Ampicillin/sulbactam compared with polymyxins for the treatment of infections caused by carbapenem-resistant Acinetobacter spp.

Oliveira, Maura Salaroli de; Prado, Gladys Villas Boas do; Costa, Sílvia Figueiredo; Grinbaum, Renato Satovschi; Levin, Anna S.

doi:10.1093/jac/dkn128

Cited by 134 publications

(82 citation statements)

References 29 publications

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“…Ampicillin-sulbactam is one of these early drugs proving in vitro activity [12] and two recent comparative, one retrospective [14] and one prospective [19], studies suggest that it may be effective against infections caused by this organism. In the retrospective study, more than 80 patients were either treated with colistin or ampicillin-sulbactam and colistin, but not ampicillin-sulbactam, proved independently associated with higher mortality rate [14]. In the prospective trial, 10 of 13 patients with ventilator-associated pneumonia by Acinetobacter spp displayed resolution or improvement of the symptoms and signs after treatment with high doses of ampicillin-sulbactam (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Both early [12] and present [13] evidences suggest that sulbactam is active in vitro against Acinetobacter spp, whereas some reports showed that this drug, given as a combination of ampicillin-sulbactam, may yield acceptable clinical success when treating infections associated with this pathogen [11,14]. However, neither large controlled clinical trials, nor pharmacodynamic studies have been undertaken to assess the efficacy of sulbactam against Acinetobacter spp [11,14].…”

mentioning

confidence: 99%

“…However, neither large controlled clinical trials, nor pharmacodynamic studies have been undertaken to assess the efficacy of sulbactam against Acinetobacter spp [11,14]. Amoxicillin-sulbactam (AMX-SUL) is an aminopenicillin/β-lactamase inhibitor combination marketed in Argentina since 1988 and is currently available in 29 countries.…”

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confidence: 99%

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Pharmacodynamic assessment of Amoxicillin-Sulbactam against Acinetobacter baumannii: searching the optimal dose and infusion time through a human ex-vivo model

Bantar¹,

Canigia²,

Berger³

et al. 2009

Braz J Infect Dis

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Amoxicillin-sulbactam (AMX-SUL) is an aminopenicillin/ß-lactamase inhibitor combination currently available in 29 countries and may be a suitable option for treating infections caused by Acinetobacter spp. Thus, we sought to search the optimal dosing strategy for this formulation through an ex vivo pharmacodynamic human model against Acinetobacter baumanniii. Four volunteers were randomized to receive alternatively a single dose AMX-SUL infused both either over 30 min or 3h at the following ratios (g/g): 1/0.5; 1/1, and 0/2. Time-kill studies were performed with the 0-, 0.5-, 2-, 4-, 6-and 8-h sera after dose against a clinical isolate of A. baumannii (sulbactam MIC, 4µg/mL). Bactericidal activity (i.e. a mean decrease ≥3 log 10 CFU/mL in the viable cell counts from the initial inoculum) was displayed by the 0.5-and the 2-h sera after dose for all formulations. The 4-h sera proved inhibitory with the AMX-SUL 1g/1g formulation, albeit a trend to regrowth was observed after 24-h incubation. With the AMX-SUL 0g/2g dose, the 4-h sera proved almost bactericidal activity (i.e. a mean decrease of 2.4 log 10 CFU/mL in the viable cell counts from the initial inoculum), whereas the 6-h sera was inhibitory, with a trend to regrowth after 24-h incubation. When infused over 3h, AMX-SUL 1g/0.5g and 1g/1g, bactericidal activity was displayed by the 0.5-, 2-and the 4-h sera after dose and the 6-h sera proved inhibitory with the AMX-SUL 1g/1g formulation. The present study, albeit preliminary, might give a rationale for the dosing strategy to treat infections caused by A. baumannii with sulbactam, either alone or combined with amoxicillin. A 2-g sulbactam dose seems to be optimal to be infused over 30 min with a 6-h dosing interval. When infused over 3h, AMX-SUL 1g/1g given every 6h or 8h seems a suitable dosing schedule.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pharmacodynamic assessment of Amoxicillin-Sulbactam against Acinetobacter baumannii: searching the optimal dose and infusion time through a human ex-vivo model

