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PubMed2002

General microbiology and in vitro susceptibility of anaerobes isolated from complicated skin and skin-structure infections in patients enrolled in a comparative trial of ertapenem versus piperacillin-tazobactam.

In a recently completed study of once-a-day ertapenem versus piperacillin-tazobactam every 6 h in the treatment of complicated skin and skin-structure infections, 540 patients were randomized in a 1rcolon;1 ratio and assigned to 1 of 2 strata: those with a complicating underlying disease or all others. The most common infections in the study were deep soft-tissue abscess (18.9%), followed by diabetic lower extremity infection (18.1%); 7.0% of these were perineal cellulitis/abscess. With the exception of methicillin-resistant Staphylococcus aureus, almost all of the predominant aerobic pathogens were susceptible to both study drugs. Eighty-seven patients (16%) had >/=1 anaerobe identified in their baseline wound cultures, with a total of 232 anaerobic isolates. Of the 141 anaerobes tested for susceptibility, 97.2% were susceptible to ertapenem and 97.9% to piperacillin-tazobactam. Ertapenem had excellent in vitro activity against the most common aerobic pathogens and almost all anaerobes recovered from patients with infections of the skin and skin structures.

Anti-Bacterial Agents↗
PubMed1985

Activity of cefotaxime and ceftriaxone alone and in combination with penicillin, ampicillin and piperacillin against neonatal meningitis pathogens.

The activities of penicillin G, ampicillin, piperacillin, cefotaxime and ceftriaxone alone and in combination against 130 isolates of Escherichia coli, group B streptococci and Listeria monocytogenes from neonatal meningitis were assessed by using agar dilution, checkerboard and time-kill techniques. Cefotaxime and ceftriaxone were highly active against E. coli and group B streptococci (MIC90 0.05-0.1 mg/1) but not active against List. monocytogenes. Penicillin G was more active than ampicillin and piperacillin against group B streptococci (MIC90 0.1, 0.12 and 0.24 mg/l respectively) and ampicillin was the most active against List. monocytogenes (MIC90 0.6 mg/l). Every double beta-lactam combination was synergistic for 3-14% of E. coli, 8-26% of group B streptococci and 67-100% of List. monocytogenes in the checkerboard titration. The ceftriaxone combinations were less synergistic than the cefotaxime combinations. In time-kill evaluations using concentrations representative for cerebrospinal fluid, the killing kinetics of E. coli were not influenced by any combination. A significant delay in killing of group B streptococci was observed with penicillin G-cephalosporin and ampicillin-cephalosporin combinations. A significant increased killing of List. monocytogenes was observed with penicillin G-cephalosporin combinations. The other combinations did not alter the killing kinetics of group B streptococci and List. monocytogenes.

Ampicillin↗
PubMed1993

Comparative susceptibility of the Bacteroides fragilis group species and other anaerobic bacteria to meropenem, imipenem, piperacillin, cefoxitin, ampicillin/sulbactam, clindamycin and metronidazole.

The in-vitro activity of meropenem, imipenem, piperacillin, cefoxitin, ampicillin/sulbactam, clindamycin and metronidazole was determined against 395 strains of strict and facultative anaerobes, including Gardnerella vaginalis, Lactobacillus spp. and Mobiluncus spp. The activities of meropenem and imipenem were within one dilution of their MIC50 and MIC90 values. One isolate of Bacteroides fragilis, two of Bacteroides distasonis, and two of Bacteroides ovatus showed resistance or diminished susceptibility to meropenem and imipenem. Metronidazole was active against almost all obligate anaerobic isolates. Some non-spore-forming Gram-positive bacilli and lactobacilli were resistant. Ampicillin/sulbactam inhibited almost all isolates at < or = 16/8 mg/L. The activity of clindamycin and cefoxitin was relatively good, but some strains of non-fragilis B. fragilis group species were resistant. Piperacillin was the least active agent tested.

