May 2012




Perioperative pharmacology

Entering into the post-antibiotic era

by Faith A. Hayden EyeWorld Staff Writer

Source: Colin Anderson/Getty Images

Are aganocides the key?

Editors' note: This article discusses the off-label use of aganocides.

Could medicine soon be entering a post-antibiotic era? Ron Najafi, Ph.D., chairman and CEO, NovaBay Pharmaceuticals (Emeryville, Calif.), believes it could be, and with good reason. Since 2003, NovaBay has been hard at work developing aganocide compounds, a synthetic class of non-antibiotic antimicrobials that mimic our own natural defense against infection without the burden of creating resistance. Aganocides harness chlorotaurine compounds, which are produced by white blood cells as they capture bacteria trying to invade the body. "There's no resistance that's been developed for chlorotaurines, and what [Dr. Najafi] and the crew at NovaBay have done is put that in a bottle," said Stephen Wilmarth, M.D., a member of NovaBay's Ophthalmology Advisory Committee. "It's good for surfaces and cavities, but you're not going to take it by mouth, and you're not going to inject it. It's highly reactive. It kills every bacteria we've ever tested."

That includes all gram-positive and gram-negative bacteria and the dreaded methicillin-resistant Staphylococcus aureus. "It kills every virus we've tested on contact, and at higher concentrations it kills the fungi," Dr. Wilmarth added. Aganocides may one day be used for a variety of dermatologic, ophthalmic, and urologic surface infections such as impetigo and urinary catheter blockage and. In ophthalmology, NovaBay is targeting viral conjunctivitis caused by adenovirus such as epidemic keratoconjunctivitis (EKC) in particular. "This is an unmet medical need," said David Stroman, Ph.D., senior vice president of ophthalmology, NovaBay. "There is no approved therapy to treat adenoconjunctivitis. Viral conjunctivitis is responsible for epidemic outbreaks every few months [elsewhere] in the world." Using aganocides for EKC specifically would be a godsend for many developing countries struggling with widespread epidemics. "If you talk to our consultants in India and Brazil, they talk about 60,000-100,000 people coming into the hospitals as an epidemic happening a few times a year in major metropolitan areas," said Dr. Wilmarth. "There is a significant number of people left with corneal scarring, light sensitivity, dry eyes, and so forth. EKC in America isn't necessarily a hot topic item, but as soon as you get out of this country and into developing countries, you realize EKC is a major issue."

NovaBay is currently in Phase IIb/III clinical trials with the aganocide compounds. So far, the safety profile has been excellent and the company knows of no contraindications to its use. "There's nothing we've seen in the first two studies that would be a warning not to develop it," said Dr. Stroman. "Right now we're treating [infections] very aggressively without any safety warning flags." Depending on the tissue in question, aganocides can be up to 400-600 times gentler than, for example, povidone iodine and don't sting upon application. Furthermore, unlike antibiotics, physicians don't need to do a culture or test for sensitivities. The compound is extremely fast, killing bacteria in minutes, even in small doses. Right now, aganocides can only be used for surfaces and cavities. The hope is to develop a way to use them elsewhere in the body, but for now they are limited in their application. "This drug is not going to solve all of our problems," said Dr. Najafi. "I wish it could. But it is going to make a dent in the problems of drug-resistant antibiotics." For more information about NovaBay and the aganocide compounds, visit

Editors' note: Drs. Najafi, Stroman, and Wilmarth are affiliated with NovaBay Pharmaceuticals.

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