This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Desbiolles, N.
Right arrow Articles by Chavanet, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Desbiolles, N.
Right arrow Articles by Chavanet, P.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, December 2001, p. 3328-3333, Vol. 45, No. 12
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.12.3328-3333.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Fractional Maximal Effect Method for In Vitro Synergy between Amoxicillin and Ceftriaxone and between Vancomycin and Ceftriaxone against Enterococcus faecalis and Penicillin-Resistant Streptococcus pneumoniae

Norbert Desbiolles, Lionel Piroth, Catherine Lequeu, Catherine Neuwirth, Henri Portier, and Pascal Chavanet*

Infectious Diseases Department and EA562, University Hospital, Dijon, France

Received 25 September 2000/Returned for modification 29 April 2001/Accepted 12 July 2001

In the present study we assessed the use of a new in vitro testing method and graphical representation of the results to investigate the potential effectiveness of combinations of amoxicillin (AMZ) plus ceftriaxone (CRO) and of CRO plus vancomycin (VAN) against strains of Streptococcus pneumoniae highly resistant to penicillin and cephalosporins (PRP strains). We used the fractional maximal effect (FME) method of time-kill curves to calculate adequate concentrations of the drugs to be tested rather than relying on arbitrary choices. The concentrations obtained, each of which corresponded to a fraction of the maximal effect, were tested alone and in combination with the bacterial strains in a broth medium. Synergy was defined as a ratio of observed effect/theoretical effect, called FME, of greater than 1, additivity was defined as an FME equal to 1, and antagonism was defined as an observed effect lower than the best effect of one of the antibiotics used alone. The area between antagonism and additivity is the indifference zone. The well-known synergy between amoxicillin and gentamicin against a reference strain of Enterococcus faecalis was confirmed, with a best FME equal to 1.07. Two strains of PRP, strains PRP-1 and PRP-2, were studied. The MICs for PRP-1 and PRP-2 were as follows: penicillin, 4 and 16 µg/ml, respectively; AMZ, 2 and 8 µg/ml, respectively, CRO, 1 and 4 µg/ml, respectively; and VAN, 0.5 and 0.25 µg/ml, respectively. For PRP-1 the best FME for the combination AMZ-CRO was 1.22 with drug concentrations of 1.68 mg/liter for AMZ and 0.17 mg/liter for CRO; the best FME for the combination VAN-CRO was 1.75 with VAN at 0.57 mg/liter and CRO at 0.17 mg/liter. For PRP-2 the best FME obtained for the combination AMZ-CRO was 1.05 with drug concentrations of 11.28 mg/liter for AMZ and 0.64 mg/liter for CRO; the best FME obtained for the combination VAN-CRO was 1.35 with VAN at 0.25 mg/liter and CRO at 1.49 mg/liter. These results demonstrated the synergy of both combinations, AMZ-CRO and VAN-CRO, against PRP strains at drug concentrations achievable in humans. Consequently, either of the combinations can be proposed for use for the treatment of PRP infections.


* Corresponding author. Mailing address: Service des Maladies Infectieuses, Hopital du Bocage, BP 1542, 21034 Dijon, France. Phone: 33 3 80 29 33 05. Fax: 33 3 80 29 36 38. E-mail: p.chavanet{at}planetb.fr.


Antimicrobial Agents and Chemotherapy, December 2001, p. 3328-3333, Vol. 45, No. 12
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.12.3328-3333.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.



This article has been cited by other articles:

  • Nguyen, H. A., Denis, O., Vergison, A., Tulkens, P. M., Struelens, M. J., Van Bambeke, F. (2009). Intracellular Activity of Antibiotics in a Model of Human THP-1 Macrophages Infected by a Staphylococcus aureus Small-Colony Variant Strain Isolated from a Cystic Fibrosis Patient: Study of Antibiotic Combinations. Antimicrob. Agents Chemother. 53: 1443-1449 [Abstract] [Full Text]  
  • Buckingham, S. C., McCullers, J. A., Lujan-Zilbermann, J., Knapp, K. M., Orman, K. L., English, B. K. (2006). Early Vancomycin Therapy and Adverse Outcomes in Children With Pneumococcal Meningitis. Pediatrics 117: 1688-1694 [Abstract] [Full Text]