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BETA LACTAM ANTIBIOTICS
Ravish Yadav
Introduction
β-Lactam antibiotics are the most widely produced and used antibacterial
drugs in the world, and have been ever since their initial clinical trials in
1941.
• β-Lactams are divided into several classes based on their structure and
function; and are often named by their origin, but all classes have a
common β-Lactam ring structure.
• Clinically useful families of beta-lactam compounds include the
• penicillins,
• cephalosporins,
• monobactams
• carbapenems
2
History
1928- Alexander Fleming discovers a mold which inhibits the growth of
staphylococcus bacteria
1940- penicillin is isolated and tested on mice by researchers at Oxford
1941- penicillin mass produced by fermentation for use by US soldiers in
WWII
1950’s- 6-APA is discovered and semi-synthetic penicillins are developed.
1960’s to today- novel β-lactams/ β-lactamase inhibitors are discovered and
modified from the natural products of bacteria
3
MOA
Target- Cell Wall Synthesis
The bacterial cell wall is a cross linked polymer called peptidoglycan
which allows a bacteria to maintain its shape despite the internal
turgor pressure caused by osmotic pressure differences.
If the peptidoglycan fails to crosslink the cell wall will lose its strength
which results in cell lysis.
All β-lactams disrupt the synthesis of the bacterial cell wall by
interfering with the transpeptidases which catalyzes the cross linking
process.
4
Peptidoglycan
Peptidoglycan is a carbohydrate composed of alternating units of
NAMA (N-acetyl muramic acid) and NAGA (N-acetyl Gluc0samine).
The NAMA units have a peptide side chain which can be cross linked
from the L-Lys residue to the terminal D-Ala-D-Ala link on a
neighboring NAMA unit.
This is done directly in Gram (-) bacteria and via a pentaglycine bridge
on the L-lysine residue in Gram (+) bacteria.
5
Mechanism
6
D-Alanine
TRANSPEPTIDASE
PENICILLIN
SUGAR
BACKBONE
NAM
L-Ala
NAG
D-Glu
L-Lys
D-Ala
D-Ala
Gly Gly Gly Gly Gly Gly GlyGlyGlyGlyL-Lys
NAG
D-Ala
D-Ala
D-Glu
L-Ala
NAM
SUGAR
BACKBONE
L-Lys Gly Gly
D-Ala
NAM
L-Ala
NAG
D-Glu
L-Lys Gly Gly Gly Gly GlyGlyGlyGly
NAG
D-Ala
D-Glu
L-Ala
NAM
Cross linking
Mechanism of action - bacterial cell wall synthesis
7
Transpeptidase- PBP
The cross linking reaction is catalyzed by a class of transpeptidases
known as penicillin binding proteins(PBPs)
A critical part of the process is the recognition of the D-Ala-D-Ala
sequence of the NAMA peptide side chain by the PBP. Interfering
with this recognition disrupts the cell wall synthesis.
β-lactams mimic the structure of the D-Ala-D-Ala link and bind to the
active site of PBPs, disrupting the cross-linking process.
8
9
10
Normal Mechanism
Peptide
Chain
D-Ala D-Ala CO2H
OH
Peptide
Chain
Gly
H
OH
Peptide
Chain
Peptide
Chain
D-Ala GlyPeptide
Chain
O
D-Ala
Mechanism of action - bacterial cell wall synthesis
11
Mechanism of β-Lactam Drugs
β-Lactams acylate the hydroxyl group on the serine residue of PBP
active site in an irreversible manner.
This reaction is further aided by the oxyanion hole, which stabilizes the
tetrahedral intermediate and thereby reduces the transition state
energy.
12
OH
Peptide
Chain
Gly
H
Blocked H2O
Blocked
HCR
O
CO2H
NH
O
Me
Me
N
S
S
HN
O
O
Me
Me
NH
CO2H
C
O
R H
S
HN
O
O
Me
Me
NH
CO2H
C
O
R H
Blocked Irreversibly blocked
Bacterial Resistance
Bacteria have many methods with which to combat the effects of β-
lactam type drugs.
• Intrinsic defenses such as efflux pumps can remove the β-lactams
from the cell.
• β-Lactamases are enzymes which hydrolyze the amide bond of the
β-lactam ring, rendering the drug useless. Thus Inactivation of the
antibiotic by beta lactamase
• Imparied penetration of drug to target PBPs
• Bacteria may acquire resistance through mutation at the genes which control
production of PBPs, altering the active site and binding affinity for the β-lactam
.
13
Range of Activity
β-Lactams can easily penetrate Gram (+) bacteria, but the outer cell
membrane of Gram (-) bacteria prevents diffusion of the drug. β-
Lactams can be modified to make use of import porins in the cell
membrane.
β-Lactams also have difficulty penetrating human cell membranes,
making them ineffective against atypical bacteria which inhabit
human cells.
Any bacteria which lack peptidoglycan in their cell wall will not be
affected by β-lactams.
14
Toxicity
About 10% of the population is allergic (sometimes severely) to some
penicillin type β-lactams.
15
PENICILLIN
Classification
Naturally
1. Ocurring
• Penicillin G
2. Semisynthetic
 Acid Resistant Penicillins
Eg. Peniciliin V
 Penicillinase resistant P.
Eg. Methicillin, Nafcillin, Oxacillin,
Cloxacillin
 Extended spectrum Penicillins
1. Amino penicillins - Eg.
Ampicillin, Amoxicillin,
2. Carboxy Penicillins-
Carbenicillin
16
3. Synthetic
 Phenethicillin
Nomenclature
• Numbering of fused bicyclic ring initiates the at N atom and assigns
the ring S the 4-position.
• Thus, penicillins are named as 4-thia-l-azabicyclo[3.2.0]heptanes,
according to this system
17
Three simplified forms of penicillin nomenclature
have been adopted for general use.
