Effect of C-5 position on the photochemical properties and phototoxicity of antofloxacin and levofloxacin: A stable and transient study

Roles of direct and indirect photodegradation in the photochemical fates of three 3rd generation fluoroquinolones

Fluoroquinolones (FQs) are widely prescribed antibiotics that are commonly detected in aquatic environments, but the persistence, fates, and ecotoxicities of new generation FQs have yet to be fully investigated. We investigated the direct and indirect (hydroxyl radical (·OH), singlet oxygen (O21), and excited stated of organic matter (3CDOM*)) photodegradation of three 3rd generation FQs, moxifloxacin (MOX), gatifloxacin (GAT), and sparfloxacin (SPAR). The photodegradation rates and photolytic quantum yields (ΦFQ) of the FQs depended on their dissociation species at different pH in a range of 1×10-4 to 1×10-3 M mol-photon-1. Unlike MOX and GAT whose zwitterions had the highest ΦFQ, the anionic form of SPAR had the highest ΦFQ. The k·OH,FQ values were in the order of: k·OH,SPAR > k·OH,GAT ≈ k·OH,MOX with the 1010M-1s-1 order of magnitude. The kO21,FQ values were in the order of: kO21,SPAR (∼108M-1s-1) > kO21,MOX (∼107M-1s-1) > >> kO21,GAT (insignificant). Higher kLC*3,FQ values were observed for MOX (109 to 1010M-1s-1) compared to GAT and SPAR (108 to 109M-1s-1). The zwitterions had the highest reactivities with ·OH and the lowest reactivities with O21 and 3CDOM*. Reactions with ·OH enhanced the formation of transformation products (TPs) from decarboxylation and sidechain oxidation pathways, whereas reactions with O21 and 3CDOM* enhanced the formation of TPs from sidechain oxidation pathways. Some of the TPs were predicted to exhibit aquatic ecotoxicity and environmental persistence. The half-lives of the FQs were estimated to be 0.42 to 0.67 h for MOX and SPAR, and 4.6 to 4.9 h for GAT. Their half-lives and main photochemical fates depended on the surface water pH and water column depth. These results highlight the key roles that photodegradation plays in removing new generation FQs from aquatic environments, though this might lead to the formation of TPs that are harmful to aquatic ecosystems.

Effects of Nanobubbles on Photochemical Processes of Levofloxacin Photosensitizer

Photodynamic therapy (PDT) stands as an efficacious modality for the treatment of cancer and various diseases, in which optimization of the electron transfer and augmentation of the production of lethal reactive oxygen species (ROS) represent pivotal challenges to enhance its therapeutic efficacy. Empirical investigations have established that the spontaneous initiation of redox reactions associated with electron transfer is feasible and is located in the gas-liquid interfaces. Meanwhile, nanobubbles (NBs) are emerging as entities capable of furnishing a plethora of such interfaces, attributed to their stability and large surface/volume ratio in bulk water. Thus, NBs provide a chance to expedite the electron-transfer kinetics within the context of PDT in an ambient environment. In this paper, we present a pioneering exploration into the impact of nitrogen nanobubbles (N2-NBs) on the electron transfer of the photosensitizer levofloxacin (LEV). Transient absorption spectra and time-resolved decay spectra, as determined through laser flash photolysis, unequivocally reveal that N2-NBs exhibit a mitigating effect on the decay of the LEV excitation triplet state, thereby facilitating subsequent processes. Of paramount significance is the observation that the presence of N2-NBs markedly accelerates the electron transfer of LEV, albeit with a marginal inhibitory influence on its energy-transfer reaction. This observation is corroborated through absorbance measurements and offers compelling evidence substantiating the role of NBs in expediting electron transfer within the ambit of PDT. The mechanism elucidated herein sheds light on how N2-NBs intricately influence both electron-transfer and energy-transfer reactions in the photosensitizer LEV. These findings not only contribute to a nuanced understanding of the underlying processes but also furnish novel insights that may inform the application of NBs in the realm of photodynamic therapy.

