This review addresses the feasibility of utilizing members of the beta-lactam group of antibiotics in the management of tuberculosis. The first part provides an introduction into the beta-lactam antibiotics as a group, their distinguishing features, their classification, their spectrum of activity, and their mechanism of antibacterial action. Next follows a brief overview of tuberculosis as a disease which poses a peculiar challenge with drug therapy. The literature review section features an extensive overview of current research publications addressing various angles of the question of utilizing beta-lactam antibiotics in tuberculosis treatment, including results from in vitro as well as in vivo testing, clinical trials, and comments from reviewers. Finally, an appraisal of the available information is done, drawing out answers to the questions of why the beta-lactams have not been used in tuberculosis treatment, what are the issues involved, how they may be used to treat tuberculosis, what conclusions may be drawn from the literature information available, and the place of combination therapy in facilitating the utility of the beta-lactams in tuberculosis therapy.
Beta-lactam antibiotics refer to a broad class of antimicrobials...
nt, what are the issues involved, how they may be used to treat tuberculosis, what conclusions may be drawn from the literature information available, and the place of combination therapy in facilitating the utility of the beta-lactams in tuberculosis therapy.
The Beta-Lactam Antibiotics
Beta-lactam antibiotics refer to a broad class of antimicrobials which possess in their chemical structure a beta-lactam ring moeity. The beta-lactam moiety (also known as a penam or azetidin-2-one) is a heterocyclic four-membered ring containing a nitrogen atom and a carbonyl group, and is essential for their antibiotic activity (Nayler, 1971). Beta-lactam antibiotics include the penicillins, cephalosporins, carbapenems, monobactams and the beta-lactamase inhibitors, which together constitute the most widely prescribed group of antibiotics in existence. They are favoured in clinical practice over other antibiotics because of their safety profile (low toxicity), wide therapeutic index, relatively affordable cost, low potential for adverse drug interactions, and broad spectrum of action.
Beta-lactam antibiotics can be broadly classified into four broad subgroups:
carbapenems (or penems)
These are the first beta-lactam antibiotics to be discovered and introduced into clinical use. They possess a thiazolidine ring fused with a beta-lactam ring.with different acylamino side chains at C6. The differences between these side chains account for the varying properties of each subclass of penicillins. Benzylpenicillin (penicillin G) is the prototype member, with a narrow spectrum and no oral activity. Phenoxymethylpenicillin (penicillin V) is orally active but also possesses a narrow