• The first uses the name “penam” for the
unsubstituted bicyclic system, including
the amide carbonyl group, with
numbering systems as just described
• Thus, penicillins generally are designated
according to this system as 6- acylamino-
3,3-dimethylpenam-2-carboxylic acids.
18
Three simplified forms of penicillin nomenclature
have been adopted for general use.
• The second, seen more frequently in the medical literature, uses the
name “penicillanic acid” to describe the ring system with substituents
that are generally present (i.e., 3,3-dimethyl and 2-carboxyl acid)
19
Three simplified forms of penicillin nomenclature
have been adopted for general use.
• A third form, uses trivial nomenclature to name the entire
• 6-carbonylaminopenicillanic acid portion of the molecule as “penicillin” and
then distinguishes compounds on the basis of the R group of the acyl portion of
the molecule
20
• Thus, penicillin G is named benzylpenicillin and penicillin V is
phenoxymethylpenicillin
21
Degradation of Penicillin
22
23
24
Penicillin -SAR
Penicillin
25
1.Penicillin can be modified at various positions to improve their ability to:
-be administered orally (survive acidic conditions)
-be tolerated by the patient (allergies)
-penetrate the outer membrane of Gram (-) bacteria
-prevent hydrolysis by β-lactamases
-acylate the PBPs(Transpeptidases) of resistant species (there are many
different PBPs)
26
Penicillins- Natural
2. Natural penicillins are those which can be obtained directly from the
penicillium mold and are not further modified. Many species of
bacteria are now resistant to these penicillins.
Penicillin G
It is not orally active
27
Penicillin G in Acidic Conditions
Penicillin G could not be administered orally due to the its inactivation
in acidic conditions of the stomach.
28
Penicillin V
3. Penicillin V is produced when phenoxyacetic acid rather than
phenylacetic acid is introduced to the penicillium culture. Adding
the oxygen decreases the nucleophilicity of the carbonyl group,
making penicillin V acid stable and orally viable.
29
N
S
H
N
O
C
O
CH2PhO
H
Penicillin V
(orally active)
electronegative
oxygen
•Better acid stability and orally active
•But sensitive to b-lactamases
•Slightly less active than penicillin G
•Allergy problems with some patients
30
• lactamases are prevalent in S. aureus and S. epidermidis, and render
them resistant to Penicillin G and V. This necessitated the
development of semi-synthetic penicillins through rational drug
design.
31
Semi-Synthetic Penicillins
4.The acyl side chain of the penicillin molecule can be cleaved using
enzyme or chemical methods to produce 6-APA, which can further
be used to produce semi-synthetic penicillins or cephalosporins
75% of the penicillin produced is modified in this manner.
6-APA
32
Penicillins- Antistaphylococcal/
Penicillinase resistant penicillins
5. In general, it was observed that, increasing the steric
hindrance at the α- carbon of the acyl group increased
resistance to staphylococcal β-lactamase .
• Thus Penicillins which have bulky side groups can block the
β-Lactamases (of bacteria)which hydrolyze the lactam ring.
This leads to development of penicillinase (β-Lactamases)
resistant penicillins.
33
Penicillins- Antistaphylococcal
7. Methicillin was the first penicillin developed with this type of
modification, and since then all bacteria which are resistant to any type of
penicillin are designated as methicillin resistant. (MRSA- methicillin-
resistant S. aureus)
34
ortho groups
important
N
S Me
Me
H
N
CO2H
O
MeO
OMe
H HC
O
Examples – Methicillin
•Methoxy groups block access to b-lactamases but not to transpeptidases
•Binds less readily to transpeptidases compared to penicillin G
•Lower activity compared to Pen G against Pen G sensitive bacteria
•Poor activity vs. some streptococci
•Inactive vs. Gram -ve bacteria
•Poor range of activity
•Active against some penicillin G resistant strains (e.g. Staphylococcus)
•Acid sensitive since there is no electron-withdrawing group
•Orally inactive and must be injected
N
S Me
Me
H
N
CO2H
O
MeO
OMe
H HC
O
ortho groups
important
N
S Me
Me
H
N
CO2H
O
MeO
OMe
H HC
O
35
Penicillins- Antistaphylococcal
8. the α-acyl carbon could be part of an aromatic (e.g.,phenyl or
naphthyl) or heteroaromatic (e.g., 4-isoxazoyl)system,which increases
antibacterial potency by making them acid stable.
36
nafcillin
Oxacillin
Penicillins- Antistaphylococcal
9. Substitutions at the ortho positions of a phenyl ring (e.g., 2,6-dimethoxy
[methicillin]) or the 2-position of a 1-naphthyl system (e.g., 2-ethoxyl
[nafcillin]) increase the steric hindrance of the acyl group and confer
more β-lactamase resistance than shown by the unsubstituted
compounds
37
nafcillin
Penicillins- Antistaphylococcal
10. Methicillin is acid sensitive hence orally inactive and has been
improved upon by adding electron withdrawing groups, as was done
in penicillin V, resulting in drugs such as oxacillin and nafcillin.
38
11. Among five-membered–ring heterocyclic derivatives bulkier
substituents are required to confer effective β-lactamase
resistance. Thus, members of the 4-isoxazoyl penicillin family
(e.g., oxacillin, cloxacillin, and dicloxacillin) require both the 3-
aryl and 5-methyl (3-methyl and 5-aryl) substituents for
effectiveness against β - lactamase–producing S. aureus.
