Mecillinam
 | |
|---|---|
| Systematic (IUPAC) name | |
| (2S,5R,6R)-6-[(azepan-1-ylmethylene)amino]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylic acid | |
| Clinical data | |
| AHFS/Drugs.com | International Drug Names |
| Pregnancy cat. | B (US) Appears safe in pregnancy[1] |
| Legal status | ℞ Prescription only |
| Routes | Intravenous, intramuscular |
| Pharmacokinetic data | |
| Bioavailability | Negligible |
| Protein binding | 5 to 10% |
| Metabolism | Some hepatic metabolism |
| Half-life | 1 to 3 hours |
| Excretion | Renal and biliary, mostly unchanged |
| Identifiers | |
| CAS number | 32887-01-7  |
| ATC code | J01CA11 |
| PubChem | CID 36273 |
| DrugBank | DB01163 |
| ChemSpider | 33357  |
| UNII | V10579P3QZ |
| KEGG | D02888 |
| ChEMBL | CHEMBL530 |
| Chemical data | |
| Formula | C15H23N3O3S |
| Mol. mass | 325.426 g/mol |
| SMILES
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| (what is this?) (verify) | |
Mecillinam (INN) or amdinocillin (USAN), trade name Coactin, is an extended-spectrum penicillin antibiotic that binds specifically to penicillin binding protein 2 (PBP2),[2] and is only considered to be active against Gram-negative bacteria. It is used primarily in the treatment of urinary tract infections, and has also been used to treat typhoid and paratyphoid fever.[3][4] Because mecillinam has very low oral bioavailability, an orally active prodrug was developed: pivmecillinam. Neither drug is available in the United States.[5]
History
With the codename FL 1060, mecillinam was developed by the Danish pharmaceutical company Leo Pharmaceutical Products (now LEO Pharma). It was first described in the scientific literature in a 1972 paper.[6][7]
Activity
Mecillinam is active against most pathogenic Gram-negative bacteria, except Pseudomonas aeruginosa and some species of Proteus.[5] Several studies have also found it to be as effective as other antibiotics for treating Staphylococcus saprophyticus infection, even though it is Gram-positive, possibly because mecillinam reaches very high concentrations in urine.[1]
Worldwide resistance to mecillinam in bacteria causing urinary tract infection has remained very low since its introduction; a 2003 study conducted in 16 European countries and Canada found resistance to range from 1.2% (Escherichia coli) to 5.2% (Proteus mirabilis).[8] Another large study conducted in Europe and Brazil obtained similar results — 95.9% of E. coli strains, for instance, were sensitive to mecillinam.[9]
Adverse effects
The adverse effect profile of mecillinam is similar to that of other penicillins.[2] The most common side effects of mecillinam use are rash and gastrointestinal upset, including nausea and vomiting.[1]
References
- ↑ 1.0 1.1 1.2 Nicolle LE (August 2000). = long&pmid = 10969050 "Pivmecillinam in the treatment of urinary tract infections". J Antimicrob Chemother 46 (Suppl A): 35–39. doi:10.1093/jac/46.suppl_1.35. PMID 10969050.
- ↑ 2.0 2.1 Neu HC (1985). "Amdinocillin: a novel penicillin. Antibacterial activity, pharmacology and clinical use". Pharmacotherapy 5 (1): 1–10. PMID 3885172.
- ↑ Clarke PD, Geddes AM, McGhie D, Wall JC (July 1976). "Mecillinam: a new antibiotic for enteric fever". Br Med J 2 (6026): 14–5. doi:10.1136/bmj.2.6026.14. PMC 1687648. PMID 820402.
- ↑ Geddes AM, Clarke PD (July 1977). "The treatment of enteric fever with mecillinam". J Antimicrob Chemother. 3 Suppl B: 101–2. PMID 408321.
- ↑ 5.0 5.1 Pham P, Bartlett JG (August 28, 2008). "Amdinocillin (Mecillinam)". Point-of-Care Information Technology ABX Guide. Johns Hopkins University. Retrieved on August 31, 2008. Freely available with registration.
- ↑ Lund F, Tybring L (April 1972). "6β-amidinopenicillanic acids—a new group of antibiotics". Nature New Biol 236 (66): 135–7. doi:10.1038/236135c0. PMID 4402006.
- ↑ Tybring L, Melchior NH (September 1975). "Mecillinam (FL 1060), a 6β-Amidinopenicillanic Acid Derivative: Bactericidal Action and Synergy In Vitro". Antimicrob Agents Chemother 8 (3): 271–6. PMC 429305. PMID 170856.
- ↑ Kahlmeter G (January 2003). "An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO·SENS Project". J Antimicrob Chemother 51 (1): 69–76. doi:10.1093/jac/dkg028. PMID 12493789.
- ↑ Naber KG, Schito G, Botto H, Palou J, Mazzei T (May 2008). "Surveillance Study in Europe and Brazil on Clinical Aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): Implications for Empiric Therapy". Eur Urol 54 (5): 1164–75. doi:10.1016/j.eururo.2008.05.010. PMID 18511178.
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