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PubMed1998

Favorable prognosis of purulent meningitis in patients infected with human immunodeficiency virus.

We prospectively reviewed all cases of purulent meningitis among human immunodeficiency virus (HIV) type 1-infected patients > 14 years old that occurred at the Hospital General Vall d'Hebron (Barcelona) during the period 1 January 1985 through 31 March 1997. There were 12 episodes of purulent meningitis in nine of 2,150 HIV-1-infected patients. The annual rate of purulent meningitis was 0.465 cases per 1,000 patients, a rate that is 150 times higher than that for the general population. During 10 episodes, CD4+ lymphocyte counts were < 200/mm3. The etiologic organism was Streptococcus pneumoniae in nine episodes (seven episodes occurred in four splenectomized patients), and Escherichia coli, Streptococcus agalactiae, and Enterococcus faecium each caused one episode. Clinical features and cerebrospinal fluid abnormalities were similar to those observed among patients without HIV-1 infection. All patients had bacteremia. The overall mortality was 8.3%. We conclude that purulent meningitis, particularly pneumococcal meningitis, is more frequent among HIV-1-infected patients than in the general population. The prognosis for HIV-1-infected patients is better than for HIV-1-negative patients.

Adult↗
PubMed2001

Multicenter surveillance of antimicrobial resistance of major bacterial pathogens in intensive care units in 2000 in Taiwan.

A susceptibility surveillance study of 1,274 bacterial isolates recovered from various clinical specimens from patients in intensive care units (ICUs) of five major teaching hospitals was carried out from March, 2000, to June, 2000, in Taiwan. This study demonstrated a high rate (66%) of oxacillin resistance in Staphylococcus aureus (ORSA), a high rate of nonsusceptibility to penicillin (intermediate, 50% and highly resistant, 8%), and high rates of cefotaxime nonsusceptibility for S. pneumoniae (intermediate, 29% and resistant, 4%), Enterobacter cloacae (57%), Serratia marcescens (34%), and Citrobacter freundii (60%). High rate of ceftazidime nonsusceptibility for Pseudomonas aeruginosa (22%), and high rates of imipenem nonsusceptibility for P. aeruginosa (15%) and Acinetobacter baumannii (22%) were also found. The percentage (11.9%) of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli was greater than that (11.3%) for Klebsiella pneumoniae. Rates of quinupristin-dalfopristin nonsusceptibility for S. pneumoniae (42%), Enterococcus faecium (71%), and ORSA (39%) were high, but no vancomycin-resistant enterococci were found in this study. The resistance rates of some pathogen varied by institution or type of ICUs. Surveillance for antimicrobial resistance among bacterial pathogens in hospitals, particularly in ICU settings with a preexisting higher resistance burden, is mandatory in establishing and/or modifying guidelines for empirical treatment of severe infections in ICU patients caused by these antimicrobial-resistant pathogens.

Bacteria↗
PubMed2005

In vitro activities of tigecycline, ertapenem, isepamicin, and other antimicrobial agents against clinically isolated organisms in Taiwan.

This study evaluated the in vitro activities of tigecycline, ertapenem, isepamicin, and other comparators against 861 bacterial isolates recovered from patients treated in three major teaching hospitals in 2003. MICs to antimicrobial agents were determined by the agar dilution method. High rates of oxacillin resistance (58%) in Staphylococcus aureus (60 isolates), and vancomycin resistance (21%) and quinupristin-dalfopristin non-susceptibility (39%) in Enterococcus faecium (34 isolates) were found. Carbapenems had excellent in vitro activities (>or=98% susceptibility) against the 419 isolates of Enterobacteriaceae, with the MIC(50) and MIC(90) of imipenem, meropenem, and ertapenem being 0.25 and 4 mg/L, 0.03 and 0.12 mg/L, and 0.03 and 0.5 mg/L, respectively. For, Pseudomonas aeruginosa (74 isolates) and Burkholderia cepacia (21 isolates), meropenem (MIC(90), 0.25, 2, and 4 mg/L, respectively) had better in vitro activities than imipenem (MIC(90), 8, 4, and 32 mg/L, respectively) and ertapenem (MIC(90), 0.5, >32, and 32 mg/L, respectively). Isepamicin had a similar activity with amikacin against all Enterobacteriaceae, Pseudomonas aeruginosa, B. cepacia, and Acinetobacter baumannii, except for C. freundii isolates in which isepamicin had an eight-fold activity better than amikacin. Tigecycline had excellent in vitro activities against all isolates tested (MIC(90), <or=1 mg/L) including 14 pandrugresistant A. baumannii isolates (MICs, 1-4 mg/L), except for Proteus mirabilis (59 isolates; MIC(90), 8 mg/L), Bacteroides fragilis (60 isolates; MIC(90), 8 mg/L), P. aeruginosa (MIC(90), 16 mg/L), and B. cepacia (21 isolates; MIC(90), 16 mg/L). Tigecycline, carbapenems, and isepamicin exhibited better or comparable in vitro activities against a wide spectrum of commonly encountered bacteria than other comparator antimicrobials and may represent therapeutic options for infections due to multidrug-resistant pathogens.

