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Karas JA, Carter GP, Howden BP, Turner AM, Paulin OKA, Swarbrick JD, Baker MA, Li J, Velkov T. Structure–Activity Relationships of Daptomycin Lipopeptides. J Med Chem 2020; 63:13266-13290. [DOI: 10.1021/acs.jmedchem.0c00780] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- John A. Karas
- Department of Pharmacology & Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Glen P. Carter
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Benjamin P. Howden
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Adrianna M. Turner
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Olivia K. A. Paulin
- Department of Pharmacology & Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - James D. Swarbrick
- Department of Pharmacology & Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Mark. A. Baker
- Priority Research Centre in Reproductive Science, School of Environmental and Life Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jian Li
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| | - Tony Velkov
- Department of Pharmacology & Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
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Abstract
OBJECTIVE To review the literature concerning the first Food and Drug Administration-approved lipopeptide antimicrobial, daptomycin. DATA SOURCES A PUBMED search was conducted to identify pertinent English-language journal articles between 1985 and November 2003, and additional references were obtained from the bibliographies of these articles. Abstracts from the Interscience Conference on Antimicrobial Agents and Chemotherapy meetings from 1985 through 2003 also were reviewed. STUDY SELECTION All studies evaluating any aspect of daptomycin. DATA SYNTHESIS Daptomycin is a semisynthetic lipopeptide, the first such antimicrobial agent to reach the marketplace. Its mechanism of action differs from that of the related agent vancomycin in that much of its effect is not because of inhibition of peptidoglycan biosynthesis, but instead is a result of alterations in cell-membrane electrical charge and transport. It exhibits a broad spectrum of activity against gram-positive aerobes and anaerobes, including methicillin-, penicillin-, aminoglycoside-, and vancomycin-resistant strains. In subjects with normal renal function, the terminal disposition half-life is about 7 to 10 hours. It is principally eliminated as unchanged drug in the urine. Available clinical trial data demonstrate efficacy in complicated skin and skin-structure infections resulting from susceptible gram-positive pathogens, but not in pneumonia. The principal adverse event of concern, although rare, is myotoxicity, manifested by muscle pain and/or weakness and elevated serum creatine phosphokinase (CPK) concentrations. The approved dosage regimen is 4 mg/kg intravenously over 30 minutes once daily for 7 days to 14 days. Studies are underway evaluating doses of up to 8 mg/kg once daily. CONCLUSIONS Daptomycin, the first lipopeptide antimicrobial to be marketed, exhibits activity against multiresistant gram-positive pathogens, including linezolid- and quinupristindalfopristin-resistant strains. As such, it is a potentially valuable agent to treat infections resulting from such pathogens. To preserve its utility, it should not be used indiscriminately for infections resulting from pathogens sensitive to other antimicrobials. It is probably best used with restricted access and used only for multiresistant gram-positive pathogens where alternative agents cannot be employed. If used, careful monitoring for the signs and symptoms of myotoxicity, including obtaining weekly serum CPK levels, is mandatory. In addition, bacterial sensitivities to this agent should be prospectively monitored by national antimicrobial surveillance programs like SENTRY, TRUST, and LIBRA.
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Affiliation(s)
- David R P Guay
- Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.
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Abstract
Daptomycin is a lipopeptide antibiotic with activity against a wide range of gram-positive bacteria. We used the neutropenic murine thigh model to characterize the pharmacodynamics of daptomycin. ICR/Swiss mice were rendered neutropenic with cyclophosphamide; and the thigh muscles of the mice were infected with strains of Staphylococcus aureus, Streptococcus pneumoniae, and Enterococcus faecium. Animals were treated by subcutaneous injection of daptomycin at doses of 0.20 to 400 mg/kg of body weight/day divided into one, two, four, or eight doses over 24 h. Daptomycin exhibited linear pharmacokinetics, with an area under the concentration-time curve (AUC) from time zero to infinity/dose of 9.4 and a half-life of 0.9 to 1.4 h. The level of protein binding was 90%. Free daptomycin exhibited concentration-dependent killing and produced in vivo postantibiotic effects (PAEs) of 4.8 to 10.8 h. Nonlinear regression analysis was used to determine which pharmacokinetic (PK) or pharmacodynamic (PD) parameter was important for efficacy by using free drug concentrations. The peak concentration/MIC (peak/MIC) ratio and 24-h AUC/MIC ratio were the PK and PD parameters that best correlated with in vivo efficacy (R(2) = 83 to 87% for peak/MIC and R(2) = 86% for the AUC/MIC ratio, whereas R(2) = 47 to 50% for the time that the concentration was greater than the MIC) against standard strains of S. aureus and S. pneumoniae. The peak/MIC ratios required for a bacteriostatic effect ranged from 12 to 36 for S. pneumoniae, 59 to 94 for S. aureus, and 0.14 to 0.25 for E. faecium. The AUC/MIC ratios needed for a bacteriostatic effect ranged from 75 to 237 for S. pneumoniae, 388 to 537 for S. aureus, and 0.94 to 1.67 for E. faecium. The free daptomycin concentrations needed to average from one to two times the MIC over 24 h to produce a bacteriostatic effect and two to four times the MIC over 24 h to produce greater than 99% killing. The long PAE and potent bactericidal activity make daptomycin an attractive option for the treatment of infections caused by gram-positive bacteria.
