Combination Of Clavulanic Acid Research Articles

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Editor's Choice

Subclinical Mastitis and Antimicrobial Susceptibility of Staphylococcus caprae and Staphylococcus epidermidis Isolated from Two Italian Goat Herds

A total of 156 goats from 2 commercial dairy goat farms were monitored for intramammary infections during an entire lactation. Most of the infections (80.7%) observed were due to coagulase-negative staphylococci (CNS) species. In herd 1, nearly all of the infections (96%) were due to CNS species, with Staphylococcus caprae (SCAP) being the most common specific pathogen observed, accounting for about 43% of the infections. In herd 2, the proportion of the infections due to CNS was 67% and Staphylococcus epidermidis (SEPI) was the most common pathogen (48% of infections) and SCAP was not present. Linear somatic cell scores (SCS) were greater in milk from infected udder halves, with an average difference of 0.78 SCS. The SCS for infected udder halves was greater than noninfected for all CNS species, although differences among species were observed. The ranking across CNS species was SCAP>other CNS>SEPI>no infection. However, infections by SEPI tended to be more persistent. Increased SCS was associated with a statistically significant decrease in milk yield, but no effect was observed for intramammary infections (IMI). Ninety-seven isolates of CNS (53 SCAP and 44 SEPI) were investigated for in vitro susceptibility to several antimicrobial agents. Benzylpenicillin was the most effective antimicrobial agent against SCAP and SEPI. A concentration of 0.05μg/mL was sufficient to inhibit growth of 90% of SCAP colonies, and 0.10μg/mL yielded a similar effectiveness for SEPI. Amoxicillin and the combination of amoxicillin and clavulanic acid were only slightly less effective. Tetracycline (62.5μg/mL) and tilmicosin (500μg/mL) were the least effective treatments for SEPI and SCAP, respectively.

Combined application of amoxicillin and clavulanic acid after oral surgical interventions.

Antibiotics represent a powerful weapon against infections. As dentists we are faced almost on a daily basis with the need to prescribe antibiotics. At the same time, we can often see that the antibiotics use tends to get out of control or that they are used indiscriminately with no real need. The aim of this case study is to investigate the effectiveness of amoxicillin and clavulanic acid combination in various dental ailments but also to demonstrate possible difference in the severity of symptoms after the use of amoxicillin and antibiotic combination of amoxicillin and clavulanic acid after surgical and oral interventions. The investigation involved 102 patients who were divided into two groups (the first group consisting of 59 and the second one of 43 patients). Following surgical treatment the first group of patients was prescribed antibiotic combination of amoxicillin and clavulanic acid in the dosage of 625 mg, 3 times per day. The second group of 43 patients was prescribed amoxicillin in the dosage of 500 mg, 4 times per day. The recommended therapy for antibiotic combination of amoxicillin and clavulanic acid was 5 to 10 days after the operation and 8 to 10 days for amoxicillin. In other words, both groups of patients started to use antibiotics after the surgical or oral intervention such as operative removal of impacted wisdom teeth, apicoectomy or complicated extractions, and also after the treatment of odontogenic abscesses etc. The same parameters were measured prior to the surgical intervention in cases when patients demonstrated the symptoms before the operational treatment while in all other cases the parameters were measured 48 hours and seven days following the operation. The measured parameters were: pain, swelling, body temperature, dysfunction such as dysphagus trismus, chewing disorder and possible allergic or gastrointestinal reactions. All parameters observed were precisely set in order to harmonize the investigation criteria and facilitate statistical data processing. With respect to pain before the operation there was no substantial statistical difference, p>0.05 (t=0.56; t=0.69). With respect to the onset of pain and the use of antibiotics after 48 hours there is a significant difference in favor of antibiotic combination of amoxicillin and clavulanic acid (X= 14.83, p= 0.002; p <0.01). Thus, pain is less acute if antibiotic combination of amoxicillin and clavulanic acid is administered. With respect to swelling and administration of antibiotics 48 hours after the operation there is no significant difference between the use of the two antibiotic therapies (X= 4.89; p=0.18; p>0.05). The investigation conducted seven days after the operation with regard to pain and the use of either antibiotic therapies demonstrated significant statistical difference (X=9.35, p<0.01) in favor of antibiotic combination of amoxicillin and clavulanic acid. In other words, patients who used amoxicillin and clavulanic acid felt significantly less intense pain. With respect to swelling, significant statistical difference between the two groups of patients was established in favor of antibiotic combination of amoxicillin and clavulanic acid, i.e. p<0.05 (X=6.45, p=0.03). The combination of amoxicillin and clavulanic has proven to be significantly more effective in comparison with the use of amoxicillin after oral-surgical interventions, and therefore antibiotic combination of amoxicillin and clavulanic acid is recommended for use in further practice.

