Trimethoprim-Sulfamethoxazole and Brain Abscess

Greene, Bruce M.; Thomas, F; Alford, Robert H.

doi:10.7326/0003-4819-82-6-812

Cited by 22 publications

(4 citation statements)

References 4 publications

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“…The MBC of TMP was 0.039 4g/ml, and that of SMX was 0.745 p,g/ml. Levels as high as 1.6 and 15.47 Fag/ml, respectively, were measured in pus from a cerebral abscess of a patient receiving doublestrength TMP-SMX twice daily (4). The median bacteriostatic concentration of rifampin was 0.039 jg/ml.…”

mentioning

confidence: 99%

Antibiotic susceptibility and synergy of clinical isolates of Listeria monocytogenes

Tuazon¹,

Shamsuddin²,

Miller³

1982

Antimicrob Agents Chemother

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(8,9,14). There is a need for alternative agents in cases where the use of penicillin drugs is indicated and also in cases of therapeutic failures.Over the last 5 years, we have accumulated 12 patients with serious infections caused by L. monocytogenes. This study looks at the antibiotic susceptibility and synergy of the organisms isolated from these patients.Twelve strains of L. monocytogenes isolated from blood or cerebrospinal fluid were available for study. Organisms were maintained on blood agar plates at 37°C and were identified by Gram stain, hemolysis on blood agar plates, and motility at 25°C. Standard antibiotic disk susceptibility tests used the Kirby-Bauer method. Antibiotic susceptibilities and drug synergy were studied with the use of the microtiter system (6).All dilutions for assays performed in this study were done in tryptic soy broth (BBL Microbiology Systems). For assays with trimethoprim-sulfamethoxazole (TMP-SMX), 0.1 IU of thymidine phosphorylase per ml was added to tryptic soy broth to convert the thymidine pool to thymine. Overnight broth cultures were adjusted to 5 x 106 organisms/ml for a standard inoculum. The 1 ratio of SMZ to TMP; Burroughs-Wellcome); and ticarcillin (Beecham Laboratories). Stock sterile solutions were stored at -20°C and were diluted with tryptic soy broth immediately before use. Rifampin and TMP at concentrations ranging from 0.0045 to 2.5 ,ug/ml, and SMZ at 0.065 to 47.5 p.g/ ml, were tested against each strain. All other drugs were assayed at concentrations of 0.039 to 200 ,ug/ml.Minimal inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs) were determined for each drug separately, and checkerboard studies were used to determine synergistic activity of rifampin plus penicillin, ampicillin, gentamicin, erythromycin, or cefamandole. The MIC was defined as the lowest concentration of antibiotic which allowed no visible growth of the organism in the microtiter plate after 18 to 24 h of incubation at 370C. MBCs were determined by subculturing 10 ,ul of solution from each well of the microtiter plate onto blood agar plates and reincubating for 18 to 24 h at 37°C. The MBC was defined as the lowest concentration of drug which permitted the growth of 10 or fewer colonies per blood agar plate.Combinations of antimicrobial agents were considered fully synergistic if inhibition of growth occurred at s25% of the MIC of each drug. Antagonism was defined as the MIC of the 525 on May 9, 2018 by guest http://aac.asm.org/ Downloaded from

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mentioning

confidence: 99%

Antibiotic susceptibility and synergy of clinical isolates of Listeria monocytogenes

Tuazon¹,

Shamsuddin²,

Miller³

1982

Antimicrob Agents Chemother

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“…Limited studies have also shown a favorable penetration of TMP/SMZ into the cerebrospinal fluid (CSF) even in the absence of meningeal inflammation [4,12,15,29],…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Trimethoprim/Sulfamethoxazole in Experimental <i>Escherichia col</i><i>i</i> Bacteremia and Meningitis

Kim¹,

Anthony²

1983

Chemotherapy

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We evaluated the activity of trimethoprim/sulfamethoxazole (TMP/SMZ) against a Kl Escherichia coli strain. Minimal inhibitory and bactericidal concentrations were 0.06/1.14 and 0.25/4.75 μg/ml, respectively. In vivo studies using an infant rat model of bacteremia and meningitis revealed that TMP/SMZ penetrated well into the cerebrospinal fluid (CSF) and that 37% of serum levels were achieved. The efficacy of TMP/SMZ was compared with that of ampicillin, chloramphenicol, cefotaxime and lamoxactam. Bacterial clearance from blood and CSF was significantly greater with TMP/SMZ than with ampicillin or chloramphenicol and mortality was significantly less than with chloramphenicol (p < 0.01). However, 3 of 21 (14%) and 2 of 8 animals (25%) still had positive blood and CSF cultures after 3 days of treatment with TMP/ SMZ. None of the survivors in the cefotaxime and lamoxactam groups were bacteremic after 1 day of therapy. Furthermore, 5 of 13 animals (38%) treated with TMP/SMZ developed meningitis during therapy, in contrast with none in the cefotaxime and lamoxactam groups. These findings indicate that although the activity of TMP/SMZ is bactericidal in vitro and in vivo against E. coli, TMP/SMZ may not provide optimal therapy for gram-negative bacillary meningitis in this model.

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“…It quickly enters the CSF to establish bactericidal levels. The use of TMP-SMX to treat GNBM in neonates and infants was reported in 1969, 21 followed by later reports of TMP-SMX use in the treatment of a bacterial brain abscess with documentation of bactericidal levels in the abscess cavity 22 and the successful treatment of five patients with meningitis. 23 In 1982, successful treatment of a patient with Klebsiella pneumonia meningitis using TMP-SMX was reported.…”

Section: Discussionmentioning

confidence: 99%

Successful Therapy of Postneurosurgical Meningitis Caused by a Resistant Strain of Enterobacter Aerogenes

et al. 1997

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Trimethoprim-Sulfamethoxazole and Brain Abscess

Cited by 22 publications

References 4 publications

Antibiotic susceptibility and synergy of clinical isolates of Listeria monocytogenes

Antibiotic susceptibility and synergy of clinical isolates of Listeria monocytogenes

Efficacy of Trimethoprim/Sulfamethoxazole in Experimental <i>Escherichia col</i><i>i</i> Bacteremia and Meningitis

Successful Therapy of Postneurosurgical Meningitis Caused by a Resistant Strain of Enterobacter Aerogenes

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