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PubMed1996

Antimicrobial resistance among lower respiratory tract isolates of Haemophilus influenzae: results of a 1992-93 western Europe and USA collaborative surveillance study. The Alexander Project Collaborative Group.

During 1992 and 1993, 2718 respiratory tract isolates of Haemophilus influenzae were obtained from two study centres in each of five West European countries and five study centres in the USA. beta-Lactamase production was assessed and MICs of 14 antimicrobial agents determined in a single co-ordinating laboratory using a broth microdilution method in Mueller-Hinton-lysed horse blood medium. The prevalence of strains producing beta-lactamase varied between 0 and 37.9%. In general, the highest prevalence was in study centres from Spain and the USA with slightly lower rates observed in France and the UK. Only a single confirmed beta-lactamase-negative, ampicillin resistant strain was recovered during the entire study. Erythromycin resistance, defined as an MIC of > or = 4.0 mg/L, was noted in 57.5% of isolates. Among the other antimicrobials tested, resistance rates > or = 1.0% were observed only with cefaclor (3.7%), chloramphenicol (1.4%) and co-trimoxazole (2.5%). In no case, was the prevalence of resistance or beta-lactamase production significantly greater in 1993 than in 1992.

Amoxicillin↗
PubMed1996

Antibiotic susceptibility patterns of community-acquired respiratory isolates of Moraxella catarrhalis in western Europe and in the USA. The Alexander Project Collaborative Group.

Eight hundred and eighteen Moraxella catarrhalis strains, isolated in 1992 and 1993 at 15 centres in Western Europe and the USA were tested for beta-lactamase production and resistance to 15 antibiotics. The proportion of beta-lactamase producing strains in Europe rose significantly from 70% in 1992 to 82% in 1993, whilst in the USA the increase (85-92%) was not significant. Penicillin and amoxycillin resistance was more prevalent in the USA than in Europe. All penicillin-resistant strains isolated in the USA exhibited beta-lactamase activity, whilst 8% of beta-lactamase-negative strains isolated in Europe were also penicillin resistant. All but three isolates were sensitive to cefaclor, cefuroxime, cefixime and ceftriaxone, all but one were sensitive to ofloxacin and all were sensitive to ciprofloxacin and amoxycillin cluvulanate. Resistance to erythromycin was not encountered, although 19 strains had MICs > or = 0.5 mg/L. Of these, 15 came from European centres. Almost all strains were highly susceptible to clarithromycin, azithromycin, doxycycline and co-trimoxazole.

4-Quinolones↗
PubMed1996

Susceptibility of respiratory strains of Staphylococcus aureus to fifteen antibiotics: results of a collaborative surveillance study (1992-1993). The Alexander Project Collaborative Group.

As part of the Alexander Project during 1992 and 1993, 690 Staphylococcus aureus strains isolated from community-acquired lower respiratory tract infections by clinical microbiology centres located in Europe and the USA were analysed by a co-ordinating laboratory that determined minimal inhibitory concentrations of 15 antimicrobial agents using a standardised microdilution technique. The prevalence of penicillin-susceptible microorganisms in this collection of pathogens was significantly higher in Europe (21.2%) than it was in the USA (12.1%). Most isolates (72.5%), however, were strains that had acquired the ability to synthesise a beta-lactamase but which were sensitive to methicillin. The incidence of methicillin-resistance (9.1% overall) was highly variable depending on geographic location and year of isolation. Analysis of MIC50, MIC90, MIC range and modal MIC of the 15 antibiotics assayed disclosed no major differences between the data sets obtained during the 2-year survey. Except for methicillin-resistant S. aureus, the activity of all the beta-lactams tested, with the exclusion of penicillin, amoxycillin and cefixime (that were completely inactive), was satisfactory. The effect of beta-lactamase synthesis was inhibited by the combination of amoxycillin with clavulanate, and by cefuroxime and ceftriaxone. Cefaclor was slightly less effective. Erythromycin, clarithromycin and azithromycin showed identical cross-resistance rates (around 10%). Resistance to the macrolides was more frequent in the USA than in Europe and was the sole trait found to increase during the survey. Doxycycline, chloramphenicol, co-trimoxazole and the two fluoroquinolones tested (ofloxacin and ciprofloxacin) were remarkably effective (resistance lower than 1%). Only doxycycline and, to a lesser extent, co-trimoxazole were partially active against methicillin-resistant strains.

Anti-Bacterial Agents↗
PubMed1998

Trends in antimicrobial resistance of Streptococcus pneumoniae in children in a Turkish hospital.