Anti-Bacterial Agents↗
PubMed2001

Protection from gastrointestinal diseases with the use of probiotics.

Probiotics are nonpathogenic microorganisms that, when ingested, exert a positive influence on the health or physiology of the host. They can influence intestinal physiology either directly or indirectly through modulation of the endogenous ecosystem or immune system. The results that have been shown with a sufficient level of proof to enable probiotics to be used as treatments for gastrointestinal disturbances are 1) the good tolerance of yogurt compared with milk in subjects with primary or secondary lactose maldigestion, 2) the use of Saccharomyces boulardii and Enterococcus faecium SF 68 to prevent or shorten the duration of antibiotic-associated diarrhea, 3) the use of S. boulardii to prevent further recurrence of Clostridium difficile-associated diarrhea, and 4) the use of fermented milks containing Lactobacillus rhamnosus GG to shorten the duration of diarrhea in infants with rotavirus enteritis (and probably also in gastroenteritis of other causes). Effects that are otherwise suggested for diverse probiotics include alleviation of diarrhea of miscellaneous causes; prophylaxis of gastrointestinal infections, which includes traveler's diarrhea; and immunomodulation. Trials of gastrointestinal diseases that involve the ecosystem are currently being performed, eg, Helicobacter pylori infections, inflammatory bowel disease, and colon cancer.

Bifidobacterium↗
PubMed2001

Probiotics: "living drugs".

The uses, mechanisms of action, and safety of probiotics are discussed. Probiotics are live microorganisms or microbial mixtures administered to improve the patient's microbial balance, particularly the environment of the gastrointestinal tract and the vagina. The yeast Saccharomyces boulardii and the bacterium Lactobacillus rhamnosus, strain GG, have shown efficacy in clinical trials for the prevention of antimicrobial-associated diarrhea. Other probiotics that have demonstrated at least some promise as prophylaxis for this type of diarrhea are Lactobacillus acidophilus, Bifidobacterium longum, and Enterococcus faecium. The use of S. boulardii as an adjunctive treatment to therapy with metronidazole or vancomycin has been found in controlled studies to decrease further recurrences of Clostridium difficile-associated disease. Other gastrointestinal disorders for which probiotics have been studied include traveler's diarrhea, acute infantile diarrhea, and acute diarrhea in adults. Several Lactobacillus species given in yogurt or in tablet or suppository form have shown clinical efficacy as a treatment for vaginal infections. Lactobacillus strains have also been examined as a treatment for urinary-tract infections. Putative mechanisms of action of probiotics include production of pathogen-inhibitory substances, inhibition of pathogen attachment, inhibition of the action of microbial toxins, stimulation of immunoglobulin A, and trophic effects on intestinal mucosa. The available probiotics are considered nonpathogenic, but even benign microorganisms can be infective when a patient is severely debilitated or immunosuppressed. Probiotics have demonstrated an ability to prevent and treat some infections. Effective use of probiotics could decrease patients' exposure to antimicrobials. Additional controlled studies are needed to clearly define the safety and efficacy of these agents.

Adult↗
PubMed2002

Linezolid: an oxazolidinone antimicrobial agent.