Ampicillin↗
PubMed1997

Time-kill study of the activity of trovafloxacin compared with ciprofloxacin, sparfloxacin, metronidazole, cefoxitin, piperacillin and piperacillin/tazobactam against six anaerobes.

A time-kill method was developed to examine the killing kinetics of trovafloxacin, ciprofloxacin, sparfloxacin, metronidazole, cefoxitin, piperacillin and piperacillin/tazobactam against one strain each of Bacteroides fragilis, Bacteroides thetaiotaomicron, Prevotella melaninogenica, Fusobacterium mortiferum, Peptostreptococcus magnus and Clostridium perfringens. Solutions and suspensions were prepared inside an anaerobic glove box, using syringes and prereduced broth. Bottles were then incubated outside the chamber and viability counts determined after incubation for 0, 6, 24 and 48 h in a shaking water bath, avoiding introduction of air. Bacteriostatic/bactericidal concentrations (mg/L) after 48 h for the six strains were: trovafloxacin, 0.03-1/0.03-1; ciprofloxacin, 0.25-16/0.25-32; sparfloxacin, 0.06-2/0.06-8; metronidazole 1-64/1-64; cefoxitin, 0.125-16/0.125-32; piperacillin, 0.125-64/0.125-64; piperacillin/tazobactam, 0.06-2/0.125-8. Bacteriostatic levels were within two dilutions of broth MICs. By this time-kill method, trovafloxacin had the lowest bacteriostatic concentrations of all compounds tested.

Anti-Infective Agents↗
PubMed2003

In vitro activity of gatifloxacin alone and in combination with cefepime, meropenem, piperacillin and gentamicin against multidrug-resistant organisms.

OBJECTIVES: To study the in vitro interaction of gatifloxacin in combination with gentamicin and with the beta-lactams cefepime, meropenem and piperacillin against clinical isolates of Stenotrophomonas maltophilia, Pseudomonas aeruginosa, Burkholderia cepacia, extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae, vancomycin-resistant Enterococcus faecium (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). METHODS: The activity of each drug alone was determined by an agar dilution method. Chequerboard synergy testing was then performed against all the isolates. Time-kill assays were done on selected isolates to assess correlation with the chequerboard results. RESULTS: Synergy was demonstrated with the following combinations at achievable serum concentrations: gatifloxacin/piperacillin for 80% and gatifloxacin/cefepime for 60% of S. maltophilia; gatifloxacin/gentamicin for 60%, and gatifloxacin/cefepime for 50% of ESBL-producing K. pneumoniae, and in all drug combinations for 50-70% of P. aeruginosa. Indifference was noted for the majority of B. cepacia and VRE isolates. Antagonism at therapeutic serum levels was observed with gatifloxacin/piperacillin against a single isolate of B. cepacia. No distinct trend in drug interaction was seen with the different drug combinations against MRSA. Time-kill analyses against selected isolates confirmed the synergic activity of the following drug combinations seen in the chequerboard assays: gatifloxacin/cefepime and gatifloxacin/piperacillin against P. aeruginosa, gatifloxacin/gentamicin against B. cepacia, and gatifloxacin/gentamicin and gatifloxacin/meropenem against ESBL-producing K. pneumoniae. CONCLUSIONS: Gatifloxacin was synergic with the beta-lactams piperacillin, cefepime and meropenem, and with gentamicin against some drug-resistant pathogens. Some of the time-kill analyses against P. aeruginosa, B. cepacia and ESBL-producing K. pneumoniae were in accordance with chequerboard results. Time-kill analyses against S. maltophilia did not confirm the synergy seen in chequerboard testing.

Anti-Bacterial Agents↗
PubMed1993

Piperacillin monotherapy compared with metronidazole and gentamicin combination in penetrating abdominal trauma.

The therapeutic efficacy and safety of piperacillin (4.5 g, every 6 hours) were compared with combined gentamicin (80 mg, every 8 hours) and metronidazole (500 mg every 6 hours) therapy in 246 patients hospitalized for penetrating abdominal injuries. Sixty-five patients had penetrating injury of the colon, rectum, or terminal ileum. The overall clinical cure rate was about 94% in both treatment groups. Adverse clinical experiences or biochemical abnormalities required discontinuation of therapy in three patients on gentamicin/metronidazole and in no patients on piperacillin.

