The oxadiazole antibacterials target the bacterial cell wall and are bactericidal. We investigated the synergism of ND-421 with the commonly used -lactams and non--lactam antibiotics by the checkerboard method and by time-kill assays. ND-421 synergizes well with -lactam antibiotics, and it also exhibits a long postantibiotic effect (4.7 h). We also evaluated the in vivo efficacy of ND-421 in a murine neutropenic thigh infection model alone and in combination with oxacillin. ND-421 has in vivo efficacy by itself in a clinically relevant infection model (1.49 log 10 bacterial reduction for ND-321 versus 0.36 log 10 for linezolid with NRS119) and acts synergistically with -lactam antibiotics in vitro and in vivo, and the combination of ND-421 with oxacillin is efficacious in a mouse neutropenic thigh methicillin-resistant Staphylococcus aureus (MRSA) infection model (1.60 log 10 bacterial reduction). The activity of oxacillin was potentiated in the presence of ND-421, as the strain would have been resistant to oxacillin otherwise.
Methicillin-resistant Staphylococcus aureus (MRSA) is a human pathogen associated with serious community-acquired infections and is one of the leading causes of nosocomial infections in the United States and around the world (1). MRSA harbors the mecA gene, which encodes penicillin-binding protein 2a (PBP2a), which confers resistance essentially to all -lactam antibiotics (2). The currently available treatment options for MRSA are glycopeptides (vancomycin and telavancin), oxazolidinones (linezolid and tedizolid), daptomycin, and ceftaroline, of which only the oxazolidinones are orally bioavailable drugs. Linezolidand vancomycin-resistant strains have already been reported (3-6); mutations leading to daptomycin resistance have also been observed (7). An increased vancomycin MIC has also been linked to a possible cross-resistance to daptomycin (8). Ceftaroline was approved in 2010 for treatment of community-acquired pneumonia and acute bacterial skin infections, owing to its ability to bind penicillin-binding proteins (PBPs). The binding in the case of the MRSA PBP2a is at both the allosteric and the active sites, imparting an interesting angle to the mechanism of action of this antibiotic (9, 10). Recently, ceftaroline heteroresistance among S. aureus strains has also been reported (11), and ceftaroline-resistant MRSA strains have been isolated (12, 13). Tedizolid was approved in 2014 for skin and soft tissue infections; resistance to it has been described in vitro (14).The oxadiazoles are a new class of non--lactam antibacterials targeting cell wall biosynthesis with excellent in vitro and in vivo activity against MRSA and other Gram-positive bacteria (15). ND-421 (Fig. 1) is a lead oxadiazole and was also found to be bactericidal against vancomycin-and linezolid-resistant MRSA (16). This compound exhibits efficacy comparable to that of linezolid in a mouse peritonitis model of infection and has low clearance, a long half-life (t 1/2 ), and 97% oral bioavailability (16). As resista...