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PubMed2005

Multidrug-resistant Salmonella enterica serovar Muenchen from pigs and humans and potential interserovar transfer of antimicrobial resistance.

Salmonella serovars are important reservoirs of antimicrobial resistance. Recently, we reported on multidrug-resistant (MDR) Salmonella enterica serovar Typhimurium strains among pigs with resistance to ampicillin, kanamycin, streptomycin, sulfamethoxazole, and tetracycline (resistance [R] type AKSSuT) and resistance to amoxicillin-clavulanic acid, ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline (R type AxACSSuT). In the present study, 67 isolates (39 from humans and 28 from pigs) of clinically important Salmonella serovar Muenchen were characterized. Among the porcine isolates, 75% showed resistance to seven antimicrobials: ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, tetracycline, amoxicillin-clavulanic acid, and kanamycin (R type ACSSuTAxK). One isolate from humans showed resistance to 10 of the 12 antimicrobials: ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, tetracycline, amoxicillin-clavulanic acid, kanamycin, gentamicin, cephalothin, and ceftriaxone (R type ACSSuTAxKGCfCro). Pulsed-field gel electrophoresis revealed no clonality between the porcine and the human strains. The porcine and the human MDR strains carried class 1 integrons of 2.0 and 1.0 kb, respectively. Genes specific to the porcine strain included aadA2, aphA1-Iab, and tetA(B). DNA sequencing revealed that the porcine isolates carried bla(OXA-30) on a class 1 integron. Genes specific to the human strain included bla(TEM), strA, strB, cmlA, tetA(A), and aadA2. No bla(CMY-2) gene was detected. Serovar Muenchen strains of porcine and human origin were able to transfer resistance genes to laboratory strain Escherichia coli MG1655 by conjugation. Plasmid restriction with four restriction enzymes, EcoRI, BamHI, HindIII, and PstI, showed that the conjugative plasmids from porcine Salmonella serovar Muenchen and Typhimurium R-type MDR strains isolated from the same farms at the same time were similar on the basis of the sizes and the numbers of bands and Southern hybridization. The plasmid profiles among the Salmonella serovar Muenchen isolates from the two host species were different. This is the first report to show a high frequency of MDR Salmonella serovar Muenchen strains from pigs and a human strain that is similar to the MDR isolates with the AmpC enzyme previously reported among Salmonella serovars Newport and Typhimurium strains. The MDR strains from the two host species independently represent public health concerns, as Salmonella serovar Muenchen is among the top 10 causes of salmonellosis in humans.

Animals↗
PubMed1985

In-vitro activity of the combinations of ampicillin with mecillinam or with beta-lactamase inhibitors against strains resistant to ampicillin.

The in-vitro activity of ampicillin, of mecillinam and of combinations of ampicillin with mecillinam, clavulanic acid or 6 beta-bromopenicillanic acid has been studied against 126 Enterobacteriaceae resistant to ampicillin. The combination of ampicillin with mecillinam showed synergy or addition in 60% of the combinations tested. Synergy was seen especially when the strains were resistant to mecillinam, indifference when they were susceptible to mecillinam. The combination of ampicillin with mecillinam was more active than the combination with clavulanic acid against Escherichia coli, Klebsiella and Enterobacter, but not against Proteus, Morganella and Providencia. The combination of ampicillin with clavulanic acid was more active than the combination with 6 beta-bromopenicillanic acid in E. coli, Klebsiella and Enterobacter strains.

Amdinocillin↗
PubMed2003

[Susceptibility of Campylobacter jejuni clinical isolates from children to eight antibiotics].

