Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/425—Thiazoles
  • A61K31/429—Thiazoles condensed with heterocyclic ring systems
  • A61K31/43—Compounds containing 4-thia-1-azabicyclo [3.2.0] heptane ring systems, i.e. compounds containing a ring system of the formula, e.g. penicillins, penems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/42—Oxazoles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/54—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame
  • A61K31/542—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one sulfur as the ring hetero atoms, e.g. sulthiame ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/545—Compounds containing 5-thia-1-azabicyclo [4.2.0] octane ring systems, i.e. compounds containing a ring system of the formula:, e.g. cephalosporins, cefaclor, or cephalexine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/04—Antibacterial agents

Definitions

• Clavulanic acid is a known compound having efficacy in inhibiting bacterial ⁇ -lactamase enzymes, which degrade ⁇ -lactam antibiotics such as penicillins and confer resistance to such antibiotics.
• Clavulanic acid in the form of its derivatives hereinafter termed "clavulanate"
• ⁇ - lactam antibiotics for example as described in GB 2005538, to suppress the activity of ⁇ -lactamase enzymes which mediate bacterial resistance to ⁇ -lactam antibiotics.
• the present invention provides the use of clavulanate to enhance the antibacterial activity of antibacterial compounds against microorganisms having an antibiotic resistance mechanism other than ⁇ - lactamase enzyme mediated resistance.
• the present invention also provides a method of use of clavulanate in the manufacture of a medicament formulation for the treatment of infection of humans or animals by microorganisms having a resistance mechanism other than ⁇ -lactamase mediated resistance.
• the present invention further provides a pharmaceutical formulation comprising clavulanate, for use as an active therapeutic substance in the treatment of infection of humans or animals by microorganisms having a resistance mechanism other than ⁇ -lactamase mediated resistance.
• the invention provides a method for the treatment of an infection by microorganisms having a resistance mechanism other than ⁇ - lactamase mediated resistance in humans or animals, which comprises administering thereto clavulanate.
• PBP penicillin-binding-protein
• This type of microorganism includes penicillin-resistant organisms such as Streptococcus spp. , e.g. S. pneumoniae, Haemophilus spp., e.g. H. influenzae, Staphylococcus spp. , Enterococcus spp., and Neisseria spp., e.g. N. gonococcus and N. meningitidis.
• Streptococcus spp. e.g. S. pneumoniae
• Haemophilus spp. e.g. H. influenzae
• Staphylococcus spp. Staphylococcus spp.
• Enterococcus spp. e.g. N. gonococcus and N. meningitidis.
• Neisseria spp. e.g. N. gonococcus and N. meningitidis.
• S. pneumoniae and H. influenzae are major pathogens.
• the clavulanate may be present as a salt, preferably as its potassium salt, ie potassium clavulanate.
• the clavulanate may in some cases be antibacterially effective by itself against the organisms, but preferably the clavulanate is used in the above uses, formulations and methods of this invention in combination with an antibacterial agent, for example an antibiotic, suitably a ⁇ -lactam antibiotic such as a penicillin or cephalosporin.
• an antibacterial agent for example an antibiotic, suitably a ⁇ -lactam antibiotic such as a penicillin or cephalosporin.
• the antibacterial agent is a ⁇ -lactam antibiotic.
• Suitable ⁇ -lactam antibiotics include the penicillins: amoxycillin, ampicillin, apalcillin, aspoxicillin, azidocillin, azlocillin, aztreonam, benzylpenicillin, bacampicillin, carbenicillin, cloxacillin, cyclacillin, dicloxicillin, epicillin, flucloxacillin, lenampicillin, mecillinam, methicillin, mezlocillin, phenoxymethylpenicillin, piperacillin, pivampicillin, propicillin, sulbenicillin, talampicillin, and ticarcillin; and the cephalo- sporins: cefaclor, cefadroxil, cefatrizine, cefclidine, cefamandole, cefazolin, cefbuperazone, cefcanel daloxate, cefdinir, cefepime, cefetamet pivoxil, cefixime, cefminox,
• cefmetazole cefonicid, cefoperazone, cefotaxime, cefotetan, cefotiam, cefotiam hexetil, cefoxitin, cefpimizole, cefpiramide, cefpirome, cefpodoxime proxetil ,cefprozil, ceftazidime, ceftibuten, ceftizoxime, ceftriaxone, cefuroxime axetil, cefuroxime, cephacetrile, cephalexin, cephaloridine, cephalothin, cephamanadole nafate, cephapirin, cephoperazone, cefsulodin, cefuzonam, cephradine, loracarbef, DQ 2556, ME 1207, S-1006, SCE-2787 and moxalactam.