The pharmacology, antimicrobial activity, pharmacokinetics, clinical efficacy, and adverse effects of linezolid are reviewed. Linezolid, the only oxazolidinone antimicrobial approved for use in the United States, has significant activity against gram-positive bacteria, including penicillin-, cephalosporin-, and vancomycin-resistant species. Linezolid inhibits bacterial protein synthesis via binding to the 50S ribosomal subunit to prevent translation. The drug lacks cross-resistance with other antimicrobials. Linezolid is primarily excreted renally as unchanged drug. The measured plasma half-life of four to five hours permits twice-daily administration for all indicated infections. Virtually complete oral bioavailability allows for 1:1 conversion between the intravenous and oral dosage forms. Controlled comparative clinical trials demonstrate that linezolid is effective in the treatment of vancomycin-resistant Enterococcus faecium and methicillin-resistant Staphylococcus aureus (MRSA) infections, nosocomial and community-acquired pneumonia, and skin and skin-structure infections due to susceptible organisms. The recommended dosage is 600 mg i.v. or p.o. twice daily for all indications except uncomplicated skin and skin-structure infections (400 mg twice daily); adjustments for mild to moderate renal or hepatic impairment are not necessary. Clinically important interactions with monoamine oxidase inhibitors have not been observed. Reversible myelosuppression has been observed in a few patients. Linezolid has gram-positive activity comparable to that of vancomycin, is effective in a variety of infections, and is well tolerated, with diarrhea, headache, and nausea being the most frequently reported adverse effects. Linezolid provides a reasonable therapeutic alternative for patients with vancomycin-resistant E. faecium infections and patients infected with MRSA who cannot tolerate vancomycin.

Acetamides↗
PubMed2003

Safety, efficacy and pharmacokinetics of linezolid for treatment of resistant Gram-positive infections in cancer patients with neutropenia.

BACKGROUND: Linezolid is a recently approved oxazalidinone with extended activity against Gram-positive bacteria. We evaluated the results of linezolid therapy in neutropenic cancer patients with Gram-positive bacterial infections from a compassionate-use program. PATIENTS AND METHODS: This was a prospective, multicenter, open-label, non-comparative, non-randomized compassionate-use treatment program in patients with serious Gram-positive infections. To qualify for enrollment patients were required to have an infection resistant to available antimicrobial agents, or in whom available agents had failed or to which they were intolerant. Patients with absolute neutrophil counts (ANC) <500 cells/mm(3) or <1000 cells/mm(3) and expected to decrease to <500 cells/mm(3), and who received linezolid 600 mg twice daily were included. Plasma samples for population pharmacokinetic analysis were collected. Clinical and microbiological assessments of outcomes were made at the end of therapy and at short-term follow-up. RESULTS: Of the patients in the compassionate-use trial, 103 were neutropenic. The mean [standard deviation (SD)] age was 50.1 (17.5) years, 47% were female, and 47.6% had a baseline ANC </=100 cells/mm(3). The mean (SD) duration of linezolid therapy was 14.6 (11.4) days. The most common site of infection was the bloodstream (90.3%), and the most commonly identified pathogen was vancomycin-resistant Enterococcus faecium (83%). A total of 83 (80.5%) and 52 (50.4%) patients were evaluable for clinical and microbiological outcomes at the end of therapy, respectively. Clinical and microbiological cure rates in the evaluable patients were 79% and 86%, respectively. Linezolid was well-tolerated in this patient population, with an overall adverse event rate of 17.5%; 5% of patients required discontinuation of the drug due to side-effects. The pharmacokinetics of linezolid in patients with neutropenia did not differ from the overall compassionate-use population. CONCLUSIONS: Linezolid was safe and effective in treating resistant Gram-positive infections in neutropenic cancer patients. Comparative clinical trials to evaluate further the effectiveness and safety of linezolid in this patient population are warranted.

Acetamides↗
PubMed1997

Approaches to limiting emergence of antimicrobial resistance in bacteria in human populations.

Infectious diseases continue to be major threats to human health around the world. Within the past few years, several divergent groups of organisms have emerged as significant causes of morbidity and mortality. Included among these are bacteria that are refractory to therapy because of the development of resistance to multiple antimicrobial agents. Multidrug resistance in strains of Mycobacterium tuberculosis, Streptococcus pneumoniae, Shigella dysenteriae, Salmonella typhi, and Enterococcus faecium has been reported. Surveillance of resistant microorganisms in the United States and abroad is fragmentary and targets relatively few organisms. Surveillance is further hampered by the fact that detection of some novel resistance mechanisms is difficult by means of current laboratory methods. Both clinicians and public health officials are likely to continue to face a variety of challenges regarding surveillance, treatment, prevention, and control of drug-resistant infections.

