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Title: The antimicrobial susceptibility of pseudomonas pseudomallei. Emergence of resistance in vitro and during treatment
Authors: D. A.B. Dance
V. Wuthiekanun
W. Chaowagul
N. J. White
Mahidol University
John Radcliffe Hospital
Sappasitthiprasong Hospital
Keywords: Medicine;Pharmacology, Toxicology and Pharmaceutics
Issue Date: 1-Sep-1989
Citation: Journal of Antimicrobial Chemotherapy. Vol.24, No.3 (1989), 295-309
Abstract: We have measured the in-vitro activity of 27 antimicrobials against 211 clinical and ten reference strains of Pseudomonas pseudomallei. Imipenem was the most active antibiotic tested, followed by piperacillin, doxycycline, amoxycillin/clavulanic acid, cefixime, cefetamet, aziocillin and ceftazidime, all of which had MICs of ≤ 2 mg/l for the majority of strains. The measured MICs were dependent on the media and inocula used, to an extent which varied with the antibiotic class under test; MICs of ureidopenicillins were particularly inoculum-dependent The β-lactams and cipro-floxacin were bactericidal, whereas the agents conventionally used to treat melioidosis (doxycycline, chloramphenicol, sulphamethoxazole and trimethoprim) had bacteriostatic activity only. Strains highly resistant to chloramphenicol (MIC ≥ 256 mg/l) emerged during treatment in 71% of patients. These strains were fully virulent, and frequently showed cross-resistance to tetracyclines, sulphamethoxazole, trimethoprim and ciprofloxacin, with paradoxical increased susceptibility to β-lactams and aminoglycosides. Similar resistance patterns were seen in mutants generated in vitro and two reference strains. One strain with isolated ceftazidime resistance, reversible by clavulanic acid, emerged during treatment. Several of the new β-lactam antibiotics are of potential value in the therapy of P. pseudomallei infections. Patients should be carefully monitored for the emergence of antibiotic-resistant strains during treatment of melioidosis. © 1989 by The British Society for Antimicrobial Chemotherapy.
ISSN: 03057453
Appears in Collections:Scopus 1969-1990

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