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In vitro activity of LY146032 alone and in combination with other antibiotics against gram-positive bacteria.

The antibacterial activity of LY146032 alone and in combination with other drugs was assayed against gram-positive isolates. Synergism was found when LY146032 was combined with netilmicin, amikacin, imipenem, and fosfomycin by both checkerboard and time-kill tests. Indifference predominated when LY146032 was combined with teicoplanin, vancomycin, and rifampin. Under no circumstances and with no combinations was an antagonistic effect detected.

Anti-Bacterial Agents↗

Impact of LY146032 on Streptococcus (Enterococcus) faecalis translocation in mice.

The susceptibility of Swiss White mice to colonization with Streptococcus (Enterococcus) faecalis was greatly increased when the animals were given 5 mg of streptomycin sulfate per ml in their drinking water. One week after initiation of streptomycin treatment, the mice were challenged orogastrically with graded doses of streptomycin-resistant S. faecalis. The number of S. faecalis cells required to implant the intestinal tract of 50% of untreated mice was 2.9 X 10(9), but was only 4.8 X 10(3) for streptomycin-treated animals. When both groups of mice were challenged orogastrically with 4.6 X 10(6) viable S. faecalis cells, the cecum and small intestine of 100% of the streptomycin-treated animals, but only 10% of the untreated animals, were colonized with the organism. Similarly, translocation of S. faecalis to extraintestinal sites occurred in a majority of streptomycin-treated mice, but in only a small number of untreated mice. Subcutaneous administration of the experimental antibiotic LY146032 (Eli Lilly & Co., Indianapolis, Ind.) to streptomycin-treated mice concomitant with orogastric challenge with 5.5 X 10(5) viable S. faecalis cells resulted in a significant decrease in the incidence of intestinal colonization by the organism, a significant reduction in S. faecalis populations, and the absence of the organism in the liver, spleen, and heart. However, once intestinal colonization had occurred and extraintestinal infections were established, LY146032 did not significantly reduce S. faecalis populations or ameliorate the infections. We conclude that LY146032 effectively prevents translocation of S. faecalis from the intestinal tract of mice but does not resolve established extraintestinal infections.

Animals↗

Early stages of in vitro killing curve of LY146032 and vancomycin for Staphylococcus aureus.

The early stages of the time-killing curves of vancomycin and LY146032 have been studied, by use of short sampling intervals, for three strains of Staphylococcus aureus. Both vancomycin and LY146032 killed S. aureus, but the time-killing curves differed: the effect of vancomycin was slow, limited, and not related to the concentration of the drug, whereas that of LY146032 was rapid, extensive, and related to concentration. When strains ATCC 25923 and CIP 6525 were exposed to LY146032, the population decreased exponentially with time. The killing rate was constant and linked to the concentration by a Michaelis-Menten relationship. The maximum killing rate and the affinity constant of LY146032, estimated from the data transformed by the Lineweaver-Burk method, differed for the two strains. The concentration of the antibiotic at which killing theoretically begins (estimated by linear regression using the logarithm of the concentration) is of the same magnitude as the MIC of LY146032, which indicates the pure bactericidal mode of action of the drug. S. aureus ATCC 12600 was more resistant to the bactericidal effect of the two drugs, and its killing curve did not conform to the model described here.

Anti-Bacterial Agents↗

In vitro activity of SK&F 104662, a new glycopeptide antibiotic.

The in vitro activity of SK&F 104662, a new glycopeptide antibiotic, against gram-positive bacteria was evaluated. Activity was comparable to those of teicoplanin and vancomycin against most organisms. SK&F 104662 inhibited diphtheroids at concentrations of less than or equal to 0.5 microgram/ml. Addition of human serum to the test medium lowered the inhibitory activity of this glycopeptide against some organisms by as much as eightfold.

Anti-Bacterial Agents↗

In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis.

Vancomycin resistance exhibited by Enterococcus faecalis isolates V583, V586, and V587 is described. The vancomycin MICs ranged from 32 to 64 micrograms/ml. Although resistant to vancomycin, the isolates were susceptible to teicoplanin (MIC, less than or equal to 0.5 micrograms/ml). Such a glycopeptide susceptibility profile has not been previously described for E. faecalis. Time kill studies showed that vancomycin resistance adversely affected the synergistic activity that vancomycin and aminoglycoside combinations usually demonstrate against enterococci. However, the ability to detect vancomycin resistance varied with the susceptibility testing method used. Whereas broth microdilution, broth macrodilution, and agar dilution methods detected resistance, disk-agar diffusion and the AutoMicrobic system Gram-Positive GPS-A susceptibility card (Vitek Systems Inc., Hazelwood, Mo.) did not. To detect vancomycin resistance reliably and establish the incidence of such E. faecalis isolates, adjustments in some susceptibility testing methods may be necessary.

