Hoda Mohamed Owais1, Manal Mohammad Baddour1, Hala Abd El-Raouf El-Metwally1, Heba Soliman Barakat2, Nour Sherif Ammar3, Marwa Ahmed Meheissen4. 1. Medical Microbiology and Immunology Department, Faculty of Medicine, Alexandria University, Khartoum Square, Azarita, Alexandria, 21512, Egypt. 2. Pharmaceutics Department, Faculty of Pharmacy, Alexandria University, Alexandria, 21512, Egypt. 3. Alexandria University Hospitals, Alexandria University, Alexandria, 21512, Egypt. 4. Medical Microbiology and Immunology Department, Faculty of Medicine, Alexandria University, Khartoum Square, Azarita, Alexandria, 21512, Egypt. marwa.meheissen@alexmed.edu.eg.
Abstract
BACKGROUND AND AIM: Extensively drug-resistant (XDR) Klebsiella pneumoniae represent a major threat in intensive care units. The aim of the current study was to formulate a niosomal form of azithromycin (AZM) and to evaluate its in vitro effect on XDR K. pneumoniae as a single agent or in combination with levofloxacin. MATERIAL AND METHODS: Forty XDR K. pneumoniae isolates (23 colistin-sensitive and 17 colistin-resistant) were included in the study. Formulation and characterization of AZM niosomes were performed. The in vitro effect of AZM solution/niosomes alone and in combination (with levofloxacin) was investigated using the checkerboard assay, confirmed with time-kill assay and post-antibiotic effect (PAE). RESULTS: The AZM niosome mean minimal inhibitory concentration (MIC) (187.4 ± 209.1 μg/mL) was significantly lower than that of the AZM solution (342.5 ± 343.4 μg/mL). AZM niosomes/levofloxacin revealed a 40% synergistic effect compared to 20% with AZM solution/levofloxacin. No antagonistic effect was detected. The mean MIC values of both AZM niosomes and AZM solution were lower in the colistin-resistant group than in the colistin-sensitive group. The mean PAE time of AZM niosomes (2.3 ± 1.09 h) was statistically significantly longer than that of the AZM solution (1.37 ± 0.5 h) (p = 0.023). CONCLUSION: AZM niosomes were proved to be more effective than AZM solution against XDR K. pneumoniae, even colistin-resistant isolates.
BACKGROUND AND AIM: Extensively drug-resistant (XDR) Klebsiella pneumoniae represent a major threat in intensive care units. The aim of the current study was to formulate a niosomal form of azithromycin (AZM) and to evaluate its in vitro effect on XDR K. pneumoniae as a single agent or in combination with levofloxacin. MATERIAL AND METHODS: Forty XDR K. pneumoniae isolates (23 colistin-sensitive and 17 colistin-resistant) were included in the study. Formulation and characterization of AZM niosomes were performed. The in vitro effect of AZM solution/niosomes alone and in combination (with levofloxacin) was investigated using the checkerboard assay, confirmed with time-kill assay and post-antibiotic effect (PAE). RESULTS: The AZM niosome mean minimal inhibitory concentration (MIC) (187.4 ± 209.1 μg/mL) was significantly lower than that of the AZM solution (342.5 ± 343.4 μg/mL). AZM niosomes/levofloxacin revealed a 40% synergistic effect compared to 20% with AZM solution/levofloxacin. No antagonistic effect was detected. The mean MIC values of both AZM niosomes and AZM solution were lower in the colistin-resistant group than in the colistin-sensitive group. The mean PAE time of AZM niosomes (2.3 ± 1.09 h) was statistically significantly longer than that of the AZM solution (1.37 ± 0.5 h) (p = 0.023). CONCLUSION: AZM niosomes were proved to be more effective than AZM solution against XDR K. pneumoniae, even colistin-resistant isolates.
Authors: Shafi Ullah; Muhammad Raza Shah; Mohammad Shoaib; Muhammad Imran; Syed Wadood Ali Shah; Imdad Ali; Farid Ahmed Journal: Drug Dev Ind Pharm Date: 2017-02-20 Impact factor: 3.225
Authors: A-P Magiorakos; A Srinivasan; R B Carey; Y Carmeli; M E Falagas; C G Giske; S Harbarth; J F Hindler; G Kahlmeter; B Olsson-Liljequist; D L Paterson; L B Rice; J Stelling; M J Struelens; A Vatopoulos; J T Weber; D L Monnet Journal: Clin Microbiol Infect Date: 2011-07-27 Impact factor: 8.067