1
|
Memar MY, Adibkia K, Farajnia S, Samadi Kafil H, Khalili Y, Azargun R, Ghotaslou R. In-vitro Effect of Imipenem, Fosfomycin, Colistin, and Gentamicin Combination against Carbapenem-resistant and Biofilm-forming Pseudomonas aeruginosa Isolated from Burn Patients. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 20:286-296. [PMID: 34567162 PMCID: PMC8457740 DOI: 10.22037/ijpr.2020.111824.13380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate in-vitro antibacterial and antibiofilm effect of colistin, imipenem, gentamicin, and fosfomycin alone and the various combinations against carbapenem-resistant Pseudomonas aeruginosa (P. aeruginosa). Eight carbapenem-resistant and biofilm-forming P. aeruginosa isolates from burn patients were collected. The mechanisms of resistance to carbapenem were determined by the phenotypic, PCR, and Real-Time PCR assays. The minimum inhibitory concentration (MIC) of antimicrobial agents was determined by the broth micro dilution. To detect any inhibitory effect of antibiotics against the biofilm, the biofilm inhibitory concentration was determined. To detect synergetic effects of the combinations of antibiotics, the checkerboard assay and the fractional inhibitory concentration (FIC) were used. The highest synergic effect was observed in colistin/fosfomycin and gentamicin/fosfomycin (5 of 8 isolates), and the lowest synergic effect was found in gentamicin/imipenem and colistin/gentamicin (1 of 8 isolates). Colistin/fosfomycin, imipenem/fosfomycin, colistin/imipenem, gentamicin/fosfomycin, and gentamicin/imipenem were shown synergic effect for 3, 2, 2, 2 and 1 isolates, respectively. The combination of antibiotics had different effects on biofilm and planktonic forms of P. aeruginosa. Therefore, a separate determination of inhibitory effects of the antibiotic in the combination is necessary. Fosfomycin/colistin and fosfomycin/gentamicin were more effective against planktonic form and fosfomycin/colistin against biofilm forms.
Collapse
Affiliation(s)
- Mohammad Yousef Memar
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Iran
| | - Khosro Adibkia
- Research Center for Pharmaceutical Nanotechnology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Safar Farajnia
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Samadi Kafil
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Iran.,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Younes Khalili
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Robab Azargun
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ghotaslou
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Iran
| |
Collapse
|
2
|
In vitro antimicrobial activity of imipenem plus amikacin or polymyxin B against carbapenem-resistant Pseudomonas aeruginosa isolates. Diagn Microbiol Infect Dis 2018; 92:152-154. [DOI: 10.1016/j.diagmicrobio.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/17/2018] [Accepted: 05/04/2018] [Indexed: 11/21/2022]
|
3
|
El-Kosasy AM, Abdel-Aziz O, Magdy N, El Zahar NM. Spectrophotometric and chemometric methods for determination of imipenem, ciprofloxacin hydrochloride, dexamethasone sodium phosphate, paracetamol and cilastatin sodium in human urine. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2016; 157:26-33. [PMID: 26709018 DOI: 10.1016/j.saa.2015.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/30/2015] [Accepted: 12/11/2015] [Indexed: 06/05/2023]
Abstract
New accurate, sensitive and selective spectrophotometric and chemometric methods were developed and subsequently validated for determination of Imipenem (IMP), ciprofloxacin hydrochloride (CIPRO), dexamethasone sodium phosphate (DEX), paracetamol (PAR) and cilastatin sodium (CIL) in human urine. These methods include a new derivative ratio method, namely extended derivative ratio (EDR), principal component regression (PCR) and partial least-squares (PLS) methods. A novel EDR method was developed for the determination of these drugs, where each component in the mixture was determined by using a mixture of the other four components as divisor. Peak amplitudes were recorded at 293.0 nm, 284.0 nm, 276.0 nm, 257.0 nm and 221.0 nm within linear concentration ranges 3.00-45.00, 1.00-15.00, 4.00-40.00, 1.50-25.00 and 4.00-50.00 μg mL(-1) for IMP, CIPRO, DEX, PAR and CIL, respectively. PCR and PLS-2 models were established for simultaneous determination of the studied drugs in the range of 3.00-15.00, 1.00-13.00, 4.00-12.00, 1.50-9.50, and 4.00-12.00 μg mL(-1) for IMP, CIPRO, DEX, PAR and CIL, respectively, by using eighteen mixtures as calibration set and seven mixtures as validation set. The suggested methods were validated according to the International Conference of Harmonization (ICH) guidelines and the results revealed that they were accurate, precise and reproducible. The obtained results were statistically compared with those of the published methods and there was no significant difference.
