CHEMO THE RAPY OCT. 1994
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- うたろう ふしはら
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1 bilis (0.78), Proteus vulgaris (1.56), Enterococcus faecalis (3.13), Staphylococcus epidermidis (6.25), Klebsiella pneumoniae (6.25), Morganella morganii (6.25), Escherichia coli (12.5), Providencia rettgeri (12.5), Pseudomonas aeruginosa (25), Staphylococcus aureus (50), Enterobacter aerogenes (50), Enterobacter cloacae (50), Serratia marcescens (50), Acinetobacter calcoaceti- PIPC, clavulanic acid/ticarcillin (CVA/TIPC), sulbactam/ ampicillin (SBT/ ABPC), cefoperazone (CPZ), sul-
2 CHEMO THE RAPY OCT. 1994
3 Table 1. Antibacterial activity of tazobactam/piperacillin against f3-lactamase producing bacteria Medium: Mueller-Hinton agar (Difco), Inoculum size: 106 cfu/ml PIPC: piperacillin, TAZ/PIPC: tazobactam/piperacillin, 2.5TAZ: 2.5 Đg/ml tazobactam, CVA/TIPC: clavulanic acid/ticarcillin, SBT/ABPC: sulbactam/ampicillin, SBT/CPZ: sulbactam/cefoperazone, CPZ: cefoperazone, CTM: cefotiam
4 CHEMOTHERAPY Table 2. Antibacterial activity of tazobactam/piperacillin against Ĉ-lactamase producing bacteria Medium: Mueller-Hinton agar (Difco) Inoculum size: 108 cfu/ml Table 3. Antibacterial activity of tazobactam/piperacillin against f-lactamase producing clinical isolates Medium: Mueller-Hinton agar (Difco), Inoculum size: 106 cfu/ml
5 Table 4. Antibacterial activity of tazobactam/piperacillin against Ĉ-lactamase producing bacteria Medium: Mueller-Hinton agar (Difco), Inoculum size: 108 cfu/ml Table 5. Antibacterial activity of tazobactam/piperacillin against ceftazidime resistant bacteria Medium: Mueller-Hinton agar (Difco) Inoculum size: 106 cfu/ml Table 6. Antibacterial activity of tazobactam/piperacillin against ceftazidime resistant bacteria Medium: Mueller-Hinton agar (Difco), Inoculum size: 108 cfu/ml
6 CHEMOTHERAPY Table 7. Antibacterial activity of tazobactam/piperacillin against anaerobic bacteria Inoculum size: 106 cfu/ml Table 8. Antibacterial activity of tazobactam/piperacillin against anaerobic bacteria Inoculum size: 108 cfu/ml
7 Table 9-1. Antibacterial activity of 0-lactams against gram-positive and gram-negative clinical isolates (106 cfu/ml)
8 CHEMOTHERAPY Table 9-2. Antibacterial activity of f3-lactams against gram-positive and gram-negative clinical isolates (106 cfu/ml)
9 Table 9-3. Antibacterial activity of /3-lactams against gram-positive and gram-negative clinical isolates (106 cfu/ml)
10 CHEMOTHERAPY OCT Table Antibacterial activity of f3-lactams against gram-positive and gram-negative clinical isolates (108 cfu/ml)
11 Table Antibacterial activity of 13-lactams against gram-positive and gram-negative clinical isolates (108 cfu/ml)
12 CHEMOTHERAPY Table Antibacterial activity of 0-lactams against gram-positive and gram-negative clinical isolates (108 cfu/ml)
13 Table 11. Influence of medium on antibacterial activity MHA: Mueller-Hinton medium, NA: Nutrient agar, HIA: Heart infusion agar, BHIA: Brain heart infusion agar, TSA: Trypticase soy agar
14 CHEMOTHERAPY Table 12. Influence of medium ph on antibacterial activity Medium: Mueller-Hinton medium
15 Table 13. Influence of serum concentration on antibacterial activity Medium: Heart infusion agar (Difco)
16 CHEMOTHERAPY Table 14. Influence of inoculum size on antibacterial activity Medium: Mueller-Hinton medium (Difco) Tazobactam/Piperacillin (TAZ/PIPC) Piperacillin (PIPC) Fig. 1. Effect of tazobactam/piperacillin and piperacillin on viability of Staphylococcus aureus 55.
