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[Macrolides, ketolides and streptogramins].

José Mensa1, Elisa García-Vázquez, Jordi Vila

  • 1Instituto Clínico de Infecciones e Inmunología. Hospital Clínic. Barcelona. España. jmensa@clinic.ub.es

Enfermedades Infecciosas Y Microbiologia Clinica
|April 12, 2003
PubMed
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Macrolides, ketolides, and streptogramins target bacterial 23S ribosomal RNA. Newer agents like telithromycin and Synercid show efficacy against resistant strains, offering treatment options for respiratory infections.

Area of Science:

  • Microbiology
  • Pharmacology
  • Infectious Diseases

Background:

  • Macrolides, ketolides, and streptogramins are antibiotic classes with overlapping spectra but differing resistance profiles.
  • These antibiotics target the 23S ribosomal RNA peptidyl transferase center, impacting protein synthesis.
  • Increasing resistance to macrolides necessitates evaluation of alternative agents.

Purpose of the Study:

  • To compare the efficacy and resistance profiles of macrolides, ketolides, and streptogramins.
  • To highlight the activity of telithromycin and Synercid against resistant bacterial strains.
  • To review the pharmacokinetic and safety profiles of these antibiotic classes.

Main Methods:

  • Comparative analysis of antibiotic mechanisms of action and binding affinities.

Related Experiment Videos

  • Review of clinical data on activity against resistant Gram-positive and intracellular microorganisms.
  • Examination of pharmacokinetic data, including metabolism, excretion, and tissue distribution.
  • Assessment of safety and tolerance profiles, including use in pregnancy.

    • Main Results:

    • Telithromycin (ketolide) and Synercid (streptogramin) demonstrate maintained activity against macrolide-resistant pneumococci and S. pyogenes.
    • These antibiotics are metabolized by CYP 3A4, potentially causing drug interactions.
    • They achieve high intracellular concentrations but do not penetrate cerebrospinal fluid.
    • Generally good tolerance and few adverse effects are noted, with specific indications for resistant infections.

    Conclusions:

    • Ketolides and streptogramins provide valuable therapeutic options against resistant bacterial infections, particularly respiratory tract infections.
    • Understanding drug metabolism and interactions is crucial for safe and effective use.
    • These agents are considered safe for use during pregnancy (Class B).