Untersuchungen zur Wirksamkeit von Cefotaxim gegen gramnegative Stäbchen in vitro

Cefoperazone versus Cefotaxime, plus Amikacin or Sisomicin, in Fever and Infection in Hematologic Granulocytopenic Patients

Forty patients with leukemia or aplastic anemia were randomized to receive one of the following antibiotic regimens at the onset of fever during granulocytopenia: cefoperazone + amikacin (regimen A), cefoperazone + sisomicin (regimen B), cefotaxime + amikacin (regimen C), cefotaxime + sisomicin (regimen D). All patients were receiving gut decontamination at the time of randomization. Patients were monitored twice weekly with swabs and cultures for bacteria and fungi. Overall, there were 56 febrile episodes: 31 were proven bacterial, 3 were probable, and 16 were of unknown origin. Response rates were comparable in all 4 treatment regimens: 90 %, 91 %, 92 % and 92 %, respectively. Three patients died of bacterial infections (2 Gram +, 1 Gram-), one patient died with probable infection, 6 febrile episodes were related to fungal infection (Candida), and 2 patients died. The mortality rate was comparable in all groups. Two patients died of renal failure. Abnormalities in liver function tests were observed, but were without consequences. There were no statistical differences in renal-hepatic toxicity in the 4 arms.

[Microbiological studies with the new penicillin BRL 17421 (temocillin)]

In vitro Evaluation of BRL 17421 (Temocillin), a New Penicillin. The in vitro antibacterial activity of BRL 17421 (temocillin), a new penicillin, was determined in quantitative serial broth dilution tests and was compared to that of mezlocillin, piperacillin, cefazolin and cefotaxime against 751 clinical isolates of the Enterobacteriaceae family. In addition, the sensitivity of 211 mezlocillin-resistant gram-negative rods to BRL 17421 was also determined. Temocillin exhibited a high level of antibacterial activity against various bacterial species of the Enterobacteriaceae family, including isolates resistant to mezlocillin. The 90% MICs against Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Enterobacter cloacae, Salmonella spp., Yersinia spp. and indole-negative and indole-positive Proteus strains ranged from 0.5 mg/l to 16 mg/l. Concentrations of 16 mg/l were required to inhibit 80% of the Serratia marcescens strains; some isolates were resistant. No significant difference between MIC and MBC values was observed.

[N-formimidoyl-thienamycin: in vitro activity in bacteria with resistance to beta-lactam antibiotics or gentamicin]

The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) of N-formimidoyl-thienamycin were determined for 25 strains each of Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens and Pseudomonas aeruginosa which were resistant to gentamicin and/or acylureido penicillins or cefotaxime, cefoperazone or moxalactam, and for 38 strains of the group D streptococci. The drug was very active against the most frequently encountered gram-negative resistant causative organisms of nosocomial infections. The MIC ranged from 0.25-1 mg/l for multiresistant Enterobacteriaceae, and from 0.5-4 mg/l for multiresistant P. aeruginosa. The group D streptococci (enterococci) showed a low MIC (median: 0.75 mg/l); the median of the MBC was greater than 64 mg/l, however.