Solithromycin

Solithromycin is a next-generation oral and intravenous fluoroketolide entering Phase II clinical development for the treatment of community-acquired bacterial pneumonia (CABP).

Macrolides & Infectious Disease

Macrolides are antimicrobial drugs that are active against aerobic and anaerobic gram-positive cocci and are prescribed for the treatment of respiratory tract and soft tissue infections.

Macrolides belong to the polyketide class of natural products. The macrolide ring - a large lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, are attached - is responsible for the antimicrobial properties of this class. By reversibly binding to the 50S subunit of the bacterial ribosome, these drugs block protein synthesis, preventing bacterial growth and reproduction. This action is primarily bacteriostatic, however at higher concentrations, macrolides can be bactericidal. Some of the most commonly prescribed macrolides include erythromycin, azithromycin (Zithromax®) and clarithromycin (Biaxin®).

Ketolides belong to the macrolide class that is used to treat respiratory tract infections. These drugs are effective against macrolide-resistant bacteria because of their ability to bind to two sites on the bacterial ribosome. Examples include telithromycin (Ketek®) and cethromycin.

The spectrum of activity of macrolides includes streptococci as well as atypical bacteria such as Mycoplasma and Legionella and intracellular bacteria such as Chlamydia.

Acquired bacterial resistance to macrolides occurs primarily through post-transcriptional methylation of the 23S bacterial ribosome. This results in cross-resistance to macrolides, lincosamides and streptogramins. Although rare, acquired resistance can also result from the production of drug-inactivating enzymes such as esterases or kinases, as well as the production of active ATP-dependent efflux proteins that transport macrolides out of the cell. As more than 45% of pneumococci are resistant to currently available antibiotics, a new macrolide is greatly needed. To address this need Cempra Pharmaceuticals is developing Solithromycin.

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Profile of Solithromycin

Solithromycin meets the requirements for a highly potent next-generation macrolide that retains activity against drug-resistant strains. In vitro and in vivo studies have shown potent activity against S. pneumoniae as well as an extended spectrum of activity against CA-MRSA, enterococci, M. avium and in animal models of malaria. It is also active against atypical bacteria, such as Legionella, Mycoplasma and Ureaplasma and against gonococci and other organisms that cause genitourinary tract infections. It is 8-16 times more potent than azithromycin and is active against azithromycin-resistant strains. Its activity against resistant strains is driven by its ability to bind to three sites on the bacterial ribosome, compared to two for current macrolides. The binding to three ribosomal sites is expected to limit resistance development.

Solithromycin does not contain a pyridine in the side chain of the molecule that could be associated with visual disturbances and exacerbations of myasthenia gravis that have been observed with telithromycin (Ketek?).

Phase I dose-escalation studies in healthy subjects showed that Solithromycin was safe and well tolerated. PK/PD results suggest that Solithromycin could be a once-daily oral treatment.

Research on Solithromycin

Publications
The links for the articles go to subscription-based sites and may require a fee to view the article.


In Vitro and In Vivo Activity of Solithromycin (CEM-101) against Plasmodium Species.
Wittlin, S., Ekland, E., Craft, J.C., Lotharius, J., Bathurst, I., Fidock, D.A., Fernandes, P.
Antimicrobial Agents and Chemotherapy. February 2012 56(2):703-7
http://www.ncbi.nlm.nih.gov/pubmed?term=fernandes%20malaria%20cem-101

Solithromycin
Fernandes, P., Pereira, D., Jamieson, B.,  and Keedy, K.
Drugs of the Future. October 2011 36(10): 751
http://journals.prous.com/journals/servlet/xmlxsl/pk_journals.xml_summary_pr?p_JournalId=2&p_RefId=1622079&p_IsPs=N

Pharmacokinetics of solithromycin (CEM-101) after single or multiple oral doses and effects of food on single-dose bioavailability in healthy adult subjects.
J .G. Still, J. Schranz, T. P. Degenhardt, D. Scott, P. Fernandes, M. J. Gutierrez, and K. Clark
Antimicrobial Agents and Chemotherapy. May 2011 55:1997-2003
http://aac.asm.org/cgi/content/abstract/55/5/1997

