Clinical Observation of Tigecycline Combined with Isepamicin in the Treatment of Multidrug-resistant Aci-netobacter baumannii Pneumonia / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of tigecycline combined with isepamicin in the treatment of multidrug-resistant Acinetobacter baumannii pneumonia. METHODS:70 patients diagnosed as multidrug-resistant A. baumannii pneumonia were selected and randomly divided into control group and observation group,with 35 cases in each group. Both groups received routine treatment oxygen therapy or mechanical ventilation,anti-hypertension,hypoglycemic therapy. Control group was given Cefoperazone sulbactam for injection 3 g added into Sodium chloride injection 100 ml,ivgtt,qid. Observation group re-ceived Tigecycline for injection 100 mg,decreasing to 50 mg added into Sodium chloride injection 250 ml,ivgtt,bid,combined with Isepamicin sulfate injection 400 mg added into Sodium chloride injection 250 ml,ivgtt,qd. The time of body temperature re-turn to normal,pulmonary rale disappearance,chest X-ray shadow disappearance and leucocyte return to normal were observed in 2 groups as well as serum inflammatory factor level before and after treatment;total effective rate,bacterial clearance rate and ADR were compared between 2 groups. RESULTS:The time of body temperature return to normal,pulmonary rale disappearance, chest X-ray shadow disappearance and leucocyte return to normal in observation group were significantly shorter than in control group,with statistical significance(P0.05). The serum inflammatory factor of 2 groups decreased significantly after treatment,and the observation group was significantly lower than the control group,with statistical significance(P0.05). CONCLUSIONS:Tigecycline combined with isepamicin is effective for multidrug-resistant A. baumannii pneu-monia,and can improve clinical symptom,control inflammation reaction,having high sterilization with good safety.

Clinical efficacy of tigecycline combined with isepamicin in treatment of multidrug-resistant Acinetobacter baumannii pneumonia / 中国生化药物杂志

Objective To evaluate the clinical efficacy of tigecycline combinated with isepamicin for treatment of pneumonia caused by multidrug-resistant Acinetobacter baumannii.Methods A retrospective analysis was performed in adult patients with multidrug-resistant Acinetobacter baumannii pneumonia in two general hospitals from January 2012 to January 2014.Total eighty-four patients with MDR-Acinetobacter baumannii pneumonia were randomly divided into two groups(n=42).One group was treated with tigecycline combinated with isepamicin(termed combination therapy group),and another group was administrated with cefoperazone sulbactam (termed control group ).The clinical cure rates,microbiological eradication rates and adverse events were collected and compared. Results There was no difference in APACHEⅡ score between two groups.The clinical cure rates in combination therapy group was significantly higher than that in control group(88% vs 61%,P<0.05),and with a higher rate of microbiological eradication(59.5% vs 35.7%,P <0.05 ).However,the occurence rate of adverse events was similar in the two groups (7.1% vs 1 1.9%). Conclusion With a higher rate of clinical efficacy and a lower rate of adverse events,the combination therapy with tigecycline and isepamicin would be a promising alternative for treatment with MDR-Acinetobacter baumannii pneumonia.

A Case of Infectious Mononucleosis-like Syndrome Induced by Ceftriaxone and Isepamicin in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

A severe adverse reaction to certain drug could be associated with hypersensitivity syndrome, showing the clinical features of infectious mononucleosis including maculopapular rash, fever, lymphadenopathy, leukocytosis, atypical lymphocytes, liver dysfunction, and renal disturbance. We report a systemic lupus erythematosus patient who developed infectious mononucleosis-like syndrome with administration of ceftriaxone/isepamicin for the treatment of pneumonia. This case warrants careful attention to infectious mononucleosis-like syndrome associated with antibiotics administration, especially in febrile patients with known autoimmune diseases such as systemic lupus erythematosus.