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Affiliation(s)
- Nasia Safdar
- Department of Medicine, Section of Infectious Diseases, University of Wisconsin, Madison 53792, USA.
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Schentag JJ, Meagher AK, Forrest A. Fluoroquinolone AUIC Break Points and the Link to Bacterial Killing Rates Part 2: Human Trials. Ann Pharmacother 2003; 37:1478-88. [PMID: 14519053 DOI: 10.1345/aph.1c419] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review clinical trials with fluoroquinolones and the pharmacokinetic and pharmacodynamic parameters predictive of clinical and microbiologic outcomes and resistance. Data on fluoroquinolones are summarized and the premise that a single AUIC target >125 may be used for all fluoroquinolones against all target organisms is examined. DATA SOURCES Primary articles were identified by a MEDLINE search (1966-February 2002) and through secondary sources. STUDY SELECTION AND DATA EXTRACTION All of the articles identified from the data sources were evaluated and all information deemed relevant was included. DATA SYNTHESIS The fluoroquinolones exhibit concentration-dependent killing. This effect clearly depends upon concentrations achieved and outcomes depend upon endpoints established by individual investigators. With AUIC values <60, the actions of fluoroquinolones are essentially bacteriostatic; any observed bacterial killing is the combined effect of low concentrations in relation to minimum inhibitory concentration and the action of host factors such as neutrophils and macrophages. AUIC values >100 but <250 yield bacterial killing at a slow rate, but usually by day 7 of treatment. AUICs >250 produce rapid killing, and bacterial eradication occurs within 24 hours. Disagreements regarding target endpoints are the expected consequences of comparing microbial and clinical outcomes across animal models, in vitro experiments (Part 1), and humans when the endpoints are clearly not equivalent. Careful attention to time-related events such as speed of bacterial killing versus global endpoints such as bacteriologic cure allows optimal break points to be defined. CONCLUSIONS Evidence from human trials favors the use of AUIC values >250 for rapid bactericidal action, regardless of whether the organism is gram-negative or gram-positive.
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Restrepo MI, Velez JA, McElmeel ML, Whitney CG, Jorgensen JH. Activity of daptomycin against recent North American isolates of Streptococcus pneumoniae. Antimicrob Agents Chemother 2003; 47:2974-7. [PMID: 12937005 PMCID: PMC182621 DOI: 10.1128/aac.47.9.2974-2977.2003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Daptomycin MICs at which 50% of isolates were inhibited (MIC(50)s) and MIC(90)s determined by the NCCLS broth microdilution method were both 0.25 microg/ml (range, 0.06 to 2 microg/ml) for 350 pneumococcal isolates. MICs determined by E test strips on commercially prepared Mueller-Hinton sheep blood agars with different calcium contents were 2 to 3 dilutions higher than those determined by strips that contained daptomycin plus calcium. Daptomycin zone diameters varied little on the same media.
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Affiliation(s)
- M I Restrepo
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas 78229, USA
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Ziglam HM, Finch RG. Limitations of presently available glycopeptides in the treatment of Gram-positive infection. Clin Microbiol Infect 2002; 7 Suppl 4:53-65. [PMID: 11688535 DOI: 10.1046/j.1469-0691.2001.00059.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The glycopeptide antibacterial drugs vancomycin and teicoplanin are widely used in hospitals for therapy of severe or multiresistant Gram-positive infections, notably staphylococcal, enterococcal and rarely pneumococcal. Vancomycin has also been used in the management of Clostridium difficile enteropathy. The incidence and potential for resistance differ between agents. The in vitro activity, pharmacokinetics and clinical use of glycopeptide, as well as epidemiology of glycopeptide resistance are discussed. There are limited comparative studies indicating the need for further investigation. Therapeutic drug monitoring has been widely used for vancomycin and less commonly for teicoplanin, but remains controversial. Advances in our understanding of their pharmacodynamics and clinical studies are helping clarify the situation. This paper reviews the current literature and highlights limitations of glycopeptides in treating Gram-positive infection.
