Summary
Pivmecillinam, a new penicillin-like antibiotic, is a member of the amidinopenicillanic acid group. Its mode of action differs from that of the classical penicillins and it exhibits no cross-resistance with them. Fifty-two gerontopsychiatric patients, median age 81 years, withE. coli, Klebsiella, andProteus bacteriurias were divided into three comparable groups. In a ten week open clinical trial the patients were treated with pivmecillinam, pivampicillin or the two drugs given alternately in doses reduced in stages. The bacteriuria in all groups cleared almost completely in three days. Pivmecillinam compared favourably with pivampicillin especially at the end of the reduced medication. The alternating treatment seemed to be superior to treatment with either drug administered separately. No development of resistance was observed. No toxic effect on the liver, kidney, or bone marrow was seen in any of the three groups. In the group receiving pivmecillinam alone, no ampicillin-like skin rashes occurred.
Zusammenfassung
Pivmecillinam, ein neues penicillinartiges Antibiotikum, gehört zur Gruppe der Amidinopenicillinsäuren. Seine Wirkungsweise unterscheidet sich von derjenigen der klassischen Penicilline und es entwickelt keine Kreuzresistenz mit ihnen. 52 geriatrischpsychiatrische Patienten im Durchschnittsalter von 81 Jahren, dieE. coli, Klebsiella undProteus im Harn aufwiesen, wurden in drei vergleichbare Gruppen eingeteilt. In einem zehnwöchigen offenen klinischen Versuch wurden die Patienten mit Pivmecillinam, Pivampicillin oder mit beiden Medikamenten abwechselnd in stufenweise reduzierten Dosen behandelt. In allen Gruppen wurde die Bakteriurie in drei Tagen nahezu vollständig beseitigt. Pivmccillinam verglich sich günstig mit Pivampicillin, besonders in der Endstufe der reduzierten Medikation. Die abwechselnde Behandlung schien der getrennten Behandlung mit jeweils einem der beiden Medikamente allein überlegen. Es wurde keine Resistenzentwicklung beobachtet. In keiner der drei Gruppen zeigte sich eine toxische Wirkung auf Leber, Niere oder Knochenmark. In der ausschließlich mit Pivmecillinam behandelten Gruppe traten keine Ampicillin-artigen Hautausschläge auf.
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Literature
Alling, B., Brandberg, Å., Seeberg, S., Svanborg, A. Aerobic and anaerobic microbial flora in the urinary tract of geriatric patients during long-term care. J. infect. Dis. 127 (1973) 34–39.
Bentzen, A. J., Vejlsgaard, R.: Bakteriuri hos ældre. Ugeskr. Læg (1975). Submitted.
Berg, K. J., Widerøe, T.-E. Pivampicillin chloride in the treatment of urinary tract infection in a medical department. Chemotherapy 18 (1973) 130–136.
Brumfitt, W., Franklin, I., Hayek, L., Purcell, R. Treatment of urinary tract infection with pivampicillin. Scand. J. infect. Dis. 5 (1973) 59–65.
Danø, P., From Hansen, P. Antibiotic treatment with pivampicillin chloride in respiratory and urinary tract infections. Chemotherapy 18 (1973) 63–71.
Kaitz, A. L., Williams, E. J. Bacteriuria and urinarytract infections in hospitalized patients. N. Engl. J. Med. 262 (1960) 425–430.
Lund, F., Tybring, L. 6β-amidinopenicillanic acids — a new group of antibiotics. Nature New Biol. 236 (1972) 135–137.
Matsuhashi, S., Kamiryo, T, Blumberg, P. M., Linnett, P., Willoughby, E., Strominger, J. L. Mechanism of action and development of resistance to a new amidino penicillin. J. Bacteriol. 117 (1974) 578–587.
Melchior, N. H.: Personal communication.
Melchior, N. H., Blom, J., Tybring, L., Birch-Andersen, A. Light and electron microscopy of the early response of Escherichia coli to a 6β-amidinopenicillanic acid (FL 1060). Acta path. microbiol. scand. (B) 81 (1973) 393–407.
Nilsson, L. B. Korttidsbehandling av urinvägsinfektioner med pivampicillinklorid (Pondocillin). Klinisk studie av effekten vid olika doseringar. Opusc. Med. 18 (1973) 223–225.
Park, J. T., Burman, L. FL 1060: A new penicillin with a unique mode of action. Biochem. biophys. Res. Commun. 51 (1973) 863–868.
Roholt, K., Nielsen, B., Kristensen, E. Pharmacokinetic studies with mecillinam and pivmecillinam. Chemotherapy 21 (1975) 146–166.
Schmidt-Mende, M., Hofstetter, A., Carl, P., Keck, W. Behandlung von Harnwegsinfektionen mit Pivampicillin. Münch. med. Wschr. 114 (1972) 1659–1663.
Shapiro, S., Slone, D., Siskin, V., Lewis, G. P., Jick, H. Drug rash with ampicillin and other penicillins. Lancet (1969/II) 969–972.
Tybring, L.: Mecillinam (FL 1060), a 6β-amidinopenicillanic acid derivative. In vitro evaluation. Antimicrob. Agents Chemother. (1975). In press.
Tybring, L., Melchior, N. H.: Mecillinam (FL 1060), a 6β-amidinopenicillanic acid derivative. Bactericidal action and synergy in vitro. Antimicrob. Agents Chemother. (1975). In press.
Vejlsgaard, R. Quantitative bacterial culture of urine. I. A preliminary report on a method and on the limit between contamination and significant bacteriuria. Acta med. scand. 179 (1966) 167–172.
Vejlsgaard, R., Justesen, T. Quantitative bacterial culture of urine. II. Evaluation of 10 different screening methods for dianosis of bacteriuria compared with results obtained by dilution technique. Acta med. scand. 193 (1973) 147–159.
Weuta, H. Das Ampicillin-Exanthem — Bericht über eine klinische Erfassungsaktion. Arzneimittel-Forsch. (Drug Res.) 22 (1972) 1300–1306.
Wolfson, S. A., Kalmanson, G. M., Rubini, M. E., Guze, L. B. Epidemiology of bacteriuria in a predominantly geriatric male population. Amer. J. med. Sci. 250 (1965) 168 to 173.
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Bentzen, A.J., Vejlsgaard, R., Jacobsen, J. et al. Clinical evaluation of a novel β-lactam antibiotic: Pivmecillinam (FL 1039). Infection 3, 154–160 (1975). https://doi.org/10.1007/BF01641339
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DOI: https://doi.org/10.1007/BF01641339