Synthesis and antibacterial activity of novel 4-aryl-[1,2,3]-triazole containing macrolides
D. Pereira and P. Fernandes
Bioorganic and Medicinal Chemistry Letters January 2011 21: 510-513
http://www.ncbi.nlm.nih.gov/pubmed/21084187

Antimicrobial characterisation of solithromycin (CEM-101), a novel fluoroketolide: activity against staphylococci and enterococci
S.D. Putnam, H.S. Sader, D.J. Farrell, D.J. Biedenbach, and M. Castanheira
International Journal of Antimicrobial Agents January 2011 37: 39-45
http://www.ncbi.nlm.nih.gov/pubmed/21084187

The in vitro evaluation of solithromycin (CEM-101) against pathogens isolated in the United States and Europe (2009)
D. J. Farrell, M. Castanheira, H. S. Sader, and R. N. Jones. 2010. 
The Journal of Infection. December 2010 61: 476-483
http://www.ncbi.nlm.nih.gov/pubmed/20831882

Molecular Characterization of Off-Target Activities of Telithromycin: a Potential Role for Nicotinic Acetylcholine Receptors
D Bertrand, S Bertrand, E Neveu, and P Fernandes
Antimicrobial Agents and Chemotherapy. December 2010 54: 5399-5402
http://aac.asm.org/cgi/content/full/54/12/5399

Binding and Action of CEM-101, a New Fluoroketolide Antibiotic That Inhibits Protein Synthesis
B Llano-Sotelo, J Dunkle, D Klepacki, W Zhang, P Fernandes, J Cate, A Mankin
Antimicrobial Agents and Chemotherapy. December 2010 54: 4961-4970
http://aac.asm.org/cgi/content/full/54/12/4961

Determination of CEM-101 activity tested against clinical isolates of Neisseria meningitides from a worldwide collection
D.J. Biedenbach, M. Castanheira, and R.N. Jones
Antimicrobial Agents and Chemotherapy. September 2010 54: 4009-4011
http://www.ncbi.nlm.nih.gov/pubmed/20625152

Antimicrobial characterization of CEM-101 activity against respiratory tract pathogens including multidrug-resistant pneumococcal serogroup 19A isolates
D.J. Farrell, H.S. Sader, M. Castanheira, D.J. Biedenbach, P.R. Rhomberg, and R.N. Jones
International Journal of Antimicrobial Agents. June 2010 35: 537-543
http://tinyurl.com/4jwmcdq

CEM-101 activity against Gram-positive organisms
L.N. Woosley, M. Castanheira, and R.N. Jones
Antimicrobial Agents and Chemotherapy. May 2010 54: 2182-2187
http://www.ncbi.nlm.nih.gov/pubmed/20176910

MIC quality control guidelines and disk diffusion test optimization for CEM-101, a novel fluoroketolide
R.N. Jones, J.E. Ross, P.R. Rhomberg, and Quality Control Working Group
Journal of Clininical Microbiology. April 2010 48: 1470-1473
http://jcm.asm.org/cgi/content/short/48/4/1470

CEM-101, a novel fluoroketolide: antimicrobial activity against a diverse collection of Gram-postive and Gram-negative bacteria
S.D. Putnam, M. Castanheira, G.J. Moet, D.J. Farrell, and R.N. Jones
Diagnostic Microbiology and Infectious Disease. April 2010 66: 393-401
http://www.ncbi.nlm.nih.gov/pubmed/20022192

In vitro activity of CEM-101, a new fluoroketolide antibiotic, against Chlamydia trachomatis and Chlamydia (Chlamydophila) pneumoniae
P.M. Roblin, S.A. Kohlhoff, C. Parker, and M.R. Hammerschlag
Antimicrobial Agents and Chemotherapy. March 2010 54: 1358-1359
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825974/

In Vitro Activity of Solithromycin against Streptococcus pneumoniae and Streptococcus pyogenes with Defined Macrolide Resistance Mechanisms
P McGhee, C Clark, KM Kosowska-Shick, K Nagai, B Dewasse, L Beachel, PC Appelbaum
Antimicrobial Agents and Chemotherapy. January 2010 54: 230-238
http://aac.asm.org/cgi/content/abstract/54/1/230

