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Mecillinam (Amdinocillin) and Pivmecillinam
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
Mecillinam has been fairly extensively used for the treatment of UTIs. Escherichia coli infections respond very well, and those caused by other Enterobacteriaceae, such as Klebsiella, Proteus, or Enterobacter spp., also usually respond satisfactorily (Bentzen et al., 1975; Verrier Jones and Asscher, 1975). The efficacy of mecillinam in both uncomplicated and complicated infections is similar to that of ampicillin or cotrimoxazole (Verrier Jones and Asscher, 1975; Damsgaard et al., 1979; Cox, 1983). Bacteriologic success rate in patients with bacteriuria in pregnancy was 87% in one study, and the drug appeared safe because there were no drug-related fetal abnormalities (Sanderson and Menday, 1984). In a randomized controlled trial pivmecillinam was compared to sulfamethizole for the treatment of uncomplicated acute cystitis, with each given for 3 days. Patients who were treated with pivmecillinam had 68.8% bacteriological cure rates compared to 77.9% in sulfamethizole group, while clinical cure rates at followup were much higher: 95.4% in pivmecillinam compared to 92.6% in sulfamethizole group (Bjerrum et al., 2009). Pivmecillinam was compared with pivampicillin in gynecologic patients with bacteriuria at the time of removal of an indwelling catheter 3–4 days after surgery. After treatment, all 17 patients in the pivmecillinam group, but only 6 of 14 patients in the pivampicillin group were cured (Aaraas et al., 1977). Clinical and bacteriologic efficacy of pivmecillinam against lower urinary tract infections caused by ESBL-producing E. coli and K. pneumoniae was evaluated in small number of patients (n = 8); all patients had good clinical response, but low bacteriologic cure rates (25%) (Titelman et al., 2012). Treatment failure rates of 44% were observed among patients with community-acquired UTIs caused by ESBL-producing E. coli and 14% in patients with non-ESBL-producing strains who were treated with pivmecillinam (SØraas et al., 2014). An increase in MICs to mecillinam was independently associated with treatment failure; thus the authors suggested the pivmecillinam dose used in most patients of 200 mg three times a day might be too low. Jansaker et al. (2014) observed higher clinical (84%) and microbiological (79%) cure rates with pivmecillinam for the treatment of ESBL-producing E. coli and K. pneumoniae UTIs. In a majority (78%) of patients in this study, pivmecillinam was dosed at 400 mg three times a day.
Infections after transrectal ultrasonic guided prostate biopsies – a retrospective study
Published in Scandinavian Journal of Urology, 2019
Lilian Danielsen, Gulia Faizi, Sabine Snitgaard, Lars Lund, Anders Frey
We got extended microbiology results for these 21 patients and they showed that 19 patients were infected with E. coli (51.5%) and 11 of these patients were CFLX-resistant (29.7%). All 19 patients with E. coli positive cultures were mecillinam-sensitive. Two patients were infected with Bacteroides thetaiotaomicron (blood) or Klebsiealla pneumoniae (urine). One patient with E. coli found in the urine also tested positive for Staphylococcus epidermidis in the blood and another with for Candida parapsilosis. However, in both cases it is most likely the E. coli caused the hospitalization (Tables 2 and 3).
Antibiotic resistance among major pathogens compared to hospital treatment guidelines and antibiotic use in Nordic hospitals 2010–2018
Published in Infectious Diseases, 2021
Vidar Möller, Åse Östholm-Balkhed, Dag Berild, Mats Fredriksson, Magnus Gottfredsson, Martin Holmbom, Asko Järvinen, Mar Kristjansson, Ulf Rydell, Ute Wolff Sönksen, Hans Joern Kolmos, Håkan Hanberger
Sweden recommended monotherapy with ceftibuten, trimethoprim-sulfamethoxazole or ciprofloxacin, or as intravenous alternatives cefotaxime, piperacillin-tazobactam, or an aminoglycoside. Finland recommended monotherapy with cefuroxime, oral ciprofloxacin or piperacillin-tazobactam for complicated cases. Denmark, Norway and Iceland recommended an aminoglycoside combined with ampicillin. Danish guidelines also included a combination of mecillinam and an aminoglycoside. Norwegian guidelines had trimethoprim/sulfamethoxazole as an option.
Predictors of Symptom Duration and Bacteriuria in Uncomplicated Urinary Tract Infection
Published in Scandinavian Journal of Primary Health Care, 2018
Marianne Bollestad, Ingvild Vik, Nils Grude, Morten Lindbæk
The second most frequently isolated microbe was S. saprophyticus, which is considered to be intrinsically resistant to mecillinam treatment. However, a clinical effect has been shown for lower UTI in women where S. Saprophyticus as the bacterial agent. It is suspected that the observed effect of mecillinam treatment on microbes intrinsically resistant to treatment is related to the high concentration of mecillinam in urine and relatively low minimal inhibitory concentration of uropathogens [25].