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Regulation of valine catabolism by ammonium in Streptomyces ambofaciens, producer of spiramycin.

In Streptomyces ambofaciens, valine favored spiramycin biosynthesis by supplying aglycone precursors. The kinetics of valine consumption and isobutyrate production showed that isobutyrate accumulated in the cell during the growth phase, was excreted in the stationary phase, and then was reassimilated during spiramycin production. When valine was in excess, its deamination led to high ammonium excretion and to a significant drop in spiramycin production. We demonstrated that ammonium ions were the cause of the negative effect. Addition of a chelator agent, Ca3(PO4)2, improved spiramycin production by sixfold. In contrast, addition of ammonium, between 0 and 48 h, severely reduced spiramycin production. The negative effect of ammonium was reversed by addition of a catabolic intermediate of valine, isobutyrate. In addition to stimulating the specific growth rate, ammonium ions slowed down valine catabolism: the specific valine uptake rate, excretion, and reassimilation of isobutyrate were lowered by the pulse of ammonium. Our study showed that in addition to valine dehydrogenase, which provided the nitrogen necessary to the cell, ammonium ions repressed ketoisovalerate dehydrogenase, which introduced valine as carbon, energy, and aglycone precursor sources. However, valine dehydrogenase and ketoisovalerate dehydrogenase did not constitute the principal enzymatic targets of the negative effect of ammonium in spiramycin production.

2-Oxoisovalerate Dehydrogenase (Acylating)↗

The effects of spiramycin and/or scaling on advanced periodontitis in humans.

It has long been questioned whether antibiotics, used as a supplement to traditional therapy, provide any lasting benefit in the treatment of chronic periodontitis. This study was designed to evaluate Spiramycin as an adjunct to scaling and root planing in the treatment of advanced chronic periodontitis. In total, 193 patients with advanced periodontitis were recruited in seven centres using selection criteria previously described. After undergoing thorough scaling and root planing, all patients randomly received either Spiramycin, 1,500,000 international units, twice per day (IU, bid) for 14 days (96 patients), or a visually-identical placebo capsule (97 patients). The clinical parameters measured were plaque index, crevicular fluid level, probing depths, bleeding on probing and attachment level changes. Data was recorded at baseline, two-, eight-, 12- and 24-weeks visits. A total of 189 patients completed the study (96 placebo, 93 Spiramycin). Statistically significant differences in probing depth, favoring Spiramycin, were seen at two weeks (p < 0.0125), eight weeks (p < 0.0020), 12 weeks (p < 0.0032) and 24 weeks (p < 0.0075). Spiramycin also produced a significant improvement in attachment level at 12 weeks (p < 0.0146). All other clinical parameters showed no difference between drug and placebo. This study shows that Spiramycin, as an adjunct to thorough scaling and root planing, provides a statistically significant improvement in probing depths for up to 24 weeks when compared with scaling and root planing alone. Both longer studies and microbiologic evaluations are necessary to determine whether a more lasting benefit is possible.

Adult↗

Spiramycin concentrations in female pelvic tissues, determined by HPLC: a preliminary report.

An automated high performance liquid chromatographic method with remote controlled column switching was used to measure the concentration of spiramycin in pelvic tissues and plasma after oral administration of the antibiotic. Three oral doses of 2 g spiramycin were given to patients scheduled for elective gynaecological surgery over the 14 h before 6 a.m. on the day of surgery. Spiramycin concentrations in serum ranged from 7.4 to 12.5 mg/l between 3 h 20 min and 9 h 20 min after the last dose of spiramycin. Spiramycin pelvic tissue concentrations were determined in five of the eleven females and ranged from 4.4 to 33.3 mg/kg. The highest concentrations were observed in the Fallopian tube. These preliminary results suggest that spiramycin has good diffusion into female pelvic tissues.

Adult↗

Lack of effect of spiramycin on cyclosporin pharmacokinetics.

1. The influence of spiramycin coadministration on cyclosporin pharmacokinetics was studied in five renal transplant patients. The plasma concentrations of cyclosporin were measured both by non-specific radioimmunoassay (RIA) and high-performance liquid chromatography (h.p.l.c.). 2. The kinetics of cyclosporin were followed before treatment, and after 1 day and then 2 weeks of oral treatment with spiramycin (3 X 10(6) iu, twice daily). The main pharmacokinetic parameters (the area under the plasma drug concentration-time curve, the maximum plasma drug concentration and the time to reach it) obtained both by RIA and h.p.l.c. were not modified by spiramycin cotreatment after 1 day, nor after 2 weeks of spiramycin administration. Therefore, the pharmacokinetics of cyclosporin (parent drug and parent drug plus metabolites) are not influenced by the coadministration of spiramycin macrolide at therapeutic dosage. 3. Spiramycin may be preferable to other macrolide antibiotics known to interact with cyclosporin such as erythromycin or josamycin.

