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Lucena R, Borges CE, Vieiralves LF, Kanga JM, Hohl P, Zappelini M, Kissling M. Cefetamet pivoxil in the treatment of uncomplicated gonorrhea. Diagn Microbiol Infect Dis 1994; 19:121-7. [PMID: 7805356 DOI: 10.1016/0732-8893(94)90122-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We studied the efficacy and safety of cefetamet pivoxil (CAT), an oral aminothiazolyl cephalosporin, in a series of open, comparative multicenter studies in 207 women (four study centers) with uncomplicated gonorrhea, and summarized and pooled the results with those of earlier open dose-finding trials (360 men; six study centers). We compared single-dose treatment regimen of CAT--over the range of 400-1500 mg--with spectinomycin, thiamphenicol, ampicillin, or amoxicillin plus probenecid. The overall cure rates were 100% in 88 women treated with 1500 mg CAT and in 137 men treated with 1200 or 1500 mg CAT, 98% (114 of 116 men) in those treated with 800 or 1000 mg CAT, and 93% (42 of 45 men) in those treated with 400 or 500 mg CAT; the composite cure rate of the comparators was 97%. The tolerability of CAT (n = 428) compared favorably (1.8% adverse events) with that of the standard drugs (n = 139) (4.3% adverse events). Single-dose treatment with 1500 mg CAT is effective and safe in adults with uncomplicated gonorrhea.
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Affiliation(s)
- R Lucena
- Public Institution-Urology, Clinical Urogynecologists Association, Rio de Janeiro, Brazil
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2
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Biedenbach DJ, Jones RN. Predictive accuracy of disk diffusion test for Proteus vulgaris and Providencia species against five newer orally administered cephalosporins, cefdinir, cefetamet, cefprozil, cefuroxime, and loracarbef. J Clin Microbiol 1994; 32:559-62. [PMID: 8150976 PMCID: PMC263078 DOI: 10.1128/jcm.32.2.559-562.1994] [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: 01/29/2023] Open
Abstract
Three members of the tribe Proteeae (Proteus vulgaris, Providencia rettgeri, and Providencia stuartii) were tested against five newer orally administered cephalosporins (cefdinir, cefprozil, cefuroxime, cefetamet, and loracarbef) by the disk diffusion and reference broth microdilution methods. One hundred strains of these organisms were tested to confirm the excessive interpretive error rates that previously had been noted for the disk diffusion test. The results indicate that the suggested disk diffusion breakpoints for cefetamet and cefuroxime were without serious interpretive errors. In contrast, loracarbef, cefdinir, and cefprozil results exceeded acceptable interpretive error rates, with very major (false-susceptible) errors of 4, 5, and 9% respectively. Loracarbef currently has a warning in the National Committee for Clinical Laboratory Standards table footnotes addressing this problem. We recommend including cefdinir and cefprozil in the list of compounds requiring this warning. In addition, MICs of cefazolin, cefaclor, and cephalothin were determined to establish whether a class MIC concept to predict susceptibility for these agents was possible. When the indole-positive Proteus strains are tested, cefazolin MICs can be used to predict MICs of all tested orally administered cephems (8 to 13% total errors, with only a 0 to 1% very major error.
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Affiliation(s)
- D J Biedenbach
- Department of Pathology, University of Iowa College of Medicine, Iowa City 52242
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3
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Biedenbach DJ, Jones RN, Erwin ME. Interpretive accuracy of the disk diffusion method for testing newer orally administered cephalosporins against Morganella morganii. J Clin Microbiol 1993; 31:2828-30. [PMID: 8253998 PMCID: PMC266029 DOI: 10.1128/jcm.31.10.2828-2830.1993] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Eight newer orally administered cephems (cefdinir, cefetamet, cefixime, cefpodoxime, cefprozil, ceftibuten, cefuroxime, and loracarbef) were tested against 100 clinical strains of Morganella morganii to determine the extent of serious interpretive very major (false-susceptible) errors when current criteria for the disk diffusion test are applied. Agar dilution MICs and disk diffusion tests were performed as recommended by the National Committee for Clinical Laboratory Standards (Villanova, Pa.) (NCCLS), and the methods were compared by regression analysis using the method of least squares and by error rate bounding. The following results are listed in the order of increasing error rates: cefdinir, loracarbef, and cefprozil, < or = 1% very major error; ceftibuten, 8% minor errors; cefuroxime, 21% minor errors; cefixime, cefpodoxime, and cefetamet, very major errors of 15, 24, and 36%, respectively. M. morganii produces unacceptable rates of test error with cefuroxime, cefixime, cefpodoxime, and cefetamet. The latter two cephalosporins currently have NCCLS table footnote warnings covering the problem observed with this organism. The inclusion of cefuroxime and cefixime in the NCCLS table footnote is strongly recommended.
