Tartrazine-containing drugs

Tobramycin, an aminoglycoside antibiotic, was used to treat 52 infections due to gram-negative organisms in 51 patients. Complicated urinary tract infections, bacteremia and pyelonephritis accounted for 80% of the infections. The rate of immediate satisfactory response was 79%. During therapy with tobramycin, resistant organisms emerged in four patients--two Pseudomonas aeruginosa and two Escherichia coli strains. There were four superinfections with tobramycin-resistant Providencia sp. In four seriously ill patients the serum creatinine concentration increased 1 mg/dL or more; in three the increase was transient. No auditory toxicity was noted in the 19 patients in whom serial audiograms were made. In vitro testing of isolates from these patients showed that tobramycin and gentamicin had equal activity against Enterobacteriaceae. Tobramycin was two to four times more active against susceptible P. aeruginosa.     

Comparison of silver sulfadiazine and gentamicin for topical prophylaxis against burn wound sepsis.

Daily prophylactic application of either 1.0% silver sulfadiazine cream or 0.1% gentamicin cream was compared for effectiveness in preventing bacterial colonization of burn wounds and sepsis. Pseudomonas aeruginosa colonized the wounds of 37% of the 38 patients treated with silver sulfadiazine and 30% of the 33 patients treated with gentamicin; gentamicin-resistant P. aeruginosa colonized the wounds of 21% of the patients treated with gentamicin. Staphylococcus aureus colonization occurred in 55% of the patients treated with silver sulfadiazine, whereas colonization with Candida species occurred in 58% of the patients treated with gentamicin. Although gentamicin-resistant organisms caused no deaths their repeated appearance resulted in discontinuation of prophylaxiz with gentamicin cream. The next year P. aeruginosa strains resistant to gentamicin were isolated from burn wounds of only two patients who had not previously received parenteral therapy with gentamicin or tobramycin. Gentamicin cream should be reserved for treating patients with wounds infected by gentamicin-sensitive P. aeruginosa and those allergic to sulfa drugs. For most patients with burn wounds silver sulfadiazine is safe and effective as an antibacterial agent for topical prophylaxis.     

Comparative activity of tobramycin and gentamicin against Pseudomonas,Proteus and Providencia species.

Tobramycin is a new antibiotic resembling gentamicin. We measured the minimal inhibitory concentrations of these two antibiotics against five bacterial species that cause hospital-acquired infections and are resistant to many presently available antibiotics. The organisms tested were 500 strains of Pseudomones aeruginosa, 100 strains of each of Proteus rettgeri and Pr. morganii, 50 strains of Pr. vulgaris and 250 strains of Providencia stuartii. Tobramycin was 2 to 4 times more active than gentamicin against Ps. aeruginosa; all except 6 of 70 strains resistant to 4 mug/ml of gentamicin were sensitive to 4 mug/ml of tobramycin. The two antibiotics showed a similar degree of activity against the other four species. Tobramycin promises to be of particular value in the treatment of Pseudomonas infections.     

Antibiotic sensitivity of the main opportunistic pathogenic aerobic bacteria

Antibiotic sensitivity of 1421 strains of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Proteus mirabilis, Proteus vulgaris, Pseudomonas aeruginosa and Klebsiella spp. was studied. Gentamicin, levomycetin (chloramphenicol) and ristomycin proved to be the antibiotics of choice in treatment of purulent inflammatory diseases caused by S. epidermidis and S. aureus. For antibiotic therapy of infections caused by gram-negative organisms gentamicin and polymixin might be recommended.     

Semisynthetic Penicillin 6-[d(—)-α-Carboxy-3-Thienylacetamido] Penicillanic Acid Active Against Pseudomonas In Vitro

