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Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-Producing Escherichia coli.
Microb Drug Resist 2019; 25(8):1132-1141MD

Abstract

Background:

Extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) is increasing worldwide. The drugs of choice for treatment of ESBLs are parenteral carbapenems. The aim of this study was to evaluate the in vitro and in vivo efficacy of a new combination of oral cephalosporins and amoxicillin/clavulanate in treatment of ESBL-EC.

Methods:

A total of 150 ESBL-EC samples were collected over 1 year from two referral centers. Synergistic studies of cephalosporins and amoxicillin/clavulanate were performed in vitro using disk approximation and disk replacement methods. Combination treatment was assessed in vivo on 20 ESBL-EC urinary tract infection (UTI) patients.

Results:

ESBL-EC isolates were confirmed in 150 patients with a mean age of 46.67 years, 75.2% of them being women. Antibiotic susceptibility testing of isolates indicated high resistance rate to oral antibiotics. The frequency of positive synergy and mean distance of synergy between cephalosporins and amoxicillin/clavulanate was significantly higher with cefotaxime and cefixime compared with cefpodoxime, cefdinir, and ceftazidime using disk approximation and disk replacement methods (p < 0.05). Addition of amoxicillin/clavulanate enhanced the susceptibility rate with cefixime from 8.6% to 86.3%, significantly higher than with other cephalosporins (p < 0.0005). Cefixime and amoxicillin/clavulanate synergy was not affected by age, gender, hospital, department, sample type, or bacterial load. Eighteen of 20 ESBL-EC-positive UTI patients had a positive in vitro synergy test and complete clinical and microbiological resolution after completion of cefixime and amoxicillin/clavulanate oral treatment course.

Conclusions:

Cefixime and amoxicillin/clavulanate combination therapy could be an effective oral outpatient treatment option for ESBL-EC. In vitro synergistic testing is simple and predictive of successful treatment.

Authors+Show Affiliations

Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan.Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan.Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan.Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan.Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31107146

Citation

Al-Tamimi, Mohammad, et al. "Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli." Microbial Drug Resistance (Larchmont, N.Y.), vol. 25, no. 8, 2019, pp. 1132-1141.
Al-Tamimi M, Abu-Raideh J, Albalawi H, et al. Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-Producing Escherichia coli. Microb Drug Resist. 2019;25(8):1132-1141.
Al-Tamimi, M., Abu-Raideh, J., Albalawi, H., Shalabi, M., & Saleh, S. (2019). Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-Producing Escherichia coli. Microbial Drug Resistance (Larchmont, N.Y.), 25(8), pp. 1132-1141. doi:10.1089/mdr.2019.0065.
Al-Tamimi M, et al. Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli. Microb Drug Resist. 2019;25(8):1132-1141. PubMed PMID: 31107146.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-Producing Escherichia coli. AU - Al-Tamimi,Mohammad, AU - Abu-Raideh,Jumana, AU - Albalawi,Hadeel, AU - Shalabi,Marwan, AU - Saleh,Saiel, Y1 - 2019/05/20/ PY - 2019/5/21/pubmed PY - 2019/5/21/medline PY - 2019/5/21/entrez KW - E. coli KW - cefixime KW - clavulanic acid KW - extended-spectrum beta-lactamase (ESBL) KW - synergy SP - 1132 EP - 1141 JF - Microbial drug resistance (Larchmont, N.Y.) JO - Microb. Drug Resist. VL - 25 IS - 8 N2 - Background: Extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) is increasing worldwide. The drugs of choice for treatment of ESBLs are parenteral carbapenems. The aim of this study was to evaluate the in vitro and in vivo efficacy of a new combination of oral cephalosporins and amoxicillin/clavulanate in treatment of ESBL-EC. Methods: A total of 150 ESBL-EC samples were collected over 1 year from two referral centers. Synergistic studies of cephalosporins and amoxicillin/clavulanate were performed in vitro using disk approximation and disk replacement methods. Combination treatment was assessed in vivo on 20 ESBL-EC urinary tract infection (UTI) patients. Results: ESBL-EC isolates were confirmed in 150 patients with a mean age of 46.67 years, 75.2% of them being women. Antibiotic susceptibility testing of isolates indicated high resistance rate to oral antibiotics. The frequency of positive synergy and mean distance of synergy between cephalosporins and amoxicillin/clavulanate was significantly higher with cefotaxime and cefixime compared with cefpodoxime, cefdinir, and ceftazidime using disk approximation and disk replacement methods (p < 0.05). Addition of amoxicillin/clavulanate enhanced the susceptibility rate with cefixime from 8.6% to 86.3%, significantly higher than with other cephalosporins (p < 0.0005). Cefixime and amoxicillin/clavulanate synergy was not affected by age, gender, hospital, department, sample type, or bacterial load. Eighteen of 20 ESBL-EC-positive UTI patients had a positive in vitro synergy test and complete clinical and microbiological resolution after completion of cefixime and amoxicillin/clavulanate oral treatment course. Conclusions: Cefixime and amoxicillin/clavulanate combination therapy could be an effective oral outpatient treatment option for ESBL-EC. In vitro synergistic testing is simple and predictive of successful treatment. SN - 1931-8448 UR - https://www.unboundmedicine.com/medline/citation/31107146/Effective_Oral_Combination_Treatment_for_Extended-Spectrum_Beta-Lactamase-Producing_Escherichia_coli L2 - https://www.liebertpub.com/doi/full/10.1089/mdr.2019.0065?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -