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Postantibiotic effects and Burkholderia (Pseudomonas) pseudomallei: evaluation of current treatment
A L Walsh1, M D Smith, V Wuthiekanun
1Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Abstract:
The postantibiotic effects (PAEs) OF 16 antibiotics or antibiotic combinations currently used against Burkholderia (Pseudomonas) pseudomallei were determined. The beta-lactams had zero PAEs, while the carbapenems and ciprofloxacin induced median PAEs of 1 and 5 h, respectively. These results emphasize the need to maintain antibiotic levels above inhibitory concentrations in blood throughout the dosing interval in cases of severe melioidosis.
Insights
The study determined postantibiotic effects (PAEs) for 16 antibiotics against Burkholderia pseudomallei. Carbapenems and ciprofloxacin showed significant PAEs, unlike beta-lactams, informing severe melioidosis treatment.
Area of Science:
- Microbiology
- Pharmacology
- Infectious Diseases
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is a severe infectious disease.
- Understanding the postantibiotic effect (PAE) is crucial for optimizing antibiotic dosing strategies.
- Current treatment guidelines for melioidosis require evaluation based on antimicrobial efficacy.
Purpose of the Study:
- To determine the postantibiotic effects (PAEs) of 16 commonly used antibiotics or antibiotic combinations against Burkholderia pseudomallei.
- To compare the PAEs induced by different antibiotic classes, including beta-lactams, carbapenems, and fluoroquinolones.
- To provide data that can inform optimal antibiotic dosing regimens for severe melioidosis.
Main Methods:
- Bacterial cultures of Burkholderia pseudomallei were exposed to 16 different antibiotics or combinations.
- Postantibiotic effects were measured by determining the duration of bacterial growth inhibition after antibiotic removal.
- Median PAEs were calculated for each antibiotic tested.
Main Results:
- Beta-lactam antibiotics exhibited negligible or zero postantibiotic effects against Burkholderia pseudomallei.
- Carbapenems demonstrated a median PAE of 1 hour.
- Ciprofloxacin induced a median PAE of 5 hours, indicating a more prolonged suppressive effect.
Conclusions:
- Antibiotic selection for severe melioidosis should consider the duration of postantibiotic effect.
- Maintaining antibiotic concentrations above the minimum inhibitory concentration (MIC) throughout the dosing interval is critical.
- Ciprofloxacin and carbapenems may offer advantages over beta-lactams in managing severe melioidosis due to their PAEs.