Uso terapeutico de amoxicilina-acido clavulanico en la enfermedad periodontal / Therapeutic use of amoxicillin-clavulanic acid in periodontal disease

En el presente trabajo se estudia la combinación amoxicilina/ßcido clavulßnico como agente que puede ser eficiente en la terapia periodontal, basßndose fundamentalmente en la revisión bibliogrßfica de comunicaciones cientÝficas; para ello se considera su efectividad clÝnica en las diferentes patologÝas periodontales, las pautas referentes a posologÝa y administración, todo lo cual contribuirß a usarlo en una forma racional, con criterio equilibrado en la terapÚutica de las periodontopatÝas

Comparative evaluation of the in vitro activity of three combinations of ß-Lactamase inhibitors: piperacillin/tazobactam, ticarcillin/clavulanic acid and amplicillin/sulbactam

Recently, two new combinations of ß-lactam antibiotics with ß-lactamase inhibitors become commercially avaiable in Brazil: piperacillin/tazobactam and ampicillin/sulbactam. This study was designed to assess and compare the in-vitro activity of theses new compounds, as well as that of ticarcillin/clavulanic acid, against bacteria isolated in our environment. A total of 749 bacteria isolated at São Paulo Hospital were tested using the disk diffusion method, in compliance with NCCLS Standardization, using strict quality control. Only one sample per patient was included in the study. Oxacillin-resistant staphylococcus samples were not included in this study. Of the total samples tested 84.5 percent were susceptible to piperacillin/tazobactam, 81.2 percent to ticarcillin/clavulanic acid, and 77.6 percent to ampicillin/sulbactam. Piperacillin/tazobactam was also found to be the most active combination of the three against Enterobacteriaceae (n=312), inhibiting 91.7 percent of the bacteria tested. Ticarcillin/clavulanic acid was active against 85.8 percent of the Enterobacteriaceae, while ampicillin/sulbactam inhibited 83.2 percent of the samples...

Evaluation in an animal model and in vitro of the combination clavulanic acid and cephalosporins against ß-lactamase producing and nonproducing staphylococcus aureus strains

ß-lactamase enzymes are the most common case of bacterial reistance to ß-lactam antibiotics. They hydrolyse the amide bound in the ß-lactam ring and produce acidic derivatives that have no antibacterial properties. The aim of this study was to evaluate a combination of clavulanic acid with cephalosporins against ß-lactamase-producing and nonproducing stains of Staphylococcus aureus using in vitro tests and a rat animal model. In vitro test (MIC) of the drug combination were done using standard methods. In an animal model, rats were submitted to surgical implantation of polyurethane sponges in their backs to induce granulomatous tissue. After seven days, the animals received cephalexin, cephalexin with clavulanic acid, ceftriaxone, ceftriaxone with clavulanic acid or clavulanic acid alone. One hour after the drug administration, granulomatous tissue was removed and placed in Petri dishes previously inoculated with 10 eight cfu of producing or non-producing ß-lactamase Staphylococcus aureus. After 24h at 37§C, the inhibition zones formad by granulomatous tissue was measured and scored for statistical analysis. Both tests (ex vivo {animal model} and in vitro) showed that the cephalexin was more active than ceftriaxone against non-producing ß-lactamase. S. aureus (p<0.01). Against ß-lactamase producing S. aureus, ceftriaxone was more active than cephalexin, which was inactive. Combinations of clavulanic acid with cephalexin or ceftriaxone had similar antimicrobial activity against non-producing ß-lactamase S. aureus compared to the cephalosporins used alone. When tested using ß-lactamase produzing strains, the combination of clavulanic acid with cephalosporins showed synergism. We conclude that the combination of cephalosporins with clavulanic acid could be useful in staphylococcal infections cauded by ß-lactamase producing strains.

Inhibidores de las beta-lactamasas / Betalactamase inhibitors

Se realiza una actualización sobre una serie de substancias; antibióticos beta-lactámicos con baja actividad bactericida, pero con una gran afinidad por las beta-lactamasas. Estas substancias al neutralizar la acción de dichas enzimas, se destruyen por lo que se denomina "inhibidores suicidas". Se menciona el efecto sinérgico que consigue al combinar un beta-lactámico con propiedades bactericidas y uno de estos inhibidores suicidas compuestos. Hasta la presente, existen tres inhibidores de las beta-lactamasas y que son utilizados en la práctica clínica, a saber: el ácido clavulánico, el sulbactam y el tazobactam. En el trabajo se hace referencia a los diferentes compuestos que existen en el comercio y que resultan de la combinación de una beta-lactámico con propiedades bactericidas y los "inhibidores suicidas". Se estudia su formacocinética, reacciones adversas, microbiología, usos clínicos, dosis recomendadas y forma de presentación