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Die antibakterielle Effektivität von Cefamandol im Vergleich mit anderen Antibiotika

The antibacterial efficacy of cefamandole in comparison with other antibiotics

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Zusammenfassung

Die antibakterielle Aktivität von Cefamandol wurde mit der Wirksamkeit von Cefuroxim, Cefoxitin, Cephalotin, Ampicillin, Mezlocillin, Azlocillin, Ticarcillin und Tobramycin bei 450 gramnegativen Bakterien sowie bei 150 grampositiven Kokken verglichen. Bei den grampositiven Bakterien wurde zusätzlich die Wirksamkeit von Penicillin und Oxacillin geprüft. Bestimmt wurden die minimalen Hemmkonzentrationen und minimalen bakteriziden Konzentrationen (partielle und totale) mittels Reihenverdünnungstest in Mueller-Hinton-Bouillon (Difco). Der Vorteil der neuen Cephalosporine (Cefamandol, Cefuroxim, Cefoxitin) liegt in ihrer größeren β-Laktamase-Stabilität gegenüber gramnegativen Bakterien. Sie wurde mit einem modifizierten Blättchentest mit den β-Laktamasen vonBacillus cereus, Staphylococcus aureus, Escherichia coli TEM,Klebsiella aerogenes K 1,Enterobacter cloacae P 99 und einem β-Laktamase-Gemisch bestimmt. Die höchste Stabilität gegen diese Enzyme besitzt Cefoxitin, während Cefuroxim und Cefamandol stabiler als Cephalotin und Cephazolin sind. Die oralen Cephalosporine Cefradin und Cephalexin sind relativ β-Laktamase-stabil. Die Penicilline werden von den meisten β-Laktamasen rasch inaktiviert, nur Oxacillin ist gegen die Staphylokokken-β-Laktamase resistent. Gegen Penicillin-sensible und Penicillin-resistente Staphylokokken, α- und β-hämolysierende Streptokokken sowie Pneumokokken besitzt Cefamandol eine dem Cephalotin ähnliche hohe Wirksamkeit. Enterokokken werden nur von Ampicillin und Mezlocillin wirksam erfaßt. Cefamandol ist bei den grampositiven Kokken dem Cefuroxim und Cefoxitin überlegen. GegenHaemophilus influenzae hat Cefamandol eine dem Cefuroxim vergleichbare hohe Aktivität, die dem Ampicillin kaum nachsteht. Bei denEnterobacteriaceae ist Cefamandol von den neuen Cephalosporinen am wirksamsten gegenE. coli, Proteus mirabilis, Citrobacter und Salmonellen. Ein Teil der Stämme vonKlebsiella, Enterobacter, Proteus rettgeri undProvidencia ist Cefamandol-sensibel. GegenSerratia, Proteus vulgaris undProteus morganii hat Cefoxitin die beste Wirksamkeit, Mezlocillin erfaß die Hälfte der Serratien, zwei Drittel vonP. rettgeri undP. morganii sowie alleP. vulgaris-Stämme. Tobramycin ist gegen die Mehrheit der gramnegativen Problemkeime effektiv. Die neuen Cephalosporine sind gegenPseudomonas aeruginosa unwirksam, die größte Aktivität gegenPseudomonas hat Tobramycin gefolgt von Azlocillin und Ticarcillin. Zwischen den neuen Cephalosporinen wurde nur eine inkomplette Kreuzresistenz festgestellt.

Summary

The antibacterial activity of cefamandole was compared with that of cefuroxime, cefoxitin, cephalothin, ampicillin, mezlocillin, alocillin, ticarcillin and tobramycin against 450 gram-negative bacterial and 150 gram-positive cocci. In addition, the efficacy of penicillin and oxacillin against gram-positive organisms was tested. The minimal inhibitory concentrations and minimal bactericidal concentrations were determined by the tube dilution method in Mueller-Hinton broth (Difco). The advantage of the new cephalosporines (cefamandole, cefuroxime and cefoxitin) is their greater β-lactamase resistance against gram-negative bacteria. The β-lactamase stability of these antibiotics was examined with a modified disc test utilizing the enzymes ofBacillus cereus, Staphylococcus aureus, Escherichia coli TEM,Klebsiella aerogenes strain K 1,Enterobacter cloacae strain P 99 and a β-lactamase mixture. Cefoxitin has the greatest resistance to these enzymes, while cefuroxime and cefamandole are more resistant than cephalothin and cephazoline. The oral cephalosporines cefradine and cephalexine are relatively resistant to β-lactamases. The penicillins were rapidly inactivated by most β-lactamases; only oxacillin was resistant to staphylococcal β-lactamase. Cefamandole has a high efficacy similar to that of cephalothin against penicillin-susceptible and penicillin-resistant staphylococci, α- and β-hemolytic streptococci, and pneumococci. Only ampicillin and mezlocillin proved effective against enterococci. Cefamandole is superior to cefuroxime and cefoxitin against gram-positive cocci. Cefamandole demonstrated a high degree of activity againstHemophilus influenzae, comparable with that of cefuroxime and ampicillin. Of the new cephalosporines, cefamandole is the most effective against theEnterobacteriacea family includingE. coli, Proteus mirabilis, Citrobacter andSalmonella. Some of the strains ofKlebsiella, Enterobacter, Proteus rettgeri andProvidencia are susceptible to cefamandole. Cefoxitin was the most effective agent againstSerratia, Proteus vulgaris andProteus morganü; mezlocillin was effective against half theSerratia strains, two thirds of theP. rettgeri andP. morganii strains and all theP. vulgaris strains. Tobramycin was effective against the majority of the problem pathogens. The new cephalosporines are not effective againstPseudomonas aeruginosa, the best activity being shown by tobramycin followed by azlocillin and ticarcillin. Only incomplete cross-resistance was found between the new cephalosporines.

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  1. Institut für Medizinische Mikrobiologie und Immunologie der Universität Hamburg, Martinistraße 52, D-2000, Hamburg 20

    H. -H. Schassan

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Schassan, H.H. Die antibakterielle Effektivität von Cefamandol im Vergleich mit anderen Antibiotika. Infection 6 (Suppl 2), S207–S218 (1978). https://doi.org/10.1007/BF01638975

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