Abstract
Antibiotic macrolides are experiencing renewed interest in anti-infective therapy since the advent of ketolides. This therapeutic class was introduced in order to broaden the narrow antibacterial spectrum of macrolides and to cope with the emergence of germs resistant to Erythromycin A and its hemisynthetic derivatives or neomacrolides (Clarithromycin, Roxithromycin, Azithromycin, Dirithromycin). From a pharmacochemical point of view, ketolides were first of all obtained by operating chemical modulations on Erythromycin A to obtain the neomacrolides, then, by replacing the neutral sugar (L-cladinose) in C3 by a ketone function coupled with the creation of an oxazolidinone like heterocycle in C11 and C12 in place of the hydroxyls present in these positions (Telithromycin, Cethromycin, Solithromycin). These modulations have enabled the improvement of the chemical stability of ketolides in gastric acid medium and increase their affinity for the ribosomal target, hence the broadening of their spectrum of action towards Gram positive germs including strains resistant to other macrolides and to neomacrolides. Therefore, the objective of this systematic review is to report the various pharmacochemical aspects undertaken since 1952 in the macrolide series based on the structure of Erythromycin A. These aspects will focus on the pharmacomodulations that have led, year after year, to the optimization of stability, the improvement of the pharmacodynamic and pharmacokinetic profile and that have allowed the development of neomacrolides, ketolides and neoketolides, which are today essential in the management of severe bronchopulmonary infections.
Highlights
The history of antibiotic macrolides began in 1952 with the discovery of Erythromycin, which has been shown to be active on penicillinase-producing strains of Staphylococcus aureus [1] [2] [3] [4]
From a pharmacochemical point of view, ketolides were first of all obtained by operating chemical modulations on Erythromycin A to obtain the neomacrolides, by replacing the neutral sugar (L-cladinose) in C3 by a ketone function coupled with the creation of an oxazolidinone like heterocycle in C11 and C12 in place of the hydroxyls present in these positions (Telithromycin, Cethromycin, Solithromycin)
With the development of total synthesis methods, they represent a real opportunity for pharmacochemists to design new and even more effective macrolide derivatives and analogues for the revival of effective antibiotic therapy
Summary
The history of antibiotic macrolides began in 1952 with the discovery of Erythromycin, which has been shown to be active on penicillinase-producing strains of Staphylococcus aureus [1] [2] [3] [4]. The renewed interest in erythromycin has led to pharmacomodulation studies around its structure in order to overcome its drawbacks of use [1] [6] These studies have led to the development of hemisynthesis macrolides or neomacrolides such as Clarithromycin, Roxithromycin, Dirithromycin and Azithromycin which have shown better stability in leaving gastric acid medium, better oral bioavailability or even widening of the antibacterial action spectrum. The objective of this literature review is to retrace the various pharmacochemical aspects undertaken around the chemical scaffold of Erythromycin A which have led to neomacrolides and ketolides It will highlight the various structural elements responsible for the activities and limits of use of Erythromycin A, as well as the various chemical modifications undertaken to overcome these limits. Spectrum of antibacterial action will be discussed in this review from the perspective of the pharmacochemist
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