Therapy of lower respiratory tract infections with moxalactam

Lentino, Joseph R.; Rytel, Michael W.; Moore, Edward R. B.

doi:10.1128/aac.19.5.801

Cited by 18 publications

(8 citation statements)

References 9 publications

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“…One of our failures had an organism with borderline susceptibility (MIC, 32 ,ug/ml; disk, 20 mm) and deteriorated after initially responding to moxalactam treatment. Our experience with pleuropulmonary infections was less favorable than that of other investigators (11); this was perhaps due to patients with "complicated" pleuropulmonary infections who required long courses of therapy and had a propensity to develop resistant organisms.…”

Section: Resultsmentioning

confidence: 41%

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Clinical evaluation of moxalactam

Mathisen¹,

Meyer²,

Thompson³

et al. 1982

Antimicrob Agents Chemother

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Moxalactam was administered intravenously or intramuscularly or both in doses of 1 to 12 g/day to 45 patients with clinically significant infections (17 soft tissue or bone, 9 pleuropulmonary, 9 septicemic, 6 urinary tract, and 4 intraabdominal infections). Mean 0.5-h postinfusion levels were 105 micrograms/ml for a 4.0-g dose, 44.7 micrograms/ml for a 2.0-g dose, and 18 micrograms/ml for a 1.0-g dose. We identified 28 isolates of Enterobacteriaceae, 10 Pseudomonas aeruginosa isolates, 9 Staphylococcus aureus isolates, and 15 anaerobic bacterial isolates. A total of 15 patients were clinically cured, 8 patients improved, 13 patients improved initially but suffered subsequent relapses or superinfections, and 10 patients failed therapy. Toxicity was generally minimal (reversible eosinophilia, and mild liver function abnormalities, and elevated prothrombin time). The selection or emergence of resistant organisms in 17 patients during treatment (particularly Pseudomonas, enterococci, and Candida) was a disturbing feature of therapy. Our results were generally favorable, considering the complicated underlying medical problems of this group of patients.

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Section: Resultsmentioning

confidence: 41%

“…The use of moxalactam (LY-127935) in the treatment of a wide spectrum of bacterial infections has been described previously (8,11,12,19,21). However, specific data on susceptibility tests, serum levels, and cultures for anaerobes have been lacking from some of these studies.…”

mentioning

confidence: 99%

Clinical evaluation of moxalactam

Mathisen¹,

Meyer²,

Thompson³

et al. 1982

Antimicrob Agents Chemother

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“…Moxalactam as a single agent was effective in treating bacteremia in this and other studies (12,13,17). Of 22 patients, 20 (91%) were cured.…”

Section: Resultsmentioning

confidence: 80%

Clinical evaluation of moxalactam: evidence of decreased efficacy in gram-positive aerobic infections

Salzer¹,

Pegram²,

McCall³

1983

Antimicrob Agents Chemother

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Moxalactam was used as initial, empirical therapy in 69 patients with a variety of serious bacterial infections, 32% of which were accompanied by bacteremia. Overall, the success rate was 83% and drug-related adverse effects were minimal. The drug was less efficacious in infections caused by aerobic gram-positive pathogens than it was in those caused by gram-negative pathogens. The following gram-positive organisms were associated with special problems during moxalactam therapy: Streptococcus pneumoniae (development of meningitis and a relapse of pneumonia with a more resistant strain), Staphylococcus epidermidis (in vivo emergence of moxalactam resistance), and the enterococci (failure of therapy and a fatal superinfection). Moxalactam performed well in infections caused by most gram-negative organisms, including aminoglycoside-resistapt strains, but the previously reported emergence of gram-negative bacillary resistance to moxalactam during therapy was reconfirmed in our series with Serratia marcescens. The use of moxalactam in the treatment of gram-negative meningitis was further supported by a patient with meningitis-ventriculitis caused by Bacteroidesfragilis who was cured with moxalactam after failure on chloramphenicol.

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“…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.…”

mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%