COMPOSITIONS AND METHODS FOR TREATING, REDUCING, AMELIORATING, OR PREVENTING INFECTIONS OF THE EAR OR UPPER

RESPIRATORY TRACT

BACKGROUND OF THE INVENTION

The present invention relates to compositions and methods for treating, reducing, ameliorating, or preventing infections of the ear and upper respiratory tract. In particular, the present invention relates to such compositions comprising quinolone carboxylic acids, derivatives thereof, and therapeutic methods of using the same. More particularly, the present invention relates to such composition comprising fluoroquinolone carboxylic acids, derivatives thereof, therapeutic methods of using the same.

Bacterial pathogens continue to pose a serious threat to public health as indicated by a worldwide resurgence of bacterial diseases. Otitis and sinusitis are two very common infections that are difficult to treat for a number of reasons, including bacterial resistance to antibiotics. Such resistance may be attributed to prior widespread, and largely effective, therapeutic and prophylactic use of antibiotics, which, unfortunately, over time has also selected for resistant strains of various bacterial pathogens. Of particular concern to the public health has been the emergence and proliferation of bacterial strains that are resistant to multiple antibiotics in the current arsenal of antimicrobial agents. Such multiantibiotic-resistant ("MAR") bacterial strains include species of Gram-positive bacteria, such as, antibiotic-resistant strains of Staphylococcus aureus, Enterococcus fecalis, and Enter ococcus fecium, which, along with antibiotic-resistant Gram-negative strains of Escherichia coli, constitute the most frequent etiological agents of nosocomial (hospital-acquired) diseases, such as

septicemia, endocarditis, and infections of wounds and the urinary tract. S. aureus is currently the most frequent cause of nosocomial bacteremia and skin or wound infection. Streptococcus pneumoniae causes several serious and life-threatening diseases, including a contagious meningitis, bacteremia, and otitis media. Annual mortality from S. pneumoniae infection alone is estimated at between 3-5 million persons globally. More recently, clinical accounts of highly aggressive skin and tissue infections by "flesh- eating" strains of Group-A streptococcus bacteria, such as Streptococcus pyogenes, has heightened the concern and need for new or improved antibacterial agents.

Quinolones constitute a group of antibiotics that have been available since the early 1960s and have proved to be valuable antibacterial agents. Quinolone carboxylic acid derivatives having various chemical structures have been synthesized, developed, and marketed. Nalidixic acid (l,4-dihydro-l-ethyl-7-methyl-l,8- naphthyridin-4-one-3-carboxylic acid), the progenitor of the series, was used primarily as a urinary- tract antiseptic. Later development provided agents with broader activity, increased potency against selected pathogens and improved pharmacokinetic and pharmacodynamic properties.

From a medical utility viewpoint, the quinolones are classified as first-, second-, and third-generation compounds. First-generation compounds like piromidic acid (8-ethyl-5,8-dihydro-5-oxo-2-(l-pyrrolidinyl)pyrido(2,3-d)py rimidine-6-carboxylic acid) and pipemidic acid (8-ethyl-5,8-dihydro-5-oxo-2-(l-piperazinyl)pyrido(2,3- d)pyrimidine-6-carboxylic acid) provided coverage for Gram-negative Enter obacteriaceae. The second-generation compounds are divided into those with enhanced but predominant Gram-negative activity, against pathogens like Escheήschia

coli and Pseudomonas aeruginosa, and those with balanced broad-spectrum activity (norfloxacin, pefloxacin, enoxacin, fleroxacin, lomefloxacin, ciprofloxacin, ofloxacin, rufloxacin, nadifloxacin). Norfloxacin, ofloxacin, and ciprofloxacin have, therefore, been used mainly for treatment of diseases including urinary tract infections, gastrointestinal infections, sexually transmitted diseases and the like. Third-generation antibiotics (levofloxacin, pazufloxacin, sparfloxacin, clinafloxacin, sitafloxacin, trovafloxacin, tosufloxacin, temafloxacin, grepafloxacin, balofloxacin, moxifloxacin, gatifloxacin) are those with enhanced activity against Gram-positive cocci (notably clinafloxacin, sitafloxacin, trovafloxacin for Streptococcus pneumoniae) and, for essentially all the third-generation quinolones, activity also against Gram-negative Haemophilus influenzae and Legionella pneumophila, and against anaerobes and atypical pathogens. Levofloxacin, moxifloxacin, and gatifloxacin have, therefore, found use for community-acquired infections such as those of the upper and lower respiratory tract infections ("RTI") like pneumonia, sinusitis and pharyngitis, and for skin and soft tissue infections ("SSI") caused by Gram-positive strains of staphylococci, pneumococci, streptococci, and enterococci.

The improvements seen in most of the third-generation antibiotics in current use are generally attributed to their uniqueness in inhibiting DNA gyrase and topoisomerase IV of the bacterial targets. Three categories of quinolone inhibition have been suggested. Type I quinolones (norfloxacin, enoxacin, fleroxacin, ciprofloxacin, lomefloxacin, trovafloxacin, grepafloxacin, ofloxacin and levofloxacin) indicate a preference for topoisomerase IV inhibition. Type II quinolones (nadifloxacin and sparfloxacin) indicate a preference for DNA gyrase inhibition. Type III quinolones to which some of the third-generation quinolones belong (e.g., gatifloxacin, pazufloxacin,