The antimicrobial susceptibilities of 143 isolates of Streptococcus pneumoniae recovered from the sputa of children with lower respiratory tract infections in a Turkish university hospital were determined. Five isolates (3.5%) were resistant and 57 isolates (39.9%) intermediately resistant to penicillin. The most common serotype among these resistant isolates was serotype 23, followed by serotypes 19 and 14. The overall resistance rates were 31% for tetracycline, 11% for erythromycin and cefaclor, 4% for chloramphenicol, 2% for cefotaxime and 0% for vancomycin. The data highlight the need for surveillance of resistance and serotype distribution of S. pneumoniae in our geographical area.

Child↗
PubMed1999

Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis.

Limited data exist to guide physicians in the cost-effective treatment of acute exacerbation of chronic bronchitis (AECB). Therefore, the main objective of this study was to determine the antimicrobial efficacy and related costs for patients with AECB. A retrospective review of 60 outpatient medical records with a diagnosis of chronic obstructive pulmonary disease (COPD) and chronic bronchitis episodes from a pulmonary clinic of a teaching institution was undertaken. The participating patients had a total of 224 episodes of AECB requiring antibiotic treatment. Before review, empirical antibiotic choices were divided into first-line (amoxycillin, co-trimoxazole, tetracyclines, erythromycin), second-line (cephradine, cefuroxime, cefaclor, cefprozil) and third-line (co-amoxiclav, azithromycin, ciprofloxacin) agents. Patients receiving first-line agents failed significantly more frequently than third-line agents (19% vs 7%, P < 0.05). Additionally, patients prescribed first-line agents were hospitalized significantly more often for AECB within 2 weeks of outpatient treatment as compared with patients prescribed third-line agents (18.0% vs 5.3% third-line agents; P < 0.02). Time between subsequent AECB episodes requiring treatment was significantly longer for patients receiving third-line agents compared with first-line and second-line agents (P < 0.005). Pharmacy costs were lowest with first-line agents (first-line US$10.30 +/- 8.76; second-line US$24.45 +/- 25.65; third-line US$45.40 +/- 11.11; P < 0.0001), but third-line agents showed a trend towards lower mean total costs of AECB treatment (first-line US$942 +/- 2173; second-line, US$563 +/- 2296; third-line, US$542 +/- 1946). The use of third-line antimicrobials, co-amoxiclav, ciprofloxacin or azithromycin, significantly reduced the failure rate and need for hospitalization, prolonged the time between AECB episodes, and showed a lower total cost for the management of AECB. Prospective studies are needed to confirm these findings.

Acute Disease↗
PubMed1999

In-vitro activity of levofloxacin against Streptococcus pneumoniae with various levels of penicillin resistance.

This in-vitro study was designed to compare the activity of levofloxacin with that of ciprofloxacin, ofloxacin, erythromycin, penicillin, amoxycillin, loracarbef, cefaclor, cefpodoxime, ceftriaxone, trimethoprim-sulphamethoxazole, clindamycin and vancomycin against a collection of 202 Streptococcus pneumoniae isolates (56% susceptible to penicillin, 34% intermediate, 10% resistant). The isolates (60% nasopharyngeal, 40% middle ear) were obtained from otherwise healthy children at child care centres in urban and rural Nebraska, and at a paediatric clinic in rural Kentucky. MICs were determined by NCCLS agar dilution methodology using an inoculum of 10(4) cfu/spot. Using NCCLS breakpoints, the percentage of penicillin-intermediate and -resistant strains susceptible to the evaluable agents were, respectively, as follows: levofloxacin (99%, 100%), ofloxacin (87%, 100%), erythromycin (52%, 65%), ceftriaxone (93%, 25%), trimethoprim-sulphamethoxazole (7%, 0%), clindamycin (93%, 100%) and vancomycin (100%, 100%). Without NCCLS interpretive criteria, no conclusions could be made concerning the susceptibility of penicillin-intermediate and -resistant strains to the other study drugs. All beta-lactam antibiotics, erythromycin and trimethoprim-sulphamethoxazole were less active against penicillin-resistant strains, indicating that these may be suboptimal agents for empirical therapy for suspected S. pneumoniae infections in these patient populations. However, levofloxacin, ofloxacin, clindamycin and vancomycin were equally active against penicillin-susceptible and -resistant strains. These data suggest that the efficacy of levofloxacin should be examined in both adult and paediatric S. pneumoniae infections involving body sites where levofloxacin concentrations > 2 mg/L can be achieved safely.