Cellular Accumulation and Pharmacodynamic Evaluation of the Intracellular Activity of Solithromycin, a Novel Fluoroketolide, against Staphylococcus aureus, Listeria monocytogenes, and Legionella pneumophila in Human THP-1 Macrophages
S Lemaire, F Van Bambeke, PM Tulkens
Antimicrobial Agents and Chemotherapy. September 2009 53: 3734-3743
http://aac.asm.org/cgi/content/abstract/53/9/3734

Comparative in vitro susceptibilities of human mycoplasmas and ureaplasmas to a new investigational ketolide, CEM-101
K.B. Waites, D.M. Crabb, and L.B. Duffy
Antimicrobial Agents and Chemotherapy. May 2009 53: 2139-2141
http://www.ncbi.nlm.nih.gov/pubmed/19258276


NACFC 2011

Anti-inflammatory Effects of Macrolides in a Model Relevant to CF Airway Epithelial Inflammation
Carla M. P. Ribeiro, Mary E.B. Martino, Brian Brighton and Prabha Fernandes
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IDSA 2011

Mechanistic Characterization of Adverse Events of Voriconazole and Telithromycin
Daniel Bertrand, Sonia Bertrand, David Pereira and Prabhavathi Fernandes
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ICAAC 2011

Establishment of Quality Control Ranges for Testing the Susceptibility of Target Organisms to Solithromycin (CEM-101) by Disk Diffusion
J. Deane, C.M. Pillar, D.F. Sahm, S. Rowshan and P. Fernandes
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Side Effects of Telithromycin and Voriconazole are Attributable to Nicotinic Acetylcholine Receptor Interactions
D. Bertrand, S. Bertrand, D. Pereira and P. Fernandes
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Intravenous Formulation of Solithromycin, a Painless Macrolide Antibiotic in a Rabbit Intravenous Injection Model
P. Fernandes, D. Pereira, S. Wu and A. Slee
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ECCMID 2011

Activity of 9 Antibiotics Against Intracellular Forms of S. pneumonia
S Lemaire, F Van Bambeke, P Tulkens
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Ribosomal Mutations Associated with Ketolide Resistance in Haemophilus Influenzae Found in the SENTRY Antimicrobial Surveillance Program
DJ Farrell, LM Deshpande, RE Mendes, RN Jones
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Antimicrobial Activity of Solithromycin (CEM-101), a Novel Fluoroketolide, Tested Against Isolates Collected in Europe during 2010 Surveillance
DJ Biedenbach, HS Sader, RN Jones, DJ Farrell
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A Phase 1 Trial to Evaluate the Safety and Pharmacokinetics of Single Doses of Intravenous (IV) Solithromycin(CEM-101) in Healthy Adult Subjects
J Schranz, K Clark, A Marion, G Ghibellini, P Fernandes
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ASTMH 2010

Spectrum of Activity

Mycobacterium leprae is Susceptible to Solithromycin (CEM-101)
R. Lahiri, T.P. Gillis, J.L. Krahenbull, P. Fernandes
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Solithromycin (CEM-101) - A New Fluoroketolide with Antimalarial Activity
J.C. Craft, S. Wittlin, J. Lotharius, I. Bathurst, P. Fernandes
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Anti-malarial Activity of CEM-101, A Fluoroketolide Antimicrobial, in Both Bloodstage and Presumptive Causal
S. Fracisco, M. Gettayacamin, A. Tungtaeng, M. Kozar, M. O'Neil, C. Craft, P. Fernandes
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IDSA 2010

Mechanisms of Action

Molecular Characterization of Off-Target Activities of Telithromycin, a Macrolide/Ketolide Antibiotic:The Role of Nicotinic Acetylcholine Receptors
D. Betrand, S. Bertrand, E. Neveu and P. Fernandes
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Spectrum of Activity

Antimicrobial Activity of a New Fluoroketolide Solithromycin (formerly CEM-101) Tested Against Fastidious Gram-negative Community-Acquired Bacterial Pneumonia Pathogens
D.J. Biedenbach, D.J. Farrell, H.S. Sader, R.N. Jones
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Antimicrobial Activity of a New Fluoroketolide(CEM-101) Tested Against Streptococcus pneumoniae
Tested by the SENTRY Surveillance Program (2008-2009)
D.J. Biedenbach, R.N. Jones , D.J. Farrell, H.S. Sader
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Mutations Associated with KetolideResistance in Streptococcus pneumonia Collected in the 2009 SENTRY Antimicrobial Surveillance Program
D.J. Farrell, L.M. Deshpande, R.E. Mended, R.N. Jones
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ICAAC 2010