This study aimed to identify the activity of eight antibiotics (ofloxacin, moxifloxacin, azithromycin, erythromycin, clindamycin, ampicillin, amoxicillin-clavulanic acid and tetracycline) against 80 strains of Campylobacter jejuni isolated from children. Minimal inhibitory concentrations (MIC) were determined by an agar dilution method. Resistance to azithromycin and erythromycin was considered when MIC > or =8 mg/l, to clindamycin when MIC > or =1 mg/l, to amoxicillin-clavulanic acid and ampicillin when MIC > or =32 mg/l, to ofloxacin and moxifloxacin when MIC > or =4 mg/l, and to tetracycline when MIC > or =16 mg/l. All strains tested were susceptible to amoxicillin-clavulanic acid. The lowest frequency of resistance was to azithromycin (2%), erythromycin (3.7%), clindamycin (4.4%) and ampicillin (4.9%), and the highest was to ofloxacin and tetracycline (61.7% for both), and moxifloxacin (37%). Considered the antibiotics of choice for the treatment of infections caused by this microorganism, macrolides showed excellent activity with MIC(90)=0.5 mg/l for azithromycin and MIC(90)=0.5 mg/l for erythromycin.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed2003

Is it possible to achieve bacterial eradication in otitis media with effusion by empirical antibiotic high doses and concomitant administration of acetaminophen? A microbiological and pharmacological study in the gerbil model.

The efficacy of amoxycillin-clavulanic acid (10 and 15 mg/kg amoxycillin) and erythromycin (20 and 50 mg/kg) was assessed in a gerbil model of otitis media with effusion induced by beta-lactamase-producing Haemophilus influenzae. Animals were divided into groups receiving acetaminophen concomitantly or not receiving it. Treatment started 2 h post-middle ear inoculation and continued t.i.d. for up to three doses. Middle ear samples were obtained on day 2 post-inoculation. Amoxycillin-clavulanic acid showed significantly higher efficacy than erythromycin, regardless of acetaminophen administration (P<0.05). Amoxycillin-clavulanic acid middle ear concentrations exceeded the amoxycillin MIC (1/0.5 microg/ml) by 1.88-fold, whereas erythromycin concentrations were below MIC level of 4 microg/ml. Animals receiving acetaminophen showed significantly fewer polymorphonuclear cells and more Haemophilus organisms in the middle ear exudate.

Acetaminophen↗
PubMed2003

Acute otitis media in children: amoxicillin remains the standard antibiotic, but justified in certain situations only.

(1) The best-assessed antibacterial agents in otitis are penicillin V and amoxicillin. No other antibacterial agents are any more effective in clinical trials. (2) In France, amoxicillin seems the best choice because it is still active against pneumococci with diminished sensitivity to penicillin. Also, amoxicillin causes very few serious adverse effects. (3) There is no firm evidence that clavulanic acid makes amoxicillin any more effective. In fact the combination of amoxicillin + clavulanic acid causes more gastrointestinal adverse effects (including potentially severe diarrhoea) than any other antibacterial agent. (4) For patients who are allergic to penicillin, a macrolide such as erythromycin, or cotrimoxazole, appear to be acceptable first-line alternatives. (5) According to a reliable randomised trial, delaying the decision about antibacterial treatment by 72 hours in children with acute otitis media does no harm. If the decision is delayed, three quarters of children avoid antibacterial therapy altogether. (6) Patients get no extra benefit from extending treatment beyond 5 to 7 days. (7) Prolonged treatment, and the use of low doses are risk factors for subsequent carriage of resistant bacteria. (8) There are no comparative trials of antibacterial agents in children at high risk of severe or complicated disease including infants under 3 months old, children with immunosuppression, and those with high fever.

Amoxicillin↗
PubMed2003

[Meta-analysis of clarithromycin compared to other antibiotics for the treatment of lower respiratory tract infections].