17 Fig. 2. Effect of tazobactam/piperacillin and piperacillin on viability of Escherichia coli TEM1. Fig. 3. Bactericidal activity and stability of piperacillin with/without tazobactam against Escherichia coli TEM1.
18 CHEMOTHERAPY 152 れ た 相 乗 効 果 を 発 揮 し た Higashitani2), TAZがPCaseに CVAが 対 し てCVAと 阻 害 で き な いCEPaseに Kitzis3)ら は 同 等 の 阻 害 活 性 を 示 し, 対 し て はSBTと 同等 以 上 の 阻 害 作 用 を 示 し た と 報 告 し て い る PIPCは10年 来 臨 床 で 使 用 さ れ た 優 れ た 抗 生 物 質 で あ る が,近 多 く 開 発 さ れ た 第3セ p aeruginosaま の のPCase産 ら で の 幅 広 い 抗 菌 ス ペ ク トル を 有 す る も 生 のE ooli, Kpneumoniae.S mreusに 対 して は十 分 な抗 菌 力 を示 す こ とが で き な い 株 が 多 か っ た 一 方,E cloacae, S. marcescens, 染 色 体 上 にCEPase遺 C freundiiな どは 伝 子 を 持 つ た め 第3世 代 セ フェム 剤 に 対 し て 耐 性 を 示 す 株 が 多 く,TAZ/PIPCの 抗 菌 力 1994 も 十 分 で な い 株 が 比 較 的 多 か っ た TAZ/PIPCはTAZ が 強 いPCase, CEPase阻 害 活 性 を 有 す る た め,PIPCの 抗 菌 力 が 不 十 分 な β-lactamase産 epidermidisに 年 数 フ ェ ム 剤 に 比 べ,S.aureusか OCT. 対 し,優 3世 代 セ フ ェ ム 剤 で あ るCPZが いM. morgmii, P 生E coli, S aureus, vulgarisに 十 分 な抗 菌 力 を 示 さ な 対 しTAZ/PIPCは 使 用 した 対 照 薬 の 中 で 最 も 強 い 抗 菌 力 を 示 し た ま た,TAZ/ PIPCが 優 れ た 抗 菌 力 を 示 す 菌 種 に 対 し て はPIPC+ TAZ2.5μg/mlがTAZ/PIPCよ TAZ2.5μg/mlで り 強 い 抗 菌 力 を 示 し, 十 分 なPIPCと た し か し,TAZ/PIPCの し て はPIPC+TAZ2.5μg/m1の の相乗 効 果 が認 め られ 抗 菌 力 が 不 十 分 な菌 種 に 対 抗 菌 力 は弱 く多 量 の TAZ (pghnh Fig. 4. Competition of tazobactam/piperacillin, of Staphylococcus aureus 209P JC. piperacillin S れ た相乗 効 果 を示 した また 第 and tazobactam for penicillin binding proteins (PBPs)
19 VOL.42 TAZが TAZ/PIPCのin S-2 必 要 と 考 え ら れ る 東 谷11),三 はTAZ/PIPCがPCase,CEPase産 れ た感 染 治 療 効 果 を示 TAZ/PIPCのin 生 株 に 対 しin え ら れ る 以 上 よ りTAZ/PIPCは vivoで 優 殺 菌 力 はPIPCに 文 1) 比 生 菌 を 用 い た 実 験 か らPIPC Gutmann inhibitor, 時 間 後 にPIPCが lactam 消 失 す る こ と よ り をTAZを mother 来 の抗菌 力 添 加 す る こ と に よ り復 活 さ せ,第3世 2) 代 セ ブ TAZ Fig. 5. Competition of tazobactam/piperacillin, of Escherichia call NIHJ JC-2. 献 Kitzis Higashitani M D, evaluation YTR-830, antibiotics 29: Yamabe of a combined against known ƒà-lactamase. 来 の 殺 菌 力 を示 さ な か っ た こ と が 明 ら か に な っ た 以 上 の こ と か らTAZ/PIPCはPIPC本 L, Comparative が 殺 菌 効 果 を 示 す こ と が で き な か っ た の は 薬 剤 作 用2 培養 液 中で 分解 β-lactamase産 生 菌 に よ る 感 染 症 の 治 療 に 有 用 な薬 剤 と考 え られ た vivoに 反 映 さ れ て い る と 考 え ら れ た ま た,TAZ/PIPCの PIPC本 153 エ ム 剤 な み の幅 広 い抗 菌 ス ペ ク トル を獲 得 させ た と考 野'3}ら し た と 報 告11 13)し て お り, vitro抗 菌 力 はin べ て 強 く,β-lactamase産 宅12),西 vitro抗 菌 力 D, with F, Hyodo J harboring Agents Che A, Ishida N, Inoue M, (μg/ml) piperacillin F: different ƒà- bacteria Antimicrob 966 `567, Acar new ƒà-lactamase and tazobactam for penicillin binding proteins (PBPs) Mit-