Adolescent↗

[Fetomaternal therapeutic follow-up of spiramycin during pregnancy].

In the preventive treatment of congenital toxoplasmosis it is admitted that spiramycin is concentrated in the placenta and crosses the placental barrier at the end of pregnancy. However, little is known about its entry in the fetal circulation. We studied fetal spiramycin blood levels during the 2nd and 3rd trimesters of pregnancy in women who, having presented with toxoplasmosis during the 1st trimester, had been given spiramycin until delivery. Microbiological titrations of spiramycin were performed--in the maternal blood at the onset of treatment, at the time of fetal blood sampling and during delivery), in the fetal blood at the time of prenatal diagnosis of toxoplasmosis, in cord blood and placenta at birth. We were able to confirm transplacental crossing of spiramycin. Fetal blood levels during the 2nd trimester were about 47% of the maternal ones and there was no correlation between maternal and fetal levels. Levels at birth showed that (1) there was no accumulation in the course of treatment, (2) spiramycin was concentrated in placenta and (3) there was a correlation between fetal and maternal levels during the 3rd trimester.

Female↗

Glycerol effect on spiramycin production and valine catabolism in Streptomyces ambofaciens.

Spiramycin production by Streptomyces ambofaciens in a chemically defined medium, with valine as nitrogen source, was controlled by the nature and the concentration of the carbon source. The production of this antibiotic was better in dextrins than in glycerol-containing medium. The negative effect of glycerol could be attributed in part to an excess of energy and a high specific growth rate. The intracellular ATP content, at the start of spiramycin production, was twofold higher in glycerol than in dextrin-containing medium. Increasing the initial concentrations of glycerol led to an increase in the specific growth rate and a drop in spiramycin production. Comparison between glycerol and a protein synthesis inhibitor effects and the use of resting cell systems (RCS) proved that glycerol exerted both inhibitory and repressive actions on spiramycin production independently from the growth. At the enzymatic level, glycerol interfered with valine catabolism by repressing partially valine dehydrogenase (VDH) and alpha-ketoisovalerate dehydrogenase (KIVDH), generator of spiramycin aglycone precursors.

Amino Acid Oxidoreductases↗

Therapeutic efficacy of halofuginone and spiramycin treatment against Cryptosporidium serpentis (Apicomplexa: Cryptosporidiidae) infections in captive snakes.

The therapeutic effect of halofuginone hydrobromide (Steronol) and spiramycin solubilized (Spirasol) applied to clinical Cryptosporidium serpentis infections in captive snakes was investigated. Pathological changes induced by C. serpentis were typical for snake cryptosporidiosis. Spiramycin induced no significant change in the pattern of shedding of fecal Cryptosporidium oocysts; biopsies and necropsies revealed cryptosporidiosis in gastric mucosa of all spiramycin-treated animals. In all, 8 of 21 (38%) halofuginone-treated snakes stopped shedding C. serpentis oocysts; examination of gastric tissue of 6 of these 8 animals revealed cryptosporidiosis in 2 snakes. Hepatotoxic and nephrotoxic pathological changes induced by halofuginone included focal or multifocal, severe, acute liver necrosis; severe liver hemosiderosis; and bilateral, severe, acute diffuse cortical and tubular necrosis and iron deposition. Postprandial regurgitation associated with midbody swelling, observed in 4 halofuginone-treated and 2 spiramycin-treated snakes at 15 and 21 weeks after drug withdrawal, did not coincide with oocyst-positive feces. Neither halofuginone nor spiramycin treatment produced a satisfactory therapeutic outcome when applied against clinical C. serpentis infections in snakes.

Animals↗

Treatment of toxoplasmosis in pregnancy: concentrations of spiramycin and neospiramycin in maternal serum and amniotic fluid.

