出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2016/07/07 12:08:07」(JST)
Systematic (IUPAC) name | |
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(1S,3R,4R,7R,9R,11R,15S,16R,17R,18S,19E,21E, 25E,27E,29E,31E,33R,35S,36R,37S)-33-[(3-amino-3,
6-dideoxy-β-L-mannopyranosyl)oxy]-1, 3,4,7,9,11,17,37-octahydroxy-15, 16,18-trimethyl-13-oxo-14, 39-dioxabicyclo[33.3.1]nonatriaconta-19, 21,25,27,29,31-hexaene-36-carboxylic acid |
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Clinical data | |
Trade names | Mycostatin, Nystop, others[1] |
AHFS/Drugs.com | Monograph |
MedlinePlus | a682758 |
Pregnancy category |
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Routes of administration |
topical, vaginal, by mouth (but not absorbed orally) |
Legal status | |
Legal status |
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Pharmacokinetic data | |
Bioavailability | 0% on oral ingestion |
Metabolism | None (not extensively absorbed) |
Biological half-life | Dependent upon GI transit time |
Excretion | Fecal (100%) |
Identifiers | |
CAS Number | 1400-61-9 Y |
ATC code | A07AA02 (WHO) D01AA01 (WHO) G01AA01 (WHO) |
PubChem | CID 14960 |
DrugBank | DB00646 Y |
ChemSpider | 23078586 N |
UNII | BDF1O1C72E Y |
KEGG | D00202 Y |
ChEBI | CHEBI:473992 Y |
ChEMBL | CHEMBL229383 N |
NIAID ChemDB | 004993 |
Chemical data | |
Formula | C47H75NO17 |
Molar mass | 926.09 |
SMILES
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InChI
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NY (what is this?) (verify) |
Nystatin, sold under the brandname Mycostatin among others, is an antifungal medication.[1] It is used to treat Candida infections of the skin including diaper rash, thrush, esophageal candidiasis, and vaginal yeast infections. It may also be used to prevent candidiasis in those who are at high risk. Nystatin may be used by mouth, in the vagina, or applied to the skin.[1]
Common side effects when applied to the skin include burning, itching, and a rash. Common side effects when taken by mouth include vomiting and diarrhea. During pregnancy use in the vagina is safe while other formulations have not been studied in this group. It works by disrupting the cell membrane of the fungal cells.[1]
Nystatin was discovered in 1950 by Rachel Fuller Brown and Elizabeth Lee Hazen.[2] It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[3] It is available as a generic medication.[1] The wholesale price of the cream in the developing world is about 0.70 USD per 30 gram tube.[4] In the United States it is less than 25 USD for a course of treatment.[5] It is made from the bacterium, Streptomyces noursei.[2]
Skin, vaginal, mouth, and esophageal Candida infections usually respond well to treatment with nystatin. It is available in many forms.
Oral nystatin is often used as a preventive treatment in people who are at risk for fungal infections, such as AIDS patients with a low CD4+ count and patients receiving chemotherapy. It has been investigated for use in patients after liver transplantation, but fluconazole was found to be much more effective for preventing colonization, invasive infection, and death.[6]
It is also used in very low birth-weight (<1500 g) infants to prevent invasive fungal infections, although fluconazole is the preferred treatment. It has been found to reduce the rate of invasive fungal infections and also reduce deaths when used in these babies. Guidelines state that the use of these agents should be restricted to extremely low birth-weight infants (<1000 g) in neonatal intensive care units with high baselines of fungal infection.[7]
Liposomal nystatin is not commercially available, but investigational use has shown greater in vitro activity than colloidal formulations of amphotericin B, and demonstrated effectiveness against some amphotericin B-resistant forms of fungi.[8] It offers an intriguing possibility for difficult-to-treat systemic infections, such as invasive aspergillosis, or infections that demonstrate resistance to amphotericin B. Additionally, liposomal nystatin appears to cause fewer cases of and less severe nephrotoxicity than observed with amphotericin B.[8]
Cryptococcus is also sensitive to nystatin. In the UK, its license for treating neonatal oral thrush is restricted to those over the age of one month (miconazole is an appropriate alternative for younger babies).[citation needed]
It is prescribed in 'units', with doses varying from 100,000 (for oral infections) to 1 million (for intestinal ones). As it is not absorbed from the gut, it is safe for oral use and does not have problems of drug interactions. Although on occasion, serum levels of the drug can be identified from oral, vaginal, or cutaneous administration and lead to toxicity.
The oral suspension form produces a number of adverse effects including but not limited to:[9]
Both the oral suspension and the topical form can cause:
Like amphotericin B and natamycin, nystatin binds to ergosterol, a major component of the fungal cell membrane. When present in sufficient concentrations, it forms pores in the membrane that lead to K+ leakage, acidification, and death of the fungus.[12] Ergosterol is unique to fungi, so the drug does not have such catastrophic effects on animals or plants. However, many of the systemic/toxic effects of nystatin are attributable to its effect on human cells via binding to mammalian sterols, namely cholesterol. This is the effect that accounts for the nephrotoxicity observed when high serum levels of nystatin are achieved.
Nystatin A1 (or referred to as nystatin) is biosynthesized by a bacterial strain, Streptomyces noursei.[13] The structure of this active compound is characterized as a polyene macrolide with a deoxysugar D-mycosamine, an amino glycoside.[13] The genomic sequence of nystatin reveals the presence of the polyketide loading module (nysA) six polyketide synthases modules (nysB, nysC, nysI, nysJ, and nysK), two thioesterase (nysK and nysE).[13] Thus, it is evident that the biosynthesis of the macrolide functionality follows the polyketide synthase I pathway.[14]
Following the biosynthesis of the macrolide, the compound undergoes post-synthetic modifications, which are aided by the following enzymes: GDP-mannose dehydratase (nysIII), P450 monooxygenase (nysL and nysN), aminotransferase (nysDII), and glycosyltransferase (nysDI).[13] The biosynthetic pathway is thought to proceed as shown to yield nystatin.
