about 15 days. Symptoms include fever, eosinophilia, hematuria (blood in the urine), and proteinuria (proteins in the urine). Signs and symptoms of acute renal failure develop in about 50% of the cases. Discontinued use of the drug usually results in complete recovery however, some patients, especially the elderly, may experience permanent renal damage. 

In penicillin-allergic patients, oral or parenteral clindamycin may be used. Alternatively, a first-generation cephalosporin such as cefazolin (1 to 2 g IV every 6 to 8 hours) may be used cautiously for patients who have not experienced immediate or anaphylactic penicillin reactions and are penicillin skin test negative. In severe cases in which cephalosporins cannot be used because of documented methicillin resistance or severe allergic reactions to /1-lactam antibiotics, IV vancomycin should be administered. 

An additional disadvantage with many penicillin and cephalosporin antibiotics is that bacteria have developed resistance to the drugs by producing enzymes capable of hydrolysing the P-lactam ring these enzymes are called P-lactamases. This type of resistance still poses serious problems. Indeed, methicillin is no longer used, and antibiotic-resistant strains of the most common infective bacterium Staphylococcus aureus are commonly referred to as MRSA (methicillin-resistant Staphylococcus aureus). The action of P-lactamase enzymes resembles simple base hydrolysis of an amide. 

---