39
Bulky and
e- withdrawing
N
O
C
O
H
N
O
CO2H
Me
MeS
N
R'
R
Me
H H
Examples - Oxacillin
•Orally active and acid resistant
•Resistant to b-lactamases
•Active vs. Staphylococcus aureus
•Less active than other penicillins
•Inactive vs. Gram -ve bacteria
•Nature of R & R’ influences absorption and plasma protein binding
•Cloxacillin better absorbed than oxacillin
•Flucloxacillin less bound to plasma protein, leading to higher levels of free drug
Bulky and
e- withdrawing
Oxacillin R = R' = H
Cloxacillin R = Cl, R' = H
Dicloxacillin R = Cl, R' = Cl
Flucloxacillin R = Cl, R' = F
N
O
C
O
H
N
O
CO2H
Me
MeS
N
R'
R
Me
H H
40
9. Due to the bulky side group, all of the
antistaphylococcal drugs have difficulty penetrating
the cell membrane and are less effective than other
penicillins.
• All of the clinically available penicillinase-resistant
penicillins are significantly less active than either
penicillin G or penicillin V against most non–β-
lactamase-producing bacteria normally sensitive to
the penicillins.
41
Penicillins- Aminopenicillins
10.In order to increase the range of activity(efficacy), the
penicillin has been modified to have more hydrophilic
groups, allowing the drug to penetrate into Gram (-) bacteria
via the porin channels.
11.Introduction of an ionized or polar group into the α-
position of the side chain benzyl carbon atom of penicillin G
confers activity against Gram-negative bacilli
Ampicillin R=Ph
Amoxicillin R= Ph-(p)OH
42
Penicillins- Aminopenicillins
11. derivatives with an ionized -amino group, such as ampicillin and
amoxicillin, are generally effective against such Gram-negative genera
as Escherichia, Klebsiella, Haemophilus, Salmonella, Shigella, and
non–indole-producing Proteus.
• Furthermore, activity against penicillin G–sensitive, Gram-positive
species is largely retained.
12. These penicillins have a wider range of activity than natural or
antistaphylococcal drugs, but without the bulky side groups are once
again susceptible to attack by β-lactamases
12.The additional hydrophilic groups make penetration of the gut wall
difficult, and can lead to infections of the intestinal tract by H. pylori
43
Penicillins- Aminopenicillins
13.Due to the effectiveness of the aminopenicillins, a second
modification is made to the drug at the carboxyl group to produce
prodrug
eg. BACAMPICILLIN prodrug of ampicillin.
14.Changing the carboxyl group to an ester allows the drug to
penetrate the gut wall where it is later hydrolyzed into the more
polar active form by esterase enzymes.
This has greatly expanded the oral availability of the aminopenicillin
class.
44
O
N
H
NC
C
NH2
S Me
Me
CO2R
H H
H
O
Prodrugs of Ampicillin (Leo Pharmaceuticals - 1969)
Properties
•Increased cell membrane permeability
•Polar carboxylic acid group is masked by the ester
•Ester is metabolised in the body by esterases to give the free drug
PIVAMPICILLINR = CH2O
C
O
CMe3
TALAMPICILLINR = O
O
BACAMPICILLIN
R = CH
Me
O
C
O
O CH2Me
45
Penicillins- Extended Spectrum
15.Extended spectrum penicillins are similar to the aminopenicillins in
structure but have either a carboxyl group or urea group instead of the
amine.
• Thus Incorporation of an acidic substituent at the α-benzyl carbon atom of
penicillin G also imparts clinical effectiveness against Gram-negative bacilli
and, furthermore, extends the spectrum of activity to include organisms
resistant to ampicillin
46
Penicillins- Extended Spectrum
16.Like the aminopenicillins the extended spectrum drugs have an
increased activity against Gram (-) bacteria by way of the import
porins.
These drugs also have difficulty penetrating the gut wall and must be
administered intravenously if not available as a prodrug.
These are more effective than the aminopenicillins and not as
susceptible to β-lactamases
47
Eg. Carbenicillin
• Carbenicillin has a broad
range of antimicrobial
activity, broader than any
other known penicillin, a
property attributed to the
unique carboxyl group.
• It has been proposed that the
carboxyl group improves
penetration of the molecule
through cell wall barriers of
Gram-negative bacilli,
compared with other
penicillins.
48
Eg. Piperacillin
• Piperacillin (Pipracil) is the
most generally useful of the
extended- spectrum
acylureidopenicillins.
• Piperacillin is destroyed
rapidly by stomach acid;
therefore, it is active only by
intramuscular or intravenous
administration
49
Therapeutic Uses
• Pneumococcal Infections
• Pneumococcal Meningitis
• Pneumococcal Pneumonia
• Streptococcal Infections
• Streptococcal Pharyngitis (including Scarlet Fever)
• Streptococcal Pneumonia, Arthritis, Meningitis, and Endocarditis
• Staphylococcal Infections
• Meningococcal Infections
• Gonococcal Infections
• Syphilis
• Actinomycosis
• Diphtheria
• Anthrax
• Clostridial Infections
• Fusospirochetal Infections
• Rat-Bite Fever
• Listeria Infections
• Lyme Disease
• Erysipeloid
• Surgical Procedures in Patients with Valvular Heart Disease 50
IUPAC names of penicillins
Penicillin G
6-Benzyl penicillin
6-(phenylacetamido)penicillanic acid
51
IUPAC names of penicillins
Methicillin
2,6-dimethoxyphenylpenicillin
52
IUPAC names of penicillins
Oxacillin
(5-methyl-3-phenyl-4-isoxazolyl)penicillin
53
IUPAC names of penicillins
Cloxacillin
[3-(o-chlorophenyl)-5-methyl-4-isoxazolyl] penicillin
54
IUPAC names of penicillins
Ampicillin
D-α-aminobenzylpenicillin
6-[D-α-aminophenylacetamido]penicillanic acid
55
IUPAC names of penicillins
Amoxicillin
6-[D- α -amino-p- hydroxyphenylacetamido]penicillanic acid
56
IUPAC names of penicillins
Carbenicillin
α -carboxybenzylpenicillin
6-[D-α-carboxyphenylacetamido]penicillanic acid
57
Cephalosporins
Cephalosporins were discovered shortly after penicillin entered into
widespread product, but not developed till the 1960’s.
