Moxalactam therapy for a wide spectrum of bacterial infections in adults

Abstract

We evaluated the efficacy and toxicity of moxalactam during treatment of 45 documented infections in 36 patients. A majority of patients received 4.5 g of moxalactam per day. There was a good clinical response in 42 of the 45 (94%) infections, including 3 bacteremias, 20 skin and soft tissue infections, 6 gramnegative lower respiratory tract infections, 6 purulent diabetic foot ulcers, 3 wound infections, 3 urinary tract infections, and 4 miscellaneous infections (meningitis, suppurative phlebitis, peritonitis, bursitis). Previously, 11 of these patients had failed to respond to other antibiotics. Our three treatment failures were attributed to abnormal host defense in two patients and to a resistant enterococcal urinary tract infection in another. Moxalactam was tolerated well and produced minimal renal, hepatic, and hematological toxicities. The only serious adverse effects were the development of documented pseudomembranous colitis in one patient and progressive renal dysfunction in another. Acquisition of resistance among noneradicated isolates during therapy was not demonstrated.Moxalactam is a new 1-oxa-f3-lactam antibiotic which has a broad spectrum of in vitro activity against aerobic gram-positive cocci and aerobic and anaerobic gram-negative bacilli, including multiply antibiotic-resistant isolates (2, 4, 7). A majority of the Enterobacteriaceae and streptococci are inhibited at a concentration of <1 jLg/ml, staphylococci are inhibited at 4 to 8 jig/ml, and Pseudomonas aeruginosa is inhibited at 16 jig/ml; these are levels which can be achieved easily after 1-g intravenous infusions (8). In

Comparison of moxalactam and gentamicin in the treatment of complicated urinary tract infections

“…Except for nonfermentative organisms, its activity against aerobic gram-negative bacilli is equal to or exceeds that of currently available aminoglycosides and other beta-lactams (1,6). Moxalactam has been shown to be effective in infections caused by susceptible bacteria (14,15). Its toxicity has been minimal and similar to that of previous cephalosporins.…”

Ceftriaxone: in vitro studies and clinical evaluation

“…Eosinophilia, elevated liver function tests, and thrombocytosis have been previously associated with the administration of third-generation cephalosporins. Eosinophilia has been reported in 4 to 11% of patients receiving moxalactam (13,27) (13,27). Though thrombocytosis can be associated with the stress of infection, a clear temporal relationship between the onset of thrombocytosis and the initiation of ceftriaxone therapy was apparent in these cases.…”

“…Though thrombocytosis can be associated with the stress of infection, a clear temporal relationship between the onset of thrombocytosis and the initiation of ceftriaxone therapy was apparent in these cases. Thrombocytosis has also been reported in 7 of 36 patients (19%) receiving moxalactam (27).…”

Clinical and pharmacokinetic evaluation of parenteral moxalactam in infants and children

“…For at least 4 h after the dose, mean serum levels were more than twice the maximum MIC for susceptible bacteria (5 ,ug/ml). Previous studies with adults (5,6,10) showed that moxalactam had a relatively small incidence of serious adverse effects. In our study, five patients developed neutropenia which resolved after therapy was completed.…”

“…Recent clinical trials (5,6,10) in adult patients have shown that a variety of acute bacterial infections are successfully treated with moxalactam. A low incidence of drug-associated adverse reactions was reported in these studies.…”