Collapse
Affiliation(s)
- A M El-Kosasy
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Organization of African Unity Street, Abassia, Cairo 11566, Egypt
| | - Omar Abdel-Aziz
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Organization of African Unity Street, Abassia, Cairo 11566, Egypt
| | - N Magdy
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Organization of African Unity Street, Abassia, Cairo 11566, Egypt
| | - N M El Zahar
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Organization of African Unity Street, Abassia, Cairo 11566, Egypt.
| |
Collapse
|
4
|
Zavascki AP, Bulitta JB, Landersdorfer CB. Combination therapy for carbapenem-resistant Gram-negative bacteria. Expert Rev Anti Infect Ther 2013; 11:1333-53. [PMID: 24191943 DOI: 10.1586/14787210.2013.845523] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The emergence of resistant to carbapenems Gram-negative bacteria (CR GNB) has severely challenged antimicrobial therapy. Many CR GNB isolates are only susceptible to polymyxins; however, therapy with polymyxins and other potentially active antibiotics presents some drawbacks, which have discouraged their use in monotherapy. In this context, along with strong pre-clinical evidence of benefit in combining antimicrobials against CR GNB, the clinical use of combination therapy has been raised as an interesting strategy to overcome these potential limitations of a single agent. Polymyxins, tigecycline and even carbapenems are usually the cornerstone agents in combination schemes. Optimization of the probability to attain the pharmacokinetic/pharmacodynamic targets by both cornerstone drug and adjuvant drug is of paramount importance to achieve better clinical and microbiological outcomes. Clinical evidence of the major drugs utilized in combination schemes and how they should be prescribed considering pharmacokinetic/pharmacodynamic characteristics against CR GNB will be reviewed in this article.
Collapse
Affiliation(s)
- Alexandre P Zavascki
- Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre, 90.035-903, Brazil
| | | | | |
Collapse
|
5
|
Fatima A, Naqvi SB, Khaliq SA, Perveen S, Jabeen S. Antimicrobial susceptibility pattern of clinical isolates of Pseudomonas aeruginosa isolated from patients of lower respiratory tract infections. SPRINGERPLUS 2012; 1:70. [PMID: 23397507 PMCID: PMC3566400 DOI: 10.1186/2193-1801-1-70] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/06/2012] [Indexed: 01/01/2023]
Abstract
The present study was conducted to determine the antibiotic susceptibility pattern of Pseudomonas aeruginosa from sputum samples of lower respiratory tract infection patients admitted to different hospitals of Karachi. Most of the hospitals are hampered with high frequency of nosocomial infections generally caused by multiresistant nosocomial pathogen. Among Gram-negative pathogens Pseudomonas aeruginosa considered as most challenging pathogen. The objective of the study was to determine frequency of Pseudomonas aeruginosa from sputum samples and to find out susceptibility pattern against four antibiotics widely used for treatment. The sputum samples from 498 patients were collected consecutively between January 2010 and March 2011 and were cultured and identified. According to CLSI (Clinical Laboratory Standards Institute) guidelines antimicrobial susceptibility testing was performed by disc diffusion method. Pseudomonas aeruginosa were isolated from 24% (120/498) of the lower respiratory tract patient. A higher resistance to Pseudomonas aeruginosa isolate was observed with piperacillin/tazobactam and cefipime i.e. 42% and 40% respectively. Imipenem was found to be most effective antibiotic against Pseudomonas aeruginosa (76% sensitivity) but amikacin resistance was continuously increasing. In conclusion the frequency of Pseudomonas aeruginosa was also higher among lower respiratory tract infection patients with alarmingly high rate of resistance among widely used antibiotics. These findings focused on careful consideration for monitoring and optimization of antimicrobial use in order to reduce occurrence and spread of antimicrobial resistant pathogen.