Cephalosporins are similar to penicillins but have a 6 member
dihydrothiazine ring instead of a 5 member thiazolidine ring.
7-aminocephalosporanic acid (7-ACA) can be obtained from bacteria,
but it is easier to expand the ring system of 6-APA because it is so
widely produced.
58
Cephalosporins
Unlike penicillin, cephalosporins have two side chains which can be
easily modified. Cephalosporins are also more difficult for β-
lactamases to hydrolyze.
59
Cephalosporins
60
b-lactam ring
penicillins cephalorsporins
Cephalosporins
• Mechanism of Action: Cephalosporins are composed of a
dihydrothiazine ring and a b-lactam ring. The mechanism of action
is identical to penicillins.
• Mechanism of Resistance: Same as penicillins.
• Cephalosporins are less susceptible to Staphylococcus beta-
lactamase; therefore have a broader spectrum of activity; however
they are not the drug of choice. Other bacteria are resistant,
because they produce distinct beta-lactamases. Methicillin-resistant
Staphylococcus is resistant to most cephalosporins.
61
Mechanism of Cephalosporins
The acetoxy group (or other R group) will leave when the drug acylates
the PBP.
62
Inhibition of Beta lactamase by Cephalosporines
63
beta lactam antibiotics
Cephalosporins- Classification
Cephalosporins are classified into four generations based on their
activity.
Later generations generally become more effective against Gram (-)
bacteria due to an increasing number of polar groups (also become
zwitterions.)
Ceftazidime (3rd gen) in particular can cross blood brain barrier and is
used to treat meningitis.
Later generations are often the broadest spectrum and are reserved
against penicillin resistant infections to prevent the spread of
cephalosporin resistant bacteria.
65
66
First generation cephalosporins:
• cephalothin, cefazolin, cefalexin. These drugs have good activity
against most Gram positive cocci (Streptococcus, pneumococcus
but not or methicillin-resistant Staphylococcus). They are more
active against Gram negative organisms (Escherichia co1i
Kiebsiella pneumoniae, and the indole negative Proteus
mirabilis) than are the natural penicillins. They are effective
against some anaerobic cocci (Peptococcus and
Peptosteptococcus, but NOT Bacteroides fragilis).
• They are ineffective against Pseudomonas aeruginosa,
Enterobacter, and indole-positive Proteus species.
• These drugs do not cross the blood-brain barrier.
67
Second generation cephalosporins:
• cefuroxime, cefamandole, cefoxitin, cefaclor.
The spectrum is extended to more Gram
negative bacteria Enterobacter species, Klebsiella
species, and indole-positive Proteus species.
Also, Haemophilus influenza is covered by
cefuroxime, cefamandole, cefaclor; Bacteroides
fragilis by cefoxitin.
• These drugs do not achieve adequate levels in
the CSF.
68
Third generation cephalosporins:
•moxalactam, cefaperazone, ceftazidirne, ceftriaxone.
These drugs demonstrate extended Gram negative
coverage, are more resistant to non-Staphylococcus b-
lactamase, and readily cross the blood-brain barrier.
The spectrum is extended to include: Enterobacter,
Pseudomonas (ceftazidime and cefaperazone only),
Serratia, b-lactamase producing Haemophillus
influenza and Neisseria species.
•Only cetizoxime and moxalactam retain good activity
against Bacteroides fragilis.
69
Fourth generation
• forth generation of cephalosporins (e.g. cefepime) are available,
these are comparable to third-generation but more resistant to some
betalactamases.
70
Degradation of Cephalosporin's
71
Pharmacokinetics
•Some cephalosporins may be given orally but most
are given parenterally (IM or IV).
•They are widely distributed in the body like
penicillins.
•Some such as cefoperazone, cefotaxime,
cefuroxime, ceftriaxone, and ceftazidime (third
generation) also cross the blood-brain barrier and
are drugs of choice for meningitis due.
72
Uses:
•A cephalosporin with or without an aminoglycoside is
first-line treatment of Klebsiella.
•First generation cephalosporins are used for surgical
prophylaxis of wound infection.
•Third generation cephalosporins are used to treat
meningitis due to pneumococci, meningococci, and
Haemophillus influenza.
•Ceftriaxone is the drug of choice for treating beta-
lactamase producing Neisseria gonorrhea.
73
Monobactams
• They are monocyclic -lactam antibiotics hence called
Monobactums.
• The development of useful monobactam antibiotics began
with the independent isolation of sulfazecin from
saprophytic soil bacteria.
• Extensive SAR studies eventually led to the development of
Aztreonam, which has useful properties as an antibacterial agent.
• SAR studies established that the 3-methoxy group was found to
contributed to the low antibacterial potency and poor chemical
stability of these antibiotics.
• A 4-methyl group, however, increases stability to β-lactamases
and activity against Gram-negative bacteria at the same time.
Unfortunately, potency against Gram-positive bacteria decreases
75
Aztreonam Spectrum
• Aztreonam is particularly active against aerobic Gram negative bacilli,
including E. coli, K. pneumoniae, Klebsiella and P. aeruginosa.
• It is used to treat urinary and lower respiratory tract infections, intra-
abdominal infections, and gynecological infections, as well as
septicemias caused by these organisms.
• It is not active against Gram-positive bacteria, anaerobic bacteria,
76
Tigemonam
• Tigemonam is a newer monobactam that is orally active.
• It is highly resistant to β-lactamases.
