In vitro synergy of ticarcillin/clavulanate in combination with aztreonam and ceftolozane/tazobactam against SPM-1-producing Pseudomonas aeruginosa strains.

Minimal inhibitory concentrations (MICs) of ticarcillin/clavulanic acid (TLc), ceftolozane/tazobactam (C/T), and aztreonam (AT) were determined for 6 SPM-1-producing Pseudomonas aeruginosa (PSA) using Etest® strips and the synergistic effect of such antimicrobials against was evaluated by gradient diffusion strip crossing (GDSC) test. The fraction inhibitory concentration indexes (FICI) were calculated and showed a synergistic (n = 3) and additive (n = 2) effects of TLc + AT against SPM-1 producers, while TLc + C/T combination caused no effect. Average MIC reduction of TLc and AT by GDSC was 3-fold and 2-fold dilutions, respectively. Thus, TLc + AT might be a candidate as a combination therapy to treat SPM-1-producing PSA infections.

Evaluation of ticarcillin/clavulanic acid versus ceftriaxone plus amikacin for fever and neutropenia in pediatric patients with leukemia and lymphoma.

BACKGROUND: The empirical use of antibiotic treatments is widely accepted as a means to treat cancer patients in chemotherapy who have fever and neutropenia. Intravenous monotherapy, with broad spectrum antibiotics, of patients with a high risk of complications is a possible alternative. METHODS: We conducted a prospective open-label, randomized study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy. Patients received either monotherapy with ticarcillin/clavulanic acid (T) or ceftriaxone plus amikacin (C+A). RESULTS: Seventy patients who presented 136 episodes were evaluated, 68 in each arm of the study. The mean neutrophil counts at admission were 217cells/mm(3) (T) and 201cells/mm(3) (C+A). The mean duration of neutropenia was 8.7 days (T) and 7.6 days (C+A). Treatment was successful without the need for modifications in 71% of the episodes in the T group and 81% in the C+A group (p=0.23). Treatment was considered to have failed because of death in two episodes (3%) in the T group and three episodes (4%) in the C+A group, and because of a change in the drug applied in one episode in the T group and two episodes in the C+A group. Overall success was 96% (T) and 93% (C+A). Adverse events that occurred in group T were not related to the drugs used in this study. CONCLUSION: In pediatric and adolescent patients with leukemia or lymphoma, who presented with fever and neutropenia, during chemotherapy, ticarcillin/clavulanic acid was as successful as the combination of ceftriaxone plus amikacin. It should be considered an appropriate option for this group of patients at high risk for infections.

Valoración en niños de la aceptabilidad de antibióticos resistentes a beta-lactamasas / Assessment of the palatability of beta-lactamase-resistant antibiotics in children

Se evaluó la aceptabilidad de tres antibióticos conocidos por su resistencia a beta-lactamasas en una muestra integrada por niños. Los resultados fueron comparados con los obtenidos en adultos. La aceptabilidad al sabor de los antibióticos en suspensión fue calificada con base en una escala analógica de 10 cm. Tanto en niños como en adultos, se asignó la calificación más alta a la azitromicina. Las significativas diferencias entre los sabores sugieren que este factor debe ser tomado en cuenta en todo estudio de aceptabilidad

Cervicofacial Actinomyces viscosus infection in a Brazilian fila: a case report and literature review.

A five-month-old, male Brazilian fila presented with a three-day history of a focal swelling in the left superior palpebra and a focal, subcutaneous swelling over the dorsal cervical region. Both lesions initially responded to warm compresses and a two-week course of oral amoxicillin-clavulanic acid therapy. The eyelid swelling recurred after discontinuation of the oral antibiotic therapy. The lesion was progressive and was refractory to trimethoprim-sulfadiazine therapy. Culture and sensitivity performed from a surgical biopsy sample of the eyelid mass identified Actinomyces viscosus and other bacterial genera. A combination of surgical debulkment, Penrose drain placement, and a one-month course of oral oxacillin therapy has resulted in clinical regression of the lesion at a six-month postoperative evaluation.

