德拉沙星:一种新型氟喹诺酮类广谱抗菌药
Delafloxacin: A Novel Fluoroquinolones Broad-Spectrum Antibacterial
摘要: 德拉沙星是一种新型的氟喹诺酮类广谱抗菌药,具有阴离子特性,在酸性条件下具有较好的抗菌活性。通过抑制细菌DNA的复制过程,从而达到杀菌的作用。对革兰氏阳性菌,革兰氏阴性菌和厌氧菌都具有较好的抗菌活性。2017年6月获得美国FDA批准用于治疗急性细菌性皮肤和皮肤结构感染。有口服片剂和注射用粉针两种剂型,推荐剂量为静脉注射300 mg或口服450 mg。具有较好的安全性和耐受性,没有明显的心脏QT间期延长和光毒性。本文对德拉沙星的基本性质,抗菌活性,作用机制,药动学,药效学,安全性和耐受性等方面进行介绍。
Abstract: Delafloxacin is a novel fluoroquinolones antibacterial with anionic properties and good antibacterial activity under acidic conditions. By inhibiting the activity of topoisomerase IV and DNA helicases, the replication of bacterial DNA was blocked and sterilization is achieved. It has a wide range of antibacterial activities for gram-positive bacteria, Gramnegative and anaerobic bacteria. In June 2017, it was approved by the US FDA for the treatment of acute bacterial skin and skin structural infections. There are two dosage forms of oral tablet and injection powder. The recommended dose is intravenous injection of 300 mg or oral 450 mg. It has good safety and tolerability, no heart QT prolongation and phototoxicity. The basic properties, antibacterial activity, mechanism of action, pharmacokinetics, pharmacodynamics, safety and tolerance of delafloxacin were reviewed in this paper.
文章引用:郭忠秋, 刘冰弥, 刘宇. 德拉沙星:一种新型氟喹诺酮类广谱抗菌药[J]. 药物资讯, 2019, 8(1): 9-15. https://doi.org/10.12677/PI.2019.81002

参考文献

[1] 韩伟佳. 目前抗菌药临床应用中的某些问题与对策[J]. 中西医结合心血管病杂志, 2018, 6(8): 26-27.
[2] Abbas, M., Paul, M. and Huttner, A. (2017) New and Improved? A Review of Novel Antibiotics for Gram-Positive Bacteria. Clinical Microbiology and Infection, 23, 697-703. [Google Scholar] [CrossRef] [PubMed]
[3] Cerceo, E., Deitelzweig, S.B., Sherman, B.M., et al. (2016) Multidrug-Resistant Gram-Negative Bacterial Infections in the Hospital Setting: Overview, Implications for Clinical Practice, and Emerging Treatment Options. Microbial Drug Resistance, 22, 412-431. [Google Scholar] [CrossRef] [PubMed]
[4] Corcione, S., De, R. and Francesco, G. (2018) The Optimal Duration of Treatment for Skin and Soft Tissue Infections and Acute Bacterial Skin and Skin Structure Infections. Current Opinion in Infectious Diseases, 31, 155-162. [Google Scholar] [CrossRef
[5] Jindamwar, P., Roy, P., Chaudhary, C.N., et al. (2016) Novel Reporting of Community Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) Strain at a Tertiary Care Centre. International Journal of Current Microbiology and Applied Sciences, 5, 555-564. [Google Scholar] [CrossRef
[6] 高红彦. 喹诺酮类抗菌药应用情况调查及合理用药分析[J]. 山东医学高等专科学校学报, 2017, 39(3): 221-223.
[7] 张磊, 毛东东, 陈秋. 2014-2016年平顶山市部分医院喹诺酮类抗菌药的应用分析[J]. 青岛医药卫生, 2018, 50(2): 109-112.
[8] Pfaller, M.A., Sader, H.S., Rhomberg, P.R., et al. (2017) In Vitro Activity of Delafloxacin Againstcontemporary Bacterial Pathogens from the United States and Europe, 2014. Antimicrobial Agents and Chemotherapy, 61, e02609-16. [Google Scholar] [CrossRef
[9] Aldred, K.J., Kerns, R.J. and Osheroff, N. (2014) Mechanism of Quinolone Action and Resistance. Biochemistry, 53, 1565-1574. [Google Scholar] [CrossRef] [PubMed]
[10] Bambeke, V.F. (2014) Renaissance of Antibiotics Against Difficult Infections: Focus on Oritavancin and New Ketolides and Quinolones. Annals of Medicine, 46, 512-529. [Google Scholar] [CrossRef] [PubMed]
[11] 毕煌垒, 张佳岳, 刘晓慧, 等. 新型广谱氟喹诺酮类抗菌药物——德拉沙星[J]. 临床药物治疗杂志, 2017, 15(7): 6-10.