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Affiliation(s)
- H M Ziglam
- The City Hospital and University of Nottingham, UK
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Fuchs PC, Barry AL, Brown SD. Daptomycin susceptibility tests: interpretive criteria, quality control, and effect of calcium on in vitro tests. Diagn Microbiol Infect Dis 2000; 38:51-8. [PMID: 11025184 DOI: 10.1016/s0732-8893(00)00164-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Daptomycin MICs were determined for 844 Gram-positive bacteria in three concentrations of Ca(++) and compared with the MICs of vancomycin and teicoplanin. Daptomycin was twofold to fourfold more active against most species when tested in 50 microg/ml of Ca(++) than in 25 microg/ml. In 50 microg/ml of Ca(++) daptomycin was more active against methicillin-resistant staphylococci and vancomycin-resistant enterococci than teicoplanin or vancomycin; 100% of these isolates were susceptible to < or =2.0 microg/ml of daptomycin. Different lots of Mueller-Hinton agar were variable in Ca(++) content, and daptomycin disk diffusion zone diameters were affected, i.e., zones were 1 to 15 mm smaller on one lot of agar with only 6 microg/ml of Ca(++) compared to another lot with 28 microg/ml. The previously proposed daptomycin interpretive breakpoints performed satisfactorily when MICs were determined in Mueller-Hinton broth with 50 microg/ml of Ca(++) and when the agar gave appropriate zones with quality control strains. To define those control limits, replicate tests with four quality control strains were performed in ten laboratories using broth microdilution tests (with Ca(++) supplemented broth) and disk diffusion tests on Mueller-Hinton agar without cation adjustments.
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Affiliation(s)
- P C Fuchs
- The Clinical Microbiology Institute, 9725 SW Commerce Circle, Wilsonville, OR 97070, USA.
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Bouza E, Muñoz P. Penicillin-resistant pneumococci in adult disease with special reference to AIDS patients. Microb Drug Resist 2000; 1:9-28. [PMID: 9156380 DOI: 10.1089/mdr.1995.1.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas-HIV, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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9
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Appelbaum PC. New prospects for antibacterial agents against multidrug-resistant pneumococci. Microb Drug Resist 2000; 1:43-8. [PMID: 9156383 DOI: 10.1089/mdr.1995.1.43] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Since the first description of penicillin-resistant pneumococci nearly 30 years ago, drug-resistance has become widespread throughout the world. This review focuses upon the in vitro susceptibility of penicillin-susceptible and -resistant pneumococci to new and existing agents.
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Affiliation(s)
- P C Appelbaum
- Department of Pathology, Hershey Medical Center, PA 17033, USA
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Davies TA, Pankuch GA, Dewasse BE, Jacobs MR, Appelbaum PC. In vitro development of resistance to five quinolones and amoxicillin-clavulanate in Streptococcus pneumoniae. Antimicrob Agents Chemother 1999; 43:1177-82. [PMID: 10223932 PMCID: PMC89129 DOI: 10.1128/aac.43.5.1177] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The ability of 50 sequential subcultures in subinhibitory concentrations of ciprofloxacin, levofloxacin, grepafloxacin, sparfloxacin, trovafloxacin, and amoxicillin-clavulanate to select for resistance was studied for six penicillin-susceptible and four penicillin-intermediate pneumococci. Subculturing in ciprofloxacin, grepafloxacin, levofloxacin, and sparfloxacin led to selection of mutants requiring increased MICs for all 10 strains, with MICs rising from (i) 0.5 to 4.0 to (ii) 4.0 to 32.0 microgram/ml after 7 to 12 passages for ciprofloxacin, from (i) 0.06 to 0.25 to (ii) 0.5 to 8.0 microgram/ml after 5 to 23 passages for grepafloxacin, from (i) 0.5 to 1.0 to (ii) 4.0 to 64 microgram/ml after 14 to 49 passages for levofloxacin, and from (i) 0.125 to 0.25 to (ii) 1.0 to 16.0 microgram/ml after 8 to 26 passages for sparfloxacin. Subculturing in trovafloxacin led to increased MICs for eight strains, with MICs rising from (i) 0.06 to 0.125 to (ii) 0.5 to 8.0 microgram/ml after 6 to 28 passages. Subculturing in amoxicillin-clavulanate led to raised MICs for only one strain, with the MIC rising from 0.015 to 0. 125 microgram/ml after 24 passages. Double mutations in both ParC and GyrA led to high-level quinolone resistance when ParC mutations were at S79. Trovafloxacin MICs were 1 to 2 microgram/ml in double mutants with ParC mutations at positions other than S79 (e.g., D83). Mutations in ParE (at D435, R447, and E474) and GyrB (at S405, D406, and D435) were found in four and six mutants, respectively. In the presence of reserpine, 29 mutants had lower ciprofloxacin MICs (2 to 16 times lower), 8 mutants had lower levofloxacin MICs (2 times), and one mutant had a lower trovafloxacin MIC (2 times), suggesting the involvement of an efflux mechanism. In contrast to the case for quinolones, subculturing in the presence of amoxicillin-clavulanate did not select for resistance to this drug.
