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Josamycin

Josamycin

(lat.
josamycin
) - a natural antibiotic of the macrolide class.
Produced by streptomycetes of the species Streptomyces narbonensis
.

Josamycin is a chemical compound

Chemically, josamycin is leukomycin V 3-Acetate-4B-(3-methylbutanoate) (and propionate). It has a 16-membered lactone ring (in the diagram below right). The empirical formula of josamycin is C42H69NO15. Josamycin is highly soluble in methanol and ethanol, soluble in ether and practically insoluble in water. The molecular weight of josamycin is 827.995.

Josamycin is a drug

Josamycin is the international nonproprietary name (INN) of the drug. According to the pharmacological index, josamycin belongs to the group “Macrolides and azalides”. According to ATC, josamycin is included in the group “J01 Antibacterial drugs for systemic use” and has the code J01FA07.

Microorganisms against which josamycin is active or inactive

Josamycin in high concentrations is active against the following bacteria:

gram-negative: Neisseria gonorrhoeae, Neisseria meningitidis
, some species of
Shigella, Haemophilus influenzae, Bordetella pertussis
gram-positive: Staphylococcus spp., Streptococcus spp.
, including
Streptococcus pyogenes and Streptococcus pneumoniae, Bacillus anthracis, Corynebacterium diphtheriae
intracellular parasites: Mycoplasma spp.
, including
Mycoplasma hominis, Mycoplasma pneumoniae, Chlamydia spp.
, including
Chlamydia trachomatis, Chlamydia pneumoniae, Ureaplasma urealyticum, Legionella pneumophila
anaerobic: Peptococcus spp., Peptostreptococcus spp., Clostridium perfringens, Bacteroides fragilis

It is believed that resistance of microorganisms to josamycin develops less than to other macrolides.

Indications for use of josamycin

Josamycin is used in the treatment of acute and chronic infections caused by bacteria, against which Josamycin is active. Infections of the upper respiratory tract and ENT organs (tonsillitis, pharyngitis, paratonsillitis, laryngitis, otitis media, sinusitis, diphtheria - in addition to treatment with diphtheria toxoid, scarlet fever in case of hypersensitivity to penicillin); lower respiratory tract infections (acute bronchitis, exacerbation of chronic bronchitis, pneumonia, including those caused by atypical pathogens, whooping cough, psittacosis); dental infections (gingivitis and periodontal disease); infections in ophthalmology (dacryocystitis, blepharitis); infections of the skin and soft tissues (pyoderma, furunculosis, anthrax, erysipelas - with hypersensitivity to penicillin, acne, lymphangitis, lymphadenitis, lymphogranuloma venereum); infections of the genitourinary system (prostatitis, urethritis, gonorrhea, syphilis - with hypersensitivity to penicillin, chlamydia, mycoplasma, including ureaplasma, and mixed infections) (Instructions for the drug).

Josamycin in Helicobacter pylori eradication regimens

According to the recommendations of Maastricht I–III, for gastric ulcers, duodenal ulcers, atrophic gastritis, MALToma and gastric resection after gastric cancer, when Helicobacter pylori
, its eradication is indicated.
The first-line eradication regimens recommended by Maastricht include the antibiotic clarithromycin. In recent years, in Russia, Helicobacter pylori
to clarithromycin has reached 28–29%.
Therefore, antibiotics began to appear that replaced clarithromycin in eradication therapy, in particular, josamycin (Minushkin O.N. et al.). The Scientific Society of Gastroenterologists of Russia recommends the use of josamycin, as an alternative to clarithromycin, in three main first-line regimens for eradication of Helicobacter pylori
(see Standards for the diagnosis and treatment of acid-dependent and Helicobacter pylori-associated diseases (4th Moscow Agreement), adopted by the X Congress of the NOGR 5.03. 2010):

Option 1.

One of the standard dosage proton pump inhibitors (omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg, esomeprazole 20 mg, rabeprazole 20 mg twice daily), amoxicillin (500 mg four times daily or 1000 mg twice daily) and josamycin (1000 mg 2 times a day) for 10–14 days.

Option 2.

The drugs used in the first option (one of the PPIs in a standard dosage, amoxicillin and josamycin) with the addition of a fourth component - bismuth tripotassium dicitrate 120 mg 4 times a day or 240 mg 2 times a day for 10-14 days.

Option 3 (in the presence of atrophy of the gastric mucosa with achlorhydria, confirmed by pH-metry).

Amoxicillin (500 mg 4 times a day or 1000 mg 2 times a day), josamycin (1000 mg 2 times a day) and bismuth tripotassium dicitrate (120 mg 4 times a day or 240 mg 2 times a day) for 10–14 days .