Quantitative Determination of Bacterial Endotoxin in Isepamicin Sulfate Injection by Kinetic Turbidimetric Assay / 中国药房

OBJECTIVE:To establish a method for the determination of the bacterial endotoxin content in isepamicin sulfate injection. METHODS: By using tinetic turbidimetric assay in which the sample was subjected to a serial dilution and the detection concentration of the sample was established by interference tests, meanwhile the standard endotoxin working curve was established for quantitative determination of the bacterial endotoxin in samples. RESULTS: The results showed that at a concentration of 6.25 mg?mL-1, isepamicin sulfate injection did no interference on tachypleus amebocyte lysate test. The bacterial endotoxin recovery ranged form 50% to 200%. CONCLUSIONS: It is feasible to use kinetic turbidimetry assay for the determination of bacterial endotoxin in isepamicin sulfate injection.

In Vitro Activities of Isepamicin and Other Aminoglycosides against Gram-Negative Organisms / 감염과화학요법

BACKGROUND: The increasing incidence of multidrug-resistant gram-negative bacteria causing nosocomial infections is an important clinical problem. Isepamicin is a recently developed aminoglycoside which has been known to have potent activity against gram-negative organisms. We evaluated the in vitro activities of isepamicin and other aminoglycosides against a large number of gram-negative organisms. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of isepamicin, amikacin, gentamicin, and tobramycin against 566 gram-negative organisms collected between January 2006 and June 2006 in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined and interpreted according to the recommendations of Clinical and Laboratory Standard Institute (CLSI). The breakpoint MIC used for interpretation of isepamicin was MIC or =64 microgram/mL as resistant. RESULTS: The MIC50/MIC90 of isepamicin for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter cloacae were 1/2, 0.5/>128, 4/16, 16/>128, and 1/2 microgram/mL, respectively. The susceptibilities for E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, and E. cloacae were 100%, 86.4%, 89.7%, 50.0%, and 96.6%, respectively. For E. coli, K. pneumoniae, P. aeruginosa, and E. cloacae, isepamicin had better in vitro activities than gentamicin and tobromycin, and had similar activities with amikacin. For A. baumanii, all four tested aminoglycosides had similar in vitro activities. CONCLUSION: Isepamicin had excellent in vitro activities against gram-negative organisms, except A. baumanii. The overall in vitro activities were similar with amikacin.

In Vitro Activities of Isepamicin and Other Aminoglycosides against Gram-Negative Organisms / 감염과화학요법

BACKGROUND: The increasing incidence of multidrug-resistant gram-negative bacteria causing nosocomial infections is an important clinical problem. Isepamicin is a recently developed aminoglycoside which has been known to have potent activity against gram-negative organisms. We evaluated the in vitro activities of isepamicin and other aminoglycosides against a large number of gram-negative organisms. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of isepamicin, amikacin, gentamicin, and tobramycin against 566 gram-negative organisms collected between January 2006 and June 2006 in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined and interpreted according to the recommendations of Clinical and Laboratory Standard Institute (CLSI). The breakpoint MIC used for interpretation of isepamicin was MIC or =64 microgram/mL as resistant. RESULTS: The MIC50/MIC90 of isepamicin for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter cloacae were 1/2, 0.5/>128, 4/16, 16/>128, and 1/2 microgram/mL, respectively. The susceptibilities for E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, and E. cloacae were 100%, 86.4%, 89.7%, 50.0%, and 96.6%, respectively. For E. coli, K. pneumoniae, P. aeruginosa, and E. cloacae, isepamicin had better in vitro activities than gentamicin and tobromycin, and had similar activities with amikacin. For A. baumanii, all four tested aminoglycosides had similar in vitro activities. CONCLUSION: Isepamicin had excellent in vitro activities against gram-negative organisms, except A. baumanii. The overall in vitro activities were similar with amikacin.

A Case of Pneumonia Caused by Ewingella americana in a Patient with Chronic Renal Failure

Though the pathogenic significance and the reservoir of Ewingella americana have not been clarified, this organism has caused several pathogenic infections, especially in immunocompromised patients. We report a pneumonia in a patient with chronic renal failure, who had chronic rejection of transplanted kidney. E. americana was identified to be the pathogen of pneumonia with clinical symptoms and signs and radiological examination. As soon as he was treated with ceftriaxone and isepamicin, clinical improvement was followed with no further growth of E. americana or other pathogenic isolates from sputum culture. This suggests to be the case of pneumonia caused by E. americana for the first time in the Korean literature.

