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Preliminary clinical trial with amikacin in chronic recurrent gram-negative bacterial infections refractory to other
Abstract:
Eleven patients with 16 infections due to Enterobacteriaceae or Pseudomonas that were in most cases refractory to treatment with cephalosporins, kanamycin, gentamicin, tobramycin, carbenicillin, or ampicillin (administered singly or in combinations) received 1 g of amikacin daily by the intramuscular route (10 patients) or 0.4 g daily (one patient with renal insufficiency). The average duration of treatment was eight days. At the beginning of treatment, 18 pathogens were sensitive to amikacin at concentrations of 0.25-2 mug/ml. Of the 16 infections, 10 were cured clinically. Thirteen of the 19 pathogens isolated initially were eradicated, and five persisted during treatment but without change in in vitro sensitivity. A strain of Pseudomonas cepacia recovered from a diabetic patient and sensitive initially to 8 mug of amikacin/ml showed an eightfold increase in minimal inhibitory concentration. Superinfection with P. cepacia resistant to amikacin was noted in one case and urinary colonization with Candida albicans in another. No abnormalities of hematopoietic, hepatic, or renal function were observed in laboratory tests.
Insights
Amikacin effectively treated serious Enterobacteriaceae and Pseudomonas infections resistant to other antibiotics. Clinical cures were achieved in 10 of 16 infections, demonstrating amikacin
Area of Science:
- Infectious Diseases
- Pharmacology
- Microbiology
Background:
- Many Enterobacteriaceae and Pseudomonas infections are refractory to standard antibiotic therapies.
- Limited treatment options exist for multidrug-resistant Gram-negative bacterial infections.
- Amikacin, an aminoglycoside antibiotic, shows promise against resistant pathogens.
Purpose of the Study:
- To evaluate the efficacy and safety of amikacin in treating severe bacterial infections.
- To assess amikacin's effectiveness against cephalosporin, penicillin, and aminoglycoside-resistant bacteria.
Main Methods:
- Eleven patients with 16 infections received daily intramuscular amikacin (1g or 0.4g for renal insufficiency).
- Pathogen susceptibility testing was performed before and during treatment.
- Clinical outcomes and laboratory parameters were monitored.
Main Results:
- Ten of sixteen infections showed clinical cure.
- Thirteen of nineteen initial pathogens were eradicated; five persisted without altered sensitivity.
- No significant hematopoietic, hepatic, or renal toxicity was observed.
Conclusions:
- Amikacin is an effective treatment option for severe infections caused by resistant Enterobacteriaceae and Pseudomonas.
- The drug demonstrated a favorable safety profile in the studied patient cohort.
- Monitoring for potential resistance development and superinfections is warranted.