Clarithromycin is a macrolide antibiotic commonly used for the treatment of respiratory infections. The aim of this study was to assess its effectiveness for the treatment of lower respiratory tract infections. A number of meta-analyses of clinical trials comparing clarithromycin to the antibiotics most frequently used in the treatment of lower respiratory tract infections, such as cephalosporins, amoxicillin-clavulanic acid, erythromycin and azithromycin, have been performed. Clarithromycin's effectiveness for the treatment of lower respiratory tract infections was better than that for cephalosporins (OR = 1.43; 95% CI = 1.09-1.86) and, although not to the same extent, that for amoxicillin-clavulanic acid (OR = 1.58; 95% CI = 0.92-2.70); however, the efficacy was only similar to that shown for azithromycin (OR = 0.57; 95% CI = 0.19-1.68). The fourth meta-analysis compared the effectiveness of clarithromycin to that of erythromycin for the treatment of pneumonia and showed a superior odds ratio in favor of clarithromycin (OR = 1.46; 95% CI = 0.97-2.2). Meta-analyses comparing clarithromycin's safety to that of the same drugs in the same conditions used in the assessment of effectiveness showed a similar incidence of adverse events compared to amoxicillin-clavulanic acid, and azithromycin, a slightly lower incidence compared to erythromycin, and a slightly higher incidence compared to cephalosporins. In conclusion, these meta-analyses show that clarithromycin is an effective and safe antibiotic for the treatment of lower respiratory tract infections. Furthermore, a new once-daily dose formulation with a positive impact on therapeutic compliance is currently available, making clarithromycin a first-line treatment for lower respiratory tract infections.

Anti-Bacterial Agents↗
PubMed1990

Implications of beta-lactamase-inhibitor combinations.

Resistance of many species of bacteria to beta-lactam antibiotics is mediated via inactivation by beta-lactamase. Beta-lactamase inhibitors irreversibly bind to beta-lactamases and thus can prevent the destruction of active beta-lactam antibiotics. In the United States three beta-lactam-antibiotic/beta-lactam-inhibitor combinations are commercially available--the orally absorbed amoxicillin/clavulanic acid (A/C), the parenteral formulations of ampicillin/sulbactam (A/S) and ticarcillin/clavulanate (T/C). In a multicenter study that focused on T/C, the in vitro activity of amoxicillin (AMOX), ampicillin (AMP) and ticarcillin (TIC) against Neisseria gonorrhoeae and Haemophilus influenzae was obliterated when beta-lactamase-positive strains were tested, but all tested strains were susceptible to the antibiotics in combination with their respective beta-lactamase inhibitors. Clavulanic acid improved the activity of TIC against most species of Enterobacteriaceae but not against those Enterobacteriaceae that elaborate type I beta-lactamase or against non-Enterobacteriaceae gram-negative bacilli (except for Pseudomonas maltophilia). Staphylococci are generally beta-lactamase positive and considered resistant to AMP and TIC, but greater than 99% of 1,137 Staphylococcus aureus isolates and 92% of coagulase-negative staphylococcal isolates were susceptible to T/C, with comparable figures obtained for A/C and A/S. The activity of TIC against Bacteroides fragilis was improved up to 64-fold by clavulanic acid, with a definite but less pronounced effect on the non-fragilis Bacteroides species. Ninety-seven percent of strains of other anaerobic genera were susceptible to both TIC and T/C.(ABSTRACT TRUNCATED AT 250 WORDS)

Amoxicillin↗
PubMed1998

Discriminatory detection of inhibitor-resistant beta-lactamases in Escherichia coli by single-strand conformation polymorphism-PCR.

Plasmid-mediated mechanisms, comprising TEM hyperproduction, TEM derivative production, and OXA production, lead to amoxicillin-clavulanic acid resistance in enterobacteria. The ability of the single-strand conformation polymorphism (SSCP)-PCR method to differentiate the genes encoding inhibitor-resistant beta-lactamases was evaluated with three bla(TEM) primer pairs. The bla(TEM) genes, which were known to be different on the basis of their nucleotide sequences (bla[TEM-1A], bla[TEM-1B], bla[TEM-2], bla[TEM-30], bla[TEM-32], and bla[TEM-35]), were identified as different by their electrophoretic mobilities. The bla(TEM-33), bla(TEM-34), bla(TEM-36), bla(TEM-37), bla(TEM-38), and bla(TEM-39) genes, whose sequence differences have been established by oligotyping, displayed different SSCP profiles for different fragments, suggesting genetic differences in addition to those defined by oligotyping. Confirmed by sequencing, these additional genetic events concerned silent mutations at certain positions and, notably, a G-->T transversion at position 1 of the -10 consensus sequence in bla(TEM-34), bla(TEM-36), bla(TEM-37), and bla(TEM-39). Applied to eight clinical isolates of Escherichia coli resistant to amoxicillin-clavulanic acid, the SSCP method detected TEM-1 in three strains and TEM-30, TEM-32, and TEM-35 in three other strains, respectively. A novel TEM derivative (TEM-58) was detected in another strain, and the deduced amino acid sequence showed two substitutions: Arg244Ser, which is known to confer amoxicillin-clavulanic acid resistance in TEM-30, and Val261Ile, which has not been described previously. The eighth strain produced an OXA beta-lactamase. Given the discriminatory power and the applicability of SSCP-PCR, this method can be proposed as a means of following the evolution of the frequencies of the different inhibitor-resistant beta-lactamases.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed1998