Comparación de dos esquemas de profilaxis antimicrobiana en cirugía de vías biliares: un ensayo clínico controlado por sorteo / Comparison of two schemes of antimicrobial prophylaxis in biliary tracta curgery: a randomized clinicar trial

Objetivo del estudio. Comparar la eficacia en la profilaxis de la amoxicilina/clavulanato y de la combinación cefalotina y clindamicina en cirugía de vesícula y de vías biliares. Diseño. Estudio clínico controlado por sorteo con un evaluador ciego a la maniobra recibida. Lugar. Centro de tercer nivel de atención médica. Pacientes. Se incluyeron 42 pacientes que fueron sometidos a cirugía de vesícula y/o de vías biliares, y se distribuyeron en dos grupos: en el A 22 pacientes (cefalotina y clindamicina) y en el B 20 (amoxicilina/clavulanato). Intervenciones. A los pacientes del grupo A se les administraron por vía intravenosa: tres dosis de cefalotina (2 g al momento de la inducción de la anestesia y dos dosis adicionales de 1 g cada seis horas) y tres dosis de clindamicina de 600 mg (la primera al momento de la inducción anestésica seguido de dos dosis adicionales). A los pacientes del grupo B se les administraron tres dosis de amoxicilina/clavulanato 1000/200 mg IV (la primera durante la inducción de la anestesia y dos dosis subsecuentes con intervalos de seis horas). Mediciones y resultados principales. En el grupo A se presentaron seis infecciones de herida quirúrgica, una de las cuales se acompañó de bacteremia. En el grupo B no se registraron infecciones (Fisher, p<0.01). Se presentó un caso de flebitis en cada grupo Conclusiones. Nuestros resultados indican que la amoxicilina/clavulanato es un esquema útil para profilaxis de cirugía biliar, y más eficaz que la combinación de cefalotina y clindamicina

[Comparison of two antimicrobial prophylaxis regimens in biliary tract surgery: a randomized controlled clinical trial]. / Comparación de dos esquemas de profilaxis antimicrobiana en cirugía de vías biliares: un ensayo clínico controlado por sorteo.

OBJECTIVE: The aim of this study was to analyze the efficacy in prophylaxis during biliary tract and gallbladder surgery with amoxicillin/clavulanate and to compare it with the combination of cephalothin and clindamycin. DESIGN: A randomized nonblinded clinical trial with a blind independent observer. PLACE: Tertiary-care center. PATIENTS: Forty-two patients were included. All had undergone biliary tract and/or gallbladder surgery. They were divided in two groups: 22 in group A (cephalothin and clindamycin), and 20 in group B (amoxicillin/clavulanate). INTERVENTIONS: Patients from group A were intravenously treated with three doses of cephalothin (2 g at anesthetic induction and two additional doses of 1 g at six-hour intervals), and three of clindamycin (600 mg every six hours). Patients from group B received three doses of amoxicillin/clavulanate (1000/200 mg IV, one during the induction of the anesthesia followed by two more at six-hour intervals). RESULTS: In group A six wound infections were recorded, one of them with secondary bacteremia. In group B we did not record any infection (Fisher p < 0.01). One case of phlebitis was recorded in each group. CONCLUSIONS: Our results indicate that amoxicillin/clavulanate is useful in the prophylaxis of gallbladder and biliary tract surgery, and more effective than the combination of cephalothin and clindamycin.

Measuring the comparative efficacy of antibacterial agents for acute otitis media: the "Pollyanna phenomenon".