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Affiliation(s)
- T A Davies
- Department of Pathology (Clinical Microbiology), Hershey Medical Center, Hershey, Pennsylvania 17033, USA
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Streptococcus pneumoniae: Activity of Newer Agents Against Penicillin-Resistant Strains. Curr Infect Dis Rep 1999; 1:13-21. [PMID: 11095761 DOI: 10.1007/s11908-999-0004-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Strains of pneumococci resistant to antimicrobial agents have been reported on all continents. In 1997, more than 50% of strains in the United States were not susceptible to penicillin, and 30% were resistant to macrolides. In addition, many strains are resistant to multiple agents, including beta-lactams, macrolides, clindamycin, chloramphenicol, tetracyclines, and trimethoprim-sulfamethoxazole. Although resistance to beta-lactams in nonmeningeal infections can usually be overcome by parenteral administration, clinically significant resistance is an important limitation in meningitis and with oral administration of beta-lactams. Decisions about treatment of pneumococcal infection are based on the site of infection, the degree of resistance to penicillin G, the presence of resistance to other agents, the severity of disease, the presence of underlying conditions, and the dose and route of administration of antimicrobial agents. The application of pharmacokinetic and pharmacodynamic variables to pneumococci has greatly improved the interpretation of susceptibility data and the development of clinically relevant breakpoints.
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Chiou CC, Liu YC, Huang TS, Hwang WK, Wang JH, Lin HH, Yen MY, Hsieh KS. Extremely high prevalence of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae among children in Kaohsiung, Taiwan. J Clin Microbiol 1998; 36:1933-7. [PMID: 9650939 PMCID: PMC104955 DOI: 10.1128/jcm.36.7.1933-1937.1998] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/1997] [Accepted: 03/30/1998] [Indexed: 02/08/2023] Open
Abstract
Resistance (intermediate and high) to penicillin among Streptococcus pneumoniae strains is an emerging problem worldwide. From 1995 to 1997, isolates of S. pneumoniae not susceptible to penicillin were seen with increasing frequency from blood, cerebrospinal fluid, pleural fluid, and middle ear fluid from pediatric patients at the Veterans General Hospital-Kaohsiung. To determine the prevalence of carriage of these penicillin-nonsusceptible S. pneumoniae isolates, we obtained nasopharyngeal swab specimens from 2,905 children (ages, 2 months to 7 years) attending day-care centers or kindergartens or seen in our outpatient clinic. S. pneumoniae was isolated from 611 children, and 584 strains were available for analysis. The oxacillin disc test was used as a screening test to evaluate penicillin susceptibility. The MICs of 11 antibiotics (penicillin, cefaclor, cefuroxime, ceftriaxone, cefotaxime, imipenem, chloramphenicol, clarithromycin, rifampin, vancomycin, and teicoplanin) were determined by the E-test. Only 169 (29%) of the strains were susceptible to penicillin; 175 (30%) strains were intermediately resistant and 240 (41%) were highly resistant. The isolates also demonstrated high rates of resistance to other beta-lactams (46% were resistant to cefaclor, 45% were resistant to cefuroxime, 45% were resistant to ceftriaxone, 31% were resistant to cefotaxime, and 46% were resistant to imipenem). The rate of resistance to macrolide antimicrobial agents was strikingly high; 95% of the isolates were not susceptible to clarithromycin. However, 97% were susceptible to rifampin and 100% were susceptible to the two glycopeptides (vancomycin and teicoplanin). While reports of penicillin-resistant S. pneumoniae increased worldwide through the 1980s, the high prevalence (71%) of resistance reported here is astonishing. Surveillance of nasopharyngeal swab specimen cultures may provide useful information on the prevalence of nonsusceptible strains causing invasive disease. Such information could be used to guide therapy of pneumococcal infections.
