Antimicrobial activity of subinhibitory concentrations of ciprofloxacin against Pseudomonas aeruginosa as determined by the killing curve method and the postantibiotic effect

An approach for the evaluation of synergy between antimicrobials

Synergy can be assessed by a variety of microbiological techniques. Mathematical modelling of synergy data can accomplish similar results and may provide more information than currently available techniques. In this study a combination of 1/4 MIC of aztreonam (AZTR) and 1 MIC of ciprofloxacin (CIPX) showed synergy against Pseudomonas aeruginosa in killing curve studies (based on the two log different criteria) at the end of 24 h. However, re-growth was always observed even when bactericidal concentrations of antibiotics were present. The surviving organisms showed a two-fold increase of MIC to CIPX after the studies and this resistance was not reversible. A mathematical model to quantitatively describe this observation is proposed.

Influence on Enterobacter cloacae metabolism, cell-surface hydrophobicity and motility of suprainhibitory concentrations of carbapenems

The impact of postantibiotic effect (PAE) of carbapenems (imipenem, meropenem) on the metabolism (biosynthesis of macromolecules, respiration), cell-surface hydrophobicity and motility of a clinical isolate of Enterobacter cloacae was examined. The metabolism was evaluated after 16 h and after 1 d of cultivation using 2x and 4x minimum inhibitory concentrations (MIC) of both antibiotics for the induction of PAE. Imipenem at 4 x MIC did not induce PAE. After a 16-h cultivation (in the postantibiotic phase of both carbapenems), inhibition of nucleosynthesis and protein synthesis was found; after a 1-d cultivation, during regrowth stimulation of mainly 14C-leucine incorporation was found. The presence of the exogenous intermediates of citrate cycle, viz. 2-oxoglutarate, increased the respiratory activity of the cells. The cell-surface hydrophobicity (evaluated by three methods--bacterial adhesion to hydrocarbon, nitrocellulose-filter test and salt-aggregation test) decreased after PAE of both carbapenems; meropenem was more effective. Motility (an important virulence factor) was inhibited in the postantibiotic phase of both carbapenems; the 4 x MIC caused a higher inhibition.

Postantibiotic effects of gentamicin and netilmicin on Serratia marcescens: effects on hydrophobicity and motility

The impact of postantibiotic effect (PAE) of aminoglycosides (gentamicin, netilmicin) on cell-surface hydrophobicity and motility of a clinical isolate Serratia marcescens was evaluated. For the induction of PAE 2x and 4xMIC concentrations of both antibiotics were used. Gentamicin and netilmicin induced a PAE of similar duration after 2xMIC concentration (2.7 and 2.8 h, respectively). Both aminoglycosides demonstrated concentration-dependent PAE. At a concentration of 4xMIC they produced PAEs of 5.9 and 8.2 h, respectively. The evaluation of hydrophobic properties of S. marcescens after affecting PAE showed that both aminoglycosides inhibited adherence to xylene. This inhibition was also concentration-dependent. More expressive was netilmicin which inhibited the adhesion by 70.5% at 2xMIC and by 85.2% at 4xMIC. Netilmicin inhibited also the adhesion to nitrocellulose filter by 34.7% at 4xMIC. Exposure of the bacterial cells to suprainhibitory concentrations of both aminoglycosides resulted only in moderate inhibition of motility of strain tested compared to the unexposed cells.

Characterization of the inoculum effect with Haemophilus influenzae and beta-lactams

An inoculum effect is defined as a four-fold or greater increase in MIC with an increase in bacterial inocula. Haemophilus influenzae was tested for an inoculum effect with ampicillin, cefuroxime, and amoxicillin/clavulanate using the standard initial inocula (5 x 10(5) CFU/mL) and a higher initial inocula (1 x 10(7) CFU/mL). An inoculum effect was observed with both beta-lactamase (TEM-1, ROB-1) positive and beta-lactamase negative strains of H. influenzae when MICs were determined based on turbidity. MICs based on viable cell counts however, demonstrated that only beta-lactamase positive strains of H. influenzae produced an inoculum effect. These observations suggest that MICs determined based on turbidity, using high initial inocula, are not reliable when examining the inoculum effect in H. influenzae. The magnitude of the inoculum effect with beta-lactamase positive strains was beta-lactam dependent (ampicillin > amoxicillin/clavulanate > cefuroxime). beta-lactam kill-curves confirmed the aforementioned results. Addition of the beta-lactamase inhibitor clavulanate completely reversed the inoculum effect in beta-lactamase (TEM-1 and ROB-1) positive strains of H. influenzae with all beta-lactams tested. Introduction of the beta-lactamase gene TEM-1 on plasmid vector pLS88 into a beta-lactamase negative strain of H. influenzae (Rd) produced an inoculum effect based on viable cell counts. In conclusion, our results suggest that the beta-lactam inoculum effect demonstrated by H. influenzae is the result of beta-lactamase production and is poorly assessed by turbidity.

