Summary
Twenty-four patients were treated with moxalactam for 25 serious infections. Nineteen patients were septicemic and 18 presented severe underlying diseases considered to impair the normal response to bacterial pathogens. All of the pathogens had MICs of less than 12 mg/l except onePseudomonas aeruginosa strain with an MIC of 32 mg/l. The dosage ranged from 3 to 12 g/day; the route of administration was either i.v. or i.m. The duration of treatment was six to 26 days. Six patients had urinary tract infections (three bacteremia), four had pulmonary abscesses (two bacteremia), five had septic thrombophlebitis (five bacteremia) and ten had miscellaneous infections (nine bacteremia). Twenty-two (92%) patients responded favourably. Four patients (16.6%) developed superinfections due to organisms highly resistant to moxalactam: threeStreptococcus faecalis, oneBacteroides fragilis and oneAspergillus flavus. Tolerance was good. Nine moderate adverse reactions were observed: three cases of transient eosinophilia, two of phlebitis, three hepatic enzyme alterations and one rash. Moxalactam kinetics were measured in serum from 15 patients with normal renal function after receiving 1 g i.v. over 30 min. The mean peak level after the infusion was 82.8±12.1 (SE) mg/l; the mean trough level 8 h later was 6.2±1.7 (SE) mg/l. The serum half-life was 2.6±0.6 (SE) h for the β phase. Plasma clearance was 76.8±8.2 ml/min. Moxalactam was found to be highly effective in the therapy of life-threatening infections.
Zusammenfassung
24 Patienten mit 25 schweren Infektionen, darunter 19 Septikämien, wurden mit Moxalactam behandelt. Bei 18 Patienten war die natürliche Abwehr gegen bakterielle Pathogene infolge schwerer Grundkrankheiten vermutlich beeinträchtigt. Die minimalen Hemmkonzentrationen von Moxalactam für die pathogenen Erreger betrugen mit einer Ausnahme weniger als 12 mg/l; einPseudomonas aeruginosa-Stamm wies eine MHK von 32 mg/l auf. Moxalactam wurde i.v. oder i.m. in Tagesdosen von 3 g bis 12 g gegeben. Sechs der Patienten litten an Harnwegsinfektionen (drei mit Bakteriämie), vier an Lungenabszessen (zwei mit Bakteriämie), fünf an septischer Thrombophlebitis (alle mit Bakteriämie) und zehn an verschiedenen anderen Infektionen (neun mit Bakteriämie). Bei 22 Patienten (92%) wurde ein Therapieerfolg erzielt. Bei vier Patienten (16.6%) traten Superinfektionen durch gegenüber Moxalactam hochresistente Erreger auf. Isoliert wurden dreimalStreptococcus faecalis, je einmalBacteroides fragilis undAspergillus flavus. Moxalactam wurde gut vertragen. Nebenwirkungen mäßigen Grades traten bei neun Patienten auf, dreimal vorübergehende Eosinophilie, zweimal Phlebitis, dreimal Anstieg der Leberenzyme und einmal Exanthem. Untersuchungen zur Moxalactam-Serumkinetik bei 15 Patienten mit normaler Nierenfunktion nach Infusion von 1 g i.v. über 30 min ergaben mittlere Spitzenspiegel von 82,8±12,1 (SE) mg/l, acht Stunden später mittlere Talspiegel von 6,2±1,7 (SE) mg/l, eine Serumhalbwertszeit von 2,6±0,6 (SE) h in der Beta-Phase und eine Plasma-Clearance von 76,8±8,2 ml/min. Moxalactam erwies sich als hochwirksames Mittel zur Behandlung lebensbedrohlicher Infektionen.
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Van der Auwera, P., Clumeck, N., Van Laethem, Y. et al. Moxalactam therapy of serious infections. Infection 11, 212–218 (1983). https://doi.org/10.1007/BF01641201
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DOI: https://doi.org/10.1007/BF01641201