[Microbial sensitivity spectrum of framycetin. Comparison with the 1972 to 1993 resistance status]. / Untersuchungen zum Empfindlichkeitsspektrum von Framycetin. Vergleich der Resistenzsituation von 1972 bis 1993.

Framycetin was tested against a variety of isolates of grampositive and gramnegative bacteria. The in-vitro activity of Framycetin against Staphylococcus aureus, Enterobacteriaceae, Pseudomonas aeruginosa as well as Pseudomonas fluorescens is today still favourable.

Medical and veterinary use of antimicrobial agents: implications for public health. A clinician's view on antimicrobial resistance.

It is often proposed that the indiscriminate use of antimicrobial agents in the veterinary field leads to increased resistance in bacteria pathogenic to humans. Although for human medicine there is some potential danger behind the use of antimicrobial agents in animals, very few species (such as Staphylococci, Salmonella, Escherichia coli, Yersinia and Campylobacter) isolated in animals, which are also pathogenic to man, have been mentioned in the literature. The present paper analyzes the areas and bacteria where the clinician faces problems in the treatment of infection in man.

[Possibilities for the use of basic cephalosporins]. / Einsatzmöglichkeiten von Basiscephalosporinen.

The always growing number of cephalosporins constitutes a significant part of the betalactam antibiotics. Depending on antibacterial spectrum and in vitro activity, different groups, e.g. the "cefuroxime-group" and the "cefotaxime-group" have been defined. Based on epidemiologic and comparative in vitro data, the present review offers some guidance where the less expensive cephalosporins of the "cefuroxime-group" may still be clinically useful.

Influence of cefpirome on pharyngeal and faecal flora after single and multiple intravenous administrations of cefpirome to healthy volunteers.

The effect of single and multiple 2 g doses of i.v. cefpirome on pharyngeal and faecal flora was studied in ten male volunteers. There was no effect on pharyngeal flora. After a single dose, cefpirome had no effect on faecal flora but numbers of Escherichia coli were reduced below the detection limit during multiple dose treatment. No strains of Clostridium difficile were selected in this study and only a slight increase in the numbers of Candida spp. were found. Cefpirome, therefore, has little, if any, effect on faecal or pharyngeal flora.

In vitro activity of cefodizime.

Cefodizime is a bactericidal cephem with the typical broad spectrum activity of an aminothiazolyl cephalosporin, including both gram-positive and gram-negative bacteria: its MIC90 is 0.125 mg/l for Streptococcus pneumoniae, Streptococcus pyogenes and other streptococci; and 0.05 mg/l for Haemophilus spp., Neisseria meningitidis, Neisseria gonorrhoeae and Moraxella catarrhalis; while beta-lactamase positive strains of M. catarrhalis require 1 mg/l. Less than 1 mg/l is needed for Escherichia coli, Klebsiella spp., Proteus spp. and Shigella spp. The MIC90 is 4 mg/l for methicillin-sensitive Staphylococcus aureus, Morganella morganii, Providencia spp. and most strains of Serratia marcescens, Citrobacter spp. and Enterobacter spp. Staphylococcus epidermidis, Enterococcus faecalis and most strains of Pseudomonas spp. and Acinetobacter spp. are considered cefodizime-resistant. Cefodizime is unaffected by plasmid-mediated beta-lactamases, but it is hydrolyzed by some chromosomally mediated enzymes, thus resembling other third-generation cephalosporins. Cefodizime has high affinity for PBP 3 and PBP IA and IB (Escherichia coli); in S. aureus it shows the highest affinity for PBP 1.

In vivo activity of cefodizime.

Cefodizime has been shown to possess high in vivo antibacterial activity in a variety of experimental infection models involving different body systems and animal species: systemic infections, pneumonia and urinary tract infections in normal mice, intrauterine infections in normal rats, and meningitis in normal rabbits, as well as systemic infections in immunosuppressed animals. Most investigations found that the therapeutic efficacy of cefodizime frequently exceeded the one expected from its in vitro values and in many cases compared favorably with those of other cephems, even when the in vitro susceptibility of the infecting organism to these drugs was markedly higher. These findings have been attributed either to the superior kinetic profile of cefodizime--prolonged serum half-life and excellent tissue penetration with long-lasting levels--or to a synergy between its high bactericidal activity and host defence mechanisms. The parallel consideration of the MIC90 values of cefodizime and the pharmacokinetic profile of this agent in humans indicate that the vast majority of the relevant respiratory and urinary pathogens are covered by once-a-day cefodizime dosage regimens of either 1 or 2 g.