Abdominal Injuries↗
PubMed1986

Piperacillin-induced anemia and leukopenia.

Piperacillin is being used with increasing frequency as an important antibiotic for the treatment of severe and life-threatening infections. Many of these patients may have multiple possible causes of leukopenia and/or anemia. An awareness of the potential for piperacillin to cause the rapid onset of leukopenia and/or anemia may have important therapeutic implications, especially in severely ill patients.

Adult↗
PubMed1989

Single-dose piperacillin versus triple-dose cefoxitin prophylaxis at vaginal and abdominal hysterectomy.

Two hundred fourteen women having vaginal or abdominal hysterectomy were entered into a prospective, randomized, blind clinical trial comparing a preoperative intravenous dose of piperacillin to three perioperative intravenous doses of cefoxitin given over an eight-hour period. Interregimen clinical, surgical, and outcome variables of the 207 evaluable subjects were statistically similar, but there were significant interprocedure differences in a variety of categories; many benefits exist when vaginal hysterectomy is possible. Efficacy of a single dose of piperacillin was similar to that of three cefoxitin doses. Seven women (3.4%) had major postoperative infection requiring parenteral antimicrobial therapy, two (1.9%) after vaginal hysterectomy and five (4.8%) after abdominal hysterectomy. Three of the latter five infections (60%) occurred after discharge from the hospital. Even with prophylaxis, postoperative anemia was associated with increased frequency of infection at the operative site after both procedures, and diabetes was associated with late infection of the abdominal incision after abdominal hysterectomy.

Adult↗
PubMed1994

Stability of piperacillin sodium in the presence of tazobactam sodium in 5% dextrose and normal saline injections.

The stability of piperacillin sodium in the presence of tazobactam sodium in 5% dextrose and normal saline i.v. admixtures has been determined using a modified stability-indicating high performance liquid chromatography assay method reported in the literature. The solutions were stored at room and refrigerator temperatures in plastic bags. They remained clear throughout the study although the pH values decreased slightly during storage. The solutions were stable for 2 days at 25 degrees C and for 28 days at 5 degrees C. Tazobactam sodium appears to have a slight adverse effect on the stability of piperacillin sodium.

Chromatography, High Pressure Liquid↗
PubMed1994

Coagulopathy with piperacillin administration in cystic fibrosis: two case reports.

Two cases are reported of coagulopathy in association with the administration of piperacillin to patients with cystic fibrosis. In both cases the coagulopathy was associated with the development of a serum sickness-like illness with fever, rash and abnormal liver function tests occurring on day 12 and day 16 of treatment, respectively. On withdrawal of the piperacillin, both the serum sickness and the coagulopathy resolved rapidly, without sequelae.

Blood Coagulation Disorders↗
PubMed1987

Analysis of the interaction between piperacillin and ciprofloxacin or tobramycin against thirteen strains of Pseudomonas aeruginosa, using killing curves.

Time-kill studies were made with thirteen strains of Pseudomonas aeruginosa, comparing the activity of ciprofloxacin plus piperacillin with the combination of tobramycin and piperacillin. Synergism was demonstrated in an equal number of strains with both combinations. No antagonism was demonstrated. The reproducibility of the killing-curve method suggests that at least two different concentrations should be used and that a decrease in viable counts below 2 log10 after 24 hours does not exclude a synergistic action.

Ciprofloxacin↗
PubMed1982

High-performance liquid chromatographic determination of piperacillin in plasma.

A high-performance liquid chromatographic method has been developed for the quantitative determination of piperacillin in plasma. The compound is first extracted from acid-treated plasma into chloroform: 1-pentanol (3:1) and reextracted into a small volume of an aqueous phase at pH 7, which is injected in the chromatographic column (microgram-Bondapack C18; 10 micrometers). The mobile phase is a mixture of 0.01 M acetate buffer (pH 4.8) and methanol. The method is accurate and reproducible with a sensitivity of about 50 ng of piperacillin per ml of serum.