[12] Bambeke, V.F. (2015) Delafloxacin, A Non-Zwitterionic Fluoroquinolone in Phase III of Clinical Development: Evaluation of Its Pharmacology, Pharmacokinetics, Pharmacodynamics and Clinical Efficacy. Future Microbiology, 10, 1111-1123. [Google Scholar] [CrossRef] [PubMed]
[13] Bassetti, M., Della, S.P., Pecori, D., et al. (2015) Delafloxacin for the Treatment of Respiratory and Skin Infections. Expert Opinion on Investigational Drugs, 24, 433-442. [Google Scholar] [CrossRef] [PubMed]
[14] Bassetti, M., Vena, A., Carnelutti, A., et al. (2018) Emerging Treatment Options for Acute Bacterial Skin and Skin Structure Infections: Focus on Intravenous Delafloxacin. Infection and Drug Resistance, 11, 479-488. [Google Scholar] [CrossRef
[15] 张建忠. 2017年6月FDA批准新药概况[J]. 上海医药, 2017, 38(15): 95.
[16] 王秀娟, 郭彦玲. 一种德拉沙星的制备方法[J]. 精细化工中间体, 2017, 47(1): 56-59.
[17] Kocsis, B., Domokos, J. and Szabo, D. (2016) Chemical Structure and Pharmacokinetics of Novel Quinolone Agents Represented by Avarofloxacin, Delafloxacin, Fnafloxacin, Zabofloxacin and Nemonoxacin. Annals of Clinical Microbiology and Antimicrobials, 15, 34. [Google Scholar] [CrossRef] [PubMed]
[18] 王亚娟. 氟喹诺酮药物结构改造与抗菌活性研究新进展[J]. 河北化工, 2011, 34(6): 12-18.
[19] Cho, J.C., Crotty, M.P., White, B.P. and Worley, M.V. (2018) What Is Old Is New Again: Delafloxacin, a Modern Fluoroquinolone. Pharmacotherapy, 38, 108-121. [Google Scholar] [CrossRef] [PubMed]
[20] So, W., Crandon, J.L. and Nicolau, D.P. (2015) Effects or Urine Matrix and pH on the Potency of Delafloxacin and Ciprofloxacin against Urogenic Escherichia coli and Klebsiella penuemoniae. Journal of Urology, 194, 563-570.
[21] Markham, A. (2017) Delafloxacin: First Global Approval. Drugs, 77, 1481-1486. [Google Scholar] [CrossRef] [PubMed]
[22] McCurdy, S., Lawrence, L., Quintas, M., et al. (2017) In Vitro Activity of Delafloxacin and Microbiological Response against Fluoroquinolone-Susceptible and Non-Susceptible S. aureus Isolates from Two Phase 3 Studies of Acute Bacterial Skin and Skin Structure Infections (ABSSSI). Antimicrobial Agents and Chemotherapy, 61, e00772-17.
[23] Hoover, R., Hunt, T., Benedict, M., et al. (2016) Safety, Tolerability, and Pharmacokinetic Properties of Intravenous Delafloxacin after Single and Multiple Doses in Healthy Volunteers. Clinical Therapeutics, 38, 53-65. [Google Scholar] [CrossRef] [PubMed]
[24] McEwen, A., Lawrence, L., Hoover, R., et al. (2015) Disposition, Metabo-lism and Mass Balance of Delafloxacin in Healthy Human Volunteers Following Intravenous Administration. Xenobiotica, 45, 1054-1062. [Google Scholar] [CrossRef] [PubMed]
[25] Hoover, R., Hunt, T., Benedict, M., et al. (2016) Single and Multiple As-cending-Dose Studies of Oral Delafloxacin: Effects of Food, Sex, and Age. Clinical Therapeutics, 38, 39-52. [Google Scholar] [CrossRef] [PubMed]
[26] Hoover, R., Harry, A.J., Laura, L., et al. (2017) Delafloxacin Pharmacokinet-ics in Subjects with Varying Degrees of Renal Function. The Journal of Clinical Pharmacology, 58, 514-521.