Spectrum of Activity

In vitro and In vivo activity of Solithromycin, a new fluoroketolide, against Mycobacterium avium complex
C.M. Shoen, M.S. DeStefano, M.R. Sklaney, M.H. Cynamon
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Preclinical Models

Pharmacokinetic-Pharmacodynamic (PK-PD) Analysis of Solithromycin Against Streptococcus pneumoniae Using Data from a Murine-Lung Infection Model
D. R. Andes, O. O. Okusanya, A. Forrest, S. M. Bhavnani, P. Fernandes, P. G. Ambrose
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Evaluation of Solithromycin (CEM-101), a Novel Fluroketolide, in Murine Infection Models
T. M. Murphy, S. Little, A. M. Slee , P. Fernandes
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Development of an Intravenous Formulation of Solithromycin (CEM-101), a Novel, Potent Fluoroketolide
P Fernandes, T Degenhardt, D Pereira
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Comparison of Solithromycin Metabolism in Mice, Rats, Monkeys and Human
D. Pereira, T Degenhardt, P Fernandes
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Clinical Data

Intrapulmonary Penetration of Solithromycin in Healthy Adult Subjects
K. A. Rodvold, M. H. Gotfried, O. O. Okusanya, A. Forrest, S. M. Bhavnani, J. G. Still, K. Clark, P. Fernandes, P. G. Ambrose
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Population Pharmacokinetics (PPK) of Solithromycin Using Data from the Plasma and Epithelial Lining Fluid (ELF) of Healthy Subjects
O. O. Okusanya, A. Forrest, S. M. Bhavnani, K. A. Rodvold, M. H. Gotfried, P. Fernandes, K. Clark, J. G. Still, P. G. Ambrose
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Pharmacokinetic-Pharmacodynamic (PK-PD) Target Attainment (TA) Analysis Supporting Solithromycin Phase 2 Dose Selection
O. O. Okusanya, S. M. Bhavnani, A. Forrest, P. Fernadnes, P. G. Ambrose
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Phase 1 Pharmacokinetic and Safety of Multiple Doses and Effects of Food on the Bioavailability of Oral Solithromycin (CEM-101) in Healthy Adult Subjects
J. Schranz, K. Clark, T. Degenhardt, D. Scott, P. Fernandes, J. G. Still, J., Kissling, S. Sharples
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Mechanism of Action

Solithromycin (CEM-101), a Novel Fluoroketolide with Exceptional Cellular Accumulation, Localizes in Lysosomes and Induces Phospholipidosis but no Apoptosis and does not Interfere with the Production of Reactive Oxygen Species(ROS) in Cultured. Comparison with Azithromycin (AZM) and Gentamicin (GEN)
D. Das, F. Van Bambeke, P.M. Tulkens
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ESM 2010

Spectrum of Activity

In vitro activity of CEM-101 compared to clarithromycin against Nocardia species
C. Flores-Penalba, C. Shoen, M. DeStefano, and M. Cynamon
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ATS 2010

Spectrum of Activity

Superior anti-inflammatory effects of a novel macrolides/fluoroketolide, CEM-101 in monocytic cells
Y. Kobayahsi, C. Rossios, P.J. Barnes, and K. Ito
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Mechanism of Action

A novel macrolides/fluoroketolide, CEM-101 reverses corticosteroid sensitivity under oxidative stress via P13K pathway inhibition
Y. Kobayashi, C. Rossios, D. Takagi, P.J. Barnes, and K. Ito
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ECCMID 2010

Clinical Data

Multiple Dose Pharmacokinetics and Safety of Solithromycin, a New Fluoroketolide, in Healthy Subjects
J.G. Still, K. Clark, T. Degenhardt, D. Scott, P. Fernandes
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Spectrum of Activity

