Ramoplanin is a glycolipodepsipeptide antibiotic obtained from the fermentation of Actinoplanes sp. ATCC 33076 that exhibits activity against clinically important multi-drug-resistant, Gram-positive pathogens including vancomycin-resistant Enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-intermediate resistant Clostridium difficile. Ramoplanin was first isolated as a complex of three closely related components A1, A2, and A3. Preclinical studies have also demonstrated that ramoplanin exerts a rapid bactericidal effect on S. aureus biofilms and that a clinical vancomycin-resistant S. aureus strain containing the vanA gene was susceptible to ramoplanin. Ramoplanin blocks bacterial cell wall biosynthesis by interfering with peptidoglycan production. Ramoplanin inhibits the N-acetylglucosaminyltransferase-catalysed conversion of lipid intermediate I to lipid intermediate II, a step that occurs before the transglycosylation and transpeptidation reactions. Ramoplanin’s mechanism of action is distinct from that of glycopeptides. Unlike glycopeptides, ramoplanin does not complex with the D-Ala–D-Ala sequence of cell wall precursors. Ramoplanin is being developed for the targeted prophylaxis of recently treated patients with C. difficile infection (CDI) at high risk for infection relapse. Twelve Phase I studies, two Phase II studies (one in CDI and one in VRE) as well as one Phase III study (in VRE) have been conducted

Kanamycin (a mixture of kanamycin A, B and C) is an aminoglycoside bacteriocidal antibiotic, available in oral, intravenous, and intramuscular forms, and used to treat a wide variety of infections. It is effective against Gram-negative bacteria and certain Gram-positive bacteria. Aminoglycosides work by binding to the bacterial 30S ribosomal subunit, causing misreading of t-RNA, leaving the bacterium unable to synthesize proteins vital to its growth. Serious side effects include tinnitus or loss of hearing, toxicity to kidneys, and allergic reactions to the drug. Mixing of an aminoglycoside with beta-lactam-type antibiotics (penicillins or cephalosporins) may result in a significant mutual inactivation. Even when an aminoglycoside and a penicillin-type drug are administered separately by different routes, a reduction in aminoglycoside serum half-life or serum levels has been reported in patients with impaired renal function and in some patients with normal renal function.

Butirosin is water-soluble aminoglycosidic antibiotic complex which is active against both Gram-positive and Gram-negative bacteria. Butirosin is less toxic than neomycin and shows a good antibacterial activity, including Pseudomonas aeruginosa, which is resistant to neomycin, ribostamycin and kanamycin.