oritavancin, sold under the brand name orbactiv, is a novel semisynthetic glycopeptide antibiotic medication for the treatment of serious gram-positive bacterial infections. its chemical structure as a lipoglycopeptide is similar to vancomycin.

the u.s. food and drug administration (fda) and the european medicines agency (ema) have approved oritavancin for treatment of acute bacterial skin and skin structure infections.

in vitro activity
oritavancin shares certain properties with other members of the glycopeptide class of antibiotics, which includes vancomycin, the current standard of care for serious gram-positive infections in the united states and europe. it possesses potent and rapid bactericidal activity in vitro against a broad spectrum of both resistant and susceptible gram-positive bacteria, including staphylococcus aureus, mrsa, enterococci, and streptococci. oritavancin was more active than either metronidazole or vancomycin against strains of clostridium difficile tested.

oritavancin has potential use as a therapy for exposure to bacillus anthracis, the gram-positive bacterium that causes anthrax, having demonstrated efficacy in a mouse model both before and after exposure to the bacterium.

mechanism
the 4'-chlorobiphenylmethyl group disrupts the cell membrane of gram-positive bacteria. it also acts by inhibition of transglycosylation and inhibition of transpeptidation.

cidofovir, brand name vistide, is an injectable antiviral medication primarily used as a treatment for cytomegalovirus (cmv) retinitis (an infection of the retina of the eye) in people with aids.

cidofovir was approved for medical use in 1996.

medical use
dna virus
its only indication that has received regulatory approval worldwide is cytomegalovirus retinitis. cidofovir has also shown efficacy in the treatment of aciclovir-resistant hsv infections. cidofovir has also been investigated as a treatment for progressive multifocal leukoencephalopathy with successful case reports of its use. despite this, the drug failed to demonstrate any efficacy in controlled studies. cidofovir might have anti-smallpox efficacy and might be used on a limited basis in the event of a bioterror incident involving smallpox cases. brincidofovir, a cidofovir derivative with much higher activity against smallpox that can be taken orally has been developed. it has inhibitory effects on varicella-zoster virus replication in vitro although no clinical trials have been done to date, likely due to the abundance of safer alternatives such as aciclovir. cidofovir shows anti-bk virus activity in a subgroup of transplant recipients. cidofovir is being investigated as a complementary intralesional therapy against papillomatosis caused by hpv.

it first received fda approval on 26 june 1996, tga approval on 30 april 1998 and ema approval on 23 april 1997.

it has been used topically to treat warts.

carmustine (bis-chloroethylnitrosourea, bcnu, bicnu) is a medication used mainly for chemotherapy. it is a nitrogen mustard ß-chloro-nitrosourea compound used as an alkylating agent.

description
carmustine is an orange-yellow solid medication used mainly for chemotherapy. it is a nitrogen mustard ß-chloro-nitrosourea compound.

mechanism of action
as an alkylating agent, carmustine can form interstrand crosslinks in dna, which prevents dna replication and dna transcription.[citation needed]

uses
carmustine is used as an alkylating agent to treat several types of brain cancer including glioma, glioblastoma multiforme, medulloblastoma and astrocytoma), multiple myeloma, and lymphoma (hodgkin's and non-hodgkin).

bcnu is sometimes used in conjunction with alkyl guanine transferase (agt) inhibitors, such as o6-benzylguanine. the agt-inhibitors increase the efficacy of carmustine by inhibiting the direct reversal pathway of dna repair, which will prevent formation of the interstrand crosslink between the n1 of guanine and the n3 of cytosine.

it is also used as part of a chemotherapeutic protocol in preparation for hematological stem cell transplantation, a type of bone marrow transplant, in order to reduce the white blood cell count in the recipient. use under this protocol, usually with fludarabine and melphalan, was developed by oncologists at the university of texas md anderson cancer center.[citation needed]

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