Cefpodoxime: comparative antibacterial activity, influence of growth conditions, and bactericidal activity.

The antimicrobial activity of cefpodoxime, the active metabolite of the new cephalosporin ester cefpodoxime proxetil, in comparison to cefixime, cefotiam, cefuroxime, and cefotaxime was determined against a broad spectrum of freshly isolated gram-positive and gram-negative bacterial strains. Cefpodoxime was demonstrated to be inhibitory at concentrations of less than or equal to 1 mg/l against 90% of strains of Moraxella catarrhalis, Haemophilus influenzae, Escherichia coli (beta-lactamase- negative strains), Klebsiella spp., Serratia spp., Proteus mirabilis, Proteus vulgaris, Providencia spp., and Salmonella spp. This antimicrobial activity of cefpodoxime was generally superior to that of cefuroxime and similar to that of cefixime. Cefpodoxime was active at less than or equal to 1 mg/l against 50% of the members of beta-lactamase-producing Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Citrobacter spp., and Morganella morganii. Cefpodoxime proved to be highly inhibitory against group A, B, and G streptococci and Streptococcus pneumoniae (MIC90 less than 0.015 mg/l). The MICs of cefpodoxime and those of the other cephalosporins were less than 2 mg/l for greater than or equal to 90% of the strains of Staphylococcus aureus and Staphylococcus epidermidis, with the exception of cefixime which had no activity with MICs below 8 mg/l against these bacteria. Pseudomonas spp., Acinetobacter spp., and Enterococcus spp. were resistant to cefpodoxime. The antibacterial activity of cefpodoxime was only to a minor degree influenced by different growth conditions with the exception of high inoculum sizes against some beta-lactamase producing strains of gram-negative bacilli.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibiotic usage for initial empirical treatment of infections in hospitalized patients in West Germany.

Antibiotic usage for initial empirical treatment of infections in hospitalized patients was assessed by means of a questionnaire sent to physicians in charge of surgical and medical intensive care units, departments of neurosurgery, neurology, general surgery, thoracic surgery, internal medicine and pediatrics. Analysis of a total of 82 questionnaires filled in by the various departments revealed that the most frequently used regimens for initial empirical therapy were combinations of a broad spectrum penicillin with an amino-glycoside or of a second generation cephalosporin with an aminoglycoside in intensive care. Third generation cephalosporins ranked third among combination partners with aminoglycosides. Imipenem and fluoroquinolones were used only rarely for first line treatment. Second line treatment was most frequently with third generation cephalosporins or imipenem/cilastatin for internal wards and intensive care with an extension for staphylococcal infections with vancomycin or teicoplanin as the most frequent additional antibiotics. Patterns of antibiotic usage changed with regard to infection sites with a predominance of third generation cephalosporins or broad spectrum penicillins in combination with an aminoglycoside and metronidazole in abdominal sepsis and peritonitis. In case of pneumonia a differentiation between community acquired and hospital acquired pneumonias was made. Treatment was predominantly carried out with penicillin G, ampicillin or a second generation cephalosporin with or without the addition of an aminoglycoside in case of community acquired pneumonia. The addition of clindamycin or metronidazole was considered for suspected staphylococcal infection or aspiration pneumonia. Third generation cephalosporins were preferred for pneumonia treatment in surgical patients.

Influence of fosfomycin on the intestinal and pharyngeal flora of man.

The influence of 5 g fosfomycin i.v. every 12 hours on the intestinal and pharyngeal flora was studied in eight healthy, male volunteers. The Escherichia coli counts were markedly reduced during application and returned to normal in all subjects within a maximum period of 12 days. The total count of Enterococci was reduced by one to two decimal potencies under medication. There was no change in the counts of Bacteroides and anaerobic lactobacteria. No selection of Clostridium difficile was observed. Throughout the study period the pharyngeal flora of all subjects was consistent, and no changes were seen. No selection of Candida spp. was observed.

