Антибиотики и Химиотерапия (May 2020)
Cefotaxime/Sulbactam: an Important Addition to the Arsenal of Inhibitor-Protected Beta-Lactam Antibiotics
Abstract
A new inhibitor-protected beta-lactam antibiotic has been registered in Russia, a fixed combination of antistreptococcal cephalosporin III, cefotaxime and inhibitor of beta-lactamase sulbactam in a 2:1 ratio. The antimicrobial spectrum of cefotaxime/sulbactam combines the high activity of protected aminopenicillins against gram-positive bacteria and the high activity of protected cephalosporins against enterobacteria. Fur thermore due to the addition of sulbactam, cefotaxime/sulbactam's antimicrobial activity spectrum also includes one of the leading infectious agents in the ICU - Acinetobacter baumannii. Adding sulbactam to cefotaxime leads to a two-fold decrease in the IPC50 of E.coli and K.pneumoniae, and even more pronounced decrease in P.mirabilis. The frequency of resistant strains of K.pneumoniae, E.cloaceae, S.marcescens, and A.baumannii significantly (3-10 times) decreases when combining cefotaxime with sulbactam in a 2:1 ratio compared to cefotaxime without an inhibitor. The high activity of cefotaxime/sulbactam against K.pneumoniae strains producing BLRS and resistant to imipenem A.baumannii is of high clinical significance for the treatment of nosocomial infections. High efficacy of cefotaxime/sulbactam in adults and children in the treatment of pneumonia, peritonitis, urinary tract infections, as well as skin and soft tissues has been shown in 4 clinical studies conducted in Russia and other countries. In accordance with the clinical guidelines of Antimicrobial Therapy Control Strategy, cefotaxime/sulbactam combination is recommended for patients of type II (community-acquired infections with risk of ESBL) and type IIIa (nosocomial infections without the risk of P.aeruginosa and carbapenemases). For moderately severe infections, cefotaxime/sulbactam combination is prescribed in a dose of 1.5 g (1+0.5 g) every 8-12 hours; in severe infections, the dose may be increased to 3 g (2+1 g) every 6 hours. Cefotaxime/sulbactam can be administered intravenously as a bolus, or as a 60-minute infusion. Infusion is preferred because it increases the likelihood of achieving the desired effect, given the time-dependent nature of the antimicrobial action of beta-lactam antibiotics.