The phenomenon of phototoxicity and long-term risks of commonly prescribed and structurally diverse drugs

Photosensitivity to structurally diverse drugs is a common but under-reported adverse cutaneous reaction and can be classified as phototoxic or photoallergic. Phototoxic reactions occur when the skin is exposed to sunlight after administering topical or systemic medications that exhibit photosensitizing activity. These reactions depend on the dose of medication, degree of exposure to ultraviolet light, type of ultraviolet light, and sufficient skin distribution volume. Accurate prediction of the incidence and phototoxic response severity is challenging due to a paucity of literature, suggesting that phototoxicity may be more frequent than reported. This paper reports an extensive literature review on phototoxic drugs; the review employed pre-determined search criteria that included meta-analyses, systematic reviews, literature reviews, and case reports freely available in full text. Additional reports were identified from reference sections that contributed to the understanding of phototoxicity. The following drugs and/or drug classes are discussed: amiodarone, voriconazole, chlorpromazine, doxycycline, fluoroquinolones, hydrochlorothiazide, nonsteroidal anti-inflammatory drugs, and vemurafenib. In reviewing phototoxic skin reactions, this review highlights drug molecular structures, their reactive pathways, and, as there is a growing association between photosensitizing drugs and the increasing incidence of skin cancer, the consequential long-term implications of photocarcinogenesis.

Comparison of 10 and 14 days of antofloxacin-based versus 14 days of clarithromycin-based bismuth quadruple therapy for Helicobacter pylori eradication: A randomized trial

OBJECTIVE

Our team previously reported the use of antofloxacin-based bismuth quadruple therapy for the eradication of Helicobacter pylori (H. pylori). This study aimed to compare the efficacy and safety of 10 and 14 days of antofloxacin-based versus 14 days of clarithromycin-based bismuth quadruple therapy in the first-line treatment for H. pylori infection.

METHODS

1174 patients with H. pylori infection were randomized into three groups: 10-days and 14-days antofloxacin (ANT10 and ANT14) groups who received 10 and 14 days of antofloxacin-based bismuth quadruple therapy (colloidal bismuth pectin 200 mg t.i.d., esomeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and antofloxacin 200 mg q.d.), 14-days clarithromycin (CLA14) group who received 14 days of clarithromycin-based bismuth quadruple therapy (colloidal bismuth pectin 200 mg t.i.d., esomeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and clarithromycin 500 mg b.i.d.). Eradication rate, antibiotic resistance and adverse events were analyzed.

RESULTS

The intention-to-treat (ITT) and per-protocol (PP) analyses have showed statistically different eradication rates between ANT14 group and ANT10 group (ITT p = 0.001; PP p < 0.001), but no statistical difference between ANT10 group and CLA14 group (ITT p = 0.340; PP p = 0.092). Treatment regimen, drug resistance and therapy duration were important clinical factors related to H. pylori eradication rates in multivariate logistic analysis. Longer durations had significantly higher eradication rates in patients with antibiotic-resistant strains or antibiotic-susceptible strains. The incidences of nausea and bitter taste were significantly higher in CLA group compared with ANT group (p = 0.002 for nausea; p = 0.002 for bitter taste). The ANT10 and ANT14 group had similar adverse event rates of gastrointestinal reactions.

CONCLUSION

The study showed that the H. pylori eradication rate with ANT14 therapy was higher than that with ANT10 and CLA14 therapy without significantly increasing the rates of adverse event. 14 days of antofloxacin-based bismuth quadruple therapy may be a more effective way as the first-line treatment for H. pylori infection.

Organic Sonosensitizers for Sonodynamic Therapy: From Small Molecules and Nanoparticles toward Clinical Development

Sonodynamic therapy (SDT) is a novel noninvasive therapeutic modality that combines low-intensity ultrasound and sonosensitizers. Versus photo-mediated therapy, SDT has the advantages of deeper tissue penetration, high accuracy, and less side effects. Sonosensitizers are critical for therapeutic efficacy during SDT and organic sonosensitizers are important because of their clear structure, easy monitoring, evaluation of drug metabolism, and clinical transformation. Notably, nanotechnology can be used in the field of sonosensitizers and SDT to overcome the inherent obstacles and achieve sustainable innovation. This review introduces organic small molecule sonosensitizers, nano organic sonosensitizers, and their clinical translation by providing ideas and references for the design of sonosensitizers and SDT so as to promote its transformation to clinical applications in the future.