Toxoplasma infection during pregnancy is widely treated with oral spiramycin to reduce the risk of congenital toxoplasmosis in the infant. Failures of therapy have been observed, however. In this study, a sensitive high-performance liquid chromatography technique was used to measure concentrations of spiramycin and neospiramycin, one of the major metabolites of spiramycin, in maternal serum and amniotic fluid. Samples were obtained from 18 women who underwent amniocentesis for polymerase chain reaction (PCR) diagnosis of fetal infection 5-109 days following the prescription of spiramycin therapy (3 g/day). Concentrations of spiramycin and neospiramycin in both serum and amniotic fluid were highly variable, ranging from nondetectable values to 1 microg/ml. None of the concentrations measured were within the range reported to inhibit growth of the parasite in vitro. Consistent with previous reports, part of the observed variability in maternal and fetal drug concentrations could be explained by individual differences in several pharmacokinetic parameters: intestinal absorption, tissue distribution, cellular uptake, metabolism, transfer across the placenta, drug accumulation in fetal tissue, and maternal and fetal drug elimination. The heterogeneity of the data could also be related to differences in patient compliance with the medication prescribed. By addressing factors that could impair adequate treatment of toxoplasmosis during pregnancy, the data presented call for a larger-scale controlled study to determine individual and diurnal variations in maternal drug levels, patient compliance, and outcomes of the offspring. The activity of neospiramycin against Toxoplasma gondii should be assessed.

Adolescent↗

Acid catalysed degradation of some spiramycin derivatives found in the antibiotic bitespiramycin.

Bitespiramycin is a novel antibiotic containing a number of 4''-acylated spiramycin derivatives (isovalerylspiramycins I-III, butanoylspiramycin III, propanoylspiramycin III and acetylspiramycin III) as major components. These spiramycin derivatives are susceptible to degradation in acid solution. Liquid chromatography-ion trap mass spectrometry (LC/MS(n)) was used to study the degradation of these spiramycin derivatives in simulated gastric fluid at 37 degrees C. All derivatives degraded by first-order reactions for which rate constants (k) and half-lives (t(1/2)) were calculated. Acyl groups at position 3 had less effect on acid-stability of spiramycin derivatives than acyl groups at position 4''. The introduction of 4''-acyl groups enhanced the acid-stability of spiramycin derivatives and altered the degradation pathway in simulated gastric fluid such that loss of forosamine rather than loss of mycarose becomes the major degradation pathway.

Anti-Bacterial Agents↗

QT interval prolongation and risk of life-threatening arrhythmias during toxoplasmosis prophylaxis with spiramycin in neonates.

We recently reported two cases of QT interval prolongation and cardiac arrest in newborns receiving antibiotic therapy with spiramycin, a macrolide agent extensively used for toxoplasmosis prophylaxis. In this study we assessed the effects of this drug on ventricular repolarization and on the potential risk of lethal arrhythmias in eight newborn infants in whom toxoplasmosis prophylaxis after birth was necessary. Electrocardiograms (ECGs) and echocardiograms were recorded during spiramycin therapy (350,000 i.u./kg/ day) and after its withdrawal. In a control group of eight healthy newborns matched for age and sex, no differences were found between two ECGs analogously recorded. The QT interval corrected for heart rate (QTc) was longer during spiramycin therapy than after drug withdrawal (448 +/- 32 msec vs 412 +/- 10 msec, +9%, p = 0.021). QTc dispersion, expressed as the difference between the longest and the shortest value in 12 different leads (QTcmax-min), was also higher during spiramycin therapy (60 +/- 32 msec vs 34 +/- 8 msec, +76%, p = 0.021), mainly because of a major lengthening of the longest QTc (QTcmax). QTc and QTc dispersion were markedly increased in the two newborns who experienced cardiac arrest after beginning treatment compared with the six neonates who had no drug-induced symptoms. During therapy seven of eight newborns had a rare abnormality in the thickening of the left ventricular posterior wall similar to that observed in patients with congenital long QT syndrome. This abnormality disappeared after drug withdrawal. Thus antibiotic therapy with spiramycin in the neonatal period may induce QT interval prolongation and increase QT dispersion. When this effect on ventricular repolarization is more marked, it may favor the occurrence of torsades des pointes and lead to cardiac arrest.

Anti-Bacterial Agents↗

Long-standing symptomatic cryptosporidiosis in a normal man: clinical response to spiramycin.