• Particularly suitable ⁇ -lactam antibiotics include the penicillins: amoxycillin, ampicillin, apalcillin, aspoxicillin, azidocillin, azlocillin, aztreonam, benzylpenicillin, bacampicillin, carbenicillin, cloxacillin, cyclacillin, dicloxicillin, epicillin, flucloxacillin, lenampicillin, mecillinam, methicillin, mezlocillin, phenoxymethylpenicillin, piperacillin, pivampicillin, propicillin, sulbenicillin, talampicillin, and ticarcillin; and the cephalosporins: cefaclor, cefadroxil, cefatrizine, cefclidine, cefamandole, cefazolin, cefbuperazone, cefcanel daloxate, cefdinir, cefepime, cefetamet pivoxil, cefminox, cefminoxime
• clavulanate together with certain of the above-listed ⁇ - lactam antibiotics is believed to be novel per se, and therefore in a further aspect of this invention there is provided a pharmaceutical formulation comprising in combination clavulanate together with a cephalosporin antibiotic selected from the cephalosporins: cefaclor, cefaclidine, cefcanel daloxate, cefetamet pivoxil, cefminox, cefodizime, cefpimizole, cefpiramide, cefpodoxime proxetil, cefprozil, cefuzonam, DQ 2556, ME 1207, S-1006, SCE-2787 and loracarbef.
• a cephalosporin antibiotic selected from the cephalosporins: cefaclor, cefaclidine, cefcanel daloxate, cefetamet pivoxil, cefminox, cefodizime, cefpimizole, cefpiramide, ce
• Suitable examples of this last-mentioned formulation include in combination clavulanate together with a cephalosporin antibiotic selected from the cephalosporins cefaclor and cefprozil
• the present invention also provides this last-mentioned formulation, e.g clavulanate in combination with cefaclor or cefprozil, for use as an active therapeutic substance in the treatment of infection of humans or animals by microorganisms.
• the invention therefore further provides the use of clavulanate in combination with with a cephalosporin antibiotic selected from this last- mentioned list, e.g clavulanate in combination with cefaclor or cefprozil, in the manufacture of a medicament for the treatment of bacterial infections.
• the invention also further provides a method of treatment of an infection by microorganisms in humans or animals, which comprises administering thereto clavulanate and a cephalosporin antibiotic selected from this last-mentioned list, e.g clavulanate in combination with cefaclor or cefprozil.
• novel formulations, uses and methods of this further aspect of the invention may be effective against ⁇ -lactamase negative penicillin resistant pathogens such as S. pneumoniae and H. influenzae, as discussed above, and may also be effective against other organisms including ⁇ -lactamase positive strains of N. gonorrhoeae, Staphylococcus spp. (e.g S.aureus), Bacteroides fragilis, Moraxella catarrhalis,
• Escherichia coli and Klebsiella pneumoniae for example in otitis media, urinary tract infections, respiratory tract, skin and soft tissue infections.
• the ⁇ -lactam antibiotics referred to herein may be in the form of the free acids or pharmaceutically acceptable salts or in-vivo hydrolysable esters.
• Preferred antibacterial agents include amoxycillin, suitably in the form of amoxycillin trihydrate for oral use, and in the form of sodium amoxycillin for parenteral use, and the cephalosporins cefaclor or cefprozil.
• the clavulanate and any other antibacterial agent such as the penicillin or cephalosporin antibiotics, as used in this invention are preferably each in a substantially pure form, e.g. at least 60% pure, more suitably at least 75% pure, preferably at least 85% especially at least 98% pure on a weight basis.