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Affiliation(s)
- C C Chiou
- Department of Pediatrics and Section of Microbiology, Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
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Barakett V, Lesage D, Delisle F, Richard G, Petit JC. Bactericidal effect of sparfloxacin alone and in combination with amoxicillin against Streptococcus pneumoniae as determined by kill-kinetic studies. Infection 1996; 24:22-5. [PMID: 8852458 DOI: 10.1007/bf01780645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ten clinical isolates of Streptococcus pneumoniae (six intermediately penicillin-sensitive, one penicillin-resistant and three penicillin-sensitive strains) were studied by kill-kinetic experiments using sparfloxacin alone and in combination with amoxicillin. Equipotent doses of the antibiotics (1x, 2x and 4x the MIC) were used in the kill-kinetic studies. Sparfloxacin had a moderate bactericidal potential at 4x MIC after 5h and the combination with amoxicillin did not significantly increase its bactericidal activity. The clinical significance of these findings warrants further studies in vivo.
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Affiliation(s)
- V Barakett
- Laboratoire de Bactériologie-Virologie, Hôpital St. Antoine, Paris, France
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Abstract
Teicoplanin, a new glycopeptide antibiotic similar to vancomycin, has proved effective in the treatment of various gram-positive infections in both the normal and the immunocompromised host. In vitro activity against most gram-positive organisms is equal to or greater than that of vancomycin. In both open and comparative clinical trials, teicoplanin has been well tolerated, rarely prompting discontinuation of treatment. Nephrotoxicity caused by teicoplanin is uncommon, even when used concomitantly with aminoglycosides or cyclosporin A. Favorable pharmacokinetics allow for intramuscular administration as well as intravenous bolus dosing, and, after appropriate loading doses, maintenance therapy may be given on a once-daily basis. The combination of all of these factors makes teicoplanin an effective, safe alternative to vancomycin in the treatment of gram-positive infections.
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Affiliation(s)
- K W Shea
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, USA
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Activity of vancomycin, teicoplanin and cephalosporins against penicillin-susceptible and penicillin-intermediate Streptococcus pneumoniae. Can J Infect Dis 1995; 6:83-7. [PMID: 22416208 DOI: 10.1155/1995/725654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/1994] [Accepted: 12/02/1994] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To report in vitro susceptibilities of penicillin-susceptible and penicillin-intermediate Streptococcus pneumoniae isolates to cephalosporins, vancomycin and teicoplanin. DESIGN Minimal inhibitory concentrations (mic) were determined according to National Committee for Clinical Laboratory Standards guidelines for 17 penicillin-susceptible isolates (mic 0.06 mg/L or less) and 16 isolates showing intermediate susceptibility to penicillin (mic 0.12 to 1.0 mg/L). SETTING Tertiary care university centre. MAIN RESULTS Comparison of the mic(90) values with those of other antibiotics tested demonstrated that ceftriaxone, cefotaxime and teicoplanin were the most active agents against penicillin-susceptible strains. However, teicoplanin had the lowest mic and was superior to other agents against strains with intermediate penicillin susceptibility. The mics of all cephalosporins increased in concordance with the mic of penicillin. CONCLUSION Isolates demonstrating intermediate susceptibility or resistance to penicillin should be routinely evaluated for susceptibility to clinically important cephalosporins.
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Goldstein FW, Geslin P, Acar JF. Comparative activity of teicoplanin and vancomycin against 400 penicillin susceptible and resistant Streptococcus pneumoniae. The French Study Group. Eur J Clin Microbiol Infect Dis 1994; 13:33-4. [PMID: 8168558 DOI: 10.1007/bf02026121] [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]
Abstract
The MICs of teicoplanin and vancomycin were determined for 400 penicillin-susceptible and -resistant strains of Streptococcus pneumoniae isolated during a multicenter study in 1992. Teicoplanin displayed a four-fold better activity than vancomycin, with modal MICs of these agents being 0.06 and 0.25 micrograms/ml, respectively. These data warrant further studies with teicoplanin in the treatment of pneumococcal infections.
