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PubMed1984

Comparative study of cefoperazone and amikacin.

A comparative study of cefoperazone and amikacin in severe surgical infections was conducted with 60 patients equally allocated to two groups. The daily dosage of cefoperazone ranged from 2 to 4 gm in two equally divided doses, and the daily dosage of amikacin ranged from 900 to 1,000 mg in two equally divided doses. All patients were given antibiotics for five to ten days. With cefoperazone, there were satisfactory clinical responses in 83% (29/35) of the infections; with amikacin, 74% (23/31). Cefoperazone was more effective than amikacin in biliary tract infections. On bacteriological examination, 7.5% of the organisms isolated were resistant to cefoperazone and 10% to amikacin. In mixed infections, cefoperazone and amikacin had failure rates of 29% and 36%, respectively. Further trials are needed to define the role of cefoperazone in anaerobic and in mixed infections.

Amikacin↗
PubMed1995

Novel galactose single point method as a measure of residual liver function: example of cefoperazone kinetics in patients with liver cirrhosis.

A novel, simple, clinically useful quantitative liver function test, called the galactose single point (GSP) method, was developed to assess residual liver function by measuring galactose blood concentration 1 hour after galactose was administered (0.5 g/kg). This method was applied to the study of cefoperazone kinetics in patients with hepatic cirrhosis. To study the influence of hepatic cirrhosis on the residual liver function and the correlation between the residual liver function and the pharmacokinetics of cefoperazone, a dose of 1 g of cefoperazone was administered to 11 healthy volunteers and 12 patients with liver cirrhosis. The GSP method, the galactose elimination capacity (GEC) test, and the modified galactose elimination capacity (MGEC) test were done for each volunteer and patient to measure residual liver function. The galactose concentrations were determined enzymatically. Cefoperazone was administered intravenously, and blood and urine samples were collected at appropriate intervals after drug administration. All blood and urine samples were stored at -30 degrees C until high-performance liquid chromatography analysis. Cefoperazone plasma concentrations were much higher in cirrhosis patients than in normal subjects at all times. The elimination half-life, hepatic clearance, mean residence time, and renal clearance of cirrhosis patients differed significantly from those of healthy volunteers. The plasma protein binding was unaltered in both groups. Urinary excretion of cefoperazone was significantly increased in cirrhosis patients (23.95 +/- 5.06% for normal men and 51.09 +/- 11.50% in cirrhosis patients). Hepatic clearance, fraction excreted in urine, and total clearance significantly correlated with GSP, GEC, and MGEC (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Penetration of cefoperazone into ascites.

The pharmacokinetics of cefoperazone was studied in eleven cirrhotic patients with ascites after i.v. administration of a single dose of 15 mg.kg-1 (n = 7) or after three doses of 15 mg.kg-1 given at 12 h intervals (n = 4). The concentrations of cefoperazone in serum and ascitic fluid were determined by HPLC. The peak serum cefoperazone concentration after a single i.v. injection of 15 mg.kg-1 was 96.0 mg.l-1. The serum elimination half-life was longer (5.0 h) than in normal subjects. The penetration of cefoperazone into ascites was satisfactory (32.3% and 58.3% after single and repeated injections, respectively). Ascitic fluid concentrations of cefoperazone exceeded 5.4 mg.ml-1 from 0.5 to 6 h after the single i.v. injection, levels which are well above the MIC of most pathogens found in spontaneous bacterial peritonitis. Adjustment of the dose of cefoperazone in cases of severe hepatic insufficiency does not appear to be necessary provided that renal function is normal.

Adult↗
PubMed1987

Single-dose cephalosporin prophylaxis of 929 surgical procedures in a prepaid group practice: a prospective, randomized comparison of cefoperazone and cefotaxime.

