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Antimicrobial Agents and Chemotherapy, November 2000, p. 2991-2998, Vol. 44, No. 11
The Anti-Infective Research Laboratory,
Department of Pharmacy Services, Detroit Receiving Hospital and
University Health Center,1 and College
of Pharmacy and Allied Health Professions2
and School of Medicine,3 Wayne
State University, Detroit, Michigan
Received 3 July 2000/Accepted 18 July 2000
Staphylococcus aureus with intermediate
glycopeptide susceptibility
(glycopeptide-intermediate S. aureus [GISA])
has been isolated from patients with apparent therapy failures. We
studied the killing activity of vancomycin over a range of simulated
conventional doses (1 to 1.5 g every 12 h) against three of
these GISA strains in an in vitro pharmacodynamic infection model. We
also studied the activity of a new glycopeptide (LY333328)
at a simulated dose of 3 mg/kg of body weight every 24 h or 5 mg/kg every 24 h, as well as the potential for vancomycin and
gentamicin synergy against these GISA strains. Four doses of vancomycin
with or without gentamicin or two doses of LY333328 were administered
over the 48-h study period. The vancomycin and LY333328 MICs and
minimal bactericidal concentrations (MBCs) for the three GISA strains
(strains 14379, 992, and Mu50) were 8 and 8 µg/ml and 1 and 2 µg/ml, respectively, for GISA 14379, 6 and 6 µg/ml and 1 and 1 µg/ml, respectively, for GISA 992, and 8 and 12 µg/ml and 2 and 8 µg/ml, respectively, for GISA Mu50. Vancomycin and LY333328 MICs and
MBCs were 0.75 and 1.0 µg/ml and 1 and 1 µg/ml, respectively for a
vancomycin-susceptible comparator strain (methicillin-resistant
S. aureus [MRSA] 494). The addition of albumin to the
growth medium increased the LY333328 MICs and MBCs approximately 8- to
16-fold. Vancomycin was bacteriostatic against the three GISA
strains at doses of 1, 1.125, and 1.25 g every 12 h.
Vancomycin was bactericidal at the dose of 1.5 g every 12 h
against all strains; bactericidal activity occurred against the GISA
strains at 8- to 10-fold lower ratios of the peak concentration to the
MIC and the area under the concentration-time curve from time zero
to 24 h (AUC0-24) to the MIC compared to those for
the vancomycin-sensitive control strain. Overall, vancomycin activity
was significantly correlated with the AUC0-24 (R2 = 0.79; P < 0.001) by
multiple stepwise regression analyses. The addition of gentamicin did
not significantly affect killing activity against any strain. LY333328
was bactericidal against GISA strains 14379 and 992 and against MRSA
494 only with the 5-mg/kg/day dose simulations. The higher dose of
LY333328 also prevented regrowth over the 48-h experiments for all
strains tested. Higher doses of vancomycin (1.5 g every 12 h) and
LY333328 (5 mg/kg every 24 h) may represent potential treatment
options for infections caused by GISA strains.
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
Activities of LY333328 and Vancomycin Administered
Alone or in Combination with Gentamicin against Three Strains of
Vancomycin-Intermediate Staphylococcus aureus in an In
Vitro Pharmacodynamic Infection Model

*
Corresponding author. Mailing address: The
Anti-Infective Research Laboratory, Department of Pharmacy Services
(1B), Detroit Receiving Hospital and University Health Center, 4201 St.
Antoine Blvd., Detroit, MI 48201. Phone: (313) 745-4554. Fax: (313)
993-2522. E-mail: mrybak{at}dmc.org.
Present address: The University of Connecticut School of Pharmacy,
Storrs, CT 06269-2092.
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