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Results for “Aztreonam”

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PubMed1992

An open, comparative trial of aztreonam with vancomycin and gentamicin with piperacillin in patients with fulminant hepatic failure.

Fifty patients admitted with fulminant hepatic failure and clinically suspected infection were allocated to receive either aztreonam and vancomycin or piperacillin and gentamicin as first line treatment. Fourteen patients died within 48 h of admission and were excluded from the analysis. Of the remaining 36 patients, 16 received aztreonam/vancomycin and 20 piperacillin/gentamicin. There were 18 episodes of infection in the aztreonam/vancomycin group and 24 in the piperacillin/gentamicin group (P = not significant). The most frequent bacterial pathogen was Staphylococcus aureus. Fungal infection developed in 13 patients (nine in the aztreonam/vancomycin group and four in the piperacillin/gentamicin group; P = not significant). Death attributed to infection occurred in 4 (25%) of 16 patients receiving aztreonam/vancomycin and 4 (20%) of 20 receiving piperacillin/gentamicin (P = not significant). Thirteen patients (three in the aztreonam/vancomycin group and ten in the piperacillin/gentamicin group) had clinical and microbiological improvement without addition or substitution of other antibiotics. No side-effects attributed to the study drugs were recorded.

Adolescent↗

PubMed1993

Activity of imipenem, third-generation cephalosporins, aztreonam and ciprofloxacin against multi-resistant gram-negative bacilli isolated from Chilean hospitals.

The activity of imipenem against nosocomial strains of Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp. and methicillin-resistant Staphylococcus aureus resistant to some third-generation cephalosporins, aztreonam, or ciprofloxacin was assessed. These strains represent the most prevalent multi-resistant nosocomial microorganisms in Chile since they were isolated from clinical specimens in 11 Chilean hospitals. A high proportion of the strains were resistant to several beta-lactams, yet all strains of K. pneumoniae and Acinetobacter spp. were susceptible to imipenem; resistance was exhibited by only one strain of P. aeruginosa and 16 strains of S. aureus. Synergy between cefotaxime and clavulanic acid was found in almost all strains of K. pneumoniae, suggesting the presence of plasmid-coded beta-lactamases, probably with extended-spectrum activity. Killing A. baumannii by imipenem was rapid, but slower for P. aeruginosa. Killing of K. pneumoniae was also somewhat slower despite the lower MIC of imipenem for this strain. Bactericidal activity was even slower against one strain of methicillin-resistant S. aureus. These results suggest that imipenem would be an adequate alternative to other broad-spectrum agents in the treatment of infections due to nosocomial multi-resistant Gram-negative bacilli.

Anti-Bacterial Agents↗

PubMed2025

Comparative in vitro activity of ceftazidime-avibactam plus aztreonam and the fixed combination aztreonam/avibactam against multidrug-resistant Pseudomonas aeruginosa.

BACKGROUND AND OBJECTIVES: MDR Pseudomonas aeruginosa is difficult to treat, despite some new beta-lactam/beta-lactamase inhibitors. A combination of ceftazidime-avibactam and aztreonam (CAZ/AVI + AZT) is frequently used to treat Gram-negative bacteria expressing metallo-beta-lactamases. A fixed combination of aztreonam/avibactam was recently licenced for use in Europe, but it remains unknown whether there are differences between both options for use against P. aeruginosa. This study evaluates the comparative in vitro efficacy of the fixed combination aztreonam/avibactam compared to the three antibiotics CAZ/AVI + AZT against clinical MDR P. aeruginosa isolates. METHODS: MICs for aztreonam/avibactam and CAZ/AVI + AZT were determined in 38 MDR P. aeruginosa isolates recovered from routine diagnostics using broth microdilution with checkerboard assays in triplicates as the reference method. Fractional inhibitory concentration (FIC) indices were calculated. Whole-genome sequencing was performed on all isolates. RESULTS: At a fixed ceftazidime concentration of 8 mg/L (EUCAST breakpoint), 25 isolates exhibited lower MICs for CAZ/AVI + AZT compared to aztreonam/avibactam alone in microdilution assays. On FIC analysis, additive and synergistic effects were seen in 28 and 2 cases, respectively. Verona integron-encoded metallo-beta-lactamase (VIM) was the most prevalent carbapenemase (21/38 isolates), followed by Imipenemase (IMP, 4/38) and New Delhi metallo-beta-lactamase (NDM, 2/38). Lower MICs were observed for the combination CAZ/AVI + AZT in isolates carrying VIM-2 as compared to VIM-1. CONCLUSIONS: In vitro testing of CAZ/AVI + AZT revealed increased in vitro susceptibility among MDR P. aeruginosa isolates in comparison to the fixed combination of aztreonam/avibactam.

