In vitro studies have shown synergistic killing activity against Pseudomonas aeruginosa (PA) with the combination of an aminoglycoside and moxalactam, a new beta-lactam agent. We describe three patients with cystic fibrosis (CF) with PA isolates that were resistant to all single-agent antibiotics, but sensitive to the combination of moxalactam-tobramycin. Initially, all patients had a good clinical response to this combination. However, during a second course of therapy, there was clinical deterioration coincident with the rapid emergence of moxalactam-tobramycin-resistant PA isolates.
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References
1.
Blessing J., Maybury B., Lewiston N.Antimicrobial susceptibility of pseudomonas from sputum of patients: 1975-1980 . Monogr Paediatr1981;14:115-9.
2.
Jorgenson JH , Crawford SA, Alexander GAIn vitro activities of moxalactam and cefotaxime against aerobic gram negative bacilli. Antimicrob Agents Chemother1980;17:937-42.
3.
Mintz L., Drew WLComparative synergistic activity of cefoperazone, cefotaxime, moxalactam, and carbencillin, combined with tobramycin against pseudomonas aeruginosa . Antimicrob Agents Chemother1981;19:332-4.
4.
Fitzpatrick BJ, Standiford HCMoxalactam: a comparative evaluation . Pharmacotherapy1982;2:197-212.
5.
Winston D., Busuttil R., Kurtz T., et al. Moxalactam therapy for bacterial infections. Arch Intern Med1981:141:1607-12.
6.
Platt R., Ehrlich S., Afarian J., et al. Moxalactam therapy of infections caused by cephalothin-resistant bacteria: influence of serum inhibitory activity on clinical response and acquisition of antibiotic resistance during therapy. Antimicrob Agents Chemother1981;20:351-5.
7.
Wade JC, Schimpff SC, Newman KA, et al. Piperacillin or ticarcillin plus amikacin: a double-blind prospective comparison of empiric antibiotic therapy for febrile granulocytopenic cancer patients. Am J Med1981;71;983-90.
8.
Klastersky J. , Cappel JR, Daneau D.Clinical significance of in vitro synergism between antibiotics in gram-negative infections. Antimicrob Agents Chemother1972;2:470-5.
9.
Dejongh CA, Wade JC, Schimpff SC, et al. Empiric antibiotic therapy for suspected infection in granulocytopenic cancer patients: a comparison between the combination of moxalactam plus amikacin and ticarcillin plus amikacin. Am J Med1982 ;73:89-96.
