Digestive tract microflora liberates low molecular weight peptides with immunotriggering activity

Antibiotic digestive tract decontamination in BALB/c-mice resulted in a significant reduction of peritoneal macrophage function and lymphocyte proliferation. Considerable evidence has accumulated showing that certain species of the indigenous gastrointestinal (GI)-tract microflora, e.g. Bacteroides sp., Clostridium sp., Lactobacillus sp., and Propionibacterium sp., liberate low molecular weight peptides which are able to trigger basic immune responses. Eradication of the GI-tract microflora apparently results in a lack of peptide production correlating to immunosuppression in experimental BALB/c-mice. Substitution of peptides in GI-tract decontaminated mice reconstituted macrophage function as well as proliferation of lymphatic tissue.

Evolution of antimicrobial susceptibility in isolates of the Bacteroides fragilis group in Spain

The species included in the Bacteroides fragilis group are the most frequent nontoxigenic anaerobic bacteria pathogenic to humans. The emergence and increase of resistance to antibiotics among this group make surveillance and state-of-the-art knowledge important. We studied the evolution of resistance to antibiotics in B. fragilis group organisms isolated at the University Clinical Hospital at Salamanca, Spain, from 1975 to 1987. No resistance to imipenem, chloramphenicol, or metronidazole was detected. The frequency of resistance to clindamycin was in the range of 6%-7%. Resistance to moxalactam, cefoxitin, mezlocillin, and piperacillin has increased steadily and is currently approximately 20%-25%.

[In vitro interaction of mezlocillin with fluorouracil and mitomycin]

The interaction of mezlocillin (Baypen) with either fluorouracil (5-fluorouracil, 5-FU) or mitomycin was tested in vitro by incubating colorectal carcinoma cell line HT 29 with varying concentrations of mezlocillin, 5-FU, mitomycin and the combinations of mezlocillin + 5-FU and mezlocillin + mitomycin. Inhibition of colony growth in soft agar of treated compared with untreated cells was used as an in vitro response parameter. Concentration ranges were representative for regional chemotherapy with mitomycin or 5-FU and perioperative antibiotic therapy with mezlocillin. Mezlocillin, 5-FU and mitomycin showed dose-dependent inhibition of colony growth. Mezlocillin produced a maximal toxicity of 16% at 1000 micrograms/ml. Toxicity of 5-FU was reduced by addition of mezlocillin. The increase of colony growth after coincubation of mezlocillin with 5-FU (compared to cells treated with 5-FU alone) at a mezlocillin concentration of 10 micrograms/ml was 47% to 116%, at 100 micrograms/ml 44% to 132%, depending on the 5-FU test concentrations. The 5-FU toxicity in some instances was nearly abolished. There was no interaction between mezlocillin and mitomycin. The interference of mezlocillin with 5-FU-toxicity should be respected in case of combined perioperative antitumor and antibiotic therapy with 5-FU mezlocillin. Similar interactions with related antibiotics cannot be excluded.

Comparison of in vitro susceptibilities among gram-negative rods

The activity of mezlocillin, azlocillin and piperacillin was compared using 100 clinical isolates of gram-negative rods. Overall piperacillin had the highest activity with 72 per cent sensitive strains; mezlocillin, 66 per cent, and azlocillin, 57 per cent. In the group of Pseudomonas aeruginosa, however, mezlocillin showed distinctly lower activity than both piperacillin and azlocillin.

Dactimicin, a new aminoglycoside: in vitro activity, post-antibiotic effect and interaction with other antibiotics

The in vitro activity of the new aminoglycoside dactimicin in comparison to amikacin was tested alone and in combination with piperacillin, mezlocillin and ceftazidime against freshly isolated clinical pathogens. Dactimicin was more active than amikacin against Enterobacter cloacae, Providencia rettgeri and Salmonella spp., and less active than amikacin against Escherichia coli, Pseudomonas aeruginosa and Acinetobacter anitratus. Using the checkerboard technique, the combination of either dactimicin or amikacin with the other drugs was shown to result in synergistic interaction against most of the 23 strains tested. Dactimicin-ceftazidime and amikacin-ceftazidime were the most effective combinations, demonstrating synergism against 91% and 95% of the isolates respectively. Antagonism was not encountered. Using the time-kill method, synergism was seen in most cases, indifference rarely being seen; antagonism was not observed. Dactimicin induced a post-antibiotic effect which ranged from 1 h for Enterobacter cloacae to 2.4 h for Escherichia coli. An average post-antibiotic effect of 0.6 h was also seen when dactimicin was combined with piperacillin, mezlocillin and ceftazidime. The findings indicate that dactimicin compares favorably in vitro with amikacin and suggest that clinical trials with this drug alone or in combination are warranted.