20 CHEMOTHERAPY suhashi S: Inhibition of j9-lactamases by tazobactam and in vitro antibacterial activity of tazobactam combination with piperacillin. J Antimicrob Chemother 25: , ) Kitzis M D, Billot-Klein D, Goldstein F W, Williamson R, Tran van Nhieu G, Carlet J, Acar J F, Gutmann L: Dissemination of the novel plasmid-mediated /3-lactamase CTX-1, which confers resistance to broad-spectrum cephalosporins, and its inhibitors. Antimicrob Agent Chemother 32: 9-14, ) Spratt B G: Distinct penicillin binding proteins involved in the division, elongation and shape of Escherichia coli K-12, Pro Nat Acad Sci USA 72: , 1975
21 In vitro activity of tazobactam/piperacillin, a new /9-lactamase inhibitor combined with a penicillin Chieko Kunugita, Kouichi Nishida, Fusahiro Higashitani, Akio Hyodo, Naobumi Ishida and Norio Unemi Anticancer & Antimicrobial Research Lab., Taiho Pharmaceutical Co. Ltd Ebisuno, Hiraishi, Kawauchi-cho, Tokushima , Japan Tazobactam (TAZ) is a novel 13-lactamase inhibitor. Tazobactam/piperacillin (TAZ/PIPC) was evaluated for its antimicrobial activity in comparison with clavulanic acid/ticarcillin (CVA/ TIPC), sulbactam/ ampicillin (SBT/ ABPC), cefoperazone (CPZ), sulbacatam/ cefoperazone (SBT/CPZ), cefotiam (CTM) and ceftazidime (CAZ). TAZ/PIPC showed 16-to 64-fold stronger activity than PIPC against TEM1/9-lactamase-producing oraganisms, and the MIC of TAZ/PIPC was smaller than those of CVA/TIPC and SBT/ABPC, and similar to that of SBT/CPZ. PIPC had poor activity against highly 19-lactamase-producing Bacteroides spp., but TAZ/PIPC had potent activity. The MIC90s of TAZ/PIPC were 50, 6.25, 0.10, 12.5, 6.25, 50, 0.78, 25, 50, 50, 50, 100, 6.25, 1.56, and 12.5 pg/ml against Staphylococcus aureus, Staphylococcus epidermidis, Moraxella (Branhamella) catarrhalis, Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Proteus mirabilis, Pseudomonas aeruginosa, Acinetobacter calcoaceticus, Serratia marcescens, Enterobacter cloacae, Citrobacter freundii, Morganella morganii, Proteus vulgaris, and Providencia rettgeri. The MIC of TAZ/PIPC was not changed under different conditions of the medium, ph, serum concentration and inoculum size. The bactericidal activity of TAZ/PIPC was stronger than that of PIPC against S. aureus 55 and E. coli TEM1 at concentations higher than 1 MIC. TAZ/PIPC showed a strong binding affinity to PBPs 2, 3 and 1 of S. aureus 209P JC, and PBPs 3, 1A and 2 of E. coli NIHJ JC-2.
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