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Mecillinam: a new antibiotic for enteric fever
Abstract:
Mecillinam is a new antibiotic related to the penicillins but more active than ampicillin against salmonellae, including Salmonella typhi. Mecillinam must be administered parenterally, but the ester, pivmecillinam, is absorbed from the gut. Eight patients suffering from typhoid fever and one suffering from paratyphoid fever were treated with the antibiotic, and seven responded satisfactorily. One patient could not tolerate pivmecillinam because of vomiting but there were no other adverse reactions. Serum and bile levels of mecillinam were many times the minimum inhibitory concentrations for most salmonellae. The antibiotic is a promising addition to the agents available for treating typhoid.
Insights
Pivmecillinam, an orally administered antibiotic, shows promise for treating typhoid fever. Clinical trials indicate satisfactory responses in most patients with typhoid and paratyphoid fevers, with minimal adverse effects.
Area of Science:
- Pharmacology
- Infectious Diseases
- Microbiology
Background:
- Mecillinam is a penicillin-related antibiotic with enhanced activity against Salmonella species, including Salmonella typhi.
- Mecillinam requires parenteral administration, but its ester, pivmecillinam, offers oral absorption for gastrointestinal delivery.
Purpose of the Study:
- To evaluate the efficacy and tolerability of pivmecillinam in patients with typhoid and paratyphoid fevers.
- To assess serum and bile concentrations of mecillinam in treated patients.
Main Methods:
- A clinical study involving nine patients diagnosed with typhoid or paratyphoid fever.
- Treatment administered with pivmecillinam, followed by measurement of serum and bile mecillinam levels.
Main Results:
- Seven out of eight patients with typhoid fever and the patient with paratyphoid fever showed satisfactory clinical responses.
- One patient experienced vomiting, leading to discontinuation of pivmecillinam; no other adverse reactions were reported.
- Achieved serum and bile mecillinam concentrations significantly exceeded the minimum inhibitory concentrations for most Salmonella strains.
Conclusions:
- Pivmecillinam demonstrates significant potential as an effective oral treatment for typhoid fever.
- The antibiotic is well-tolerated, with high drug concentrations achieved in relevant bodily fluids.
- Mecillinam represents a valuable addition to the therapeutic options for Salmonella infections.