Pseudomonas aeruginosa↗

PubMed1989

Aztreonam in the management of gram-negative infections in penicillin-allergic patients: a review.

Penicillins and cephalosporins, which are well-tolerated by most patients, can result in hypersensitivity reactions. This factor not only limits the use of beta-lactam antibiotics but also presents challenges to the selection of alternative drugs because of the potential for cross-reactivity. Evidence suggests that aztreonam, the prototype of the new monobactam class of beta-lactam antibiotics, may be a safe alternative antibiotic for managing Gram-negative infections in penicillin-allergic patients.

Aztreonam↗

PubMed2003

Cefepime versus ticarcillin and clavulanate potassium and aztreonam for febrile neutropenia therapy in high-dose chemotherapy patients.

An open labeled randomized trial comparing the efficacy and cost of empirically applied cefepime (C) as monotherapy versus combination therapy consisting of ticarcillin and clavulanate potassium and aztreonam (T/A) was performed in febrile neutropenic patients following high-dose chemotherapy (HDC) +/- radiation, with or without peripheral blood stem cell support. Over a 28-month period, 126 patients were screened and included in the study. Using afebrile status following 3 days of therapy as a primary endpoint, both regimens produced comparable clinical response rates (C = 55% vs. T/A = 61%). Also, the use of vancomycin for resistant gram-positive infections and alteration of gram-negative infection coverage was similar in both groups (C = 40% vs. T/A = 47% and C = 29% vs. T/A = 24%). Both treatment groups had similar needs for empirical antifungal therapy (C = 25% vs. T/A = 22%). There was a postrandomization difference between the two groups in that the "C" group had a significantly higher number of allogeneic transplants and non-stem-cell-supported patients, whereas the "T/A" group had a significantly greater number of autologous peripheral blood stem cell patients (p < 0.0001). Despite this difference, the C group had a significantly lower cost ratio than the T/A group (p = 0.016). In conclusion, we have shown that C treatment of febrile neutropenic patients following HDC results in similar efficacy and lower cost when compared to T/A, despite the inclusion of higher risk patients in the C group.

Adult↗

PubMed1991

Tolerance to aztreonam in patients allergic to beta-lactam antibiotics.

To evaluate the safe use of aztreonam (AZT) in patients allergic to penicillins and other beta-lactam antibiotics we studied 29 patients from a group of subjects allergic to beta-lactams, diagnosed by presenting systemic reactions after skin tests or challenge tests. Skin tests with benzylpenicilloyl (BPO), benzylpenicilloate, benzylpenicillin, ampicillin, amoxicillin, cephamandole and AZT, radioallergosorbent test (RAST) to BPO and AZT, RAST inhibition and challenge tests were performed. One patient was skin test-positive to AZT, another patient was RAST AZT-positive. IgE antibodies were specific to AZT as demonstrated by RAST inhibition studies with AZT coupled to epsilon-amino caproic acid. Nevertheless, AZT was unable to inhibit either a pool of sera or individual sera positive to BPO. Although all our 29 patients tolerated the administration of AZT (including those with skin test or RAST positive) and AZT appears to be safe in these subjects, this does not indicate that all beta-lactam-allergic patients tolerate AZT administration.

Anti-Bacterial Agents↗

PubMed1990

[Estimate of aztreonam (AZT) hydrolyzing enzymes from clinically isolated AZT-resistant gram-negative bacilli].

The MICs of Aztreonam (AZT) against 590 clinical isolates of Gram-negative bacilli were determined. About 13.4% (79 strains) of the isolates were AZT-resistant (MIC; 12.5 micrograms/ml less than or equal to). The resistance pattern against various beta-lactams and the effects on MICs of combination of Clavulanic acid (CVA) and AZT against AZT resistant strains suggested that AZT was inactivated by either type of IV (K1), Va (OXA1), or PSE2 beta-lactamases.

Aztreonam↗

PubMed1996

Effect of recombinant human granulocyte colony-stimulating factor on combination therapy with aztreonam and clindamycin for infections in neutropenic patients with hematologic diseases.

