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PubMed1977

Serologic relationship of fimbriae among Enterobacteriaceae.

The existence of serological relationship of fimbriae among serotypes of the same genus and among genera of Enterobacteriaceae was determined by agglutination and absorption procedures. It was found that fimbriae of different serotypes of the same genus and among the genera a) Escherichia, Shigella and Klebsiella, and b) Salmonella, Arizona and Citrobacter were more or less antigentically related. No relationship was found among fimbriae of the Edwardsiella, Enterobacter, Hafnia, Serratia, Proteus and Providencia. It was also found that in Klebsiella, MS and MR fimbriae differed antigenically. On the basis of the results obtained nine antigentically distinct types of fimbriae were distinguished.

Antigens, Bacterial↗

PubMed1996

Screening of in vitro antibacterial activity from Syzygium Guineense (Willd) hydrosoluble dry extract.

Diarrhoea is one of the most important causes of infant mortality in the world. As modern drugs are expensive or unavailable in developing countries, many people use traditional medicines in Africa for the treatment of several diseases. In our study, we investigated the antibacterial activity of Syzygium Guineense extract in order to assess its activity on some bacterial strains involved in diarrhoeal diseases and to justify its use. The aqueous dry extract was prepared by decoction followed by evaporating to dryness and tested according to dilution method. This extract showed an antibacterial activity against some bacterial strains: Salmonella E., Shigella D., Shigella F., E. Coli., Enterobacter A. It did not show any activity against Citrobacter F., Proteus M., Klebsiella P. Storage conditions (27 degrees C, glass flask) did not affect antibacterial properties of the extract.

Anti-Bacterial Agents↗

PubMed1996

[Lipopolysaccharides containing sialic acid].

Sialic acids which are important constituents of animal tissue glycoconjugates are also present in antigens of some bacterial strains. Capsular polysaccharides with sialic acid have been extensively studied whereas little is known on lipopolysaccharides which contain sialic acid. The paper presents review of the data concerning structure of bacterial endotoxic lipopolysaccharides. Methodological peculiarities were described. Specially emphasized were endotoxins of Escherichia coli O24, O56, O104, Salmonella toucra O48, Citrobacter freundii O37 and Hafnia alvei strain PCM2386.

Bacterial Toxins↗

PubMed1977

[Microbiological pollution of the environment due to breeding. I. Enterobacteriaceae due to cattle breeding].

Enterobacteriaceae from faeces of cattle belonging to four cattle farms situated in the Ferrara district were investigated. At the same time, investigation was made of effluent sewage and recipient wells (upstream and downstream). The cattle (of the Italian Frisona breed) resulted uncontaminated by Salmonellae, but proved to be very susceptible to Arizona, Citrobacter, Shigella and S. gallinarum-pullorum infections, coming from the environment. Predominant species in faeces were as follows: Proteus, Klebsiella, Enterbacter and coliforms. One farm proved to be heavily polluted by Edwardsiella tarda. Yersinia enterocolitica strains were also isolated from faeces and sewage.

Air Microbiology↗

PubMed1998

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1996). I. Susceptibility distribution].

