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PubMed2001

Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: the randomized, double-blind, prospective trial.

OBJECTIVE: To assess the value of single-dose, intravenous, prophylactic ampicillin and sulbactam (AS) in the prevention of wound infections during open prosthetic inguinal hernia repair by a double-blind, prospective, randomized trial. SUMMARY BACKGROUND DATA: The use of antibiotic prophylaxis during open prosthetic inguinal hernia surgery is controversial, and no prospective trial has been conducted to examine this issue. METHODS: Patients undergoing unilateral, primary inguinal hernia repair electively with the Lichtenstein technique using polypropylene mesh were randomized to receive 1.5 g intravenous AS before the incision or an equal volume of placebo according to a predetermined code of which the surgeons were unaware. Patients with recurrent, femoral, bilateral, giant, or incarcerated hernias or any systemic diseases were excluded. Age, sex, body mass index, American Society of Anesthesiologists score, type of hernia, type of anesthesia, duration of surgery, and use of drains were recorded. Infection was defined according to the criteria of Centers for Disease Control. Patients were evaluated 1 week, 1 month, 6 months, and 1 year after surgery by an independent surgeon. All complications were recorded. Results were assessed using chi-square, Fisher's exact, and Student t tests as appropriate. RESULTS: Between September 1996 and July 1998, 280 patients (140 AS, 140 placebo group) entered the protocol. Four patients from the AS group and seven from the placebo group were excluded because of inadvertent antibiotic administration or follow-up problems. Groups were well matched for all the variables studied and postoperative complications, excluding wound infections, which occurred at a rate of 0.7% in the AS group and 9% in the placebo group (P =.00153). Twelve patients in the placebo group developed wound infections, requiring five repeat hospital admissions in three patients. These three patients suffered deep infections reaching the graft, which resulted in graft loss in two. The single infected patient in the AS group had his graft removed as well because of deep persistent infection. CONCLUSIONS: This study documented a significant (10-fold) decrease in overall wound infections when single-dose, intravenous AS was used during Lichtenstein hernia repair. Deep infections and wound infection-related readmissions were also reduced by the use of AS. Proponents of mesh repairs may therefore be advised to use prophylactic single-dose intravenous antibiotic coverage in the light of the results of this trial. AS proved to be an effective antimicrobial agent.

Adult↗
PubMed2001

The penetration of cefoperazone and sulbactam into the lumbar intervertebral discs.

Six patients received 1 g and six other patients received 2 g of cefoperazone and sulbactam 15 minutes before lumbar disc surgery. Liquid chromatographic analysis of disc tissue revealed that only patients receiving the 2-g dose had mean tissue levels above the minimum inhibitory concentration for Staphylococcus aureus and epidermidis.

Anti-Bacterial Agents↗
PubMedDate not supplied

Sultamicillin (ampicillin-sulbactam) in the treatment of acute otitis media in children.

Sultamicillin, a dimer of ampicillin and a beta-lactamase-inhibiting agent, sulbactam, was given in oral form to 50 infants and children with acute otitis media. Tympanocentesis was performed on entry into the trial. Beta-lactamase-positive Haemophilus influenzae or Branhamella catarrhalis was isolated from 14 of 73 (19.2%) middle ear effusions in 9 children. Relief of symptoms (fever/otalgia) occurred in all children who completed therapy. However, in 8 children (16%), the antimicrobial agent was discontinued due to presumed adverse side effects (primarily gastrointestinal); vomiting which began prior to entry was noted in another subject who was withdrawn. An additional 14 children completed the course of treatment despite having diarrhea. Of the 41 children who completed drug therapy, 11 (26.8%) were effusion-free after 10 days, and 22 of 33 (66.7%) evaluable children were effusion-free after 6 weeks. Sultamicillin is a novel therapeutic approach to beta-lactamase-producing bacteria. In its oral form, however, diarrhea is a troublesome side effect.

Ampicillin↗
PubMed1986

Assays of sulbactam in the presence of ampicillin.

Three assays for sulbactam, a beta-lactamase inhibitor, in serum in the presence of ampicillin were compared. A synergistic bioassay, a gas chromatographic assay with detection by mass spectrometry, and a high performance liquid chromatography assay were similar with respect to both accuracy and precision.