Adult↗
PubMed1982

Aminoglycoside-resistant gram-negative bacilli in a community hospital: comparative in vitro activity of cefotaxime, moxalactam, cefoperazone, and piperacillin.

All aminoglycoside-resistant gram-negative bacilli isolated during 1 year at a community hospital were tested for in vitro sensitivity to cefotaxime, moxalactam, cefoperazone, and piperacillin. The majority of Enterobacteriaceae were susceptible to all four antibiotics. Cefoperazone and piperacillin were the most active for pseudomonas aeruginosa, and activity for other nonfermentative gram-negative bacilli was variable.

Aminoglycosides↗
PubMed1984

In vitro susceptibilities of 393 recent clinical isolates to WIN 49375, cefotaxime, tobramycin, and piperacillin.

The in vitro susceptibilities of 393 recent clinical isolates to WIN 49375, a new quinolone derivative, were determined and concurrently tested with cefotaxime, tobramycin, and piperacillin. In general, members of the family Enterobacteriaceae were not as susceptible to tobramycin and piperacillin as they were to WIN 49375. Methicillin-resistant and -susceptible Staphylococcus aureus were equally susceptible to WIN 49375.

Anti-Bacterial Agents↗
PubMed1984

In vitro activity of apalcillin compared with those of piperacillin and carbenicillin against 6,797 bacterial isolates from four separate medical centers.

Quantitative susceptibility tests were performed in four separate medical centers, in which apalcillin was compared with piperacillin and carbenicillin. Data from tests of 6,797 isolates confirmed that apalcillin and piperacillin had nearly identical spectra of activity but that apalcillin was significantly more active against Pseudomonas aeruginosa (MIC required to inhibit 90% of strains, 2.0 versus 64 micrograms/ml) and Acinetobacter calcoaceticus subsp. anitratus (MIC required to inhibit 90% of strains, 2.0 versus 16 micrograms/ml). Against 166 anaerobic bacterial isolates, apalcillin demonstrated in vitro activity.

Ampicillin↗
PubMed1984

Effect of aztreonam in combination with azlocillin or piperacillin on Pseudomonas aeruginosa.

Aztreonam, a synthetic monobactam antimicrobial agent specifically active against aerobic, gram-negative microorganisms, was studied in combination with the extended-spectrum penicillins azlocillin and piperacillin against 46 strains of Pseudomonas aeruginosa. Of these strains, 4.3% were synergistically inhibited, and 19.7% showed evidence for an additive effect of the antibiotics. All other strains showed indifference. The addition of cefoxitin to these combinations increased the MICs of azlocillin and piperacillin by two to three tubes, whereas zero- to one-tube increases were noted for aztreonam MICs. Attempts to block cefoxitin-induced beta-lactamase production by using clindamycin were unsuccessful even at high clindamycin concentrations.

Anti-Bacterial Agents↗
PubMed1985

In vitro activities of enoxacin, ticarcillin plus clavulanic acid, aztreonam, piperacillin, and imipenem and comparison with commonly used antimicrobial agents.

A total of 745 gram-negative and 313 gram-positive clinical isolates were tested against enoxacin, ticarcillin plus clavulanic acid, aztreonam, imipenem, and piperacillin and compared with commonly used antimicrobial agents. Ticarcillin plus clavulanic acid, imipenem, and piperacillin were active against Pseudomonas aeruginosa and Acinetobacter spp. and most Pseudomonas spp. Aztreonam was active against members of the family Enterobacteriaceae but was less effective against the nonfermenters. Enoxacin was active against the Enterobacteriaceae, P. aeruginosa, the staphylococci, and most Acinetobacter spp. but was less active against Pseudomonas spp. and streptococci. Imipenem was very active against all gram-positive and -negative organisms tested except for Pseudomonas maltophilia.

Anti-Bacterial Agents↗