Anti-Bacterial Agents↗
PubMed2000

Streptococcus pneumoniae in the USA: in vitro susceptibility and pharmacodynamic analysis.

Ninety-two laboratories in the USA submitted isolates of Streptococcus pneumoniae to a single laboratory for susceptibility testing. Overall, 64% of 4489 isolates were susceptible to penicillin, 24% were intermediate and 13% were resistant to penicillin, although susceptibilities varied depending on geographical region. Macrolide/azalide resistance varied from 4 to 30%, with some regions having macrolide/azalide resistance higher than penicillin resistance. Children 12 years of age were significantly more likely to be infected with a penicillin-resistant pneumococcus than were adolescents or adults. Isolates from the respiratory tract were more likely to be penicillin resistant and >50% of pneumococci from the ear were resistant to penicillin. Almost 25% of penicillin-susceptible isolates had cefaclor MICs 2.0 mg/L and 15% of penicillin-susceptible isolates had loracarbef MICs 2.0 mg/L. These isolates would be erroneously reported as susceptible using NCCLS guidelines, and this finding may explain the lack of clinical response in patients treated with these antibiotics. The predicted plasma concentrations of all cephalosporins tested exceeded the geometric mean MIC for at least 40% of the dosing interval for penicillin-susceptible S. pneumoniae; for penicillin-intermediate S. pneumoniae, only cefprozil (56%), cefuroxime (64%) and cefpodoxime (63%) reached >40% of time above the geometric mean MIC in the dosing interval. None of the cephalosporins evaluated achieved a substantial time above the geometric mean MIC during its dosing interval for fully penicillin-resistant S. pneumoniae.

Adolescent↗
PubMed2000

Antibiotic resistance in respiratory tract isolates of Haemophilus influenzae and Moraxella catarrhalis collected from across Canada in 1997-1998.

Between September 1997 and November 1998 respiratory tract isolates of Haemophilus influenzae (n = 1352) and Moraxella catarrhalis (n = 428) were collected by 18 Canadian medical centres. beta-Lactamase was produced by 24.0 and 94.2% of H. influenzae and M. catarrhalis isolates, respectively. Resistance rates for H. influenzae were highest for ampicillin (24.0%), trimethoprim/sulphamethoxazole (13. 7%), loracarbef (6.1%) and cefaclor (4.2%), and </= 1% for amoxycillin/clavulanate, cefotaxime, cefprozil, cefixime, imipenem, ciprofloxacin, levofloxacin, grepafloxacin, trovafloxacin and chloramphenicol. M. catarrhalis resistance rates, derived using NCCLS breakpoint criteria for Haemophilus spp., were </= 1% for all antibiotics tested except ampicillin (49.5%) and trimethoprim/sulphamethoxazole (1.6%).

Anti-Bacterial Agents↗
PubMed2002

Antimicrobial resistance amongst isolates of Streptococcus pyogenes and Staphylococcus aureus in the PROTEKT antimicrobial surveillance programme during 1999-2000.

The pattern of susceptibility to a range of antimicrobials was tested for 1485 isolates of Streptococcus pyogenes and 1547 isolates of Staphylococcus aureus included in the international PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin) surveillance study (1999-2000). Overall, almost 10% of S. pyogenes isolates were erythromycin A resistant. There was a wide heterogeneity of resistance, with high levels of macrolide resistance in Poland (42%), Hong Kong (28%), Italy (25%), Portugal (24%) and Spain (21%), and no macrolide resistance in Indonesia, Austria, Belgium, the Netherlands or the UK. Using NCCLS tentative breakpoints, 97.6% of isolates were susceptible to telithromycin, with MIC(90) < or = 0.015 mg/L in most regions. Resistance among S. pyogenes to the beta-lactams (MIC(90) < or = 0.12 mg/L for all except cefaclor) and fluoroquinolones was not detected. Macrolide resistance was present among the S. aureus isolates, and as with S. pyogenes, there was a wide heterogeneity of resistance, with lower rates in Australia, Indonesia, Hungary, Austria, Germany, the Netherlands, Portugal, Sweden and Switzerland. Methicillin-resistant isolates were resistant to the beta-lactams and the macrolides. Resistance to telithromycin was detected in methicillin-resistant isolates in Latin and North America, Asia and Europe. Telithromycin resistance was non-existent or low (MIC(90 )range 0.06-0.25 mg/L) in Australia, Indonesia, Hungary, Austria, Germany, the Netherlands, Portugal, Sweden and Switzerland. Regardless of methicillin susceptibility, resistance to linezolid, teicoplanin or vancomycin was not apparent globally.