Ampicillin↗
PubMed1985

Penetration of sulbactam-ampicillin and clavulanic acid-amoxicillin into the pelvic peritoneum.

Sixteen patients were given single intravenous injections of ampicillin (0.5 g) with sulbactam (0.5 g), and 15 patients were given amoxicillin (1 g) with clavulanic acid (0.2 g) before elective laparoscopy. At 2 h after dosing, the concentrations of the four compounds in serum and in the peritoneal fluid from the Pouch of Douglas and the ratio of each combination reached levels shown to be effective for antimicrobial activity in vitro.

Adult↗
PubMed1986

Comparative activity of beta-lactamase inhibitors YTR 830, clavulanate, and sulbactam combined with beta-lactams against beta-lactamase-producing anaerobes.

The in vitro activities of the beta-lactamase inhibitors YTR 830, clavulanate, and sulbactam combined with six beta-lactams against 88 beta-lactamase-producing anaerobes were determined. When combined with the beta-lactams, the three beta-lactamase inhibitors showed no synergy against the 10 Bacteroides fragilis homology group II strains. When the beta-lactams were combined with the inhibitors, their geometric mean MICs against the remaining 78 strains were reduced from 4.2 to 150.2 micrograms/ml to 0.2 to 12.9 micrograms/ml. The activity of the beta-lactams combined with the beta-lactamase inhibitors was significantly greater than that of the beta-lactams alone against all groups except B. fragilis homology group II, with 76 to 100% of the strains susceptible to ampicillin plus inhibitor and greater than or equal to 90% susceptible to the other combinations.

Anti-Bacterial Agents↗
PubMed1999

Treatment of experimental staphylococcal endocarditis due to a strain with reduced susceptibility in vitro to vancomycin: efficacy of ampicillin-sulbactam.

We evaluated several 3-day antimicrobial regimens in the treatment of experimental endocarditis caused by an oxacillin-resistant Staphylococcus aureus strain exhibiting intermediate susceptibility in vitro to vancomycin (VISA). Neither vancomycin alone nor trovafloxacin exhibited in vivo efficacy; addition of amikacin to vancomycin yielded a modest in vivo effect. In contrast, the combination of ampicillin and sulbactam was highly effective in vivo, causing a mean decrease in VISA vegetation densities of >5 log(10) CFU/g versus those of untreated controls.

Ampicillin↗
PubMed1999

Pharmacokinetics and pharmacodynamics of amoxicillin-sulbactam, a novel aminopenicillin-beta-lactamase inhibitor combination, against Escherichia coli.

We evaluated the pharmacokinetics of amoxicillin-sulbactam (AMX-SUL), a novel drug combination, and its pharmacodynamics against Escherichia coli in 12 volunteers receiving a single oral dose (1, 000 mg). Peak serum bactericidal and urine inhibitory activities in most volunteers were observed against E. coli strains for which AMX-SUL MICs were low (2- to 4-mg/liter) (2 strains) and high (>/=16-mg/liter) (47 strains), respectively.

Adult↗
PubMed1985

Cefoperazone and cefoperazone-sulbactam susceptibility tests with anaerobic bacteria by the thioglycolate disk elution method.

Tests were performed with 104 anaerobic microorganisms to evaluate the thioglycolate disk elution technique for the detection of resistance to cefoperazone and cefoperazone-sulbactam. An unacceptably high false-resistance rate and a poor reproducibility record make the disk elution procedure unsatisfactory for routine testing of this drug or combination of drugs.

Bacteria, Anaerobic↗
PubMed1998

In vitro activities of ampicillin-sulbactam and amoxicillin-clavulanic acid against Acinetobacter baumannii.

