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Antimicrobial Agents and Chemotherapy, December 2004, p. 4898-4902, Vol. 48, No. 12
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.12.4898-4902.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

In Vitro Activities of OPT-80 and Comparator Drugs against Intestinal Bacteria

Sydney M. Finegold,1,2,3,4* Denise Molitoris,2 Marja-Liisa Vaisanen,2 Yuli Song,2 Chengxu Liu,2 and Mauricio Bolaños2

Medical,1 Research Services, VA Greater Los Angeles Healthcare System,2 Departments of Medicine,3 Microbiology, Immunology and Molecular Genetics, UCLA School of Medicine, Los Angeles, California4

Received 4 July 2004/ Returned for modification 28 July 2004/ Accepted 31 August 2004


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ABSTRACT
 
The activities of OPT-80 against 453 intestinal bacteria were compared with those of seven other drugs. OPT-80 showed good activity against most clostridia, staphylococci, and enterococci, but streptococci, aerobic and facultative gram-negative rods, anaerobic gram-negative rods, and Clostridium ramosum were resistant. Poor activity against anaerobic gram-negative rods may maintain colonization resistance.


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TEXT
 
Drugs that are poorly absorbed orally may have a place in therapy for intestinal infections and in certain other situations in which intestinal bacteria may play a role (7). It is also important to note the activity of such drugs against members of the bowel flora that might confer colonization resistance (19). Vancomycin is used systemically for therapy of severe or multiresistant gram-positive infections and orally for Clostridium difficile infections. Although the drug is highly effective against those infections, vancomycin resistance has been observed in various organisms, including enterococci, Lactobacillus spp., Leuconostoc spp., Pediococcus spp., and staphylococci (4, 9, 15, 17). Such gram-positive organisms are often resistant to other agents as well (8).

OPT-80 is an 18-membered macrocyclic antibiotic, also known as tiacumicin B, that, like vancomycin, targets gram-positive organisms (16, 18). It is currently under development as a new, narrow-spectrum antibacterial agent to treat C. difficile-associated diarrhea (CDAD) and colitis. Toxigenic C. difficile is the causative agent in 20% of cases of antibiotic-associated diarrhea (2) and is the principal cause of antibiotic-associated colitis. Current treatments for this disease include oral vancomycin and metronidazole, but both of these drugs have a relatively broad spectrum and may exacerbate disruption of gut flora that led to CDAD originally. Indeed, a major drawback to both treatments is the incidence of recurrence of CDAD, which is approximately 20% (5). A unique feature of OPT-80 is its selectivity for Clostridium, particularly C. difficile and Clostridium perfringens; previous work has shown that the MIC for C. difficile is approximately 10- to 100-fold lower than those for other organisms, including other gram-positive organisms (1, 16, 18). OPT-80 is also primarily retained in the gut, with low levels in serum following oral administration in hamsters (16), rats, monkeys, and humans (Optimer Pharmaceuticals, personal communication).

This study was designed to evaluate the in vitro activity of OPT-80 and comparator agents against intestinal bacteria. Antimicrobial concentration ranges were selected to encompass or surpass the levels that would be achieved in the gut (to the extent that this information is available), subject to the limitations of solubility of the drugs in the testing medium. Table 1 is a summary of the range of concentrations of antimicrobial agents used during testing and the levels achieved in the bowel or feces (6, 11, 12).


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  		TABLE 1. Summary of drug concentrations tested and fecal drug levels reported previouslya

The bacteria included in this study were mostly recent isolates representative of the indigenous bowel flora. Bacteria were identified according to established procedures (10), supplemented in a number of cases by 16S rRNA sequence analysis. Drug MICs for anaerobes were determined by the NCCLS-approved Wadsworth agar dilution technique (14). Aerobic and facultative bacteria were tested according to NCCLS guidelines (13), using Mueller-Hinton (Sigma, St. Louis, Mo.) agar without blood except for Streptococcus mitis and Streptococcus sanguinis, for which 5% fresh sheep blood was added. The antimicrobial agents tested were obtained as powders from the following companies: amoxicillin, clindamycin, metronidazole, tobramycin, and vancomycin from Sigma; lithium clavulanate from GlaxoSmithKline (King of Prussia, Pa.); linezolid from Pfizer (Groton, Conn.); ciprofloxacin from ICN Biomedicals (Irvine, Calif.); and OPT-80 from Optimer Pharmaceuticals, Inc. (San Diego, Calif.).

