Macrolides elimination

The complete degradation of sulfamethoxazole was also reported within 14 days with P. chrysosporium, Bjerkandera sp. R1 and B. adusta [4], although, contrary to the reports of enzymatic transformation, metabolites were not identified. Partial removal (from 30% to 55%) of sulfamethoxazole from activated-sludge-mixed liquor and the effluent of a WWTP was demonstrated at bench scale within 5 days with P. chrysosporium propagules entrapped in a granular bioplastic formulation [25]. This approach was also successful in the partial elimination of other kinds of antibiotics, eg., ciprofloxacin (see below) and the macrolide erythromycin. 

Tolterodine undergoes hepatic metabolism involving CYP450 2D6 and 3A4 isoenzymes. Therefore, elimination can be impaired by CYP450 3A4 inhibitors including fluoxetine, sertraline, fluvoxamine, macrolide antibiotics, imidazoles, and grapefruit juice. 

A synthesis of 149, cucujolide VIII, proceeded via the tert-butyldimethylsi-lyl-(TBS)-ether of methyl (E)-12-hydroxydodec-4-enoate B [293] (Fig. 7). Deprotonation in a-position and reaction with di(4-methoxyphenyl)diselenide furnished C. This was transformed to the macrolide E after saponification of the ester moiety, deprotection of the hydroxy group, and Mitsunobu lactonization. Alternatively, the unsaturated lactone F was synthesized from B following a sequence similar to that from C to D. Oxidative elimination of the arylseleno group... 

Rapamycin (sirolimus), a macrolide antibiotic, has been used recently in organ transplantation for its potent immunosuppressive actions by inhibiting both cytokine mediated and growth factor mediated proliferation of smooth muscle cells and lymphocytes [55, 56]. In the RAVEL trial of non-acute single vessel lesions, the Sirolimus-eluting stent was compared to bare metal stent (BMS) in a 1 1 fashion [57]. One-year major adverse cardiovascular events and 6 month neointimal proliferation as assessed by late luminal loss (-0.01 0.33 mm in Sirolimus stent versus 0.80 0.53 mm in BMS) were improved. The Sirolimus-eluting stent thus virtually eliminated in-stent restenosis with no evidence of edge effect, dissection, or in-stent thrombosis. 

The macrolides are orally absorbed but they are acid-labile. They therefore need to be administered in acid-resistant capsules or as acid-resistant esters. The macrolides are widely distributed into all fluids except the CNS. Protein binding is about 90%. They are eliminated via biliary excretion with extensive enterohepatic circulation. Elimination half-lives vary from 1.4 h for erythromycin to 40-60 h for azithromycin. 

Roxithromycin, clarithromycin, azithromycin and dirithromycin are more recently developed macrolides with similar antimicrobial activity to erythromycin. However they are better absorbed, have longer elimination half-lives and lower incidence of gastrointestinal side-effects. Azithromycin and... 

Mecfianism of Action A macrolide that reversiblybindstobacterial ribosomes, inhibiting bacterial protein synthesis. Therapeutic Effect Bacteriostatic. Pharmacokinetics Variably absorbed from the GI tract (depending on dosage form used). Protein binding 70%-90%. Widely distributed. Metabolized in the liver. Primarily eliminated in feces by bile. Not removed by hemodialysis. Half-life 1.4-2 hr (increased in impaired renal function). 

In general, the macrolides are administered orally but sometimes also paren-terally. All the members of this group are well absorbed and are distributed extensively in tissues, especially in the lungs, liver, and kidneys, with high tissue to plasma ratios. They are retained in the tissues for long periods after the levels in the blood have ceased to be detectable. Elimination of all macrolides occurs primarily through hepatic metabolism, which accounts for approximately 60% of an administered intravenous dose the remainder is excreted in active form in the urine and bile. With oral and intramuscular administration, urinary excretion decreases, but biliary excretion and hepatic metabolism increase proportionally. Milk has often macrolide concentrations severalfold greater than in plasma (7). 

Erythromycin distributes widely in the body with residue levels in tissues generally exceeding those in serum. Both hepatic and renal routes of elimination of erythromycin are significant and it undergoes enterohepatic circulation. Elimination of erythromycin in relatively high levels in the feces may follow its oral administration. As with almost all macrolides, the principal metabolic pathway of erythromycin is by A-desmethylation of the desosamine sugar (107). 

Macrolides.1 A new route to macrolides uses an ynamine group as an activated -C H.COOH group. The method was used to obtain 14-tetradecanolide (6). The hydroxy group was protected as the bromopropenyl ether, which is stable to base, but removable by /(-elimination with (-butyllithium.-1 Ring closure is effected with HI-, ethernte the lactone (6) is liberated hy acid hydrolysis of 5. 

Semisynthetic Derivatives. 3 -O-Acyl derivatives have not been found via fermentation, but chemical acylation of the 3/ -hydroxyl group yields products having good antibiotic activity and better pharmacokinetics than the parent macrolides. Two such compounds have been developed 3r/-O-propionyl-leucomycin Af (rokitamycin) C42H 9N015, formerly TMS-19-Q, and 9,3 -di-O-acetylmidecamyein (miokamycin) C HtiNOi . At least part of the in viva improvement was attributed to slower elimination of active metabolites from serum. 

As indicated in Scheme VII/32, cyclononanone (VII/165) is transformed into hydroperoxide hemiacetal, VII/167, which is isolated as a mixture of stereoisomers. The addition of Fe(II)S04 to a solution of VII/167 in methanol saturated with Cu(OAc)2 gave ( )-recifeiolide (VII/171) in quantitative yield. No isomeric olefins were detected. In the first step of the proposed mechanism, an electron from Fe2+ is transferred to the peroxide to form the oxy radical VII/168. The central C,C-bond is weakened by antiperiplanar overlap with the lone pair on the ether oxygen. Cleavage of this bond leads to the secondary carbon radical VII/169, which yields, by an oxidative coupling with Cu(OAc)2, the alkyl copper intermediate VII/170. If we assume that the alkyl copper intermediate, VII/170, exists (a) as a (Z)-ester, stabilized by n (ether O) —> <7 (C=0) overlap (anomeric effect), and (b) is internally coordinated by the ester to form a pseudo-six-membered ring, then only one of the four -hydrogens is available for a syn-//-elimination. [111]. This reaction principle has been used in other macrolide syntheses, too [112] [113]. 

This precise sequence was discovered only through very careful double labelling experiments and after the discovery of specific inhibitors for the enzyme. Since polyketides can be made from the acyl polymalonate pathway with or without reduction and elimination at any step, the number of possible structures is vast. With more reduction, no aromatic ring can be formed macrolide antibiotics such as brefeldin A come from this route. 

Some macrolides have a dose- and time-related effect on methylprednisolone elimination, resulting in a prolonged half-life and reduced clearance (157). These changes were considered advantageous (steroid sparing) in patients with asthma (158,159). However, a retrospective analysis of 3995 patients treated with azithromycin did not show any pharmacokinetic interaction in patients who were also taking methylprednisolone (127,128). 

Verapamil is both a snbstrate and an inhibitor of CYP3A4, which is inhibited by clarithromycin and erythromycin. Giving these macrolide antibiotics dnring verapamil therapy is likely to rednce the first-pass metabolism of verapamil, increase its systemic availability, and impair its elimination. In patients taking this combination, verapamil should be started in a low dosage and its hemodynamic effects should be monitored closely. 

Elimination All macrolides are hepatically eliminated. Clarithromycin is hepatically activated to the 14-OH metabolite. Vk erythromycin < clarithromycin < azithromycin. 

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