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Affiliation(s)
- D J Biedenbach
- Department of Pathology, University of Iowa College of Medicine, Iowa City 52242
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4
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Bryson HM, Brogden RN. Cefetamet pivoxil. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 1993; 45:589-621. [PMID: 7684677 DOI: 10.2165/00003495-199345040-00009] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cefetamet pivoxil is an oral third-generation cephalosporin which is hydrolysed to form the active agent, cefetamet. Cefetamet has excellent in vitro activity against the major respiratory pathogens Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis and group A beta-haemolytic streptococci; it is active against beta-lactamase-producing strains of H. influenzae and M. catarrhalis, but has poor activity against penicillin-resistant S. pneumoniae. Cefetamet has marked activity against Neisseria gonorrhoeae and possesses a broad spectrum of activity against Enterobacteriaceae. Both staphylococci and Pseudomonas spp. are resistant to cefetamet. Cefetamet pivoxil has been investigated in the treatment of both upper and lower community-acquired respiratory tract infections and has demonstrated equivalent efficacy to a number of more established agents, namely cefaclor, amoxicillin and cefixime. In patients with group A beta-haemolytic streptococcal pharyngotonsillitis, a 7-day course of cefetamet pivoxil was as effective as a 10-day course of the standard agent, phenoxymethylpenicillin, in this indication. In complicated urinary tract infections, cefetamet pivoxil showed similar efficacy to cefadroxil, cefaclor and cefuroxime axetil. Cefetamet pivoxil was effective in the treatment of otitis media, pneumonia, pharyngotonsillitis and urinary tract infections in children. Preliminary data indicate that single dose cefetamet pivoxil can effectively eradicate N. gonorrhoeae from both men and women. Cefetamet pivoxil has a tolerability profile similar to that of other oral cephalosporins, with gastrointestinal effects being the most commonly reported adverse events. To date, no symptoms of carnitine deficiency have been reported with cefetamet pivoxil. Cefetamet pivoxil offers effective alternative oral therapy for outpatient treatment of community-acquired respiratory tract infections, with the advantage of improved activity against H. influenzae and increased beta-lactamase stability. However, its use in areas with a high incidence of penicillin-resistant S. pneumoniae is likely to be limited. Cefetamet pivoxil is also effective in the treatment of urinary tract infections, although further trials are required to define any comparative advantages over other oral agents.
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Affiliation(s)
- H M Bryson
- Adis International Limited, Auckland, New Zealand
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5
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Jones RN, Erwin ME. Haemophilus test medium interpretive criteria for disk diffusion susceptibility tests with cefdinir, cefetamet, cefmetazole, cefpodoxime, cefdaloxime (RU29246, HR-916 metabolite), and trospectomycin. Diagn Microbiol Infect Dis 1992; 15:693-701. [PMID: 1478050 DOI: 10.1016/0732-8893(92)90073-3] [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: 12/27/2022]
Abstract
The disk diffusion zones and the MICs of six newer antimicrobials with significant activity against Haemophilus influenzae were compared using the Haemophilus test medium (HTM) and National Committee for Clinical Laboratory Standards methods. The rank order of potency was cefpodoxime (MIC50, < or = 0.03 micrograms/ml) > cefetamet > cefdinir > cefdaloxime = trospectomycin > cefmetazole (MIC50, 2 micrograms/ml). Susceptible breakpoint interpretive criteria for HTM tests were established that conformed to prior recommendations for each drug when tested against other species. Absolute agreement between methods ranged from 89% to 100% with < or = 1% false-susceptible interpretive errors. The recommended, tentative disk diffusion susceptible interpretive criteria were for 5-micrograms cefdinir disks > or = 20 mm (MIC correlate, < or = 1 micrograms/ml); for 10-micrograms cefetamet disks > or = 18 mm (MIC correlate, < or = 4 micrograms/ml); for 30-micrograms cefetamet disks > or = 21 mm (MIC correlate, < or = 4 micrograms/ml); for 30-micrograms cefmetazole disks > or = 16 mm (MIC correlate, < or = 16 micrograms/ml); for 10-micrograms cefpodoxime disks > or = 21 mm (MIC correlate, < or = 2 micrograms/ml); for 30-micrograms cefdaloxime disks > or = 23 mm (MIC correlate, < or = 2 micrograms/ml) and for 30-micrograms trospectomycin disks > or = 17 mm (MIC correlate, < or = 16 micrograms/ml). beta-Lactamase-negative, ampicillin-resistant (BLNAR) H. influenzae isolates consistently had the highest MICs for each cephalosporin tested.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R N Jones