The activity of 6-[d(-)-alpha-carboxy-3-thienylacetamido] penicillanic acid, BRL2288, was determined against Pseudomonas aeruginosa and various gram-negative bacilli. The majority of Pseudomonas strains (89%) were inhibited by 100 mug of the antibiotic per ml. BRL2288 is twofold more active than carbenicillin against Pseudomonas at 100 mug/ml or less. Among Enterobacteriaceae tested, 87% Enterobacter and 87% of Proteus mirabilis strains were inhibited by 25 mug/ml or less. Indole-positive Proteus were inhibited by 10 mug/ml or less. Fifty-five per cent of ampicillin-resistant Escherichia coli were inhibited by 100 mug/ml. Klebsiella were uniformly resistant. BRL2288 is not hydrolyzed by most resistant Pseudomonas, but it is destroyed by the beta-lactamases of E. coli and P. mirabilis. The antibiotic shows synergy with gentamicin but not with penicillinase-resistant penicillins such as cloxacillin. Activity of BRL2288 against gram-positive organisms is two- to eightfold less than that of ampicillin or benzylpenicillin G.     

Antimicrobial activity of 2,5-dihydroxy-3-methyl-1,4-benzoquinone from Embelia schimperi

Chromatographic separation of an ethyl acetate extract from Embelia schimperi led to the isolation of a new compound identified as 2,5-dihydroxy-3-methyl-1,4-benzoquinone (1) on the basis of spectroscopic and physical data. The plant's crude extract and pure compound 1 were assayed for in vitro antimicrobial activity against clinical strains of Salmonella spp., Proteus spp., Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Cryptococcus neoformans, Shigella dysentriae and Staphylococcus aureus. Disc diffusion method was used and zones of inhibition, after respective incubation periods, were used to quantify antimicrobial activity. Standard antibiotics namely: augmentin, cotrimoxazole, gentamycin, tetracycline and lyncomycin were used as controls. The crude extract was inactive while the pure compound 1 showed significant activities against Salmonella spp., Proteus spp., Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Cryptococcus neoformans, Shigella dysentriae and Staphylococcus aureus with zones of inhibition ranging from 10-20 mm. The most sensitive microorganism was P aeruginosa while C. neoformans was insensitive to both the crude extract and compound 1.     

Tobramycin (Nebramycin Factor 6): In Vitro Activity Against Pseudomonas aeruginosa

Tobramycin (factor 6 of the nebramycin complex) is a new aminoglycoside antibiotic isolated from Streptomyces tenebrarius which is active against S. aureus, Enterobacteriaceae, and Pseudomonas aeruginosa. Susceptibility to tobramycin of 96 strains of P. aeruginosa, including 45 recent isolates from blood, was studied by using agar and broth dilution methods. The minimum inhibitory concentration (MIC) for 83 of 96 strains was 3.12 mug/ml or lower in Mueller Hinton agar; MIC values were two to eight times lower in Mueller Hinton broth tests. Agar dilution MIC values were generally lower than those obtained in parallel tests with gentamicin. Killing curves obtained from serial sampling of broth cultures showed a 100- to 10,000-fold decline in viability of log-phase organisms within 30 min of exposure to the drug. Two-dimensional agar dilution tests with carbenicillin and tobramycin with 79 strains showed additive or synergistic effects; no antagonism was documented. Seventy-eight of 79 strains were inhibited by a combination of 50 mug of carbenicillin per ml and 1.56 mug of tobramycin per ml, blood levels which seem attainable in man. Tobramycin appears to be a potent, rapidly bactericidal antibiotic against P. aeruginosa and merits clinical evaluation.     

In vitro antibacterial activity of a new 1-oxa cephalosporin compound

The in vitro activity of a unique new 1-oxa cephalosporin beta-lactam antibiotic (LY 127935) was tested against clinical isolates of gram-positive and gram-negative bacteria and compared with the activities of cefoxitin, cefamandole, cephalothin, clindamycin, amikacin, tobramycin, gentamicin, ticarcillin, and carbenicillin. The new compound was observed to have a broad spectrum of antibacterial activity which far exceeded the activity of older cephalosporins against aerobic gram-negative enteric bacilli. This new compound was the most active drug tested against Klebsiella, Serratia, Enterobacter, indole-negative and positive Proteus species, and E. coli. Against clinical isolates of Pseudomonas species the new compound was more active than cefoxitin, cefamandole, cephalothin, and clindamycin, comparable to ticarcillin and carbenicillin, and less active than gentamicin, tobramycin, and amikacin. Yet, most of the Pseudomonas isolates were inhibited by 16 micrograms/ml of the new compound. Against both beta-lactamase and non beta-lactamase producing Staphylococcus aureus isolates, the new 1-oxa compound was less active than the older cephalosporins of which cephalothin and cefamandole were the most effective. The 1-oxa compound had no appreciable activity against isolates of Streptococcus faecalis. Activity of all four cephalosporins studied was decreased in the presence of an increased inoculum of Enterobacteriaceae in trypticase soy and Mueller-Hinton broth. The activity of the new compound against Pseudomonas species was also decreased by an increased inoculum in Mueller-Hinton but not in trypticase soy broth. These results indicate that this new 1-oxa compound may have great promise as a broad spectrum antibiotic and may warrant controlled clinical trials in man.     

