Placebo-controlled double-blind evaluation of trimethoprim-sulfamethoxazole treatment of Yersinia enterocolitica gastroenteritis.
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Biomedical subjects
Publications and source records attributed to E Tuomanen.
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D-Isomers of several amino acids completely protected growing cultures of Escherichia coli against all antibacterial effects of beta-lactam antibiotics up to approximately two to three times the MICs of the antibiotics. L-Isomers of amino acids were ineffective. Protection depended on the concentration and time of addition of the D-amino acids. This appears to be the first demonstration of natural products capable of reversing the antibacterial effects of beta-lactam antibiotics.
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Erythromycin ethylsuccinate therapy was compared with no treatment in a randomized, prospective trial of treatment of Campylobacter enteritis in infants and children. Patients received either erythromycin ethylsuccinate (N = 15), 40 mg/kg/day every six hours, for seven days or no treatment (N = 12). The mean age (5.5 v 3.7 years), sex ratio, and mean duration of illness before admission to study (5.5 v 6.4 days) of the two groups were similar. No difference was noted in the mean days to resolution of diarrhea (3.2 v 3.8 days). However, the mean duration of bacterial shedding was shorter in the treatment group (2.0 days) compared with the group without treatment (16.8 days). Bacteriologic relapse occurred in one patient in the treatment group, and three relapses occurred in the group without treatment. Two secondary cases occurred among household contacts, one in each group.
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beta-Lactam antibiotics rapidly kill bacteria during logarithmic growth but fail to kill nongrowing cells. This trait is the most universal example of phenotypic tolerance (the ability of bacteria to evade the bactericidal activity of antibiotics). Both nongrowing and slowly growing bacteria are found very frequently during infection in vivo, and phenotypic tolerance to the bactericidal activity of antibiotics as a consequence of reduced growth rate can be detected in vivo. With the use of an in vitro model system of nongrowing bacteria, a select group of beta-lactam antibiotics has been found that demonstrates a striking and unusual ability to kill nongrowing bacteria despite phenotypic tolerance to conventional beta-lactam antibiotics. These same compounds also effectively kill phenotypically tolerant cells in cerebrospinal fluid and serum. The extension of bactericidal activity to nongrowing and slowly growing bacteria may be a major advance in efforts to improve the chemotherapy for infectious diseases.
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