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 680 bacterial strains isolated from patients with urinary tract infections (UTIs) in 10 hospitals during the period of June 1996 to May 1997. Of the above bacterial isolates, Gram-positive bacteria accounted for 30.4% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 69.6% and most of them were Escherichia coli. Susceptabilities of several isolated bacteria to antimicrobial agents were as followed; 1. Enterococcus faecalis Ampicillin (ABPC) showed the highest activity against E. faecalis isolated from patients with UTIs. Its MIC90 was 1 microgram/ml. Imipenem (IPM) and vancomycin (VCM) were also active with the MIC90S of 2 micrograms/ml. The others had low activities with the MIC90S of 16 micrograms/ml or above. 2. Staphylococcus aureus including MRSA Arbekacin (ABK) and VCM showed the highest activities against both S. aureus and MRSA isolated from patients with UTIs. The MIC90S of them were 1 or 2 micrograms/ml. The others except minocycline (MINO) had low activities with the MIC90S of 32 micrograms/ml or above. 3. Staphylococcus epidermidis ABK and VCM showed the strongest activities against S. epidermis isolated from patients with UTIs. The MICs for all strains were equal to or lower than 2 micrograms/ml. Cefazolin (CEZ), cefotiam (CTM) and cefozopran (CZOP) were also active with the MIC90S of 4 micrograms/ml. Compared with antimicrobial activities of cephems is 1995, the MIC90S of them had changed into a better state. They ranged from 4 micrograms/ml 16 micrograms/ml in 1996. 4. Streptococcus agalactiae All drugs except MINO were active against S. agalactiae. ABPC, CZOP, IPM, and clarithromycin (CAM) showed the highest activities. The MICs for all strains were equal to or lower than 0.125 micromilligrams. Tosufloxacin (TFLX) and VCM were also active with the MIC90S of 0.5 micromilligrams. 5. Citrobacter freundii Gentamicin (GM) showed the highest activity against C. freundii isolated from patients with UTIs. Its MIC90 was 0.5 micrograms/ml. IPM and amikacin (AMK) were also active with the MIC90S of 1 microgram/ml and 2 micrograms/ml, respectively. Cefpirome (CPR) and CZOP were also active with the MIC90S of 8 micrograms/ml. The MIC90S of the others were 16 micrograms/ml or above. 6. Enterobacter cloacae IPM showed the highest activity against E. cloacae. The MICs for all strains were equal to or lower than 0.5 microgram/ml. The MIC90S of ciprofloxacin (CPFX) and TFLX were 1 microgram/ml, the MIC90 of AMK was 2 micrograms/ml, the MIC90S of CZOP, GM and ofloxacin (OFLX) were 4 micrograms/ml. The MIC50S of cephems except CEZ, cefmetazole (CMZ) and cefaclor (CCL) had changed into a better state in 1996, compared with those in 1995. 7. Escherichia coli All drugs except penicillins and MINO were active against E. coli. Particularly CPR, CZOP and IPM showed the highest activities against E. coli. The MIC90S of them were 0.125 microgram/ml or below. Among E. coli strains, those with low susceptibilities to cephems except CEZ, cefoperazone (CPZ), latamoxef (LMOX) and CCL have increased in 1996, compared with those in 1995. 8. Klebsiella pneumoniae K. pneumoniae was susceptible to all drugs except penicillins, with the MIC90S of 2 micrograms/ml or below. CPR had the strongest activity, the MICs for all strains were equal to or lower than 0.25 microgram/ml. Flomoxef (FMOX), cefixime (CFIX), CZOP and carumonam (CRMN) were also active with the MIC90S of 0.125 microgram/ml or below. 9. Pseudomonas aeruginosa All drugs except quinolones were not so active against P. aeruginosa with the MIC90S were 32 micrograms/ml or above. Quinolones were more active in 1996 than 1995. The MIC90S of them were between 4 micrograms/ml and 8 micrograms/ml, and the MIC50S of them were between 1 microgram/ml and 2 micrograms/ml. 10. Serratia marcescens GM showed the highest activity against S. marcescens. Its MIC90 was 1 micro

Anti-Bacterial Agents↗

PubMed1997

Coliforms and Salmonella in seawater near to domestic sewage sources in Fortaleza (Ceará, Brazil).

The bacteriological conditions of the coastal region of Fortaleza (Ceará, Brasil), including the coastal zones of the Ceará and Cocó rivers, were examined. The study was conducted during June, September and December 1993, and March 1994. The region was divided into two areas: (i) Direct Influence Area (DIA), consisting of 20 sampling stations located near to discharge zones of the submarine pipeline system, where collections were carried out at the surface, and (ii) Indirect Influence Area (IIA), located near to the coastal zone, including Barra do Ceará, Kartódromo, Volta de Jurema, Mucuripe, Farol and Caça e Pesca beaches, totalling 26 sampling stations. The most probable number (MPN) of both total and fecal coliforms in DIA was positive only in station number 6, near to the sewage discharge exit. The following bacteria were identified: Citrobacter sp., Enterobacter aerogenes and Escherichia coli. Kartódromo beach was contaminated throughout the sampling period. Results of total fecal MPN was essentially lower than 3.0 x 10(2) coliforms/100 ml at Caça e Pesca beach. In December, at both DIA and IIA, Salmonella was identified in several samples. In DIA, the spatial distribution for Salmonella suggests that there should be a coastal sea current from east to west along the coastline. In IIA, Salmonella was identified at Kartódromo and Farol beaches throughout the sampling period.

Atlantic Ocean↗

PubMedDate not supplied

Polynucleotide sequence divergence among strains of Salmonella sub-genus IV and closely related organisms.

