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Resistance of Acinetobacter spp. to Antimicrobials — Overview of Clinical Resistance Patterns and Therapeutic Problems
Published in E. Bergogne-Bénézin, M.L. Joly-Guillou, K.J. Towner, Acinetobacter, 2020
The role of sulbactam, acting as a ß-lactamase inhibitor in association with its intrinsic antibacterial activity, in combinations with fl- lactams and/or an aminoglycoside should be defined and may offer a new therapeutic approach to problem Acinetobacter infections. The place of fluoroquinolones is more questionable because of their non-synergic activity in combinations, but newer molecules such as sparfloxacin seem to be more active and may provide improved potency when combined, after careful in vitro susceptibility testing, with ticarcillin, ceftazidime, or imipenem. The surprising activity of rifampicin against Acinetobacter (MIC range of 2-4 mg/L), as described by Bergogne-Berezin et al. (1985), may also have a role, provided that rifampicin is included in a synergic combination in order to avoid or reduce the risk of spontaneous mutation to rifampicin resistance. Finally, prevention measures and antibiotic policies to control antibiotic use are also important measures for controlling Acinetobacter spread and contamination. In this respect, the possible role of selective digestive tract decontamination should also be defined (Joly-Guillou et al., 1994a; see also Chapter 4).
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
Sulbactam sodium is a semisynthetic beta-lactamase inhibitor obtained by oxidation of the thiazolidine sulfur of penicillanic acid (English et al., 1978). It exhibits good activity against the clinically important plasmid-mediated beta-lactamases most frequently responsible for transferred drug resistance. It is somewhat less potent than clavulanic acid in that respect. Unlike clavulanic acid, it is active against inducible chromosomally mediated enzymes that cause resistance to third-generation cephalosporins (Jacobs et al., 1986b; Klastersky and Van Der Auwera, 1989; Sawai and Yamaguchi, 1989). It is used in combination with ampicillin (see Chapter 15, Ampicillin–sulbactam).
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
Extensively-drug resistant Acinetobacter baumannii bacteremia in neonates: effective treatment with the combination of colistin and ampicillin/sulbactam
Published in Journal of Chemotherapy, 2020
Despoina Gkentzi, Asimina Tsintoni, Irini Christopoulou, Ilias Mamalis, Fotini Paliogianni, Stelios F. Assimakopoulos, Markos Marangos, Gabriel Dimitriou
Polymyxins exert their antimicrobial activity through a complex interaction with the fatty component of the lipopolysacharide of the outer membrane of the Gram Negative bacteria. A. baumannii has the ability to develop resistance rapidly mainly via changes to the lipopolysacharide. Studies have shown that a combination of antibiotics can reduce the potential of resistance development. The use of ampicillin/sulbactam appears to be a reasonable initial approach to treat these infections and to further prevent the development of resistance to colistin, which could be devastating for the individual patient as well as for the control of the outbreak in the NICU. The high dose of ampicillin/sulbactam exerts its effects via sulbactam against A. baumannii. Sulbactam is a β-lactamase inhibitor that is usually administrated as a combination with ampicillin has shown efficacy against MDR A. baumannii in both laboratory and clinical reports.11,14 It has been previously shown to exert synergistic action with colistin against carbapenem resistant A. baumannii.9,10
Successful treatment of multidrug-resistant Acinetobacter baumannii meningitis with ampicillin sulbactam in primary hospital
Published in British Journal of Neurosurgery, 2018
Leitao Sun, Xiaohong Wang, Zefu Li
Overall results of drug-resistant strains of bacteria confirmed sulbactam is an effective pharmaceutical in treating drug-resistant. Ampicillin sulbactam is a mixture by ampicillin sodium and sulbactam sodium in a ratio of 2: 1. Ampicillin/sulbactam was useful in the treatment of uncomplicated urinary tract infections.22 Sulbactam penetrates into the CSF of patients with bacterial meningitis in a pattern similar to that of ampicillin as high as 32% of serum concentrations.23,24 But there are few clinical data on the treatment of meningitis with ampicillin/sulbactam. Meanwhile, this drug is cheap and easy to get.
Pharmacokinetics-pharmacodynamics of β-lactamase inhibitors: are we missing the target?
Published in Expert Review of Anti-infective Therapy, 2019
Marguerite L Monogue, David P Nicolau
Sulbactam is an intravenous β-lactam BLI developed in combination with ampicillin or cefoperazone. Ampicillin-sulbactam (2:1 ratio) is currently the only available sulbactam combination in the United States. Sulbactam inhibits Ambler class A β-lactamases; however, it is less potent against SHV-1 and TEM-2 compared with clavulanate and tazobactam [39,40]. A unique characteristic of sulbactam is its intrinsic antibacterial activity against Acinetobacter spp. and Bacteroides spp. due sulbactam’s capability to bind to PBPs [41,42]. The MIC of ampicillin-sulbactam is currently reported by CLSI in a 2:1 ratio, similar to amoxicillin-clavulanate.