• The antibacterial spectrum of activity resembles that of
aztreonam.
• 4,4-Gem-dimethyl substitution Increses antibacterial potency
after oral administration.
77
• In contrast to the poor oral bioavailability
of aztreonam, the oral absorption of
tigemonam is excellent.
• It could become a valuable agent for the
oral treatment of urinary tract infections
and other non–life-threatening infections
caused by β-lactamase–producing Gram-
negative bacteria.

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beta lactam antibiotics

  • 2. Introduction β-Lactam antibiotics are the most widely produced and used antibacterial drugs in the world, and have been ever since their initial clinical trials in 1941. • β-Lactams are divided into several classes based on their structure and function; and are often named by their origin, but all classes have a common β-Lactam ring structure. • Clinically useful families of beta-lactam compounds include the • penicillins, • cephalosporins, • monobactams • carbapenems 2
  • 3. History 1928- Alexander Fleming discovers a mold which inhibits the growth of staphylococcus bacteria 1940- penicillin is isolated and tested on mice by researchers at Oxford 1941- penicillin mass produced by fermentation for use by US soldiers in WWII 1950’s- 6-APA is discovered and semi-synthetic penicillins are developed. 1960’s to today- novel β-lactams/ β-lactamase inhibitors are discovered and modified from the natural products of bacteria 3
  • 4. MOA Target- Cell Wall Synthesis The bacterial cell wall is a cross linked polymer called peptidoglycan which allows a bacteria to maintain its shape despite the internal turgor pressure caused by osmotic pressure differences. If the peptidoglycan fails to crosslink the cell wall will lose its strength which results in cell lysis. All β-lactams disrupt the synthesis of the bacterial cell wall by interfering with the transpeptidases which catalyzes the cross linking process. 4
  • 5. Peptidoglycan Peptidoglycan is a carbohydrate composed of alternating units of NAMA (N-acetyl muramic acid) and NAGA (N-acetyl Gluc0samine). The NAMA units have a peptide side chain which can be cross linked from the L-Lys residue to the terminal D-Ala-D-Ala link on a neighboring NAMA unit. This is done directly in Gram (-) bacteria and via a pentaglycine bridge on the L-lysine residue in Gram (+) bacteria. 5
  • 7. D-Alanine TRANSPEPTIDASE PENICILLIN SUGAR BACKBONE NAM L-Ala NAG D-Glu L-Lys D-Ala D-Ala Gly Gly Gly Gly Gly Gly GlyGlyGlyGlyL-Lys NAG D-Ala D-Ala D-Glu L-Ala NAM SUGAR BACKBONE L-Lys Gly Gly D-Ala NAM L-Ala NAG D-Glu L-Lys Gly Gly Gly Gly GlyGlyGlyGly NAG D-Ala D-Glu L-Ala NAM Cross linking Mechanism of action - bacterial cell wall synthesis 7
  • 8. Transpeptidase- PBP The cross linking reaction is catalyzed by a class of transpeptidases known as penicillin binding proteins(PBPs) A critical part of the process is the recognition of the D-Ala-D-Ala sequence of the NAMA peptide side chain by the PBP. Interfering with this recognition disrupts the cell wall synthesis. β-lactams mimic the structure of the D-Ala-D-Ala link and bind to the active site of PBPs, disrupting the cross-linking process. 8
  • 9. 9
  • 10. 10
  • 11. Normal Mechanism Peptide Chain D-Ala D-Ala CO2H OH Peptide Chain Gly H OH Peptide Chain Peptide Chain D-Ala GlyPeptide Chain O D-Ala Mechanism of action - bacterial cell wall synthesis 11
  • 12. Mechanism of β-Lactam Drugs β-Lactams acylate the hydroxyl group on the serine residue of PBP active site in an irreversible manner. This reaction is further aided by the oxyanion hole, which stabilizes the tetrahedral intermediate and thereby reduces the transition state energy. 12 OH Peptide Chain Gly H Blocked H2O Blocked HCR O CO2H NH O Me Me N S S HN O O Me Me NH CO2H C O R H S HN O O Me Me NH CO2H C O R H Blocked Irreversibly blocked
  • 13. Bacterial Resistance Bacteria have many methods with which to combat the effects of β- lactam type drugs. • Intrinsic defenses such as efflux pumps can remove the β-lactams from the cell. • β-Lactamases are enzymes which hydrolyze the amide bond of the β-lactam ring, rendering the drug useless. Thus Inactivation of the antibiotic by beta lactamase • Imparied penetration of drug to target PBPs • Bacteria may acquire resistance through mutation at the genes which control production of PBPs, altering the active site and binding affinity for the β-lactam . 13
  • 14. Range of Activity β-Lactams can easily penetrate Gram (+) bacteria, but the outer cell membrane of Gram (-) bacteria prevents diffusion of the drug. β- Lactams can be modified to make use of import porins in the cell membrane. β-Lactams also have difficulty penetrating human cell membranes, making them ineffective against atypical bacteria which inhabit human cells. Any bacteria which lack peptidoglycan in their cell wall will not be affected by β-lactams. 14
  • 15. Toxicity About 10% of the population is allergic (sometimes severely) to some penicillin type β-lactams. 15
  • 16. PENICILLIN Classification Naturally 1. Ocurring • Penicillin G 2. Semisynthetic  Acid Resistant Penicillins Eg. Peniciliin V  Penicillinase resistant P. Eg. Methicillin, Nafcillin, Oxacillin, Cloxacillin  Extended spectrum Penicillins 1. Amino penicillins - Eg. Ampicillin, Amoxicillin, 2. Carboxy Penicillins- Carbenicillin 16 3. Synthetic  Phenethicillin
  • 17. Nomenclature • Numbering of fused bicyclic ring initiates the at N atom and assigns the ring S the 4-position. • Thus, penicillins are named as 4-thia-l-azabicyclo[3.2.0]heptanes, according to this system 17