Polynucleotide sequence relatedness studies were carried out to determine the extent of divergence present in Salmonella sub-genus IV strains, related strains of Salmonella of other sub-genera and the Citrobacter genus. Salmonella sub-genus IV were 91-97% related. The Salmonella of sub-genus I, II and III showed lower binding (79-87%) to Salmonella sub-genus IV. The change in thermal elution midpoint closely followed the reassociation data. Relatedness of Salmonella sub-genus IV and C. freundii ranged between 44 and 57%, which confirms that these organisms belong to different genera. The taxonomic position of Salmonella sub-genus IV is discussed according to the actual classification of the family Enterobacteriaceae.

Base Sequence↗

PubMedDate not supplied

[An additional dehydrogenase or oxidation-reduction test in the classification of enterobacteria].

The dehydrogenase (DHG) or oxidation-reduction test is proposed for use together with the determination of such enzymes as hydrolases, cytochrome oxidase, dehydrocarboxylase, urease, etc. 200 Citrobacter freundii cultures and 76 strains of enteropathogenic Escherichia (EPE) were studied with the determination of their DHG activity in semiliquid mannitol and in Kligler's medium. The study revealed that this test, characterized by the reduction of the indicator, similarly to that in salmonellae and shigellae, was constantly negative in semiliquid mannitol in C. freundii and in 97.3% of cases in EPE. In 17.5% of C. freundii lactose-positive cultures the DHG test in Kligler's medium was positive, which made it possible to regard them as a separate biovar. Taking into account the results of this investigation, the subdivision of C. freundii into 3 biovars is proposed.

Bacteriological Techniques↗

PubMed1987

Imipenem and cilastatin in acute osteomyelitis and suppurative arthritis. Therapy in infants and children.

Twenty-five infants and children with acute osteomyelitis (n = 7), suppurative arthritis (n = 11), or both (n = 7) were treated with imipenem and cilastatin sodium. Patients ranged in age from 5 months to 11.3 years. Needle aspiration of infected sites was performed in all patients, and 11 (44%) required further surgical drainage. Imipenem and cilastatin sodium in a dosage of 100 mg/kg/d was used for children 3 years of age or younger, while older ones received 60 mg/kg/d intravenously, divided in four equal doses. Bacterial pathogens were identified in 15 patients (60%): Staphylococcus aureus in five, Haemophilus influenzae b in four, Pseudomonas aeruginosa in two, Streptococcus pneumoniae in one, group A Streptococcus in one, Kingella kingae in one, and Citrobacter amalonaticus in one. All isolates were susceptible to imipenem in vitro. Imipenem and cilastatin therapy was continued for a median of six days followed by treatment with appropriate orally administered antibiotics. Median peak serum bactericidal titers after imipenem and cilastatin infusions were 1:512 for S aureus, 1:32 for H influenzae b, 1:512 for streptococci, and 1:16 for gram-negative rods. All but one patient with P aeruginosa osteomyelitis responded favorably to imipenem and cilastatin. The median duration until resolution of symptoms was six days. Imipenem and cilastatin infusions were well tolerated, and side effects included maculopapular rash in one patient, watery diarrhea in one, and mild transient elevation of alanine aminotransferase levels in three. Because of imipenem and cilastatin's unusually broad spectrum of activity and its relative safety, this drug combination can be used for the initial, empiric therapy of acute bone and joint infections in pediatric patients.

Acute Disease↗

PubMed1996

Aerobic and anaerobic microbiology of superficial suppurative thrombophlebitis.

OBJECTIVE: To study the aerobic and anaerobic microbiologic characteristics of superficial suppurative thrombophlebitis. DESIGN: Retrospective review of microbiologic and clinical data. SETTING: Navy Hospital in Bethesda, Md. RESULTS: Sixty-one isolates, 36 aerobic and 25 anaerobic, were isolated from samples obtained from 42 patients. Aerobic bacteria only were found in 26 (62%) patients; anaerobic only, in 11 (26%); and mixed aerobic and anaerobic bacteria, in five (12%). The predominant aerobic bacteria were Staphylococcus aureus (n = 9), Escherichia coli (n = 7), Pseudomonas aeruginosa (n = 4), and Klebsiella sp (n = 3). The most frequently recovered anaerobic bacteria were Peptostreptococcus sp (n = 8), Propionibacterium acnes (n = 6), Bacteroides fragilis group (n = 5), Prevotella intermedia (n = 3), and Fusobacterium nucleatum (n = 3). Propionibacterium acnes and Peptostreptococcus sp were associated with cannula-related superficial suppurative thrombophlebitis; B fragilis and Enterobacteriaceae, with abdominal surgery or pathology; and S aureus and P aeruginosa and Citrobacter sp, with burns. CONCLUSION: These data illustrate the importance of anaerobic bacteria in superficial suppurative thrombophlebitis.

