Assessment of the combination of doripenem plus a fluoroquinolone against non-susceptible Acinetobacter baumannii isolates from nosocomial pneumonia patients

J Chemother. 2013 Jun;25(3):141-7. doi: 10.1179/1973947813Y.0000000074.

Abstract

Carbapenem- and fluoroquinolone-non-susceptible Acinetobacter baumannii were obtained from four nosocomial pneumonia patients who were clinically cured following combination therapy with doripenem/levofloxacin or ciprofloxacin. In vitro synergy of doripenem/levofloxacin or ciprofloxacin was evaluated using time-kill analysis. In vivo synergy was tested using a mouse lethal infection model. In time-kill studies, doripenem and levofloxacin were both bactericidal when tested at Cmax; at ½Cmax, the combination showed synergy up to 8 hours. Ciprofloxacin, alone or combined with doripenem, was not bactericidal. For mouse septicemia, doripenem (100 mg/kg) was ≥90% effective in preventing death in all four isolates. Levofloxacin (200 mg/kg) was 73% effective, and ciprofloxacin (35 mg/kg) was ineffective in preventing death. At lower drug concentrations, increased efficacy was observed for doripenem/levofloxacin, but not for doripenem/ciprofloxacin. Overall, the results suggest that a doripenem/levofloxacin combination may have clinical utility in treating some non-susceptible A. baumannii infections.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acinetobacter Infections / drug therapy*
  • Acinetobacter baumannii* / drug effects
  • Animals
  • Carbapenems / administration & dosage*
  • Carbapenems / pharmacology
  • Ciprofloxacin / administration & dosage*
  • Ciprofloxacin / pharmacology
  • Doripenem
  • Dose-Response Relationship, Drug
  • Drug Resistance, Multiple*
  • Drug Synergism
  • Drug Therapy, Combination
  • Female
  • Levofloxacin*
  • Mice
  • Ofloxacin / administration & dosage*
  • Ofloxacin / pharmacology
  • Pneumonia, Ventilator-Associated / drug therapy*
  • Random Allocation
  • Survival Analysis

Substances

  • Carbapenems
  • Ciprofloxacin
  • Levofloxacin
  • Ofloxacin
  • Doripenem