In this report, we summarize 929 surgical cases (812 evaluable) receiving preoperatively prophylaxis with either cefoperazone (1 g), or cefotaxime (1 g). The patients were randomized to one of the two single-dose cephalosporin regimens and by operative procedure groups that included hysterectomies, genitourinary procedures, gastrointestinal operations, and the "other procedures" category that was dominated by orthopedic cases, such as total joint replacements and open fracture reductions. The postoperative wound infectious morbidity rates were: cefoperazone 2.2% and cefotaxime 3.0% (overall rate, 2.6%). Most wound infections were superficial, with more than half discovered after patient discharge and unrelated to the surgical prophylaxis. The wound infections associated with colorectal surgery cases given a single-dose of cefoperazone were twofold higher than the control regimen. Non-wound infectious morbidity was 5.8% (p greater than 0.05) for cefoperazone, mostly urinary tract infections causes by Escherichia coli, Streptococcus faecalis, and Staphylococcus spp. Side effects were not considered severe and occurred at a very low rate. Abnormally elevated prothrombin times of patients receiving cefoperazone were not any more frequent than the control regimens. The two prophylaxis regimens were not different statistically (p greater than 0.05) as to the infectious morbidity or adverse reactions. By using either studied single-dose schedule in our prepaid group practice setting, compared with the previously used multi-dose schedules, we could predict an annualized cost savings of $50,000 (cefazolin) and greater than $200,000 (cefoxitin). We propose a single 1-g dose of cefoperazone or cefotaxime (FDA approved) as a cost-effective prophylaxis alternative.

Adolescent↗
PubMed1983

High-performance liquid chromatographic determination of cefoperazone in human serum and urine.

A gradient high-performance liquid chromatographic (HPLC) procedure has been developed for the determination of microgram amounts of cefoperazone in human serum and urine. The method employs a muBondapak C18 column and gradient elution with two mobile phases. Excellent separation of the drug from potential degradation products as well as from representative penicillins (sodium ampicillin, sodium methicillin, potassium penicillin G) and aminoglycosides (tobramycin, gentamicin, kanamycin) has been demonstrated. Coefficients of variation of 7.3% or less were obtained for 25-100 micrograms/ml cefoperazone in both serum and urine. Average recoveries of the drug from spiked serum and urine samples corresponded to 97.6% and 98.6%, respectively. Amounts as low as 1 microgram cefoperazone per ml of sample can be estimated using sample volumes corresponding to 0.1 ml serum or 1 ml urine. Good correlation between the HPLC assay and a microbiological cylinder-plate assay employing Micrococcus luteus ATCC 9341 has been demonstrated for human serum and urine of patients treated with cefoperazone. While the microbiological method is less time-consuming, it lacks specificity in the presence of other antibiotics. The HPLC method can be used to analyze cefoperazone in the presence of penicillins and aminoglycosides which can potentially be co-administered with cefoperazone.

Anti-Bacterial Agents↗
PubMed2003

Pharmacodynamics and pharmacokinetics of cefoperazone and cefamandole in dogs following single dose intravenous and intramuscular administration.

The pharmacokinetics and intramuscular (i.m.) bioavailability of cefoperazone and cefamandole (20mg/kg) were investigated in dogs and the findings related to minimal inhibitory concentrations (MICs) for 90 bacterial strains isolated clinically from dogs. The MICs of cefamandole for Staphylococcus intermedius (MIC(90) 0.125 microg/mL) were lower than those of cefoperazone (MIC(90) 0.5 micro/mL) although the latter was more effective against Escherichia coli strains (MIC(90) 2.0 microg/mL vs. 4.0 microg/mL). The pharmacokinetics of the drugs after intravenous administrations were similar: a rapid distribution phase was followed by a slower elimination phase (t((1/2)lambda2) 84.0+/-21.3 min for cefoperazone and 81.4+/-9.7 min for cefamandole). The apparent volume of distribution and body clearance were 0.233 L/kg and 1.96 mL/kg/min for cefoperazone, 0.190 L/kg and 1.76 mL/kg/min for cefamandole. After i.m. administration the bioavailability and peak serum concentration of cefamandole (85.1+/-13.5% and 35.9+/-5.4 microg/mL) were significantly higher than cefoperazone (41.4+/-7.1% and 24.5+/-3.0 micog/mL), but not the serum half-lives (t(1/2el) 134.3+/-12.6 min for cefoperazone and 145.4+/-12.3 min for cefamandole). The time above MIC(90) indicated that cefamandole can be administered once daily to dogs for the treatment of staphylococcal infections (T>MIC for S. intermedius 23.8+/-0.3 and for Staphylococcus aureus 21.6+/-0.6h).

Animals↗
PubMedDate not supplied

Multicentered clinical evaluation of cefoperazone for the treatment of lower respiratory tract infections.

