Other Antibiotic Macrolides

Numerous biologically active macrocycles are antibiotics isolated from various microorganisms, with a wide variety of structures and ring sizes ranging from 12- 

Zampanolide (79), a macrolide which exhibits significant activity against a variety of tumor cell lines, was recently isolated from the sponge Ductylospongiu sp. The RCM cyclization step for the synthesis of this compound was done on substrate 77 however, as with other substrates bearing protected hydroxy groups, the reaction 

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In combination with proton pnmp inhibitors and other antibiotics, macrolides are still snccessfnUy nsed for the eradication of H. pylori infection (67,68). However, resistance of H. pylori to macrolides has emerged in a nnmber of conntries. The first case of H. pylori resistance to clarithromycin has now also been docnmented in Denmark and follows increased nse of this macrolide in eradication regimens (69). 

Following the biogenetic classification, we first address macrolactones, divided into the main family groups that have received synthetic attention via RCM (re-sorcinylic, salycilates, other antibiotic macrolides, macrocyclic musks, epothilones, amphidinolides, other polyketides, and natural cyclophanes), then the terpenoids, followed by the macrocycles obtained from the amino acid metabolism (lactams, depsipeptides, alkaloids), and finally the glycolipids. 

A number of fungal immunosuppressives have been isolated from fermentation broths and demonstrated to have immunotherapeutic efficacy. Other than cyclosporin (35), two fungal metaboHtes, sirolimus (36), previously known as rapamycin (80), and FK-506 (37) (81) are in various stages of development (see Antibiotics, macrolides). 

Secondary metabolites generated via the propionate route are quite unusual in nature. Relevant exceptions are some antibiotic macrolides from Streptomycetes [42], but wholly propionate-derived macrolides are rare. This biosynthetic pathway has been well proved for erythromycin (13), where the aglycone is produced by assembling seven propionate units [43, 44], and for a few related antibiotics [45]. However, very sophisticated biosynthetic experiments [46] have established that some apparent propionate units in other macrolides (e.g., aplasmomycin [46]) from Streptomycetes could be formed either by C-methylation through S-adenosylmethionine or from glycerol. 

Oxazinomycin (l)5 is a 1,3-oxazine antibiotic. There are five other antileukemic antibiotic macrolides of known tetrahydro-l,3-oxazine-2-one structures. Maytansine, Maytanprine, and Maytanbutine were found by Kupchan et a/.278,278 in Maytenus ovatus and Maytenus buchananii, and in Maytenus serrata by Meyers et al.,277 and Calubrinol... 

The resistance mechanisms that cause the inactivation of penicillins, cephalosporins, aminoglycosides, macrolides and tetracyclines do not apply to fluoroquinolones, and there is therefore no cross-resistance between quinolones and other antibiotics. 

Plasmid (or transposon)-encoded enzymes are thus responsible for the degradation of several different types of antibiotics. The inactivation of several /J-lactams, AGACs, 14-membered macrolides, other macrolides, lin-cosamides and streptogramis (MLS) and chloramphenicol is a major resistance mechanism it has yet to be shown that inactivation of other antibiotics falls into this category. 

PROPAFENONE I. ANTIARRHYTHMICS - disopyra-mide, procainamide 2. ANTIBIOTICS - macrolides (especially azithromycin, clarithromycin, parenteral erythromycin, telithromycin), quinolones (especially moxifloxacin), quinupristin/ dalfopristin 3. ANTICANCER AND IMMUNOMODULATING DRUGS -arsenic trioxide 4. ANTIDEPRESSANTS - TCAs, venlafaxine 5. ANTIEMETICS-dolasetron 6. ANTIFUNGALS-fluconazole, posaconazole, voriconazole 7. ANTIHISTAMINES - terfenadine, hydroxyzine, mizolastine 8. ANTI-M ALARIALS - artemether with lumefantrine, chloroquine, hydroxychloroquine, mefloquine, quinine 9. ANTIPROTOZOALS - pentamidine isetionate 10. ANTIPSYCHOTICS-atypicals, phenothiazines, pimozide II. BETA-BLOCKERS - sotalol 12. BRONCHODILATORS -parenteral bronchodilators 13. CNS STIMULANTS - atomoxetine Risk of ventricular arrhythmias, particularly torsades de pointes Additive effect these drugs prolong the Q-T interval. Also, amitriptyline, clomipramine and desipramine levels may be t by propafenone. Amitriptyline and clomipramine may t propafenone levels. Propafenone and these TCAs inhibit CYP2D6-mediated metabolism of each other Avoid co-administration... 

Streptomyces nanchangensis produces the polyether antibiotic nanchangmycin 28, the 16-membered macrolide meilingmycin, and at least two other antibiotics of unknown structure (18). 

Chemical/Pharmaceutical/Other Class Antibiotic Macrolide... 

The MLS (macrolides, lincosamides, streptogramins) group of antibiotics all inhibit protein synthesis by binding to the 50S ribosomal subunit. Resistance mechanisms specific to individual members occur but resistance to all may be conferred by a single mechanism that involves 23S rRNA. However, it is claimed that the quinupristin-dalfopristin combination does not demonstrate cross-resistance to other antibiotics within the MLS group or to other antibiotics. 

In specific antibiotic research areas, development of improved e-lactams (see Chapter li) and work on aminocyclitol antibiotics represented a significant portion of the effort. Advances were also made in areas of interest on other antibiotics of importance in medicine or agriculture, such as the macrolides, tetracyclines, lincomycins, ansamycins, novobiocins, polyethers, and peptides. 

Answer A- Microbial resistance to fluoroquinolones is increasing, and some strains of Streptococcus pneumoniae are now resistant to ciprofloxacin. The mechanism can involve changes in the structure of topoisomerase IV, one of the targets of fluoroquinolones, which inhibit nucleic acid synthesis. Pneumococcal resistance to penicillins is also increasing via changes in penicillin-binding proteins (PBPs). The other mechanisms listed underlie microbial resistance to other antibiotics as follows sulfonamides (choice B), macrolides (choice C), extended-spectrum penicillins (choice D), and beta-lactams (choice E). 

The aminoglycosides are bacteriocidal. Other antibiotics whose mechanism of action involves inhibition of protein synthesis (tetracycline, the macrolides, lincomycin, etc.) are invariably bacteriostatic. The reason for this difference is not known. In fact, the reason that protein inhibition by aminoglycosides should be a cell-killing process has not been satisfactorily addressed. The accumulation of nonsense proteins due to misreading of mRNA has been shown not to be the reason. If ribosomal binding were an irreversible process, lethality might be comprehensible SM does not bind irreversibly. 

Clindamycin binds exclusively to the 50S subunit of bacterial ribosomes and suppresses protein synthesis. Although clindamycin, erythromycin, and chloramphenicol are not structurally related, they act at sites in close proximity, and binding by one of these antibiotics to the ribosome may inhibit the interaction of the others. There are no clinical indications for the concurrent use of these antibiotics. Macrolide resistance due to ribosomal methylation by encoded enzymes also may produce resistance to clindamycin. However, because cUndamycin does not induce the methylase, there is cross-resistance only if the enzyme is produced con-stitutively. Clindamycin is not a substrate for macrolide efflux pumps thus, strains that are resistant to macrolides by this mechanism are susceptible to clindamycin. Altered metabolism occasionally causes clindamycin resistance. 

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