Anti-Bacterial Agents↗

LY146032 in a hamster model of Staphylococcus aureus pneumonia--effect on in vivo clearance and mortality and in vitro opsonophagocytic killing.

The effect of the new peptolide LY146032 (LY) was studied in a hamster model of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. In vivo, after infection with one of two well-encapsulated strains of MRSA, A83 and A116 (type 8 and type 5), LY was protective only in A116 pneumonia. An in vitro assay of the effect of subinhibitory concentrations of LY on opsonophagocytic killing by pulmonary phagocytes demonstrated marked enhancement of killing of A116 (92.6 and 63.8% kill with 1/10 MIC and 1/50 MIC LY; no kill in the absence of LY). This effect was dependent on the presence of fresh serum. LY in subinhibitory concentrations produces a surface effect that may allow complement binding and activation and subsequent phagocytosis and killing to take place. The opsonizing effect of subinhibitory concentrations of LY was not demonstrable for the A83 strain. Differences in capsular types may be determinants of response to therapy of MRSA infections.

Animals↗

Newer agents against methicillin and/or gentamicin-resistant and -susceptible staphylococci.

The in vitro activities of the newer agents Deptomycin, Difloxacin, A-56620 and Ciprofloxacin were compared with those of vancomycin, rifampin and gentamicin against methicillin-susceptible and -resistant Staphylococcus aureus and coagulase-negative staphylococci. All isolates were susceptible to vancomycin, rifampin, deptomycin and the quinolones tested. Newer agents had activity superior to that of vancomycin, whereas the activity of the newer agents and rifampin was comparable. Gentamicin resistance was frequent, however, the resistant staphylococci were susceptible to other antibiotics tested.

Anti-Bacterial Agents↗

Quinolone, everninomycin, glycylcycline, carbapenem, lipopeptide and cephem antibacterials in clinical development.

The development of antibacterials was a very successful endeavor in the pharmaceutical company repertoire through the late 1970s, when interest in investing in antibiotic research and development temporarily waned. More recently, there have been a number of failures in late stage development or post-launch of human antibiotics. The answer to the dilemma of less-than-desired success may be the introduction of novel classes of agents, as well as development of new agents in traditional classes. This review provides an overview of the various "miscellaneous" antibacterials in development, excluding glycopeptides, macrolides, ketolides, and oxazolidinones. Among the agents highlighted in this review are the clinical candidates of quinolones, everninomycins, carbapenems, lipopeptides, glycylcyclines, and cephems. In several cases, certain quinolone agents described in this review will have been approved for marketing before press time.

4-Quinolones↗

Newer antibiotics for serious gram-positive infections.

Four newer antibiotics are available to treat gram-positive bacterial infections that are resistant to traditional antibiotics and to vancomycin. They should preferably be used with the help of an infectious-disease consultant: specific therapy should be chosen on the basis of the bacteria involved, the site of infection, whether the patient has kidney or liver disease, other medications the patient is taking, and side effects that develop.

Acute Disease↗

Treatment evaluation of experimental staphylococcal infections: comparison of beta-lactam, lipopeptide, and glycopeptide antimicrobial therapy.

LY 146032, teicoplanin, vancomycin, oxacillin, cephalothin, cefamandole, ampicillin plus sulbactam, and cefoperazone plus sulbactam were studied against six isolates of staphylococci (including both Staphylococcus aureus and coagulase negative staphylococci) using in vivo and in vitro methods. In vitro susceptibility measurements demonstrated that all six isolates were sensitive to LY 146032 and vancomycin and that five of six isolates were sensitive to tiecoplanin, cefamandole, ampicillin plus sulbactam, and cefoperazone plus sulbactam. Comparison of antimicrobial therapy in an in vivo rabbit model demonstrated that cefoperazone plus sulbactam was active against the greatest number of isolates (five of six) based on a reduction of greater than or equal to 5.0 log10 colony forming units per milliliter (CFU/ml) from growth control at the end of the animal treatment study. Vancomycin and oxacillin were equal in achieving reductions of greater than or equal to 5.0 log10 CFU/ml in four of the six isolates. Comparing each isolate's in vivo outcome to in vitro data shows that in vitro susceptibility tests overpredict the sensitivity of these six isolates to LY 146032 and vancomycin, are variable for teicoplanin, cefamandole, ampicillin plus sulbactam, and cefoperazone plus sulbactam, and underpredict for oxacillin.

Ampicillin↗