Adult patients with bacterial infections of the lower respiratory tract were given either cefoperazone or cefamandole in a multicenter clinical study of the clinical and bacteriologic efficacy of cefoperazone. Clinical diagnoses included pneumonia, bronchitis, lung abscess, and bronchiectasis. Efficacy was evaluated in 119 patients given cefoperazone and 73 patients given cefamandole. Major pathogens isolated included Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Satisfactory clinical responses were noted for 96% of the patients in both treatment groups, including 14 of 17 patients given cefoperazone who were primarily infected with P. aeruginosa. Satisfactory bacteriologic responses were noted for 88% of the group given cefoperazone and 89% of the group given cefamandole. Adverse reactions related to the antibiotic occurred infrequently in each treatment group. The results of this study indicate that cefoperazone is a safe and effective antibiotic for the treatment of lower respiratory tract infections due to S. pneumoniae, H. influenzae, S. aureus, and many gram-negative bacilli, including susceptible strains of P. aeruginosa, in adult patients.

Adult↗
PubMedDate not supplied

Cefoperazone sodium in the treatment of serious bacterial infections in 2,100 adults and children: multicentered trials in Europe, Latin America, and Australasia.

Data from noncomparative multicenter trials of cefoperazone sodium in 17 countries throughout Australasia, Europe, and Latin America were analyzed. The study populations included 1,659 adults and 438 children with a wide variety of serious urinary tract infections, respiratory tract infections, and miscellaneous infections. Most adult patients received either 1 g (42%) or 2 g (53%) of cefoperazone iv twice daily for 8-10 days. Satisfactory clinical responses were achieved in 91% of 586 assessable patients with respiratory tract infections, 94% of 571 with urinary tract infections, and 93% of 301 with miscellaneous infections. Organisms resistant to most cephalosporins, including Pseudomonas aeruginosa, other Pseudomonas species, Enterobacter, indole-positive Proteus, Serratia, Bacteroides fragilis, and Streptococcus faecalis (nonendocarditis infections) responded to cefoperazone treatment. Ten percent of patients reported one or more adverse effects directly attributable to cefoperazone, most of which were mild or moderate in severity. In a global evaluation that took into account baseline disease severity, clinical and bacteriological outcome, and toleration, investigators judged cefoperazone as excellent or good in 83% of patients, fair in 10%, and poor in 7%. The usual dosage for pediatric patients was 25-50 mg/kg two or three times daily for about seven days. Overall clinical effectiveness in 417 assessable patients was 89% for a wide variety of infections. Ten of 11 cases of meningitis were cured. Mild adverse reactions were reported for 14 patients. The results indicate that cefoperazone sodium is a safe and effective antibiotic for use in adults and children with serious bacterial infections.

Adolescent↗
PubMed1983

Cefoperazone versus cefamandole in the treatment of acute bacterial lower respiratory tract infections.

In a randomized comparative study, 113 patients were treated with cefoperazone or cefamandole for acute bacterial lower respiratory tract infections. Most patients had Streptococcus pneumoniae or Haemophilus influenzae infections, although five patients in the cefoperazone group had infections caused by other Gram-negative bacilli (two with Pseudomonas aeruginosa). The clinical responses and adverse effects were not significantly different between the two treatment groups. Satisfactory clinical responses occurred in 36/39 (92%) of evaluable patients in the cefoperazone group and 33/34 (97%) of evaluable patients treated with cefamandole. Two failures in the cefoperazone group were secondary to superinfection (Acinetobacter and Ps. aeruginosa). Bacteriological and symptomatic failure occurred in one patient with Ps. aeruginosa lung abscess treated with cefoperazone and in one patient with a polymicrobial empyema treated with cefamandole. The results of this study indicate that cefoperazone is safe and effective in the therapy of acute bacterial lower respiratory tract infections.

Acute Disease↗
PubMed1992

Effect of impaired renal function on the pharmacokinetics of coadministered cefoperazone and sulbactam.

The pharmacokinetics of cefoperazone 2 g combined with sulbactam 1 g after a single dose administered intravenously were evaluated in 24 subjects with normal and impaired renal function. Subjects were categorized into four groups based on endogenous creatinine clearance Clcr. Patients in groups 1, 2 and 3 had ClcrS of greater than 60, 31 to 60, and 10 to 30 mL/min/1.73 m2, respectively. Patients in group 4 required maintenance haemodialysis and were assumed to have Clcr less than 10 mL/min/1.73 m2. Pharmacokinetic parameters were determined by noncompartmental methods. No significant differences (P greater than 0.05) in mean peak serum cefoperazone-sulbactam concentrations for group 1 (208.4/29.0 mg/L), group 2 (199.0/34.1 mg/L), group 3 (163.2/35.0 mg/L), and group 4 (234.0/66.0 mg/L) were noted. Correlations between both total serum (r = 0.58) and renal (r = 0.35) clearance and creatinine clearances were negative for cefoperazone, although both were shown to decline with diminished renal function. Correlations between serum (r = 0.85) and renal (r = 0.72) clearances and creatinine clearance for sulbactam were, on the other hand, both positive and declined in a linear fashion. No significant differences in steady state volumes of distribution were noted for either cefoperazone (P = 0.53) or sulbactam (P = 0.85) amongst the four groups. After 24 h, urinary recovery was also comparable for both cefoperazone (P = 0.64) and sulbactam (P = 0.85) amongst the four groups. The concentrations of cefoperazone and sulbactam remained at or above the MICs (16/8 mg/L) for common bacterial pathogens for 2.5, 3, 7 and 14 h in groups 1, 2, 3 and 4, respectively.

