title: Bactericidal activity of low-dose ceftizoxime plus metronidazole compared with cefoxitin and ampicillin-sulbactam.
abstract: Eighteen volunteers received ceftizoxime 1 g plus metronidazole 500 mg intravenously every 12 hours, cefoxitin 2 g intravenously every 6 hours, and ampicillin-sulbactam 3 g every 6 hours in a triple-crossover, open-label study to compare serum bactericidal titers (SBTs) against two strains of Escherichia coli and Bacteroides fragilis. Serum was analyzed for drug concentration and bactericidal activity. Ceftizoxime-metronidazole exhibited a significantly greater (p < 0.05) area under the bactericidal curve and percentage of the dosing interval with SBTs of 1:2 or above against E. coli than cefoxitin or ampicillin-sulbactam. The respective values were equal to those of ampicillin-sulbactam for one strain of B. fragilis (both greater than cefoxitin) and greater than cefoxitin and ampicillin-sulbactam for the other strain. A 1-g dose of ceftizoxime given with metronidazole 500 mg every 12 hours should be an effective alternative to standard antibiotic treatment of mixed aerobic-anaerobic bacterial infections.
authors.affiliation: Department of Pharmacy, Hartford Hospital, CT 06115.
authors.forename: C D
authors.initials: CD
authors.lastname: Freeman
authors.forename: C H
authors.initials: CH
authors.lastname: Nightingale
authors.forename: D P
authors.initials: DP
authors.lastname: Nicolau
authors.forename: P P
authors.initials: PP
authors.lastname: Belliveau
authors.forename: P R
authors.initials: PR
authors.lastname: Tessier
authors.forename: Q
authors.initials: Q
authors.lastname: Fu
authors.forename: D W
authors.initials: DW
authors.lastname: Xuan
authors.forename: R
authors.initials: R
authors.lastname: Quintiliani
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000097:blood / Q000494:pharmacology; D001441:Bacteroides fragilis / Q000187:drug effects*; D002440:Cefoxitin / Q000097:blood / Q000494:pharmacology; D015296:Ceftizoxime / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D004926:Escherichia coli / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D008826:Microbial Sensitivity Tests; D015610:Serum Bactericidal Test; D013407:Sulbactam / Q000097:blood / Q000494:pharmacology
chemical_list: D008795:Metronidazole; C035444:sultamicillin; D002440:Cefoxitin; D000667:Ampicillin; D015296:Ceftizoxime; D013407:Sulbactam