Bacterial Infections↗
PubMed1989

Penicillin-aminoglycoside synergy and post-antibiotic effect for enterococci.

The post-antibiotic effect (PAE) on seven strains of enterococci was studied using a novel ATP method and conventional viable counting. There was a good correlation between the results of the two techniques. In strains exhibiting low-level resistance to penicillin and streptomycin, PAEs of 1 to 2.4 h (mean 1.8 h) resulted from exposure to penicillin; shorter PAEs were induced by streptomycin (0.2-0.3 h; mean 0.2 h). Addition of streptomycin to pencillin increased the duration of penicillin-induced PAEs by two-fold to three-fold. Enterococci exhibiting high-level streptomycin resistance but low-level penicillin resistance did not exhibit a PAE with streptomycin but exhibited a short PAE with gentamicin (0.3-0.6 h). For these strains, the addition of gentamicin, but not streptomycin, to penicillin increased the penicillin-induced PAEs. Penicillin alone or in combination with streptomycin or gentamicin did not induce PAEs for a single strain of Enterococcus faecium which exhibited high-level resistance to both penicillin and streptomycin. During penicillin-induced PAEs, extracellular ATP was detectable and only during this time period were enterococci susceptible to the action of gentamicin. The addition of aminoglycosides to penicillin not only extended the PAE for enterococci but also the periods when organisms leaked ATP and were susceptible to growth inhibition by gentamicin.

Adenosine Triphosphate↗
PubMed1989

Comparative in-vitro activity of meropenem on clinical isolates from the United Kingdom.

MICs of meropenem were determined for a wide range of common bacteria of clinical importance. For Enterobacteriaceae, Aeromonas spp., Haemophilus influenzae, Branhamella catarrhalis, Neisseria gonorrhoeae, Gardnerella vaginalis, Campylobacter coli/jejuni, beta-haemolytic streptococci and anaerobes other than Clostridium difficile, MICs were almost always within the range 0.002-0.5 mg/l. The activity of meropenem for these organisms was always greater than that of imipenem and piperacillin, and was similar to that of ceftazidime and cefotaxime except that strains resistant to these latter, and to piperacillin, were usually sensitive to imipenem and meropenem. Meropenem was also active against most non-fermentative Gram-negative bacilli, with MICs in the range 0.12-4 mg/l but Pseudomonas (Xanthomonas) maltophilia was often resistant, as it was to all the other drugs tested. Staphylococci, Strreptococcus pneumoniae and other alpha-haemolytic streptococci were usually more sensitive to imipenem than to meropenem, but even methicillin-resistant staphylococci were sensitive to both drugs (MICs less than 4 mg/l). Enterococci were also less sensitive to meropenem than to imipenem, and Enterococcus faecium was invariably highly resistant to all the drugs tested except ciprofloxacin, which had marginal activity. Results for Ps. maltophilia and Haem. influenzae were affected by media used for sensitivity testing.

Bacteria↗
PubMed1990

Modification of penicillin-binding proteins of penicillin-resistant mutants of different species of enterococci.

Mutants resistant to penicillin G were selected in a stepwise manner from nine different species of enterococci. Mutants with the highest level of resistance showed cross-resistance to all beta-lactams tested. For eight of the nine species, resistance correlated with increased production of a low molecular weight penicillin-binding protein (PBP). Two of these species produced a new PBP of low molecular weight, while two other species produced an additional PBP of high molecular weight. With the exception of Enterococcus faecium, no difference was observed in terms of lysis or bactericidal effect when the sensitive strains and their resistant mutants were tested at ten times their respective MICs of penicillin G. With E. faecium an increased lytic and bactericidal effect was observed for the resistant mutant.

Bacterial Proteins↗
PubMed1995

Meropenem: a microbiological overview.