Adolescent↗
PubMed1981

A review and summary of the pharmacokinetics of cefoperazone: a new, extended-spectrum beta-lactam antibiotic.

Cefoperazone is a new piperazine cephalosporin derivative which has a broad antibacterial activity against aerobic and anaerobic gram-positive and gram-negative cocci and bacilli, including Pseudomonas aeruginosa. In studies of the intramuscular (i.m.) administration of cefoperazone at doses of 0.25, 0.5, and 1 g, mean peak serum concentrations were 22, 33, and 67 micrograms/ml at 1 hr. At 8 hr, serum levels were 2.1, 4.8, and 5.6 micrograms/ml, respectively, for the three doses. The mean half-life after intramuscular injection was 108-154 min. Urinary recovery ranged from 14 to 18% of an administered dose. Intravenous (i.v.) administration of cefoperazone by rapid (3-5 min) infusion produced serum levels at 15 min of 76, 156, and 244 micrograms/ml after doses of 0.5, 1, and 2 g, respectively. Concentrations of cefoperazone at 8 hr were 2.4, 6.5, and 11.8 micrograms/ml after these respective doses. Serum half-life was 115-120 min and urinary recovery, 29-33%. Levels determined at 5 min after bolus injection were 200 micrograms/ml for 1 g, 275 micrograms/ml for 2 g and 518 micrograms/ml for 3 g. Intravenous infusion studies of cefoperazone in which 2 g of the drug has been infused over 15, 30, or 120 min have yielded levels of 250-260 micrograms/ml. At 12 hr, levels of 1-2 micrograms/ml were still present. The half-life found in these studies ranged from 1.6 to 2.38 hr. Urinary recovery was 25-30%. Serum clearances have been 80-90 ml/min and renal clearances, 18-30 ml/min. The apparent volume of distribution of the compound has ranged from 10 to 16 liters. Comparative studies have shown that cefoperazone produced higher serum levels than cefazolin, cefamandole, cefotaxime, and moxalactam. Biliary concentrations exceed 400 micrograms/ml and are two to four times the levels found with cefazolin or cefamandole. In the presence of renal failure there is a minimal increase in serum half-life; but in the presence of biliary obstruction, serum half-life may reach 11 hr, depending on the degree of biliary obstruction. In the presence of biliary obstruction, the drug is 90% removed from the body by renal excretion.

Cefoperazone↗
PubMed1982

Comparison of cefoperazone with penicillin, ampicillin, gentamicin, and chloramphenicol in the therapy of experimental meningitis.

Cefoperazone was compared with penicillin against Streptococcus pneumoniae, gentamicin against Escherichia coli, and ampicillin and chloramphenicol against Haemophilus influenzae in the therapy of experimental meningitis in rabbits. Meningitis was produced by intracisternal inoculation into cerebrospinal fluid, and all antibiotics were administered intravenously over 8 h in dosages that would achieve serum levels comparable to those found in humans. The mean percent penetration into purulent cerebrospinal fluid, expressed as (cerebrospinal fluid concentration/serum concentration) x 100%, was 2.6% for penicillin, 22.0% for gentamicin, 12.1% for ampicillin, 23.8% for chloramphenicol, and 6.4% for cefoperazone. The mean cerebrospinal fluid antibiotic concentrations exceeded the minimum bactericidal concentration for the test strain in each experimental model, except for ampicillin in experimental meningitis due to the beta-lactamase-producing H. influenzae. Cefoperazone produced a significantly faster bactericidal effect after 4 h of treatment when compared with penicillin (P = 0.037) and ampicillin (P = 0.01) in meningitis caused by S. pneumoniae and H. influenzae (ampicillin susceptible), respectively. In meningitis caused by E. coli, cefoperazone was significantly (P = 0.006) more rapidly bactericidal after 8 h of treatment when compared to gentamicin. In addition, cefoperazone was significantly more rapidly bactericidal than either ampicillin or chloramphenicol in experimental meningitis due to beta-lactamase-producing H. influenzae. Cefoperazone deserves further evaluation in the therapy of bacterial meningitis in humans.

