Sch 22591 (5-episisomicin), gentamicin, sisomicin, and tobramycin were compared for their ability to protect mice from lethal intraperitoneal challenge with 12 Pseudomonas strains, all susceptible to each of the aminoglycosides (minimal inhibitory concentrations and minimal bactericidal concentrations were -6.2 ,ug/ml). Median 50% protective doses were 5.8, 6.4, 7.7, and 17.8 mg/kg for Sch 22591, tobramycin, sisomicin, and gentamicin, respectively. Those for Sch 22591 were significantly lower than gentamicin in five protection tests and significantly lower than both gentamicin and tobramycin in one test. Microbial analysis of the therapeutic effect indicated that protection from lethality by each of the four aminoglycosides was associated with either a complete eradication or a reduction in the number of challenge bacteria in both the heart blood and peritoneum. In rare instances, challenge isolates exhibiting decreased susceptibility to one or more of the aminoglycosides were recovered from animals. However, this in vivo selection of resistance did not appear related to either the aminoglycoside used in therapy or the outcome of therapy, and resistant isolates were recovered as frequently from untreated animals as from those receiving one of the four aminoglycosides.Sch 22591 (5-episisomicin) is a new semisynthetic aminoglycoside structurally similar to sisomicin. In vitro, Sch 22591 has been shown to possess greater activity than gentamicin, sisomicin, tobramycim, amikacin, netilmicin, or kanamycin against a variety of gram-positive and gram-negative organisms (5, 7). In vivo, Sch 22591 also appears to be more active than other aminoglycosides in the treatment of mice infected with Pseudomonas aeruginosa (7). In view of the greater activity of Sch 22591 over other aminoglycosides, studies were performed to evaluate this compound more extensively in vivo. These studies were designed to compare Sch 22591, sisomicin, gentamicin, and tobramycin for their ability to (i) protect mice lethally infected with a variety of Pseudomonas species, (ii) eradicate or reduce the number of the challenge bacteria in the heart blood and peritoneum of infected mice, and (iii) select aminoglycosideresistant bacteria in vivo.
MATERIALS AND METHODSChallenge strains. All strains were recent clinical isolates from St. Joseph Hospital or the Veterans Administration Hospital, Omaha, Nebr.Determination of virulence of challenge bacterial strains. Strains were grown for 16 h on brain heart infusion agar slants (Difco Laboratories). These cultures were used to inoculate Mueller-Hinton broth (Difco), which was then incubated with shaking at