Collapse
Affiliation(s)
- Anab Fatima
- Department of Pharmaceutics, Faculty of Pharmacy, Hamdard University, Karachi, Pakistan
| | | | | | | | | |
Collapse
|
6
|
Dundar D, Otkun M. In-vitro efficacy of synergistic antibiotic combinations in multidrug resistant Pseudomonas aeruginosa strains. Yonsei Med J 2010; 51:111-6. [PMID: 20046523 PMCID: PMC2799966 DOI: 10.3349/ymj.2010.51.1.111] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 03/17/2009] [Accepted: 03/24/2009] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Combination antibiotic treatment is preferred in nosocomial infections caused by Pseudomonas aeruginosa (P. aeruginosa). In vitro synergism tests were used to choose the combinations which might be used in clinic. The aim of this study was to investigate the synergistic efficacy of synergistic antibiotic combinations in multidrug resistant P. aeruginosa strains. MATERIALS AND METHODS Synergistic efficacies of ceftazidime-tobramycin, piperacillin/tazobactam-tobramycin, imipenem-tobramycin, imipenem-isepamycin, imipenem-ciprofloxacin and ciprofloxacin-tobramycin combinations were investigated by checkerboard technique in 12 multiple-resistant and 13 susceptible P. aeruginosa strains. RESULTS The ratios of synergy were observed in ceftazidime-tobramycin and piperacillin/tazobactam-tobramycin combinations as 67%, and 50%, respectively, in resistant strains, whereas synergy was not detected in other combinations. The ratios of synergy were observed in ceftazidime-tobramycin, piperacillin/tazobactam-tobramycin, imipenem-tobramycin, imipenem-ciprofloxacin and imipenem-isepamycin combinations as 31%, 46%, 15%, 8%, 8%, and respectively, in susceptible strains, whereas synergy was not detected in ciprofloxacin-tobramycin combination. Antagonism was not observed in any of the combinations. CONCLUSION Although the synergistic ratios were high in combinations with ceftazidime or piperacillin/tazobactam and tobramycin, the concentrations in these combinations could not usually reach clinically available levels. Thus, the solution of the problems caused by multiple resistant P. aeruginosa should be based on the prevention of the development of resistance and spread of the causative agent between patients.
Collapse
Affiliation(s)
- Devrim Dundar
- Department of Clinical Microbiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.
| | | |
Collapse
|
7
|
Penetration of moxifloxacin into bone evaluated by Monte Carlo simulation. Antimicrob Agents Chemother 2009; 53:2074-81. [PMID: 19223648 DOI: 10.1128/aac.01056-08] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Moxifloxacin is a fluoroquinolone with a broad spectrum of activity and good penetration into many tissues, including bone. Penetration of moxifloxacin into bone has not yet been studied using compartmental modeling techniques. Therefore, we determined the rate and extent of bone penetration by moxifloxacin and evaluated its pharmacodynamic profile in bone via Monte Carlo simulation. Twenty-four patients (10 males, 14 females) undergoing total hip replacement received 400 mg moxifloxacin orally 2 to 7 h prior to surgery. Blood and bone specimens were collected. Bone samples were pulverized under liquid nitrogen by a cryogenic mill, including an internal standard. Drug concentrations were analyzed by high-performance liquid chromatography. We used ADAPT II (results reported), NONMEM, and WinBUGS for pharmacokinetic analysis. Monte Carlo simulation was performed to reverse engineer the necessary area under the free concentration-time curve fAUC(SERUM)/MIC in serum and total AUC(BONE)/MIC in bone for a successful clinical or microbiological outcome. The median (10% to 90% percentile for between-subject variability) of the AUC in bone divided by the AUC in serum (AUC(BONE)/AUC(SERUM)) was 80% (51 to 126%) for cortical bone and 78% (42 to 144%) for cancellous bone. Equilibration between serum and bone was rapid. Moxifloxacin achieved robust (> or = 90%) probabilities of target attainment (PTAs) in serum, cortical bone, and cancellous bone up to MICs of < or = 0.375 mg/liter based on the targets fAUC(SERUM)/MIC > or = 40 and AUC(BONE)/MIC > or = 33. Moxifloxacin showed high bone concentrations and a rapid equilibrium between bone and serum. The favorable PTAs compared to the 90%-inhibitory MIC of Staphylococcus aureus warrant future clinical trials on the effectiveness of moxifloxacin in the treatment of bone infections.