The present multicenter study was performed to evaluate the effect of recombinant human granulocyte-colony stimulating factor (rhG-CSF) on combination therapy using aztreonam (AZT) and clindamycin (CLDM) to treat severe infection in neutropenic patients with hematologic diseases. Forty-three neutropenic patients with infections (rhG-CSF group) were treated with AZT (2 g) and CLDM (600 mg) 2-3 times daily as well as rhG-CSF (Lenograstim or Filgrastim: 2-5 mu/kg/day). The clinical efficacy of this regimen was compared to that obtained in 44 febrile neutropenic patients, with hematologic diseases, who received only AZT and CLDM in a previous study (historical control group). The overall efficacy rate was 69.8% (30/43) in the rhG-CSF group and 65.9% (29/44) in the historical control group. Although the neutrophil count was significantly increased and C-reactive protein tended to be lower in the rhG-CSF group, the daily maximum body temperature profiles of the 2 groups were nearly the same. These results suggest that rhG-CSF is of little benefit in the treatment of single infectious episodes in neutropenic patients, and that appropriate antibiotic therapy is more important.

Acute Disease↗

PubMed1983

Comparative in vitro activity of cefodizime, ceftazidime, aztreonam, and other selected antimicrobial agents against Neisseria gonorrhoeae.

The in vitro activities of three new beta-lactam antimicrobial agents, cefodizime, ceftazidime, and aztreonam (formerly azthreonam), were compared with those of cefotaxime, cefuroxime, cefoxitin, and penicillin against 100 beta-lactamase-negative and 42 beta-lactamase-positive Neisseria gonorrhoeae strains. The three new antimicrobial agents showed excellent activity against N. gonorrhoeae regardless of beta-lactamase production. Cefodizime was as active as cefotaxime and more active than the other test antimicrobial agents. It inhibited all isolates at a concentration of less than or equal to 0.016 micrograms/ml.

Anti-Bacterial Agents↗

PubMed1983

Oral bioavailability of the monobactam aztreonam (SQ 26,776) in healthy subjects.

To investigate the oral bioavailability of aztreonam (SQ 26,776), we administered single 500-mg doses of this monobactam as an oral solution, as two 250-mg capsules, and as a 3-min intravenous infusion to 15 healthy male subjects at 1-week intervals according to a three-way crossover study design. Serum and urine samples were assayed by microbiological methods. The absolute systemic bioavailability of each oral formulation, defined as the ratio of areas under the serum concentration-time curves after oral and intravenous administration, was less than 1%. Peak serum levels achieved with oral solution, capsule, and intravenous infusion were 0.15, 0.14, and 56.7 micrograms/ml, respectively, and cumulative urinary excretion was 0.7, 0.6, and 68% of the administered dose, respectively.

Administration, Oral↗

PubMed1983

Activities of aztreonam and new cephalosporins against infrequently isolated gram-negative bacilli.

The susceptibilities of 159 clinical isolates of glucose nonfermentative gram-negative bacilli were determined for eight new monobactam or beta-lactam antibiotics. Imipemide (N-formimidoyl thienamycin) was effective against the largest number of species, although not against Pseudomonas maltophilia. Cefoperazone and ceftazidime, but not cefsulodin, were active against infrequently isolated Pseudomonas species. Aztreonam, moxalactam, cefotaxime, and ceftizoxime demonstrated selective activity against several species, including certain amino-glycoside-resistant isolates.

Anti-Bacterial Agents↗

PubMed1984

Comparative efficacies of piperacillin, azlocillin, ticarcillin, aztreonam, and tobramycin against experimental Pseudomonas aeruginosa pneumonia.

The therapeutic efficacies of the newer beta-lactam antibiotics piperacillin, azlocillin and aztreonam were compared with the efficacies of ticarcillin and tobramycin in a guinea pig model of experimental Pseudomonas aeruginosa pneumonia. For animals challenged with 2 X 10(8) CFU, tobramycin treatment resulted in survival rates and intrapulmonary killing of pseudomonads which were significantly greater than those found with any of the beta-lactam agents. There were no significant differences noted among the individual beta-lactam agents. When animals were challenged with 200-fold-fewer organisms (10(6) CFU), there was no significant difference between the efficacy of tobramycin and those of the various beta-lactams. These data suggest that tobramycin is particularly valuable in treating more severe P. aeruginosa pneumonia, whereas a number of different beta-lactam agents are of equivalent value in less severe lung infections.

Animals↗

PubMed1984

Immunology of the monobactam aztreonam.