For analysis, the bacteria tested were generally placed into genus, species, or other groups with at least 10 isolates. The ranges and the MICs at which 50 and 90% of isolates were inhibited were determined except for organisms with fewer than 10 strains tested, for which only the ranges are reported (Table 2).


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  		TABLE 2. In vitro activity of Optimer-80 and six comparative agents against 453 bacterial isolates

Although vancomycin showed relatively poor activity against gram-negative anaerobes, including the Bacteroides fragilis group, these organisms are usually suppressed in the intestinal tract by the very high levels achieved in the bowel by oral administration (Finegold et al., unpublished data).

OPT-80 was distinctly less active against the B. fragilis group than vancomycin. Vancomycin had good activity against all clostridia, whereas OPT-80 had fairly good activity against Clostridium bolteae and Clostridium clostridioforme, fair activity against Clostridium innocuum, and relatively poor activity against C. ramosum. It is interesting that among the clostridia studied, susceptibility or resistance to OPT-80 correlated with the taxonomic clusters of clostridia (3) to which they belong. Clostridia that were very sensitive to OPT-80 were all in clostridial clusters I and XI; those that were less susceptible belong to clusters XIVa, XVI, and XVIII. Both OPT-80 and vancomycin had good activity against most anaerobic gram-positive non-spore-forming rods and anaerobic gram-positive cocci. Vancomycin had better activity against streptococci, both showed good activity against enterococci and staphylococci, and both had poor activity against nonanaerobic gram-negative bacilli (data for the latter group not shown).

C. difficile-associated colitis has generally responded well to therapy with vancomycin, metronidazole, or bacitracin, all administered orally; the current data indicate that it should respond well to oral OPT-80 as well, but studies on this are not available yet. Additional indications for therapy with some or all of the drugs in this study include neutropenic enterocolitis, intestinal colonization with vancomycin-resistant enterococci and staphylococci or antibiotic-resistant viridans group streptococci in an immunocompromised host, preoperative bowel preparation, D-lactic acidosis, bowel bacterial overgrowth syndrome, and investigational use in late-onset autism (7).

Factors that would help determine the relative utility of these various agents would include such things as usefulness of the compounds for therapy of serious systemic infections, levels of drug achieved in the gastrointestinal tract, maintenance of colonization resistance in the bowel, bactericidal activity, drug allergy, absorbability of the drugs with oral administration, gastrointestinal and systemic toxicity, frequency with which resistance develops, cross-resistance with other compounds (particularly those that are used systemically), frequency of dosage required, patient tolerance of the medication (over prolonged periods in the case of autism), palatability, ease of administration to young children (liquid preparation preferred), and cost. Clinical studies are needed to assess the clinical utility of the various drugs with good activity against intestinal bacteria in these situations.


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ACKNOWLEDGMENTS
 
This study was funded by Optimer Pharmaceuticals, Inc., San Diego, Calif., and Veterans Administration Merit Review research funds.


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FOOTNOTES
 
* Corresponding author. Mailing address: Infectious Diseases Section (111 F), VA Medical Center West Los Angeles, 11301 Wilshire Blvd., Los Angeles, CA 90073. Phone: (310) 268-3678. Fax: (310) 268-4928. E-mail: sidfinegol{at}aol.com. Back


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Antimicrobial Agents and Chemotherapy, December 2004, p. 4898-4902, Vol. 48, No. 12
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.12.4898-4902.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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