Fluoroquinolone antibiotics sensitized photodegradation of isoproturon

Fluoroquinolone (FQ) antibiotics are a group of contaminants of emerging environmental concern. In the present study, we demonstrated that norfloxacin (NORF) and ofloxacin (OFLO), two typical FQs, have photochemical reactivity analogous to chromophoric dissolved natural organic matter (DOM) in surface waters and can sensitize the photodegradation of isoproturon (IPU), a phenylurea herbicide. Such photochemical reactivity is ascribed to the quinolone chromophore that is excited to a triplet state (³FQ*) upon UV-A irradiation. ³FQ* further reacts with dissolved oxygen to give rise to singlet oxygen. ³FQ* steady-state concentrations of 6.72 × 10^-15 and 1.27 × 10^-15 M were measured in 10 μM NORF and OFLO solutions, respectively, under UV_365nm irradiation. The degradation of IPU was due to the reaction with ³FQ*, with bimolecular rate constants of 6.07 × 10⁹ and 1.51 × 10¹⁰ for ³NORF* and ³OFLO*, respectively. Intriguingly, NORF and OFLO per se were unstable and photolyzed during UV-A irradiation, but the photochemical reactivities of the solutions were not lost accordingly. High-resolution mass spectrometry analysis revealed that defluorination and piperazine moiety oxidation were the main photolysis pathways, while the core quinolone structure remained intact. Thus, the photolysis products largely inherited the photochemical reactivity of the parent compounds. Since all FQs share the same quinolone structure, similar photochemical reactivity is expected. The presence of FQs in surface water would affect the transformation and fate of coexisting compounds. To the best of our knowledge, this is the first study examining the environmental behavior of FQs as photosensitizers. The findings greatly advance the understandings of the influence of FQs in aquatic environment.

Antofloxacin-based bismuth quadruple therapy is safe and effective in Helicobacter pylori eradication: A prospective, open-label, randomized trial

BACKGROUND AND STUDY AIMS

The present study was designed to evaluate the safety, efficacy, and tolerability of antofloxacin-based bismuth quadruple therapy in Chinese patients with Helicobacter pylori infection.

PATIENTS AND METHODS

Total 290 patients with H. pylori infection were randomly and equally divided into two groups as per different bismuth quadruple therapies for 14 d: colloidal bismuth pectin 200 mg thrice a day, lansoprazole 30 mg twice a day, amoxicillin 1 g twice a day, and antofloxacin 200 mg once a day (ACLA group) or levofloxacin 500 mg once a day (LCLA group). Eradication was assessed with ¹³C-urea breath test 6 wk after treatment completion; the primary endpoint was the eradication rate by intention-to-treat (ITT) and per-protocol (PP) analyses. The minimum inhibitory concentration was measured with the PDM epsilometer test to assess the susceptibility of H. pylori strains on gastric biopsy specimens to antofloxacin and levofloxacin.

RESULTS

The eradication rates of H. pylori in the ACLA group were 93.8% and 97.8% for the ITT and PP analysis, respectively; these rates were significantly higher than those in the LCLA group, at 86.2% and 92.6%, respectively (p = 0.031 and 0.041, respectively). The total incidence of adverse events during the eradication therapy did not significantly differ between the ACLA and LCLA groups (31.7% vs. 37.9%%, p = 0.267), and the two groups displayed similar severity of adverse events (p = 0.156) and compliance rate (100% by ACLA vs. 97.8% by LCLA, p = 0.080). The eradication rate with the antofloxacin susceptible strains in the ACLA group was significantly higher than that with the resistant strains (99.2% vs. 66.7%, p = 0.045). Moreover, the eradication rate with the levofloxacin susceptible strains in the LCLA group was significantly higher than that with the resistant strains (95.3% vs. 80.0%, p = 0.013).