[In vitro activity of 10 antibiotics including pristinamycin and its two components (RP 12536 and 27404) against strict anaerobes].

The activities of the pristinamycin and its two components (RP 12536 and RP 27404) were investigated using the reference agar dilution method M11A3, on 175 anaerobic strains in comparison with that of erythromycin, clindamycin, metronidazole, amoxycillin either alone or combined with clavulanic acid, piperacillin, cefoxitin, cefotetan and cefotaxime. beta-lactamase production was detected for all the 55 B. fragilis group strains and 8/12 Prevotella and 2/18 Fusobacterium strains, respectively. On the whole anaerobes, resistance rates (%) were respectively: RP 27404 (69), RP 12536 (64), pristinamycin (5) erythromycin (31), clindamycin (17), metronidazole (7) amoxycillin (24), amoxycillin-clavulanic acid (2), piperacillin (7), cefoxitin (14), cefotetan (21) and cefotaxime (27). RP 27404 and 12536 had low activities on anaerobes but acted synergistically as pristinamycin. The greatest anti-anaerobic potencies were obtained with amoxycillin-clavulanic acid combination, pristinamycin, metronidazole and piperacillin. As resistance was not found for pristinamycin among Prevotella, Fusobacterium, Gram+ rods and Peptostreptococcus, this streptogramin may be an appropriate agent for the treatment of periodontitis, pulmonary, ENT, gynecologic and soft tissue infections where these anaerobes are frequently involved.

Anti-Bacterial Agents↗
PubMed2002

Drug-induced liver damage -- a three-year study of patients from one gastroenterological department.

BACKGROUND: The aim of our study was to analyze drug-induced liver disease over a 3-year period in one gastroenterological department. MATERIAL/METHODS: International consensus standard definitions and criteria for assessing causality of adverse drug reactions were applied to all patients with abnormal hepatic test results. RESULTS: Drugs were implicated in hepatic injury in 14 patients (8 females) in whom causal relationship between drug and liver disease was definite or highly probable. The drugs responsible were amoxicillin with clavulanic acid (3 cases), fluvastatin and pravastatin (3 cases), antituberculous drugs (2 cases), estrogens, roxithromycin, asacol, satolol, enalapril and thiamazol. A total of 78.6% (11 cases) were classified as hepatocellular or mixed hepatitis, while cholestatic injury was found in 21.4% (3 cases). There were no lethal or severe (prothrombin < 50%) hepatic drug reactions. In 13 patients the course of liver disease after withdrawal of the offensive drug was either acute or protracted, while in one patient there was chronic cholestasis (>3 years) resulting from injury to interlobular bile ducts by amoxicllin with clavulanic acid. CONCLUSIONS: A thorough history of drug intake should be taken in all patients presenting with abnormal hepatic test results. Amoxicillin & clavulanic acid, cholesterol-lowering and antituberculin drugs were the most frequent hepatotoxic factors in our patients. In a majority of cases the liver injury was not severe, and resolved after prompt withdrawal of the responsible drug.

Adult↗
PubMed2000

Palatability of oral antibiotics among children in an urban primary care center.

