Evaluation of aztreonam in the treatment of severe bacterial infections

Abstract

Aztreonam (AZT) is a member of a new class of monocyclic synthetic P-lactam agents with in vitro activity against the vast majority of gram-negative bacteria, including members of the family Enterobacteriaceae and most isolates of Pseudomonas aeruginosa. The compound is inactive against aerobic, gram-positive and anaerobic bacteria. It is likely that this selective spectrum of action causes minimal disturbance of normal human fecal flora, thus decreasing the risk of overgrowth of enterococci and other resistant strains (12,15,21,23,34,35).High levels of AZT in serum can be obtained with a 1-g parenteral dose, protein binding is about 56%, and the terminal half life in serum is 1.7 h. AZT is not metabolized in the body, renal excretion occurs by glomerular filtration, and about 65% of the antibiotic is recovered unchanged from the urine (18,29,(31)(32)(33).With these considerations in mind, we evaluated the clinical efficiency, tolerance, and toxicity of AZT in the treatment of 46 patients with 50 episodes of severe bacterial infections. MATERIALS AND METHODSPatients. Forty-six hospitalized patients were selected for the study. All had clear symptoms and signs of infection and microorganisms supposedly responsible for the infection had been identified within the previous 48 h.We considered as urinary tract infection (UTI) the isolation of significant bacteriuria (>105 CFU/ml) in the presence of related clinical symptoms. Our single case with respiratory tract infection was a patient with pneumonia defined by the presence of fever and pulmonary infiltrates and the isolation of a single pathogen from an endotracheal aspiration. Our diagnoses of osteomyelitis were supported by the presence of concomitant bacteremia in one case, with the isolation of the responsible microorganisms during surgical procedures in six patients and direct isolation from an open * Corresponding author.

Aztreonam in the treatment of severe urinary tract infections in pediatric patients

“…The percentage of superinfections (8,20,23) we found during and at the end of aztreonam treatment was also similar to that reported in comparable clinical trials in adults. Superinfections, mostly by gram-positive bacteria, were almost exclusively restricted to immunocompromised patients or to those with predisposing conditions (8,23).…”

“…Aztreonam was well tolerated. Hematologic and biochemical side effects in our patients were similar to those described in adult patients treated with the drug (8,20,23) and in pediatric patients treated with other new beta-lactam antibiotics (1,4,12,21,22). Thus, it seems reasonably safe to use aztreonam also in severely ill patients and in patients with renal failure.…”

“…produces effective serum concentrations for 8 to 12 h; the drug is primarily excreted in the urine (28). Aztreonam has been evaluated in the treatment of serious gram-negative infections in adult patients (6,8,20,23), whereas no data are available so far on its clinical efficacy and safety in pediatric patients.…”

Characterization of a Fish Antimicrobial Peptide: Gene Expression, Subcellular Localization, and Spectrum of Activity

“…We show here that pleurocidin notably exhibits both anticandidal and antibacterial activity against clinical isolates, which may decrease the chance of candidal superinfections normally associated with antibacterial treatment of conditions such as urinary tract infections, bacterial meningitis, and bacterial vaginosis (15,29,30). Pleurocidin may prove beneficial in the treatment or prevention of sequelae.…”

The life and times of the Enterococcus.

“…The use of antimicrobial agents lacking enterococcal activity has been implicated as an important factor in the development of enterococcal superinfection (16,46,74,98,137,176,207,230). Moellering reviewed 2,107 patients treated with moxalactam and found that 2.1% developed an enterococcal superinfection during or shortly after moxalactam therapy (137).…”