In vitro susceptibility patterns of newer beta-lactamase-inhibiting antibiotics ampicillin-sulbactam (A/S) and amoxicillin-clavulanic acid (A/C) for 100 consecutive isolates of Acinetobacter baumannii obtained from various clinical samples were studied. The A/C MIC for 86% of the strains was more than 16/8 microgram/ml, whereas there was an A/S MIC of more than 16/8 microgram/ml for only 38% of the strains. This showed that A/S has significantly superior in vitro activity compared to A/C against A. baumannii, although, theoretically, both should have similar activities. The therapeutic superiority of A/S over A/C needs to be studied, or else the breakpoints for these agents in in vitro tests need to be redefined.

Acinetobacter↗
PubMed1988

Beta-lactamase inhibition by acetylmethylene penicillanic acid compared to that of clavulanate and sulbactam.

The beta-lactamase inhibitory properties of 6-acetylmethylene penicillanic acid (6-AMPA) were investigated and compared with those of other beta-lactamase inhibitors. 6-AMPA inhibited the TEM-1, TEM-2, SHV-1, PSE-1, PSE-2, PSE-3, PSE-4, OXA-2, OXA-3, and Staphylococcus aureus beta-lactamases. It also inhibited the chromosomally-mediated beta-lactamases of the Richmond-Sykes type Ia, Ic and Id type and the type IV Klebsiella enzymes. Beta-lactamases of Branhamella catarrhalis and Bacteroides fragilis were inhibited. The 6-AMPA I50 values for various enzymes were less than 0.01 microgram/ml TEM-1 and PSE-4, and 0.01 microgram/ml SHV-1, 0.02 microgram/ml S. aureus, 0.04 microgram/ml Proteus vulgaris, 0.04 microgram/ml K. oxytoca, 6.8 micrograms/ml P99, and 9.7 micrograms/ml Sabath-Abraham Pseudomonas enzyme. With isolated beta-lactamases 6-AMPA was a more potent inhibitor than clavulanate or sulbactam. 6-AMPA was an irreversible inhibitor of beta-lactamases. The penetration index for Escherichia coli JT4 was 23 compared to 3 for clavulanate. 6-AMPA at 10 micrograms/ml acted synergistically with ampicillin against beta-lactamase containing bacteria, but it was less active than clavulanate and did not act synergistically with ampicillin against Enterobacter, Citrobacter or Pseudomonas. Although 6-AMPA has excellent beta-lactamase inhibitory properties with isolated enzymes, it is less useful with intact organisms.

Bacteria↗
PubMed1999

Determination of the etiological organism during acute exacerbations of COPD and efficacy of azithromycin, ampicillin-sulbactam, ciprofloxacin and cefaclor. Turkish Thoracic Society COPD Working Group.

Acute exacerbations, most of which are due to lower respiratory tract infections, cause great morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) and most of these are due to lower respiratory tract infections. The aim of this study was to determine the causative organism and the effects of azithromycin, ampicillin sulbactam (sultamicillin), ciprofloxacin and cefaclor monohydrate therapy in COPD. One hundred and six patients with COPD in acute exacerbation were randomized into four groups for empiric antibiotic treatment following lung function tests and sputum examination. The most common strains isolated from sputum were Haemophilus influenzae (30.8%), Streptoccocus pneumoniae (12%) and Moraxella catarrhalis (7.7%). Azithromycin, sultamicillin, ciprofloxacin and cefaclor monohydrate were found to be effective in treating COPD exacerbations.

Ampicillin↗
PubMed2004

Beta-lactams in the new millennium. Part-II: cephems, oxacephems, penams and sulbactam.

Beta-lactam ring-containing compounds such as penicillins, ampicillin, amoxicillin, cephalosporins and carbapenems are among the most famous antibiotics. This article reviews the recent developments in study of cephems, oxacephems, penams and sulbactam. Many of the compounds reviewed have potential antibacterial activity, even against resistant strains such as MRSA, and enzyme inhibitory activity.

Anti-Bacterial Agents↗
PubMed1991

[Strict anaerobic bacteria: comparative study of various beta-lactam antibiotics in combination with tazobactam or sulbactam].