moxifloxacin and clinafloxacin) display, however, a dual-targeting property, and equally influence DNA gyrase inhibition and topoisomerase IV inhibition. (M. Takei, et al., Antimicrobial Agents and Chemotherapy, Vol. 45, 3544-49 (2001)). DNA gyrase is the primary target in bacteria, and thus is explained the weaker activity in Gram-positive bacteria of the topoisomerase IV-targeting second-generation quinolones like norfloxacin, ciprofloxacin, ofloxacin, and levofloxacin. The unusual activity of nadifloxacin described in the literature, especially against Gram-positive S. aureus, now can be explained by its ability to target DNA gyrase (N. Oizumi, et al., J. Infect. Chemother., Vol. 7, 191-194 (2001)). That some third-generation quinolones are primarily capable of targeting topoisomerase IV in Gram-positive staphylococci, and DNA gyrase in Gram-positive S. pneumoniae, explains the advantages provided by the dual-targeting third-generation quinolones like moxifloxacin and gatifloxacin. However, because of continuing threat of new strains of antibiotic-resistant bacteria that may surface in the future, continued effort has been devoted to develop new broad-spectrum antibiotics.

A family of fluoroquinolones was recently developed, and some compounds of this family show good antimicrobial activity against a wide range of Gram-positive and Gram-negative bacteria. See U.S. Patents 5, 385,900; 5,447,926; 6,685,958; and 6,699,492; all of which are incorporated herein by reference in their entirety. Therefore, it is very desirable, in one aspect, to develop improved therapeutic compositions that incorporate this family of fluoroquinolones. It is also very desirable to provide novel and more effective compositions and methods for the treatment of infection of the ear and/or upper respiratory tract. In addition, it is also very desirable to provide novel

compositions and methods for the treatment, reduction, or amelioration of otitis and/or sinusitis that is caused by bacteria resistance to common antibiotics.

SUMMARY OF THE INVENTION

In general, the present invention provides pharmaceutical compositions and methods of using such compositions for the treatment, reduction, amelioration, or prevention of infection of an ear or a portion of upper respiratory tract.

In one aspect, said infection is selected from the group consisting of otitis, sinusitis, nasopharyngitis, oropharyngitis, and combinations thereof.

In another aspect, such compositions comprise at least one member of a family of fluoroquinolones that have Formula I or salts thereof,

wherein R ¹ is selected from the group consisting of hydrogen, unsubstituted lower alkyl groups, substituted lower alkyl groups, cycloalkyl groups, unsubstituted Cs-C ₂₄ aryl groups, substituted Cs-C ₂₄ aryl groups, unsubstituted Cs-C ₂₄ heteroaryl groups, substituted Cs-C ₂₄ heteroaryl groups, and groups that can be hydrolyzed in living bodies;

R ² is selected from the group consisting of hydrogen, unsubstituted amino group, and amino groups substituted with one or two lower alkyl groups; R ³ is selected from the group consisting of hydrogen, unsubstituted lower alkyl groups, substituted lower alkyl groups, cycloalkyl groups, unsubstituted lower alkoxy groups, substituted lower alkoxy groups, unsubstituted C ₅ -C ₂₄ aryl groups, substituted C ₅ -C ₂₄ aryl groups, unsubstituted C ₅ -C ₂₄ heteroaryl groups, substituted C5-C ₂₄ heteroaryl groups, unsubstituted C ₅ -C ₂₄ aryloxy groups, substituted C5-C24 aryloxy groups, unsubstituted C5-C ₂₄ heteroaryloxy groups, substituted C ₅ -C ₂₄ heteroaryloxy groups, and groups that can be hydrolyzed in living bodies; X is selected from the group consisting of halogen atoms; Y is selected from the group consisting of CH ₂ , O, S, SO, SO ₂ , and NR ⁴ , wherein R ⁴ is selected from the group consisting of hydrogen, unsubstituted lower alkyl groups, substituted lower alkyl groups, and cycloalkyl groups; and Z is selected from the group consisting of oxygen and two hydrogen atoms.

In still another aspect, a composition of the present invention comprises a single enantiomer of a compound having Formula I.

In still another aspect, a composition of the present invention comprises a member of a family of fluoroquinolones having Formula II or salts thereof,

wherein R ¹ , R ³ , X, Y, and Z have the meanings as disclosed above.

In still another aspect, the present invention provides a method for treating, reducing, ameliorating, or preventing an infection of an ear or a portion of an upper respiratory tract. The method comprises administering a composition comprising a fluroquinolone having Formula I or II to a site of infection to treat, reduce, or ameliorate said infection.

In one embodiment, the method comprises topically administering such a composition. In another embodiment, the method comprises orally administering such a composition.

In yet another aspect, said otitis is selected from the group consisting of otitis externa, otitis media, and combinations thereof.

In a further aspect, said sinusitis is selected from the group consisting of maxillary sinusitis, frontal sinusitis, ethmoid sinusitis, sphenoid sinusitis, and combinations thereof.

Other features and advantages of the present invention will become apparent from the following detailed description and claims.

DETAILED DESCRIPTION

As used herein, the term "lower alkyl" or "lower alkyl group" means a C ₁ - Ci ₅ linear- or branched-chain saturated aliphatic hydrocarbon monovalent group, which may be unsubstituted or substituted. The group may be partially or completely substituted with halogen atoms (F, Cl, Br, or I). Non-limiting examples of lower alkyl groups include methyl, ethyl, n-propyl, 1 -methylethyl(isopropyl), n-butyl, n-pentyl, 1,1- dimethylethyl (t-butyl), and the like. It may be abbreviated as "AIk".