A healthy immunocompetent 26-year-old man developed prolonged symptomatic cryptosporidiosis. He only achieved clinical improvement after treatment with spiramycin. Other family members suffered from chronic undiagnosed diarrhea, and resolution occurred only after a trial of spiramycin. Thus, Cryptosporidium had provoked a prolonged symptomatic infection in a normal host; spiramycin therapy was required for parasite eradication and clinical cure, and a therapeutic trial with spiramycin was beneficial for family members with chronic undiagnosed diarrhea. Many infections with Cryptosporidium have serious morbidity, and thus, spiramycin may be more generally indicated in the treatment of this infection.

Adult↗

Spiramycin in triple therapy of Helicobacter pylori-associated peptic ulcer disease. An open pilot study with 12-month follow-up.

BACKGROUND: Spiramycin (Rovamycin) is a well-established macrolide antibiotic with good anti-Helicobacter pylori activity in vitro. It is acid-stable and found in high concentration in various body fluids and cells after oral administration. Its anti-H. pylori activity in vivo has not yet been tested. METHODS: Twenty-five consecutive patients with endoscopically verified peptic ulcer and a positive biopsy urease test were given spiramycin tables 1.5 MIU instead of oxytetracycline 500 mg q.d.s. in our triple therapy regimen with bismuth subnitrate suspension 10 mL (150 mg bismuth subnitrate) q.d.s. and metronidazole 400 mg t.d.s. for 10 days. Bismuth was taken between meals and spiramycin and metronidazole with meals. Re-endoscopy and 14C-urea breath test were performed 4 weeks after completion of therapy. Those who were H. pylori negative according to the breath test returned for 1-year follow-up. RESULTS: Per protocol analysis at 4 weeks showed that 21 out of 23 patients were H. pylori negative and had healed ulcers. These 21 patients were persistingly H. pylori negative and had no ulcers at 1-year follow-up. H. pylori eradication and ulcer healing rates were thus 91.3%; 95% confidence interval from 72.0% to 98.9%. Side-effects limiting daily activity were significantly less frequent than we have experienced previously using oxytetracycline in triple therapy. CONCLUSIONS: Spiramycin appears to be an alternative to tetracycline in the triple therapy of H. pylori infection. Further studies to position spiramycin as an anti-H. pylori drug are warranted.

Adult↗

Spiramycin concentrations in plasma and genital-tract secretions after intravenous administration in the ewe.

Uterine infections are associated with reduced fertility in ruminant species. Spiramycin is a macrolide antibiotic potentially active against most of the microorganisms isolated from secretions of infected genital tracts. The present work investigated the ability of systemically administered spiramycin to enter genital secretions, by determining the disposition kinetics of the antibiotic in both plasma and uterine genital secretions. Five healthy ovariectomized ewes were given a single intravenous (i.v.) injection of spiramycin, at a dose of 20 mg/kg. Plasma and genital secretion samples were collected at predetermined intervals for 5 days post-injection. Blood was collected from the jugular vein while mucus was obtained by inserting polyurethane sponges into the vagina. The spiramycin concentration peak in genital-tract secretions was obtained 2.53 +/- 0.63 h after the i.v. administration. The mean residence time was significantly longer (P less than 0.01) in the mucus (18.31 +/- 3.24 h) than in plasma (6.99 +/- 2.53 h). An average mucus to plasma ratio of 7.87 +/- 3.00 was calculated from the area under concentration-time curves covering the period under study. These data indicate that after systemic administration to ewes, spiramycin is rapidly found in genital-tract secretions, at concentrations which are sufficiently high and persistent to suggest its use in the treatment of post-partum uterine infections.

Animals↗

Pharmacokinetics of spiramycin after intravenous, intramuscular and subcutaneous administration in lactating cows.

Spiramycin is a macrolide antibiotic that is active against most of the microorganisms isolated from the milk of mastitic cows. This work investigated the disposition of spiramycin in plasma and milk after intravenous, intramuscular and subcutaneous administration. Twelve healthy cows were given a single injection of spiramycin at a dose of 30,000 IU/kg by each route. Plasma and milk were collected post injection. Spiramycin concentration in the plasma was determined by a high performance liquid chromatography method, and in the milk by a microbiological method. The mean residence time after intravenous administration was significantly longer (P less than 0.01) in the milk (20.7 +/- 2.7 h) than in plasma (4.0 +/- 1.6 h). An average milk-to-plasma ratio of 36.5 +/- 15 was calculated from the area concentration-time curves. Several pharmacokinetic parameters were examined to determine the bioequivalence of the two extravascular routes. The dose fraction adsorbed after intramuscular or subcutaneous administration was almost 100% and was bioequivalent for the extravascular routes, but the rates of absorption, the maximal concentrations and the time to obtain them differed significantly between the two routes. Spiramycin quantities excreted in milk did not differ between the two extravascular routes but the latter were not bioequivalent for maximal concentration in the milk. However, the two routes were bio-equivalent for the duration of time the milk concentration exceeded the minimal inhibitory concentration (MIC) of various pathogens causing infections in the mammary gland.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Spiramycin (rovamycin), a macrolide antibiotic for oral treatment of outpatient pneumonia].

