Drug-resistance has become a challenging clinical problem. Ketolides, a new class of erythromycin derivatives, have shown promising effectiveness in killing drug-resistant bacteria. This article reviews recent development in synthesis of ketolides, with focus on the modification and synthesis of some important positions on erythromycin A cycles.
Animals ; Anti-Bacterial Agents ; chemical synthesis ; chemistry ; pharmacology ; Drug Resistance, Bacterial ; Erythromycin ; analogs & derivatives ; chemical synthesis ; pharmacology ; Humans ; Ketolides ; chemical synthesis ; chemistry ; pharmacology ; Macrolides ; chemical synthesis

The in vitro antibacterial activities of oral cephem antibiotics and ketolide telithromycin against major respiratory pathogens possessing beta-lactam-resistant mutations (within the pbp gene) and/or macrolide-resistant genes (erm and mef) were examined in clinical isolates collected at 66 institutes in all over the Japan between 2002 and 2003. Telithromycin showed the strongest antibacterial activity against methicillinsusceptible Staphylococcus aureus strains with and without macrolide-resistant genes, such as ermA or ermC gene. All the cephem antibiotics showed potent antibacterial activity against Streptococcus pyogenes, with minimum inhibitory concentrations (MICs) of 0.015 mg/L or lower. Cefdinir had a much higher MIC90 against genotypic penicillin-resistant Streptococcus pneumoniae (gPRSP) than cefditoren and cefcapene (8 mg/L cefdinir vs. 1 mg/L cefditoren and cefcapene). The majority of gPRSP harbored either ermB or mefA, and the antibacterial activity of telithromycin against these strains was decreased however some susceptibility was still sustained. Cefditoren exerted the strongest antibacterial activity against beta-lactamase-negative ampicillin-resistant Haemophilus influenzae, with an MIC90 of 0.5 mg/L. These results underline the importance of checking the susceptibility and selecting an appropriate antibiotic against target pathogens.
Streptococcus pyogenes/*drug effects ; Streptococcus pneumoniae/*drug effects ; Staphylococcus aureus/*drug effects ; Microbial Sensitivity Tests ; Methicillin Resistance ; Ketolides/*pharmacology ; Humans ; Haemophilus influenzae/*drug effects ; Cephalosporins/*pharmacology ; Administration, Oral