Synergy of gatifloxacin with cefoperazone and cefoperazone-sulbactam against resistant strains of Pseudomonas aeruginosa

Fluoroquinolone-Transition Metal Complexes: A Strategy to Overcome Bacterial Resistance

Fluoroquinolones (FQs) are antibiotics widely used in the clinical practice due to their large spectrum of action against Gram-negative and some Gram-positive bacteria. Nevertheless, the misuse and overuse of these antibiotics has triggered the development of bacterial resistance mechanisms. One of the strategies to circumvent this problem is the complexation of FQs with transition metal ions, known as metalloantibiotics, which can promote different activity and enhanced pharmacological behaviour. Here, we discuss the stability of FQ metalloantibiotics and their possible translocation pathways. The main goal of the present review is to frame the present knowledge on the conjunction of biophysical and biological tools that can help to unravel the antibacterial action of FQ metalloantibiotics. An additional goal is to shed light on the studies that must be accomplished to ensure stability and viability of such metalloantibiotics. Potentiometric, spectroscopic, microscopic, microbiological, and computational techniques are surveyed. Stability and partition constants, interaction with membrane porins and elucidation of their role in the influx, determination of the antimicrobial activity against multidrug-resistant (MDR) clinical isolates, elucidation of the mechanism of action, and toxicity assays are described for FQ metalloantibiotics.

Synergy of drug combinations in treating multidrug-resistant Pseudomonas aeruginosa

BACKGROUND

With the emergence of metallo-betalactamases (MBL) in Pseudomonas aeruginosa (P. aeruginosa), the value of carbapenem, the drug of last resort, is being severely compromised. Curtailing the use of carbapenems becomes paramount if resistance is to be reined in.

AIMS

To study the role of synergy between combinations of drugs as an alternative treatment choice for P. aeruginosa. Synergy was studied between combinations of levofloxacin with piperacillin-tazobactam and levofloxacin with cefoperazone-sulbactam by time-kill and chequerboard techniques.

METHODS

P. aeruginosa were tested for antibiotic susceptibility by the disc diffusion assay (260 isolates) and E-test (60 isolates). Synergy testing by chequerboard and time-kill assays was performed with combinations of piperacillin-tazobactam with levofloxacin (11 isolates) and cefoperazone-sulbactam with levofloxacin (10 isolates).

RESULTS

Nearly all isolates were susceptible to piperacillin-tazobactam (96.1 per cent), followed by piperacillin (78.5 per cent). Seventy-one isolates (27.3 per cent) were found to be multidrug resistant and 19.6 per cent were ESBL producers. MIC50 of amikacin was 32μg/ml and MIC90 was 64μg/ml. MIC50 and MIC90 of cefoperazone-sulbactam was 32μg/ml and 64μg/ml, and for levofloxacin it was 10μg/ml and 240μg/ml, respectively. Piperacillin-tazobactam had MIC50 and MIC90 of 5μg/ml and 10μg/ml, respectively. Synergy was noted in 72.7 per cent isolates for levofloxacin and piperacillin-tazobactam combination, the remaining 27.3 per cent isolates showed addition by both chequerboard and time-kill assay. For levofloxacin and cefoperazone-sulbactam, only 30 per cent isolates had synergy, 40 per cent showed addition, 20 per cent indifference, and 10 per cent were antagonistic by the chequerboard method.

CONCLUSION

The combination of levofloxacin and piperacillin-tazobactam is a good choice for treatment of such strains.

UV spectrophotometric simultaneous determination of cefoperazone and sulbactam in pharmaceutical formulations by derivative, Fourier and wavelet transforms

Signal processing methods based on the use of derivative, Fourier and wavelet transforms were proposed for the spectrophotometric simultaneous determination of cefoperazone and sulbactam in powders for injection. These transforms were successfully applied to UV spectra and ratio spectra to find suitable working wavelengths. Wavelet signal processing was proved to have distinct advantages (i.e. higher peak intensity obtained, additional smooth function and scaling factor process eliminated) over derivative and Fourier transforms. Especially, a better resolution of spectral overlapping bands was obtained by the use of double signal transform in the sequences such as (i) spectra pre-processed by Fractional Wavelet Transform and subsequently subjected to Continuous Wavelet Transform or Discrete Wavelet Transform, and (ii) derivative - wavelet transforms combined. Calibration graphs for cefoperazone and sulbactam were recorded for the range 10-35 mg/L. Good accuracy and precision were reported for all proposed methods by analyzing synthetic mixtures of cefoperazone and sulbactam. Furthermore, these methods were statistically comparable to RP-HPLC.