The in vitro activity of flomoxef compared to four other cephalosporins and imipenem.

The antibacterial activity of the oxacephalosporin flomoxef was evaluated in comparison to cefpirome, cefuzoname, cefotaxime, ceftazidime, and imipenem against fresh clinical isolates. Flomoxef is an antibiotic with strong antibacterial activity against staphylococci including methicillin-resistant strains and streptococci with the exception of Enterococcus faecalis and Enterococcus faecium. It is very active against gram-negative cocci and rods including gram-positive and gram-negative anaerobes. Against Pseudomonas sp. flomoxef has no activity.

Concentration of ciprofloxacin in bone tissue after single parenteral administration to patients older than 70 years.

The concentrations of ciprofloxacin produced in bone, cartilage and menisci after a single administration of 200 mg were determined at different intervals in a group of patients with an average age of 80 years. Concentrations of 0.11 to 0.94 mg/kg bone tissue were measured after 0.5 to 5 hours. In the cartilage a concentration of active substance was measureable only once (4.18 mg/kg). In the presence of marked circulatory disorders the active substance concentrations reached in the bone were above those found in the seriously damaged muscle. Although the concentrations reached in the bone are effective, no risk should be taken in osteomyelitis. Ciprofloxacin should therefore be used at high dosage and possibly be combined with another substance. Given for therapeutic purposes, a single dose of ciprofloxacin is naturally not effective enough, and given for prophylactic purposes, not safe enough to prevent a post-traumatic osteitis.

[In vitro evaluation of lomefloxacin]. / In-vitro-Bewertung von Lomefloxacin.

Lomefloxacin (1-ethyl-6,8-difluoro-1,4-dihydro-7-(3-methyl-1-piperazinyl)-4- oxoquinoline-3-carboxylic acid monohydrochloride, SC-47111) is a broad-spectrum antibiotic of the 4-quinolone group. In this comparative study the antimicrobial in-vitro activity of lomefloxacin was tested against 863 gram-negative and 415 gram-positive strains from fresh clinical isolates. As comparative agents ciprofloxacin, norfloxacin and ofloxacin were used. The minimal inhibitory concentrations were determined by means of a serial dilution with the agar-dilution procedure. Lomefloxacin showed an antibacterial efficacy comparable to other quinolones. Ciprofloxacin in general was two-fold dilutions more active. No cross-resistance with beta-lactamase producing-methicillin resistant or aminoglycoside-, tetracycline-, chloramphenicol- and co-trimoxacol-resistant strains could be found. Lomefloxacin showed in this study a broad antimicrobial activity. The clinical utilities of this new fluoroquinolone will depend on the pharmacokinetic properties and the adverse event profile.

Transductional analysis of imipenem-ceftazidime-and azactam resistant Pseudomonas aeruginosa strains from nosocomial infections.

Six strains of P. aeruginosa, resistant to IMI, CTZ and/or AZA, or to two of these drugs even to all three antibiotics, have been analysed by transduction by standard transducing phages F116 and G101, propagated on these strains, as well by a wildtype phage isolated from one of P. aeruginosa strains resistant to CTZ and AZA. Analysis of occurrence of resistance determinants in individual sets of transductants allows us to conclude that all three antibiotic-resistance determinants are separable by transduction and, thus, the resistance to any of these three antibiotics is genetically governed by independent determinants. None strain, resistant to these antibiotics, could hydrolyse any of these drugs, with an exception of slow hydrolysis of IMI, observed also by other investigators [8]. In contrast, strains hydrolysed classical, first-generation cephalosporins as well as Cefoxitin, and transferability of these two determinants could be proved by transfers, to Enterobacteriaceae (P. aeruginosa are naturally resistant to these two antibiotics). Thus, resistance to IMI, CTZ and/or AZA, is not co-transferred, with determinants of resistance to more classical cephalosporins.