Randomized, prospective, and double-blind trial of new beta-lactams in the treatment of appendicitis

Lau, Wan-yee; Fan, Sheung‐Tat; Chu, Kin Wah; Suen, Hon‐Chi; Yiu, T. F.; Wong, K K

doi:10.1128/aac.28.5.639

Cited by 36 publications

(18 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Resistance to clindamycin was low, and it continues to be a very valuable drug in our armamentarium against these species. It is important to choose antimicrobial agents that are active against the pathogens involved in the infection (4,(6)(7)(8).…”

mentioning

confidence: 99%

Comparative activities of newer beta-lactam agents against members of the Bacteroides fragilis group

Cuchural

Tally

Jacobus

et al. 1990

Antimicrob Agents Chemother

View full text Add to dashboard Cite

A nationwide susceptibility survey of 557 isolates of the Bacteroidesfragiis group was continued in 1986. The most active ,B-lactam drugs were imipenem and ticarcillin-clavulanic acid, which had 0.2 and 1.7% resistance, respectively. The rank order of activity of P-lactam drugs was imipenem, ticarcillin-clavulanic acid, cefoxitin, piperacillin, moxalactam, ceftizoxime, cefotetan, cefotaxime, cefoperazone, and ceftazadime.Members of the Bacteroides fragilis group of organisms are the most frequently recovered anaerobic bacterial pathogens of humans. Their high ability to invade and relative resistance to commonly employed antimicrobial agents underlie their significance as anaerobic bacterial pathogens (1, 10).Nonduplicated clinical isolates of the B. fragilis group were collected by the seven centers making up the study group (10) and were sent to the Tufts Anaerobe Laboratory from January 1986 through December 1986. Species identification was performed by established methodology (5). Susceptibility testing was determined as previously described (13). For ticarcillin-clavulanic acid testing, the clavulanic acid concentration was kept constant at 2 ,ug/ml, while the ticarcillin component was varied.The most active P-lactam drug was imipenem (Table 1).Imipenem had MICs for 50 and 90% of isolates (MIC50 and MIC90) of <0.06 and 1 ,ug/ml, respectively. Ticarcillinclavulanic acid was less potent with an MIC50 and an MIC93 of 1 and 16 jig/ml, respectively. Resistance rates at the lower breakpoints of Table 1 were used throughout and were 0 and 1.7%, respectively. Cefoxitin was the next most active drug, with an MIC50 and an MIC90 of 8 and 16 ,ug/ml, respectively, and an 11% resistance rate. The MIC50 and MIC90 of moxalactam were 4 and 128 ,ug/ml, respectively, with a resistance rate of 23%. Piperacillin, cefotetan, and ceftizoxime were less active drugs. They had an MIC50 and an MIC90 of 8 and 128 ,ug/ml, respectively, with higher resistance rates of 16, 36, and 33%, respectively. The remaining cephalosporins, cefotaxime, cefoperazone, and ceftazidime, did poorly as a group. The MIC50s were greater than or equal to 32 ,ug/ml; 53, 66, and 87% resistance was found, respectively.No isolates were found to be resistant to metronidazole or chloramphenicol within the B. fragilis group. The MIC50 and MIC90 of cindamycin were 0.06 and 2 pug/ml, respectively, with a 5% resistance rate.The susceptibility of the various species within the B. fragilis group revealed marked species-dependent activity * Corresponding author. for some of the drugs, especially cephamycins. Among the various species in the group, B. fragilis continued to be the most susceptible to the P-lactam drugs. B. distasonis, B.ovatus, and B. thetaiotaomicron were more resistant. Imipenem, ticarcillin-clavulanic acid, clindamycin, chloramphenicol, and metronidazole showed essentially no species variability. Piperacillin and cefoxitin showed some resistance variability, with B. distasonis displaying the most variability of resistance (1o). Cefotetan and moxalactam ...

show abstract

mentioning

confidence: 99%

Comparative activities of newer beta-lactam agents against members of the Bacteroides fragilis group

