Antibiotics have been the most important medical development to mankind. The discovery of penicillin from fungi for treating Staphylococcus started a gold rush in antibiotic development. Then mass production of these antibiotics helped eliminate deaths in common colds and prolonged our lives.
Unfortunately the world is on the edge of a post-antibiotic (#antibiotic) era due to overuse. Before everyone panics, let’s consider the facts. First we have an increase in bacteria resistant to drugs like MRSA. Then came the discovery of bacteria resistant to colistin in patients and livestock which is considered the last line of antibiotic defense. Bacteria is becoming completely resistant to treatment which some have coined antibiotic apocalypse. Think of it, common infections would kill, while surgery and cancer therapies, which are reliant on antibiotics, would be under threat.
Chinese scientists identified a new mutation, dubbed the MCR-1 gene, that prevented colistin from killing bacteria.
The report in the Lancet Infectious Diseases showed resistance in a fifth of animals tested, 15% of raw meat samples and in 16 patients. The resistance has to various bacterial strains and species, including E. coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. You might think, oh, it’s China so we don’t have to worry. Remember we live in a global economy and products and people travel all over. So it’s not a case of if but rather when antibiotic resistance begins.
There is a call to action among nations including a discussion of whether colistin should be banned for agricultural use and whether the same antibiotics should not be used in veterinary and human medicine. Since we are what we eat and the last thing you want is an exposure to food that has resistance to antibiotics needed for human survival.
When you think antibiotics, you think a pill for treatment of an infection. There are antibiotics which are injectable antibiotics. Solithromycin (#Solithromycin) is a next-generation oral and intravenous antibiotics. Solithromycin is not currently available for use but rather it is in Phase 3 clinical development which is the final testing parameters before being released to the general public. It is being developed for the treatment of moderate to moderately-severe community acquired bacterial pneumonia (CABP) and urethritis.
Solithromycin is a highly potent macrolide, the first fluoroketolide, which has potent activity against most macrolide-resistant strains. Macrolides are antimicrobial drugs that are active against aerobic and anaerobic gram-positive cocci and are prescribed for the treatment of respiratory tract and soft tissue infections. Macrolides are important for those patients that are allergic to penicillin since they are able to treat a wider range of bacteria. These antibiotics are considered protein synthesis inhibitors in the sense that they prevent the bacteria from reproducing and spreading. As they die off, the infection goes away.
Studies have shown that this antibiotic is potent activity against resistant strains is driven by its ability to bind to three sites on the bacterial ribosome, compared to one or two for current macrolides. Ribosomes are these complex molecular machines that are located in our cells that serve as the site for protein synthesis. These are our manufacturing plants. Some of the most commonly prescribed macrolides include erythromycin, azithromycin (Zithromax®) and clarithromycin (Biaxin®). The ketolides belong to the macrolide class that is used to treat respiratory tract infections. By combining these two components, you get an antibiotic that can kill of a few types of drug resistant bacteria.
Based on what i have read, the phase 1 study of Solithromycin was successful in treatment for pediatric patients. Phase 2 was tested for chronic obstructive pulmonary disease (COPD) and nonalcoholic steatohepatitis (NASH). Phase three is currently in progress and was given fast track approval as long as it meets its required goals. We shall see what it brings.