Influence of penicillin/amoxicillin non-susceptibility on the activity of third-generation cephalosporins against Streptococcus pneumoniae

  • A. Fenoll
  • M. J. Giménez
  • O. Robledo
  • L. Aguilar
  • D. Tarragó
  • J. J. Granizo
  • J. E. Martín-Herrero


To study the influence of penicillin/amoxicillin non-susceptibility on the activity of third-generation cephalosporins, 430 consecutive penicillin non-susceptible Streptococcus pneumoniae 2007 isolates received in the Spanish Reference Pneumococcal Laboratory were tested. For comparative purposes, 625 penicillin-susceptible 2007 isolates were also tested. Susceptibility was determined by agar dilution using Mueller-Hinton agar supplemented with 5% sheep blood. Penicillin-susceptible strains were susceptible to amoxicillin, cefotaxime and ceftriaxone, 99.8% to cefpodoxime and 99.5% to cefdinir, and were inhibited by 0.12 μg/ml of cefditoren and 4 μg/ml of cefixime. Penicillin-intermediate strains were susceptible to cefotaxime and ceftriaxone, with <50% susceptibility to cefdinir and cefpodoxime. The MIC50 and MIC90 values of cefditoren were 0.25 μg/ml and 0.5 μg/ml, respectively, whereas cefixime exhibited only marginal activity (MIC90=16 μg/ml). Penicillin-resistant strains were resistant to cefdinir and cefpodoxime, with 74.8% and 94.1% susceptibility to cefotaxime and ceftriaxone, respectively. Cefditoren MIC50/MIC90 (0.5/1 μg/ml) were lower than cefotaxime and ceftriaxone. Among amoxicillin non-susceptible strains, susceptibility to cefdinir and cefpodoxime was <10%, and susceptibility to cefotaxime decreased from 87.9% in the intermediate category to 63.0% in the resistant group. Cefditoren MIC50/MIC90 (0.5/1 μg/ml) were lower than cefotaxime. In conclusion, the activity of cefixime, cefdinir and cefpodoxime was highly affected by penicillin/amoxicillin non-susceptibility, while parenteral third-generation cephalosporins exhibited higher intrinsic activity (MIC90=1 μg/ml for penicillin-resistant and 2 μg/ml for amoxicillin-resistant strains). Cefditoren exhibited one-dilution lower MIC90 values for these strains, even against those of the most troublesome serotypes.


Amoxicillin Ceftriaxone Cefotaxime Cefixime Cefpodoxime 
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This study was supported by an unrestricted grant from GlaxoSmithKline S.A., Tres Cantos, Madrid, Spain.


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • A. Fenoll
    • 1
  • M. J. Giménez
    • 2
  • O. Robledo
    • 1
  • L. Aguilar
    • 2
  • D. Tarragó
    • 1
  • J. J. Granizo
    • 3
  • J. E. Martín-Herrero
    • 4
  1. 1.Spanish National Reference Pneumococcal LaboratoryInstituto de Salud Carlos IIIMajadahondaSpain
  2. 2.Microbiology Department, School of MedicineUniversity ComplutenseMadridSpain
  3. 3.Granadatos SLPozuelo de AlarcónSpain
  4. 4.Medical DepartmentGlaxoSmithKline S.A.Tres CantosSpain

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