Collapse
|
8
|
Ermertcan S, Hoşgör M, Tünger O, Coşar G. Investigation of synergism of meropenem and ciprofloxacin against Pseudomonas aeruginosa and Acinetobacter strains isolated from intensive care unit infections. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2002; 33:818-21. [PMID: 11760161 DOI: 10.1080/00365540110027222] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The aim of this study was to determine synergistic effects of meropenem and ciprofloxacin against Pseudomonas aeruginosa and Acinetobacter strains isolated from intensive care unit (ICU) infections. A total of 18 P. aeruginosa and 17 Acinetobacter strains were tested. MICs were determined using the broth microdilution method. The synergy of meropenem and ciprofloxacin was investigated in glass tubes using time-kill methodology. The synergistic effect of meropenem and ciprofloxacin in combination was found to be 22% at 0.5 x the MIC and 61% at 1 x the MIC in P. aeruginosa strains. Two strains (11%) showed synergy at both 0.5 and 1 x the MIC. Of the 18 P. aeruginosa strains, 1 strain (6%) did not show a synergistic effect at either 0.5 or 1 x the MIC. In Acinetobacter strains, the synergistic effect of meropenem and ciprofloxacin in combination was found to be 29% at 0.5 x the MIC and 18% at 1 x the MIC. One strain (6%) showed synergy at both 0.5 and 1 x the MIC. Of the 17 Acinetobacter strains, 8 strains (47%) did not show a synergistic effect at either 0.5 or 1 x the MIC. According to the results of this study, the combination of meropenem and ciprofloxacin is more effective than either antibiotic alone in ICU infections due to P. aeruginosa strains.
Collapse
Affiliation(s)
- S Ermertcan
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Ege University, Izmir, Turkey.
| | | | | | | |
Collapse
|
9
|
Abstract
OBJECTIVE To review the pharmacology, antimicrobial activity, pharmacokinetics, clinical efficacy, and safety of trovafloxacin. DATA SOURCES A MEDLINE search (January 1966-April 1998) was conducted for relevant literature using the terms CP-99,219, CP-116,519, trovafloxacin, and alatrofloxacin. Abstracts published by the American Society of Microbiology during 1995-1997 meetings were also reviewed. STUDY SELECTION AND DATA EXTRACTION All in vitro, animal, and human studies were reviewed for the antimicrobial activity, pharmacokinetics, efficacy, and safety of trovafloxacin. DATA SYNTHESIS Trovafloxacin is a new fluoroquinolone with enhanced activity against gram-positive and anaerobic microorganisms. The oral bioavailability under fasting conditions is approximately 88%. The elimination half-life of trovafloxacin is approximately 10 hours. Less than 10% of trovafloxacin is eliminated unchanged in the urine. Trovafloxacin is effective in the treatment of community-acquired pneumonia and nosocomial pneumonia with cure rates of > 90% and 77%, respectively. Trovafloxacin is comparable with ceftriaxone in the treatment of meningococcal meningitis in children; each produces a cure rate of approximately 90%. In treatment of uncomplicated urinary tract infection, both ciprofloxacin and trovafloxacin achieve an eradication rate of > or = 93%. Trovafloxacin is similar to ofloxacin in the treatment of urogenital Chlamydia trachomatis and acute exacerbations of chronic bronchitis, with clinical success in 97% of patients with each drug. The common adverse effects of trovafloxacin include dizziness, headache, and gastrointestinal intolerance. CONCLUSIONS The advantages of once-daily dosing and enhanced activity of trovafloxacin against gram-positive and anaerobic organisms may expand its use over available fluoroquinolones. Further studies are needed to define its role in the treatment of various infectious diseases.