Postantibiotic effects of imipenem and enoxacin against S. typhimurium and S. enteritidis and the influence on their surface hydrophobicity

The influence of the postantibiotic effect (PAE) and the postantibiotic sub-MICs effect (PA SME) of imipenem and enoxacin on the surface hydrophobicity of S. typhimurium and S. enteritidis strains were studied by evaluating Congo red binding and the aggregation in molar solutions of ammonium sulfate (SAT). A PAE was induced by 2x and 4 x MIC of antibiotics tested for 0.5 h. Suprainhibitory concentrations of imipenem against S. typhimurium induced a short PAE (0.3-0.6 h) compared to S. enteritidis (6.0-9.7 h). Suprasubinhibitory concentrations of imipenem did not allow a regrowth of S. enteritidis. Similar results were also found for enoxacin. Evaluation of surface hydrophobic properties of the salmonellas after affecting both PAEs and PA SMEs has shown that imipenem at concentrations 4 x MIC and 4 x MIC + 0.3 x MIC partially influenced the hydrophobicity of S. typhimurium. S. enteritidis was more susceptible toward both antibiotics tested.

Influence of the postantibiotic effect and postantibiotic sub-MICs effect of netilmicin, tobramycin, ciprofloxacin and pefloxacin on alginate production by Pseudomonas aeruginosa

The postantibiotic effect (PAE) (postantibiotic phase induced by 2x or 4x MIC) as well as the postantibiotic effect of subinhibitory concentrations (0.1x, 0.2x and 0.3x MIC) (PA SME) of netilmicin, tobramycin, ciprofloxacin and pefloxacin affected the production of the virulence factor alginate by a P. aeruginosa strain. Aminoglycosides and ciprofloxacin at a concentration of 4x MIC inhibited the alginate production more significantly than 2x MIC. Suprainhibitory concentrations of aminoglycosides were more effective than pefloxacin (2x or 4x MIC) and ciprofloxacin (2x MIC). PA SME demonstrated by the above antibiotics (with the exception of ciprofloxacin 2x MIC + 0.1x MIC) suppressed alginate production more efficiently.

Postantibiotic effects and postantibiotic sub-MIC effects of ciprofloxacin, pefloxacin and amikacin on the biological properties of Salmonella strains

The postantibiotic effect (PAE) and the postantibiotic sub-MIC effect (PASME) of ciprofloxacin, pefloxacin and amikacin were studied for Salmonella typhimurium and S. enteritidis strains. PAE was induced by 2 x and 4 x MIC of antibiotics studied for 0.5 h. After PAE and PASME their effect on prophage induction of a lysogenic S. typhimurium strain and on Congo red binding for both strains as a marker of their surface hydrophobicity was examined. The longest PAE was found after treatment with ciprofloxacin, higher values being observed with S. typhimurium. PAEs of pefloxacin and amikacin were much lower, except for the suprainhibitory concentration 4 x MIC of amikacin with S. enteritidis (6.9h). PASMEs of ciprofloxacin did not allow any regrowth of either strain. For other antibiotics the PASMEs were different while concentrations of 2 x MIC + 0.2 x MIC and 0.3 x MIC, and of 4 x MIC + 0.1 x MIC, 0.2 x MIC and 0.3 x MIC of amikacin did not allow any regrowth of S. enteritidis. PAEs of the antibiotics tested did not affect the Congo red binding by both Salmonella strains, but the PAEs of ciprofloxacin and pefloxacin expressively induced a prophage of lysogenic S. typhimurium strain. We noted the influence of Congo red binding after applying 4 x MIC + 0.1 x MIC, 0.2 x MIC and 0.3 x MIC of amikacin for S. typhimurium and 2 x MIC + 0.1 x MIC for S. enteritidis.

