{"id":174,"date":"2019-10-07T20:47:24","date_gmt":"2019-10-07T15:17:24","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=174"},"modified":"2019-10-07T20:47:24","modified_gmt":"2019-10-07T15:17:24","slug":"new-antibacterials","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/new-antibacterials\/","title":{"rendered":"New Antibacterials"},"content":{"rendered":"\n

NEWER ANTIBACTERIALS<\/strong><\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

DALBAVANCIN<\/strong><\/p>\n\n\n\n

  • Novel second-generation\u00a0lipoglycopeptide\u00a0antibiotic<\/li>
  • Approved by FDA <\/li>
  • Mechanism -binds to the D-alanyl-D-alanyl residue on growing peptidoglycan chains-prevents transpeptidation, transglycosylation of peptidoglycan- cell wall formation-\u00a0 bactericidal effect \u00a0<\/li>
  • Effective against VRE, VRSA <\/li><\/ul>\n\n\n\n
    \"\"<\/figure><\/div>\n\n\n\n
    • The long half-life of 150-250 hours (protein binding >90%)<\/li>
    • The dosage regimen of 2 doses one week apart <\/li>
    • IV infusion -(1 g followed one week later by 500 mg) <\/li><\/ul>\n\n\n\n

      USES AND DISADVANTAGE<\/strong><\/p>\n\n\n\n

      • Most widely used -MRSA<\/li>
      • Also used in-acute bacterial skin and skin structure infections\n(ABSSSIs), streptococcus pyogens (methicillin-sensitive & resistant\nstrains)<\/li>
      • Not active against vancomycin-resistant S. <\/em>aureus\n(VRSA).  <\/li><\/ul>\n\n\n\n

        IN PREGNANCY & LACTATION<\/p>\n\n\n\n

        • Used in caution<\/li>
        • No evidence in animals \u2013 teratogenicity<\/li><\/ul>\n\n\n\n

          FUTURE DEVELOPMENT<\/strong><\/p>\n\n\n\n

          • Single-dose regimen <\/li>
          • For use-hospitalized community-acquired pneumonia (CAP) due to MRSA\nand pediatric osteomyelitis<\/li><\/ul>\n\n\n\n

            ORITAVANCIN<\/strong><\/p>\n\n\n\n

            • Novel semisynthetic glycopeptide antibiotic <\/li>
            • Approved by FDA <\/li>
            • Mechanism of action- inhibition of transglycosylation &\ntranspeptidation-disruption of cell wall<\/li>
            • oritavancin and Telavancin\ndisrupt the membrane potential and thus increase cell permeability causing\nrapid bactericidal activity<\/strong><\/li>
            • long half-life of about 250 hours (about 90% protein binding)<\/li>
            • Single-dose regimen -1.2 G IV<\/li>
            • Pregnancy- Category C<\/li>
            • USES
              • Used for -treatment of serious Gram-positive bacterial\ninfections & ABSSSI<\/li><\/ul>
                • More effective- clostridium difficile infection<\/li><\/ul><\/li><\/ul>\n\n\n\n

                  ADVANTAGES\nOVER VANCOMYCIN<\/strong><\/p>\n\n\n\n

                  • Longer half-life<\/li>
                  • Less frequent dosing<\/li>
                  • No known nephrotoxicity<\/li><\/ul>\n\n\n\n

                    CEPHALOSPORINS<\/strong><\/p>\n\n\n\n

                    • Resistant Gram-negative Enterobacteriaceae \u2013increasing <\/li>
                    • To fix this problem-<\/li><\/ul>\n\n\n\n

                      1. New cephalosporins + beta-lactamase inhibitors<\/p>\n\n\n\n

                      2. Old \ncephalosporin + new beta-lactamase inhibitors<\/p>\n\n\n\n

                      Ceftaroline<\/strong><\/p>\n\n\n\n

                      • New  5th-generationcephalosporin<\/li>
                      • Broad-spectrum Beta-lactam antimicrobial agent<\/li>
                      • Effective against  MRSA, VISA,\nVRSA, Cephalosporin resistant S.Pneumonia.<\/li>
                      • Has potent bactericidal activity by binding to PBP (inhibits transpeptidation\n& cell wall synthesis)<\/li>
                      • Exhibits- bind to (PBPs1-4))<\/li>
                      • greater binding affinity than the other cephalosporins for PBP2a\n(MRSA)<\/li>
                      • Developed by modifying the\nstructure of the<\/strong> fourth generation cephalosporin Cefozopran.<\/strong><\/li>
                      • IV dose-600 mg every 12 hours-infusion<\/li><\/ul>\n\n\n\n