SBP and the pathogenesis of renal failure-the hidden triangle

SBP and the pathogenesis of renal failure-the hidden triangle

The vitro efficacy of β-lactam and β-lactamase inhibitors against multidrug resistant clinical strains of Mycobacterium tuberculosis

In vitro activity of β-lactam antibiotics and their β-lactamase inhibitor combinations were evaluated for their activity against clinical isolates of Mycobacterium tuberculosis and M. tuberculosis H37Ra. Agar dilution, the BACTEC 460 system and β-lactamase activity tests were used. Results using the BACTEC 460 and enzyme activity tests showed the best β-lactamase inhibitor for M. tuberculosis H37Ra to be clavulanic acid. Cefazolin–clavulanic acid gave the lowest minimal inhibitory concentration (MIC) values using dilution tests and M. tuberculosis H37Ra. β-Lactam antibiotics were combined with clavulanic acid and tested for in vitro activity against 50 selected multidrug-resistant (MDR) and 50 susceptible clinical isolates. Seventy-four percent of the isolates were inhibited by cefazolin–clavulanic acid combination. These results suggested that an appropriate combination of β-lactam and β-lactamase inhibitors might be useful in the treatment of tuberculosis due to multidrug-resistant strains.

The combination of oral amoxicillin plus clavulanic acid and chlorhexidine rinses reduces the incidence of alveolar osteitis associated with the extraction of mandibular third molars

A total of 177 patients, 82 males and 95 females, with a 0689 mean age of 24 years participated in the study. One mandibular third molar was removed from each patient. Patients were randomly divided into 3 groups. One0689 group rinsed with chlorhexidine before removal of the tooth and twice daily for 7 days following the extraction. A second group also rinsed with chlorhexidine but was also prescribed 500 mg amoxicillin plus 125 mg clavulanic acid twice daily for 5 days following the extraction. A third control group rinsed with sterile saline alone. The presence of alveolar osteitis was determined at 30689 and 7 days after third molar removal. Alveolar osteitis was diagnosed when the patient reported pain that was unrelieved by paracetamol (acetaminophen) and exposed bone or necrotic tissue was present at the site of the tooth extraction. The incidence of alveolar osteitis was 20.9% in the0689 chlorhexidine-rinse-only group, 8.9% in the chlorhexidine/amoxicillin-plus-clavulanic-acid group, and 23.7% in the saline-rinse-only group. The incidence of alveolar osteitis was significantly less ( P = .001, χ 2 test) in the group that rinsed with chlorhexidine and received the antibiotic. Chlorhexidine rinse alone did not significantly reduce the incidence of dry socket as compared with the control group.

Clinical aspects of abscess development in parotitis

The purpose of this paper was to analyse parotideal abscesses on the basis of a larger number of patients. The data of 36 patients (mean age 44 years) with a parotideal abscess was analysed. Ultrasound scan was always necessary to verify the diagnosis. The surgical drainage was done under myoelectric monitoring of the facial nerve. Only in 1 patient a temporary minor paralysis of the mandibular branch was noticed. The most common bacteria were Staph. aureus, Streptococcus, and Peptostreptococcus. In 2 cases a tuberculosis and in 2 children an atypical mycobacterial infection was discovered. In another patient a metastasis of a squamous cell carcinoma was found. In every patient with an acute swelling of the parotid region without consideration of age, number of leucocytes or a typical fluctuation, an ultrasound scan should be used. The surgical drainage of the abscess should be done under myoelectric monitoring (Cave: muscle relaxant). In every case, a specimen for microbiological analysis (bacterial determination) and a biopsy (to exclude malignoma or atypical mycobacteria) are necessary. A peri- and post-operative therapy with a combination of aminopenicillin and clavulanic acid or with cephalosporine is recommended.