• clavulanate and an antibacterial agent such as the penicillin or cephalosporin antibiotics, e.g amoxycillin, cefaclor or cefprozil, may be administered together, simultaneously, successively or in any order, but typically may be administered together as a co-formulation.
• an antibacterial agent such as the penicillin or cephalosporin antibiotics, e.g amoxycillin, cefaclor or cefprozil
• the formulation may be formulated for administration by any route, such as oral, topical or parenteral.
• the route of choice may for example be determined by the route of choice for the antibacterial agent used in combination with the clavulanate.
• the formulation may be in the form of tablets, capsules, powders, granules, lozenges, creams or liquid preparations, such as oral or sterile parenteral solutions or suspensions.
• the topical formulations of the present invention may be presented as, for instance, ointments, creams or lotions, eye ointments and eye or ear drops, impregnated dressings and aerosols, and may contain appropriate conventional additives such as preservatives, solvents to assist drug penetration and emollients in ointments and creams.
• the formulations may also contain compatible conventional carriers, such as cream or ointment bases and ethanol or oleyl alcohol for lotions.
• suitable conventional carriers such as cream or ointment bases and ethanol or oleyl alcohol for lotions.
• Such carriers may be present at from about 1% up to about 98% of the formulation. More usually they will form up to about 80% of the formulation.
• Tablets and capsules for oral administration may be in unit dose presentation form, and may contain conventional excipients such as binding agents, for example syrup, acacia, gelatin, sorbitol, tragacanth, or polyvinylpyrollidone; fillers, for example lactose, sugar, maize-starch, calcium phosphate, sorbitol or glycine; tabletting lubricants, for example magnesium stearate, talc, polyethylene glycol or silica; disintegrants, for example potato starch; or acceptable wetting agents such as sodium lauryl sulphate.
• Such tablets may also include an effervescent couple of generally known type, e.g a solid carboxylic acid and an alkali metal carbonate or bicarbonate.
• Such tablets may also include a chewable base such as mannitol, sorbitol or lactose, optionally together with an effervescent couple, for example as described in EP 0389177.
• a chewable base such as mannitol, sorbitol or lactose, optionally together with an effervescent couple, for example as described in EP 0389177.
• Such tablets and solid dosage forms may be made by any of the generally known methods for such dosage forms, and may be coated according to methods well known in normal pharmaceutical practice.
• Oral liquid preparations may be in the form of, for example, aqueous or oily suspensions, solutions, emulsions, syrups or elixirs, or may be presented as a dry product for reconstitution with water or other suitable vehicle before use.
• Such liquid preparations may contain conventional additives, such as suspending agents, for example sorbitol, methyl cellulose, glucose syrup, gelatin, hydroxyethyl cellulose, carboxymethyl cellulose, aluminium stearate gel or hydrogenated edible fats, emulsifying agents, for example lecithin, sorbitan monooleate, or acacia; non-aqueous vehicles (which may include edible oils), for example almond oil, oily esters such as glycerine, propylene glycol, or ethyl alcohol; preservatives, for example methyl or propyl p-hydroxybenzoate or sorbic acid, and, if desired, conventional flavouring or colouring agents.
• suspending agents for example sorbitol, methyl cellulose, glucose syrup, gelatin, hydroxyethyl cellulose, carboxymethyl cellulose, aluminium stearate gel or hydrogenated edible fats, emulsifying agents, for example lecithin, sorbitan monooleate, or
• Suppositories will contain conventional suppository bases, e.g. cocoa-butter or other glyceride.
• fluid unit dosage forms are prepared utilizing clavulanate and any antibacterial agent and a sterile vehicle, water being preferred.
• active compounds depending on the vehicle and concentration used, can be either suspended or dissolved in the vehicle.
• the active compounds can be dissolved in water for injection and filter sterilised before filling into a suitable vial or ampoule and sealing.
• agents such as a local anaesthetic, preservative and buffering agents can be dissolved in the vehicle.
• the formulation can be frozen after filling into the vial and the water removed under vacuum.