OBJECTIVE: To evaluate the palatability of antimicrobial agents effective against beta-lactamase-producing bacteria in American children. DESIGN: In a taste test of 4 antimicrobial agents, azithromycin (cherry flavored), cefprozil (bubble gum flavored), cefixime (strawberry flavored), and amoxicillin-clavulanic acid (banana flavored) were compared. SETTING: An urban inner-city primary care clinic. SUBJECTS: A volunteer sample of 30 healthy children (aged 5-8 years). INTERVENTION: Palatability was determined using a single-blind taste test of 4 flavored antimicrobial agents. The 4 antimicrobial agents used were azithromycin, cefprozil, cefixime, and amoxicillin-clavulanic acid. MAIN OUTCOME MEASURES: After each antimicrobial test dose, subjects rated the taste on a 10-cm visual analog scale incorporating a facial hedonic scale. Preference assessments for the best-tasting and worst-tasting agent were also conducted. RESULTS: Of the 20 children who expressed a preference, significantly more children (9 [45%], P<.05) selected the cefixime preparation as the best-tasting formulation compared with the other preparations. The cefixime preparation was also significantly the least likely to be selected as the worst-tasting preparation (2 [10%], P<.05). There were no significant differences between the other 3 preparations with respect to being selected as either the best or worst tasting. The mean (+/- SD) visual analog scale score for cefixime was highest (8.53 [2.49]) compared with the scores for azithromycin (6.78 [3.45]), cefprozil (6.26 [4.04]), and amoxicillin-clavulanic acid (6.24 [4.01]). CONCLUSION: The cefixime preparation was most commonly rated as best tasting by children.

Administration, Oral↗
PubMedDate not supplied

Extended broad spectrum beta-lactamase in Klebsiella pneumoniae including resistance to cephamycins.

A plasmid-encoded beta-lactamase conferring extended broad spectrum resistance including cephamycins was identified in a Klebsiella pneumoniae strain isolated from a patient's wound. Strains harbouring the plasmid pMVP-1 were resistant to penicillins, cephalosporins of all generations (parenteral and new oral compounds) cephamycins, aztreonam, tetracycline, chloramphenicol, sulfonamides and to all aminoglycosides modified by AAC-(6)-I-transferase. beta-lactams still active against these strains were temocillin, ceftazidime, cefpirome, carumonam and the carbapenems imipenem and meropenem. The new cephamycinase (CMY-1) was more strongly inhibited by sulbactam in the majority of combinations than by clavulanic acid or tazobactam. MICs of ceftazidime and carumonam were not reduced by inhibitors in the wild type and the transconjugant. A transferable plasmid (pMVP-1) of about 9.6 x 10(7) dalton was demonstrated by gel-electrophoresis. In the wild type and the transconjugant a beta-lactamase with an isoelectric point of 8.0 was identified. This enzyme CMY-1 is different from the other extended broad spectrum beta-lactamases (TEM-3 to TEM-10, SHV-2 to SHV-5). The incidence of this enzyme may be underestimated, since resistance to cephamycins in Klebsiella and Escherichia coli has so far been regarded as almost exclusively chromosomally encoded and sensitivity of CMY-1 to clavulanic acid is low. Therefore, screening for CMY-1 beta-lactamases by the usual double disk test including clavulanic acid is not sensitive enough to detect CMY-1 producers. Sulbactam (e.g. in combination with ampicillin) disks and a cephamycin should therefore be used as well when screening for super extended broad spectrum (SEBS-) beta-lactamases.

Cephamycins↗
PubMed1999

Comparative In Vitro Activities of Moxifloxacin (Bay 12-8039) and Other Antimicrobial Agents Against Respiratory Tract Pathogens in Brazil.