Adult↗

PubMed2000

Emergence of domestically acquired ceftriaxone-resistant Salmonella infections associated with AmpC beta-lactamase.

CONTEXT: Ceftriaxone, an expanded-spectrum cephalosporin, is an antimicrobial agent commonly used to treat severe Salmonella infections, especially in children. Ceftriaxone-resistant Salmonella infections have recently been reported in the United States, but the extent of the problem is unknown. OBJECTIVES: To summarize national surveillance data for ceftriaxone-resistant Salmonella infections in the United States and to describe mechanisms of resistance. DESIGN AND SETTING: Case series and laboratory evaluation of human isolates submitted to the Centers for Disease Control and Prevention from 17 state and community health departments participating in the National Antimicrobial Resistance Monitoring System (NARMS) for enteric bacteria between 1996 and 1998. PATIENTS: Patients with ceftriaxone-resistant Salmonella infections between 1996 and 1998 were interviewed and isolates with decreased ceftriaxone susceptibility were further characterized. MAIN OUTCOME MEASURES: Exposures and illness outcomes, mechanisms of resistance. RESULTS: The prevalence of ceftriaxone-resistant Salmonella was 0.1% (1 of 1326) in 1996, 0.4% (5 of 1301) in 1997, and 0.5% (7 of 1466) in 1998. Ten (77%) of the 13 patients with ceftriaxone-resistant infections were aged 18 years or younger. The patients lived in 8 states (California, Colorado, Kansas, Massachusetts, Maryland, Minnesota, New York, and Oregon). Nine (82%) of 11 patients interviewed did not take antimicrobial agents and 10 (91%) did not travel outside the United States before illness onset. Twelve of the 15 Salmonella isolates with ceftriaxone minimum inhibitory concentrations of 16 microg/mL or higher were serotype Typhimurium but these isolates had different pulsed-field gel electrophoresis patterns. Thirteen of these 15 isolates collected between 1996 and 1998 were positive for a 631-base pair polymerase chain reaction product obtained by using primers specific for the ampC gene of Citrobacter freundii. CONCLUSIONS: Domestically acquired ceftriaxone-resistant Salmonella has emerged in the United States. Most ceftriaxone-resistant Salmonella isolates had similar AmpC plasmid-mediated resistance.

Adolescent↗

PubMedDate not supplied

Production of L-DOPA(3,4-dihydroxyphenyl-L-alanine) from benzene by using a hybrid pathway.

As an alternative approach to the production of L-DOPA from a cheap raw material, we constructed a hybrid pathway consisting of toluene dioxygenase, toluene cis-glycol dehydrogenase, and tyrosine phenol-lyase. In this pathway, catechol is formed from benzene through the sequential action of toluene dioxygenase and toluene cis-glycol dehydrogenase, and L-DOPA is synthesized from the resulting catechol in the presence of pyruvate and ammonia by tyrosine phenol-lyase cloned from Citrobacter freundii. When the hybrid pathway was expressed in E. coli, production of L-DOPA was as low as 3 mM in 4 h due to the toxic effect of benzene on the cells. In order to reduce lysis of cells, Pseudomonas aeruginosa was employed as an alternative, which resulted in accumulation of about 14 mM L-DOPA in 9 h, showing a stronger resistance to benzene.

Antiparkinson Agents↗

PubMed2002

Comparison of long-chain alcohols and other volatile compounds emitted from food-borne and related Gram positive and Gram negative bacteria.