Influence of coadministration on the pharmacokinetics of mezlocillin and cefotaxime in healthy volunteers and in patients with renal failure

The pharmacokinetic disposition of cefotaxime, desacetyl cefotaxime, and mezlocillin after the administration of each drug singly and in combination was examined in eight healthy volunteers and in five anuric patients with end-stage renal disease (ESRD). In the presence of ESRD, the total body clearance of cefotaxime decreased from 256.7 +/- 41.5 to 65.4 +/- 42.0 ml/min, and its elimination half-life (t1/2) increased from 1.1 to 3.6 hours as compared with healthy volunteers. Concomitant administration of mezlocillin in healthy volunteers decreased the total body clearance of cefotaxime by 42% and increased its steady-state volume of distribution. This reduction in clearance was reflected by a decrease in both renal and nonrenal clearances. In the presence of ESRD, coadministration of mezlocillin increased the t1/2 of cefotaxime to 5.8 hours. Desacetyl cefotaxime accumulated in ESRD with a prolongation of its elimination t1/2 to 18.7 hours from 1.7 hours in healthy volunteers. Desacetyl cefotaxime peak plasma concentrations occurred later with the combination regimen in the presence of ESRD. The clearance of mezlocillin was reduced and t1/2 prolonged in ESRD from 194.6 +/- 31.9 to 76.4 +/- 38.8 ml/min and 1.4 to 2.3 hours, respectively. Concomitant administration of cefotaxime did not alter the pharmacokinetics of mezlocillin. These data suggest that in the presence of normal renal function, lower doses of cefotaxime may be adequate to maintain similar cefotaxime plasma concentrations when mezlocillin is coadministered compared to when cefotaxime is given alone. Additional pharmacodynamic and clinical studies with this combination are warranted to further elucidate the clinical impact of this pharmacokinetic interaction.

Study of in vitro antibacterial activity of 19 antimicrobial agents against Pseudomonas aeruginosa

The in vitro antibacterial activity of 19 antimicrobial agents against 40 strains of P aeruginosa was studied. The 19 antimicrobial agents included 7 semisynthetic penicillins, 6 third generation cephalosporins, 5 aminoglycosides and 1 quinolone agent. The minimal inhibition concentrations (MIGs) were measured by the serial dilution on solid agar. Ceftazidime was the most active in 19 antimicrobial agents again P aeruginosa (MIC50: 1 microgram/ml, MIC90: 2 micrograms/ml) Amikacin and ofloxaxin followed it in activity. Acylureido-penicillins, such as azlocillin, furbenicillin and piperacillin were highly active against P aeruginosa, which could inhibit, 92.5%, 90% and 85% of these strains at a concentration of 8 micrograms/ml. Cefsulodine and cefoperazone were also active against the same strains, inhibiting 92.5% and 99% of the strains at a concentration of 8 micrograms/ml. The potency of the agents mentioned above against P. aeruginosa was similar to that of aminoglycosides. The drug susceptibility of 10 strains isolated in our hospital was compared with that of 29 strains of other hospitals in Beijing. The MICS of 5 penicillins and 3 cephalosporins against the isolates of our hospital was higher than that of other hospitals, suggesting that the susceptibility of beta-lactam antibiotics against isolates of our hospital was lower. The effects of combined use of azlocillin with oxacillin and piperacillin with ofloxacin against 4 strains of carbenicillin-resistant P aeruginosa was studied using check-board testing. The synergy and partial synergy were observed in both combinations.