The minimal inhibitory concentrations of piperacillin (PIP) or cefotaxime (CTX) alone or in combination with tazobactam (TAZ) were determined against 168 anaerobes. All the strains were inhibited by PIP + TAZ, but certain strains resistant to CTX + TAZ were found among B. fragilis, Eubacterium and Peptostreptococcus. The second investigations included 30 strains of Bacteroides fragilis. Concentrations of 2, 4 and 8 mg/l of TAZ and sulbactam (SUL) were combined with piperacillin or cefotaxime. The two beta-lactamase-inhibitors had similar activities when used at 2 or 4 mg/l, but at 8 mg/l TAZ was more active than SUL. All B. fragilis strains were inhibited by PIP + TAZ or PIP + SUL, whereas resistance was observed with CTX + SUL or CTX + TAZ. On the same strains the activities of 6 beta-lactams (PIP, mezlocillin, ticarcillin (TIC), CTX, ceftriaxone and ceftazidime) were determined in combination with either SUL 4 mg/l or TAZ 8 mg/l. Only PIP or TIC + SUL or TAZ were able to inhibit at least 90% of tested strains. No resistance could be detected with PIP + TAZ combination. As conclusion, the two inhibitors when combined with PIP or TIC offered greater activity against both Gram positive or negative anaerobes and PIP + TAZ remained the more potent combination.

Anti-Bacterial Agents↗
PubMed1991

Ampicillin-sulbactam and ticarcillin-clavulanic acid: a comparison of their in vitro activity and review of their clinical efficacy.

Sulbactam (SB) and clavulanic acid (CA) are irreversible inhibitors of the beta-lactamases in the Richmond and Sykes classes II-VI. When combined with ampicillin and ticarcillin, SB and CA, respectively, extend the spectrum of activity of these penicillins to include some beta-lactamase-producing aerobes (Enterobacteriaceae, Hemophilus influenzae, staphylococci) and anaerobes (Bacteroides fragilis group) which would otherwise be resistant. Neither effectively inhibits the class I beta-lactamases frequently produced by Pseudomonas aeruginosa, Enterobacter, and Serratia, in part explaining the resistance observed with these organisms. Clinically, both agents were as effective as the comparative therapies in all but two of the trials reviewed. Given the current data, the decision to add these agents to the formulary should be based on hospital resistance patterns and on the cost of these antimicrobials in comparison to conventional therapies.

Ampicillin↗
PubMed1991

[Postoperative infections in otorhinolaryngologic surgery. Open study on efficacy and tolerability of antibiotic prophylactic treatment with sulbactam-ampicillin].

The paper reports the results of an open study on the efficacy and tolerability of the association of sulbactam-ampicillin in antibiotic prophylaxis in ENT surgery. The study include 55 cases and confirmed both the total absence of major side-effects and a notable therapeutic efficacy of the drug in question. It is interesting to note the results obtained in ENT cancer surgery: out of 12 cases of partial or total laryngectomies there were 2 cases of infection in extra-operative sites (polmoniti ab ingestis from Pseudomonas aeruginosa) and none within the site of operation. Data regarding the efficacy of the drug were in line or better than previously published results and its low toxicity indicates the elective use of sulbactam/ampicillin in ENT surgical prophylaxis.

Adolescent↗
PubMed1991

[In vitro activity of beta-lactam antibiotics in combination with sulbactam against enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter. Results of a multicenter study].

The in vitro antimicrobial activity of ticarcillin (TICAR), mezlocillin (MEZLO), piperacillin (PIPER), cefoperazone (CPZ), cefotaxime (CTX) and ceftazidime (CAZ), alone and in combination with 8 micrograms/ml of sulbactam (SULB), was studied by agar dilution against TICAR resistant strains isolated in 8 hospitals over a period of 3 months in 1989 (747 enterobacteria, 110 Ps. aeruginosa and 48 Acinetobacter sp.). SULB did not modify the activity of beta-lactam antibiotics against Ps. aeruginosa. The 6 beta-lactam antibiotics SULB combinations were only active for 27% of Acinetobacter SULB sensitive. SULB restored the activity of: MEZLO, PIPER, CPZ in Enterobacteria producing a penicillinase; PIPER, CTX and CAZ in Enterobacteria producing a broad-spectrum beta-lactamase; MEZLO, PIPER, CTX and CAZ in M. morganii producing a derepressed cephalosporinase.

Acinetobacter↗