Emerging drugs for pneumococcal pneumonia

Tulathromycin exerts proresolving effects in bovine neutrophils by inhibiting phospholipases and altering leukotriene B4, prostaglandin E2, and lipoxin A4 production

The accumulation of neutrophils and proinflammatory mediators, such as leukotriene B4 (LTB4), is a classic marker of inflammatory disease. The clearance of apoptotic neutrophils, inhibition of proinflammatory signaling, and production of proresolving lipids (including lipoxins, such as lipoxin A4 [LXA4]) are imperative for resolving inflammation. Tulathromycin (TUL), a macrolide used to treat bovine respiratory disease, confers immunomodulatory benefits via mechanisms that remain unclear. We recently reported the anti-inflammatory properties of TUL in bovine phagocytes in vitro and in Mannheimia haemolytica-challenged calves. The findings demonstrated that this system offers a powerful model for investigating novel mechanisms of pharmacological immunomodulation. In the present study, we examined the effects of TUL in a nonbacterial model of pulmonary inflammation in vivo and characterized its effects on lipid signaling. In bronchoalveolar lavage (BAL) fluid samples from calves challenged with zymosan particles (50 mg), treatment with TUL (2.5 mg/kg of body weight) significantly reduced pulmonary levels of LTB4 and prostaglandin E2 (PGE2). In calcium ionophore (A23187)-stimulated bovine neutrophils, TUL inhibited phospholipase D (PLD), cytosolic phospholipase A2 (PLA2) activity, and the release of LTB4. In contrast, TUL promoted the secretion of LXA4 in resting and A23187-stimulated neutrophils, while levels of its precursor, 15(S)-hydroxyeicosatetraenoic acid [15(S)-HETE], were significantly lower. These findings indicate that TUL directly modulates lipid signaling by inhibiting the production of proinflammatory eicosanoids and promoting the production of proresolving lipoxins.

Pharmacotherapy for pneumococcal infections: an update

INTRODUCTION

The management of pneumococcal diseases still places a significant burden on medical and economic resources. The subjects at greatest risk of pneumococcal infections are children.

AREAS COVERED

The aim of this review is to analyse the best current therapeutic approach to pneumococcal resistance, taking into account the level of susceptibility of Streptococcus pneumoniae, and the pharmacokinetics and pharmacodynamics of different antibiotics in the various pneumococcal diseases.

EXPERT OPINION

Antibiotic treatment of a number of pneumococcal diseases remains difficult or impossible due to the presence of strains resistant to commonly used antibiotics. In children the problem is significantly more important than in adults due to the reduced number of licenced drugs for subjects in the first years of life. The new conjugate pneumococcal vaccines containing 10 (PCV10) and 13 serotypes (PCV13), which include most of the recently emerging strains, might reduce the incidence of pneumococcal infections and the circulation of resistant pathogens. However, it is likely that optimal results will only be reached after the development of effective vaccines based on conserved proteins that are capable of preventing all pneumococcal infections, regardless of the serotype of the causative organism.