- Department of Pathology, University of Iowa College of Medicine, Iowa City 52242
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Barrett MS, Jones RN. Susceptibility testing interpretive criteria and drug stability for cefdinir, cefetamet, and cefpodoxime against Neisseria gonorrhoeae. Diagn Microbiol Infect Dis 1992; 15:685-91. [PMID: 1478049 DOI: 10.1016/0732-8893(92)90072-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cefdinir, cefetamet, and cefpodoxime, three orally administered cephalosporins, were tested against 100 strains of Neisseria gonorrhoeae having various antimicrobial susceptibility patterns. Triplicate testing of each organism strain was performed for all agar dilution and disk diffusion tests. Cefdinir was the most active compound (MIC90) micrograms/ml) especially against gonococci with chromosomal-mediated resistance to penicillin. The recommended susceptible interpretive criteria were as follows: for the 5-micrograms cefdinir disk, > or = 31 mm (MIC correlate, < or = 0.25 microgram/ml); for the 10-micrograms cefetament disk, > or = 29 mm (MIC correlate, < or = 0.5 microgram/ml; for the 30-micrograms cefetamet disk, > or = 31 mm (MIC correlate, < or = 0.5 microgram/ml); and for the 10-micrograms cefpodoxime disk, > or = 29 mm (MIC correlate, < or = 0.5 microgram/ml). No organisms resistant to these new cephalosporins were detected. Cefdinir, cefetamet, and defpodoxime were stable in GC agar medium for at least 21 days when stored at 2 degrees-5 degrees C.
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Affiliation(s)
- M S Barrett
- Department of Pathology, University of Iowa College of Medicine, Iowa City
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7
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Erwin ME, Jones RN, Koontz FP, Gerlach EH, Murray PR, Washington JA. MIC and disk diffusion quality control guidelines for Neisseria gonorrhoeae susceptibility tests of cefdinir, cefetamet, CI-960, fleroxacin, lomefloxacin, and temafloxacin. J Clin Microbiol 1992; 30:1317-9. [PMID: 1316371 PMCID: PMC265275 DOI: 10.1128/jcm.30.5.1317-1319.1992] [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: 12/26/2022] Open
Abstract
Cefdinir (FK482), cefetamet (Ro 15-8074), CI-960, fleroxacin, lomefloxacin, and temafloxacin have potent activities against Neisseria gonorrhoeae. They were tested in a multilaboratory study to establish quality control guidelines. Quality control ranges for N. gonorrhoeae ATCC 49226 were determined by using multiple GC agar lots, three disk lots, and a number of test replicates consistent with the M23-T guidelines of the National Committee for Clinical Laboratory Standards. The MIC ranges included 2 to 4 log2 dilution steps. The recommended inhibition zone diameter ranges were generally 7 to 8 mm and included greater than or equal to 91.3% of all recorded study results.
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Affiliation(s)
- M E Erwin
- Anti-Infectives Research Center, University of Iowa College of Medicine, Iowa City 52242
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8
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Jones RN, Erwin ME. Preliminary disk diffusion susceptibility testing criteria for cefdaloxime (RU29246, HR-916 metabolite), a new orally administered cephalosporin. J Clin Microbiol 1992; 30:1297-300. [PMID: 1583135 PMCID: PMC265269 DOI: 10.1128/jcm.30.5.1297-1300.1992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cefdaloxime (formerly RU29246; Hoechst-Roussel Pharmaceuticals Inc., Somerville, N.J.) a new active component of the HR-916 ester, was tested by dilution and two disk (10- and 30-micrograms) diffusion susceptibility tests against 391 clinical isolates. Interpretive criteria were proposed for three potential MIC breakpoints of less than or equal to 1, less than or equal to 2, and less than or equal to 4 micrograms/ml. Analyses by regression line and error rate bounding methods minimized false-susceptible (very major) errors and produced a greater than or equal to 90% absolute interpretive agreement between susceptibility test methods. The less than or equal to 2-micrograms/ml breakpoint seemed optimal when 10-micrograms disks and the available human pharmacokinetics were used. The following inhibition zone diameter criteria were proposed: susceptible, greater than or equal to 19 mm; resistant, less than or equal to 15 mm. These recommendations for clinical trials should remain tentative until additional information about cefdaloxime formulations, pharmacokinetics, and patient outcomes can be correlated with in vitro susceptibility test results.
