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Cephalosporin Therapy for SalmonellosisQuestions of Efficacy and Cross Resistance With Ampicillin
Charles E. Cherubin, MD;
Robert H. K. Eng, MD;
Sharon M. Smith, PhD;
Ellie J. C. Goldstein, MD
Arch Intern Med. 1986;146(11):2149-2152.
Abstract
• The new cephalosporins should be explored for Salmonella septicemia efficacy, because of multiple-drug resistance, the high incidence of patient allergies to ampicillin and sulfamethoxazole-trimethoprim, and the limited number of antibiotics with proven efficacy. This study reports on six widely used cephalosporins: cephalothin, cefamandole, cefoperazone, cefoxitin, cefotaxime, and ceftriaxone with respect to in vitro killing of Salmonella. This in vitro activity was related to the stability of the agents to β-lactamases. Cefoperazone was the least stable, followed by cefamandole and cephalothin. Cefoxitin, cefotaxime, and ceftriaxone were the most stable. The β-lactamase—unstable agents permitted regrowth of β-lactamase—producing salmonella within 36 hours. Standard susceptibility tests showed good inhibitory levels by these unstable agents at 18 hours, but the minimum inhibitory concentrations increased dramatically with longer incubation periods. Based on these results, past cephalothin failures for ampicillin-resistant Salmonella can be explained. Additionally, there should be a dichotomy of effectiveness in the new cephalosporins depending on their β-lactamase stability. The stable cephalosporins deserve further clinical trials In the treatment of β-lactamase—producing Salmonella infections.
(Arch Intern Med 1986;146:2149-2152)
Author Affiliations
From the Department of Medicine, Bayley Seton Hospital, Staten Island, NY (Dr Cherubin), the Infectious Disease Section, Medical Service Microbiology Section, Laboratory Service, Veterans Administration Medical Center, East Orange, NJ (Dr Eng), and R. M. Alden Laboratory, Los Angeles (Drs Smith and Goldstein).
Footnotes
Accepted for publication March 3, 1986.
Reprint requests to Medical Service-111, Veterans Administration Medical Center, East Orange, NJ 07019 (Dr Eng).
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