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Antimicrobial Agents and Chemotherapy, December 2001, p. 3328-3333, Vol. 45, No. 12
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.
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
*
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.
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