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Affiliation(s)
- R N Jones
- Department of Pathology, University of Iowa College of Medicine, Iowa City
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9
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Jones RN, Erwin ME, Gooding BB. Interpretive criteria for disk diffusion tests using 5-microgram cefdinir disks with rapidly growing clinical isolates. J Clin Microbiol 1992; 30:1022-3. [PMID: 1572959 PMCID: PMC265208 DOI: 10.1128/jcm.30.4.1022-1023.1992] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Preliminary interpretive zone diameter criteria were calculated for the 5-micrograms cefdinir disk diffusion test by using two potential MIC breakpoints (less than or equal to 0.5 and less than or equal to 1 micrograms/ml). The absolute agreement between tests ranged from 85.9 to 92.4%, and the false-susceptibility errors were principally contributed by the Enterobacter spp. (2.2% error). One proposed criterion was greater than or equal to 20-mm zone diameter (less than or equal to 1 micrograms/ml) for susceptibility and less than or equal to 16-mm zone diameter (greater than 2 micrograms/ml) for resistance to cefdinir. Clinical laboratory users of the disk diffusion method should be cautioned about the possibility of very major interpretive errors among enterobacter isolates.
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Affiliation(s)
- R N Jones
- Department of Pathology, University of Iowa College of Medicine, Iowa City 52242
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10
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Bradford PA, Sanders CC. Use of a predictor panel for development of a new disk for diffusion tests with cefoperazone-sulbactam. Antimicrob Agents Chemother 1992; 36:394-400. [PMID: 1605604 PMCID: PMC188447 DOI: 10.1128/aac.36.2.394] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The proper disk mass for diffusion susceptibility tests with cefoperazone-sulbactam was determined by using a predictor panel of clinical isolates that included staphylococci and gram-negative bacteria intrinsically susceptible, intrinsically resistant, and of various susceptibilities because of the production of different types and amounts of beta-lactamase. A primary panel of 24 isolates was used to screen various disk masses of cefoperazone and sulbactam in disk diffusion susceptibility tests. Regression analyses were performed for each combination by comparing MICs to zone diameters. Analysis of each component demonstrated that decreasing the disk mass of cefoperazone shifted the regression line to the left while decreasing the disk mass of sulbactam diminished the slope of the line. Ten candidate disks that adequately separated susceptible and resistant strains among the primary panel were identified, and these 10 disks, along with the previously proposed 75/30-micrograms disk, were then tested against an expanded panel of 265 isolates. Results indicated that a 30/20-micrograms cefoperazone-sulbactam disk provided the best separation between susceptible and resistant strains when interpretive criteria of less than or equal to 15 mm for resistance, 16 to 19 mm for moderate susceptibility, and greater than or equal to 20 mm for susceptibility were used. They also identified discrepancies between agar and broth microdilution MICs of sufficient size to warrant separate interpretive criteria for the two methods. Overall, the use of a predictor panel to develop interpretive criteria for susceptibility tests appeared to be a very useful approach, especially when antibiotics designed to be used against drug-resistant organisms are involved.
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Affiliation(s)
- P A Bradford
- Department of Medical Microbiology, Creighton University, Omaha, Nebraska 68178
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11
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Bale MJ, Jones RN, Erwin ME, Koontz FP, Gerlach EH, Murray PR, Washington JA. MIC quality control guidelines for Haemophilus susceptibility tests using cefdinir (FK482), cefepime, cefetamet, cefpirome, ceftibuten, fleroxacin, temafloxacin, clarithromycin, RP59500, and trospectomycin. J Clin Microbiol 1992; 30:225-6. [PMID: 1310329 PMCID: PMC265027 DOI: 10.1128/jcm.30.1.225-226.1992] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A multilaboratory study was performed to establish broth microdilution MIC quality control (QC) guidelines for 10 investigational drugs which previously demonstrated significant activity against Haemophilus influenzae. MIC QC ranges for H. influenzae ATCC 49247 with Haemophilus test medium were determined by using multiple contemporary lots of Haemophilus test medium and the National Committee for Clinical Laboratory Standards' recommended numbers of replicate tests. On the basis of these results, QC ranges (generally modal MIC +/- one log2 dilution) are proposed for cefdinir, cefepime, cefetamet, cefpirome, ceftibuten, fleroxacin, temafloxacin, clarithromycin, RP59500, and trospectomycin. The proposed QC guidelines for clarithromycin and temafloxacin were recently accepted by the National Committee for Clinical Laboratory Standards.