Numerous reports have been published on the antimicrobial activity of synthetic volatile long chain alcohols, such as 1-decanol and 1-dodecanol, against bacteria and fungi. The objective of the present study was to survey microorganisms for emission patterns of naturally occurring long chain alcohols and other volatile components to determine if these compounds are associated with certain groups of bacteria. Cultures were grown in trypticase soy broth overnight and volatile compounds were trapped on a porous polymer and identified by mass spectrometry. Subsequently, volatile compounds were collected from 26 strains of food associated bacteria using solid-phase microextraction and analyzed by gas chromatography. Alcohols comprising 1-octanol, 1-decanol, and 1-dodecanol occurred as products from enteric Gram negative bacteria, which included Citrobacter, Enterobacter, Klebsiella, Salmonella, and Shigella. However, the long chain alcohols were not detected as products from the nonenteric Gram negative species studied which included Acinetobacter, Pseudomonas, and Shewanella. Among Gram positive bacteria, including Bacillus, Enterococcus, Lactococcus, Leuconostoc, Listeria, Staphylococcus, and Streptococcus, the only long chain alcohol detected was 1-decanol and, if present, it occurred in relatively small amounts. Other classes of compounds emitted by bacteria included methylketones and sulfides. The methylketones were found as products from Gram positive and Gram negative bacteria, whereas the sulfides were closely associated with Gram positive bacteria. In summary, the emission patterns of volatile compounds from bacteria showed many trends including the association of long chain alcohols with enteric Gram negative bacteria. The results provide a basis for future in vivo studies to determine if volatile compounds such as natural long chain alcohols function in the ecology of food-borne Gram negative bacterial pathogens.

Alcohols↗

PubMed1996

Antimicrobial effects of oligoamines.

Twenty-four oligoamines belonging to six (1-6) structurally different types were tested in vitro for their antibacterial activity against 14 different bacterial species comprising a total of 187 strains. Ten compounds were able to inhibit growth of at least one strain at concentrations < or = 10 mumol/L. For three compounds, minimum inhibitory concentrations for some strains were even below 1 mumol/L. Clear structure-activity relationships showed that the inhibitory effect depended on the bridge connecting the nitrogen atoms, the substitution of the nitrogens, and the number of nitrogen atoms present in one molecule. Substitutions like N-4-phenylbutyl, N-octyl, and N-nonyl were most active, while short (butyl) and long (dodecyl) substituents diminished or abolished the activity. The antimicrobial spectrum of the oligoamines tested here covered gram-positive (e.g. Staphylococcus aureus, Listeria monocytogenes, Bacillus subtilis) and gram-negative (e.g. Escherichia coli, Citrobacter spp., Acinetobacter spp.) microorganisms. The type of action was classified as bactericidal. As the inhibition of growth is complete immediately after the addition of the oligoamines, an interaction with the bacterial cell-membrane is probable.

Amines↗

PubMed1985

Bacteria and food poisoning organisms in milk.

Individual milk samples of 50 goats, 50 ewes and 50 cows were examined for the total viable count, coliform bacteria, staphylococci and salmonellae. Growth of enterotoxin A producing Staphylococcus aureus NCTC 10652 in the milk of the three animal species was also studied. The average total count was 1.9 X 10(7) cells/ml for cow's, 7.7 X 10(6) for goat's and 2.7 X 10(6) for ewe's milk with micrococci staphylococci, rods and streptococci being the predominant organisms in the three milks, respectively. Goat's milk contained the lowest numbers of coliforms and ewe's milk the highest numbers. Staphylococcus aureus could not be detected in goat's milk, whilst 16 and 26% of the ewe's and cow's milk samples contained 100 and 80 cells/ml, respectively. Out of 39 coagulase positive staphylococci, 27 were thermonuclease positive, 18 produced lecithinase and 15 fermented mannitol. Red blood cells of sheep origin were much more resistant to lysis by ewe's strains compared to bovine strains. Growth curves of Staphylococcus aureus were nearly linear at 17 degrees C but exponential at 31 degrees C without lag phase. Hazardous numbers of about 10(6) cells/ml were readily reached at 31 degrees C after 6 h and at 17 degrees C after 18 h. Salmonellae could not be detected in any of the samples examined. Out of 19 enterobacteria suspected to be salmonellae 11 proved to be Proteus and 8 Citrobacter.

Animals↗

PubMed1988

A survey of clinical experience with ciprofloxacin, a new quinolone antimicrobial.