Ex vivo 12 h bactericidal activity of oral co-amoxiclav (1.125 g) against beta-lactamase-producing Haemophilus influenzae.

The aim of the study was to evaluate the in vitro/ex vivo bactericidal activity of a new coamoxiclav single-dose sachet formulation (1 g amoxicillin + 0.125 g clavulanic acid) against a beta-lactamase-producing strain of Haemophilus influenzae. The evaluation covered the 12 h period after antibiotic administration. Serum specimens from the 12 healthy volunteers included in the pharmacokinetic study were pooled by time point and in equal volumes. Eight of 12 pharmacokinetic sampling time points were included in the study. At time points 0.5, 0.75, 1, 1.5, 2.5, 5, 8 and 12 h post-dosing, the kinetics of bactericidal activity were determined for each of the serial dilutions. Each specimen was serially diluted from 1:2 to 1:256. The index of surviving bacteria (ISB) was subsequently determined for each pharmacokinetic time point. For all the serum samples, bactericidal activity was fast (3-6 h), marked (3-6 log(10) reduction in the initial inoculum) and sustained over the 12 h between-dosing interval. The results obtained also confirmed that the potency of the amoxicillin plus clavulanic acid combination was time dependent against the species under study and that the time interval over which the concentrations were greater than the MIC (t > MIC) was 100% for the strain under study. The data thus generated constitute an interesting prerequisite with a view to using co-amoxiclav 1.125 g in a bd oral regimen.

Pathologies infectieuses à Haemophilus: situation actuelle en pédiatrie

Haemophilus influenzae is the main pathogen in community-acquired infections in children. Prior to the introduction of H. influenzae type b immunization (Hib), capsular type b H. influenzae was the most invasive type of H. influenzae, and was the major cause of meningitis in children in France and many developing countries. The introduction of a Hib vaccine program results in rapid and dramatic decline in the incidence of Hib infections in children. The resistance rate to beta-lactam antibiotics is slowly increasing with beta-lactamase production. Third generation cephalosporins are used for the treatment of invasive infection (meningitis etc.). The empiric treatment of otitis and respiratory tract infections in children is the combination of clavulanic acid and amoxicillin or third generation cephalosporins.

Susceptibility of multidrug-resistant strains of Mycobacterium tuberculosis to amoxycillin in combination with clavulanic acid and ethambutol.

Thirty clinical isolates of Mycobacterium tuberculosis, 20 of which were multidrug-resistant (MDR), were tested for susceptibility to different combinations of amoxycillin, clavulanic acid and subinhibitory concentrations of ethambutol. beta-Lactamase production was assessed semiquantitatively with the nitrocefin method and susceptibility testing was performed with the BACTEC method. All isolates were beta-lactamase positive and were resistant to 16 mg/L amoxycillin. The MIC of amoxycillin in combination with clavulanic acid was > or =2 mg/L for 27/30 (90%) isolates. Addition of subinhibitory concentrations of ethambutol significantly reduced the MIC of amoxycillin for all tested isolates. Twenty-nine (97%) isolates had an MIC of amoxycillin of < or =0.5 mg/L when subinhibitory concentrations of ethambutol were added; this is well below the concentrations achievable in serum and tissue.

Inhibitor-Resistant TEM β-Lactamases: Revision of the TEM-41 Sequence

We have recently found that one of the β-lactamases reported in the paper by Stapleton et al. on incidence and mechanisms of resistance to the combination of amoxicillin and clavulanic acid in Escherichia coli (1) was misidentified. Redetermination of the DNA sequence of the TEM gene from strain 51864, in both the French and British laboratories, has revealed that the nucleotides corresponding to the amino acid at position 244 are AGC. Thus, the amino acid at this position is serine rather than threonine and the enzyme is TEM-30 and not TEM-41.

