Oritavancin: A New Lipoglycopeptide Antibiotic in the Treatment of Gram-Positive Infections.
Oritavancin: A New Lipoglycopeptide Antibiotic in the Treatment of Gram-Positive Infections.
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DOI：
10.1007/s40121-016-0103-4
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发表时间：
2016-03
影响因子：
5.4
通讯作者：
Rybak MJ
中科院分区：
文献类型：
--
作者：
Brade KD;Rybak JM;Rybak MJ
过去几年，革兰氏阳性菌的耐药性一直在稳步增加；然而，用于治疗这些微生物引起的感染的新抗生素的开发还不能满足紧急需求。具体来说，金黄色葡萄球菌和肠球菌之间的耐药性。必需抗生素的使用被认为是一个主要问题。奥利万星是一种半合成脂糖肽抗生素，最近被批准用于治疗急性细菌性皮肤和皮肤结构感染（ABSSSI）。虽然奥利万星在结构上与万古霉素相关，但它还具有独特的作用机制，可大大增强其对多重耐药病原体（包括 VanA 和 VanB 介导的万古霉素耐药肠球菌）的抗菌效力。由于添加了高度疏水性的尾基，奥利万星的半衰期延长至 200-300 小时。尽管奥利万星目前仅被美国食品和药物管理局批准用于 ABSSSI，但该药物最终可能在需要新的创新疗法的其他适应症中发挥作用，包括菌血症和深层革兰氏阳性感染，如感染性心内膜炎或骨髓炎。本综述将重点关注奥利万星的活性谱、作用机制和耐药性、药代动力学和药效学特性，以及评估其用途的已完成和正在进行的临床研究。本文的在线版本 (doi:10.1007/s40121-016-0103-4) 包含补充材料，可供授权用户使用。
Resistance among Gram-positive organisms has been steadily increasing over the last several years; however, the development of new antibiotics to treat infections caused from these organisms has fallen short of the emergent need. Specifically, resistance among Staphylococcus aureus and Enterococcus spp. to essential antibiotics is considered a major problem. Oritavancin is a semisynthetic lipoglycopeptide antibiotic that was recently approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). While structurally related to vancomycin, oritavancin also possesses unique mechanisms of action that greatly enhance its antimicrobial potency against multi-drug resistant pathogens including both VanA- and VanB-mediated vancomycin-resistant enterococci. Owing to the addition of the highly hydrophobic tail group, oritavancin possesses a prolonged half-life ranging from 200–300 h. Although oritavancin is only currently Food and Drug Administration approved for ABSSSI, this agent may eventually play a role in additional indications where new innovative therapy is needed including bacteremia and deep-seeded, Gram-positive infections such as infective endocarditis or osteomyelitis. This review will focus on oritavancin’s spectrum of activity, mechanisms of action and resistance, pharmacokinetic and pharmacodynamic properties, and the completed and ongoing clinical studies evaluating its use. The online version of this article (doi:10.1007/s40121-016-0103-4) contains supplementary material, which is available to authorized users.