COMPARATIVE-EVALUATION OF ORALLY-ACTIVE ANTIBIOTICS AGAINST COMMUNITY-ACQUIRED PATHOGENS - A MULTICENTER STUDY IN 5 MEDITERRANEAN COUNTRIES

In 5 Mediterranean countries 7902 pathogens, all isolated in 1992 and 1993 from community-acquired infections, were studied for susceptibility to the following orally active antibiotics: penicillin G, ampicillin, ampicillin + sulbactam, amoxycillin + clavulanic acid (both 2:1 ratio), cefalexin, cefaclor, cefuroxime, cefetamet, doxycycline and erythromycin. Ten centers in Italy, 4 centers in Greece, 3 centers in Spain, and 1 center in Lebanon and Saudi Arabia contributed to this study; all centers used preformed standardized microtiter panels (Sceptor(R), BBL, Heidelberg, FRG). The most frequently isolated pathogens were Escherichia call (n=1267), Proteus mirabilis (n=843), Klebsiella pneumoniae (n=771), enteric Salmonella spp. (n=629), Enterobacter cloacae (n=486), Citrobacter freundii (n=383), Streptococcus agalactiae (n=346), Haemophilus influenzae (n=298), Streptococcus pyogenes (n=294), Streptococcus pneumoniae (n=246), Klebsiella oxytoca (n=243), and Shigella spp. (n=185). Statistical analysis was performed for each of the above countries and for all pooled data available. The penicillin antibiotics were the most active compounds against the gram-positive cocci, exceeding the MIC(50) values 2- to 8-fold over all cephalosporins. Regarding the gram-negatives (above all Klebsiella spp.) cefetamet was by far the most active compound (MIC(50), 1 mg/l). Regarding the percentage of resistant isolates, there were no striking discrepancies between the centers and countries involved in this study. There was, however, complete cross-resistance in penicillin-resistant S. pneumoniae isolates (MIC(50) = 2 mg/l). By far the majority of the penicillin-resistant pneumococci showed additional resistance to doxycycline and erythromycin. Regarding all 11 compounds included in this study cefetamet was the only agent with well balanced activity against both grampositive and gram-negative pathogens.