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Affiliation(s)
- F W Goldstein
- Hôpital Saint-Joseph, Laboratoire de Microbiologie Médicale, Paris, France
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Klugman KP. Activity of teicoplanin and vancomycin against penicillin-resistant pneumococci. Eur J Clin Microbiol Infect Dis 1994; 13:1-2. [PMID: 8168552 DOI: 10.1007/bf02026115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Caputo GM, Singer M, White S, Weitekamp MR. Infections due to antibiotic-resistant gram-positive cocci. J Gen Intern Med 1993; 8:626-34. [PMID: 8289105 DOI: 10.1007/bf02599723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Gram-positive cocci are becoming increasingly resistant to traditionally used antimicrobial agents. Staphylococcus aureus, coagulase-negative staphylococci, the enterococcus, and Streptococcus pneumoniae are the most commonly encountered of such pathogens in clinical practice. Clinicians should be keenly aware of the usual types of infections that are caused by these organisms and the importance of documenting susceptibilities of infecting strains. The basic mechanisms of resistance should be familiar to clinicians so that an inappropriate empiric regimen will not be selected (e.g., addition of a beta-lactamase inhibitor for penicillin-resistant pneumococci). Vancomycin remains the agent of choice, sometimes in combination with gentamicin and/or rifampin, for most cases of infection due to these resistant gram-positive organisms. Last, increased efforts toward prevention, such as strict adherence to infection control measures, selective use of broad-spectrum antibiotics, and increased use of pneumococcal vaccine, may be useful to help stem the rising tide of infections due to resistant gram-positive cocci.
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Affiliation(s)
- G M Caputo
- Department of Medicine, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey 17033
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Friedland IR, Paris M, Ehrett S, Hickey S, Olsen K, McCracken GH. Evaluation of antimicrobial regimens for treatment of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis. Antimicrob Agents Chemother 1993; 37:1630-6. [PMID: 8215275 PMCID: PMC188032 DOI: 10.1128/aac.37.8.1630] [Citation(s) in RCA: 182] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The most appropriate therapy for meningitis caused by Streptococcus pneumoniae strains resistant to the extended-spectrum cephalosporins is unknown. We evaluated ceftriaxone, vancomycin, and rifampin alone and in different combinations and meropenem, cefpirome, and clinafloxacin alone in the rabbit meningitis model. Meningitis was induced in rabbits by intracisternal inoculation of one of two pneumococcal strains isolated from infants with meningitis (ceftriaxone MICs, 4 and 1 microgram/ml, respectively). Two doses, 5 h apart, of each antibiotic were given intravenously (except that ceftriaxone was given as one dose). Cerebrospinal fluid bacterial concentrations were measured at 0, 5, 10, and 24 h after therapy was started. Clinafloxacin was the most active single agent against both strains. Against the more resistant strain, ceftriaxone or meropenem alone was ineffective. The combination of vancomycin and ceftriaxone was synergistic, suggesting that this combination might be effective for initial empiric therapy of pneumococcal meningitis until results of susceptibility studies are available.
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Affiliation(s)
- I R Friedland
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas 75235-9063
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Barakett V, Lesage D, Delisle F, Vergez P, Petit JC. Killing kinetics of vancomycin and rifampin tested alone and in combination against penicillin-resistant Streptococcus pneumoniae. Eur J Clin Microbiol Infect Dis 1993; 12:69-71. [PMID: 8462570 DOI: 10.1007/bf01997066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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22
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Spangler SK, Jacobs MR, Appelbaum PC. Susceptibilities of penicillin-susceptible and -resistant strains of Streptococcus pneumoniae to RP 59500, vancomycin, erythromycin, PD 131628, sparfloxacin, temafloxacin, win 57273, ofloxacin, and ciprofloxacin. Antimicrob Agents Chemother 1992; 36:856-9. [PMID: 1323956 PMCID: PMC189460 DOI: 10.1128/aac.36.4.856] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The MICs of four new quinolones, sparfloxacin (AT-4140, CI-978), PD 131628 (the active form of the prodrug CI-990), temafloxacin, and Win 57273, compared with those of ciprofloxacin and ofloxacin were tested against 53 penicillin-susceptible, 35 penicillin intermediate-resistant, and 51 penicillin-resistant pneumococci. Susceptibility to RP 59500, a new streptogramin, was also tested and compared with those to the quinolones, erythromycin, and vancomycin. All MICs were determined by a standardized agar dilution method by using Mueller-Hinton agar supplemented with sheep blood. Quinolone, vancomycin, and RP 59500 susceptibilities were not affected by susceptibility or resistance to penicillin. For Win 57273, the MICs for 50% (MIC50) and 90% (MIC90) of strains tested were 0.015 and 0.03 micrograms/ml, respectively. MIC50S of both sparfloxacin and PD 131628 were 0.25 micrograms/ml, and MIC90S were 0.5 micrograms/ml. The MIC50 of temafloxacin was 0.5 micrograms/ml, and the MIC90 was 1.0 micrograms/ml. By comparison, ofloxacin and ciprofloxacin both yielded MIC50S of 1.0 micrograms/ml and MIC90s of 2.0 micrograms/ml. RP 59500 yielded an MIC50 of 0.5 microgram/ml and an MIC90 of 1.0 microgram/ml and was only 1 doubling dilution less active against 17 erythromycin-resistant strains. Vancomycin was active against all strains (MIC50, 0.25 microgram/ml; MIC90, 0.5 microgram/ml). All four experimental quinolones as well as RP 59500 show promise for therapy of infections with penicillin-resistant and -susceptible pneumococci.