Triphenyltin salicylate-antimicrobial effect and resistance--the pyrophosphatase connection

The effect of Triphenyltin salicylate (TPS) was tested against six bacteria, Escherichia coli, Staphylococcus aureus, Shigella flexneri, Pseudomonas aeruginosa, Klebsiella pneumoniae and Salmonella typhi and five fungi, Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, Rhodotorula spp. and Saccharomyces spp. Sensitivity tests were determined with 5-500 microg/ml of TPS. All organisms were sensitive to the compound except Klebsiella pneumoniae, Pseudomonas aeruginosa, Rhodotorula spp. and Saccharomyces spp. The minimum dose of TPS that can kill 50% of the susceptible microorganisms is in the range 5-50 microg/ml. Membrane bound pyrophosphatase(s) from the organisms was non-competitively inhibited by 5 microM TPS with Ki values of 7.6, 18, 8.8 and 6.9 microM for Escherichia coli, Shigella flexneri, Aspergillus niger, and Aspergillus fumigatus, respectively. The physiological index of efficiency of the enzyme (Vmax/KM) for TPS susceptible organisms was reduced by 17-68% in the presence of 5-10 microM of the compound. In contrast the index for the non-susceptible organisms was unaffected. The mode of action of TPS is discussed.     

Sensitivity to antibiotics of bacterial strains isolated from clinical specimens during the years 1985-1986

Sensitivity of 312 strains of staphylococci, 386 strains of streptococci and 1193 strains of aerobic gram-negative bacilli to the selected antibiotics was tested. These strains were isolated from the clinical material at the Clinical Hospital No. 1 in Warsaw within 1985-1986. Staphylococci were sensitive to pristinamycin, cefazolin, fusidic acid, oxacillin, and clindamycin. In 1986, a decrease in the number of strains sensitive to these antibiotics, except cefazolin, was seen. In case of streptococci the most active proved chloramphenicol and gentamicin but a significant decrease in the percentage of sensitive strains was also noted in 1986. The highest number of gram-negative bacilli was sensitive to amikacin, colistin, nalidixic acid, pipemidic acid, and gentamicin. In 1986, a decrease in the percentage of sensitive strains was noted. Amikacin and colistin were the most active against Pseudomonas spp. while amikacin and nalidixic and pipemidic acids--against Proteus spp. Comparison of the results with those obtained in 1981-1984 has shown that the sensitivity of staphylococci changed the most significantly and this change was unfavourable. Gentamicin and amikacin remained the most active against gram-negative bacilli while amikacin and colimycin against Pseudomonas spp. In case of anaerobes the majority of strains was sensitive to chloramphenicol, tetracycline and clindamycin. Metronidazole was active against high percentage of Clostridium spp. and all gram-negative bacilli while the percentage of gram-positive bacilli and cocci was sensitive to metronidazole.     

Gentamicin- and silver-resistant pseudomonas in a burns unit.

