Aztreonam: a new β-lactam antibiotic
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Aztreonam: a new antibiotic Compared with gentamicin •.. Aztreonam [SO 26 180; Squibb) is the first of a class of monocyclic ,8-lactam antibiotics, the monobactams. In 2 trials, 1 comparative and the other open, the efficacy of aztreonam was assessed in patients with urinary tract infections requiring systemic therapy. In the comparative study aztreonam (35 patients) or gentamicin (17) was administered to patients for 5-10 days in uncomplicated cases or for 10-14 days if bacteraemia was present. The open study included patients infected with an organism known to be resistant to gentamicin or those with renal failure. 26 patients received aztreonam.3 g/day received 6 g/day. 13 patients received gentamicin 3 mg/kg/day and 4 received 5.1 mg/kg/day. Favourable microbiological response was observed in all 35 patients on aztreonam and in 14/17 patients on gentamicin. The difference in response was significant. However, there was no difference in the relapse rate of infections at a 4-6 week evaluation. 12/35 patients on aztreonam and 8/17 on gentamicin had relapse, reinfection or failure of treatment. Of these patients 11 and 7, respectively, had associated anatomical or physiological abnormalities in the urinary tract. All 11 patients in the open study were cured without relapse or reinfection following treatment with aztreonam (1.5 - 6.0 gjday). Aztreonam appeared to be more active than gentamicin against Klebsiella, Citrobacter, and Pseudomonas and gentamicin was more active against Enterobacter. Side effects noted in the aztreonam group included phlebitis at the injection site, a bad taste after drug infusion and 1 case of Candida vaginitis. Liver function abnormalities occurred in 7 aztreonam and 2 gentamicin treated patients and returned to normal after treatment. Renal function deteriorated in 4 patients on gentamicin. Aztreonam showed no advantage in microbial response over gentamicin in these patients. However, the fact that aztreonam is unlikely to be nephrotoxic, has activity against gentamicin-resistant Gram-negative bacilli and remains bactericidal under anaerobic conditions provides it with some advantages over the aminoglycopides. Aztreonam ' ..• may have a role in therapy of serious gram- negative infections.' Sattler. F.R. et al.: Lancet 1: 1315 (16 Jun 1984) ... and cefamandole 30 patients with recurrent urinary tract infections entered this study in which the efficacies of aztreonam and cefamandole were compared. 20 patients received aztreonam and 10 received cefamandole each 19 tid for a mean duration of 8.5 and 9.6 days, respectively. 0156-2703/84/0728-0005/0$01.00/0 © ADIS Press All patients responded successfully to both treatments and there was no significant difference in the rate of relapse (3 patients in each group at 14 days). After a 6-week follow-up the original pathogen was excluded from urine cultures in 80% vs 70% of patients who were treated with aztreonam and cefamandole, respectively. Adverse effects were mild and included mild elevation of transaminase in 2 patients on az.treonam, prolonged prothrombin time in 1 patient in each treatment group and mild pain at the site of injection. Aztreonam is a promising antibiotic compound ' ••• and deserves further evaluation in a variety of systemic and 'difficult-to-treat' Gram-negative aerobic infections.' Glamarellou, H. et al.: Chemioterapia 3: 127 (Apr 1984) INPHARMA® 28 Jul 1984 5
Transcript of Aztreonam: a new β-lactam antibiotic
Aztreonam: a new ~-Iactam antibiotic
Compared with gentamicin •.. Aztreonam [SO 26 180; Squibb) is the first of a
class of monocyclic ,8-lactam antibiotics, the monobactams. In 2 trials, 1 comparative and the other open, the efficacy of aztreonam was assessed in patients with urinary tract infections requiring systemic therapy. In the comparative study aztreonam (35 patients) or gentamicin (17) was administered to patients for 5-10 days in uncomplicated cases or for 10-14 days if bacteraemia was present. The open study included patients infected with an organism known to be resistant to gentamicin or those with renal failure.
26 patients received aztreonam.3 g/day an~ ~ received 6 g/day. 13 patients received gentamicin 3 mg/kg/day and 4 received 5.1 mg/kg/day. Favourable microbiological response was observed in all 35 patients on aztreonam and in 14/17 patients on gentamicin. The difference in response was significant. However, there was no difference in the relapse rate of infections at a 4-6 week evaluation. 12/35 patients on aztreonam and 8/17 on gentamicin had relapse, reinfection or failure of treatment. Of these patients 11 and 7, respectively, had associated anatomical or physiological abnormalities in the urinary tract. All 11 patients in the open study were cured without relapse or reinfection following treatment with aztreonam (1.5 - 6.0 gjday).
Aztreonam appeared to be more active than gentamicin against Klebsiella, Citrobacter, Serrat~a and Pseudomonas and gentamicin was more active against Enterobacter.
Side effects noted in the aztreonam group included phlebitis at the injection site, a bad taste after drug infusion and 1 case of Candida vaginitis. Liver function abnormalities occurred in 7 aztreonam and 2 gentamicin treated patients and returned to normal after treatment. Renal function deteriorated in 4 patients on gentamicin.
Aztreonam showed no advantage in microbial response over gentamicin in these patients. However, the fact that aztreonam is unlikely to be nephrotoxic, has activity against gentamicin-resistant Gram-negative bacilli and remains bactericidal under anaerobic conditions provides it with some advantages over the aminoglycopides. Aztreonam ' ..• may have a role in therapy of serious gramnegative infections.' Sattler. F.R. et al.: Lancet 1: 1315 (16 Jun 1984)
... and cefamandole 30 patients with recurrent urinary tract infections
entered this study in which the efficacies of aztreonam and cefamandole were compared. 20 patients received aztreonam and 10 received cefamandole each 19 tid for a mean duration of 8.5 and 9.6 days, respectively.
0156-2703/84/0728-0005/0$01.00/0 © ADIS Press
All patients responded successfully to both treatments and there was no significant difference in the rate of relapse (3 patients in each group at 14 days). After a 6-week follow-up the original pathogen was excluded from urine cultures in 80% vs 70% of patients who were treated with aztreonam and cefamandole, respectively.
Adverse effects were mild and included mild elevation of transaminase in 2 patients on az.treonam, prolonged prothrombin time in 1 patient in each treatment group and mild pain at the site of injection.
Aztreonam is a promising antibiotic compound ' ••• and deserves further evaluation in a variety of systemic and 'difficult-to-treat' Gram-negative aerobic infections.' Glamarellou, H. et al.: Chemioterapia 3: 127 (Apr 1984)
INPHARMA® 28 Jul 1984 5
