Surotomycin

This information is for educational purpose only. It is not for clinical use.

Class: Cyclic lipopeptide.
Semisynthetic derivative of daptomycin.
Molecular weight: 1680.7 g/mol.
It is minimally absorbed from the bowel.

Mechanism of action:
Depolarisation of the bacterial cell membrane – bactericidal. It does not form pores in the cell membrane.
Inhibition of macromolecular synthesis (in DNA, RNA, proteins, and cell wall).

Activity:
Gram-positive organism (similar to daptomycin) including MRSA and VRE. It has shown some activity against daptomycin non-susceptible strains in initial evaluations.
It has activity against both growing and non-growing Clostridium difficile (concentration-dependent killing).

Clinical trial:
A randomized, double-blind, Phase 3 trial by Daley et al found Surotomycin non-inferior to vancomycin for treatment of C difficile associated diarrhoea.
In another randomized, double-blind, active-controlled, multicenter, international trial by Boix et al, surotomycin failed to meet the criteria for noninferiority versus vancomycin for the primary and key secondary endpoints.
Surotomycin demonstrated a statistically non-significant reduction in C difficile associated diarrhoea recurrence rates and improved clinical response in BI/NAP1/027-positive case when compared to vancomycin.

Dose:
Dose used in clinical trials (Phase II-III) 125mg – 250 mg BD.

Adverse effect:
Study-drug related adverse effects reported in the clinical trials – Headache, abdominal cramp, elevated CK. nausea, vomiting, dizziness, increased ALT etc

Ref:
Mohammed Zahidul Alam et al, Mode of Action and Bactericidal Properties of Surotomycin against Growing and Nongrowing Clostridium difficile, Aug 2015, 59 (9) 5165-5170

Daley et al, Surotomycin versus vancomycin in adults with Clostridium difficile infection: primary clinical outcomes from the second pivotal, randomized, double-blind, Phase 3 trial, Journal of Antimicrobial Chemotherapy, Volume 72, Issue 12, December 2017, Pages 3462–3470

Boix et al, Primary Outcomes From a Phase 3, Randomized, Double-Blind, Active-Controlled Trial of Surotomycin in Subjects With Clostridium difficile Infection, Open Forum Infectious Diseases, Volume 4, Issue 1, Winter 2017, ofw275

M. Lindsay Grayson. Kucers’ The Use of Antibiotics: A Clinical Review of Antibacterial, Antifungal, Antiparasitic, and Antiviral Drugs. 7th Edition. Boca Raton : CRC Press, 2017



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