As used herein, the term "lower alkoxy" or "lower alkoxy group" means a Ci -C is linear- or branched-chain saturated aliphatic alkoxy monovalent group, which may be unsubstituted or substituted. The group may be partially or completely substituted with halogen atoms (F, Cl, Br, or I). Non-limiting examples of lower alkoxy groups include methoxy, ethoxy, n-propoxy, 1-methylethoxy (isopropoxy), n-butoxy, n- pentoxy, t-butoxy, and the like.

The term "cycloalkyl" or "cycloalkyl group" means a stable aliphatic saturated 3- to 15-membered monocyclic or polycyclic monovalent radical consisting solely of carbon and hydrogen atoms which may comprise one or more fused or bridged ring(s), preferably a 3- to 7-membered monocyclic rings. Other exemplary embodiments of cycloalkyl groups include 7- to 10-membered bicyclic rings. Unless otherwise specified, the cycloalkyl ring may be attached at any carbon atom which results in a stable structure and, if substituted, may be substituted at any suitable carbon atom which

results in a stable structure. Exemplary cycloalkyl groups include cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, cyclooctyl, cyclononyl, cyclodecyl, norbornyl, adamantyl, tetrahydronaphthyl (tetralin), 1-decalinyl, bicyclo[2.2.2]octanyl, 1-methylcyclopropyl, 2-methylcyclopentyl, 2-methylcyclooctyl, and the like.

As used herein, the term "aryl" or "aryl group" means an aromatic carbocyclic monovalent or divalent radical. In some embodiments, the aryl group has a number of carbon atoms from 5 to 24 and has a single ring (e.g., phenyl or phenylene), multiple condensed rings (e.g., naphthyl or anthranyl), or multiple bridged rings (e.g., biphenyl). Unless otherwise specified, the aryl ring may be attached at any suitable carbon atom which results in a stable structure and, if substituted, may be substituted at any suitable carbon atom which results in a stable structure. Non-limiting examples of aryl groups include phenyl, naphthyl, anthryl, phenanthryl, indanyl, indenyl, biphenyl, and the like. It may be abbreviated as "Ar".

The term "heteroaryl" or "heteroaryl group" means a stable aromatic monocyclic or polycyclic monovalent or divalent radical, which may comprise one or more fused or bridged ring(s). In some embodiments, the heteroaryl group has 5-24 members, preferably a 5- to 7-membered monocyclic or 7- to 10-membered bicyclic radical. The heteroaryl group can have from one to four heteroatoms in the ring(s) independently selected from nitrogen, oxygen, and sulfur, wherein any sulfur heteroatoms may optionally be oxidized and any nitrogen heteroatom may optionally be oxidized or be quaternized. Unless otherwise specified, the heteroaryl ring may be attached at any suitable heteroatom or carbon atom which results in a stable structure and, if substituted, may be substituted at any suitable heteroatom or carbon atom which

results in a stable structure. Non-limiting examples of heteroaryls include furanyl, thienyl, pyrrolyl, oxazolyl, thiazolyl, imidazolyl, pyrazolyl, isoxazolyl, isothiazolyl, oxadiazolyl, triazolyl, tetrazolyl, thiadiazolyl, pyridinyl, pyridazinyl, pyrimidinyl, pyrazinyl, triazinyl, indolizinyl, azaindolizinyl, indolyl, azaindolyl, diazaindolyl, dihydroindolyl, dihydroazaindoyl, isoindolyl, azaisoindolyl, benzofuranyl, furanopyridinyl, furanopyrimidinyl, furanopyrazinyl, furanopyridazinyl, dihydrobenzofuranyl, dihydrofuranopyridinyl, dihydrofuranopyrimidinyl, benzothienyl, thienopyridinyl, thienopyrimidinyl, thienopyrazinyl, thienopyridazinyl, dihydrobenzothienyl, dihydrothienopyridinyl, dihydrothienopyrimidinyl, indazolyl, azaindazolyl, diazaindazolyl, benzimidazolyl, imidazopyridinyl, benzthiazolyl, thiazolopyridinyl, thiazolopyrimidinyl, benzoxazolyl, benzoxazinyl, benzoxazinonyl, oxazolopyridinyl, oxazolopyrimidinyl, benzisoxazolyl, purinyl, chromanyl, azachromanyl, quinolizinyl, quinolinyl, dihydroquinolinyl, tetrahydroquinolinyl, isoquinolinyl, dihydroisoquinolinyl, tetrahydroisoquinolinyl, cinnolinyl, azacinnolinyl, phthalazinyl, azaphthalazinyl, quinazolinyl, azaquinazolinyl, quinoxalinyl, azaquinoxalinyl, naphthyridinyl, dihydronaphthyridinyl, tetrahydronaphthyridinyl, pteridinyl, carbazolyl, acridinyl, phenazinyl, phenothiazinyl, and phenoxazinyl, and the like.

In general, the present invention provides a pharmaceutical composition and a method for treating, reducing, or ameliorating an infection of an ear or a portion of an upper respiratory tract.

In one aspect, said infection is selected from the group consisting of otitis, sinusitis, nasopharyngitis, oropharyngitis, and combinations thereof.