                        USES<\/strong><\/p>\n\n\n\n

                        • Low Drug interaction.<\/li>
                        • Used-treatment of CAP and hospital-acquired pneumonia (HAP) in\nadults<\/li>
                        • Active against-MRSA<\/li><\/ul>\n\n\n\n

                          DISADVANTAGE<\/strong><\/p>\n\n\n\n

                          • Hydrolyzed by extended-spectrum\n\u00df-lactamases (ESBL) and AmpC beta-lactamases <\/li>
                          • Dose adjustments in renal  impairment<\/li>
                          • Side effects-Nausea, Vomiting,\ndysgeusia and caramel taste like taste disturbance.<\/li><\/ul>\n\n\n\n

                            CEFTOBIPROLE<\/strong><\/p>\n\n\n\n

                            • Broad spectrum- MRSA, P.aeruginosa, Penicillin-resistant\nS.pneumoniae, Enterococci.<\/li>
                            • Stronger affinity for PBP2a of MRSA & PBP2x of S.Pneumonia<\/li>
                            • 500 mg iv 12 hourly<\/li><\/ul>\n\n\n\n

                              CEFTAZIDIME-AVIBACTAM \u2013 Avycaz<\/strong><\/p>\n\n\n\n

                              • Approved by FDA – complicated intra-abdominal infections in\ncombination with metronidazole  & UTI<\/li>
                              • Avibactam – extends its activity to ESBL and AmpC  producing strains & carbapenemases (KPC)<\/li><\/ul>\n\n\n\n

                                DOSAGE REGIMEN<\/strong><\/p>\n\n\n\n

                                • 2.5 gm IV every 8 hourly<\/li>
                                • 2 hours infusion<\/li>
                                • Duration-7-14 days<\/li><\/ul>\n\n\n\n

                                  DISADVANTAGE<\/strong><\/p>\n\n\n\n

                                  • Avibactam -does not protect against other resistance mechanisms\n(penetration, efflux)<\/li>
                                  • ADVERSE EFFECT – <\/strong>Nausea, vomiting, Dizziness, Anxiety, Increase in liver enzymes<\/li><\/ul>\n\n\n\n

                                    CEFTOLOZANE-TAZOBACTAM<\/strong><\/p>\n\n\n\n

                                    • New cephalosporin- against Pseudomonas<\/li>
                                    • combination with tazobactam- effective  against Enterobacteriaceae with ESBL\nproduction<\/li>
                                    • 1 g\/0.5 g – every 8 hours by IV infusion over 1 hour<\/li><\/ul>\n\n\n\n

                                      NEWER\nCARBAPENEMS<\/strong><\/p>\n\n\n\n

                                      Doripenem<\/strong><\/p>\n\n\n\n

                                      • Parenteral carbapenem approved for the treatment of complicated\nurinary tract infections and intra-abdominal infections.<\/li>
                                      •  The high binding affinity to\nPBP-2 and -3 may enhance its activity against drug-resistant P.<\/em> aeruginosa.\n<\/li>
                                      • a suitable alternative to currently available anti-pseudomonal carbapenems<\/li>
                                      • Gram-positive cocci like imipenem and activity against gram-negative\nbacilli like meropenem<\/li>
                                      • stable to ESBLs produced by E. coli<\/em> and Klebsiella\nspecies and to AmpC \u03b2-lactamases enzymes; <\/li><\/ul>\n\n\n\n

                                        Razupenem\n(PZ-601)<\/strong><\/p>\n\n\n\n

                                        • novel carbapenem active against multidrug-resistant gram-positive\nand gram-negative (ESBL producers) bacteria and is currently in trials for\ncSSSI<\/li><\/ul>\n\n\n\n

                                          meropenem and vaborbactam 2017<\/strong><\/p>\n\n\n\n

                                          • combination of meropenem, a\npenem antibacterial, and vaborbactam, a beta-lactamase inhibitor.<\/li>
                                          • complicated urinary tract\ninfections<\/li><\/ul>\n\n\n\n