Postantibiotic effects of subinhibitory concentrations of some antibiotics and their influence on Pseudomonas aeruginosa enzymic activity

The postantibiotic effects of subinhibitory concentrations (PA SMEs) and virulence factor alterations induced by ciprofloxacin, tobramycin and netilmicin in Pseudomonas aeruginosa were studied. After induction of the postantibiotic phase (PA) (2x or 4x MIC) the cultures were exposed to subinhibitory concentrations (0.1, 0.2 and 0.3x MIC) of the same antibiotic (PA SME). The regrowth of treated as well as control cultures was followed for 24 or 45 h. In the sterile culture filtrates obtained from these bacterial cultures, elastase and proteinase were determined. Ciprofloxacin and aminoglycosides exhibited PA SMEs of 35-35 h for certain combinations of supra-subinhibitory antibiotic concentrations. Longer PA SMEs were observed after treatment with higher sub-MICs. Tobramycin at 0.2 and 0.3x MIC (postantibiotic phase induced by 2x MIC) and at alt sub-MICs added to the bacteria previously exposed to 4x MIC do not allow any regrowth of bacterial culture. PA SMEs of tested antibiotics affected virulence factors of P. aeruginosa. Elastase compared to proteinase was suppressed more effectively. Ciprofloxacin at 0.3x MIC reduced elastase and proteinase activity most significantly (to 14.2 and 60% of the control values).

Pharmacodynamic parameters of aminoglycosides and their effect on exoenzymes of Pseudomonas aeruginosa

Aminoglycosides at 2x or 4x minimum inhibitory concentration induced postantibiotic effects against Pseudomonas aeruginosa lasting 3.5-4.9 h (gentamicin) and 0.5-3.7 h (selemycin). Postantibiotic effects of subinhibitory concentrations of the aminoglycosides tested were substantially longer. Some combinations of supra- and subinhibitory concentrations of antibiotics did not even allow any regrowth of the bacterial strain. The postantibiotic effects and postantibiotic effects of subinhibitory concentrations of gentamicin and selemycin were associated with changes of P. aeruginosa elastase and proteinase. Combinations of supra- and subinhibitory concentrations more pronouncedly suppressed enzymic activities than did suprainhibitory concentrations alone.

Preclinical and clinical evaluation of once-daily aminoglycoside chemotherapy

The rationale for and effectiveness of extended dosage intervals for aminoglycosides are reviewed. Aminoglycoside antibiotics have a prolonged postantibiotic effect against a variety of common Gram-negative and Gram-positive organisms: higher serum aminoglycoside levels are associated with a longer postantibiotic effect and increased bactericidal activity. Moreover once daily aminoglycoside administration may reduce the potential for adaptive postexposure resistance by allowing less contact time between bacteria and antibiotic. A longer dosage interval may decrease the risk of nephro- and ototoxicity. At least 33 published clinical trials suggest that once-daily administration of aminoglycosides and conventional regimens involving shorter dosage intervals are equally effective in patients with normal renal function and Gram-negative infections: besides, once-daily administration may reduce the frequency of aminoglycoside toxicity or delay it.

Pharmacokinetic contributions to postantibiotic effects. Focus on aminoglycosides

The postantibiotic effect (PAE) refers to a period of time after complete removal of an antimicrobial during which there is no growth of the target organism. The PAE appears to be a feature of most antimicrobial agents and has been documented with a variety of common bacterial pathogens. Various factors influence the presence or duration of the PAE including the type of organism, type of antimicrobial, concentration of antimicrobial, duration of antimicrobial exposure, antimicrobial combinations, and inoculum and medium used. beta-Lactams demonstrate a PAE against Gram-positive cocci, but produce only a short PAE with Gram-negative bacilli. Antimicrobial agents that inhibit RNA or protein synthesis have a PAE against Gram-positive cocci and Gram-negative bacilli. In vivo studies of aminoglycosides suggest that area under the plasma concentration-time curve is the pharmacokinetic parameter that best correlates with clinical efficacy. This is thought to be due to the concentration-dependent killing and PAE possessed by these antimicrobials. Animal and human studies have reported that once-daily administration of aminoglycoside is as effective as, or more effective than, and possibly less toxic than traditional multiple daily administration.