《Working with Tigecycline 》.pptxVIP

Working with Tigecycline – What Experience Tells Us;Robert G Masterton, UK, within the last 12 months has been a consultant and/or a speaker for Sumitomo, Johnson Johnson, Cubist, Theravance, Astellas, Pfizer AstraZeneca ;This presentation may include limited information about non-approved uses of certain pharmaceutical products for the purpose of scientific information sharing and discussion, which does not represent the opinion of a specific pharmaceutical company. Full prescribing information and primary references should be consulted for complete safety and efficacy information relating to the approved use of such products. Physicians have the professional responsibility to ensure that pharmaceutical products are prescribed and used appropriately, based on their own judgment and accepted standards of care.;Heritage of the Glycylcyclines;Tetracycline resistance was first reported in 19531 The utility of tetracyclines has been increasingly compromised by a variety of mechanisms2 Expression of efflux pumps Ribosomal protection mechanisms Decreased drug permeability Target mutations Enzymatic degradation of the antibiotics The first two mechanisms currently predominate in clinical settings2;Pankey GA. J Antimicrob Chemother. 2005;56:470-480.;Tigecycline has been shown to form additional strong contacts with the nucleotides in RNA helices H34 (red) and H18 (yellow) when compared to tetracycline and minocycline;Tigecycline inhibits protein translation in bacteria through ribosomal binding1 30S ribosomal subunit binding Binding affinity is greater than tetracycline or minocycline Overcomes two mechanisms of resistance2 Ribosomal protection Efflux from the cell Generally, tigecycline is considered to be a bacteriostatic agent3,4 Bactericidal activity has been shown against isolates of Streptococcus pneumoniae and Legionella pneumophila;The high affinity of tigecycline ( ) for the ribosome ( ), and its unique orientation when bound, may help preve