China
Africa
Explore chapters and articles related to this topic
Beta-Lactamase Inhibitors
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Pascalis Vergidis, Matthew E. Falagas
Beta-lactamase inhibitors are used in combination with beta-lactam antibiotics to prevent their destruction by various beta-lactamases. Clavulanic acid is a potent inhibitor of many beta-lactamases (Reading et al., 1983). The drug binds initially beta-lactamases and functions as a competitive inhibitor; this is followed by acylation of these enzymes through the beta-lactam carbonyl part of the clavulanic acid molecule. This mechanism is similar to the reaction between a beta-lactamase and a labile beta-lactam antibiotic, such as penicillin G. In the latter case, the acyl enzyme undergoes rapid hydrolysis to release active enzyme, again together with penicillin-degradation products. By contrast, the acyl enzyme formed by reaction with clavulanic acid is hydrolyzed only very slowly, and therefore the enzyme is transiently inhibited. Beta-lactamases differ in their susceptibility to inhibition by clavulanic acid. Those that are readily inhibited include staphylococcal and E. faecalis beta-lactamases and the plasmid-mediated enzymes (e.g. TEM-1), which are widespread among the Enterobacteriaceae, P. aeruginosa, H. influenzae, N. gonorrhoeae, and M. catarrhalis. Clavulanic acid is a more potent inhibitor compared to sulbactam for both conventional- and extended-spectrum beta-lactamases (Payne et al., 1994). Overall, clavulanic acid and tazobactam had similar potency against both sets of enzymes.
Complications of Antibiotic Therapy
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Mohamed Fahim, Chad M. Thorson, Nicholas Namias
Beta-lactamase inhibitors used in combination drugs have been remarkably safe. Clavulanate has been known to cause dose-dependent diarrhea, but neither sulbactam nor tazobactam has caused any significant adverse effects.24
Problematic Beta-Lactamases: An Update
Published in Robert C. Owens, Lautenbach Ebbing, Antimicrobial Resistance, 2007
Marion S. Helfand, Louis B. Rice
Class C beta-lactamases remain an important source of antimicrobial resistance in specific pathogens like C. freundii, E. aerogenes and E. cloacae, Morganella morganii, Pseudomonas aeruginosa (PSDA), and Serratia marcescens. In addition, plasmid-mediated AmpC enzymes have found their way into organisms such as Klebsiella spp., E. coli, and Salmonella spp., and may be mistakenly identified as ESBLs (20). Class C beta-lactamases are cephalosporinases by nature, due to their naturally larger active site that can more easily accommodate the bulky R1 sidechains of third-generation cephalosporins. The Class A beta-lactamase inhibitors, clavulanic acid, tazobactam, and sulbactam, are not clinically effective against the bacteria that produce Class C beta-lactamases. In general, beta-lactams such as carbapenems, monobactams such as aztreonam, and the advanced generation cephalosporin, cefepime, can be used to treat patients with Class C producers. Sometimes, bacteria will restrict entry of antibiotics through the loss of OMPs; coupled with Class C beta-lactamase production, this can lead to carbapenem and cefepime resistance.
Lemierre’s syndrome with muscle necrosis and chronic osteomyelitis
Published in Baylor University Medical Center Proceedings, 2021
Azka Latif, Muhammad Junaid Ahsan, Amman Yousaf, Asim Tameezuddin, Akshat Sood, Joseph Thirumalareddy
The management of LS warrants an integrated approach from different specialties. Antibiotics are the mainstay of treatment, but there is a lack of consensus on specific agents. Ideally, antibiotic therapy should include at least one beta-lactamase inhibitor. As a combination drug, metronidazole has shown promising results in LS, but our patient had progression of myositis even on metronidazole. Different antibiotics, including beta-lactam drugs and clindamycin, can be employed as single-agent regimens. We used a combination of piperacillin/tazobactam and daptomycin to counter the infection. As an antipseudomonal drug, piperacillin/tazobactam was used for Fusobacterium. Daptomycin was added against the gram-positive bacteria, as the patient had a positive nasal swab test. The duration of antibiotic therapy is prolonged—at least 3 to 6 weeks.11
Synthesis and evaluation of polymeric micelle containing piperacillin/tazobactam for enhanced antibacterial activity
Published in Drug Delivery, 2019
Milani Morteza, Salehi Roya, Hamishehkar Hamed, Zarebkohan Amir, Akbarzadeh Abolfazl
Antibiotic treatment of this pathogen is extremely difficult due to multiple resistance mechanisms, such as b-lactamases, efflux pumps, and the impermeability of the outer membrane (Bassetti et al., 2018). In fact, this leads to a serious limitation of the options for the treatment of P. aeruginosa infections. Nowadays several antibiotics are used to treat P. aeruginosa infections. Piperacillin is a potent, broad-spectrum ureidopenicillin that is used against gram-negative, gram-positive and anaerobic bacteria. When combined with beta-lactamase inhibitors such as tazobactam, it demonstrates a broader spectrum of activity against lactamase-producing bacteria. For its spectrum of activity, Piperacillin/tazobactam is a β-lactam/β-lactamase inhibitor combination widely employed in first-line therapy, particularly for nosocomial infections (Grant et al., 2002; Fonseca et al., 2004; Lodise et al., 2007). Based on some studies, treatment with subinhibitory concentrations of antibiotics may be effective on bacterial virulence factors, such as adherence, motility and biofilm formation (Wolter & McCormack, 1998; Wilson et al., 2002; Fonseca et al., 2004). The emergence of multidrug-resistant pathogens including cephalosporins and fluoroquinolones has led to the use of Piperacillin/Tazobactam. On the other hand, Piperacillin/Tazobactam is considered a safe antimicrobial agent and has fewer side effects than penicillin derivatives.
Lemierre’s syndrome in adulthood, a case report and systematic review
Published in Acta Clinica Belgica, 2021
Marco Moretti, Deborah De Geyter, Lode Goethal, Sabine D. Allard
Additionally, we systematically reviewed case reports of late-onset LS in adulthood published between 1 January 2013 and the 1 January 2019. Comorbidities such as diabetes mellitus and upper gastrointestinal malignancy, both known to be risk factors for thrombosis, might play a role in the development of LS in the studied population. Preferred antibiotics were beta-lactams with a beta-lactamase inhibitor or a combination of beta-lactams with metronidazole. The latter should not be used in monotherapy as its spectrum is limited to anaerobic bacteria and Streptococci are as well frequent pathogens in LS in adulthood. Early diagnosis and aggressive treatment are requisite to prevent morbidity and mortality, which are particularly elevated in this older population.