In randomized, double-blind trials of antibiotic therapy for acute otitis media that determined both clinical and bacteriologic outcomes, clinical success rates were (93%) 236 of 253 for patients with bacteriologic success, (62%) 25 of 40 for those with bacteriologic failure, and (80%) 124 of 155 for those with nonbacterial acute otitis media. These rates were used to calculate the effectiveness of three strategies for assessing drug efficacy: (1) tympanocentesis and culture before and during therapy (bacteriologic efficacy), (2) tympanocentesis before therapy and assessment of clinical efficacy in bacterial acute otitis media, and (3) no tympanocentesis and assessment of clinical efficacy in clinical (total) acute otitis media. For a drug with a bacteriologic efficacy of 100%, calculated clinical efficacy was 93% for bacterial acute otitis media and 89% for clinical acute otitis media. For a drug with bacteriologic efficacy of 27%, a rate consistent with no antibacterial therapy, efficacy was 71% for bacterial acute otitis media and 74% for clinical acute otitis media. We conclude that if efficacy is measured by symptomatic response, drugs with excellent antibacterial activity will appear less efficacious than they really are and drugs with poor antibacterial activity will appear more efficacious than they really are. The predominant phenomenon is that drugs with poor antibacterial activity will appear to be clinically effective in the treatment of acute otitis media.

Lack of influence of beta-lactamase-producing flora on recovery of group A streptococci after treatment of acute pharyngitis.

Because production of beta-lactamase by normal pharyngeal flora could account for penicillin treatment failure, we studied the effect of anaerobic and aerobic beta-lactamase-producing bacteria on bacteriologic outcome in acute group A beta-hemolytic streptococcal (GABHS) pharyngitis. We compared 10-day courses of orally administered phenoxymethyl penicillin and amoxicillin-clavulanic acid, using a randomized, single-blind treatment protocol. Eligible patients were 2 to 16 years of age and had culture-proven acute GABHS pharyngitis; 89 patients (43 penicillin, 46 amoxicillin-clavulanic acid) were compliant with therapy. beta-Lactamase-producing organisms were isolated before therapy from the throats of 67% of patients treated with penicillin and 63% treated with amoxicillin-clavulanic acid. Throat cultures after completion of therapy were positive for GABHS in 7 (7.9%) of 89 patients. The initial GABHS T type persisted (treatment failure) in only 4 (4.5%) of 89 patients, including 3 (6.5%) of 46 who received amoxicillin-clavulanic acid and in 1 (2.3%) of 43 who received penicillin (not statistically significant). Bacteriologic treatment failure was unrelated to recovery of beta-lactamase-producing bacteria at the time of enrollment or after treatment. We conclude that beta-lactamase production by normal pharyngeal flora does not fully explain the failure of penicillin therapy for acute streptococcal pharyngitis. Using an antibiotic effective against beta-lactamase-producing bacteria will not eliminate the problem of bacteriologic treatment failure.

A randomized controlled trial of amoxicillin plus clavulanate compared with cefaclor for treatment of acute otitis media.

We performed a randomized controlled trial of amoxicillin plus clavulanate versus cefaclor for treatment of acute otitis media. Total daily doses given in three divided doses were 40 mg/kg amoxicillin plus 10 mg/kg clavulanate, and 40 mg/kg cefaclor. Pathogens were eradicated from the middle ear exudate after 3 to 6 days of therapy in 35 (97%) of 36 patients given amoxicillin-clavulanate compared with 24 (75%) of 32 given cefaclor (P = 0.028). When analysis was restricted to patients with positive urine or serum drug assays during therapy, pathogens were eliminated in 33 (97%) of 34 patients given amoxicillin-clavulanate compared with 21 (75%) of 28 given cefaclor (P = 0.026). Bacterial isolates associated with bacteriologic failure of cefaclor therapy were Streptococcus pneumoniae (two patients), beta-lactamase-negative Haemophilus influenzae (four), and beta-lactamase-positive Branhamella catarrhalis (two). The single failure with amoxicillin-clavulanate therapy was associated with non-beta-lactamase-producing H. influenzae isolated from the middle ear exudate. We conclude that cefaclor is less efficacious than amoxicillin-clavulanate for the treatment of acute otitis media.