Efficacy of Ceftriaxone, Cefepime, Doxycycline, Ciprofloxacin, and Combination Therapy for Vibrio vulnificus Foodborne Septicemia

Abstract

Foodborne infections are associated with higher rates of sepsis and mortality than wound infections; however, antibiotic efficacy studies have not been performed in foodborne infection models. The efficacies of ceftriaxone, cefepime, doxycycline, ciprofloxacin, and combination therapy were assessed in intestinal infection in mice in order to model foodborne infections. In accordance with prior studies of cefotaxime, cefepime was synergistic with doxycycline and ciprofloxacin ; combination therapy significantly decreased bacterial growth, by ≥2 log units, from that with antibiotic monotherapy ( < 0.01). , survival rates in the ceftriaxone (50%), doxycycline (79%), and ciprofloxacin (80%) groups were significantly higher than those in the control group (0%) ( < 0.0001). Survival was significantly higher with ceftriaxone-doxycycline (91%) or ceftriaxone-ciprofloxacin (100%) therapy than with ceftriaxone (50%) ( ≤ 0.05). Survival with cefepime-doxycycline (96%) or cefepime-ciprofloxacin (90%) therapy was significantly higher than that with cefepime alone (20%) ( < 0.001). There was no difference in survival between the combination therapy groups. Thus, we conclude that combination therapy was the most effective treatment for foodborne septicemia. In a septic patient with a recent ingestion of raw seafood, cefepime in combination with doxycycline or ciprofloxacin should be initiated for coverage of resistant Gram-negative organisms and pending a microbiological diagnosis. Once a diagnosis of foodborne septicemia is established, treatment can safely transition to ceftriaxone in combination with doxycycline or ciprofloxacin.

A case of Vibrio vulnificus related wound infection diagnosed by next-generation sequencing

“…Prompt treatment with appropriate antimicrobial is essential for the best prognosis. It has already been demonstrated that the use of quinolone alone or the combination of tetracycline and third generation cephalosporin had the lowest mortality and should be the priority selection for V. vulnificus infection [11,12]. However, V. vulnificus infection may be increasingly difficult to treat as the inappropriate use of antimicrobials has increased resistance.…”

Patients with Monomicrobial Aeromonas Necrotizing Fasciitis Had Higher Mortality Rates Than Those of Vibrio vulnificus Infections

“…Although Vibrio vulnificus isolates were recorded susceptible to ampicillin, amikacin, ceftazidime, ceftriaxone, cefuroxime, ciprofloxacin, gentamicin, imipenem, piperacillin, and sufamethoxazoletrimethoprim by clinical microbiology laboratory, many countries demonstrated a small porportion of clinical isolates resistance to penicillin, ampicillin, amoxicillin, streptomycin, cephalexin and erythromycin (29,30). In a study by Trinh et al, the survival rate was significantly higher with ceftriaxone-doxycycline (91%), ceftriaxone-ciprofloxacin (100%), cefepime-doxycycline (96%), and cefepime-ciprofloxacin (90%) combination therapy for Vibrio vulnificus septicemia (31). But otherwise recent literatures indicated that Aeromonas spp.…”

Vibrio vulnificus infection: a persistent threat to public health

“…An animal experiment suggested that the combination of ciprofloxacin and cefotaxime is an effective treatment option for V. vulnificus -infected people [ 39 ]. A recent study suggested that cefepime combined with doxycycline or ciprofloxacin should be initiated to cover gram-negative-resistant organisms and V. vulnificus while awaiting a microbiological diagnosis; once a diagnosis of V. vulnificus septicemia is confirmed, treatment can be safely changed to ceftriaxone combined with doxycycline or ciprofloxacin [ 42 ]. Another recent study suggested that tigecycline alone might be a better therapeutic option than a traditional combination regimen of ceftazidime plus doxycycline in patients with V. vulnificus infection [ 43 , 44 ].…”