  • 18. Three simplified forms of penicillin nomenclature have been adopted for general use. • The first uses the name “penam” for the unsubstituted bicyclic system, including the amide carbonyl group, with numbering systems as just described • Thus, penicillins generally are designated according to this system as 6- acylamino- 3,3-dimethylpenam-2-carboxylic acids. 18
  • 19. Three simplified forms of penicillin nomenclature have been adopted for general use. • The second, seen more frequently in the medical literature, uses the name “penicillanic acid” to describe the ring system with substituents that are generally present (i.e., 3,3-dimethyl and 2-carboxyl acid) 19
  • 20. Three simplified forms of penicillin nomenclature have been adopted for general use. • A third form, uses trivial nomenclature to name the entire • 6-carbonylaminopenicillanic acid portion of the molecule as “penicillin” and then distinguishes compounds on the basis of the R group of the acyl portion of the molecule 20
  • 21. • Thus, penicillin G is named benzylpenicillin and penicillin V is phenoxymethylpenicillin 21
  • 23. 23
  • 24. 24
  • 26. 1.Penicillin can be modified at various positions to improve their ability to: -be administered orally (survive acidic conditions) -be tolerated by the patient (allergies) -penetrate the outer membrane of Gram (-) bacteria -prevent hydrolysis by β-lactamases -acylate the PBPs(Transpeptidases) of resistant species (there are many different PBPs) 26
  • 27. Penicillins- Natural 2. Natural penicillins are those which can be obtained directly from the penicillium mold and are not further modified. Many species of bacteria are now resistant to these penicillins. Penicillin G It is not orally active 27
  • 28. Penicillin G in Acidic Conditions Penicillin G could not be administered orally due to the its inactivation in acidic conditions of the stomach. 28
  • 29. Penicillin V 3. Penicillin V is produced when phenoxyacetic acid rather than phenylacetic acid is introduced to the penicillium culture. Adding the oxygen decreases the nucleophilicity of the carbonyl group, making penicillin V acid stable and orally viable. 29
  • 30. N S H N O C O CH2PhO H Penicillin V (orally active) electronegative oxygen •Better acid stability and orally active •But sensitive to b-lactamases •Slightly less active than penicillin G •Allergy problems with some patients 30
  • 31. • lactamases are prevalent in S. aureus and S. epidermidis, and render them resistant to Penicillin G and V. This necessitated the development of semi-synthetic penicillins through rational drug design. 31
  • 32. Semi-Synthetic Penicillins 4.The acyl side chain of the penicillin molecule can be cleaved using enzyme or chemical methods to produce 6-APA, which can further be used to produce semi-synthetic penicillins or cephalosporins 75% of the penicillin produced is modified in this manner. 6-APA 32
  • 33. Penicillins- Antistaphylococcal/ Penicillinase resistant penicillins 5. In general, it was observed that, increasing the steric hindrance at the α- carbon of the acyl group increased resistance to staphylococcal β-lactamase . • Thus Penicillins which have bulky side groups can block the β-Lactamases (of bacteria)which hydrolyze the lactam ring. This leads to development of penicillinase (β-Lactamases) resistant penicillins. 33
  • 34. Penicillins- Antistaphylococcal 7. Methicillin was the first penicillin developed with this type of modification, and since then all bacteria which are resistant to any type of penicillin are designated as methicillin resistant. (MRSA- methicillin- resistant S. aureus) 34 ortho groups important N S Me Me H N CO2H O MeO OMe H HC O
  • 35. Examples – Methicillin •Methoxy groups block access to b-lactamases but not to transpeptidases •Binds less readily to transpeptidases compared to penicillin G •Lower activity compared to Pen G against Pen G sensitive bacteria •Poor activity vs. some streptococci •Inactive vs. Gram -ve bacteria •Poor range of activity •Active against some penicillin G resistant strains (e.g. Staphylococcus) •Acid sensitive since there is no electron-withdrawing group •Orally inactive and must be injected N S Me Me H N CO2H O MeO OMe H HC O ortho groups important N S Me Me H N CO2H O MeO OMe H HC O 35
  • 36. Penicillins- Antistaphylococcal 8. the α-acyl carbon could be part of an aromatic (e.g.,phenyl or naphthyl) or heteroaromatic (e.g., 4-isoxazoyl)system,which increases antibacterial potency by making them acid stable. 36 nafcillin Oxacillin
  • 37. Penicillins- Antistaphylococcal 9. Substitutions at the ortho positions of a phenyl ring (e.g., 2,6-dimethoxy [methicillin]) or the 2-position of a 1-naphthyl system (e.g., 2-ethoxyl [nafcillin]) increase the steric hindrance of the acyl group and confer more β-lactamase resistance than shown by the unsubstituted compounds 37 nafcillin
  • 38. Penicillins- Antistaphylococcal 10. Methicillin is acid sensitive hence orally inactive and has been improved upon by adding electron withdrawing groups, as was done in penicillin V, resulting in drugs such as oxacillin and nafcillin. 38
  • 39. 11. Among five-membered–ring heterocyclic derivatives bulkier substituents are required to confer effective β-lactamase resistance. Thus, members of the 4-isoxazoyl penicillin family (e.g., oxacillin, cloxacillin, and dicloxacillin) require both the 3- aryl and 5-methyl (3-methyl and 5-aryl) substituents for effectiveness against β - lactamase–producing S. aureus. 39 Bulky and e- withdrawing N O C O H N O CO2H Me MeS N R' R Me H H
  • 40. Examples - Oxacillin •Orally active and acid resistant •Resistant to b-lactamases •Active vs. Staphylococcus aureus •Less active than other penicillins •Inactive vs. Gram -ve bacteria •Nature of R & R’ influences absorption and plasma protein binding •Cloxacillin better absorbed than oxacillin •Flucloxacillin less bound to plasma protein, leading to higher levels of free drug Bulky and e- withdrawing Oxacillin R = R' = H Cloxacillin R = Cl, R' = H Dicloxacillin R = Cl, R' = Cl Flucloxacillin R = Cl, R' = F N O C O H N O CO2H Me MeS N R' R Me H H 40