Clinical isolates of respiratory tract pathogens were susceptibility tested against six different antimicrobial agents. The in vitro activity of moxifloxacin was compared with that of levofloxacin, cefaclor, amoxicillin-clavulanate acid, azithromycin and trimethoprim-sulfamethoxazole against 111 isolates, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and other species isolated from respiratory tract infections. All isolates were susceptible to moxifloxacin, except for two isolates of Pseudomonas aeruginosa which showed intermediate-resistance (MIC=6µg/mL), and one isolate of Escherichia coli which showed resistance (MIC>32µg/mL). Only moxifloxacin and amoxicillin-clavulanic acid were active against 100% of S. pneumoniae isolates at the suceptible breakpoint (MIC90, 0.25 µg/mL and 0.064 µg/mL respectively). The rank order of the activity among this group of drugs against S. pneumoniae was as follows (% of susceptibility): moxifloxacin = amoxicillin-clavulanic acid (100%) > levofloxacin (97%) > cefaclor (71%) > trimethoprim-sulfamethoxazole (54%) > azithromycin (53%). Except for trimethoprim-sulfamethoxazole, all antimicrobial agents were 100% active against H. influenzae and M. catarrhalis. The fluoroquinolones, moxifloxacin and levofloxacin, were the most potent compounds against these pathogens (MIC(90) 0.032 0.19 µg/mL). These in vitro susceptibility testing data of moxifloxacin support the view that this fluoroquinolone will have an important therapeutic role in the treatment of respiratory tract diseases.

Journal Article↗
PubMed2003

Evaluation of MicroScan ESBL confirmation panel for Enterobacteriaceae-producing, extended-spectrum beta-lactamases isolated in Japan.

We assessed use of the MicroScan ESBL confirmation panel (Dade Behring, Tokyo, Japan) for the detection of eight Enterobacteriaceae-producing extended-spectrum beta-lactamases (ESBL) species. Of 137 bacterial strains isolated from patients in 32 hospitals in the Kinki area of Japan, 91 produced ESBL and comprised 60 bacteria (of E. coli, K. oxytoca, and K. pneumoniae) targeted by the NCCLS ESBL test and 31 non-target bacteria such as chromosomal AmpC-producing bacteria (e.g., Serratia marcescens, Enterobacter spp.). Sensitivity and specificity of the MicroScan panel for the target bacteria were 92% and 93%, respectively; sensitivity and specificity for non-target bacteria were 52% and 100%, respectively. There were 20 ESBL-positive strains that were not inhibited by clavulanic acid in the MicroScan panel (3 of 32 ESBL-producing E. coli strains, 1 of 24 K. pneumoniae, 1 of 4 K. oxytoca, 8 of 13 E. cloacae, and 7 of 14 S. marcescens), and most of them were bacteria not targeted by the NCCLS test. In 19 of the 20 strains, the synergy effect of clavulanic acid was observed in the modified-double-disk synergy test using only the cefepime-disk. Because these strains had high MICs of > or = 16 microg/ml for cephamycins such as cefoxitin and cefmetazole, these strains might produce high levels of AmpC in addition to ESBL. The MicroScan ESBL confirmation panel showed excellent performance in detecting target, but not other bacteria. Addition of cefepime and clavulanic acid to the MicroScan panel may significantly improve detection of non-target bacteria.

Anti-Bacterial Agents↗
PubMed1992

[Evaluation of the efficacy of the combination amoxicillin-clavulanic acid-tobramycin for the prevention of infections after surgery for ORL cancers].

The clinic and economic evaluation of a probabilist antibiotherapy Augmentin/Nebcine administered until the wound healing was studied in 60 patients, operated of upper aerodigestives tracts cancer. The antibiotherapy efficiency was estimated at the end of 6 days in terms of clinic and bacteriologic results. In case of therapeutic failure, the treatment was adapted according to antibiogram results. The association Augmentin/Nebcine was effective in 93% of cases. Antibiotherapy was to be modified for five patients (one for allergy and four for bacteriological unsuccessful). The bacteriologic sample shows the predominance of Gram(-) germs. 83% of them were sensitive to one of these antibiotics in vitro. The daily mean cost of antibiotherapy was about FF 71. The overcost, due to antibiotherapy failures, represented only 1% of the whole cost of the 60 treatments. These results justify the use of a large spectrum antibiotherapy reaching Gram(-) germs.

Aged↗
PubMed1983

[Clinical evaluation of BRL 25000 (clavulanic acid-amoxicillin) in the fields of obstetrics and gynecology].