Solithromycin, a novel fluoroketolide, tested against European clinical isolates from 2009 (first-year surveillance results)
R. Jones, D. Farrell, H. Sader, M. Stilwell, M. Castaheira
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Solithromycin, a novel ketolide; in vitro activity against Legionella pneumophila
J. Dubois, P. Fernandes
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Solithromycin, a novel ketolide, in vitro activity against resistant strains of Streptococcus pnuemoniae and Haemophilus influenza
J. Dubois, P. Fernandes
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Expanded studies of Solithromycin, a novel fluoroketolide, tested against invasive isolates of N. meningitidis, including flouroquinolone-non-susceptible resistant strains
R. Jones, D. Biedenbach, L. Woosley, G.Gerken, M. Castaheira
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IDSA 2009

Spectrum of Activity

Solithromycin, a novel fluoroketolide: Activity against recent(2008) isolates of multidrug-resistant (MDR) S. pneumoniae (SPN)
R.N. Jones , M.G. Stilwell H.S. Sader, P. Fernandes
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ICAAC 2009

Spectrum of Activity

Activity of Solithromycin, a Novel Fluoriketolide, Tested Against Invasive Isolates of N. meningitides (NM) from a Worldwide Collection
DJ Biedenbach, LN Woosley, GD Gerken, HS Sader, RN Jones
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In Vitro Activity of Solithromycin against Legionella Spp.
J Dubois, P Fernandes
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In Vitro Activity of Solithromycin Against Resistant Strains of Staphylococcus aureus
J Dubois, P Fernandes
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Resistance

Capability of Solithromycin to Select for Resistant Pneumococcal and Group A Streptococcal Clones by Multistep Resistance Selection
C Clark, K Kosowska-Shick, P McGhee, PC Appelbaum
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Mechanism of Action

Proposed Mechanisms to Explain the Unusual Visual Disturbances Associated with Telithromycin
D Bertrand, S Bertrand, P Fernandes
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Preclinical Data

First Year Antimicrobial Surveillance Results for Solithromycin, a Novel Fluoroketolide with Potent Activity Against Pathogens Associated with Community-acquired Bacterial Pneumonia (CABP)
RN Jones, HS Sader, MJ Janechek, GJ Moet
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Evaluation of Solithromycin, a Novel Fluoroketolide, in a Rat H. influenzae Pulmonary Infection Model
T Murphy, S Little, R Wu, A Slee, P Fernandes
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ICC 2009

Spectrum of Activity

Pharmacodynamic evaluation of the intracellular activity of CEM-101, a novel fluoro ketolide, towards Staphylococcus aureus, Listeria monocytogenes, and Legionella pneumophila in human THP-1 macrophages
S. Lemaire, F. Van Bambeke, and P.M. Tulkens
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ECCMID 2009

Spectrum of Activity

Antimicrobial Characterization of Solithromycin: Activity Against Staphylococci, β-Haemolytic and Viridans Group Streptococci
R.N. Jones, H.S. Sader, D.J. Biedenbach
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Activity of Solithromycin Tested Against Emerging Telithromycin-Resistant β-Haemolytic Streptococci
R.N. Jones, L.N. Woosley, G.J. Moet, P.R. Rhomberg
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Comparative Activities of the Novel Ketolide Solithromycin and Telithromycin (TEL) Towards Streptococcus pneumoniae (SP) Resistant to Macrolides (ML) from Patients with Confirmed Community-Acquired Pneumonia (CAP)
A.Lismond, F. Bambeke, P.M. Tulkens
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Preclinical Data

Efficacy and Pharmacodynamic Evaluation of Solithromycin, a Novel Macrolide, in Murine Infection Models
T.M. Murphy, M. Gaffney, S. Little, R. Wu, A.M. Slee, C. Ong, P. Fernandes
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ICAAC/IDSA 2008

Mechanism of Action

SAR of 11, 12-Carbamate Macrolides/Ketolides Linked With 1,4-Substituted-[1,2,3]-Triazoles
C Hwang, J Duffield, Y Chiu, C Liang, S Yao, N Roberts, F Babakhani, P Sears, Y Shue, Y Ichikawa, P Fernandes, D Pereira, A Romero
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Binding and Action of Solithromycin, a New Macrolide/Ketolide in Development for Treating Infections with Macrolide-Resistant and Macrolide-Susceptible Bacteria
B Llano-Sotelo, D Klepacki, N Vazquez-Laslop, AS Mankin
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Video: Alexander S. Mankin discusses binding of Solithromycin