In another aspect, a composition of the present invention comprises at least one member of a family of fluoroquinolones that have Formula I or salts thereof,

wherein R is selected from the group consisting of hydrogen, unsubstituted lower alkyl groups, substituted lower alkyl groups, cycloalkyl groups, unsubstituted Cs-C ₂₄ aryl groups, substituted Cs-C ₂₄ aryl groups, unsubstituted C ₅ -C ₂₄ heteroaryl groups, substituted C ₅ -C ₂₄ heteroaryl groups, and groups that can be hydrolyzed in living bodies; R ² is selected from the group consisting of hydrogen, unsubstituted amino group, and amino groups substituted with one or two lower alkyl groups; R is selected from the group consisting of hydrogen, unsubstituted lower alkyl groups, substituted lower alkyl groups, cycloalkyl groups, unsubstituted lower alkoxy groups, substituted lower alkoxy groups, unsubstituted C ₅ -C ₂₄ aryl groups, substituted C ₅ -C ₂₄ aryl groups, unsubstituted C ₅ -C ₂₄ heteroaryl groups, substituted C ₅ -C ₂₄ heteroaryl groups, unsubstituted C ₅ -C ₂₄ aryloxy groups, substituted C ₅ -C ₂₄ aryloxy groups, unsubstituted C ₅ -C ₂₄ heteroaryloxy groups, substituted C ₅ -C ₂₄ heteroaryloxy groups, and groups that can be hydrolyzed in living bodies; X is selected from the group consisting of halogen atoms; Y is selected from the group consisting of CH ₂ , O, S, SO, SO ₂ , and NR ⁴ , wherein R ⁴ is selected from the group consisting of hydrogen, unsubstituted lower alkyl groups, substituted lower

alkyl groups, and cycloalkyl groups; and Z is selected from the group consisting of oxygen and two hydrogen atoms..

In another aspect, a composition of the present invention further comprises a pharmaceutically acceptable carrier.

In one aspect, R ¹ is selected from the group consisting of hydrogen, Ci -C ₅ (or alternatively, C ₁ -C ₃ ) substituted and unsubstituted alkyl groups, C ₃ -C ₁₀ (or alternatively, C ₃ -C5) cycloalkyl groups, Cs-Ci ₄ (or alternatively, C _O -CH, or C5-Q ₀ , or C ₆ - C ₁₀ ) substituted and unsubstituted aryl groups, C5-C ₁ 4 (or alternatively, C ₆ -Ci ₄ , or C ₅ -C ₁₀ , or Cή-Cio) substituted and unsubstituted heteroaryl groups, and groups that can be hydrolyzed in living bodies. In one embodiment, R ¹ is selected from the group consisting of C ₁ -C ₅ (or alternatively, C ₁ -C ₃ ) substituted and unsubstituted alkyl groups.

In another aspect, R ² is selected from the group consisting of unsubstituted amino group and amino groups substituted with one or two C ₁ -C ₅ (or alternatively, Ci- C ₃ ) alkyl groups.

In still another aspect, R ³ is selected from the group consisting of hydrogen, C ₁ -C ₅ (or alternatively, C1-C3) substituted and unsubstituted alkyl groups, C ₃ -C ₁₀ (or alternatively, C ₃ -C ₅ ) cycloalkyl groups, C ₁ -C ₅ (or alternatively, C ₁ -C ₃ ) substituted and unsubstituted alkoxy groups, C5-C14 (or alternatively, C _O -C _I4 , or C5-C ₁ 0, or C ₅ -C ₁₀ ) substituted and unsubstituted aryl groups, C5-Q4 (or alternatively, C ₆ -Ci ₄ , or C ₅ -C ₁₀ , or C ₆ -C ₁ 0) substituted and unsubstituted heteroaryl groups, and C ₅ -C ₁₄ (or alternatively, Ce- C ₁₄ , or C5-C10, or C ₆ -C 10) substituted and unsubstituted aryloxy groups. In one

embodiment, R ³ is selected from the group consisting of C3-C10 (or alternatively, C ₃ -C5) cycloalkyl groups.

In yet another aspect, X is selected from the group consisting of Cl, F, and Br. In one embodiment, X is Cl. In another embodiment, X is F.

In a further aspect, Y is CH ₂ . In still another aspect, Z comprises two hydrogen atoms.

Some non-limiting members of the family of compounds having Formula I are shown in Table 1. Other compounds of the family not listed in Table 1 are also suitable in selected situations.

Table 1

Some Selected Fluoroquinolones

embodiment, the fluoroquinolone carboxylic acid has a Formula III.

In still another aspect, a composition of the present invention comprises an enantiomer of one of the compounds having Formula I, II, or III.

In still another aspect, a composition of the present invention comprises a mixture of enantiomers of one of the compounds having Formula I, II, or III.

A fluoroquinolone compound disclosed herein can be formulated into a pharmaceutical composition for topical, oral, or systemic administration for the treatment, reduction, amelioration, or prevention of infection of an ear or a portion of the upper respiratory tract. Such a composition comprises a fluoroquinolone compound and a pharmaceutically acceptable carrier for the administration, as can be determined by a person having skill in the art of pharmaceutical formulation for the applications disclosed above. For example, various pharmaceutically acceptable carriers known in the art can be used to formulate a solution, suspension, dispersion, ointment, gel, capsule, or tablet. A fluoroquinolone compound disclosed herein is particularly suitable for a treatment, reduction, amelioration, or prevention of infections of the ear or a portion of the upper respiratory tract caused by bacteria, including, but not being limited to, those bacteria disclosed above. In one embodiment, such a fluroquinolone is formulated into a solution, ointment, suspension, dispersion, or gel.

