User:Tbdusername42/sandbox

General plan
The article for Macrolides on Wikipedia is pretty badly organized. It starts with a pretty short introductory section and then immediately proceeds to mention examples of Macrolides in a relatively ineffective manner (shown below). In general, the article's organization could definitely be changed (so as to not have the examples section be the first section), could use some more sections (such as a history section of some sort), and needs more citations (the section on resistance for example does not contain any citations whatsoever).

My goal is to make it so the Macrolide article better adheres to Wikipedia's standards. I strongly suspect that some information that could found in the pages for different types of Macrolides could be used to help complete a History section, summarize the class of drug better, and just help the article become more complete.

I think a stronger organization for the article than the one it currently has would be to start with a History section and to place the examples after the Uses section (I'll come up with more changes after starting to edit the article).

= Macrolide = From Wikipedia, the free encyclopedia

The macrolides are a class of natural products that consist of a large macrocyclic lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, may be attached. The lactone rings are usually 14-, 15-, or 16-membered. Macrolides belong to the polyketide class of natural products. Some macrolides have antibiotic or antifungal activity and are used as pharmaceutical drugs.

History
The first macrolide discovered was erythroymycin, which was first used in 1952. Erythromycin was widely used as a substitute to penicillin in cases where patients were allergic to penicillin or had penicillin-resistant illnesses. Later macrolides developed, including azithromycin and clarithromycin, stemmed from chemically modifying erythromycin; these compounds were designed to be more easily absorbed and have less side-effects (erythromycin caused gastrointestinal side-effects in a significant proportion of users). Plan: do enough research to add at least a brief history section to the article. Depending on how much citable content I find this could end up being the bulk of my project.

Uses[edit]
Antibiotic macrolides are used to treat infections caused by Gram-positive bacteria (e.g., Streptococcus pneumoniae) and limited Gram-negative bacteria (e.g., Bordetella pertussis, Haemophilus influenzae), and some respiratory tract and soft-tissue infections. The antimicrobial spectrum of macrolides is slightly wider than that of penicillin, and, therefore, macrolides are a common substitute for patients with a penicillin allergy. Beta-hemolytic streptococci, pneumococci, staphylococci, and enterococci are usually susceptible to macrolides. Unlike penicillin, macrolides have been shown to be effective against Legionella pneumophila, mycoplasma, mycobacteria, some rickettsia, and chlamydia.

Macrolides are not to be used on non-ruminant herbivores, such as horses and rabbits. They rapidly produce a reaction causing fatal digestive disturbance. It can be used in horses less than one year old, but care must be taken that other horses (such as a foal's mother) do not come in contact with the macrolide treatment.

Macrolides can be administered in a variety of ways that include tablets, capsules, suspensions, injectings and topically.

Antibiotic macrolides[edit]
US FDA-approved :


 * Azithromycin - unique; does not extensively inhibit CYP3A4
 * Clarithromycin
 * Erythromycin
 * Fidaxomicin
 * Telithromycin

Non-US FDA-approved:


 * Carbomycin A
 * Josamycin
 * Kitasamycin
 * Midecamycin/midecamycin acetate
 * Oleandomycin
 * Solithromycin
 * Spiramycin - approved in the EU, and in other countries
 * Troleandomycin - used in Italy and Turkey
 * Tylosin/tylocine - used in animals
 * Roxithromycin

Ketolides[edit]
Ketolides are a class of antibiotics that are structurally related to the macrolides. They are used to treat respiratory tract infections caused by macrolide-resistant bacteria. Ketolides are especially effective, as they have two ribosomal binding sites.

Ketolides include:


 * Telithromycin - the first and only approved ketolide
 * Cethromycin
 * Solithromycin

Fluoroketolides[edit]
Fluoroketolides are a class of antibiotics that are structurally related to the ketolides. The fluoroketolides have three ribosomal interaction sites.

Fluoroketolides include:


 * Solithromycin - the first and currently the only fluoroketolide (not yet approved)

Non-antibiotic macrolides[edit]
The drugs tacrolimus, pimecrolimus, and sirolimus, which are used as immunosuppressants or immunomodulators, are also macrolides. They have similar activity to ciclosporin.

Antifungal drugs[edit]
Polyene antimycotics, such as amphotericin B, nystatin etc., are a subgroup of macrolides. Cruentaren is another example of an antifungal macrolide.

Toxic macrolides[edit]
A variety of toxic macrolides produced by bacteria have been isolated and characterized, such as the mycolactones.

This section contains differing amounts of information on all the different types of Macrolides. Some information could be added here.