Spiramycin activity against acute pneumonia has been studied in 21 outpatients (15 adults and 6 children). The drug was administered orally twice daily in a dose 3,000,000 units. The course lasted from 7 to 14 days. All the cases were confirmed roentgenologically. The disease ran a moderate-severity course. The response rate reached 95.2%. Another course of antibiotic therapy was not needed. Side effects were not registered. Bacteriological efficacy of spiramycin made up 71.3%. 14 out of 16 isolated strains of causative agents (S.pneumoniae, S.pyogenes, S.aureus, H.influenzae in 5, 1, 7 and 3 patients, respectively) proved sensitive to spiramycin. 2 patients developed mycoplasma infection diagnosed serologically. The findings confirm high therapeutic efficacy of spiramycin, its good tolerance. Spiramycin may be considered the drug of the priority choice in outpatient treatment of acute pneumonia.

Administration, Oral↗

The spiramycin paradox.

Spiramycin has been found to be effective in a variety of clinical and experimental infections despite modest in-vitro activity. In animal models of infection, spiramycin has been found to be as effective as or more effective than erythromycin despite inferior in-vitro activity. These paradoxical results are explained in part by spiramycin's ability to achieve intra-cellular and tissue concentrations that exceed serum concentrations by a factor of ten or more. Furthermore, spiramycin clearance from these sites is much lower resulting in sustained tissue and intracellular concentrations. Finally, spiramycin appears to produce a substantial post-antibiotic effect and, possibly, subinhibitory effects that may further enhance its in-vivo activity.

Animals↗

Comparison of spiramycin and doxycycline in the empirical treatment of acute sinusitis: preliminary results.

In an open randomized comparative study, the clinical and bacteriological efficacy and safety of spiramycin were compared with those of doxycycline in patients with acute sinusitis. Spiramycin was given at a dose of 1 g bd for 10 days and doxycycline at 200 mg once a day on day 1 and 100 mg once a day from day 2 to day 10. Clinical and bacteriological evaluations of efficacy were carried out at the end of therapy. In case of clinical cure, a last follow-up visit was made 15 days after the end of therapy. Adverse effects were recorded. To date 12 assessable patients have been treated with spiramycin and 15 with doxycycline. In the spiramycin group, nine patients were clinically cured at the end of therapy (with no relapse at the last follow-up visit). In the doxycycline group, nine patients were clinically cured at the end of therapy (with no relapse at the last follow-up visit). The data so far available from this study suggest that spiramycin presents an alternative to doxycycline in the treatment of acute sinusitis.

Acute Disease↗

Comparison of spiramycin and tetracycline used adjunctively in the treatment of advanced chronic periodontitis.

This study was designed to compare both clinical and microbiological changes during the treatment of advanced periodontal disease with mechanical debridement, with or without the adjunctive use of either spiramycin or tetracycline. The study, which included 96 patients with advanced periodontitis, was performed as a controlled double-blind parallel randomized trial. All patients received thorough scaling and root planing as well as adjunctive placebo or spiramycin or tetracycline. Probing depth measurements, attachment level changes, plaque level, gingival crevicular fluid, bleeding on probing and microbiological evaluation were carried out at baseline, 2-, 8-, 12- and 24-week visits. Seventy-nine patients (24 placebo, 27 tetracycline and 28 spiramycin) completed the study. At 24 weeks there were no intergroup differences in the improvement of any of the clinical parameters. Spiramycin was the only antibiotic which produced a significantly greater decrease in the proportion of spirochaetes than the placebo group at the 24-week visit. It was concluded that mechanical debridement alone was sufficient in decreasing the subgingival bacteria to a level which would result in the return to periodontal health. The study was not long enough to determine whether or not the difference in spirochaete level was an indication that the spiramycin group would have maintained the benefits of treatment for a longer time.

Adult↗