Cuchural

Tally

Jacobus

et al. 1990

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…In comparative clinical trials, poor results have been observed with cephaloridine [45,46], cefamandole [47,48], and cefoperazone [48,49]. In contrast, successful treatment of appendicitis and other intra-abdominal infections has been reported with cephalosporins that have good activity against anaerobic and aerobic/facultative bacteria, such as cefoxitin [50][51][52][53] and ceftizoxime [54,55].…”

Section: Cephalosporinsmentioning

confidence: 97%

Piperacillin/tazobactam in the treatment of polymicrobial infections

Gorbach

1994

Intensive Care Med

View full text Add to dashboard Cite

Polymicrobial infections are characterized by the presence of micro-organisms from more than one group of bacteria. Empirical treatment of polymicrobial infections requires an agent active against both anaerobic and aerobic/facultative bacteria. An aminoglycoside used in combination with an anti-anaerobe agent is commonly used to treat polymicrobial infections. However, aminoglycoside nephrotoxicity and treatment failures raise questions about the use of such regimens. Among non-aminoglycoside treatment regimens such as penicillin and cephalosporins, effectiveness has been compromised by bacteria producing extended spectrum beta-lactamases. Cefoxitin shows satisfactory results for treatment of intra-abdominal infections. Other studies have shown good results with imipenem, cefotetan and piperacillin used as single agents. Piperacillin/tazobactam, a new combination broad-spectrum antibiotic and potent beta-lactamase inhibitor, can be used for the treatment of infections caused by piperacillin-sensitive micro-organisms as well as beta-lactamase-producing, piperacillin-resistant organisms. This broad-spectrum activity is appropriate for infections traditionally treated empirically by double or triple antibiotic therapy.

show abstract

“…Clinical correlates with these observations are not readily apparent in controlled trials. One possibly relevant report concerns the large study of appendicitis in which patients were randomized to receive cefoperazone, cefotaxime or moxalactam [11], In vitro studies and studies in our animal model show that of the three, only moxalactam has good activity against B. fragilis [2]. The results 358 Dezfulian/Bitar/Bartlett Efficacy of Ceftriaxone of the clinical trial showed no variation in out come among patients with uncomplicated ap pendicitis, whereas moxalactam was signifi cantly better in those who had late operations with gangrenous appendicitis, perforation or abscess formation.…”

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Ceftriaxone in Experimental Infections Involving <i>Bacteroides fragilis </i>and <i>Escherichia coii</i>

Dezfulian¹,

Bitar²,

Bartlett³

1993

Chemotherapy

View full text Add to dashboard Cite

The in vivo activity of ceftriaxone was examined in an experimentally induced subcutaneous infection involving Bacteroides fragilis and Escherichia coli. Mice were challenged with 1 of 10 strains of B. fragilis or E. coli, or a dual combination of the two species. The efficacy was measured by a reduction in the count of viable organisms when antimicrobial treatment was initiated 1 h after challenge and continued for 5 days. Ceftriaxone exhibited impressive activity against E. coli but showed poor in vivo activity versus B. fragilis. The antimicrobial activity of ceftriaxone was influenced by the microbial interaction in our dual-isolate model. Pharmacokinetic studies showed that ceftriaxone penetrated into abscesses and achieved peak levels of about 40% of the peak serum levels. However, in abscesses infected with B. fragilis nearly all biological activity of ceftriaxone was lost.

show abstract

Randomized, prospective, and double-blind trial of new beta-lactams in the treatment of appendicitis

Cited by 36 publications

References 29 publications

Comparative activities of newer beta-lactam agents against members of the Bacteroides fragilis group

Comparative activities of newer beta-lactam agents against members of the Bacteroides fragilis group

Piperacillin/tazobactam in the treatment of polymicrobial infections

Comparative Efficacy of Ceftriaxone in Experimental Infections Involving <i>Bacteroides fragilis </i>and <i>Escherichia coii</i>

Contact Info

Product

Resources

About