In one embodiment, a topical composition of the present invention comprises an aqueous solution or suspension. Typically, purified or deionized water is used. The pH of the composition is adjusted by adding any physiologically and otically acceptable pH adjusting acids, bases, or buffers to within the range of about 3 to about 8.5 (or alternatively, or from about 4 to about 7.5, or from about 4 to about 6.5, or from about 5 to about 6.5). Examples of acids include acetic, boric, citric, lactic, phosphoric,

hydrochloric, and the like, and examples of bases include sodium hydroxide, sodium phosphate, sodium borate, sodium citrate, sodium acetate, sodium lactate, tromethamine, THAM (trishydroxymethylaminomethane), and the like. Salts and buffers include citrate/dextrose, sodium bicarbonate, ammonium chloride and mixtures of the aforementioned acids and bases. pH buffers are introduced into the composition to maintain a stable pH and to improve product tolerance by the user. In some embodiments, the pH is in the range from about 4 to about 7.5. Biological buffers for various pHs are available, for example, from Sigma- Aldrich. A composition of the present invention can have a viscosity in the range from about 10 to 100,000 centipoise ("cp") or mPa.s. Alternatively, a composition of the present invention can have a viscosity in the range from about 10 to 10,000 cp; or from about 10 to 1,000 cp; or from about 10 to 100 cp; or from about 100 to 1,000 cp; or from about 100 to 10,000 cp; or from about 100 to 50,000 cp; or from about 1,000 to 10,000 cp; or from about 1,000 to 50,000 cp.

In another embodiment, a topical composition of the present invention comprises an ointment, emulsion or cream (such as oil-in-water emulsion), or gel.

Ointments generally are prepared using either (1) an oleaginous base; i.e., one consisting of fixed oils or hydrocarbons, such as white petrolatum or mineral oil, or (2) an absorbent base; i.e., one consisting of an anhydrous substance or substances which can absorb water, for example anhydrous lanolin. Customarily, following formation of the base, whether oleaginous or absorbent, the active ingredient (compound) is added to an amount affording the desired concentration.

Creams are oil/water emulsions. They consist of an oil phase (internal phase), comprising typically fixed oils, hydrocarbons, and the like, such as waxes, petrolatum, mineral oil, and the like, and an aqueous phase (continuous phase), comprising water and any water-soluble substances, such as added salts. The two phases are stabilized by use of an emulsifying agent, for example, a surface active agent, such as sodium lauryl sulfate, hydrophilic colloids, such as acacia colloidal clays, veegum, and the like. Upon formation of the emulsion, the active ingredient (compound) customarily is added in an amount to achieve the desired concentration.

Gels comprise a base selected from an oleaginous base, water, or an emulsion-suspension base. To the base is added a gelling agent which forms a matrix in the base, increasing its viscosity. Examples of gelling agents are hydroxypropyl cellulose, acrylic acid polymers, and the like. Customarily, the active ingredient (compound) is added to the formulation at the desired concentration at a point preceding addition of the gelling agent.

The amount of a fluoroquinolone compound herein disclosed that is incorporated into a formulation of the present invention is not critical; the concentration should be within a range sufficient to permit ready application of the formulation to the affected tissue area in an amount which will deliver the desired amount of compound to the desired treatment site and to provide the desired therapeutic effect. In some embodiments of the present invention, compositions comprise a fluoroquinolone in a concentration in a range from about 0.0001% to 10% by weight (or alternatively, from about 0.001% to about 5%, or from about 0.01% to about 5%, or from about 0.01% to

about 2%, or from about 0.01% to about 1%, or from about 0.01% to about 0.7%, by weight).

Moreover, a topical composition of the present invention can contain one or more of the following: surfactants, adjuvants including additional medicaments, antioxidants, tonicity adjusters, preservatives, viscosity modifiers, and the like.

Preservatives may be used to inhibit microbial contamination of the product when it is dispensed in single or multidose containers, and can include, but are not limited to: quaternary ammonium derivatives, (benzalkonium chloride, benzylammonium chloride, cetylmethyl ammonium bromide, cetylpyridinium chloride), benzethonium chloride, organomercury compounds (Thimerosal, phenylmercury acetate, phenylmercury nitrate), methyl and propyl p-hydroxy-benzoates, betaphenylethyl alcohol, benzyl alcohol, phenylethyl alcohol, phenoxyethanol, biguanides (e.g., alexidine, PHMB), and mixtures thereof. These compounds are used at effective concentrations, typically from about 0.005% to about 5% (by weight), depending on the preservative or preservatives selected. The amount of the preservative used should be enough so that the solution is physically stable; i.e., a precipitate is not formed, and antibacterially effective.

The solubility of the components, including a fluoroquinolone having Formula I, II, or III, of the present compositions may be enhanced by a surfactant or other appropriate co-solvent in the composition or complexing agents such as cyclodextrins (hydroxypropyl, hydroxyethyl, glucosyl, maltosyl and maltotriosyl derivatives of α-, β-, and γ-cyclodextrin), EDTA, citrate buffer, and succinate buffer. In one embodiment, the composition comprises 0.1% to 20% hydroxypropyl- β-

cyclodextrin; alternatively, 1% to 15% (or 2% to 10%) hydroxypropyl- β-cyclodextrin. Co-solvents include polysorbates (for example, polysorbate 20, 60, and 80), polyoxyethylene/polyoxypropylene surfactants (e.g., Pluronic® F68, F84, F127, and P 103), cyclodextrin, fatty-acid triglycerides, glycerol, polyethylene glycol, other solubility agents such as Octoxynol 40 and Tyloxapol, or other agents known to those skilled in the art and mixtures thereof. The amount of solubility enhancer used will depend on the amount of fluoroquinolone in the composition, with more solubility enhancer used for greater amounts of fluoroquinlones. Typically, solubility enhancers are employed at a level of from 0.01% to 20% (alternatively, 0.1% to 5%, or 0.1% to 2%) by weight depending on the ingredient.