Professional medical publications addressing the use of josamycin in the eradication of Helicobacter pylori

Parolova N.I. Comparative assessment of the effectiveness of eradication therapy for H. pylori infection in children. Abstract of dissertation. PhD, 14.00.09 – pediatrics. SPbGPMA, St. Petersburg, 2008.
Vertkin A.L., Masharova A.A. Treatment of peptic ulcer in a modern clinic // Attending physician. – 2000. – No. 8. – p. 14–19.

On the website gastroscan.ru in the literature catalog there is a section “Antibiotics used in the treatment of gastrointestinal diseases”, containing articles on the use of antimicrobial agents in the treatment of diseases of the digestive tract.

Method of administration of josamycin and dose

Josamycin is taken orally, between meals. The film-coated tablets should be swallowed whole with a small amount of water. Dispersible tablets can be taken in two ways: swallowed whole with water, or diluted with water (at least 20 ml) before use, and the resulting suspension is thoroughly mixed.

for children under 14 years of age, the dose is determined based on 40–50 mg of josamycin per kg of child weight per day, divided into three doses per day
for patients over 14 years of age - 1-2 g of josamycin per day is prescribed (the dose can be increased by the doctor to 3 g / day) in 2-3 doses, the initial recommended dose is 1 g

The duration of therapy is determined by the doctor.
When treating streptococcal infections - at least 10 days. When eradicating Helicobacter pylori

The duration, dose and order of taking josamycin are determined by the selected eradication regimen.

In the presence of atrophy of the gastric mucosa with achlorhydria, confirmed by pH-metry: amoxicillin 1 g 2 times a day + josamycin 1 g 2 times a day + tripotassium bismuth dicitrate 240 mg 2 times a day.

Treatment of acne vulgaris and globulus is 500 mg of josamycin twice a day for 2–4 weeks, then 500 mg of josamycin once a day for 8 weeks.

Use of josamycin during pregnancy and lactation

If indicated, josamycin can be used in the treatment of pregnant and breastfeeding mothers. The FDA category of effect on the fetus during treatment with josamycin has not been determined.

Interaction of josamycin with other drugs

Josamycin inhibits cytochrome P450 enzymes, suppresses metabolism and increases blood concentrations of indirect anticoagulants, theophylline, cyclosporine, carbamazepine, valproic acid, disopyramide, and ergot alkaloids in plasma. Josamycin is incompatible with terfenadine, astemizole, cisapride due to the risk of developing severe heart rhythm disturbances caused by prolongation of the QT interval. Simultaneous use with penicillins and cephalosporins reduces the effect of josamycin. Increases the bioavailability of digoxin when taken orally by reducing its inactivation by intestinal microflora. Antacids reduce the absorption of josamycin in the digestive tract.

Medicines containing the active ingredient josamycin

In Russia, two drugs with the active substance josamycin are (have) been approved: Vilprafen and Vilprafen Solutab.
The following brands of josamycin are registered in Europe: Josalid, Josacine, Iosalide, Josamina, and in Japan - Josamy. It is not approved for use in the USA.

There are contraindications, side effects and application features; consultation with a specialist is necessary. Back to section

Vilprafen tablets ppo 500 mg No. 10

Compound

Active substance: josamycin - 500 mg. Excipients: microcrystalline cellulose - 101 mg, polysorbate 80 - 5 mg, colloidal silicon dioxide - 14 mg, carmellose sodium - 10 mg, magnesium stearate - 5 mg, methylcellulose - 0.12825 mg, polyethylene glycol 6000 - 0.3846 mg, talc - 2.0513 mg, titanium dioxide - 0.641 mg, aluminum hydroxide - 0.641 mg, copolymer of methacrylic acid and its esters - 1.15385 mg.

Pharmacokinetics

After oral administration, josamycin is rapidly absorbed from the gastrointestinal tract. Cmax is achieved 1-2 hours after administration. 45 minutes after taking a dose of 1 g, the average concentration of josamycin in plasma is 2.41 mg/l.

Plasma protein binding does not exceed 15%.

An equilibrium state is achieved after 2-4 days of regular use.

Josamycin is well distributed in the body and accumulates in various tissues: in the lungs, lymphatic tissue of the palatine tonsils, organs of the urinary system, skin and soft tissues. Particularly high concentrations are determined in the lungs, tonsils, saliva, sweat and tear fluid. The concentration of josamycin in human polymorphonuclear leukocytes, monocytes and alveolar macrophages is approximately 20 times higher than in other cells of the body.

Josamycin is biotransformed in the liver to less active metabolites.

Excreted mainly in bile, excretion in urine is less than 20%.

Indications for use

Infectious and inflammatory diseases caused by microorganisms sensitive to the drug:
Infections of the upper respiratory tract and upper respiratory tract: tonsillitis, pharyngitis, paratonsillitis, laryngitis, otitis media, sinusitis, diphtheria (in addition to treatment with diphtheria toxoid), scarlet fever (in case of hypersensitivity to penicillin) .

Lower respiratory tract infections: acute bronchitis, exacerbation of chronic bronchitis, community-acquired pneumonia, including those caused by atypical pathogens, whooping cough, psittacosis.