• the dry lyophilized powder is then sealed in the vial and an accompanying vial of water for injection may be supplied to reconstitute the liquid prior to use.
• Parenteral suspensions are prepared in substantially the same manner except that the ingredients of the suspension are suspended in the vehicle instead of being dissolved and sterilization cannot be accomplished by filtration.
• the formulation can be sterilised by exposure of its dry constituents to ethylene oxide before suspending in the sterile vehicle.
• a surfactant or wetting agent is included in the formulation to facilitate uniform distribution of the active compounds.
• Aqueous solution and suspension formulations of this invention can only be provided in the form of dry solids for make up into aqueous solution or suspension shortly prior to use, for example 5 days in the case of oral suspensions. It may also be necessary to maintain such suspensions at low temperatures, e.g >5°C.
• a formulation according to the invention may be in unit dosage form, for example unit dosage form for oral or parenteral administration, which latter will primarily include administration by injection or infusion, especially intramuscular and intravenous administration.
• the above-mentioned formulations may contain 0.1 - 90% by weight, preferably from 10 - 60% by weight of the active materials, depending on the method of administration.
• the clavulanate may suitably be administered to the patient at a daily dosage of from 0.3 to 15 mg/kg, preferably from 0.7 to 10 mg/kg, for example from 0.7 to 7 mg/kg, of body weight.
• for an adult human (of approximately 70 kg body weight) from 25 to 1000 mg, preferably from 50 to 500 mg, of clavulanate expressed as its free acid equivalent may be administered daily, suitably in from 1 to 6, preferably from 2 to 4, separate doses. Higher or lower dosages may, however, be used in accordance with clinical practice.
• each unit dose may suitably comprise from 12.5 to 1000 mg, preferably from 12.5 to 250 mg, of clavulanate.
• Each unit dose may, for example, be 12.5, 25, 50, 75, 100, 125, 150, 200, or 250 mg of clavulanate.
• the ratio of the amount of the clavulanate used according to the invention to the amount of any antibacterial agent present may vary within a wide range.
• the said ratio may, for example, be from 1:1 to 1:30; more particularly, it may, for example, be from 1:1 to 1:12, for example 1:2, 1:3, 1:4,1:5, 1:6, 1:7, 1:8, or 1:9 by weight, suitably within a variance of ⁇ 10%.
• Suitable unit dosages and maximum daily dosages of any antibacterial agent used in combination with clavulanate in this invention may for example be determined according to the unit dosages and maximum daily dosages of the agent used conventionally.
• amoxycillin is generally provided in unit dosages of 125 to 1000 mg, administered from 2 to 4 times daily to a typical daily dosage of 125 to 3000 mg per day.
• cefaclor is generally provided in unit dosages of 250 and 500 mg, and may be dosed up to a maximum daily dosage of 4000 mg per day.
• a preferred combination of this invention is clavulanate with amoxycillin, in a ratio clavulanate : amoxycillin in the range 1:1 to 1:12, for example together in a formulation.
• An example of a suitable formulation according to the invention for oral administration is one comprising from 125 to 3000 mg, preferably from 500 to 1000 mg, of amoxycillin trihydrate, in admixture or conjunction with from 12.5 to 250 mg, preferably from 25 to 125 mg, of potassium clavulanate per unit dose.
• a further example of a suitable formulation according to this invention for parenteral administration is one comprising from 125 to 3000 mg of sodium amoxycillin, in admixture or conjunction with from 12.5 to 250 mg, preferably from 25 to 125 mg, of potassium clavulanate.
• An example of a unit dosage form of a formulation of this invention comprises 12.5 to 1000 mg of potassium clavulanate and 62.5 to
• Figs. 1 to 5 show graphically the level of S. pneumoniae growth in vivo following administration of amoxycillin : clavulanate, cefaclor : clavulanate and cefprozil : clavulanate compared with comparisons and controls.
• NTC non treated control
• AMX amoxycillin
• CA potassium clavulanate
• CEC cefaclor
• PRO cefprozil
• doses of clavulanate and the antibiotics in mg/kg are shown in the graphs against og-jn cfu per pair of lungs.