Meropenem is a parenteral carbapenem antibiotic which has excellent bactericidal activity in vitro against almost all clinically significant aerobes and anaerobes. Its high activity is explained by ease of entry into bacteria combined with good affinity for essential penicillin binding proteins, including those associated with cell lysis. Breadth of spectrum is due, in part, to stability to all serine-based beta-lactamases, including those which hydrolyse third-generation cephalosporins. Meropenem has an antibacterial spectrum which is broadly similar to that of imipenem but, whilst slightly less active against staphylococci and enterococci, it is more active against Pseudomonas aeruginosa, all Enterobacteriaceae and Haemophilus influenzae. Amongst common human pathogens, only methicillin-resistant staphylococci and Enterococcus faecium are uniformly resistant to meropenem. The meropenem MICs for penicillin-resistant Streptococcus pneumoniae are higher than for penicillin-susceptible strains but the organisms remain susceptible. Clinical susceptibility in vitro to meropenem is defined by MICs of < or = 4 mg/L, intermediate susceptibility by MICs of 8 mg/L and MICs of > or = 16 mg/L define resistance; equivalent figures for zones of growth inhibition are > or = 14 (susceptible), 12-13 (intermediate) and < or = 11 (resistant) mm. Studies in guinea pig models of systemic infection and infections localised to the lungs, urinary tract and the central nervous system, some of which used immunocompromised animals, confirm the potential of meropenem demonstrated in vitro. These factors, combined with the human plasma, tissue or urinary concentrations of meropenem which exceed modal MICs for the pathogens isolated in clinical trials for most or all of the recommended 8 h dosing interval, predict that meropenem should be efficacious in the treatment of infections at many body sites.

Animals↗
PubMed1996

In-vitro activity of ramoplanin (a novel lipoglycopeptide), vancomycin, and teicoplanin against gram-positive clinical isolates from cancer patients.

The in-vitro activities of ramoplanin, vancomycin, and teicoplanin against Gram-positive organisms isolated from cancer patients were determined. Ramoplanin was the most active agent tested inhibiting all isolates at a concentration of < or = 0.5 mg/L. Although all isolates were also susceptible to vancomycin and teicoplanin, their activities were surpassed by that of ramoplanin. The activity of teicoplanin was moderately better than that of vancomycin against Bacillus cereus, Enterococcus faecium, Listeria monocytogenes, methicillin-resistant Staphylococcus aureus, and most streptococcal isolates, and was comparable to vancomycin for the remainder of the isolates tested.

Anti-Bacterial Agents↗
PubMed1997

In-vitro pharmacodynamic studies of piperacillin/tazobactam with gentamicin and ciprofloxacin.

Six isolates each of Enterococcus faecium, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Stenotrophomonas maltophilia, Pseudomonas aeruginosa, Citrobacter spp., Serratia spp., Acinetobacter spp. and Enterobacter spp. (total 60 strains) were studied against the combination of piperacillin/tazobactam plus gentamicin or ciprofloxacin at physiological concentrations by the microtitre chequerboard method incorporating simultaneous time-kill curves. Tazobactam was fixed at 4 mg/L. Gentamicin plus piperacillin/tazobactam was a synergic combination against 28 strains at 2 h, 51 at 5 h and 54 at 24 h as assessed by time-kill curves and synergic or additive (FBC index < or = 1) against all 60 strains at 24 h by chequerboards. The corresponding figures for ciprofloxacin plus piperacillin/tazobactam were seven, 26, 52 and 58 respectively. Antagonism (FBC index > or = 4) was demonstrated for one strain to each combination at 24 h. There were no significant differences between FIC indices and FBC indices for each antibiotic combination. Gentamicin plus piperacillin/tazobactam gave > or = 3 log kill for 47 strains by 2 h, 56 by 5 h and 59 by 24 h. Ciprofloxacin plus piperacillin/tazobactam gave > or = 3 log kill for 22 strains by 2 h, 36 by 5 h and 56 by 24 h. In conclusion both antibiotic combinations at physiological concentrations were synergic or additive at 24 h for the majority of strains tested although notably gentamicin plus piperacillin/tazobactam gave faster kill. Antagonism was rarely seen. Both combinations are likely to prove beneficial for treatment of serious infections.

Anti-Bacterial Agents↗
PubMed1997

In-vitro microbiological assessment of a new penem, Men 10700.

The in-vitro antibacterial activity of Men 10700, a novel penem, has been compared with that of ritipenem, ciprofloxacin, amikacin, cefotaxime and co-amoxiclav against 539 strains taken from 17 genera. Men 10700 was most active against staphylococci and streptococci (MIC90 < 0.5 mg/L), slightly less active against Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Citrobacter spp., Moraxella catarrhalis and peptostreptococci (MIC90 0.5-2 mg/L), moderately active against Enterococcus faecalis, members of the tribe Proteae, Serratia marcescens, Acinetobacter spp., clostridia and Bacteroides spp. (MIC90 4-16 mg/L), and inactive against Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Enterococcus faecium. Its antibacterial spectrum is thus slightly less broad than that of imipenem, but it compares favourably with an oral third-generation cephalosporin. Men 10700 was more active than ritipenem against many species, especially Enterobacter spp. and Citrobacter spp.