Anti-Bacterial Agents↗
PubMed2003

Effect of extended-spectrum beta-lactamases on the susceptibility of Haemophilus influenzae to cephalosporins.

The extended-spectrum beta-lactamases (ESBLs) TEM-3, TEM-4 and TEM-5 were cloned into Haemophilus influenzae. These recombinant strains exhibited cefotaxime MICs of 0.5, 0.25 and 0.12 mg/L for TEM-3, -4 and -5, respectively, and the MIC of cefaclor was 4.0 mg/L. These MICs are higher than those of beta-lactamase-negative strains, or those producing simple wild-type TEM-1 beta-lactamase, but not high enough to be categorized as resistant according to the breakpoints of the NCCLS. The clones were also categorized as susceptible using NCCLS disc diffusion methodology and interpretive criteria. This study shows that current NCCLS susceptibility testing methods may have difficulty in detecting ESBLs if they were to occur in H. influenzae.

Cephalosporin Resistance↗
PubMed2003

Natural antimicrobial susceptibilities of strains of 'unusual' Serratia species: S. ficaria, S. fonticola, S. odorifera, S. plymuthica and S. rubidaea.

The natural susceptibility to 71 antibiotics of 104 Serratia strains of Serratia ficaria (n = 15), Serratia fonticola (n = 18), Serratia odorifera (n = 16), Serratia plymuthica (n = 32) and Serratia rubidaea (n = 23) was examined. MICs were determined using a microdilution procedure in IsoSensitest broth for all the strains and in cation-adjusted Mueller-Hinton broth for some strains. With few exceptions, all species tested were uniformly naturally resistant to penicillin G, oxacillin, cefazolin, cefuroxime, all tested macrolides, lincosamides, streptogramins, glycopeptides, fusidic acid and rifampicin, and naturally sensitive to several aminoglycosides, piperacillin, piperacillin/tazobactam, carbapenems, some cephalosporins, fluoroquinolones and folate-pathway inhibitors. Major species-related differences in natural susceptibility affecting clinical assessment criteria were seen with tetracyclines, some aminoglycosides, aminopenicillins, ticarcillin, cefaclor, loracarbef, cefoxitin, pipemidic acid, chloramphenicol, nitrofurantoin and fosfomycin. Differences in susceptibility dependent on the medium were seen with macrolides, tetracycline, fosfomycin and some beta-lactams. The natural antibiotic susceptibility patterns suggest novel species-specific mechanisms of antibiotic resistance. Uncharacterized species-specific aminoglycoside-modifying enzymes and multidrug efflux systems affecting tetracyclines, quinolones and chloramphenicol are probably responsible for some of the phenotypes observed. The natural amoxicillin sensitivity of several strains of some species combined with natural resistance to some narrow-spectrum cephalosporins indicate the expression of naturally occurring beta-lactamases with unique substrate profiles. beta-Lactamases of representative strains of each species were characterized phenotypically and genotypically. It was shown that all species expressed naturally occurring AmpC beta-lactamases and, with respect to S. fonticola, also a species-specific class A beta-lactamase. Inducibility of these enzymes was shown in all species with the exception of S. rubidaea and four of five strains of S. plymuthica.

Anti-Infective Agents↗
PubMed2003

Antimicrobial susceptibility of lower respiratory tract pathogens in Great Britain and Ireland 1999-2001 related to demographic and geographical factors: the BSAC Respiratory Resistance Surveillance Programme.