In 1977-8 gentamicin-resistant strains of Pseudomonas aeruginosa became very common in a burns unit, over 90% being resistant at the peak of the outbreak. Some strains were also resistant to silver nitrate, though silver resistance was not found in any other strains of Ps aeruginosa isolated. Unlike the gentamicin resistance, the silver resistance was unstable, and strains became sensitive on repeated subculture. All the gentamicin-resistant strains of Ps aeruginosa were of the same serotype (O:11, H:2,5). Though gentamicin resistance could be transferred in vitro from resistant strains of Ps aeruginosa to one sensitive strain of Ps aeruginosa, there was no evidence of in-vivo transfer of gentamicin resistance between strains of pseudomonas in the patients'' burns, nor was there evidence of transfer of gentamicin resistance between Ps aeruginosa and enterobacteria. Carbenicillin-resistant and gentamicin-resistant Ps aeruginosa were sometimes found in the same burns, but no gentamicin-carbenicillin (doubly) resistant strains were found among the 986 strains tested during the outbreak. The outbreak of gentamicin-resistant Ps aeruginosa from burns was not reduced by stopping treatment with gentamicin and its analogues but only by segregating all patients with Ps aeruginosa in one of the two wards of the unit and admitting new patients only to the other ward.     

Aminoglycoside resistance rates, phenotypes, and mechanisms of Gram-negative bacteria from infected patients in upper Egypt

With the re-emergence of older antibiotics as valuable choices for treatment of serious infections, we studied the aminoglycoside resistance of Gram-negative bacteria isolated from patients with ear, urinary tract, skin, and gastrointestinal tract infections at Minia university hospital in Egypt. Escherichia coli (mainly from urinary tract and gastrointestinal tract infections) was the most prevalent isolate (28.57%), followed by Pseudomonas aeruginosa (25.7%) (mainly from ear discharge and skin infections). Isolates exhibited maximal resistance against streptomycin (83.4%), and minimal resistance against amikacin (17.7%) and intermediate degrees of resistance against neomycin, kanamycin, gentamicin, and tobramycin. Resistance to older aminoglycosides was higher than newer aminoglycosides. The most common aminoglycoside resistance phenotype was that of streptomycin resistance, present as a single phenotype or in combination, followed by kanamycin-neomycin as determined by interpretative reading. The resistant Pseudomonas aeruginosa strains were capable of producing aminoglycoside-modifying enzymes and using efflux as mechanisms of resistance. Using checkerboard titration method, the most frequently-observed outcome in combinations of aminoglycosides with β-lactams or quinolones was synergism. The most effective combination was amikacin with ciprofloxacin (100% Synergism), whereas the least effective combination was gentamicin with amoxicillin (53.3% Synergistic, 26.7% additive, and 20% indifferent FIC indices). Whereas the studied combinations were additive and indifferent against few of the tested strains, antagonism was never observed. The high resistance rates to aminoglycosides exhibited by Gram-negative bacteria in this study could be attributed to the selective pressure of aminoglycoside usage which could be controlled by successful implementation of infection control measures.     

Effectiveness of gentamicin sulfate in suppurative-inflammatory processes of varying localization]

Antibiotic sensitivity of 486 strains of grampositive and gramnegative organisms isolated from patients with purulent infections was studied in vitro. Gentamicin was shown to be highly active as compared to kanamycin and other antibiotics against the main causative agents of purulent inflammatory infections including multiresistant E. coli, Proteus, Ps. aeruginosa, Staphylococcus. High efficiency of gentamicin in therapy of peritonitis, septic conditions, purulent postoperative wounds, infections of the urinary tract, pneumonia, etc. (197 patients) was shown. Positive results were obtained in 87.4 per cent of the cases. Side effects, such as albuminuria, hyperthermic reaction, rash, pruritis were registered in 3 per cent of the patients.     

Antibiotic sensitivity pattern; experience at University Hospital, Riyadh, Saudi Arabia