Incidence and Mechanisms of Resistance to the Combination of Amoxicillin and Clavulanic Acid in Escherichia coli

Incidence and Mechanisms of Resistance to the Combination of Amoxicillin and Clavulanic Acid in <i>Escherichia coli</i>

Isolation and characterization of a porin-like protein of 45 kilodaltons from Bacteroides fragilis

Resistance to the combination of amoxicillin and clavulanic acid in some Bacteroides fragilis strains may be associated with a lack of porin proteins. Comparison of outer membrane protein profiles from one resistant strain ( B. fragilis CFPL 358) and two susceptible strains of B. fragilis (ATCC 25285 and CFPL 92125) showed that a few proteins were missing in the resistant strain, especially a 45-kDa protein. To determine whether this protein was a porin-like protein, we attempted to isolate it from the two susceptible strains by using gel filtration (Sephacryl S-200, Superose 6) and ion exchange chromatographies (DEAE Trisacryl, DEAE Sepharose Fast Flow). Elution from DEAE resins was poor compared to the 60–67-kDa region, which suggested that the 45-kDa protein exhibited stronger cationic forms. The use of sodium dodecyl sulfate during elution improved the recovery of the 45-kDa protein, showing that detergent modified its conformation and its ionic bounds with the chromatographic matrices but it was not sufficient for good purification. Superose 6 gel filtration also failed to separate this protein from the 60–67-kDa region. The only method resulting in the positive recovery of a purified 45-kDa band from both susceptible B. fragilis strains was electroelution from SDS-PAGE. The swelling assay showed that the 45-kDa protein was a porin-like protein. From this study, we concluded that the 45-kDa protein from B. fragilis was a porin-like protein which might be involved in the antibiotic resistance of a strain in which this protein was missing.

Bacteriology of preserved stallion semen and antibiotics in semen extenders

Three experiments were conducted to evaluate the effects of different antibiotics in a milk-glucose semen extender on motility of equine sperm and elimination of bacteria following storage of extended semen in vitro. In Experiment 1, 7 antibiotics were compared: amikacin, gentamicin, streptomycin, potassium penicillin, sodium penicillin, ticarcillin, and polymixin B. In Experiment 2, 3 antibiotic treatments were compared: potassium penicillin G, amikacin, or a combination of potassium penicillin G and amikacin. In Experiment 3, 3 antibiotic treatments were compared: potassium penicillin G-amikacin, ceptiofur, and a combination of ticarcillin and clavulanic acid (Timentin). Control treatments (antibiotic-free extender) were included in each experiment. Six motility variables were evaluated: percentage of motile sperm; percentage of progressively-motile sperm; percentage of rapidly-motile sperm; mean curvilinear velocity; mean average path velocity; and mean straight-line velocity. In Experiment 1, mean percentages of motile, progressively motile and rapidly motile sperm were lower (P < 0.05) in semen exposed to polymixin B then in other treatments. Mean average-path velocity of sperm in extender containing polymixin B was lower (P < 0.05) than that of all other treatments, with exception of control or ticarcillin. Mean straight-line velocity of sperm in extender containing polymixin B was lower (P < 0.05) than that of all other treatments, with exception of control, streptomycin or ticarcillin. Semen samples containing gentamicin, amikacin, streptomycin, or potassium penicillin were more effective (P < 0.05) at eliminating bacterial growth than those samples containing polymixin B. Semen samples containing gentamicin were also more effective (P < 0.05) at eliminating bacterial growth than those samples containing ticarcillin or sodium penicillin. In Experiment 2, mean percentage of rapidly-motile sperm, and mean curvilinear, average-path, and straight-line velocities were greater (P < 0.05) for potassium penicillin-amikacin than values for all other treatments. In 2 of 3 stallions, an effect of treatment on percentage of motile sperm was detected (P < 0.05). For one stallion, mean motility of potassium penicillin-amikacin was greater (P < 0.05) than that of all other treatment groups. For another stallion, mean motility of the control was lower (P < 0.05) than that of the other treatments. Following storage, potassium penicillin ( 16 18 [89%]) or potassium penicillin-amikacin ( 17 19 [94%]) were more effective (P < 0.05) at controlling aerobic and anaerobic bacterial isolates in semen specimens than was amikacin ( 10 18 [56%]). In Experiment 3, a difference among treatment groups for motility variables was not detected (P > 0.05). No bacterial growth was recovered in antibiotic-treated semen, with exception of Micrococcus sp. (2 colonies) which were isolated from one semen specimen treated with ceptiofur.