Effect of antibiotics on laser-induced thrombus formation in rat mesenteric arterioles

Antibiotics were tested in a thrombosis model, in which thrombi are produced in small rat mesenteric arterioles. An interference contrast system based on a Leitz Orthoplan microscope, was used to visualize thrombus formation. Vascular lesions were produced with a Coherent CR-2 supergraphite ion laser (argon laser) in arterioles of 25-35 microns diameter. Cefmenoxim, cefotaxim (i.v.) and cephalexin orally at doses of 20 and 40 mg/kg and gentamycin 10 and 20 mg/kg (i.v.) had a marked and significant antithrombotic effect. Even more effective were cefoperazon and lamoxactam 20 and 40 mg/kg (i.v.) and tobramycin 10 and 20 mg/kg (i.v.). Azlocillin, cefoxitin, mezlocillin or spectinomycin (20 mg/kg i.v.) and penicillin or piperacillin (50 mg/kg i.v.) also showed a significant antithrombotic effect, which, however, disappeared on doubling of the applied dose.

Studies on the synergism of sulbactam and beta-lactam antibiotics under in vitro conditions and in healthy volunteers after intravenous administration. Antibacterial activity in vitro, compatibility and pharmacokinetics of the drugs in combination

Sulbactam, a new beta-lactam inhibitor, increased the in vitro activity of cefotaxime, mezlocillin and piperacillin against 803 clinical bacterial isolates. The synergism of sulbactam and these antibiotics was particular marked against 467 beta-lactamase positive strains, both aerobic and anaerobic. In the presence of sulbactam the mean minimal inhibitory concentrations (MICs) of the antibiotics against beta-lactamase positive bacteria were greatly reduced: with cefotaxime by 58%, with mezlocillin by 64% and with piperacillin by 70%. Sulbactam alone at low concentrations inhibited the growth of only a few strains (Neisseria spp., Acinetobacter spp.). The inhibitor proved to be very stable in infusion media under a variety of conditions and was compatible in vitro with 14 different beta-lactam antibiotics. The pharmacokinetics profiles of sulbactam and the antibiotics cefotaxime, mezlocillin and piperacillin were similar after infusion to healthy volunteers. The relevant pharmacokinetic parameters of the single substances were essentially unchanged when administered in combination. The general similarity between the pharmacokinetics of sulbactam and of the beta-lactam antibiotics appears to be an essential precondition for the therapeutic success of such a synergistic combination. Thus the physicochemical and pharmacological properties of sulbactam apparently permit flexible dosage in combination with different penicillins or cephalosporins and sulbactam can be administered as non-fixed combination in the clinical treatment of bacterial infections.

Intestinal microflora of BALB/c-mice and function of local immune cells

BALB/c-mice were treated for 7 days with oral nonabsorbable dosages of mezlocillin to achieve digestive tract decontamination. Such a procedure resulted in rapid eradication of most species of aerobic and anaerobic intestinal microflora. Various functions of peritoneal macrophages (e.g. chemiluminescence response, chemotactic motility, bactericidal and cytostatic ability) and lymphocyte proliferation were decreased in decontaminated animals as compared to non-treated controls.

Cefoperazone plus mezlocillin for empiric therapy of febrile cancer patients

Two dosing regimens of cefoperazone plus mezlocillin were compared in a prospective, randomized trial for therapy of febrile cancer patients. The two regimens were 5 g mezlocillin plus 2 g cefoperazone intravenously every four hours (higher dose) or 3 g mezlocillin plus 1 g cefoperazone intravenously every four hours (lower dose). Although the overall response rate was higher with the higher dose regimen (78 percent versus 66 percent, p = 0.04), the two regimens were comparable in patients with documented infections (72 percent versus 68 percent). Likewise, the two regimens were equally effective against those infections in which the pathogen could be determined (82 percent versus 82 percent). Serum bactericidal titers of at least 1:32 against a known pathogen were associated with a higher response rate than were titers of less than 1:32, but the higher dose regimen did not result in higher serum bactericidal titers. Hypoprothrombinemia was a side effect, especially with the higher dose regimen, before prophylactic vitamin K was routinely administered to patients. Since there were no major benefits with the use of the higher dose regimen of mezlocillin plus cefoperazone, the lower dose regimen is more appropriate for routine usage.

