methicillin

methicillin, antibiotic formerly used in the treatment of bacterial infections caused by organisms of the genus Staphylococcus. Methicillin is a semisynthetic derivative of penicillin. It was first produced in the late 1950s and was developed as a type of antibiotic called a penicillinase-resistant penicillin—it contained a modification to the original penicillin structure that made it resistant to a bacterial enzyme called penicillinase (beta-lactamase). This enzyme is produced by most strains of Staphylococcus and disrupts certain types of penicillins by hydrolyzing the beta-lactam ring that is central to the antimicrobial activity of these drugs.

Methicillin required administration via intramuscular or intravenous injection because it was inactivated by gastric acid in the stomach when taken orally. Side effects associated with its use included diarrhea and allergic reactions, such as skin rash and anaphylaxis. Some patients experienced severe hemorrhagic cystitis, characterized by inflammation and hemorrhaging of the bladder. Methicillin was suspected to exert its bacteria-killing actions by inhibiting bacterial cell-wall synthesis, a mechanism of action similar to that of other penicillins. Methicillin was active against certain species of Staphylococcus, including Staphylococcus aureus and S. epidermis. The drug also was effective against organisms of the genus Streptococcus, namely Streptococcus pyogenes, which can cause scarlet fever, and S. pneumoniae, which can cause pneumonia.

The emergence of methicillin-resistant strains of bacteria, which first appeared in the 1960s, eventually rendered the drug useless for clinical purposes. Resistance to methicillin is believed to have resulted from bacterial acquisition of a gene that encodes a protein capable of binding the drug and thus preventing the drug from killing the organism. Today a strain known as methicillin-resistant S. aureus (MRSA) is pandemic, causing infection in thousands of hospital patients and healthy individuals worldwide each year. Various antibiotics are used against MRSA; examples include daptomycin, linezolid, sulfamethoxazole and trimethoprim (SMZ-TMP), and vancomycin.