Spectrum of Activity

Activity of Solithromycin Compared to Other Agents Against Macrolide Susceptible and-Resistant Streptococci
P McGhee, K Nagai, PC Appelbaum
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Antimicrobial Characterization of Solithromycin: Activity Against 331 Respiratory Tract Pathogens Including Multidrug-Resistant Pneumococcal Serogroup 19A (MDR-19A) Isolates
RN Jones, DJ Biedenbach, PR Rhomberg, TR Fritsche, HS Sader
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Video: Ronald N. Jones discusses Solithromycin research

Antimicrobial Characterization of Solithromycin: Activity Against Enterococci, Uncommon Gram-positive Pathogens, N. gonorrhoeae and Anaerobes
DJ Biedenbach, LM Deshpande, TR Fritsche, HS Sader, RN Jones
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Video: Ronald N. Jones discusses Solithromycin research

Antimicrobial Characterization of Solithromycin: Potential Application Against Species Causing Enteritis/Gastroenteritis
RN Jones, HS Sader, TR Fritsche, DJ Biedenbach, M Castanheira
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Video: Ronald N. Jones discusses Solithromycin research

In Vitro Activity of Solithromycin, a New Ketolide Antibiotic, Against Chlamydia trachomatis and Chlamydia pneuomoniae
PM Roblin, SA Kohlhoff, MR Hammerschlag
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Antimicrobial Activity of Solithromycin a New Macrolide, Tested Against Diverse Collections of Bacterial Biowarfare/Bioterrorism (BW/BT) Agents
HS Heine, L Miller, J Bassett, K Holman
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Comparative In Vitro Susceptibilities of a New Investigational Macrolide Solithromycin Against Human Mycoplasmas and Urealplasmas
KB Waites, DM Crabb, LB Duffy
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Solithromycin, a Novel Macrolide/Ketolide, Shows Improved Intracellular Activity Against Phagocytised S. aureus in Comparison with Azithromycin (AZM), Clarithromycin (CLR), or Telithromycin (TEL)
S Lemaire, F Van Bambeke, PM Tulkens
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Video: Paul Tulkens discusses intracellular activity of Solithromycin

Antimicrobial Characterization of Solithromycin: PAE, Bactericidal Activity and Combinations
HS Sader, DJ Biedenbach, PR Rhomberg, RN Jones
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Video: Ronald N. Jones discusses Solithromycin research

Resistance

Antimicrobial Characterization of Solithromycin: Single Step, Selection by Passaging and Inducible Resistances
RN Jones, PR Rhomberg, HS Sader
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Video: Ronald N. Jones discusses Solithromycin research

Influence of Inhibitors of P-glycoprotein (P-gp) and Multidrug Resistance-Associated Protein (MRP) on the Accumulation and Intracellular Activity of Solithromycin, a Novel Macrolide/Ketolide, in Human THP-1 Macrophages: Comparison with Azithromycin
S Lemaire, F Van Bambeke, PM Tulkens
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Video: Paul Tulkens discusses intracellular activity of Solithromycin

Assay Standards

Proposed MIC Quality Control Ranges for Solithromycin Using the CLSI Multi-Laboratory M23-A2 Study Design
PR Rhomberg, JE Ross, RN Jones
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Video: Ronald N. Jones discusses Solithromycin research

Assessment of Solithromycin Susceptibility Testing Conditions and Optimization of Disk Diffusion Methods
RN Jones, TR Fritsche, HS Sader, DJ Biedenbach, PR Rhomberg
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Video: Ronald N. Jones discusses Solithromycin research

Preclinical Data

Evaluation of Solithromycin, a Novel Macrolide, in Murine Infection Models
TM Murphy, S Little, M Gaffney, AM Slee, P Fernandes
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Video: Andrew M. Slee discusses Solithromycin data

Safety

Single Oral Dose Pharmacokinetics and Safety of Solithromycin in Healthy Subjects
JG Still, K Clark, TP Degenhardt, D Scott, P Fernandes, MJ Gutierrez
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