The use of viscosity enhancing agents to provide the compositions of the invention with viscosities greater than the viscosity of simple aqueous solutions may be desirable to increase absorption of the active compounds by the target tissues or to increase the retention time in the ear. Such viscosity enhancing agents include, for example, polyvinyl alcohol, polyvinyl pyrrolidone, methyl cellulose, hydroxypropylmethyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose, hydroxypropyl cellulose or other agents know to those skilled in the art. Such agents are typically employed at a level of from 0.01% to 10% (alternatively, 0.1% to 5%, or 0.1% to 2%) by weight.

Suitable surfactants include polyvinyl pyrolidone, polyvinyl alcholol, polyethylene glycol, ethylene glycol, and propylene glycol. Other surfactants are polysorbates (such as polysorbate 80 (polyoxyethylene sorbitan monooleate), polysorbate 60 (polyoxyethylene sorbitan monostearate), polysorbate 20

(polyoxyethylene sorbitan monolaurate), commonly known by their trade names of Tween® 80, Tween® 60, Tween® 20), poloxamers (synthetic block polymers of ethylene oxide and propylene oxide, such as those commonly known by their trade names of Pluronic®; e.g., Pluronic® F127 or Pluronic® F108) ), or poloxamines (synthetic block polymers of ethylene oxide and propylene oxide attached to ethylene diamine, such as those commonly known by their trade names of Tetronic®; e.g., Tetronic® 1508 or Tetronic® 908, etc., other nonionic surfactants such as Brij®, Myrj®, and long chain fatty alcohols (i.e., oleyl alcohol, stearyl alcohol, myristyl alcohol, docosohexanoyl alcohol, etc.) with carbon chains having about 12 or more carbon atoms (e.g., such as from about 12 to about 24 carbon atoms). The surfactant helps a topical formulation to spread on the surface of narrow passages.

It is often that an infection is followed by inflammation. Therefore, in another aspect, a composition of the present invention further comprises an anti- inflammatory agent. Anti-inflammatory agents include the well-known glucocorticosteroids and the non-steroidal anti-inflammatory drugs ("NSAIDs").

Non-limiting examples of the glucocorticosteroids are: 21- acetoxypregnenolone, alclometasone, algestone, amcinonide, beclomethasone, betamethasone, budesonide, chloroprednisone, clobetasol, clobetasone, clocortolone, cloprednol, corticosterone, cortisone, cortivazol, deflazacort, desonide, desoximetasone, dexamethasone, diflorasone, diflucortolone, difluprednate, enoxolone, fluazacort, flucloronide, flumethasone, flunisolide, fluocinolone acetonide, fluocinonide, fluocortin butyl, fluocortolone, fluorometholone, fluperolone acetate, fluprednidene acetate, fluprednisolone, flurandrenolide, fluticasone propionate, formocortal, halcinonide,

halobetasol propionate, halometasone, halopredone acetate, hydrocortarnate, hydrocortisone, loteprednol etabonate, mazipredone, medrysone, meprednisone, methylprednisolone, mometasone furoate, paramethasone, prednicarbate, prednisolone, prednisolone 25-diethylamino-acetate, prednisolone sodium phosphate, prednisone, prednival, prednylidene, rimexolone, tixocortol, triamcinolone, triamcinolone acetonide, triamcinolone benetonide, triamcinolone hexacetonide, their physiologically acceptable salts, combinations thereof, and mixtures thereof.

The preferred glucocorticoids for otic use include dexamethasone, loteprednol, rimexolone, prednisolone, fluorometholone, hydrocortisone, and their derivatives. The preferred glucocorticoids for nasal use include mometasone, fluticasone, beclomethasone, flunisolide, triamcinolone, budesonide, and their derivatives.

Non-limiting examples of the NSAIDs are: aminoarylcarboxylic acid derivatives (e.g., enfenamic acid, etofenamate, flufenamic acid, isonixin, meclofenamic acid, mefenamic acid, niflumic acid, tamiflumate, terofenamate, tolfenamic acid), arylacetic acid derivatives (e.g., aceclofenac, acemetacin, alclofenac, amfenac, amtolmetin guacil, bromfenac, bufexamac, cinmetacin, clopirac, diclofenac sodium, etodolac, felbinac, fenclozic acid, fentiazac, glucametacin, ibufenac, indomethacin, isofezolac, isoxepac, lonazolac, metiazinic acid, mofezolac, oxametacine, pirazolac, proglumetacin, sulindac, tiaramide, tolmetin, tropesin, zomepirac), arylbutyric acid derivatives (e.g., bumadizon, butibufen, fenbufen, xenbucin), arylcarboxylic acids (e.g., clidanac, ketorolac, tinoridine), arylpropionic acid derivatives (e.g., ahninoprofen, benoxaprofen, bermoprofen, bucloxic acid, carprofen, fenoprofen, flunoxaprofen,

flurbiprofen, ibuprofen, ibuproxam, indoprofen, ketoprofen, loxoprofen, naproxen, oxaprozin, piketoprolen, pirprofen, pranoprofen, protizinic acid, suprofen, tiaprofenic acid, ximoprofen, zaltoprofen), pyrazoles (e.g., difenamizole, epirizole), pyrazolones (e.g., apazone, benzpiperylon, feprazone, mofebutazone, morazone, oxyphenbutazone, phenylbutazone, pipebuzone, propyphenazone, ramifenazone, suxibuzone, thiazolinobutazone), salicylic acid derivatives (e.g., acetaminosalol, aspirin, benorylate, bromosaligenin, calcium acetylsalicylate, diflunisal, etersalate, fendosal, gentisic acid, glycol salicylate, imidazole salicylate, lysine acetylsalicylate, mesalamine, morpholine salicylate, 1-naphthyl salicylate, olsalazine, parsalmide, phenyl acetylsalicylate, phenyl salicylate, salacetamide, salicylamide o-acetic acid, salicylsulfuric acid, salsalate, sulfasalazine), thiazinecarboxamides (e.g., ampiroxicam, droxicam, isoxicam, lornoxicam, piroxicam, tenoxicam), ε-acetamidocaproic acid, S-(5'-adenosyl)-L- methionine, 3-amino-4-hydroxybutyric acid, amixetrine, bendazac, benzydamine, α- bisabolol, bucolome, difenpiramide, ditazol, emorfazone, fepradinol, guaiazulene, nabumetone, nimesulide, oxaceprol, paranyline, perisoxal, proquazone, superoxide dismutase, tenidap, zileuton, their physiologically acceptable salts, combinations thereof, and mixtures thereof.

