Tiamulin is a semi–synthetic analogue of pleuromutilin in which the hydroxyacetyl side chain is replaced with a larger diethylaminoethylthioacetyl moiety, providing greater hydrophobicity and an ionisable group for salt formation and greater water solubility. Tiamulin is a potent and highly selective antibiotic active against a range of Gram positive bacteria, with no cross resistance to existing antibiotic classes due to its unique mode of action. Like pleuromutilin, it inhibits protein synthesis by binding to domain V of 23S rRNA.
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