Results of sensitivity testing were discussed based on examination of 5192 isolates of the various bacteria isolated from clinical specimens from King Khalid University Hospital in Riyadh, Saudi Arabia. Streptococcus pyogenes and Streptococcus pneumoniae were sensitive to penicillin and erythromycin. The sensitivity pattern of Staphylococcus aureus was also predictable as they were fairly sensitive to both methicillin (98%) and erythromycin (96%). Neisseria gonorrhoeae (27%) showed a high level of resistance to penicillin. The resistance of Haemophilus influenzae to ampicillin and chloramphenicol was low. Brucella species was sensitive to tetracycline and rifampicin; resistance to streptomycin and cotrimoxazole was minimal being 1% and 6% respectively. The resistance of E. coli, Klebsiella species and Proteus species to second and third generation cephalosporins and amikacin was fairly low ranging from 1.3% to 3%. The gentamicin resistance for these organisms was also within the acceptable range (3%-10%). Gentamicin and amikacin resistance for Pseudomonas aeruginosa was low (2-8%). Salmonella typhi was sensitive to ampicillin, cotrimoxazole, and chloramphenicol. Salmonella enteritidis, Shigella species, and enteropathogenic E. coli were highly resistant to various antibiotics. Campylobacter jejuni was sensitive to gentamicin but 6% of isolates were resistant to erythromycin. Ninety six percent of Gram-negative rods except P. aeruginosa isolated from urine of patients having urinary tract infections were sensitive to amoxycillin-clavulanic acid. In addition, P. aeruginosa showed fairly low resistance to norfloxacin which is given orally to treat cystitis caused by this organism.     

Plasmid-mediated high-level gentamicin resistance among enteric bacteria isolated from pet turtles in Louisiana

The sale of small turtles is banned by the Food and Drug Administration from the U.S. market due to concerns about their excretion of Salmonella spp. To produce a safe pet for the export market, the Louisiana pet turtle industry uses gentamicin sulfate baths (1,000 microg/ml) to eradicate Salmonella spp. from turtle eggs. In 1999, we analyzed bacterial samples recovered from turtle farms and found that strains of Salmonella enterica subsp. arizonae and other bacteria, such as Enterobacter cloacae, Citrobacter freundii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia, were resistant to high concentrations of gentamicin (>2,000 microg/ml) and to other aminoglycosides. The goal of this study was to identify the gene(s) which contributes to the high-level gentamicin resistance phenotype observed in bacteria from environmental samples with turtle farming activity, particularly the salmonellae, and to estimate the incidence of such genes in these bacteria. R plasmids from gentamicin-resistant strains were transferred by conjugation and transformation to naive Escherichia coli cells. Cloning and sequencing of the gentamicin resistance determinants on these plasmids revealed the presence of the aminoglycoside acetyltransferase genes aac(3)-IIa and aac(3)-VIa; the latter was present as a gene cassette of a class 1 integron. Multiplex PCR assays showed that every gentamicin-resistant isolate carried one of these acetyltransferase genes. Pulsed-field gel electrophoresis and restriction enzyme digestion analysis of R plasmids carrying these genes revealed different restriction profiles and sizes, indicating a dissemination of the gentamicin resistance genes through mobile molecular elements. The data presented highlight the need to develop an alternate method for the eradication of Salmonella spp. from turtle eggs.     

Antibacterial spectrum of lactoferricin B, a potent bactericidal peptide derived from the N-terminal region of bovine lactoferrin.

A physiologically diverse range of Gram-positive and Gram-negative bacteria was found to be susceptible to inhibition and inactivation by lactoferricin B, a peptide produced by gastric pepsin digestion of bovine lactoferrin. The list of susceptible organisms includes Escherichia coli, Salmonella enteritidis, Klebsiella pneumoniae, Proteus vulgaris, Yersinia enterocolitica, Pseudomonas aeruginosa, Campylobacter jejuni, Staphylococcus aureus, Streptococcus mutans, Corynebacterium diphtheriae, Listeria monocytogenes and Clostridium perfringens. Concentrations of lactoferricin B required to cause complete inhibition of growth varied within the range of 0.3 to 150 micrograms/ml, depending on the strain and the culture medium used. The peptide showed activity against E. coli O111 over the range of pH 5.5 to 7.5 and was most effective under slightly alkaline conditions. Its antibacterial effectiveness was reduced in the presence of Na+, K+, Mg2+ or Ca2+ ions, or in the presence of various buffer salts. Lactoferricin B was lethal, causing a rapid loss of colony-forming capability in most of the species tested. Pseudomonas fluorescens, Enterococcus faecalis and Bifidobacterium bifidum strains were highly resistant to this peptide.     