Ampicillin↗
PubMed1982

Comparison of cefoperazone and cefoxitin concentrations in serum and pelvic tissue of abdominal hysterectomy patients.

Cefoperazone and cefoxitin concentrations were determined in serum and pelvic tissue samples obtained at various intervals after a 2-g intramuscular dose. These levels were determined in 59 women scheduled for elective abdominal hysterectomy. Concentrations were measured by a new high-pressure liquid chromatography method which correlated with the microbiological assay. The mean times (+/- standard deviation) of specimen collection were 188.5 +/- 61 and 185.5 +/- 55 min for cefoperazone and cefoxitin, respectively. The mean serum levels (+/- standard deviation) were 60.8 +/- 18.0 and 14.6 +/- 8.6 micrograms/ml, respectively. For cefoperazone, the mean pelvic tissue concentration was 19.8 micrograms/g. The mean pelvic tissue concentration for cefoxitin was 7.8 micrograms/g. The ratio of tissue concentration to serum concentration varied from 0.220 to 0.469 for cefoperazone and from 0.176 to 1.031 for cefoxitin. Although the serum and tissue concentrations of cefoperazone were much higher than those of cefoxitin, a greater portion of cefoxitin remained in the tissue. The tissue levels of both cefoperazone and cefoxitin were above the minimum inhibitory concentration of most sensitive pathogens several hours after a single prophylactic dose of either antibiotic.

Cefoperazone↗
PubMed1983

Concentrations of cefoperazone in cerebrospinal fluid during bacterial meningitis.

Cefoperazone was administered to 15 patients with bacterial meningitis before lumbar punctures were performed. Patients received one of the following three dosage regimens before collection of cerebrospinal fluid (CSF): one dose of 50 mg/kg (maximum, 2 g; group I), one dose of 100 mg/kg (maximum, 4 g; group II), three doses of 100 mg/kg each every 8 h (maximum, 4 g each dose; group III). Of 44 CSF samples, 26 had detectable cefoperazone levels (59%); drug concentrations in CSF ranged from less than 0.8 to 11.5 micrograms/ml (median, 1.97 micrograms/ml). Although the percentage of patients with detectable cefoperazone levels in CSF was higher in group III (69%) than in group II (64%) or group I (50%), the differences were not statistically significant; however, the mean drug concentration in CSF in group I (1.53 micrograms/ml) was significantly lower than that in group III (3.1 micrograms/ml). A high protein concentration in CSF (as an indicator of meningeal inflammation) correlated best with high cefoperazone concentrations in CSF. These findings differ from previous investigations of cefoperazone penetration into CSF; however, cefoperazone may not penetrate reliably into CSF and therefore may not be an optimal candidate drug for the treatment of bacterial meningitis.

Adolescent↗
PubMed1988

Multiple-dose pharmacokinetics and toleration of intravenously administered cefoperazone and sulbactam when given as single agents or in combination.

The multiple-dose pharmacokinetics and toleration of cefoperazone (3 g every 12 h) and sulbactam (1.5 g every 12 h) were studied when these antimicrobial agents were administered continuously over 7 days as a 15-min infusion of individual agents and as a 3/1.5-g cefoperazone-sulbactam combination. Fourteen male volunteers participated in an open, three-way crossover study of Latin Square design with a 1-week washout period between phases. On days 1 and 7 of each phase, serial serum samples and urine were collected for drug assay over a 12-h period. Hematological and clinical chemistry determinations were made within 10 days before the first antibiotic dose and for each treatment phase just before the first dose, on day 4 of treatment, and within 24 h of the last dose. For cefoperazone as a single agent on days 1 and 7, the average maximal concentration in serum (Cmax) was approximately 430 micrograms/ml, the terminal elimination half-life (t1/2) was 1.8 h, and the average percentage of dose excreted unchanged in the urine (%Ur) was 30%. For sulbactam as a single agent, the Cmax was approximately 90 micrograms/ml, the t1/2 was 1 h, and the %Ur was 89% on days 1 and 7. When comparing individual versus simultaneous drug administration, the only pharmacokinetic alteration observed was a statistically significant but minor (about 10%) decrease in sulbactam renal clearance, on both days 1 and 7, resulting in a similar decrease in total body clearance (CL). The area under the curve, apparent volume of distribution by the area method (V), t1/2, and Cmax were not significantly altered. Although cefoperazone pharmacokinetic parameters were not significantly altered when comparing single-agent to combination drug administration, the area under the curve was slightly lower and CL, nonrenal clearance, and V were modestly higher from day 1 to day 7. Because Cmax and t1/2 were unaffected, these minor day effects would not be of clinical significance. Intravenous administration of cefoperazone and sulbactam given as individual agents compared with the combination did not show pharmacokinetic differences that are likely to produce clinically relevant effects. The combination of cefoperazone and sulbactam was well tolerated, and the safety profile of the combination was similar to that either drug given alone under the conditions of this study.