Bantar¹,

Canigia²,

Berger³

et al. 2009

Braz J Infect Dis

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“…In Brazil, CRAB is generally associated with carbapenemase production (OXA-23), which is reported in other countries (Dalla-Costa et al, 2003;Corrêa et al, 2012). Ampicillin/sulbactam may be a safe option, even for severe Acinetobacter infections (Levin et al, 2003;Oliveira et al, 2008;Chu et al, 2013). Amoxicillin/sulbactam may be another option because sulbactam is the main active molecule with antimicrobial properties against Acinetobacter (Kitzis et al, 1983).…”

Section: Monotherapy For Acinetobactermentioning

confidence: 99%

“…Current studies support monotherapy with sulbactam, carbapenems (meropenem or imipenem) or polymyxins in the treatment of severe infections caused by A. baumannii (Levin et al, 1999(Levin et al, , 2003Oliveira et al, 2008). However, there are many doubts about monotherapy in other severe infections, such as meningitis and even recurrent pneumonia (Tuon et al, 2010a, b).…”

Section: Monotherapy For Acinetobactermentioning

confidence: 99%

Combined therapy for multi-drug-resistant Acinetobacter baumannii infection – is there evidence outside the laboratory?

Tuon

Rocha

Merlini

2015

Journal of Medical Microbiology

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Acute Kidney Injury in Patients Treated with IV Beta‐Lactam/Beta‐Lactamase Inhibitor Combinations

Rutter

Burgess

2017

Pharmacotherapy

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Study Objective Increased acute kidney injury (AKI) incidence has been reported in patients receiving piperacillin-tazobactam (PTZ) therapy compared to other beta-lactams. This study sought to determine if the addition of beta-lactamase inhibitors impact AKI incidence by comparing patients treated with PTZ or ampicillin-sulbactam (SAM). Design Retrospective cohort study Setting Large academic tertiary care hospital Patients Overall, 2,448 patients received PTZ (n=1,836) or SAM (n=612) for at least 48 hours between September 1, 2007 and September 30, 2015. Patients were excluded for pregnancy, cystic fibrosis, chronic kidney disease, and initial creatinine clearance (CrCl) < 30 mL/min. Patients were matched on Charlson Comorbidity Index (CCI), initial CrCl, hypotension exposure, various nephrotoxic drug exposures, history of diabetes, heart failure, and hypertension. Measurements and Main results AKI occurred in 265 patients at similar rates for both groups (PTZ 11.4% vs SAM 9.2%; p=0.14). After stratifying by vancomycin exposure and controlling for confounders, there was no difference in the risk of AKI for SAM or PTZ (adjusted OR 0.87, 95% CI 0.59–1.25). The addition of vancomycin to PTZ increased the likelihood of AKI compared to PTZ alone (adjusted OR 1.77, 95% CI 1.26–2.46). Concomitant SAM and VAN therapy was not associated with a significant increase in AKI compared to SAM monotherapy (adjusted OR 1.01, 95% CI 0.48–1.97). Conclusion Rates of AKI were similar for PTZ and SAM in a matched cohort. The addition of a beta-lactamase inhibitor is not likely the mechanism in the observed increased rates of AKI in patients treated with vancomycin and PTZ.

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Ampicillin/sulbactam compared with polymyxins for the treatment of infections caused by carbapenem-resistant Acinetobacter spp.

Cited by 134 publications

References 29 publications

Pharmacodynamic assessment of Amoxicillin-Sulbactam against Acinetobacter baumannii: searching the optimal dose and infusion time through a human ex-vivo model

Pharmacodynamic assessment of Amoxicillin-Sulbactam against Acinetobacter baumannii: searching the optimal dose and infusion time through a human ex-vivo model

Combined therapy for multi-drug-resistant Acinetobacter baumannii infection – is there evidence outside the laboratory?

Acute Kidney Injury in Patients Treated with IV Beta‐Lactam/Beta‐Lactamase Inhibitor Combinations

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