Collapse
|
10
|
Postelnick M, Halbur SR. Pharmacologic considerations with antimicrobials used in oncology. Cancer Treat Res 1998; 96:247-82. [PMID: 9711403 DOI: 10.1007/978-0-585-38152-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Postelnick
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois 60611, USA
| | | |
Collapse
|
11
|
Bugnon D, Potel G, Xiong YQ, Caillon J, Navas D, Gras C, Kergueris MF, Le Conte P, Jehl F, Baron D, Drugeon H. Bactericidal effect of pefloxacin and fosfomycin against Pseudomonas aeruginosa in a rabbit endocarditis model with pharmacokinetics of pefloxacin in humans simulated in vivo. Eur J Clin Microbiol Infect Dis 1997; 16:575-80. [PMID: 9323468 DOI: 10.1007/bf02447919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The bactericidal activity of pefloxacin and fosfomycin alone and in combination against Pseudomonas aeruginosa was evaluated in an experimental rabbit endocarditis model after 24 h of treatment. Two strains with intermediate susceptibility to pefloxacin and good susceptibility to fosfomycin were tested. The serum kinetics obtained during administration of 400 mg every 12 h in humans were simulated in the animals using computer-controlled variable-flow infusion. Fosfomycin was administered as a continuous infusion at a constant flow, allowing a steady-state concentration of 47.4 +/- 11.9 mg/ml to be reached in serum. In valvular vegetations, pefloxacin was less bactericidal than fosfomycin, and in combination treatment, it reduced (but did not abolish) the bactericidal effect of fosfomycin. The duration of the pretreatment interval (12-48 h) had a negative effect on the bactericidal activity of both drugs, especially that of fosfomycin.
Collapse
Affiliation(s)
- D Bugnon
- Laboratoire d'Antibiologie Clinique et Expérimentale de la Faculté de Médecine de Nantes, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Milatovic D, Wallrauch C. In vitro activity of trovafloxacin in combination with ceftazidime, meropenem, and amikacin. Eur J Clin Microbiol Infect Dis 1996; 15:688-93. [PMID: 8894583 DOI: 10.1007/bf01691162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The in vitro activity of trovafloxacin alone and in combination with ceftazidime, meropenem, and amikacin was studied by determining the minimal inhibitory concentrations (MICs) for 111 gram-negative and 71 gram-positive bacteria. In addition, the synergy of these combinations against 46 strains of gram-negative and gram-positive organisms was studied by checkerboard titration and time-kill kinetics. Trovafloxacin exhibited excellent in vitro activity against all strains tested. Synergism was observed in 17% of the gram-negative strains and in 32% of the gram-positive strains. No antagonism was observed with any of the combinations tested.
Collapse
Affiliation(s)
- D Milatovic
- Institute of Medical Microbiology, Immunology and Hygiene, Munich, Germany
| | | |
Collapse
|
13
|
Affiliation(s)
- E Bergogne-Bérézin
- Department of Microbiology, Bichat-Claude Bernard University-Hospital, Paris, France
| |
Collapse
|
14
|
Abstract
In an attempt to overcome some of the gaps in their antibacterial spectrum, e.g. some Gram-positive bacteria (notably streptococci and Streptococcus pneumoniae) and anaerobes, the fluoroquinolones have been combined with other bactericidal and bacteriostatic agents. In general, the fluoroquinolones rarely show either synergy or antagonism when used in combination with other antimicrobial agents against most bacteria. Therefore, in infections where the fluoroquinolones do not provide cover against all potential organisms, combined treatment with an appropriate agent may be considered. Current data suggest that the fluoroquinolones are not antagonistic with beta-lactams, macrolides, clindamycin and the imidazoles. Aminoglycosides in combination with the fluoroquinolones do not show synergy. Antipseudomonal penicillins, ceftazidime or imipenem in combination with the fluoroquinolones are synergistic and may be useful for treating infections in immunocompromised patients. Rifampicin in combination with a fluoroquinolone for the treatment of staphylococcal endocarditis or osteomyelitis may be useful, although in vitro and in vivo results do not always coincide.