CONCLUSION

Antofloxacin is safe and effective for H. pylori eradication. Antofloxacin-based bismuth quadruple therapy could be an alternative treatment for H. pylori eradication.

Fluoroquinolone-Induced Photosensitivity: A Chemical Fragment-Based Approach by a Case/Non-case Study in VigiBase®

INTRODUCTION

Fluoroquinolones are widely used to treat bacterial infections. Many in vitro and in vivo studies have established a chemical relationship between fluoroquinolones' particular chemical structure and photosensitivity. The aim of this study was to establish a relationship between the chemical structure of fluoroquinolones and the risk of photosensitivity adverse effects from real-world data.

METHODS

All the Individual Case Safety Reports (ICSRs) related to fluoroquinolones and registered in the World Health Organization global database (VigiBase^®) up to December 31, 2017 were collected. A disproportionality analysis was performed in order to quantify the photosensitivity risk for each fluoroquinolone by calculating their reporting odds ratio (ROR).

RESULTS

Up to December 31, 2017, 282,805 ICSRs related to fluoroquinolones were selected, of which 1647 were photosensitivity adverse event cases. Sparfloxacin had the highest adjusted ROR of 161.10 (95% confidence interval [CI] 133.66-194.02) followed by grepafloxacin (40.30 [26.30-59.60]) closely followed by lomefloxacin (32.61 [28.61-37.07]), then enoxacin (11.04 [8.33-14.32]) and fleroxacin (8.22 [5.06-12.56]).

CONCLUSION

This study confirms the high reporting rate of photosensitivity adverse effects for sparfloxacin from real-world data. Moreover, our data suggest more photosensitivity adverse effects reporting for fluoroquinolones with a halogen at their 8th position.

Influence of pH and DO on the ofloxacin degradation in water by UVA-LED/TiO2 nanotube arrays photocatalytic fuel cell: mechanism, ROSs contribution and power generation

The influence of pH and dissolved oxygen (DO) on the degradation of ofloxacin (OFX) in water by UVA-LED/TiO₂ nanotube arrays photocatalytic fuel cell (UVA-LED/TNA PFC) was investigated. The degradation pathway depended on the location of OFX frontier orbital with different ionization states and the role of reactive oxidative species (ROSs) played with varied pH and DO values. In presence of DO, the quencher tests revealed that O₂^- played a key role at pH 3.0, 7.0 and 11.0, while OH made its greatest contribution at pH 3.0 and the effect of h⁺ was largely inhibited at pH 11.0. Hydroxylation for cationic OFX was more significant, while demethylation and piperazinyl ring oxidation for anionic OFX occurred more quickly compared to other forms. Besides, zwitterionic OFX underwent decarboxylation and combination of demethylation & hydroxylation more easily. Much higher power generation was observed in presence of DO at pH 7.0, probably due to the enhanced adsorption of OFX on the TNA, and DO could amplify the electric potential between the two electrodes. The degradation efficiencies were almost the same in presence or absence of DO, but the pathways were different and e-_aq may replace O₂- as the leading ROSs in absence of DO.

Photophysical Properties Controlled by Substituents with Lone-Pair Electrons at the Ortho- or Para-Positions of Fluoroquinolone Antibiotics

The ortho- or para-substituents of NH₂ or N-alkyl-containing lone-pair electrons were found to change the energy levels and transition configurations of the highest occupied molecular orbital for some fluoroquinolone-based antibiotics (FQs) and can significantly influence the electronic structure, intermolecular hydrogen bonding, internal conversion, and fluorescence and intersystem crossing efficiencies of FQs in acetonitrile or aqueous solution after photoexcitation. These findings provide new insights that can help in the molecular design strategies to regulate the photophysical properties of photosensitive medicines, photodynamic therapy reagents, and energy conversion materials that contain similar aromatic carbonyl structures.