OBJECTIVE: The aim of this study was to assess the antimicrobial susceptibility of community-acquired lower respiratory pathogens in Great Britain and Ireland, and investigate its relationship with demographic and geographical factors using multiple logistic regression analysis. METHODS: A total of 1328 isolates of Streptococcus pneumoniae, 1894 Haemophilus influenzae and 845 Moraxella catarrhalis were collected from lower respiratory clinical specimens (primarily sputum) by 20 laboratories in Great Britain (England, Wales and Scotland) and Ireland (Northern Ireland and Eire) between 1999 and 2001. RESULTS: Of 1154 S. pneumoniae from Great Britain, 92-100% were susceptible to beta-lactams (only 0.2% having penicillin MICs > or =2 mg/L), 89% were susceptible to erythromycin, 93% susceptible to tetracycline, and 94-100% intermediate or susceptible to fluoroquinolones. Susceptibility to agents other than fluoroquinolones was less frequent in the 174 isolates from Ireland: beta-lactam susceptibility was 68-99% (3.4% having penicillin MICs > or =2 mg/L), erythromycin susceptibility was 78% and tetracycline susceptibility was 82%. In multivariate analysis, susceptibility in S. pneumoniae was associated with country and patient age, being most common overall in the 20-49 years age group. Of 1894 H. influenzae, 15% produced beta-lactamase and 79-100% were susceptible to beta-lactams other than cefaclor. Ninety-six per cent were intermediate and 1% susceptible to erythromycin, 97% susceptible to tetracycline, and 89% susceptible to trimethoprim. Only one isolate showed resistance to ciprofloxacin. H. influenzae from sputum were more likely to be susceptible than isolates from other sources. Of 845 M. catarrhalis, 92% produced beta-lactamase and 9% were susceptible to ampicillin, >99% were susceptible to co-amoxiclav, cefotaxime, erythromycin and fluoroquinolones. CONCLUSIONS: Clinically relevant demographic factors predictive of susceptibility were country and patient age in S. pneumoniae, and specimen type (sputum/non-sputum) in H. influenzae. Susceptibility to most antimicrobials remains high in Ireland and very high in Great Britain.

Adult↗
PubMed2003

Comparison of BSAC agar dilution and NCCLS broth microdilution MIC methods for in vitro susceptibility testing of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis: the BSAC Respiratory Resistance Surveillance Programme.

OBJECTIVE: The aim of this study was to establish the degree of comparability between the NCCLS broth microdilution and BSAC agar dilution MIC methods of antimicrobial susceptibility testing. METHODS: Six hundred and sixty-one clinical isolates of Streptococcus pneumoniae, 936 Haemophilus influenzae and 421 Moraxella catarrhalis, collected in the winter of 1999-2000 by 20 laboratories in the UK and Eire from patients with presumed community-acquired lower respiratory infections, were tested by the two methods. MIC agreement was defined as excellent (good) if results were within +/- 1 doubling dilution for > or =90% (> or =80%) of isolates and within +/- 2 doubling dilutions for > or =95%. Isolates were categorized as susceptible, intermediate or resistant using the breakpoints appropriate to the testing method. RESULTS: MIC agreement was good or excellent in 27 of 36 organism-agent combinations. Agreement was less for M. catarrhalis than for other species, and lower in all three species for cefaclor and trimethoprim than for other antimicrobials. Discrepancies in categorization occurred only occasionally, and were generally explained by differences in breakpoints rather than in measured MICs. One exception was S. pneumoniae with penicillin. Despite excellent MIC agreement and identical breakpoints, 9% of these had minor discrepancies, mainly because 7% of isolates were found intermediate by the BSAC method but resistant by the NCCLS method. CONCLUSION: There is generally very good agreement between the MICs obtained by the BSAC agar dilution and NCCLS broth microdilution methods in this population of isolates, comparable to the level of agreement achieved between different laboratories using a single method. Breakpoint differences contribute to most of the discrepancies in susceptibility categorization.

Agar↗
PubMedDate not supplied

Erythromycin resistance in group A beta-hemolytic streptococci.

Recent reports have indicated a high incidence of erythromycin resistance in Group A streptococci isolated from children in Japan. The present study investigated antibiotic susceptibility patterns of 280 pharyngeal isolates from ambulatory patients using the plate dilution technique. The incidences of resistance to erythromycin and tetracycline were 4.3 and 7.8%, respectively. No resistance to penicillin, ampicillin, methicillin, oxacillin, cefaclor or moxalactam was found, and there was no evidence of penicillin tolerance using the standard tube dilution technique. The erythromycin-resistant isolates were of T-pattern 12, M-type 12, and two erythromycin-resistant isolates were also resistant to tetracycline. Data on the source of the isolates suggest that a localized outbreak of erythromycin-resistant streptococcal infection occurred.

Anti-Bacterial Agents↗
PubMedDate not supplied

Bacteremia in ambulatory children.