Collapse
Affiliation(s)
- H C Neu
- Division of Infectious Diseases, College of Physicians and Surgeons, Columbia University, New York
| |
Collapse
|
15
|
|
16
|
Abstract
Combinations of fluoroquinolones with other antimicrobial agents have been extensively investigated. Combinations of fluoroquinolones with aminoglycosides, beta-lactams, imidazoles, macrolides and clindamycin infrequently show synergy against Enterobacteriaceae and gram-positive bacteria. These combinations rarely show antagonism. Combinations of rifampin with fluoroquinolones tested against Staphylococcus aureus have been reported to show synergy and antagonism, and in vitro results have not correlated with results of animal infection experiments. Against Pseudomonas aeruginosa combinations of antipseudomonas penicillins or imipenem with fluoroquinolones are synergistic for 20% to 50% of isolates in vitro and also are synergistic in animal models of infection, whereas combinations of aminoglycosides with fluoroquinolones rarely show synergy against Pseudomonas aeruginosa. Against anaerobic species such as Bacteroides fragilis combinations of fluoroquinolones with clindamycin, anti-anaerobic penicillins, cephalosporins or imidazoles are occasionally synergistic but usually indifferent. Ciprofloxacin and ofloxacin combined with antituberculosis agents have activity against Mycobacterium tuberculosis and atypical mycobacteria. In general, fluoroquinolones should be combined with other agents not to achieve synergy, which is extremely variable, but to provide activity against bacteria inadequately inhibited by the fluoroquinolones.
Collapse
Affiliation(s)
- H C Neu
- Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York 10032
| |
Collapse
|
17
|
Díez Enciso M. In vitro activity of aztreonam, cefotaxime, ceftazidime and imipenem combined with ciprofloxacin against gram-negative bacilli and compared with amikacin combinations against Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis 1991; 10:90-2. [PMID: 1907544 DOI: 10.1007/bf01964415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
18
|
Bustamante CI, Wharton RC, Wade JC. In vitro activity of ciprofloxacin in combination with ceftazidime, aztreonam, and azlocillin against multiresistant isolates of Pseudomonas aeruginosa. Antimicrob Agents Chemother 1990; 34:1814-5. [PMID: 2126693 PMCID: PMC171935 DOI: 10.1128/aac.34.9.1814] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The combinations of ciprofloxacin plus ceftazidime, ciprofloxacin plus aztreonam, and ciprofloxacin plus azlocillin were evaluated for the presence of synergy against multiresistant isolates of Pseudomonas aeruginosa. The frequency of synergy was dependent on antibiotic susceptibilities. If the organism was resistant to ciprofloxacin, synergy was observed in more than 50% of the isolates; however, if the organism was resistant to the beta-lactam (with the exception of ceftazidime), synergy was generally observed in less than 10% of the isolates. Antagonism was not observed with any of the combinations. These results may be helpful in making clinical decisions in treating P. aeruginosa infections.
Collapse
Affiliation(s)
- C I Bustamante
- Department of Medicine, University of Maryland, Baltimore
| | | | | |
Collapse
|
19
|
Clark RB, Pakiz CB, Hostetter MK. Synergistic activity of aminoglycoside-beta-lactam combinations against Pseudomonas aeruginosa with an unusual aminoglycoside antibiogram. Med Microbiol Immunol 1990; 179:77-86. [PMID: 2113159 DOI: 10.1007/bf00198528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The bactericidal activity of aminoglycosides alone and in combination with various beta-lactams was studied by the time-kill technique against ten Pseudomonas aeruginosa isolates with an unusual antibiogram (amikacin-resistant, gentamicin-resistant, tobramycin-susceptible [ArGrTs]). Previous studies have indicated that ArGrTs isolates are moderately resistant to all aminoglycosides and many are multiply resistant to beta-lactams. Aminoglycoside-beta-lactam combinations showed infrequent synergistic (16%) or enhanced killing (12%) against the ArGrTs isolates. Synergistic activity, when present, was more likely to occur with tobramycin and amikacin than with gentamicin, even though these differences were not statistically significant. Antibiotic resistance patterns were not predictive of synergy or enhanced killing. Systemic infections produced by ArGrTs isolates that are multiply resistant to the beta-lactams may not respond to combination therapy with an aminoglycoside and beta-lactam. Alternative treatment with polymyxin B or a quinolone may be required for these infections.