Other non-steroidal anti-inflammatory agents include the cyclooxygenase type II selective inhibitors, such as Celecoxib, and etodolac; PAF antagonists, such as apafant, bepafant, minopafant, nupafant, and modipafant; PDE IV inhibitors, such as ariflo, torbafylline, rolipram, filaminast, piclamilast, cipamfylline, and roflumilast; inhibitors of cytokine production, such as inhibitors of the NF-κB transcription factor; or other anti-inflammatory agents known to those skilled in the art.

The concentrations of the anti-inflammatory agents contained in the compositions of the present invention will vary based on the agent or agents selected and the type of inflammation being treated. The concentrations will be sufficient to reduce inflammation in the targeted otic or upper respiratory tract tissues following topical application of the compositions to those tissues. Such concentrations are typically in the range from about 0.0001 to about 3% by weight (or alternatively, from about 0.01 to about 2%, or from about 0.05% to about 1%, by weight).

Bacterial pathogens that have been isolated from cases of ear infection include Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyrogenes, Streptococcus faecalis, Haemophilus influenzae, Moraxella catarahalis, Escherichia coli, Proteus species, Klebsiella species, and Enterococcus species. Several of these species from the isolates have been found to be resistant to a number of antimicrobial drugs. For example, a published study of antimicrobial -resistant pathogens in middle-ear fluid of children with acute otitis media shows that thirty percent of the S. pneumoniae isolates were intermediately or fully resistant, and eight percent fully resistant, to penicillin; ten percent of the isolates were resistant to amoxicillin or amoxicillin-clavulanate. M.R. Jacobs et al., Antimicrobial Agents and Chemotherapy, Vol. 42, No. 3, 589 (1998). The same study shows that thirty percent of H. influenzae isolates produced β-lactamase, and thus, were expected to be resistant to penicillin.

Bacterial pathogens that have been isolated from cases of upper respiratory infection include Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus

pneumoniae, Streptococcus pyrogenes, Haemophilus influenzae, Peptostreptococcus species, and Bacteroides species.

Anti-bacterial activity of the compound having Formula III was tested against several Gram-negative reference bacteria strains and compared to the antibacterial activity of three commercially available antibiotics (nadifloxacin, ofloxacin, and sparfloxacin). The results are shown in Table 2 as MIC ₉₀ values (minimum concentration of the active compound required to inhibit ninety percent of the growth of a specified pathogen, in μg/ml).

Table 2

Comparison of In vitro Anti-bacterial Activity of Compound Having Formula III, Nadifloxacin, Ofloxacin, and Sparfloxacin Against Gram-negative Bacteria

Anti-bacterial activity of the compound having Formula III was tested against several Gram-positive reference bacteria strains and compared to the antibacterial activity of three commercially available antibiotics (nadifloxacin, ofloxacin, and sparfloxacin). The results are shown in Table 3 as MIC ₉₀ values.

Table 3

Comparison of In vitro Anti-bacterial Activity of Compound Having Formula III, Nadifloxacin, Ofloxacin, and Sparfloxacin Against Gram-positive Bacteria

Anti-bacterial activity of the compound having Formula III was tested against some methicillin-resistant Staphylococcus aureus bacteria strains and compared

to the anti-bacterial activity of three commercially available antibiotics (nadifloxacin, ofloxacin, and sparfloxacin). The results are shown in Table 4 as MIC ₉₀ values.

Table 4

Comparison of In vitro Anti-bacterial Activity of Compound Having Formula III, Nadifloxacin, Ofloxacin, and Sparfloxacin Against Methicillin-resistant Staphylococcus aureus Isolates

Anti-bacterial activity of the compound having Formula III was tested against selected anaerobic reference bacteria and compared to the anti-bacterial activity of three commercially available antibiotics (nadifloxacin, ofloxacin, and sparfloxacin). The results are shown in Table 5 as MIC ₉₀ values.

Table 5

Comparison of In vitro Anti-bacterial Activity of Compound Having Formula III, Nadifloxacin, Ofloxacin, and Sparfloxacin Against Anaerobic Bacteria

Anti-bacterial activity of the compound having Formula III was tested against some ophthalmologic clinical bacteria isolates and compared to the anti-bacterial activity of three commercially available antibiotics (nadifloxacin, ofloxacin, and ciprofloxacin). As disclosed above, most of these bacteria strains are also relevant to infections of the ear and upper respiratory tract. The results are shown in Table 6 as MIC90 values.

Table 6

Comparison of In vitro Anti-bacterial Activity of Compound Having Formula III, Nadifloxacin, Ofloxacin, and Ciprofloxacin Against Some Clinical Bacteria Isolates

The results show that the compound having Formula III is effective against bacteria, including some antibiotic-resistant strains, which have been found in cases of infection of the ear and upper respiratory tract. Although the applicants do not wish to be bound by any particular theory, they believe that the unique moieties on the fluoroquinolones disclosed herein provide their advantageous antibacterial property and are effective for the treatment, reduction, amelioration, or prevention of infection of the ear, including otitis externa and otitis media, and infection of the upper respiratory tract, including sinusitis, nasopharyngitis, and oropharyngitis.

