The use of aztreonam in serious gram-negative infections

Aztreonam, the first available monobactam, was used to treat 38 episodes of serious infection presumed or proven to be due to aerobic Gram-negative bacteria. On 15 occasions it was used empirically in combination with other antibiotics and on 23 occasions as therapy specifically directed against Gram-negative pathogens. Thirty-six Gram-negative infections were documented (including 23 septicaemias) and 35 of them were clinically cured by aztreonam. Likewise 35 of the 36 aerobic Gram-negative pathogens were eradicated. Both of the failures (one clinical and one microbiological were Salmonella infections). No major toxicity was seen but there were five superinfections (four due to Streptococcus faecalis). The results indicate that aztreonam is a useful alternative to the aminoglycosides or the broad-spectrum beta-lactam antibiotics for the treatment of severe Gram-negative infections.