  • 41. 9. Due to the bulky side group, all of the antistaphylococcal drugs have difficulty penetrating the cell membrane and are less effective than other penicillins. • All of the clinically available penicillinase-resistant penicillins are significantly less active than either penicillin G or penicillin V against most non–β- lactamase-producing bacteria normally sensitive to the penicillins. 41
  • 42. Penicillins- Aminopenicillins 10.In order to increase the range of activity(efficacy), the penicillin has been modified to have more hydrophilic groups, allowing the drug to penetrate into Gram (-) bacteria via the porin channels. 11.Introduction of an ionized or polar group into the α- position of the side chain benzyl carbon atom of penicillin G confers activity against Gram-negative bacilli Ampicillin R=Ph Amoxicillin R= Ph-(p)OH 42
  • 43. Penicillins- Aminopenicillins 11. derivatives with an ionized -amino group, such as ampicillin and amoxicillin, are generally effective against such Gram-negative genera as Escherichia, Klebsiella, Haemophilus, Salmonella, Shigella, and non–indole-producing Proteus. • Furthermore, activity against penicillin G–sensitive, Gram-positive species is largely retained. 12. These penicillins have a wider range of activity than natural or antistaphylococcal drugs, but without the bulky side groups are once again susceptible to attack by β-lactamases 12.The additional hydrophilic groups make penetration of the gut wall difficult, and can lead to infections of the intestinal tract by H. pylori 43
  • 44. Penicillins- Aminopenicillins 13.Due to the effectiveness of the aminopenicillins, a second modification is made to the drug at the carboxyl group to produce prodrug eg. BACAMPICILLIN prodrug of ampicillin. 14.Changing the carboxyl group to an ester allows the drug to penetrate the gut wall where it is later hydrolyzed into the more polar active form by esterase enzymes. This has greatly expanded the oral availability of the aminopenicillin class. 44
  • 45. O N H NC C NH2 S Me Me CO2R H H H O Prodrugs of Ampicillin (Leo Pharmaceuticals - 1969) Properties •Increased cell membrane permeability •Polar carboxylic acid group is masked by the ester •Ester is metabolised in the body by esterases to give the free drug PIVAMPICILLINR = CH2O C O CMe3 TALAMPICILLINR = O O BACAMPICILLIN R = CH Me O C O O CH2Me 45
  • 46. Penicillins- Extended Spectrum 15.Extended spectrum penicillins are similar to the aminopenicillins in structure but have either a carboxyl group or urea group instead of the amine. • Thus Incorporation of an acidic substituent at the α-benzyl carbon atom of penicillin G also imparts clinical effectiveness against Gram-negative bacilli and, furthermore, extends the spectrum of activity to include organisms resistant to ampicillin 46
  • 47. Penicillins- Extended Spectrum 16.Like the aminopenicillins the extended spectrum drugs have an increased activity against Gram (-) bacteria by way of the import porins. These drugs also have difficulty penetrating the gut wall and must be administered intravenously if not available as a prodrug. These are more effective than the aminopenicillins and not as susceptible to β-lactamases 47
  • 48. Eg. Carbenicillin • Carbenicillin has a broad range of antimicrobial activity, broader than any other known penicillin, a property attributed to the unique carboxyl group. • It has been proposed that the carboxyl group improves penetration of the molecule through cell wall barriers of Gram-negative bacilli, compared with other penicillins. 48
  • 49. Eg. Piperacillin • Piperacillin (Pipracil) is the most generally useful of the extended- spectrum acylureidopenicillins. • Piperacillin is destroyed rapidly by stomach acid; therefore, it is active only by intramuscular or intravenous administration 49
  • 50. Therapeutic Uses • Pneumococcal Infections • Pneumococcal Meningitis • Pneumococcal Pneumonia • Streptococcal Infections • Streptococcal Pharyngitis (including Scarlet Fever) • Streptococcal Pneumonia, Arthritis, Meningitis, and Endocarditis • Staphylococcal Infections • Meningococcal Infections • Gonococcal Infections • Syphilis • Actinomycosis • Diphtheria • Anthrax • Clostridial Infections • Fusospirochetal Infections • Rat-Bite Fever • Listeria Infections • Lyme Disease • Erysipeloid • Surgical Procedures in Patients with Valvular Heart Disease 50
  • 51. IUPAC names of penicillins Penicillin G 6-Benzyl penicillin 6-(phenylacetamido)penicillanic acid 51
  • 52. IUPAC names of penicillins Methicillin 2,6-dimethoxyphenylpenicillin 52
  • 53. IUPAC names of penicillins Oxacillin (5-methyl-3-phenyl-4-isoxazolyl)penicillin 53
  • 54. IUPAC names of penicillins Cloxacillin [3-(o-chlorophenyl)-5-methyl-4-isoxazolyl] penicillin 54
  • 55. IUPAC names of penicillins Ampicillin D-α-aminobenzylpenicillin 6-[D-α-aminophenylacetamido]penicillanic acid 55
  • 56. IUPAC names of penicillins Amoxicillin 6-[D- α -amino-p- hydroxyphenylacetamido]penicillanic acid 56
  • 57. IUPAC names of penicillins Carbenicillin α -carboxybenzylpenicillin 6-[D-α-carboxyphenylacetamido]penicillanic acid 57
  • 58. Cephalosporins Cephalosporins were discovered shortly after penicillin entered into widespread product, but not developed till the 1960’s. Cephalosporins are similar to penicillins but have a 6 member dihydrothiazine ring instead of a 5 member thiazolidine ring. 7-aminocephalosporanic acid (7-ACA) can be obtained from bacteria, but it is easier to expand the ring system of 6-APA because it is so widely produced. 58