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Affiliation(s)
- S K Spangler
- Department of Pathology (Clinical Microbiology), Hershey Medical Center, Pennsylvania 17033
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23
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Infections respiratoires dues aux pneumocoques résistants : expérience clinique et difficultés thérapeutiques. Med Mal Infect 1992. [DOI: 10.1016/s0399-077x(05)81455-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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24
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JENSEN KJELDTRUBERG, SCHØNHEYDER HENRIK, PERS CHARLOTTE, THOMSEN VILLYFRØLUND. In vitroactivity of teicoplanin and vancomycin against Grampositive bacteria from human clinical and veterinary sources. APMIS 1992. [DOI: 10.1111/j.1699-0463.1992.tb00909.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Abstract
The relationship of virulence and antimicrobial susceptibility with morbidity due to bacterial respiratory pathogens is complex and evolving. Ultimately, decreasing the incidence of pneumonia due to bacterial pathogens will be dependent on successful preparation and distribution of effective vaccines. Until effective vaccines are widely available, control of a majority of respiratory infections will depend on promotion of rational therapeutic strategies. Though limited to a few specific serotypes and strains, changes in virulence of bacterial respiratory pathogens have been noted. Co-infections due to multiple respiratory pathogens may increase morbidity; however, the epidemiology of co-infections is not clear. Relationships between respiratory viruses and bacteria may exist that increase virulence of both agents, but information regarding these relationships awaits further investigation. Resistance of respiratory pathogens to the more commonly used antimicrobials, such as penicillin, erythromycin, chloramphenicol, and cotrimoxazole, is being documented globally with increasing frequency. The evolution of antimicrobic resistance, especially among strains of Streptococcus pneumoniae, the most common and deadly agent of lower respiratory tract infections, provides impetus to develop and promote effective pneumococcal vaccines and to search for new and effective antimicrobials.
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Affiliation(s)
- R R Facklam
- Respiratory Diseases Branch, National Center for Infectious Diseases, Atlanta, Georgia 30333
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26
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Abstract
Ofloxacin is a fluoroquinolone whose primary mechanism of action is inhibition of bacterial DNA gyrase. In vitro it has a broad spectrum of activity against aerobic Gram-negative and Gram-positive bacteria, although it is poorly active against anaerobes. Ofloxacin, unlike most other broad spectrum antibacterial drugs, can be administered orally as well as intravenously. Penetration into body tissues and fluids is highly efficient. Clinical trials with orally and intravenously administered ofloxacin have confirmed its potential for use in a wide range of infections, where it has generally proved as effective as standard treatments. Ofloxacin in well tolerated, and in comparison with other available fluoroquinolones is less likely to cause clinically relevant drug interactions. Ofloxacin thus offers a valuable oral treatment (with an option for intravenous administration if necessary) for use in a wide range of clinical infections, but with a particular advantage in more severe or chronic infections when recourse to parenteral broad spectrum agents would normally be required, thereby providing cost savings and additionally allowing outpatient treatment.