[27] Hoover, R., Mar-bury, T.C., Preston, R.A., et al. (2017) Clinical Pharmacology of Delafloxacin in Patients with Hepatic Impairment. The Journal of Clinical Pharmacology, 57, 328-335. [Google Scholar] [CrossRef] [PubMed]
[28] Lepak, A.J. and Andes, D.R. (2016) In Vivo Phar-macodynamic Target Assessment of Delafloxacin against Staphylococcus aureus, Streptococcus pneumoniae and Klebsiella pneumoni-ae in the Murine Lung Infection Model. Antimicrobial Agents and Chemotherapy, 60, 4764-4769. [Google Scholar] [CrossRef
[29] O’Riordan, W., Mehra, P., Manos, P., Kingsley, J., Lawrence, L. and Cammarata, S. (2015) A Randomized Phase 2 Study Comparing Two Doses of Delafloxacin with Tigecycline in Adults with Complicated Skin and Skin-Structure Infections. International Journal of Infectious Diseases, 30, 67-73. [Google Scholar] [CrossRef] [PubMed]
[30] Kingsley, J., Mehra, P., Lawrence, L.E., et al. (2016) A Randomized, Dou-ble-Blind, Phase 2 Study to Evaluate Subjective and Objective Outcomes in Patients with Acute Bacterial Skin and Skin Structure Infec-tions Treated with Delafloxacin, Linezolid or Vancomycin. Journal of Antimicrobial Chemotherapy, 71, 821-829. [Google Scholar] [CrossRef] [PubMed]
[31] Melinta Therapeutics. A Phase 3, Multicenter, Randomized, Double-Blind, Ac-tive-Controlled Study to Evaluate the Efficacy and Safety of Delafloxacin Compared with Vancomycin plus Aztreonam in Patients with Acute Bacterial Skin and Skin Structure Infections. 2017-3-15/2018-5-25.
https://clinicaltrials.gov/ct2/show/NCT01811732
[32] Melinta Therapeutics. A Phase 3, Multicenter, Randomized, Double-Blind, Active Controlled Study to Evaluate the Efficacy and Safety of IV and Oral Delafloxacin Compared with Vancomycin plus Aztreonam in Patients with Acute Bacterial Skin and Skin Structure Infections.2017-3-15/2018-5-25.
https://clinicaltrials.gov/ct2/show/NCT01984684
[33] O’Riordan, W., Overcash, S., Lawrence, L., et al. (2017) Outcomes with IV/Oral Delafloxacin Compared to Vancomycin/Aztreonam in Treatment of Patients with Acute Bacterial Skin and Skin Structure In-fections (ABSSSI) and Gram-Negative Pathogens. Presented at: IDWeek; San Diego, CA, USA. Poster 1856.
[34] Overcash, S., O’Riordan, W., Lawrence, L., et al. (2017) Outcomes with IV/Oral Delafloxacin Compared to Vancomycin/Aztreonam in Treatment of Patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSI) and Gram-Positive Pathogens. Presented at: IDWeek; San Diego, CA, USA. Poster 1857.
[35] Bassetti, M., Pecori, D., Cojutti, P., Righi, E. and Pea, F. (2017) Clinical and Pharmacokinetic Drug Evaluation of Delafloxacin for the Treatment of Acute Bacterial Skin and Skin Structure Infections. Expert Opinion on Drug Me-tabolism & Toxicology, 13, 1193-1200. [Google Scholar] [CrossRef] [PubMed]
[36] Litwin, J.S., Benedict, M.S., Thorn, M.D., et al. (2015) A Thorough QT Study to Evaluate the Effects of Therapeutic and Supratherapeutic Doses of Delafloxacin on Car-diac Repolarization. Antimicrobial Agents and Chemotherapy, 59, 3469-3473. [Google Scholar] [CrossRef
[37] Ferguson, J., Lawrence, L., Paulson, S., Schlosser, M.J. and Cammarata, S. (2015) Assessment of Phototoxicity Potential of Delafloxacin in Healthy Male and Female Subjects: A Phase 1 Study. Poster Board Number F-1198A. 2015-09-17/2018-05-25. http://melinta.com/wp-content/uploads/2016/03/ICAAC15-Dela_phototoxicity_ph1.pdf
[38] Red-grave, L.S., Sutton, S.B., Webber, M.A. and Piddock, L.J.V. (2014) Fluoroquinolone Resistance: Mechanisms, Impact on Bacteria, and Role in Evolutionary Success. Trends in Microbiology, 22, 438-445. [Google Scholar] [CrossRef] [PubMed]
[39] Remy, J.M., Tow-Keogh, C.A., McConnell, T.S., Dalton, J.M. and DeVito, J.A. (2012) Activity of Delafloxacin against Methicillin-Resistant Staphylococcus aureus: Resistance Selection and Characterization. Journal of Antimicrobial Chemotherapy, 67, 2814-2820. [Google Scholar] [CrossRef] [PubMed]
[40] 巴合努拉∙赛提哈布勒. 研究氟喹诺酮类药物的不良反应及临床合理用药[J]. 世界最新医学信息文摘, 2018, 18(3): 90-91.