In vitro activities of streptomycin and 11 oral antimicrobial agents against clinical isolates of Klebsiella rhinoscleromatis

Abstract

We tested in vitro the activities of streptomycin and tetracycline-antibiotics that have long been used to treat rhinoscleroma-as well as several newer oral agents by using 23 isolates of the causative organism KlebsieUla rhinosckeromatis. All isolates were inhibited by clinically achievable concentrations of trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, chloramphenicol, ciprofloxacin, cephalexin, cefuroxime, and cefpodoxime.Klebsiella rhinoscleromatis causes rhinoscleroma, a chronic granulomatous infection of the upper airways. This disease occurs sporadically in the United States (3,11,19); but it is endemic in parts of Europe, Africa, Central and South America, and southern Asia, where thousands of humans may be afflicted (12). Prolonged antimicrobial treatment is required to cure rhinoscleroma. Streptomycin in combination with tetracycline has long been regarded as the standard treatment (7, 10), although rifampin (7, 8) has more recently been found to be effective either by topical application or oral ingestion. Trimethoprim-sulfamethoxazole (TMP-SMX) (1, 7) has also been recommended, but this recommendation has been made in the absence of published clinical trials. Anecdotal reports describe the efficacy of expanded-spectrum cephalosporins (3). No systematic in vitro study of the antibiotic susceptibility of K rhinoscleromatis has been described for two decades, and the efficacies of more recently available antibiotics that are administered orally have not been reported. We examined the in vitro inhibitory and bactericidal activities of antimicrobial agents that have traditionally been used to treat rhinoscleroma as well as those of some newly available ones. Since prolonged treatment is required in treating this disease, we directed our study toward orally available antimicrobial agents.Twenty

Natural antibiotic susceptibility of Klebsiella pneumoniae, K. oxytoca, K. planticola, K. ornithinolytica and K. terrigena strains

“…All taxa were naturally resistant or intermediate to amoxicillin and ticarcillin, but sensitive to amoxicillin/clavulanate and cephalosporins. These ®ndings are consistent with data of Perkins et al [26] and Podschun and Ullmann [10]. Because of higher MIC values to all â-lactam agents it is likely that the strains included in the latter study showed an increased â-lactamase expression compared with strains in the present study.…”

Antimicrobial-resistant Klebsiella species isolated from free-range chicken samples in an informal settlement

“…Klebsiella rhinoscleromatis is normally sensitive to the majority of antibiotics that are active on Gram-negative bacteria except for penicillin, ampicillin and sulfonamide [14], with ciprofloxacin and rifampin the most effective antimicrobials [15]; in terms of efficacy/cost, the association of trimethoprim-sulfamethoxazole is the best compromise [7]. Botelho-Nevers et al .…”

Rhinoscleroma: eight Peruvian cases

“…In vitro, these bacteria are inhibited by clinically achievable concentrations of amoxicillin -clavulanate, chloramphenicol, trimethoprim -sulfamethoxazole, cephalosporins, streptomycin, tetracyclines and ciprofloxacin 32 . However, in vivo, antibiotics with demonstrated efficacy are streptomycin, doxycycline, tetracycline, rifampicin, second-and third-generation cephalosporin, sulfonamides, clofazimine, ciprofloxacin 11 and ofloxacin 31 .…”