Loading to 5
Modules 6-12
Modules 13 -18
Completed molecule
Like many other antifungals and antibiotics, nystatin is of bacterial origin. It was isolated from Streptomyces noursei in 1950 by Elizabeth Lee Hazen and Rachel Fuller Brown, who were doing research for the Division of Laboratories and Research of the New York State Department of Health. Hazen found a promising micro-organism in the soil of a friend's dairy farm. She named it Streptomyces noursei, after William Nourse, the farm's owner.[15] Hazen and Brown named nystatin after the New York State Health Department Laboratory (now known as the Wadsworth Center) in 1954.
It is also used in cellular biology as an inhibitor of the lipid raft-caveolae endocytosis pathway on mammalian cells, at concentrations around 3 µg/ml.
In certain cases, nystatin has been used to prevent the spread of mold on objects such as works of art. For example, it was applied to wood panel paintings damaged as a result of the Arno River Flood of 1966 in Florence, Italy.
Nystatin is also used as a tool by scientists performing "perforated" patch-clamp electrophysiologic recordings of cells. When loaded in the recording pipette, it allows for measurement of electrical currents without washing out the intracellular contents, because it forms pores in the cell membrane that are permeable to only monovalent ions.[16]
Due to its toxicity profile when high levels in the serum are obtained, no injectable formulations of this drug are currently on the US market. However, injectable formulations have been investigated in the past.[8]
The original brandname was Fungicidin
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リンク元 | 「抗菌薬」「ナイスタチン」「ニスタチン」 |
Mechanism of action | Drugs | |
1 | Block cell wall synthesis by inhibition of peptidoglycan cross-linking | penicillin, ampicillin, ticarcillin, piperacillin, imipenem, aztreonam, cephalosporins |
2 | Block peptidoglycan synthesis | bacitracin, vancomycin, cycloserine |
3 | Disrupt bacterial/fungal cell membranes | polymyxins |
4 | Disrupt fungal cell membranes | amphotericin B, nystatin, fluconazole/azoles |
5 | Block nucleotide synthesis | sulfonamides, trimethoprim |
6 | Block DNA topoisomerases | quinolones |
7 | Block mRNA synthesis | rifampin |
8 | Block protein synthesis at 50S ribosomal subunit | chloramphenicol, erythromycin/macrolides, lincomycin, clindamycin, streptogramins (quinupristin, dalfopristin), linezolid |
9 | Block protein synthesis at 30S ribosomal subunit | aminoglycosides, tetracyclines, spectinomycin ATuSi → あつし |
感染臓器・臨床診断 | 原因菌 | 投与期間(抗菌薬) |
髄膜炎 | インフルエンザ菌 | 7-10日 |
肺炎球菌 | 10-14日 | |
髄膜炎菌 | 7-10日 | |
GBS,腸内細菌,リステリア | 21日 | |
中耳炎 | <2 歳 | 10日 |
2 歳≦ | 5-7日 | |
咽頭炎 | A 群連鎖球菌 | 10日(ペニシリン系薬) |
5日(セフェム系薬) | ||
肺炎 | 肺炎球菌,インフルエンザ菌 | 解熱後3-4日 |
黄色ブドウ球菌 | 3-4週間 | |
マイコプラズマ,クラミジア | 10-21日 | |
腎臓、膀胱炎、腎盂腎炎 | 大腸菌,プロテウス,腸球菌 | 3日 |
14日 | ||
骨髄炎 | 黄色ブドウ球菌 | 21日 |
連鎖球菌,インフルエンザ菌 | 14日 |
骨 | 骨髄炎 | 4-6週 | |
耳鼻咽喉 | 中耳炎 | 5-7日 | |
副鼻腔炎 | 5-14日 | ||
A群溶連菌咽頭炎 | 10日 | ||
肺 | 肺炎 | 肺炎球菌 | 7-10日 or 解熱後3日間 |
インフルエンザ菌 | 10-14日 | ||
マイコプラズマ | 14日(7-10日) | ||
レジオネラ | 21日 | ||
肺化膿症 | 28-42日 | ||
心臓 | 感染性心内膜炎 | α連鎖球菌 | 2-4週 |
黄色ブドウ球菌 | 4-6週 | ||
消化管 | 腸炎 | 赤痢菌 | 3日 |
チフス | 14日(5-7日) | ||
パラチフス | |||
腹膜炎 | 特発性 | 5日 | |
二次性 | 10-14日 | ||
胆肝膵 | 肝膿瘍 | 細菌性 | 4-8週 |
アメーバ性 | 10日 | ||
尿路 | 膀胱炎 | 3日 | |
急性腎盂腎炎 | 14日(7-10日) | ||
急性腎盂腎炎・再発 | 6週 | ||
慢性前立腺炎 | 1-3ヶ月 | ||
髄腔 | 髄膜炎 | インフルエンザ菌 | 7-10日 |
髄膜炎菌 | |||
肺炎球菌 | 10-14日 | ||
リステリア | 21日 | ||
敗血症 | 敗血症 | コアグラーゼ陰性ブドウ球菌 | 5-7日 |
黄色ブドウ球菌 | 28日(14日) | ||
グラム陰性桿菌 | 14日(7-14日) | ||
カンジダ | 血液培養陰性化後, 14日 |
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