                                            \nPleuromutilin<\/strong><\/p>\n\n\n\n

                                            • Retapamulin<\/strong><\/li>
                                            • Novel topical antibiotic<\/strong> and the first approved member in this new class.<\/strong><\/li>
                                            • It is approved for the treatment of skin and soft tissue infections caused by\u00a0S. pyogenes<\/em>\u00a0and\u00a0S. aureus<\/em>, ineffective against gram-negative organisms<\/strong><\/li>
                                            • Retapamulin is a semisynthetic pleuromutilin derivative isolated from\u00a0Clitopilus scyphoides<\/em>\u00a0(an edible mushroom). <\/li>
                                            • It is a protein synthesis inhibitor that acts by binding to the 50-S subunit of bacterial ribosomes. <\/strong><\/li>
                                            • Plasma protein binding of Retapamulin is 94% and it is metabolized mainly in the liver by CYP3A4<\/sub>\u00a0to numerous metabolites<\/li>
                                            • The most common adverse effect is pruritus at the application site.<\/li><\/ul>\n\n\n\n
                                              \"\"<\/figure>\n\n\n\n

                                              Telithromycin<\/strong><\/p>\n\n\n\n

                                              • It is the first ketolide<\/strong> to enter clinical use for the treatment of CAP,\nchronic bronchitis and acute sinusitis.<\/li>
                                              • In 2010, a published report\ndescribed the likely mechanism of action underlying not only the cases of liver failure but also cases of visual\ndisturbances and exacerbations of myasthenia gravis.<\/strong> <\/li>
                                              • The study showed that a pyridine moiety that is part of the telithromycin\nmolecule acts as an antagonist on cholinergic receptors located in the\nneuromuscular junction<\/strong>, the ciliary ganglion of the eye and the vagus nerve\ninnervating the liver. <\/li>
                                              • Other macrolides, such as\nazithromycin and clarithromycin and the fluoroketolide, solithromycin, do not\ncontain the pyridine moiety and do not antagonize these cholinergic receptors\nsignificantly.<\/li>
                                              • FDA “black box\nwarning,” \u00e0 should not be used in patients with myasthenia gravis, a disease\nthat causes muscle weakness.\u2019<\/li>
                                              • Following this decision,\nSanofi-Aventis withdrew the drug from\nactive sales<\/strong> in the United States.<\/li><\/ul>\n\n\n\n

                                                Fidaxomicin <\/strong><\/p>\n\n\n\n

                                                • Alternative to Vancomycin and Metronidazole against CDI.<\/li>
                                                • Trial \u2013 Non inferior to Vancomycin<\/li>
                                                • Recurrence rates of CDI lower <\/li>
                                                • 200 mg oral dose twice daily.<\/li><\/ul>\n\n\n\n

                                                  Omadacycline <\/strong><\/p>\n\n\n\n

                                                  • modernized tetracycline\nspecifically designed to overcome tetracycline resistance.<\/li>
                                                  • community-acquired bacterial\npneumonia and acute bacterial skin and skin structure infections<\/li>
                                                  • Adult patients with\ncommunity-acquired bacterial pneumonia (CABP) caused by the following\nsusceptible microorganisms: Streptococcus pneumonia, Staphylococcus aureus\n(methicillin-susceptible isolates), Haemophilus influenzae, Haemophilus\nparainfluenzae, Klebsiella pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae,\nand Chlamydophila pneumoniae.<\/li><\/ul>\n\n\n\n
                                                    • Adult patients with acute\nbacterial skin and skin structure infections (ABSSSI) caused by the following\nsusceptible microorganisms: Staphylococcus aureus (methicillin-susceptible and\n-resistant <\/li><\/ul>\n\n\n\n

                                                      isolates),\nStaphylococcus lugdunensis, Streptococcus pyogenes, Streptococcus anginosus\ngrp. (includes S. anginosus, S. intermedius, and S. constellatus), Enterococcus\nfaecalis, Enterobacter cloacae, and Klebsiella pneumoniae.<\/p>\n\n\n\n