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Affiliation(s)
- M J Bale
- Special Microbiology, University of Iowa, College of Medicine, Iowa City 52242
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12
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Jones RN, Barry AL. Antimicrobial activity, spectrum, and recommendations for disk diffusion susceptibility testing of ceftibuten (7432-S; SCH 39720), a new orally administered cephalosporin. Antimicrob Agents Chemother 1988; 32:1576-82. [PMID: 3190185 PMCID: PMC175922 DOI: 10.1128/aac.32.10.1576] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The antimicrobial activity and spectrum of ceftibuten (7432-S; SCH 39720) was determined on a wide variety of bacterial species selected for resistance to oral and parenteral beta-lactam antimicrobial agents. Ceftibuten was found to be the most active beta-lactam tested against members of the family Enterobacteriaceae, inhibiting 81.6% of strains at less than or equal to 8.0 micrograms/ml compared with 75.0 and 54.8% of strains inhibited by cefixime and cefuroxime, respectively. All strains of Haemophilus influenzae (MIC for 90% of strains [MIC90], less than or equal to 0.06 microgram/ml), Branhamella catarrhalis (MIC90, 3.0 micrograms/ml), and pathogenic Neisseria spp. (MIC90, less than or equal to 0.06 and 0.019 microgram/ml) were susceptible to ceftibuten. Beta-hemolytic Streptococcus spp. (serogroups A, B, C, and G) were also inhibited by ceftibuten, but penicillin-resistant pneumococci were generally resistant to cefixime and ceftibuten. The activity and spectrum of ceftibuten seem most applicable to infections of the respiratory and urinary tract plus those infections caused by pathogenic Neisseria spp. Ceftibuten disks (30 micrograms) were evaluated and found to have an acceptable correlation (r = 0.88) with ceftibuten MICs. Preliminary zone size interpretive criteria for MIC breakpoints of less than or equal to 4.0 and less than or equal to 8.0 micrograms/ml were calculated.
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Affiliation(s)
- R N Jones
- Clinical Microbiology Institute, Tualatin, Oregon 97062
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13
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Hohl P, von Graevenitz A, Zollinger-Iten J. Cefetamet pivoxil: bacteriostatic and bactericidal activity of the free acid against 355 gram-negative rods. Infection 1988; 16:194-8. [PMID: 3403040 DOI: 10.1007/bf01644102] [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: 01/05/2023]
Abstract
The in vitro activity of the free acid of cefetamet pivoxil (Ro 15-8075) was tested against 355 clinical isolates, namely enteropathogenic bacteria, glucose non-fermentative gram-negative rods (excluding Pseudomonas aeruginosa) and Legionella pneumophila. Ceftriaxone was included in the study as reference compound. Although the free acid of the orally active cephalosporin was generally weaker than ceftriaxone, it inhibited 88.2% and 94.5% of Enterobacteriaceae and Vibrionaceae at a concentration of 4 mg/l and 8 mg/l or less, respectively. Campylobacter jejuni proved resistant to both compounds. The activity of the new compound against glucose non-fermentative gram-negative rods was generally insufficient to be of promise for broad clinical use. Although the compound was at least twofold more active than ceftriaxone against Pseudomonas acidovorans, Pseudomonas alcaligenes and Pseudomonas cepacia, the former was at least two dilution steps less active than the latter against 14 species of the other less common glucose non-fermentative organisms.