Ciprofloxacin is a new quinolone antimicrobial agent with activity against a broad spectrum of gram-negative and gram-positive organisms, including Pseudomonas aeruginosa and methicillin-resistant strains of staphylococci. The efficacy and safety results of 80 clinical studies of the oral form of ciprofloxacin are reported. Drug safety was assessed in 2236 courses in 2203 adult patients treated primarily in the United States. Data from 1676 courses were suitable for analysis of drug efficacy. The unit dose for most patients ranged from 250 mg to 750 mg (median, 500 mg), usually given every 12 hours. The duration of treatment ranged from 3 to 231 days (median, 10 days). Predominant among 1722 infections were those of the urinary tract (43%), skin structures (29%), and respiratory tract (19%); the remainder were bone and joint infections (5%), bacteremias (2%), and intra-abdominal (1%), gastrointestinal (1%), and pelvic infections (less than 1%). Signs and symptoms of infection resolved in 79% of all cases; a further 15% improved, and 5% failed to improve. Pathogens were eradicated in 89% of urinary tract infections and persisted in 5%; 80% of patients still had sterile urine at the 3-to 6-week follow-up. In 81% of nonurinary tract infections, pathogens were eradicated; they persisted in 11%, and superinfection occurred in less than 5%. After treatment, 89% of the 2253 causative organisms were eradicated and 2% were reduced to clinically insignificant counts; 8% persisted. Of 411 isolates of P. aeruginosa, 77% were eradicated, as were 97% of 421 Escherichia coli and 80% of 248 Staphylococcus aureus isolates. Also eradicated were 95% of 166 Klebsiella, 96% of 139 Proteus mirabilis, 100% of 20 other Proteus, 94% of 123 Enterobacter, 100% of 68 Haemophilus influenzae, 96% of 49 Citrobacter, 89% of 45 Serratia, 95% of 41 Streptococcus pneumoniae, 91% of 43 Salmonella, 100% of 38 Morganella morganii, and 100% of 35 Providencia isolates. Adverse reactions were judged probably or possibly drug-related in 14.8% of courses; drug treatment had to be stopped prematurely in 3.5%. The most frequent reactions were gastrointestinal complaints (chiefly nausea, diarrhea, and vomiting), metabolic disorders (elevated SGOT, SGPT, serum creatinine, or blood urea nitrogen), and nervous system effects (dizziness, light-headedness, restlessness, tremor, and headache). Crystalluria, judged to be related to ciprofloxacin, occurred in two patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMedDate not supplied

Ceforanide: antibacterial activity, pharmacology, and clinical efficacy.

Ceforanide is a new cephalosporin with a longer elimination half-life than any currently available cephalosporin. Its activity is very similar to that of cefamandole, a second-generation cephalosporin, except that ceforanide is less active against most gram-positive organisms. Many coliforms, including Escherichia coli, Klebsiella, Enterobacter, and Proteus, are susceptible to ceforanide, as are most strains of Salmonella, Shigella, Hemophilus, Citrobacter and Arizona species. However, most strains of Serratia marcescens and all Pseudomonas aeruginosa are resistant to this compound. Peak serum concentrations in excess of 100 micrograms/ml are achieved after a 1 g intravenous dose. The elimination half-life of ceforanide is about 3 hrs in patients with normal renal function; this allows twice daily dosing for the majority of patients. As renal excretion amounts for 85-90% of drug elimination, the serum half-life increases to approximately 20 hours in anuric patients. Tissue penetration studies demonstrate inhibitory concentrations in cardiac tissue, bone, and joint fluid. Minor adverse effects have been reported after large doses of ceforanide. Clinical trials indicate that ceforanide is effective in the treatment of skin and soft tissue, pulmonary and urinary tract infections, bone and joint infections, and endocarditis. Ceforanide also has been shown to be as effective as cephalothin or cephaloridine when given prophylactically for vaginal hysterectomy.

Adolescent↗

PubMedDate not supplied

Amoxicillin and potassium clavulanate: an antibiotic combination. Mechanism of action, pharmacokinetics, antimicrobial spectrum, clinical efficacy and adverse effects.

The combination of amoxicillin and potassium clavulanate will soon be marketed in 2:1 and 4:1 fixed ratio dosage forms. In vitro and in vivo evidence suggests that clavulanic acid, a potent inhibitor of many bacterial beta-lactamase enzymes, will increase the spectrum of amoxicillin to include, at achievable serum concentrations, Haemophilus influenzae, H. ducreyi, Neisseria gonorrhoeae, Staphylococcus aureus and Branhamella catarralis and, at achievable urine levels, many beta-lactamase-producing strains of E. coli, Klebsiella, Proteus and Citrobacter. Both amoxicillin and clavulanic are well absorbed after oral administration, reach peak serum levels in 40-120 min and have similar half-lives of 45 to 90 min. This combination will be suitable for the treatment of complicated urinary tract infections, otitis media, sinusitis and respiratory tract infections. However, precise recommendations for its use will need to await further clinical trials that compare amoxicillin/clavulanate to alternative therapies.

Amoxicillin↗