Anti-Bacterial Agents↗
PubMed1997

The in-vitro activity of trovafloxacin, a new fluoroquinolone, against Gram-positive bacteria.

The in-vitro activity of trovafloxacin, a new quinolone, was compared with that of ciprofloxacin, erythromycin, various beta-lactam antibiotics and, where appropriate, clindamycin and vancomycin against a range of Gram-positive bacteria including staphylococci (n = 201), Streptococcus pneumoniae (n = 83), beta-haemolytic streptococci (n = 46), viridans group streptococci (n = 100), Streptococcus milleri (n = 18) and enterococci (n = 161) by an agar dilution technique. In addition, time-kill studies were performed to estimate the bactericidal activity of trovafloxacin against S. milleri and viridans group streptococci. Trovafloxacin was the most active agent tested against staphylococci. It also showed good activity, at least four-fold and usually eight- to 16-fold that of ciprofloxacin, against all the streptococci. Trovafloxacin showed good activity against vancomycin-sensitive Enterococcus faecalis and Enterococcus faecium, but was less active against the 11 isolates of vancomycin-resistant enterococci. Trovafloxacin showed comparable or superior bactericidal activity to amoxycillin against the S. milleri and viridans group streptococci tested.

Anti-Bacterial Agents↗
PubMed1998

Comparative in-vitro activity of ketolide HMR 3647 and four macrolides against gram-positive cocci of known erythromycin susceptibility status.

The in-vitro activity of the novel ketolide HMR 3647 was compared with four other macrolides against 335 strains of staphylococci, pneumococci and enterococci with predetermined susceptibility status to erythromycin. HMR 3647 was the most active agent against staphylococci (irrespective of methicillin resistance) of sensitive (MIC90 = 0.25 mg/L) or inducibly resistant phenotype (MIC90 = 2 mg/L), but was inactive against constitutively resistant strains. HMR 3647 was very active against erythromycin-sensitive enterococci (MIC90 = 0.06 mg/L), irrespective of vancomycin resistance, but less active against strains that were resistant to erythromycin (MIC90 = 32 mg/L). The ketolide was highly active against pneumococci (irrespective of penicillin resistance), both erythromycin sensitive (MIC90 = 0.03 mg/L) and erythromycin resistant (MIC90 = 0.25 mg/L). A bactericidal action was found against some erythromycin-sensitive staphylococci, pneumococci and Enterococcus faecium. The microbiological properties of HMR 3647 are thus superior to those of other macrolides.

Anti-Bacterial Agents↗
PubMed1998

The effects of increasing levels of quinolone resistance on in-vitro activity of four quinolones.

A panel of 266 clinically isolated Gram-positive cocci and Gram-negative bacilli with varying levels of resistance to ciprofloxacin were analysed for susceptibility to Du-6859a, ciprofloxacin, ofloxacin, temafloxacin and nalidixic acid. Staphylococci were divided into ciprofloxacin-susceptible, moderately resistant and highly resistant subgroups. Du-6859a was the most potent quinolone against all taxa. As ciprofloxacin resistance increased to high levels, MICs of all quinolones increased but Du-6859a MICs increased least, and ciprofloxacin MICs increased most. Less susceptible single-step mutants were selected from 80% of 15 representative clinical isolates exposed to ciprofloxacin, 71% of isolates exposed to temafloxacin, 67% of isolates exposed to Du-6859a and 53% of isolates exposed to ofloxacin. Du-6859a inhibited more mutants (67%) at a concentration of 1 mg/L than did the other quinolones (26-43%) at their susceptible breakpoints. Du-6859a was the most rapidly bactericidal quinolone in time-kill studies with Enterococcus faecalis and Enterococcus faecium. This study indicated that Du-6859a is more potent than the comparator quinolones, is less affected by the mechanisms responsible for high-level quinolone resistance and may be less likely to select resistant mutants if it has a susceptible breakpoint of 1 mg/L.

Anti-Infective Agents↗

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