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Affiliation(s)
- P A Todd
- Adis International Limited, Auckland, New Zealand
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27
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Knothe H, Shah PM, Eckardt O. Cefpodoxime: comparative antibacterial activity, influence of growth conditions, and bactericidal activity. Infection 1991; 19:370-6. [PMID: 1800379 DOI: 10.1007/bf01645371] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The antimicrobial activity of cefpodoxime, the active metabolite of the new cephalosporin ester cefpodoxime proxetil, in comparison to cefixime, cefotiam, cefuroxime, and cefotaxime was determined against a broad spectrum of freshly isolated gram-positive and gram-negative bacterial strains. Cefpodoxime was demonstrated to be inhibitory at concentrations of less than or equal to 1 mg/l against 90% of strains of Moraxella catarrhalis, Haemophilus influenzae, Escherichia coli (beta-lactamase- negative strains), Klebsiella spp., Serratia spp., Proteus mirabilis, Proteus vulgaris, Providencia spp., and Salmonella spp. This antimicrobial activity of cefpodoxime was generally superior to that of cefuroxime and similar to that of cefixime. Cefpodoxime was active at less than or equal to 1 mg/l against 50% of the members of beta-lactamase-producing Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Citrobacter spp., and Morganella morganii. Cefpodoxime proved to be highly inhibitory against group A, B, and G streptococci and Streptococcus pneumoniae (MIC90 less than 0.015 mg/l). The MICs of cefpodoxime and those of the other cephalosporins were less than 2 mg/l for greater than or equal to 90% of the strains of Staphylococcus aureus and Staphylococcus epidermidis, with the exception of cefixime which had no activity with MICs below 8 mg/l against these bacteria. Pseudomonas spp., Acinetobacter spp., and Enterococcus spp. were resistant to cefpodoxime. The antibacterial activity of cefpodoxime was only to a minor degree influenced by different growth conditions with the exception of high inoculum sizes against some beta-lactamase producing strains of gram-negative bacilli.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Knothe
- Klinikum der J. W. Goethe Universität, Frankfurt am Main, Germany
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28
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Abstract
Penicillin-resistant pneumococci were first reported in Australia in 1967 and appeared in the UK in 1976. Their prevalence is increasing but varies greatly worldwide. The mechanism of resistance lies in the alteration of penicillin-binding proteins. Penicillin-resistant strains are often also resistant to a variety of non-beta-lactam antibiotics. Many different serotypes have been found to be penicillin resistant, type 23 being the most common resistant serotype in the UK. Use of oxacillin discs is recommended for penicillin sensitivity testing, otherwise resistant isolates may escape detection. Treatment of infected patients depends on several factors including the degree of resistance of the infecting strain, the sensitivity to alternative agents and the achievable concentration of antibiotic at the site of the infection. Carriage of penicillin-resistant pneumococci is more common in children, especially the recently hospitalized and those recently exposed to antibiotics. Outbreaks of infection have occurred and various control measures have been suggested in attempts to limit the spread of resistant strains.
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Affiliation(s)
- K D Allen
- Department of Microbiology, Whiston Hospital, Prescot, Merseyside
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30
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Abstract
The geographic distribution of pneumococci resistant to one or more of the antibiotics penicillin, erythromycin, trimethoprim-sulfamethoxazole, and tetracycline appears to be expanding, and there exist foci of resistance to chloramphenicol and rifampin. Multiply resistant pneumococci are being encountered more commonly and are more often community acquired. Factors associated with infection caused by resistant pneumococci include young age, duration of hospitalization, infection with a pneumococcus of serogroup 6, 19, or 23 or serotype 14, and exposure to antibiotics to which the strain is resistant. At present, the most useful drugs for the management of resistant pneumococcal infections are cefotaxime, ceftriaxone, vancomycin, and rifampin. If the strains are susceptible, chloramphenicol may be useful as an alternative, less expensive agent. Appropriate interventions for the control of resistant pneumococcal outbreaks include investigation of the prevalence of resistant strains, isolation of patients, possible treatment of carriers, and reduction of usage of antibiotics to which the strain is resistant. The molecular mechanisms of penicillin resistance are related to the structure and function of penicillin-binding proteins, and the mechanisms of resistance to other agents involved in multiple resistance are being elucidated. Recognition is increasing of the standard screening procedure for penicillin resistance, using a 1-microgram oxacillin disk.
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Affiliation(s)
- K P Klugman
- Laboratory of Bacteriology and Immunology, Rockefeller University, New York, New York 10021
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31
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Mazzulli T, Simor AE, Jaeger R, Fuller S, Low DE. Comparative in vitro activities of several new fluoroquinolones and beta-lactam antimicrobial agents against community isolates of Streptococcus pneumoniae. Antimicrob Agents Chemother 1990; 34:467-9. [PMID: 2334158 PMCID: PMC171616 DOI: 10.1128/aac.34.3.467] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The in vitro susceptibilities of 551 community isolates of Streptococcus pneumoniae from the Canadian province of Ontario to several new fluoroquinolones and beta-lactam antimicrobial agents were determined by a broth microdilution technique. Eight (1.5%) of these isolates were moderately susceptible (MICs, greater than or equal to 0.12 and less than or equal to 1.0 microgram/ml) to penicillin; none was resistant. Temafloxacin, ciprofloxacin, and ofloxacin (MICs for 90% of strains tested, between 1 and 2 micrograms/ml) were the most active fluoroquinolones tested, and BMY-28100 (MIC for 90% of strains tested, 0.25 microgram/ml) was the most active of the new beta-lactams tested.
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Affiliation(s)
- T Mazzulli
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
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