                                                      Eravacycline<\/strong><\/p>\n\n\n\n

                                                      • tetracycline-class antibacterial.<\/li>
                                                      • complicated intra-abdominal\ninfections<\/li>
                                                      • supplied as a solution for\nintravenous administration. To reduce the development of drug-resistant\nbacteria and maintain the effectiveness of Xerava and other antibacterial\ndrugs, Xerava should be used only to treat or prevent infections that are\nproven or strongly suspected to be caused by susceptible bacteria. <\/li>
                                                      • The recommended dose regimen of\nXerava is 1 mg\/kg every 12 hours. Administer intravenous infusions over\napproximately 60 minutes every 12 hours.<\/li>
                                                      • The recommended duration of\ntreatment with Xerava for cIAI is 4 to 14 days. <\/li>
                                                      • The duration of therapy should\nbe guided by the severity and location of infection and the patient\u2019s clinical\nresponse.<\/li><\/ul>\n\n\n\n

                                                        Plazomicin<\/strong><\/p>\n\n\n\n

                                                        • aminoglycoside antibacterial.<\/li>
                                                        • complicated urinary tract\ninfections<\/li>
                                                        • specifically indicated in\npatients 18 years of age or older for the treatment of complicated urinary\ntract infections (cUTI), including pyelonephritis caused by the following\nsusceptible microorganism(s): Escherichia coli, Klebsiella pneumoniae, Proteus\nmirabilis, and Enterobacter cloacae.<\/li>
                                                        • supplied as a solution for\nintravenous infusion. <\/li>
                                                        • To reduce the development of\ndrug-resistant bacteria and maintain the effectiveness \u00e0\nshould be used only to treat or prevent infections that are proven or strongly\nsuspected to be caused by susceptible bacteria. <\/li>
                                                        • recommended dosage regimen \u00e0 15 mg\/kg administered every 24 hours by intravenous (IV) infusion\nover 30 minutes in patients 18 years of age or older and with creatinine\nclearance (CLcr) greater than or equal to 90 mL\/min. <\/li>
                                                        • The duration of therapy should\nbe guided by the severity of the infection and the patient\u2019s clinical status\nfor up to 7 days.<\/li>
                                                        • During treatment, dosage\nadjustments may be required based on the change in renal function.<\/li><\/ul>\n\n\n\n

                                                          Delafloxacin<\/strong><\/p>\n\n\n\n

                                                          • fluoroquinolone antibacterial.<\/li>
                                                          • acute bacterial skin and skin\nstructure infections<\/li>
                                                          • indicated for use in adults for\nthe treatment of acute bacterial skin and skin structure infections (ABSSSI)\ncaused by susceptible isolates of the following:<\/li>
                                                          • Gram-positive organisms:\nStaphylococcus aureus (including MRSA], Staphylococcus haemolyticus,\nStreptococcus agalactiae, Streptococcus pyogenes, and Enterococcus faecalis.<\/li>
                                                          • Gram-negative organisms:\nEscherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, and Pseudomonas\naeruginosa<\/li><\/ul>\n\n\n\n

                                                            Black Box Warning:<\/strong><\/p>\n\n\n\n

                                                            • Tendinitis and tendon rupture, <\/li>
                                                            • Peripheral neuropathy, <\/li>
                                                            • may exacerbate muscle weakness\nin patients with myasthenia gravis. Avoid in patients with a known history of\nmyasthenia gravis.<\/li><\/ul>\n\n\n\n

                                                              Ozenoxacin<\/strong><\/p>\n\n\n\n

                                                              • quinolone antimicrobial.<\/li>
                                                              • specifically indicated for the treatment of impetigo<\/strong> due to Staphylococcus aureus or Streptococcus pyogenes in adult and pediatric patients 2 months of age and older.<\/li>
                                                              • supplied as an ointment for topical administration<\/li><\/ul>\n\n\n\n
                                                                \"\"<\/figure>\n\n\n\n