Uses[edit]
Antibiotic macrolides are used to treat infections caused by Gram-positive bacteria (e.g., Streptococcus pneumoniae) and limited Gram-negative bacteria (e.g., Bordetella pertussis, Haemophilus influenzae), and some respiratory tract and soft-tissue infections. The antimicrobial spectrum of macrolides is slightly wider than that of penicillin, and, therefore, macrolides are a common substitute for patients with a penicillin allergy. Beta-hemolytic streptococci, pneumococci, staphylococci, and enterococci are usually susceptible to macrolides. Unlike penicillin, macrolides have been shown to be effective against Legionella pneumophila, mycoplasma, mycobacteria, some rickettsia, and chlamydia.

Macrolides are not to be used on non-ruminant herbivores, such as horses and rabbits. They rapidly produce a reaction causing fatal digestive disturbance. It can be used in horses less than one year old, but care must be taken that other horses (such as a foal's mother) do not come in contact with the macrolide treatment.

Macrolides can be administered in a variety of ways that include tablets, capsules, suspensions, injectings and topically.

Antibacterial[edit]
Macrolides are protein synthesis inhibitors. The mechanism of action of macrolides is inhibition of bacterial protein biosynthesis, and they are thought to do this by preventing peptidyltransferase from adding the growing peptide attached to tRNA to the next amino acid (similarly to chloramphenicol) as well as inhibiting ribosomal translation. Another potential mechanism is premature dissociation of the peptidyl-tRNA from the ribosome.

Macrolide antibiotics do so by binding reversibly to the P site on the 50S subunit of the bacterial ribosome. This action is considered to be bacteriostatic. Macrolides are actively concentrated within leukocytes, and thus are transported into the site of infection.

Diffuse panbronchiolitis[edit]
The macrolide antibiotics erythromycin, clarithromycin, and roxithromycin have proven to be an effective long-term treatment for the idiopathic, Asian-prevalent lung disease diffuse panbronchiolitis(DPB). The successful results of macrolides in DPB stems from controlling symptoms through immunomodulation (adjusting the immune response), with the added benefit of low-dose requirements.

With macrolide therapy in DPB, great reduction in bronchiolar inflammation and damage is achieved through suppression of not only neutrophil granulocyte proliferation but also lymphocyte activity and obstructive secretions in airways. The antimicrobial and antibiotic effects of macrolides, however, are not believed to be involved in their beneficial effects toward treating DPB. This is evident, as the treatment dosage is much too low to fight infection, and in DPB cases with the occurrence of the macrolide-resistant bacterium Pseudomonas aeruginosa, macrolide therapy still produces substantial anti-inflammatory results.

Resistance (section on Macrolides article, will be making edits)
The primary means of bacterial resistance to macrolides occurs by post-transcriptional methylation of the 23S bacterial ribosomal RNA. This acquired resistance can be either plasmid-mediated or chromosomal, i.e., through mutation, and results in cross-resistance to macrolides, lincosamides, and streptogramins (an MLS-resistant phenotype).

Two other types of acquired resistance rarely seen include the production of drug-inactivating enzymes (esterases or kinases), as well as the production of active ATP-dependent efflux proteins that transport the drug outside of the cell.

Azithromycin has been used to treat strep throat (Group A streptococcal (GAS) infection caused by Streptococcus pyogenes) in penicillin-sensitive patients, however macrolide-resistant strains of GAS are not uncommon. Cephalosporin is another option for these patients. - Plan for editing : This section does not have any citations at all. I plan on obtaining some research

Side-effects[edit]
A 2008 British Medical Journal article highlights that the combination of some macrolides and statins (used for lowering cholesterol) is not advisable and can lead to debilitating myopathy. This is because some macrolides (clarithromycin and erythromycin, not azithromycin) are potent inhibitors of the cytochrome P450 system, particularly of CYP3A4. Macrolides, mainly erythromycin and clarithromycin, also have a class effect of QT prolongation, which can lead to torsades de pointes. Macrolides exhibit enterohepatic recycling; that is, the drug is absorbed in the gut and sent to the liver, only to be excreted into the duodenum in bile from the liver. This can lead to a buildup of the product in the system, thereby causing nausea. In infants the use of erythromycin has been associated with pyloric stenosis.

Some macrolides are also known to cause cholestasis, a condition where bile cannot flow from the liver to the duodenum. A new study found an association between erythromycin use during infancy and developing IHPS in infants. However, no significant association was found between macrolides use during pregnancy or breastfeeding.

Interactions[edit]
Macrolides should not be taken with colchicine as it may lead to colchicine toxicity. Symptoms of colchicine toxicity include gastrointestinal upset, fever, myalgia, pancytopenia, and organ failure.