Collapse
Affiliation(s)
- R B Clark
- Department of Pathology, Crozer-Chester Medical Center, Upland, Chester, PA 19013
| | | | | |
Collapse
|
20
|
Goldman MP. Ciprofloxacin drug utilization review and prospective drug use evaluation. DICP : THE ANNALS OF PHARMACOTHERAPY 1990; 24:82-6. [PMID: 2301191 DOI: 10.1177/106002809002400115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ciprofloxacin is a fluoroquinolone antimicrobial with activity against both gram-negative and -positive bacteria including pseudomonal and staphylococcal species. It is the only available oral agent possessing this unique spectrum of activity that achieves serum concentrations adequate to treat a variety of systemic infections. A retrospective drug utilization review and a prospective drug use evaluation of ciprofloxacin were performed to determine if the agent was being used for appropriate indications, to ensure correct dosing and appropriate monitoring, and to determine whether its use is cost effective at the Veterans Administration Medical Center, Cleveland (VAMCC). For the retrospective review, 40 patients' charts were randomly chosen for review from computerized inpatient and outpatient prescription records. Drug use review criteria were developed by the Pharmacy Service and Infectious Disease Section. For the prospective evaluation, data were collected for all inpatient and outpatient requests for ciprofloxacin during a six-month period (May to November 1988) using the same criteria as in the retrospective study. Cost analysis was performed by identification and cost comparison of alternative therapy and by estimating the number of days saved by using appropriate oral therapy. All charts from the retrospective review were found to meet criteria for appropriate use. All patients for whom documented follow-up was performed had microbiologic or clinical cures. In the prospective evaluation, 168 patients were started on ciprofloxacin. Ninety-five percent of patients had appropriate justification for use according to criteria. Drug cost savings for the six-month period was +14,962.54 or +29,925.08/year. This covered drug and minibag acquisition costs only. An estimated 127 hospital days were saved (shortened length of +71,717.00 or +143,434.00/year.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- M P Goldman
- Veterans Administration Medical Center, Cleveland, OH
| |
Collapse
|
21
|
Abstract
Combinations of ciprofloxacin with aminoglycosides or beta-lactams are infrequently synergistic and only rarely antagonistic against Enterobacteriaceae or gram-positive bacteria. Against Pseudomonas aeruginosa, combinations of ciprofloxacin with an aminoglycoside are synergistic for a minority of isolates, whereas rates of synergistic interactions between ciprofloxacin and beta-lactams against this group of organisms vary over a wide range.
Collapse
Affiliation(s)
- G M Eliopoulos
- Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts 02215
| | | |
Collapse
|
22
|
Abstract
The fluoroquinolones, a new class of potent orally absorbed antimicrobial agents, are reviewed, considering structure, mechanisms of action and resistance, spectrum, variables affecting activity in vitro, pharmacokinetic properties, clinical efficacy, emergence of resistance, and tolerability. The primary bacterial target is the enzyme deoxyribonucleic acid gyrase. Bacterial resistance occurs by chromosomal mutations altering deoxyribonucleic acid gyrase and decreasing drug permeation. The drugs are bactericidal and potent in vitro against members of the family Enterobacteriaceae, Haemophilus spp., and Neisseria spp., have good activity against Pseudomonas aeruginosa and staphylococci, and (with several exceptions) are less potent against streptococci and have fair to poor activity against anaerobic species. Potency in vitro decreases in the presence of low pH, magnesium ions, or urine but is little affected by different media, increased inoculum, or serum. The effects of the drugs in combination with a beta-lactam or aminoglycoside are often additive, occasionally synergistic, and rarely antagonistic. The agents are orally absorbed, require at most twice-daily dosing, and achieve high concentrations in urine, feces, and kidney and good concentrations in lung, bone, prostate, and other tissues. The drugs are efficacious in treatment of a variety of bacterial infections, including uncomplicated and complicated urinary tract infections, bacterial gastroenteritis, and gonorrhea, and show promise for therapy of prostatitis, respiratory tract infections, osteomyelitis, and cutaneous infections, particularly when caused by aerobic gram-negative bacilli. Fluoroquinolones have also proved to be efficacious for prophylaxis against travelers' diarrhea and infection with gram-negative bacilli in neutropenic patients. The drugs are effective in eliminating carriage of Neisseria meningitidis. Patient tolerability appears acceptable, with gastrointestinal or central nervous system toxicities occurring most commonly, but only rarely necessitating discontinuance of therapy. In 17 of 18 prospective, randomized, double-blind comparisons with another agent or placebo, fluoroquinolones were tolerated as well as or better than the comparison regimen. Bacterial resistance has been uncommonly documented but occurs, most notably with P. aeruginosa and Staphylococcus aureus and occasionally other species for which the therapeutic ratio is less favorable. Fluoroquinolones offer an efficacious, well-tolerated, and cost-effective alternative to parenteral therapies of selected infections.