Isolation and characterization of a porin-like protein of 45 kilodaltons from Bacteroides fragilis.

Resistance to the combination of amoxicillin and clavulanic acid in some Bacteroides fragilis strains may be associated with a lack of porin proteins. Comparison of outer membrane protein profiles from one resistant strain (B. fragilis CFPL 358) and two susceptible strains of B. fragilis (ATCC 25285 and CFPL 92125) showed that a few proteins were missing in the resistant strain, especially a 45-kDa protein. To determine whether this protein was a porin-like protein, we attempted to isolate it from the two susceptible strains by using gel filtration (Sephacryl S-200, Superose 6) and ion exchange chromatographies (DEAE Trisacryl, DEAE Sepharose Fast Flow). Elution from DEAE resins was poor compared to the 60-67-kDa region, which suggested that the 45-kDa protein exhibited stronger cationic forms. The use of sodium dodecyl sulfate during elution improved the recovery of the 45-kDa protein, showing that detergent modified its conformation and its ionic bounds with the chromatographic matrices but it was not sufficient for good purification. Superose 6 gel filtration also failed to separate this protein from the 60-67-kDa region. The only method resulting in the positive recovery of a purified 45-kDa band from both susceptible B. fragilis strains was electroelution from SDS-PAGE. The swelling assay showed that the 45-kDa protein was a porin-like protein. From this study, we concluded that the 45-kDa protein from B. fragilis was a porin-like protein which might be involved in the antibiotic resistance of a strain in which this protein was missing.

Multiple antibiotic resistance (MAR) index and its reversion in Pseudomonas aeruginosa.

The MAR indexes of hospital isolates of Pseudomonas aeruginosa were determined with reference to nine different cephalosporins. The values for all the strains were higher than 0.2 suggesting their origin from a high risk source of contamination where antibiotics are often used. Emergence of MAR pathogenic strains of Ps. aeruginosa indicated possible nosocomial infection in the hospital environment. beta-Lactamases produced by these organisms were tested and their inhibition by clavulanic acid was studied. beta-Lactamase produced by one of these strains (Ps-1) could not be inhibited by clavulanic acid whereas beta-lactamases of three other strains (Ps-2, Ps-3 and Ps-4) could be inhibited by clavulanic acid in the presence of cephalosporins, suggesting a possible use of clavulanic acid in combination with cephalosporins, to combat beta-lactamase induced resistance in Ps. aeruginosa.

Acute Liver Injury Associated With Amoxicillin-Clavulanic Acid

We would like to comment on an article written by García Rodriguez et al¹on the risk of acute liver injury associated with the combination of amoxicillin and clavulanic acid. As we have had the opportunity to review, in some detail, the data that were presented, together with much of the source material from which this publication was derived, we would like to draw the attention of your readership to the following methodological flaws in the study: There are clear differences between the populations exposed to the 2 drugs under investigation with respect to age, concurrent medications, and, in particular, potentially hepatotoxic drugs, concurrent disease, and duration of exposure. No adjustment has been made by the authors for these important confounding factors. Using the criteria strictly as detailed in a consensus publication2 and applying them to the Value Added Medical Products Research in the United Kingdom (VAMP)