1-N-(S-3-amino-2-hydroxypropionyl) gentamicin B (Sch 21420): A collaborative in vitro susceptibility comparison with amikacin and gentamicin against 12,984 clinical bacterial isolates

Schering Compound Sch 21420 is an aminoglycoside with antibacterial activity similar to amikacin but with a potential for renal toxicity lower than that of gentamicin. The in vitro activity of Sch 21420, amikacin, and gentamicin was compared with 12,984 bacterial isolates from six clinical laboratories. Agar dilution and broth microdilution techniques were both used with comparable results. Against most of the Enterobacteriaceae, Sch 21420 had equal or only slightly greater activity than amikacin.Proteus species were generally more susceptible to amikacin and gentamicin. Gentamicin was more active against most isolates included in this study.Pseudomonas aeruginosa recovered in the different institutions showed marked variations in susceptibility to gentamicin; amikacin and Sch 21420 were effective against most gentamicin-resistant strains that produce inactivating enzymes: but all three drugs were ineffective against permeability mutants. If diminished renal- and ototoxicity are confirmed, Sch 21420 promises to be a welcome addition to the antibiotic armamentarium.     

Evaluation of the In Vitro Activity of Tobramycin as Compared with That of Gentamicin Sulfate

The in vitro activity of tobramycin was quantitatively compared with that of gentamicin sulfate against 195 bacterial isolates from clinical material. Tobramycin was found to be twice as active as gentamicin against isolates of Pseudomonas aeruginosa. Conversely, gentamicin proved fourfold more active than tobramycin against isolates of Serratia marcescens. Both drugs were of comparable activity against isolates of Staphylococcus aureus and the majority of the enterobacterial isolates other than S. marcescens. On the basis of the obtained data, the following criteria are proposed for the interpretation of diffusion susceptibility tests with 10-μg discs of gentamicin and tobramycin. Enterobacteriaceae and isolates of S. aureus are designated as susceptible to gentamicin and tobramycin if the zones of inhibition measure 15 mm or more in diameter; zones of 14 mm or less are indicative of resistance. Pseudomonadaceae are interpreted as sensitive to tobramycin and gentamicin if the inhibition zones measure at least 15 and 12 mm in diameter, respectively.     

Analysis of the etiological structure and dynamics of antibiotic resistance in the causative agents of suppurative inflammatory diseases in the patients at a large general hospital

The structure of the causative agents isolated from patients with pyoinflammatory infections in 1980-1983 was analysed. It was shown that the surgical and urological infections were mainly caused by gram-negative bacteria. The other pyoinflammatory infections were mainly due to gram-positive cocci. A relatively high frequency of the strains of gram-negative bacteria, especially among Pseudomonas spp. and Enterobacter spp., resistant to aminoglycoside antibiotics, such as gentamicin, sisomycin and tobramycin with preserved sensitivity to amikacin and netilmicin in the majority of the strains was shown. Among the beta-lactam antibiotics cephotaxim and cephalotin were most active against gram-negative bacteria and staphylococci, respectively. The majority of the antibiotic resistant strains of gram-negative bacteria had analogous structures and levels of resistance to 7-12 antibiotics which might indicate the occurrence of 1-2 resistance plasmids among the clinical strains.     

In Vitro Studies of Semisynthetic α- (Substituted-Ureido) Penicillins

The activity of three alpha-(substituted-ureido) penicillins was evaluated in vitro against 599 clinical isolates of gram-negative bacilli, by use of the broth-dilution technique. At a concentration of 12.5 mug or less/ml, BL-P1597 inhibited 90% of isolates of Pseudomonas sp., 56% of Enterobacter sp., 67% of indole-positive Proteus spp., 72% of Escherichia coli, and 85% of Proteus mirabilis. BL-P1654 had similar activity, whereas BL-P1532 was much less active. At a concentration of 25 mug or less/ml, BL-P1597 also inhibited nearly 60% of isolates of Klebsiella sp. and nearly 40% of Serratia sp. BL-P1597 and BL-P1654 were as active as ampicillin and carbenicillin against E. coli and P. mirabilis. They were less active than carbenicillin against indole-positive Proteus spp. Both drugs were substantially more active than carbenicillin against Pseudomonas sp. A strain of Pseudomonas sp. which developed resistance to carbenicillin also developed resistance to the alpha-(substituted-ureido) penicillins simultaneously.