[Ciprofloxacin in combination with other antimicrobial substances]

The antibacterial activity of ciprofloxacin, either alone or in combination with azlocillin, imipenem, mezlocillin or tobramycin, was tested against enterococcus and pseudomonas species. No synergy or antagonism was found by means of the checkerboard titration method used. Subsequently, the bactericidal activity of ciprofloxacin (2 x minimal inhibitory concentration, MIC), azlocillin, imipenem, mezlocillin or tobramycin (2 x MIC) either alone or in combination (1 x MIC each of each substance) was tested against individual strains. No reduction of bactericidal activity in comparison with the effect of the single substances at higher concentration was found, even though the concentrations of each substance were halved. An antagonism is unlikely when ciprofloxacin is combined with one of the beta-lactams studied or with tobramycin. More likely is a slight synergistic effect.

Evaluation of the Cobas Bact automated system for susceptibility testing of Enterobacteriaceae, Pseudomonas aeruginosa, and Enterococcus faecalis to azlocillin, mezlocillin, and ciprofloxacin compared to NCCLS and DIN standards

The aim of automated susceptibility testing systems like the Cobas Bact is to provide the clinicians with rapid and reliable results for the care of patients and to decrease the work load in microbiological laboratories. Because data about accuracy on mezlocillin, azlocillin and ciprofloxacin were lacking, we investigated 184 bacterial strains and compared the results of the Cobas Bact susceptibility testing to standardized agar dilution and agar diffusion methods. Essential correlations for all methods compared exceeded 90% for the three chemotherapeutics and all species investigated, with the exception of Pseudomonas aeruginosa. On an average only 1.5% very major errors were observed with the several species of Enterobacteriaceae, whereas P. aeruginosa and Enterococcus faecalis were characterized by the complete absence of very major errors when Cobas Bact was correlated to NCCLS agar diffusion.

Bactericidal activity and killing rate of serum in volunteers receiving pefloxacin alone or in combination with ceftazidime, piperacillin or mezlocillin against Pseudomonas aeruginosa

The activity of the combination of pefloxacin with ceftazidime, piperacillin, or mezlocillin was compared to the activity of the same antibiotics given alone, by measurement of serum bactericidal titres and the rate of killing of ten strains of Pseudomonas aeruginosa. Three groups of five volunteers each received pefloxacin (12 mg/kg iv) with or without ceftazidime, piperacillin or mezlocillin (25 mg/kg iv). Serum samples were obtained at the end of the infusion. The mean serum concentration of pefloxacin at this time was 13.9 mg/l (3.2, S.D.). The activity of each of the three combinations was identical to the corresponding activity of the beta-lactam alone. However, the emergence of resistance to pefloxacin was prevented by ceftazidime (five out of five strains), and piperacillin (two out of five strains). We conclude that combinations of pefloxacin with beta-lactam antibiotics may not increase efficacy against P. aeruginosa.

A comparison of the in-vitro activity of seventeen antibiotics against Streptococcus faecalis

The in-vitro activity of seventeen antibiotics against 177 clinical strains of Streptococcus faecalis was evaluated. Ampicillin and mezlocillin were the most active beta-lactams tested (geometric mean MICs, 0.61 and 0.74 mg/l, respectively). Aminoglycosides showed poor activity and 22.6% of the strains were resistant to 2000 mg/l of streptomycin. No correlation was observed between MICs of gentamicin and streptomycin. Moderate activity was observed when testing norfloxacin and ciprofloxacin. Teicoplanin and co-trimoxazole were extremely active, showing geometric mean MICs of 0.59 and 0.08 mg/l respectively. All strains were susceptible to vancomycin and teicoplanin.

Antibiotic treatment, intestinal aerobic microflora and experimental sarcoma L-1 growth in Balb/c-mice

The present paper deals with the influence of a 10 days treatment with mezlocillin, piperacillin, cefotaxime, clindamycin or gentamicin on the endogenous intestinal microflora of Balb/c-mice and on the local growth of sarcoma L-1 tumor. Clindamycin and gentamicin demonstrated no influence, whereas cefotaxime and piperacillin caused the eradication of gram-negative resp. gram-positive bacteria but these antibiotics didn't produce a growth inhibition of local L-1 sarcoma tumor. The oral or parenteral application of mezlocillin (a 3 days treatment was sufficient) eradicated the complete aerobic and anaerobic intestinal microflora. This effect was significantly correlated with an increase of the cecum weight and the inhibition of local tumor growth. Possible mechanisms of these effects are discussed.