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Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-Producing Escherichia coli.

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.

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  • Authors+Show Affiliations

    ,

    1 Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan.

    ,

    1 Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan.

    ,

    1 Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan.

    ,

    2 Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan.

    2 Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan.

    Source

    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.), 2019.
    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.
    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.), 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 May 20; 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/entrez KW - KW - cefixime KW - clavulanic acid KW - extended-spectrum beta-lactamase (ESBL) KW - synergy JF - Microbial drug resistance (Larchmont, N.Y.) JO - Microb. Drug Resist. 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 -