Bacteremia is a relatively common event in young, apparently mildly ill febrile children. The bacteremia is associated with certain risk factors including age, elevated temperature and high white blood cell count or increased erythrocyte sedimentation rate. The disease and bacteremia clears without antimicrobial agents in some children, but many untreated children have persistent disease. Culture of blood is valuable in children with risk features and may be enhanced in the future as methods for detection of antigen become more widely available. Available data from randomized trials of therapy do not provide clear guidelines for treatment and opinions about optimal management of children at risk for bacteremia vary. My judgement is that presumptive therapy is warranted for the child who is 6 to 24 months of age, who has high fever and has high white blood cell count. Therapy should be effective for the pneumococcus and for H. influenzae. Currently, I recommend amoxicillin or, for children allergic to penicillin, trimethoprim-sulfamethoxazole or cefaclor. After 48 to 72 hours the physician can judge the clinical course and will have data from cultures to base decisions about management of the illness.

Ambulatory Care Facilities↗
PubMedDate not supplied

Treatment of impetigo: a review.

A number of well-designed comparison studies have shown the superiority of oral or injectable antibiotics over typical treatment in the treatment of impetigo contagiosa. Erythromycin, phenoxymethyl penicillin, intramuscular benzathine penicillin G as well as clindamycin, cefaclor and amoxicillin with clavulanic acid have been shown to be extremely effective. Because of significant differences in study design, it is difficult to compare drugs investigated in different studies. Intramuscular benzathine penicillin G consistently has been associated with the highest cure rates, especially in studies specifically of streptococcal impetigo. It is unclear whether these high cure rates reflect superior efficacy or are the result of lesser compliance with oral medication, but the latter explanation is quite likely. This information generally translates into daily practice as a recommendation of a penicillin or an erythromycin preparation for streptococcal impetigo unless the lesions are small and few in number, in which case topical therapy is probably sufficient. If oral antibiotics are prescribed they should be given for 10 days. Systemic as opposed to topical antibiotics should be considered more strongly in situations where the incidence of impetigo is high, since these drugs are clearly superior in sterilizing the lesions quickly to prevent transmission. Other situations that favor the use of systemic as opposed to topical antibiotics include the presence of nephritogenic strains in the population, whether endemic or epidemic, more severe or spreading lesions and a population with poor hygiene.

Administration, Oral↗
PubMed1987

Malabsorption of oral antibiotics in humans and rats with giardiasis.

We observed unexplained treatment failures in 13 patients with serious infections and apparent incidental giardiasis. Antibiotic concentrations were assayed in the serum from patients before initiating anti-Giardia therapy and again 2 to 3 weeks after therapy. The peak serum concentrations of antibiotics were higher after treatment for giardiasis. The rat model of giardiasis was used to examine the hypothesis that oral antibiotics are malabsorbed during Giardia lamblia infection. Twenty-eight-day-old Sprague-Dawley rats were fed amoxicillin (50 mg/kg/dose), ampicillin (50 mg/kg/dose), cefaclor (50 mg/kg/dose), cephalexin (50 mg/kg/dose), erythromycin (50 mg/kg/dose), penicillin V (50 mg/kg/dose) or sulfamethoxazole (20 mg/kg/dose) and sera were assayed for antibiotics at 1, 2, 4, 6 and 12 hours after therapy. The same rats were fed 10(5) G. lamblia cysts on 4 consecutive days. On Day 7 of infection the rats were fed the same antibiotic and sera were assayed for antibiotics at 1, 2, 4, 6 and 12 hours after therapy. The mean peak serum concentrations for all drugs except sulfamethoxazole were significantly higher in the rats before infection with G. lamblia. These data suggest that oral antibiotic therapy maybe compromised by decreased absorption in the presence of giardiasis.

Administration, Oral↗
PubMed1987

In vitro activity of a new broad spectrum, beta-lactamase-stable oral cephalosporin, cefixime.

Cefixime is a new orally absorbed iminomethoxy, aminothiazolyl cephalosporin. It inhibits the majority, 90%, of Streptococcus pneumoniae, Streptococcus pyogenes, Branhamella catarrhalis, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Neisseria gonorrhoeae at concentrations less than or equal to 0.25 micrograms/ml. It inhibits 90% of the other members of the Enterobacteriaceae at concentrations less than 1 microgram/ml, with the exception of some strains of Enterobacter spp., Citrobacter freundii and Morganella morganii, Cefixime does not inhibit enterococci, Listeria, Pseudomonas aeruginosa, Acinetobacter, Bacteroides spp. or staphylococci. In general, cefixime has in vitro activity superior to cephalexin, cephradine, cefadroxil and cefaclor against all bacteria with the exception of staphylococci. Cefixime is not destroyed by most of the common plasmid and chromosomal beta-lactamases and its activity is not reduced by serum, blood or urine. Cefixime overall has excellent in vitro activity against the commonly encountered respiratory and urinary tract pathogens.

Bacteria↗