SAR (structure-activity relationship) in tossicologia

Transcription

1 SAR (structure-activity relationship) in tossicologia L esempio dei fluorochinoloni Wednesday, December 14, 11

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4 Asian Journal of Andrology (2011) 13, ß 2011 AJA, SIMM & SJTU. All rights reserved X/11 $ ORIGIAL ARTICLE Fluoroquinolone macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction Vittorio Magri 1, Emanuele Montanari 2, Višnja Škerk 3, Alemka Markotić 3, Emanuela Marras 4, Antonella Restelli 5, Kurt G aber 6 and Gianpaolo Perletti 4 We previously demonstrated the safety and efficacy of fluoroquinolone macrolide combination therapy in category II chronic bacterial prostatitis (CBP). The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin (500 mg, thrice-weekly) with a once-daily 500- or 750-mg dose of ciprofloxacin (Cipro-500 or Cipro-750 cohort, respectively). Combined administration of azithromycin (1500 mg week 21 ) with ciprofloxacin at the rate of 750 mg day 21 for 4 weeks rather than at 500 mg day 21 for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen (PSA) were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction (ED) at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation. Asian Journal of Andrology (2011) 13, ; doi: /aja ; published online 18 July 2011 Wednesday, December 14, 11

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13 A-AAARGH!! ETCIU Wednesday, December 14, 11

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15 Acido nalidixico Identificato nel 1962, nel corso di una ricerca finalizzata alla ricerca di nuovi antimalarici Wednesday, December 14, 11

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17 Methyl Fluoride pyrrolidine or piperazine cyclopropane or ethyl Methoxy Wednesday, December 14, 11

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21 F: 30-40% t1/2: 3-4 h spettro: solo Gram(-) tossicità: BASSA (GI) F: 70-80% t1/2: 4 h spettro: Gram (-) tossicità: TEDIITI, condropatie F: 99% t1/2: 8 h spettro: Gram (-), alcuni Gram (+) pochi anaerobi tossicità: tendiniti (>cipro), CS, cardio (+3msec) F: 90% t1/2: 15 h spettro: Ampio [Gram (-), Gram (+), Anaerobi] tossicità: cardio (+6msec), tendiniti, epatite fulmin. F: 70% t1/2: 12h spettro: Gram (-), Gram (+) tossicità: cardio (morte improv, +10msec), CS, GI, Liver Wednesday, December 14, 11

22 R 5 O R 6 COOH R 7 X R 8 R 1 generation drug [orig. ref./patent]] 1 nalidixic acid [283;284] X R 8 R 1 -CH 2 -CH 3 R 5 R 6 R 7 H H -CH3 2a norfloxacin [ C H -CH 2 -CH 3 H F H pefloxacin [288;289] C H -CH 2 -CH 3 H F H 3 C H 3 C lomefloxacin [290;291] C F -CH 2 -CH 3 H F H 3 C ciprofloxacin [ ] C H H F H ofloxacin [295;296] C O CH 3 H F H 3 C levofloxacin [297;298] C O CH 3 H F H 3 C 2b H 3 C sparfloxacin [299;300] C F -H 2 F H 3 C H 3 C H 3 C grepafloxacin [301;302] C H -CH 3 F H 3 C 3a H 3 C gatifloxacin [303;304] C -O-CH 3 H F H 3 C trovafloxacin [305;306] F H F H 2 F moxifloxacin [307;308] C -O-CH 3 H F H 3b gemifloxacin [309;310] H F H 2 H 3 CO 4 H 3 C garenoxacin [311;312] C -O-CHF 2 H H H Wednesday, December 14, 11

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25 Gram (+/-)

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28 Tendinopatie e condropatie

29 Torsade de pointes (torsione di punta) Wednesday, December 14, 11

30 Dermatite fototossica

31 cardiotoxicity

32 photo/cardiotoxicity<=>potency chondrotoxicity<=>gyrase binding activity<=>genotoxicity Gram(+)<=>t1/2<=>CS(GABA)/ SAID(seizures) P450 inh<=>f<=>potency P450 inh<=>anaerobes<=>f Wednesday, December 14, 11