title: Comparative in vitro and in vivo activities of piperacillin combined with the beta-lactamase inhibitors tazobactam, clavulanic acid, and sulbactam.
abstract: Tazobactam (YTR-830H), a novel beta-lactamase inhibitor, was compared with clavulanic acid and sulbactam for enhancement of the activity of piperacillin against beta-lactamase-producing, piperacillin-resistant clinical isolates. Piperacillin MICs were determined in media containing a fixed concentration of 2 or 4 micrograms of the inhibitors per ml. The higher concentration was generally more effective. Tazobactam was superior to sulbactam in enhancing the spectrum and potency of piperacillin. Although the calvulanic acid combination was more potent, tazobactam was effective for a similar spectrum of resistant gram-negative clinical isolates containing beta-lactamase. MICs were reduced to the susceptible range for Escherichia coli, Klebsiella pneumoniae, Proteus spp., Salmonella spp., and Shigella spp. Combinations with tazobactam and sulbactam, but not clavulanic acid, were effective against Morganella spp. Some antagonism of the activity of piperacillin was observed with clavulanic acid but not with tazobactam or sulbactam. The inhibitors were similarly effective with piperacillin against beta-lactamase-positive Staphylococcus spp. and the Bacteroides fragilis group. Piperacillin-tazobactam was more effective against a broader spectrum of gram-negative enteric bacteria than ticarcillin plus clavulanic acid was. Combinations with tazobactam or clavulanic acid had a broader spectrum of activity than combinations with sulbactam against bacteria that produce characterized plasmid-mediated enzymes of clinical significance. In particular, piperacillin with tazobactam or clavulanic acid, but not with sulbactam, inhibited TEM-1, TEM-2, and SHV-1 enzymes. In vitro activity was reflected in vivo. Tazobactam and clavulanic acid were superior to sulbactam in enhancing the therapeutic efficacy of piperacillin in mice infected with beta-lactamase-positive E. coli, K. pneumoniae, Proteus mirabilis, and Staphylococcus aureus. Only combinations with tazobactam and sulbactam were effective against the Morganella infection. Tazobactam has a good potential for enhancing the clinical efficacy of piperacillin.
authors.affiliation: Medical Research Division, American Cyanamid Co., Lederle Laboratories, Pearl River, New York 10965.
authors.forename: N A
authors.initials: NA
authors.lastname: Kuck
authors.forename: N V
authors.initials: NV
authors.lastname: Jacobus
authors.forename: P J
authors.initials: PJ
authors.lastname: Petersen
authors.forename: W J
authors.initials: WJ
authors.lastname: Weiss
authors.forename: R T
authors.initials: RT
authors.lastname: Testa
mesh_terms: D000818:Animals; D001419:Bacteria / Q000187:drug effects; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D019818:Clavulanic Acid; D002969:Clavulanic Acids / Q000494:pharmacology* / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D051379:Mice; D008826:Microbial Sensitivity Tests; D010397:Penicillanic Acid / Q000494:pharmacology* / Q000627:therapeutic use; D010878:Piperacillin / Q000494:pharmacology* / Q000627:therapeutic use; D013407:Sulbactam / Q000494:pharmacology* / Q000627:therapeutic use; D000078142:Tazobactam; D065093:beta-Lactamase Inhibitors
chemical_list: D002969:Clavulanic Acids; D065093:beta-Lactamase Inhibitors; D019818:Clavulanic Acid; D010397:Penicillanic Acid; D013407:Sulbactam; D000078142:Tazobactam; D010878:Piperacillin