cefoxitin and Fusobacterium-Infections

Topics: Anti-Bacterial Agents; Cefoxitin; Cellulitis; Cephamycins; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Metronidazole; Middle Aged; Palatine Tonsil; Pharynx; Sexual Behavior; Streptococcal Infections; Streptococcus oralis

Topics: Adolescent; Arthritis, Infectious; Bacteremia; Cefoxitin; Clindamycin; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Jugular Veins; Male; Metronidazole; Peritonsillar Abscess; Pharyngitis; Syndrome; Thrombophlebitis

beta-Lactamase production (nitrocefin disk method) and agar dilution susceptibility of amoxicillin, amoxicillin-clavulanate, ticarcillin, ticarcillin-clavulanate, cefoxitin, imipenem, and metronidazole were determined for 320 Bacteroides species (not Bacteroides fragilis group) and 129 fusobacteria from 28 U.S. centers. Overall, 64.7% of Bacteroides species and 41.1% of fusobacteria were beta-lactamase positive. Among the Bacteroides species, positivity rates were highest for B. bivius (85.0%), followed by B. splanchnicus (83.3%), B. eggerthii (77.8%), and B. oralis (77.1%); 54.5% of black-pigmented Bacteroides species were beta-lactamase positive. Among the fusobacteria, Fusobacterium mortiferum showed the highest rate of beta-lactamase positivity (76.9%). MICs of amoxicillin (128 micrograms/ml) and ticarcillin (64 micrograms/ml) for 90% of all beta-lactamase-positive strains were reduced to 4 and 2 micrograms/ml, respectively, with the addition of clavulanate. MICs of amoxicillin and ticarcillin for 90% of all beta-lactamase-negative strains were 1 and 4 micrograms/ml, respectively, and greater than or equal to 98.4% of the strains were susceptible to the beta-lactams tested. Of the beta-lactamase-producing strains, 45.9% were susceptible to amoxicillin at less than or equal to 4 micrograms/ml and 93.4% were susceptible to ticarcillin at less than or equal to 64 micrograms/ml; the addition of clavulanate raised the rates to 90.4 and 100%, respectively. All strains were susceptible to cefoxitin, imipenem, and metronidazole. The activity of amoxicillin against 29 beta-lactamase-producing strains (10 Bacteroides species and 19 fusobacteria) was not enhanced by the addition of clavulanate; however, 82.7% of these strains were susceptible to amoxicillin, and all were susceptible to ticarcillin. Although beta-lactamase positivity is on the increase in non-B. fragilis group Bacteroides species and fusobacteria, amoxicillin-clavulanate, ticarcillin, cefoxitin, imipenem, and metronidazole should be suitable for the treatment of infections with these strains. The addition of clavulanate does not appreciably improve the efficacy of ticarcillin against these organisms.

Topics: Amoxicillin; Anti-Bacterial Agents; Bacteroides; Bacteroides Infections; beta-Lactamase Inhibitors; beta-Lactamases; Cefoxitin; Clavulanic Acid; Clavulanic Acids; Fusobacterium; Fusobacterium Infections; Imipenem; Metronidazole; Microbial Sensitivity Tests; Ticarcillin; United States

The efficacy of cefoxitin, mezlocillin, latamoxef and metronidazole in anaerobic lung infection was studied using a rabbit model. A mixture of Bacteroides fragilis, Peptococcus morbillorum, Eubacterium lentum and Fusobacterium nucleatum was inoculated transtracheally to produce infection within the lung. Mezlocillin was most effective, achieving bacteriologic cure in 5 out of 8 animals. With cefoxitin therapy, 4 out of 8 became bacteriologically sterile. Severe diarrhea with elevated titers of Clostridium difficile toxin was noted in most cefoxitin-treated animals. Latamoxef- and metronidazole-treated animals had apparently healed lesions, but cultures were positive in 6 and 7 out of 8 in each group, respectively. The commonest pathogen isolated in the last two groups was P. morbillorum. The therapeutic superiority of mezlocillin over metronidazole and latamoxef was statistically significant (p less than or equal to 0.05).

Topics: Animals; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Eubacterium; Fusobacterium Infections; Male; Metronidazole; Mezlocillin; Microbial Sensitivity Tests; Moxalactam; Peptococcus; Pneumonia; Rabbits