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NEW DRUG DEVELOPMENTS

Iclaprim, a Novel Diaminopyrimidine for the Treatment of Resistant Gram-Positive Infections

Associate Professor of Pharmacy Practice and Vice-Chair of Acute Care, College of Pharmacy, Midwestern University Chicago, Downers Grove, IL

Justin M Schmidt, PharmD BCPS

Assistant Professor of Pharmacy Practice, College of Pharmacy, Midwestern University Chicago

Reprints: Dr. Sincak, College of Pharmacy, Midwestern University Chicago, 555 31st St., Downers Grove, IL 60515, fax 630/515-6958, csinca{at}midwestern.edu

OBJECTIVE: To review the pharmacology, microbiology, in vitro susceptibility, pharmacokinetics, clinical trial data, safety, and tolerability of iclaprim, a novel dihydrofolate reductase (DHFR) inhibitor.

DATA SOURCES: A MEDLINE search was conducted from 1966 through December 2008. Additional sources included abstracts from meetings of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America from 2001 to 2008 and information available from the manufacturer's Web site.

STUDY SELECTION AND DATA EXTRACTION: In vitro and clinical studies, in addition to Phase 1, 2, and 3 clinical trials, were included.

DATA SYNTHESIS: Iclaprim, a novel diaminopyrimidine and DHFR antagonist, has a mechanism of action similar to that of trimethoprim. It has in vitro activity mainly against gram-positive organisms, including resistant Staphylococcus aureus. In Phase 2 and 3 clinical trials, oral and intravenous administration of iclaprim was effective and well tolerated for the treatment of complicated skin and skin structure infections (cSSSI). Trials are currently ongoing for the treatment of ventilator-associated and healthcare-associated pneumonia.

CONCLUSIONS: Iclaprim is a promising antimicrobial agent for the treatment of gram-positive organisms, including resistant S. aureus and trimethoprim-, macrolide-, fluoroquinolone-, and glycopeptide-resistant strains. Additionally, in vitro activity similar to that of trimethoprim has been observed against gram-negative and atypical organisms.

Key Words: AR-100, dihydrofolate reductase, gram-positive, iclaprim

Published Online, May 12, 2009. www.theannals.com, DOI 10.1345/aph.1L167

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-09-010-H01-P