Infections in dentistry: gingivitis, pericoronitis, periodontitis, alveolitis, alveolar abscess.

Infections in ophthalmology: blepharitis, dacryocystitis.

Infections of the skin and soft tissues: folliculitis, furuncle, furunculosis, abscess, anthrax, erysipelas, acne, lymphangitis, lymphadenitis, phlegmon, panaritium, wound (including postoperative) and burn infections.

Infections of the genitourinary system: urethritis, cervicitis, epididymitis, prostatitis caused by chlamydia and/or mycoplasmas, gonorrhea, syphilis (with hypersensitivity to penicillin), lymphogranuloma venereum.

Diseases of the gastrointestinal tract associated with H. pylori: peptic ulcer of the stomach and duodenum, chronic gastritis, etc.

Contraindications

severe liver dysfunction;
hypersensitivity to erythromycin and other macrolide antibiotics.

Directions for use and doses

When taken orally by adults and children over 14 years of age - 1-2 g/day in 2-3 divided doses.
Children under 14 years of age - 30-50 mg/kg/day in 3 divided doses.

The duration of treatment depends on the indications for use.

Storage conditions

Store at a temperature not exceeding 25 ° C in a place protected from light.
Keep the medicine out of the reach of children.

Best before date

4 years. Should not be used after the expiration date stated on the packaging.

special instructions

If pseudomembranous colitis develops, josamycin should be discontinued and appropriate therapy should be prescribed. Drugs that reduce intestinal motility are contraindicated.

In patients with renal failure, adjustment of the dosage regimen is required in accordance with CC values.

Josamycin is not prescribed to premature babies. When used in newborns, it is necessary to monitor liver function.

The possibility of cross-resistance to various macrolide antibiotics should be taken into account (for example, microorganisms that are resistant to treatment with antibiotics related in chemical structure may also be resistant to josamycin).

Description

Antibiotic of the macrolide group.

Dosage form

White or almost white, film-coated tablets, oblong, biconvex, scored on both sides.

Use in children

Josamycin is not prescribed to premature babies. When used in newborns, it is necessary to monitor liver function.

Pharmacodynamics

Antibiotic of the macrolide group.
It has a bacteriostatic effect due to inhibition of protein synthesis by bacteria. When high concentrations are created at the site of inflammation, it has a bactericidal effect. Highly active against intracellular microorganisms: Chlamydia trachomatis and Chlamydia pneumonuae, Mycoplasma pneumoniae, Mycoplasma hominis, Ureaplasma urealyticum, Legionella pneumophila; against gram-positive aerobic bacteria: Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae (pneumococcus), Corynebacterium diphtheriae; gram-negative aerobic bacteria: Neisseria meningitidis, Neisseria gonorrhoeae, Haemophilus influenzae, Bordetella pertussis; against some anaerobic bacteria: Peptococcus, Peptostreptococcus, Clostridium perfringens.

Josamycin is also active against Treponema pallidum.

Side effects

From the digestive system: rarely - lack of appetite, nausea, heartburn, vomiting, diarrhea, pseudomembranous colitis; in some cases - increased activity of liver transaminases, impaired bile outflow and jaundice.

Allergic reactions: rarely - urticaria.

Other: in some cases - dose-dependent transient hearing impairment.

Use during pregnancy and breastfeeding

Use during pregnancy and lactation is possible only in cases where the expected benefit to the mother outweighs the potential risk to the fetus or child.

When treating with macrolides and simultaneous use of hormonal contraceptives, non-hormonal contraceptives should be additionally used.

Interaction

Bacteriostatic antibiotics may reduce the bactericidal effect of other antibiotics, such as penicillins and cephalosporins (simultaneous use of josamycin with penicillins and cephalosporins should be avoided).
With the simultaneous use of josamycin with lincomycin, the effectiveness of both drugs may be reduced.
Josamycin slows down the elimination of theophylline to a lesser extent than other macrolide antibiotics.
Josamycin slows the elimination of terfenadine or astemizole, which increases the risk of life-threatening arrhythmias.
There are isolated reports of increased vasoconstrictor effects with simultaneous use of macrolide antibiotics and ergot alkaloids. There was 1 case of ergotamine intolerance when taking josamycin.
With the simultaneous use of josamycin and cyclosporine, it is possible to increase the concentration of cyclosporine in the blood plasma up to nephrotoxic.
With the simultaneous use of josamycin and digoxin, an increase in the level of the latter in the blood plasma is possible.
In rare cases, during treatment with macrolides, the contraceptive effect of hormonal contraceptives may be insufficient.

Overdose

To date, there is no data on specific symptoms of overdose. In case of overdose, the symptoms described in the “Side Effects” section should be expected, especially from the gastrointestinal tract.

Impact on the ability to drive vehicles and operate machinery

There was no effect of the drug on the ability to drive vehicles or operate machinery.