In another aspect, a composition of the present invention (especially one having low viscosity) is useful to treat, reduce, ameliorate, or prevent otitis media in patients with tympanic tubes.

The following examples are provided to further illustrate non-limiting compositions of the present invention, and methods of preparing such composition, for the treatment, reduction, amelioration, or prevention of infection of the ear and/or upper respiratory tract. EXAMPLE 1 : Otic or Nasal Solution

An appropriate proportion (shown in the above table) of Pluronic® F 127 is added to phosphate buffer in a stainless steel jacketed vessel equipped with a stirring mechanism. An appropriate amount of BAK is added to the buffer solution while mixing three to ten minutes. The mixture may be heated up to 75 ⁰ C. Then, an appropriate amount of the compound having Formula III is added to the contents of the vessel over a period of three to five minutes while mixing continues until the compound is completely dissolved. EDTA and NaCl are then added to the mixture while mixing continues for five more minutes. To a second vessel containing an appropriate amount of distilled water, also equipped with a stirring mechanism, heated to about 75° C, an appropriate amount of HPMC is added, over a period of three to five minutes to form a uniform dispersion. Polysorbate 60 and cetyl stearyl alcohol are added to the mixture in the second vessel. The contents of the second vessel are cooled to about room temperature and then added to the mixture in the first vessel. The resulting mixture is cooled to 25 to 30° C, if it is not already in this temperature range. The final composition is packaged in appropriate containers.

EXAMPLE 2: Otic or Nasal Solution

A procedure similar to that of Example 1 is used to produce this solution.

EXAMPLE 3: Otic or Nasal Solution

A procedure similar to that of Example 1 is used to produce this solution having the following composition.

EXAMPLE 4: Otic or Nasal Solution

A procedure similar to that of Example 1 is used to produce this solution having the following composition.

EXAMPLE 5: Otic or Nasal Suspension

A procedure similar to that of Example 1 is used to produce this suspension having the following composition.

EXAMPLE 6: Otic or Nasal Emulsion

A modification of the procedure of Example 1 is used to produce this emulsion having the composition shown in the table immediately below.

Polysorbate 60 (Tween 60) is added to water in a first sterilized stainless steel jacketed vessel, equipped with a stirring mechanism, at a temperature of 50° C to 60° C in amounts corresponding the proportions shown in the table below. The resulting aqueous solution is heated to 61° C to 75° C. At a temperature of 66° C, benzyl alcohol (a preservative) is added to the aqueous solution while mixing three to ten minutes. At a temperature of 75° C, appropriate amounts of the compound having Formula III and

loteprednole etabonate are added to Mygliol oil in a second sterilized vessel, also equipped with a stirring mechanism, over a period of three to five minutes while stirring continues. Sorbitan monostearate and cetyl stearyl alcohol are added to the oil mixture. The resulting oil mixture is heated to a temperature in the range from 62° C to 75° C. The oil mixture is then added with vigorous mixing to the aqueous solution in the first vessel at a temperature of 66° C over a period of three to five minutes. Sodium sulfate and sulfuric acid and/or sodium hydroxide are added to the mixture to adjust pH to 5.5. The resulting composition is cooled to 35° C to 45° C and homogenized by mixing with a high shear emulsifier or running through a homogenizer. The composition is further cooled to 25° C to 30° C. The final composition is packaged in appropriate containers.

Typically, the oil used in an emulsion is a non-irritating emollient oil. Illustrative but non-limiting examples thereof include a mineral oil, vegetable oil, and a reformed vegetable oil of known composition. More specific but non-limiting examples of the oil can be selected from the group consisting of peanut oil, sesame seed oil,

cottonseed oil, and a medium chain (C(, to Ci ₂ ) triglycerides (e.g., Miglyol Neutral Oils 810, 812, 818, 829, 840, etc., available from HuIs America Inc.). Typical emulsifiers employed can be selected from the group consisting of sorbitan monostearate and Tween 60 (also known as Polysorbate 60). Preferably, the emulsifiers are nonionic. The emulsifiers can be employed in an amount of 1.5 to 6.5% by weight of the composition, and preferably, 3 to 5% by weight of the composition. The hydrophobic phase of the emulsion can be in an amount of 15 to 25% by weight of the composition, and preferably, 18 to 22% by weight of the composition.

EXAMPLE 7: Otic or Nasal Emulsion

A procedure similar to that of Example 6 is used to produce this emulsion having the following composition.

EXAMPLE 8: Otic or Nasal Ointment

A procedure similar to that of Example 1 is used to produce this ointment having the following composition.

EXAMPLE 9: Otic or Nasal Ointment

A procedure similar to that of Example 1 is used to produce this ointment having the following composition.

The present invention also provides a method for treating, reducing, ameliorating, or preventing infection of the ear or upper respiratory tract. In one aspect, the method comprises administering one or more drops of a composition of the present invention to the ear canal, nasal cavity, or back of the throat of a subject who has indication of infection or whose risk of infection is indicated. A composition of the present invention can also be formulated into a spray, which can be administered into the otic or nasal cavity of such a subject.

While specific embodiments of the present invention have been described in the foregoing, it will be appreciated by those skilled in the art that many equivalents, modifications, substitutions, and variations may be made thereto without departing from the spirit and scope of the invention as defined in the appended claims.