brl-28500 and Pelvic-Inflammatory-Disease

Sulbactam (SB) and clavulanic acid (CA) are irreversible inhibitors of the beta-lactamases in the Richmond and Sykes classes II-VI. When combined with ampicillin and ticarcillin, SB and CA, respectively, extend the spectrum of activity of these penicillins to include some beta-lactamase-producing aerobes (Enterobacteriaceae, Hemophilus influenzae, staphylococci) and anaerobes (Bacteroides fragilis group) which would otherwise be resistant. Neither effectively inhibits the class I beta-lactamases frequently produced by Pseudomonas aeruginosa, Enterobacter, and Serratia, in part explaining the resistance observed with these organisms. Clinically, both agents were as effective as the comparative therapies in all but two of the trials reviewed. Given the current data, the decision to add these agents to the formulary should be based on hospital resistance patterns and on the cost of these antimicrobials in comparison to conventional therapies.

Topics: Ampicillin; Arthritis, Infectious; Bacterial Infections; Bacteroides fragilis; beta-Lactamase Inhibitors; Clavulanic Acids; Clinical Trials as Topic; Drug Resistance, Microbial; Drug Therapy, Combination; Enterobacteriaceae; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Microbial Sensitivity Tests; Osteomyelitis; Pelvic Inflammatory Disease; Respiratory Tract Infections; Sulbactam; Ticarcillin

Ticarcillin plus clavulanic acid (Timentin) has a broad-spectrum activity that includes gram-positive aerobes, and facultative and obligate anaerobes. Numerous studies have demonstrated that single agents, including this combination, are as efficacious as clindamycin plus an aminoglycoside in treating gynecologic soft tissue infections. Its spectrum of activity, together with its potential for treating Chlamydia trachomatis, makes it suitable for the treatment of pelvic inflammatory disease.

Topics: beta-Lactamase Inhibitors; beta-Lactamases; Clavulanic Acids; Connective Tissue Diseases; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Humans; Pelvic Inflammatory Disease; Ticarcillin; Vagina

In an open study, ticarcillin/clavulanate was used to treat upper genital tract infections in 91 women. The clinical success rate was 92% in outpatient-acquired salpingitis (pelvic inflammatory disease), 50% in salpingitis with tuboovarian abscess, 85% in postpartum endometritis, 87% in endometritis after chorioamnionitis and 90% in postoperative parametritis. The primary adverse reaction was diarrhea, in 10 patients. Among the 129 aerobes isolated, 18 (14%) were beta-lactamase positive, as were 32% (20/63) of the anaerobes.

Topics: Abortion, Septic; Adult; Bacteria; beta-Lactamase Inhibitors; Cellulitis; Clavulanic Acids; Drug Evaluation; Drug Therapy, Combination; Endometritis; Female; Genital Diseases, Female; Humans; Pelvic Inflammatory Disease; Penicillins; Pregnancy; Ticarcillin

Clinical studies were conducted on BRL 28500 (a formulation containing 15 parts ticarcillin plus 1 part clavulanic acid). BRL 28500 was administered at doses of 1.6 g or 3.2 g b.i.d., generally for 10 days by drip infusion to patients with pelvioperitonitis or Douglas' abscess. The results obtained were summarized as follows. 1. Clinical efficacy was evaluated in 18 patients (pelvioperitonitis 14, Douglas' abscess 4), but 8 patients out of a total of 26 patients were excluded. 2. In the evaluation of clinical improvement by doctors in charge, clinical improvement rates were 44.4% on day 3, 88.2% on day 5. 3. On the basis of committee judgement, the clinical efficacy rate was 100%. 4. The bacteriological eradication rate of causative organisms was 100% in 11 patients (15 strains). Five strains out of a total of 15 strains produced beta-lactamase. 5. As a side effect, nausea was observed in 1 case. In laboratory examination, liver function abnormalities were observed in 1 case. 6. Regarding usefulness as judged by doctors in charge, the satisfactory rate was 83.3%. From the above results, it has been concluded that BRL 28500 is very useful in the treatment of pelvioperitonitis and Douglas' abscess.

Topics: Abscess; Adult; Aged; Bacteria; beta-Lactamase Inhibitors; Clavulanic Acids; Douglas' Pouch; Drug Combinations; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Pelvic Inflammatory Disease; Penicillins; Peritonitis; Ticarcillin