Mecillinam activity compared to ampicillin, trimethoprim/sulfamethoxazole, ciprofloxacin and nitrofurantoin against urinary tract isolates of gram-negative bacilli.

Abstract

Recent Canadian, American and European studies have reported increased ampicillin and trimethoprim/sulfamethoxazole resistance among urinary tract isolates of Escherichia coli. This trend suggests that a reevaluation of first- and second-line therapies for the treatment of community-acquired urinary tract infections is necessary. Mecillinam, a beta-lactam with preferential activity against gram-negative penicillin binding protein 2 (unlike other beta-lactams which preferentially bind gram-negative penicillin binding proteins 1a, 1b or 3), may offer clinically significant activity against ampicillin-resistant and trimethoprim/sulfamethoxazole-resistant E. coli. To test this assertion, the activity of mecillinam was compared with ampicillin, trimethoprim/sulfamethoxazole, nitrofurantoin and ciprofloxacin against 258 consecutive gram-negative urinary tract isolates collected at a Canadian tertiary care hospital. Mecillinam demonstrated significantly better activity than ampicillin and trimethoprim/sulfamethoxazole and significantly less activity than ciprofloxacin and nitrofurantoin against the 258 isolates tested. Against E. coli isolates specifically, mecillinam was significantly more active than ampicillin and trimethoprim/sulfamethoxazole (p < 0. 001) and as active as ciprofloxacin and nitrofurantoin. Mecillinam was active against 91.9% of ampicillin-resistant E. coli and 95.9% of trimethoprim/sulfamethoxazole-resistant E. coli. We conclude that mecillinam should be reevaluated for potential use in the treatment of community-acquired urinary tract infections.

• Authors: G G Zhanel, J A Karlowsky, B Schwartz, S B Jensen, D J Hoban
• Journal: Chemotherapy (Chemotherapy) 1998 Nov-Dec Vol. 44 Issue 6 Pg. 391-6 ISSN: 0009-3157 [Print] Switzerland
• PMID: 9755298 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents
• Anti-Infective Agents, Urinary
• Penicillins
• Ciprofloxacin
• Ampicillin
• Trimethoprim, Sulfamethoxazole Drug Combination
• Nitrofurantoin
• Amdinocillin

Topics

• Amdinocillin (pharmacology)
• Ampicillin (pharmacology)
• Anti-Infective Agents (pharmacology)
• Anti-Infective Agents, Urinary (pharmacology)
• Ciprofloxacin (pharmacology)
• Gram-Negative Bacteria (drug effects)
• Gram-Negative Bacterial Infections (urine)
• Humans
• Microbial Sensitivity Tests
• Nitrofurantoin (pharmacology)
• Penicillins (pharmacology)
• Trimethoprim, Sulfamethoxazole Drug Combination (pharmacology)