BRL 25000 was administered to 37 cases with infections in the fields of obstetrics and gynecology, and the following results were obtained. The drug was administered to 17 cases with adnexitis, 13 cases with intrauterine infection and 7 cases with parametritis and/or inflammation of pelvic dead space, etc. The percentage of efficacy (excellent and good) was 74.3%. Of 7 cases where no therapeutic effect was obtained with other drugs, the percentage of efficacy was 57.1%. Antibacterial effect of BRL 25000 was studied in terms of percentage of eradication (including replacement) of clinical isolates. A high percentage of eradication (94.4% or 17/18) was obtained. Among all clinical isolates, 37.9% or 11/29 were beta-lactamase producing organisms. Eradication or replacement by BRL 25000 was noted in all these 9 strains, and BRL 25000 was proved to have a high efficacy also against penicillin or cephalosporin resistant organisms. No abnormality was noted in any patient in hematological, hepatic and renal function before and after administration of BRL 25000. As adverse reaction, diarrhea was found in 1 of 37 cases (2.7%), but it reduced after off-dose.

Adult↗
PubMed1992

Correlation between in vitro antimicrobial susceptibilities and beta-lactamase plasmid contents of isolates of Haemophilus ducreyi from the United States.

We determined the susceptibilities of 94 strains of Haemophilus ducreyi isolated in various municipalities in the United States between 1982 and 1989 to the following antimicrobial agents: amoxicillin-clavulanic acid, ceftriaxone, erythromycin, azithromycin, ciprofloxacin, ofloxacin, trimethoprim, and spectinomycin. Ceftriaxone (MIC, less than or equal to 0.008 micrograms/ml), azithromycin (MIC, less than or equal to 0.125 micrograms/ml), erythromycin (MIC, less than or equal to 0.125 micrograms/ml), ciprofloxacin (MIC, less than or equal to 0.25 micrograms/ml), and ofloxacin (MIC, less than or equal to 0.25 micrograms/ml) were highly active against all isolates. Amoxicillin-clavulanic acid (MICs, 0.25 to 8.0 micrograms/ml), trimethoprim (MICs, 0.06 to 16.0 micrograms/ml), and spectinomycin (MICs, 2.0 to greater than or equal to 32.0 micrograms/ml) were less active against these isolates. Isolates possessing the 5.7-MDa beta-lactamase plasmid were less susceptible to erythromycin, trimethoprim, and spectinomycin than were isolates possessing the 3.2-MDa beta-lactamase plasmid. The susceptibilities of plasmidless isolates to erythromycin, trimethoprim, and spectinomycin were distributed bimodally; the median MIC for the more susceptible plasmidless isolates corresponded to that for isolates with the 3.2-MDa plasmid, and the median MIC for the less susceptible plasmidless isolates corresponded to that for isolates with the 5.7-MDa plasmid. Thus, plasmid profiles may be valuable markers for geographical variations in antimicrobial susceptibilities of H. ducreyi strains that may indicate the relative efficacy of regimens for the treatment of chancroid. Of the regimens recommended by the U.S. Public Health Service for the treatment of chancroid, our results support the use of erythromycin, ceftriaxone, and ciprofloxacin, and perhaps ofloxacin, but suggest that amoxicillin-clavulanic acid and sulfamethoxazole-trimethoprim should be used with caution.

Anti-Bacterial Agents↗
PubMed1995

Antimicrobial susceptibility of subgingival bacterial flora in cats with gingivitis.

The aerobic and anaerobic flora from gingival pockets of 40 cats with established gingivitis were cultured. The susceptibility of each isolate to four antimicrobial agents currently approved for use in cats (amoxicillin-clavulanic acid; clindamycin; cefadroxil; enrofloxacin) was determined. Amoxicillin-clavulanic acid (Clavamox) had the highest in-vitro susceptibility against all isolates (92%) and all anaerobes (99% [co-equal with clindamycin]) tested; enrofloxacin (Baytril) had the highest in-vitro susceptibility against all aerobes (90%) tested.

Amoxicillin-Potassium Clavulanate Combination↗