Bactericidal activity of oral beta-lactam antibiotics in plasma and urine versus isogenic Escherichia coli strains producing broad- and extended-spectrum beta-lactamases

Int J Antimicrob Agents. 2005 Jun;25(6):479-87. doi: 10.1016/j.ijantimicag.2005.02.012.

Abstract

Bacteria harbouring extended-spectrum beta-lactamases (ESBLs), derived by mutation from TEM-1, TEM-2 or SHV-1 beta-lactamases, have been described world-wide. The in vitro activities of these enzymes against beta-lactam antibiotics, including oral cephalosporins, are well recognised. The aim of this investigation was to assess the bactericidal activity of oral beta-lactam antibiotics available in Croatia (amoxicillin/clavulanate, cephalexin, cefuroxime, cefadroxil and ceftibuten), in biological fluids against isogenic Escherichia coli strains producing broad-spectrum (TEM-1, TEM-2 and SHV-1) and extended-spectrum beta-lactamases (SHV-2, SHV-3, SHV-4, SHV-5, SHV-12). Bactericidal activity of oral beta-lactams in plasma and urine was tested in time-kill experiments and by determining bactericidal titres at different time intervals post-dose. The killing rate of antibiotics in urine was slower than in plasma, but faster than in Mueller-Hinton broth. High bactericidal titres in urine were only maintained throughout the whole dosing interval by ceftibuten against strains producing broad-, SHV-2 and SHV-3 beta-lactamases. The older generation cephalosporins can be considered for the therapy of urinary tract infections caused by E. coli harbouring TEM-1, TEM-2 and SHV-1 beta-lactamases but a shorter dosing interval is needed. Ceftibuten can be recommended with caution in ESBL producing E. coli except those producing SHV-4, SHV-5 and SHV-12 that confer resistance to it. If these enzymes are produced, fluoroquinolones or carbapenems could be considered.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / blood
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / urine
  • Blood / microbiology
  • Colony Count, Microbial
  • Escherichia coli / drug effects*
  • Escherichia coli / enzymology*
  • Escherichia coli / growth & development
  • Female
  • Humans
  • Kinetics
  • Microbial Sensitivity Tests
  • Middle Aged
  • Serum Bactericidal Test
  • Urine / microbiology
  • beta-Lactamases / biosynthesis*
  • beta-Lactams / blood
  • beta-Lactams / pharmacology*
  • beta-Lactams / urine

Substances

  • Anti-Bacterial Agents
  • beta-Lactams
  • beta-Lactamases