To assess the immunological cross-reactivity of the monobactam antibiotic aztreonam (AZ), rabbits were immunized with protein conjugates of benzylpenicillin, cephalothin (CEPH), and AZ. The resulting antibenzylpenicilloyl (BPO) and anti-CEPH rabbit antibodies showed negligible cross-reactivity with AZ conjugated to human serum albumin (AZ-HSA), whereas anti-AZ showed negligible cross-reactivity with BPO-HSA and CEPH-HSA. Unlike benzylpenicillin and CEPH, unconjugated AZ was as effective as AZ conjugated to epsilon aminocaproic acid (AZ-EACA) in inhibiting the binding of homologous antibody. Studies with various analogs of AZ confirmed that immunoglobulin G (IgG) anti-AZ was entirely side-chain specific. The inhibition of the binding of human IgE anti-penicilloyl to BPO-HSA was studied in the presence of AZ-EACA, BPO-formyl lysine, and CEPH-EACA. Whereas CEPH-EACA displayed 3% cross-reactivity with BPO-lysine, AZ-EACA showed little or no cross-reactivity (much less than 0.9%). To assess the immunogenicity of AZ in humans, IgE and IgG antibodies were measured in sera from 36 healthy male volunteers receiving 0.5 or 1 g intravenously or intramuscularly every 8 h for 7 days. None of the subjects had detectable preexisting IgE reactive with AZ or demonstrated an IgE response to antibiotic administration. Four subjects gave evidence for naturally occurring IgG cross-reactive with AZ, but only one subject demonstrated a rise in IgG levels after exposure to AZ. This anti-AZ IgG did not cross-react with BPO or CEPH conjugates of bovine thyroglobulin and was completely side-chain specific. These studies suggest that AZ displays very low immunological cross-reactivity with other beta-lactam antibiotics and may be only weakly immunogenic in humans.

Animals↗

PubMed1984

In vitro activities of aztreonam, piperacillin, and ticarcillin combined with amikacin against amikacin-resistant Pseudomonas aeruginosa and P. cepacia isolates from children with cystic fibrosis.

Amikacin, combined with aztreonam, piperacillin, or ticarcillin, synergistically inhibited amikacin-resistant sputum isolates of Pseudomonas aeruginosa and P. cepacia from children with cystic fibrosis. Ticarcillin-amikacin was the least active combination. Aminoglycoside resistance should not preclude the use of beta-lactam-aminoglycoside combinations in the treatment of pulmonary infections in cystic fibrosis.

Amikacin↗

PubMed1985

Comparative in vitro activities of aztreonam, ciprofloxacin, norfloxacin, ofloxacin, HR 810 (a new cephalosporin), RU28965 (a new macrolide), and other agents against enteropathogens.

The in vitro activity of drugs currently used in the treatment of diarrhea against 595 enteropathogens from worldwide sources was compared with that of six newly developed antibiotics, ciprofloxacin; norfloxacin; ofloxacin; aztreonam; HR810, an expanded-spectrum cephalosporin; and RU28965, a new macrolide. In contrast with ampicillin and chloramphenicol, trimethoprim-sulfamethoxazole showed an excellent activity against all of the enteropathogens tested, except Campylobacter species. Ciprofloxacin had the highest activity, with an overall 90% MIC of less than or equal to 0.097 micrograms/ml, except for Campylobacter species (0.39 micrograms/ml). Unlike other cephalosporins, HR810 showed a satisfactory activity against Campylobacter species (90% MIC of 3.12 micrograms/ml). RU28965 was three times less active than erythromycin against Campylobacter species.

Anti-Bacterial Agents↗

PubMed1985

In vitro activities of Ro 17-2301 and aztreonam compared with those of other new beta-lactam antibiotics against clinical isolates of Pseudomonas aeruginosa.

The in vitro activities of Ro 17-2301 and aztreonam against 191 Pseudomonas aeruginosa isolates were compared with those of five other beta-lactam antibiotics. Both compounds showed activities comparable to that of ceftazidime and were bactericidal. They were as effective against gentamicin-or carbenicillin-resistant isolates as against susceptible ones.

Anti-Bacterial Agents↗

PubMed1986

Aztreonam penetration into synovial fluid and bone.

Eighteen patients with uncomplicated degenerative joint disease requiring joint replacement (hip or knee) were given a single 2-g intravenous dose of aztreonam over a 5-min period preoperatively. The mean concentration in synovial fluid of 83.0 +/- 9.2 micrograms/ml averaged 0.99 times the concomitant levels in serum. The mean concentration in cancellous bone of 16.0 +/- 4.3 micrograms/g averaged 0.20 times the concomitant levels in serum.

Adult↗

PubMed1986

Aztreonam concentration in abdominal tissues and bile.

Abdominal tissue, serum, and bile samples were obtained from 37 patients given a single, 2-g intravenous infusion of aztreonam immediately prior to an elective abdominal operation. Samples were obtained at 0 to 6 h after dosing. Mean concentrations in tissues and fluids and specimen/serum rations are reported. Levels in tissue and bile exceeded the reported MICs for 90% of most members of the family Enterobacteriaceae for up to 6 h.

Abdomen↗