                                                                Oxazolidinone<\/strong><\/p>\n\n\n\n

                                                                • Linezolid -oxazolidinone available in the market for the treatment\nof gram-positive infections, including those caused by MRSA or VRE. <\/li>
                                                                • Newer oxazolidinones with improved potency, aqueous solubility, and\nreduced toxicity –by modifications of A, B and C rings of linezolid]<\/li>
                                                                • Approved by FDA for the treatment of cSSSI and uSSSI respectively,\ncompleted phase II clinical trials. <\/li>
                                                                • Activated form – inhibits protein synthesis by binding to\nthe 23-s portion of 50S ribosomal subunit of bacteria- bacteriostatic activity<\/li>
                                                                • Torezolid <\/strong>is the active moiety of the prodrug, torezolid phosphate,-4-16 fold\ngreater potency than linezolid against gram-positive species including MRSA.<\/strong><\/li>
                                                                • Has higher binding\naffinity & longer half-life<\/strong><\/li>
                                                                • Resistance to linezolid\nresults from mutations in ribosomal RNA (rRNA) that has been overcome by newer\noxazolidinones by additional hydrogen bond interactions with 23-S rRNA.<\/strong><\/li>
                                                                • Dose-200 mg once daily for 6 days(linezolid-600mg bd-10days)<\/li>
                                                                • Available in oral and intravenous forms<\/li><\/ul>\n\n\n\n

                                                                  Uses<\/p>\n\n\n\n

                                                                  Used\nin \u2013SSSI caused by streptococcus pyogenes, MRSA<\/p>\n\n\n\n

                                                                  More\neffective- enterococcus faecalis<\/p>\n\n\n\n

                                                                  Side\neffects<\/p>\n\n\n\n

                                                                  • Peripheral & optic neuropathy<\/li>
                                                                  • Haematological side effects(treated >6 days)<\/li>
                                                                  • Nausea, vomiting<\/li>
                                                                  • Headache, dizziness<\/li><\/ul>\n\n\n\n

                                                                    Glycylcyclines-\nTigecycline<\/strong><\/p>\n\n\n\n

                                                                    • A new class of antimicrobials –chemical derivatives of minocycline.<\/li>
                                                                    • Approved by FDA for cSSTIs, intraabdominal infections, and CAP.<\/li>
                                                                    • Overcome Resistance mediated by acquired efflux pumps and by\nribosomal protection. <\/li>
                                                                    • 20 fold more efficient than tetracycline.<\/li>
                                                                    • Tigecycline has a broader spectrum of activity against aerobic and\nanaerobic gram-negative and positive pathogens. <\/li>
                                                                    • In vitro<\/em> data — very good\nantibacterial activity against ESBL as well. <\/li>
                                                                    • Not active against P. aeruginosa<\/em>, which is an important\ngap in its antimicrobial spectrum<\/li>
                                                                    • Tissue and intracellular penetration are good. pharmacokinetics is\nunaffected by food, age, race, and renal disease<\/li>
                                                                    • The primary route of elimination is the biliary excretion so dose\nadjustment is recommended in hepatic disease<\/li><\/ul>\n\n\n\n


                                                                      \nIclaprim<\/strong><\/p>\n\n\n\n

                                                                      • synthetic diaminopyrimidine, selective\ninhibitor of the enzyme dihydrofolate reductase, which is similar to\ntrimethoprim<\/strong><\/li>
                                                                      •  Iclaprim is particularly potent against S.\npneumoniae<\/em> and S. aureus<\/em>, including trimethoprim-resistant\nisolates<\/strong><\/li>
                                                                      • Iclaprim -single agent, 0.8 mg\/kg 12 hourly<\/li>
                                                                      • Non-inferior to Linezolid.<\/li><\/ul>\n\n\n\n

                                                                        Bedaquiline<\/em><\/strong><\/p>\n\n\n\n

                                                                        • drug-susceptible, MDR and XDR mycobacterium strains, with no\ncross-resistance to current first-line drugs<\/em><\/li>
                                                                        • bactericidal and sterilizing activity against Mycobacterium TB) and other\nmycobacterial species <\/em><\/li>
                                                                        • Inhibition of subunit c of ATP synthase \u2013 affects bacillary energy\nmetabolism.<\/em><\/li>
                                                                        • Better sputum & cell culture conversion<\/em><\/li><\/ul>\n\n\n\n