• the infection persisted in the rats' lungs for at least four days at a mean count of 7.0 log 10 cfu/lungs, although the mortality rate was low.
• Oral therapy commenced 24 h post infection and continued ql2h for three days. Assessment of therapy was by counts of bacteria recovered from lung samples at intervals during the studies.
• Amoxycillin (200 mg/kg) showed little activity against this strain, but amoxycillin/clavulanate (200/100 mg/kg) was effective in reducing numbers of S. pneumoniae from the lungs within 48 h of therapy, and with a further significant reduction to 2-3 log 10 cfu/lungs at 72 h and 96 h.
• Rats were dosed intraperitoneally with 0.5 ml cyclophosphamide (Endoxana, Boehringer Ingelheim Ltd.,
• Organism S. pneumoniae N1387 was used in both studies.
• Inoculum A stock inoculum of S. pneumoniae N1387 (stored at - 70°C) was grown on blood agar at 37°C and the growth from six plates was suspended in 3 ml Todd Hewitt broth (TH). This was further diluted
• Rats were anaesthetised by separate intramuscular injections of 50 ⁇ l of fentanyl fluanisone at 0.1 ml/kg (Hypnorm, Janssen Pharmaceuticals Ltd., Grove), diazepam at 0.5 mg/kg (Valium, Roche products Ltd,. Welwyn Garden City).
• the drugs were prepared in sterile distilled water.
• Anaesthetised rats were infected by intrabronchial instillation of a 50 ⁇ l inoculum containing 6-7 log 10 cfu S. pneumoniae by means of non-surgical intratracheal intubation.
• Example 1 again using specific pathogen-free rats.
• therapy with potassium clavulanate amoxycillin
• therapy with potassium clavulanate cefaclor and potassium clavulanate : cefprozil was also investigated.
• amoxycillin alone and in the presence of clavulanate was tested, and no loss of active amoxycillin was detected in the site of infection, i.e. the lungs of rats treated with amoxycillin alone or with clavulanate, confirming the absence of ⁇ -lactamase-producing organisms.
• Fig. 3. shows that amoxycillin : clavulanate was significantly more effective than amoxycillin alone against three penicillin resistant strains of S. pneumonia
• Fig. 4 shows that cefaclor : potassium clavulanate was significantly more effective than cefaclor alone against penicillin resistant
• Fig. 5 shows that cefprozil : potassium clavulanate was significantly more effective than cefprozil alone against penicillin resistant S. pneumoniae N1387, showing effectiveness at cefprozil : clavulanate 50 : 50 mg/kg and 25 : 50 mg/kg.
• Example 3 shows that cefprozil : potassium clavulanate was significantly more effective than cefprozil alone against penicillin resistant S. pneumoniae N1387, showing effectiveness at cefprozil : clavulanate 50 : 50 mg/kg and 25 : 50 mg/kg.
• MIC minimum inhibitory concentration
• agar used was Mueller Hinton (BBL) supplemented with 5% lysed horse blood in the case of H. influenzae and M. catarrhalis, except for B. fragilis where Wilkins-Chalgren agar (Oxoid) was used.
• BBL Mueller Hinton
• a multipoint inoculator was used to drop l ⁇ l of undiluted culture of S. aureus, 10-fold dilutions of B. fragilis, H. influenzae and M. catarrhalis and 100-fold dilutions ofE. coli and pneumoniae onto the surface of the agar, to give an inoculum of approximately 10 ⁇ to 10* ⁇ cfu/spot.
• pneumoniae was also improved by clavulanic acid, the Gmean MIC values being reduced considerably (Table 1).
• clavulanic acid at a concentration of 2 or 4 ⁇ g/ml improved the activity of cefaclor.

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• 1994
  • 1994-01-21 AU AU58638/94A patent/AU5863894A/en not_active Abandoned
  • 1994-01-21 JP JP6516811A patent/JPH08505868A/ja not_active Ceased
  • 1994-01-21 DE DE69425131T patent/DE69425131T2/de not_active Expired - Lifetime
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  • 1994-01-21 EP EP00201268A patent/EP1034784A3/de not_active Withdrawn
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