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Affiliation(s)
- P Hohl
- Pharmaceutical Research, F. Hoffmann-La Roche & Co. Ltd., Basel
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14
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Jones RN, Barry AL. Antimicrobial activity and disk diffusion susceptibility testing of U-76,253A (R-3746), the active metabolite of the new cephalosporin ester, U-76,252 (CS-807). Antimicrob Agents Chemother 1988; 32:443-9. [PMID: 3377457 PMCID: PMC172198 DOI: 10.1128/aac.32.4.443] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Compound U-76,253A (R-3746), the active metabolite sodium salt of the prodrug ester U-76,252 (CS-807), was demonstrated to be active against members of the family Enterobacteriaceae with 82 and 85% of strains inhibited by less than or equal to 2.0 and less than or equal to 4.0 micrograms/ml, respectively. In addition, U-76,253A inhibited all strains of Branhamella catarrhalis, Haemophilus influenzae, pathogenic Neisseria spp., oxacillin-susceptible Staphylococcus aureus, beta-hemolytic streptococci, and pneumococci at less than or equal to 4.0 micrograms/ml. Pseudomonas spp., Acinetobacter spp., enterococci, and oxacillin-resistant staphylococci were resistant to U-76,253A. This U-76,253A antimicrobial activity and spectrum was generally superior to that of comparison orally administered cephems (cefaclor, cefuroxime, and cefixime) and the amoxicillin-clavulanic acid combination. Tests with beta-lactamase-producing isolates indicated that U-76,253A was bactericidal and that its MICs were only influenced by high inoculum concentrations (10(7) CFU/ml) against type Ia and IVc enzyme-producing strains. Preliminary disk diffusion interpretive zone criteria were calculated for 10- and 30-micrograms U-76,253A disks and several possible susceptible MIC breakpoints. The absolute interpretive agreement between MICs and zone diameters ranged from 87.8 to 95.6%. Final selection of interpretive criteria awaits further U-76,252 pharmacokinetic information.
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Affiliation(s)
- R N Jones
- Clinical Microbiology Institute, Tualatin, Oregon 97062
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15
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Jones RN, Barry AL. Disk diffusion susceptibility testing for LY163892 (KT-3777), a new orally administered 1-carbacephem. J Clin Microbiol 1988; 26:770-3. [PMID: 3259247 PMCID: PMC266445 DOI: 10.1128/jcm.26.4.770-773.1988] [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: 01/04/2023] Open
Abstract
LY163892, a new orally administered 1-carbacephem, was found to have a spectrum of antimicrobial activity very similar to that of cefaclor. Diffusion tests with 30-micrograms LY163892 disks produced acceptable interpretive error rates with greater than or equal to 22 mm as the susceptibility zone diameter. This was required to reduce potential false-susceptibility results, particularly among Enterobacter spp. and Providencia stuartii: both species included strains that produce beta-lactamases capable of hydrolyzing Ly163892. Preliminary recommendations for LY163892 disk tests are presented, but the continued use of the 30-micrograms cephalothin "class representative" disk might be the best procedure to minimize LY163892 interpretive errors for clinical trials. A separate LY163892 disk for testing Haemophilus influenzae strains should be seriously considered.
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Affiliation(s)
- R N Jones
- Clinical Microbiology Institute, Tualatin, Oregon 97062
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16
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Antimicrobial activity, spectrum and pharmacokinetics of old and new orally administered cephems. ACTA ACUST UNITED AC 1988. [DOI: 10.1016/0738-1751(88)90015-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Jones RN, Barry AL. Disk diffusion susceptibility testing and broth microdilution quality control guidelines for BMY-28100, a new orally administered cephalosporin. J Clin Microbiol 1987; 25:2211-3. [PMID: 3121667 PMCID: PMC269444 DOI: 10.1128/jcm.25.11.2211-2213.1987] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The BMY-28100 30-micrograms-disk test was evaluated by using 615 clinical isolates. Regression analyses and error rates were determined, leading to the recommendation of greater than or equal to 18-mm zone diameters (MIC correlate, greater than or equal to 8.0 micrograms/ml) for susceptibility and less than or equal to 14-mm zone diameters (MIC correlate, greater than or equal to 32 micrograms/ml) for resistance. Nearly all false-susceptible disk test results were among the Providencia spp. and the beta-lactamase-positive Haemophilus influenzae strains. Susceptibility disk test results for these species should be interpreted with caution. The following broth microdilution MIC quality control guidelines were determined from results of a multilaboratory trial: Escherichia coli ATCC 25922, 1.0 to 4.0 micrograms/ml; Enterococcus faecalis ATCC 29212, 4.0 to 16 micrograms/ml; Staphylococcus aureus ATCC 29213, 0.25 to 1.0 microgram/ml; and Pseudomonas aeruginosa ATCC 27853, greater than 32 micrograms/ml.
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Affiliation(s)
- R N Jones
- Clinical Microbiology Institute, Tualatin, Oregon 97062
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