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Table 1. Antibacterial activity of cefdinir, cefixime, cefteram, cefuroxime, cefaclor and amoxicillin against standard strains Inoculum size: 108 cells/ml CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin

Table 2. Antibacterial activity of cefdinir, cefixime, cefteram, cefuroxime, cefaclor and amoxicillin against standard strains Inoculum size:106cells/ml CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 2. Sensitivity distribution of clinical isolates of Staphylococcus aureus (outpatients), 19 strains. CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin ()1: Cumulative percent of strains inhibited (%) Fig. 3. Sensitivity distribution of clinical isolates of Staphylococcus aureus (inpatients), 24 strains.

Fig. 4. Sensitivity distribution of clinical isolates of Staphylococcus aureus (MRSA), 60 strains. Fig. 5. Sensitivity distribution of clinical isolates of Staphylococcus epidermidis, 34 strains.

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin( ): Cumulative percent of strains inhibited (%) Fig. 6. Sensitivity distribution of clinical isolates of Streptococcus pneumoniae, 28 strains. CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin() : Cumulative percent of strains inhibited (%) Fig. 7. Sensitivity distribution of clinical isolates of Streptococcus pyogenes, 28 strains.

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin () Cumulative percent of strains inhibited (%) Fig. 8. Sensitivity distribution of clinical isolates of Enterococcus avium, 18 strains. CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 9. Sensitivity distribution of clinical isolates of Enterococcus faecelis, 46 strains.

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 10. Sensitivity distribution of clinical isolates of Enterococcus faecium, 29 strains. CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin() : Cumulative percent of strains inhibited (%) Fig. 11. Sensitivity distribution of clinical isolates of Escherichia coli, 32 strains.

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 12. Sensitivity distribution of clinical isolates of Klebsiella pneumoniae, 29 strains. CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: (): Cumulative percent of strains inhibited (%) Fig. 13. Sensitivity distribution of clinical isolates of Klebsiella oxytoca, 17 strains.

CFDN: cefdinir, CFIX: cefixirne, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 14. Sensitivity distribution of clinical isolates of Proteus mirabilis, 20 strains. CFDN: cefdinir, CFIX: cefixirne, CFTM: cefteram, CXM cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 15. Sensitivity distribution of clinical isolates of Proteus vulgaris, 20 strains.

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 16. Sensitivity distribution of clinical isolates of Morganella morganii, 20 strains. CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 17. Sensitivity distribution of clinical isolates of Providencia rettgeri, 20 strains.

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin() : Cumulative percent of strains inhibited (%) Fig. 18. Sensitivity distribution of clinical isolates of Providencia stuartii, 24 strains. CFDN: cefdinir, CFIX: cefixime, CFTM cefterarn, CXM: cefuroxime, CCL: cefaclor, AMPC:amosicillin( ): Cumulative percent of strains inhibited (%) Fig. 19. Sensitivity distribution of clinical isolates of Serratia marcescens, 27 strains.

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin ()Cumulative percent of strains inhibited (%) Fig. 20. Sensitivity distribution of clinical isolates of Enterobacter cloacae, 22 strains. CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 21. Sensitivity distribution of clinical isolates of Pseudomonas aeruginosa, 18 strains.

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin() : Cumulative percent of strains inhibited (%) Fig. 22. Sensitivity distribution of clinical isolates of Haemophilus influenzae, 18 strains. CFDN: cefdinir, CFIX cefixime, CFTM cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 23. Sensitivity distribution of clinical isolates of Bordetella pertussis, 21 strains.

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin Cumulative percent of strains inhibited (%) (): Fig. 24. Sensitivity distribution of clinical isolates of Neisseria gonorrhoeae (non-ppng), 40 strains. CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor, AMPC: amoxicillin (): Cumulative percent of strains inhibited (%) Fig. 25. Sensitivity distribution of clinical isolates of Neisseria gonorrhoeae (PPNG), 33 strains.

CFDN: cefdinir, CFIX: cefixime, CFTM: cefteram, CXM: cefuroxime, CCL: cefaclor (): Cumulative percent of strains inhibited (%), AMPC: amoxicillin Fig. 26. Sensitivity distribution of clinical isolates of Bacteroides fragilis, 23 strains.

Inoculum size: 106 cells/ml Fig. 27. MIC50 and MIC80 of cefdinir against clinical isolates.

Fig. 28. Bactericidal activity of cefdinir, cefixime, cefteram, cefuroxime, cefaclor and amoxicillin against Klebsiella pneumoniae 3K25.