Acute Liver Injury Associated With Amoxicillin-Clavulanic Acid-Reply

Our response to the comments included in the letter by Fletcher and colleagues have already been previously submitted to the manufacturer of amoxicillin and clavulanate potassium (Augmentin, SmithKline Beecham Pharmaceuticals, Philadelphia, Pa). Two of the authors of this letter have been consultants for this drug company and have reviewed our data at the company's request. In summary, the reply to all concerns raised by Fletcher and colleagues is as follows: Table 4 presents stratified analyses for age, concurrent hepatotoxic drugs, and duration of treatment. The results clearly show that adjusting for these factors further increases the relative risk of acute liver injury associated with the combination of amoxicillin and clavulanic acid. As stated in our article, we adapted the criteria of the consensus publication such that when the values for alanine aminotransferase were not available we used those for aspartate aminotransferase instead. Also, as we stated, agreement on

Systemic antibiotic prophylaxis after gastrointestinal hemorrhage in cirrhotic patients with a high risk of infectio

In cirrhotic patients with gastrointestinal hemorrhage, bacterial infections are frequent and play a significant role in mortality. We have previously found that patients with a Child-Pugh's class C or a rebleeding are a subgroup of cirrhotic patients with a high risk of infection. The aims of the study were (1) to validate these indicators and (2) to assess the effectiveness of a systemic antibiotic treatment in preventing bacterial infections in bleeding cirrhotics with a high risk of infection. One hundred and nineteen bleeding cirrhotic patients were divided into 3 groups. Patients with a Child-Pugh's class A-B and no rebleeding (i.e., with a low risk of infection) constituted group 1 (n = 55). Patients with a high risk of infection were randomly allocated to serve as controls (group 2, n = 34) or to receive the ciprofloxacin and a combination of amoxicillin and clavulanic acid for 3 days after hemorrhage (group 3, n = 30). This antibiotic prophylaxis was administered first intravenously and then orally when the bleeding was controlled. The study period was defined as 10 days after hemorrhage. Incidence of bacterial infections was significantly higher in patients from group 2 than in patients from group 1 (52.9% vs. 18.2%; P < .001). Moreover, infections were more severe in group 2: a sepsis syndrome or a septic shock developed in 66.7% of infected patients from this group, but in only 20% of infected patients from group 1. Incidence of bacterial infections was much lower in patients from group 3 than in those from group 2 (13.3% vs. 52.9%; P < .001). Eight patients from group 2 (23.5%) and 4 patients from group 3 (13.3%) died during the first four weeks (P-not significant). Septic shock was the cause of death in 3 patients from group 2 and in only 1 patient from group 3. The cost of antibiotic therapy, including antibiotic prophylaxis in group 3, was $208 +/- $63 per patient in group 2 and $167 +/- $42 per patient in group 3 (P < .05). We conclude that (1) patients with a Child-Pugh's class C and/or a rebleeding are a subgroup of cirrhotic patients with a high risk of infection after gastrointestinal hemorrhage and that (2) in these patients, a prophylactic treatment with systemic antibiotics is very effective in preventing bacterial infections. (Hepatology 1996 Oct;24(4):802-6)

Evaluation of Vitek GPS-SA card for testing of oxacillin against borderline-susceptible staphylococci that lack mec

Fifty-one Staphylococcus aureus strains lacking mec for which oxacillin MICs were 1 to 8 micrograms/ml were tested against oxacillin and the combination of oxacillin and clavulanic acid with the Vitek GPS-SA card, the reference broth microdilution method, and the oxacillin agar screen plate. Of the 51 strains, 44 (86%) did not grow on the oxacillin agar screen plate, broth microdilution MICs were 1 to 2 micrograms/ml, and GPS-SA card MICs were < or = 2 micrograms/ml, with the exception of 3 strains that failed to grow in the card on repeated attempts. Another seven strains did grow on the oxacillin agar screen plate. For four of the latter group of strains, oxacillin broth microdilution MICs were > 4 micrograms/ml and GPS-SA card MICs were > or = 4 micrograms/ml; for the other 3 strains, corresponding MICs were 4 and < or = 2 micrograms/ml, respectively. The GPS-SA card classified 86% of strains as oxacillin susceptible.