azlocillin and Endocarditis--Bacterial

Topics: Azlocillin; Clinical Trials as Topic; Drug Administration Schedule; Endocarditis, Bacterial; Humans; Infusions, Intravenous

We report a case of endocarditis caused by a ciprofloxacin-resistant strain of Serratia marcescens in a 50-year-old female neutropenic patient with non-Hodgkin's lymphoma which occurred while receiving ciprofloxacin prophylaxis. She made poor progress on first line therapy with azlocillin and gentamicin by bolus injection t.d.s. The infection was finally eliminated by a regimen of continuous infusion of azlocillin and once daily gentamicin.

Topics: Azlocillin; Ciprofloxacin; Drug Resistance, Microbial; Endocarditis, Bacterial; Female; Gentamicins; Humans; Infusions, Intravenous; Lymphoma, Non-Hodgkin; Middle Aged; Serratia Infections; Serratia marcescens

Left-sided endocarditis caused by Pseudomonas aeruginosa is frequently associated with failure of medical therapy in man. The efficacy of ciprofloxacin and netilmicin + azlocillin has been studied in 79 rabbits with aortic valve endocarditis caused by a serum-resistant strain of P. aeruginosa. Infected animals received either: no therapy; ciprofloxacin (80 mg/kg/day); or netilmicin (6.5 mg/kg/day) + azlocillin (400 mg/kg/day). Ciprofloxacin significantly lowered vegetation titers of P. aeruginosa at days 6 and 10 of therapy compared with netilmicin + azlocillin (P less than 0.001). Similarly, ciprofloxacin was significantly more effective in sterilizing vegetations (P less than 0.005), curing P. aeruginosa endocarditis (P less than 0.001), and preventing bacteriological relapse after discontinuing antibiotic therapy (P less than 0.005). Both antibiotic regimens were equally effective in sterilizing renal abscesses. Resistance to azlocillin was occasionally observed in vivo among P. aeruginosa isolates within cardiac vegetations during the second week of therapy, but not to ciprofloxacin or netilmicin.

Topics: Abscess; Animals; Anti-Infective Agents; Aortic Valve; Azlocillin; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Kidney Diseases; Microbial Sensitivity Tests; Netilmicin; Penicillin Resistance; Pseudomonas Infections; Quinolines; Rabbits

The efficacy of azlocillin + amikacin was compared to ciprofloxacin (with and without amikacin) in 96 rabbits with right-sided endocarditis due to Pseudomonas aeruginosa. Animals received either: no therapy (controls); amikacin (15 mg/kg/day) + azlocillin (400 mg/kg/day); ciprofloxacin (80 mg/kg/day) or amikacin + ciprofloxacin (above dosages). All three antibiotic regimens were significantly more effective than no therapy in reducing mortality (p less than 0.0005), preventing pulmonary infarction (p less than 0.0005) and reducing mean vegetation titers of P. aeruginosa (p less than 0.0005). Also, the three therapy regimens were equivalent in preventing bacteriologic relapse after discontinuing therapy. No development of antibiotic resistance in vivo was observed.

Topics: Amikacin; Animals; Azlocillin; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Kanamycin; Penicillin Resistance; Pseudomonas aeruginosa; Pseudomonas Infections; Quinolines; Rabbits; Time Factors

The efficacy of ciprofloxacin (Bay o 9867), a promising new quinolone, was compared with the efficacy of azlocillin plus tobramycin in rabbits with experimentally induced Pseudomonas aeruginosa endocarditis. The MBCs of ciprofloxacin, azlocillin, and tobramycin against the test strain were 0.5, 8, and 4 micrograms/ml respectively. Ciprofloxacin at a concentration of 50 mg/kg or azlocillin at a concentration of 200 mg/kg in combination with tobramycin at a concentration of 5 mg/kg was administered intramuscularly at 8-h intervals for 4 days. Both regimens produced median peak serum bactericidal titers of 1:8. The concentrations of ciprofloxacin, azlocillin, and tobramycin in serum, 1.8 +/- 0.7, 154 +/- 48, and 9.1 +/- 2.4 micrograms/ml (mean +/- standard deviation), respectively, closely approximated concentrations found in humans after accepted dosages. At the end of treatment, the titers of P. aeruginosa were 3.0 +/- 1.6 log10 CFU/g of vegetation (mean +/- standard deviation) for recipients of ciprofloxacin and 3.2 +/- 1.3 log10 CFU/g of vegetation for recipients of azlocillin plus tobramycin. These values compared with control titers of 7.3 +/- 1.6 CFU/g. These data indicate that at the doses used, ciprofloxacin was as effective as azlocillin plus tobramycin in the treatment of P. aeruginosa endocarditis in rabbits. Since the latter drug combination has proven efficacy, ciprofloxacin deserves further evaluation in the therapy of systemic infections in animal models and in humans.

Topics: Animals; Azlocillin; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Quinolines; Rabbits; Tobramycin

Topics: Animals; Azlocillin; Bacterial Infections; Disease Models, Animal; Endocarditis, Bacterial; Male; Meningitis; Mice; Osteomyelitis; Penicillins; Pseudomonas Infections; Pyelonephritis; Rabbits; Rats; Rats, Inbred Strains