Collapse
Affiliation(s)
- J S Wolfson
- Harvard Medical School, Boston, Massachusetts
| | | |
Collapse
|
23
|
Chow AW, Wong J, Bartlett KH, Shafran SD, Stiver HG. Cross-resistance of Pseudomonas aeruginosa to ciprofloxacin, extended-spectrum beta-lactams, and aminoglycosides and susceptibility to antibiotic combinations. Antimicrob Agents Chemother 1989; 33:1368-72. [PMID: 2508546 PMCID: PMC172656 DOI: 10.1128/aac.33.8.1368] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The susceptibilities of 270 clinical isolates of Pseudomonas aeruginosa from diverse sources (82 burn patients, 76 cystic fibrosis [CF] patients, and 112 other sources) to ciprofloxacin and three other quinolones, nine extended-spectrum beta-lactams, and three aminoglycosides were determined by an agar dilution method in cation-supplemented Mueller-Hinton medium. Ciprofloxacin, ceftazidime, imipenem, and aztreonam were the most active. MICs for burn isolates were consistently higher than those for other isolates for most antibiotics, whereas those for CF strains were consistently lower. Multidrug resistance to aminoglycosides and beta-lactams occurred in 21% of the burn isolates, 2.6% of the CF isolates, and 8.9% of the other isolates. Ninety percent of these strains remained susceptible to ciprofloxacin. Seven percent of the isolates were resistant to ciprofloxacin (MIC, greater than or equal to 2 micrograms/ml). Concurrent resistance to ciprofloxacin and beta-lactams or aminoglycosides was rare (1.8 to 4%). Analysis by Spearman rank correlation revealed a high degree of correlation of MICs among antibiotics within the same class, except for imipenem. An inoculum effect was observed for all antibiotics between 10(6) and 10(4) CFU (P less than 0.05), with those for piperacillin and cefoperazone being the most pronounced (16-fold and 8-fold differences, respectively), and was least apparent for the quinolones, aminoglycosides, imipenem, and aztreonam (twofold differences). Selected strains for which there were high MICs of ciprofloxacin (greater than or equal to 1 micrograms/ml) were tested against ciprofloxacin in combination with other agents in a checkerboard agar dilution assay. Synergistic (summated fractional inhibitory concentration, </=0.5) interactions at clinically achievable concentrations were most frequent with mezlocillin (33%), piperacillin (21%), and (7.6%), aztreonam (3.7%), and the aminoglycosides (3.7%). Antagonism (summated fractional inhibitory concentration, >/= 4) was observed in only one instance (with gentamicin).
Collapse
Affiliation(s)
- A W Chow
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | | | | |
Collapse
|
24
|
Abstract
When antibiotic combinations are used to provide a broader spectrum of antimicrobial activity or in an attempt to prevent the emergence of resistant organisms, it is rarely necessary or practical to perform tests of drug interactions in vitro. In vitro testing of combinations may be useful when combinations are used in an attempt to attain synergistic interactions. In some cases, screening methods can be used as substitutes for formal synergy testing. This paper examines the mechanisms of antibiotic interaction leading to synergism or antagonism, surveys attempts to correlate in vitro observations with efficacy in animal models, and reviews clinical data providing evidence for or against a useful role of synergistic antibiotic interactions in the treatment of human infections.
Collapse
Affiliation(s)
- G M Eliopoulos
- Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts 02215
| | | |
Collapse
|