Adult↗
PubMed1988

In vitro activity of cefoperazone plus sulbactam compared with that of other antimicrobial agents against anaerobic bacteria.

The activity of two cefoperazone-sulbactam combinations against anaerobic bacteria was tested and compared both with that of cefoperazone alone and with that of other commonly used antimicrobial agents. Imipenem was the most active of the tested agents, followed by chloramphenicol, metronidazole, and cefoperazone-sulbactam (90 to 100% of bacterial growth inhibited). Clindamycin and cefoxitin inhibited approximately 80%, cefoperazone inhibited 63%, and penicillin G inhibited 47% of the strains tested. The agents were variable in activity against the Bacteroides fragilis group, with percents susceptible as follows: cefoperazone-sulbactam, imipenem, metronidazole, and chloramphenicol, 99 to 100%; cefoxitin and clindamycin, approximately 80%; cefoperazone, 49%; and penicillin G, 15.5%.

Anti-Bacterial Agents↗
PubMed1986

Predicting the susceptibility of anaerobes to cefoperazone, cefotaxime, and cefoxitin with the thioglycolate broth disk procedure.

A variety of clinical anaerobic isolates were tested against cefoperazone (216 strains), cefoxitin (120 strains), and cefotaxime (120 strains) by the thioglycolate anaerobic broth disk method, and the results were compared with the National Committee for Clinical Laboratory Standards reference agar dilution method. The broth disk and reference breakpoint concentrations were as follows: cefoperazone, 60 and 64 or 30 and 32 micrograms/ml; cefotaxime, 30 and 32 micrograms/ml; cefoxitin, 18 and 16 micrograms/ml, respectively. Discrepant results were retested to obtain a mode. There was 99% agreement between the broth disk and reference methods for cefotaxime, 98% for cefoperazone with 60- and 64-micrograms/ml breakpoints and 91% with 30- and 32-micrograms/ml breakpoints, and 75% for cefoxitin. All but one of the strains that produced false susceptibility results by broth disk were members of the Bacteroides fragilis group, 1 with cefoperazone using the 60-micrograms/ml concentration, 14 with cefoperazone at the 30-micrograms/ml concentration, and 27 with cefoxitin. One strain of Clostridium difficile produced false susceptibility results to cefoperazone at the 30-micrograms/ml concentration. The lack of agreement between the broth disk and reference methods with cefoxitin may be a reflection of the number of isolates at the 16-micrograms/ml level and that the broth disk breakpoint was slightly higher than this concentration. Increased incubation time did not improve the results significantly.

Bacteria, Anaerobic↗
PubMed1987

In vitro antimicrobial spectrum, occurrence of synergy, and recommendations for dilution susceptibility testing concentrations of the cefoperazone-sulbactam combination.

Broth microdilution tests and an antimicrobial interaction (synergy) studies using various combinations of cefoperazone and sulbactam were performed in an effort to determine the most appropriate in vitro dilution test system. The test results with cefoperazone and sulbactam were categorized as synergistic (complete or partial) for nearly 80% of the strains isolated from clinical trial patients. The results indicate that the cefoperazone-sulbactam fixed ratio (2:1) maximized the cefoperazone spectrum of activity and best approximated the parenteral formulation of the drug. The cefoperazone-sulbactam combination had a greater antimicrobial activity than did the other comparison beta-lactams, except for imipenem, tested against strains of the family Enterobacteriaceae. To be consistent with the National Committee for Clinical Laboratory Standards interpretive breakpoints for cefoperazone alone, the following MIC breakpoints should be applied to the combination (2:1 ratio): less than or equal to 16/8 micrograms/ml, susceptible; 32/16 micrograms/ml, moderately susceptible; and greater than or equal to 64/32 micrograms/ml, resistant.

Bacteria↗