Pleuromutilin is a natural product of the fungi Pleurotus mutilus (now called Clitopilus scyphoides) that inhibits bacterial protein synthesis by binding to the peptidyl transferase site on 23S RNA of the 50S ribosome. Many analogs have been made to enhance activity and bioavailability as this molecule is metabolized extensively. The structure consists of a common tricyclic mutilin core, a C21 keto group, essential for antimicrobial activity, and various diverse chemical extensions at C14.

During the early 1980s, extensive effort was devoted to formulate azamulin [27] but because of potent inhibition of cytochrome P450, its development was subsequently discontinued.

Another member of this class, retapamulin, was approved by the FDA in 2006 for topical use to treat impetigo.

Another pleuoromutilin, tiamulin, has been used as a veterinary drug in Europe and Canada.

https://www.sciencedirect.com/science/article/pii/S0006295216303082

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