  • 59. Cephalosporins Unlike penicillin, cephalosporins have two side chains which can be easily modified. Cephalosporins are also more difficult for β- lactamases to hydrolyze. 59
  • 61. Cephalosporins • Mechanism of Action: Cephalosporins are composed of a dihydrothiazine ring and a b-lactam ring. The mechanism of action is identical to penicillins. • Mechanism of Resistance: Same as penicillins. • Cephalosporins are less susceptible to Staphylococcus beta- lactamase; therefore have a broader spectrum of activity; however they are not the drug of choice. Other bacteria are resistant, because they produce distinct beta-lactamases. Methicillin-resistant Staphylococcus is resistant to most cephalosporins. 61
  • 62. Mechanism of Cephalosporins The acetoxy group (or other R group) will leave when the drug acylates the PBP. 62
  • 63. Inhibition of Beta lactamase by Cephalosporines 63
  • 65. Cephalosporins- Classification Cephalosporins are classified into four generations based on their activity. Later generations generally become more effective against Gram (-) bacteria due to an increasing number of polar groups (also become zwitterions.) Ceftazidime (3rd gen) in particular can cross blood brain barrier and is used to treat meningitis. Later generations are often the broadest spectrum and are reserved against penicillin resistant infections to prevent the spread of cephalosporin resistant bacteria. 65
  • 66. 66
  • 67. First generation cephalosporins: • cephalothin, cefazolin, cefalexin. These drugs have good activity against most Gram positive cocci (Streptococcus, pneumococcus but not or methicillin-resistant Staphylococcus). They are more active against Gram negative organisms (Escherichia co1i Kiebsiella pneumoniae, and the indole negative Proteus mirabilis) than are the natural penicillins. They are effective against some anaerobic cocci (Peptococcus and Peptosteptococcus, but NOT Bacteroides fragilis). • They are ineffective against Pseudomonas aeruginosa, Enterobacter, and indole-positive Proteus species. • These drugs do not cross the blood-brain barrier. 67
  • 68. Second generation cephalosporins: • cefuroxime, cefamandole, cefoxitin, cefaclor. The spectrum is extended to more Gram negative bacteria Enterobacter species, Klebsiella species, and indole-positive Proteus species. Also, Haemophilus influenza is covered by cefuroxime, cefamandole, cefaclor; Bacteroides fragilis by cefoxitin. • These drugs do not achieve adequate levels in the CSF. 68
  • 69. Third generation cephalosporins: •moxalactam, cefaperazone, ceftazidirne, ceftriaxone. These drugs demonstrate extended Gram negative coverage, are more resistant to non-Staphylococcus b- lactamase, and readily cross the blood-brain barrier. The spectrum is extended to include: Enterobacter, Pseudomonas (ceftazidime and cefaperazone only), Serratia, b-lactamase producing Haemophillus influenza and Neisseria species. •Only cetizoxime and moxalactam retain good activity against Bacteroides fragilis. 69
  • 70. Fourth generation • forth generation of cephalosporins (e.g. cefepime) are available, these are comparable to third-generation but more resistant to some betalactamases. 70
  • 72. Pharmacokinetics •Some cephalosporins may be given orally but most are given parenterally (IM or IV). •They are widely distributed in the body like penicillins. •Some such as cefoperazone, cefotaxime, cefuroxime, ceftriaxone, and ceftazidime (third generation) also cross the blood-brain barrier and are drugs of choice for meningitis due. 72
  • 73. Uses: •A cephalosporin with or without an aminoglycoside is first-line treatment of Klebsiella. •First generation cephalosporins are used for surgical prophylaxis of wound infection. •Third generation cephalosporins are used to treat meningitis due to pneumococci, meningococci, and Haemophillus influenza. •Ceftriaxone is the drug of choice for treating beta- lactamase producing Neisseria gonorrhea. 73
  • 74. Monobactams • They are monocyclic -lactam antibiotics hence called Monobactums. • The development of useful monobactam antibiotics began with the independent isolation of sulfazecin from saprophytic soil bacteria.
  • 75. • Extensive SAR studies eventually led to the development of Aztreonam, which has useful properties as an antibacterial agent. • SAR studies established that the 3-methoxy group was found to contributed to the low antibacterial potency and poor chemical stability of these antibiotics. • A 4-methyl group, however, increases stability to β-lactamases and activity against Gram-negative bacteria at the same time. Unfortunately, potency against Gram-positive bacteria decreases 75
  • 76. Aztreonam Spectrum • Aztreonam is particularly active against aerobic Gram negative bacilli, including E. coli, K. pneumoniae, Klebsiella and P. aeruginosa. • It is used to treat urinary and lower respiratory tract infections, intra- abdominal infections, and gynecological infections, as well as septicemias caused by these organisms. • It is not active against Gram-positive bacteria, anaerobic bacteria, 76
  • 77. Tigemonam • Tigemonam is a newer monobactam that is orally active. • It is highly resistant to β-lactamases. • The antibacterial spectrum of activity resembles that of aztreonam. • 4,4-Gem-dimethyl substitution Increses antibacterial potency after oral administration. 77 • In contrast to the poor oral bioavailability of aztreonam, the oral absorption of tigemonam is excellent. • It could become a valuable agent for the oral treatment of urinary tract infections and other non–life-threatening infections caused by β-lactamase–producing Gram- negative bacteria.