Neuromuscular Blockade of Mivacurium Following the Duration of Isepamicin Intramuscular Injection in Rabbits / 대한마취과학회지

BACKGROUND: Isepamicin, a new aminoglycoside antibiotic, was usually administered to patients for prophylactic use. Mivacurium has a short duration of action. The current study was undertaken to evaluate the neuromuscular blockade of mivacurium following the duration of an intramuscular injection of isepamicin 20 mg/kg/d in rabbits. METHODS: In the first study, the dose-response relations of mivacurium were studied in forty rabbits during thiopental anesthesia. Rabbits were randomly assigned to four groups; group 1: normal saline 2 ml/d IM for 7 days; group 2: isepamicin 20 mg/kg/d IM for 1 day; group 3: isepamicin 20 mg/kg/d IM for 3 days; group 4: isepamicin 20 mg/kg/d IM for 7 days. They received mivacurium 10, 20 and 30ng/kg in groups 1, 2 and 3; mivacurium 20, 30 and 40ng/kg in group 4, respectively. In the second study, time courses of action of mivacurium 0.18 mg/kg in forty rabbits were evaluated in each group. RESULTS: The calculated ED50 for mivacurium in groups 1, 2, 3 and 4 were 19.2 +/- 3.1ng/kg, 15.4 +/- 3.7ng/kg, 20.1 +/- 3.5ng/kg and 31.2 +/- 4.4ng/kg, respectively and corresponding ED95 was 29.9 +/- 3.7ng/kg, 22.1 +/- 4.5ng/kg, 30.1 +/- 5.9ng/kg and 43.4 +/- 5.1ng/kg, respectively. There were significant differences between group 4 and the others (P < 0.05). In the second study, the times after mivacurium 0.18 mg/kg until 95% twitch recovery in groups 1, 2, 3 and 4 were 35.1 +/- 5.1 min, 42.2 +/- 6.2 min, 32.8 +/- 4.9 min and 24.9 +/- 3.6 min, respectively. There were significant differences between group 2 and others, and between group 4 and group 1 or 3, respectively (P < 0.05). CONCLUSIONS: Mivacurium when used as a bolus isepamicin therapy, has both an increased potency and a longer duration of action, but when used during concurrent isepamicin therapy, has both a decreased potency and a shorter duration of action.

Comparison of the effïcacy and safety of isepamicin plus metronidazole and amikacin plus metronidazole in intra-abdominal infections.

Intra-abdominal infections due to penetrating wound through the abdominal wall or rupture of the gastrointestinal tract are acute conditions requiring prompt surgical intervention and the use of appropriate antimicrobial agents. Isepamicin is an effective aminoglycoside against various Gram-negative pathogens causing intra-abdominal infections. The objective of the present study is to compare the efficacy and safety of isepamicin (15 mg/kgBW IV o.d.) with amikacin (7.5 mg/kgBB b.i.d.), in conjunction with metronidazole for both drugs. An open, randomized, parallel design was applied in this trial. The subject allocation ratio for isepamicin: amikacin is 2:1. Out of 50 patients enrolled in this study, 27 fuffilled the criteria for safety and efficacy population, and 46 for intent-to-treat population. In the safety and efficacy population, the clinical success rare for isepamicin and amikacin group did not differ significantly (i.e., 95% and 100%, respectively). In the intent-to-treat population, the clinical success rates for isepamicin and amikacin group were also insignifficantly different (i.e., 97% and 100%, respectively). The rates of bacteriological elimination for isepamicin and amikacin, were 95% and 100%, respectively in the efficacy and safety population, and 90% and 93%, respectively in the intent-to-treat population. Streptococci and staphylococci were the most frequent (40%) pathogens isolated from pus, and Acinetobacter anitratus (55%) was the most common one isolated from blood. In the efficacy and safety population, the mean (± SD) length of hospital stay in the isepamicin and amikacin groups was 10.7 ± 3.9 and 11.1 ± 3.8 days, respectively, while in the intent-to-treat population, the mean (± SD) length of hospital stay in the isepamicin and amikacin groups was 10.1 ± 3.4 and 10.5 ± 3 days, respectively. In the present study, both aminoglycosides were well tolerated and there was no patient withdrawal associated with side effect. It is concluded that for intra-abdominal infections, intravenous isepamicin given once daily is as effective as intravenous amikacin given twice daily in combination with metronidazole.