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Increasing the usefulness of antibiotics: Treatment of infections caused by gram‐negative bacilli
Author(s) -
Sabath Leon D.,
Gerstein Deborah A.,
Leaf Charles D.,
Finland Maxwell
Publication year - 1970
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt1970112161
Subject(s) - antibiotics , microbiology and biotechnology , bacilli , gentamicin , enterobacter cloacae , cloxacillin , ampicillin , gram negative bacteria , enterobacter , medicine , bacteria , biology , enterobacteriaceae , biochemistry , genetics , escherichia coli , gene
Resistance of gram‐negative bacteria to many antibiotics often necessitates the use of relatively toxic antibiotics to treat infections caused by organisms that are resistant to less toxic ones. However, some relatively nontoxic antibiotics that appear to be ineffective against many gram‐negative bacilli by conventional tests can, in some instances, be made much more active by appropriate adjunctive measures. The measures studied were: (1) the use of analogues to inhibit destruction of antibiotic by bacterial enzymes (more specifically penicillinases) and (2) adfustment of the pH of the medium to maximize antibiotic activity. Both were applied to patients with infections caused by gram‐negative bacilli. Ampicillin plus a ±‐Iactamase inhibitor, cloxacillin, were used to treat a patient with endocarditis due to Enterobacter cloacae. Gentamicin was found to be 100 or more times as active in vitro at pH 8.5 as at pH 5.0 against most strains of gram‐negative bacilli that were studied. The concomitant use of bicarbonate or acetazolamide to allcalinize the urine permitted the use of this antibiotic in a much reduced dose.