                                                                          Pretomanid\/Delaminid<\/em><\/strong><\/em><\/p>\n\n\n\n

                                                                          • Kills both replicating & Non-replicating organisms. <\/em><\/li><\/ul>\n\n\n\n

                                                                            NEWER\nTARGETS & STRATEGIES FOR ANTIBACTERIAL DRUG DISCOVERY<\/strong><\/p>\n\n\n\n

                                                                            • virulence gene regulation that controls virulence gene expression; and\nbacterial adhesion to host cells e.g., inhibition of the formation of pili by\npilicides<\/strong><\/li>
                                                                            • Virulence inhibitors could\ntarget – toxin function<\/strong> e.g., B.\nanthracis<\/em> lethal factor catalytic activity<\/li>
                                                                            • Inhibiting\n\u03b2-ketoacyl-acyl-carrier-protein synthase I\/II enzyme required for fatty acid biosynthesis <\/strong>\u00e0 Platensimycin preclinical trials block enzymes involved in the\ncondensation steps in fatty acid biosynthesis<\/li>
                                                                            • Toll-like receptor activators and modulators —<\/strong> antimicrobial role by producing antimicrobial peptides that\nactivates the adaptive immune response to combat the infection<\/li><\/ul>\n\n\n\n
                                                                              • BACTERIOPHAGE<\/strong>
                                                                                • (SASPs) genes <\/li><\/ul>
                                                                                  • S. aureus<\/em>-specific delivery bacteriophage<\/li><\/ul>
                                                                                    • inactivate bacterial DNA \u00e0 BACTERICIDAL<\/li><\/ul>
                                                                                      • Advantage -high specificity for\ntheir host without any notable adverse effects or probability of emergence of\nresistance<\/li><\/ul>
                                                                                        • Treatment  -osteomyelitis, skin\/wound infections, UTI,\nand ear infection<\/li><\/ul><\/li><\/ul>\n\n\n\n
                                                                                          • BACTERIOCINS<\/strong>
                                                                                            • Proteins secreted by bacteria\nin response to challenges of nutrient starvation or inter bacterial competition<\/li><\/ul>
                                                                                              • Treatment- chronic bacterial\ninfection<\/li><\/ul>
                                                                                                • Eg: colicin<\/li><\/ul><\/li><\/ul>\n\n\n\n
                                                                                                  • NATURAL PRODUCTS<\/strong>
                                                                                                    • Antimicrobial compounds from\nnatural products \u2013Effective against gm \u2013ve bacteria<\/li><\/ul>
                                                                                                      • Actinonin , pleuromutilin,\nramoplanin, and tiacumicin B (undergoing analysis)<\/li><\/ul><\/li><\/ul>\n\n\n\n
                                                                                                        • BIOENHANCERS<\/strong>
                                                                                                          • No pharmacological activity at\nthe therapeutic dose.<\/li><\/ul>
                                                                                                            • Increase the efficacy and bioavailability\nof the drug.<\/li><\/ul>
                                                                                                              • combining antibiotic\ntetracycline with loperamide enhance the efficacy of tetracycline by increasing\nits permeability<\/li><\/ul>
                                                                                                                • Cow urine distillate (CUD)  with rifampicin increased the activity of\ndrug by about 5-7 times against Escherichia coli<\/em> and 3-11\ntimes against gram-positive bacteria<\/li><\/ul><\/li><\/ul>\n\n\n\n
                                                                                                                  • Alternative form of drug\ndelivery methods<\/strong>
                                                                                                                    • Inhaled Amikacin available as a\nnanoscale liposomal formulation<\/li><\/ul>
                                                                                                                      • potential for the treatment of\nchronic P. aeruginosa<\/em> lung infections in cystic fibrosis\npatients<\/li><\/ul>
                                                                                                                        • biofilm penetration and\nsustained release from liposomes.<\/li><\/ul><\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"

                                                                                                                          NEWER ANTIBACTERIALS DALBAVANCIN Novel second-generation\u00a0lipoglycopeptide\u00a0antibiotic Approved by FDA Mechanism -binds to the D-alanyl-D-alanyl residue on growing peptidoglycan chains-prevents transpeptidation, transglycosylation of peptidoglycan- cell wall formation-\u00a0 bactericidal effect \u00a0 Effective against VRE, VRSA The long half-life of 150-250 hours (protein binding >90%) The dosage regimen of 2 doses one week apart IV infusion -(1 g followed[…]\n","protected":false},"author":3,"featured_media":176,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/174"}],"collection":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/comments?post=174"}],"version-history":[{"count":0,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/174\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media\/176"}],"wp:attachment":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media?parent=174"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/categories?post=174"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/tags?post=174"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}