Fig. 29. Enzymatic stability of cefdinir and other antibiotics

Table 3. Protective effect of cefdinir and other antibiotics on experimental infection in mice *5% mucin added ED50: Van der Waerden method (95% confidence limit) MLD: Minimum lethal dose Administration: p.o., 1 h after infection Mouse: ICR, 4 W,. 19 }1g, 6 animals/group

Table 4. Protective effect of cefdinir and other antibiotics on experimental infection in mice *5% mucin added ED50: Van der Waerden method (95% confidence limit) MLD: Minimum lethal dose Administration: p.o., 1h after infection Mouse: ICR, 4W,, 19 }1g, 6 animals/group

Table 5. Protective effect of cefdinir and other antibiotics in mice infected simultaneously with Escherichia coli and Bacteroides fragilis *5% mucin added ED50: Van der Waerden method (95% confidence limit) MLD: Minimum lethal dose Administion: p.o. 1h after infection Mouse: ICR, 4W,, 19 }1g, 6 animals/group Challenge dose: 1.2 ~107 cfu/mouse Therapy:5mg/mouse, p.o., bid ~3days after challenge Challenge dose: 3 ~108cfu/mouse Therapy: lmg/mouse, p.o., 6 h after challenge Fig. 30. Therapeutic effect of CFDN and other antibiotics on experimental urinary tract infection due to Escherichia coli KU-3 in mice. Fig. 31. Therapeutic effect of CFDN and other antibiotics on viable cells in lungs of mice intranasally infected with Streptococcus pneumoniae TMS3. 1) MINE Y, KAMIMURA T, WATANABE Y, TAWARA S, MATSUMOTO Y, SHIBAYAMA F. KIKUCHI H, TAKAYA T, KUWAHARA s: In vitro antibacterial activity of FK482, a new orally active cephalosporin. J. Antibiot. 41: 1873 `1887, 1988

Table 6. Protective effect of cefdinir and other antibiotics on experimental infection in mice intranasally infected with Klebsiella pneumoniae 3K25 *Intranasal infection: 50ƒÊl ED50: Van der Waerden method (95% confidence limit) MLD: Minimum lethal dose (1 ~107 i. p. challenge) Administration: p. o., 6 h after infection Mouse: ICR, 4W,, 19 }1g, 6 animals/group Table 7. Comparative protective effect of cefdinir and other antibiotics on experimental infection in normal and neutropenic mice *5% mucin added * cyclophosphamide(250mg/kg) *, i.p., 4 days before infection ED50: Van der Waerden method(95% confidence limit) MLD: Minimum lethal dose (normal mice 1 ~106cfu/mouse, neutropenic mice 4.8 ~105 cfu/ mouse) Administration: p. o., 1h after infection Mouse: ICR, 4W,, 19 }1g, 6 animals/group 2) MINE Y, YOKOTA Y, WAKAI Y, KAMIMURA T, TAWARA S, SHIBAYAMA F, KIKUCHI H, KUWAHARA S: In vivo antibacterial activity of FK482, a new orally, active cephalosporin. J. Antibiot. 41: 1888 `1895, 1988

cefdinir cefixime cefteram pivoxil cefuroxime axetil cefaclor amoxicillin Fig. 32. Serum level in mice. Table 8. Kidney and lung levels of cefdinir and other antibiotics after oral dosing in mice Administration: p. o., 1mg/mouse Mouse: ICR, 4W,, 19 }1g, 5 animals/group 8) SAKAMOTO H, HIROSE T, NAKAMOTO S, HATANO K, SHIBAYAMA F, KIKUCHI H, MINE Y, KUWAHARA S: Pharmacokinetics of FK482, a new orally active cephalosporin, in animals. J.Antibiot. 41: 1896 `1905, 1988

IN VITRO AND IN VIVO ANTIBACTERIAL ACTIVITIES OF CEFDINIR, A NEW ORAL CEPHALOSPORIN SACHIKO GOTO, MASATOSHI OGAWA, YASUKO KANEKO and SHOGO KUWAHARA Department of Microbiology, School of Medicine, Toho University 5-21-16 Omori-nishi, Ota-ku, Tokyo 143, Japan The in vitro and in vivo antibacterial activities of cefdinir (CFDN), a new oral cephalosporin, were studied and compared with those of cefixime (CFIX), cefteram pivoxil (CFTM-PI, in vitro: CFTM), cefuroxime axetil (CXM-AX, in vitro: CXM), cefaclor (CCL) and amoxicillin (AMPC). 1. CFDN had potent activity against Gram-positive organisms, such as Staphylococcus aureus, Staphylococcus epidermidis, etc., and moderately potent activity against methicillin-resistant S. aureus and Enterococcus faecalis resistant to other oral cephalosporins. Against Gram-negative organisms, the activity of CFDN was slightly inferior to that of CFIX and CFTM, and superior to that of CXM, CCL and AMPC. 2. The bactericidal activity of CFDN against Klebsiella pneumoniae 3K25 was superior to that of the comparative drugs. Furthermore, the drug was bactericidal at sub-mic levels. 3. CFDN, like CFIX and CFTM, was extremely stable to various types of Ĉ-lactamase. 4. In mice infected experimentally with Gram-positive organisms, the therapeutic effect of CFDN was superior to that of CFIX, CFTM-PI, CXM-AX and CCL. In mice infected experimentally with Gram-negative organisms, it was also superior to that of CXM-AX, CCL and AMPC, but inferior to that of CFIX and CFTM -PI. In neutropenic mice, the therapeutic effect of CFDN was almost the same as that in normal mice. 5. The serum, lung and kidney levels of CFDN in mice were lower than those of the comparative drugs.

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