Antimicrobial Section / Original Paper

Hernandez B.N.a· Dilworth T.b· Kesner J.c· Ryan K.a· Thelen H.a· Mercier R.-C.a

Author affiliations

aDepartment of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
bDepartment of Pharmacy, Advocate Aurora Health Milwaukee, Milwaukee, WI, USA
cDepartment of Pharmacy, Lovelace Medical Center, Albuquerque, NM, USA

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Article / Publication Details

First-Page Preview

Received: May 12, 2022
Accepted: August 11, 2022
Published online: August 24, 2022

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 1

ISSN: 0009-3157 (Print)
eISSN: 1421-9794 (Online)

For additional information: https://www.karger.com/CHE

Abstract

Introduction: Recent evidence has shown that oral antibiotic therapy is not inferior to IV antibiotic therapy in the treatment of complicated Staphylococcus aureus infections. Therefore, oral antibiotic therapy is now frequently prescribed in clinical practice due to cost benefit, ease of administration, decreased complication rate, and lack of need for IV access. In vitro susceptibility testing for β-lactam oral antibiotics is not routinely performed as the guidelines provided by the Clinical and Laboratory Standards Institute (CLSI) recommend using oxacillin and cefoxitin as surrogate markers. Hence, oral antibiotic susceptibilities for cephalexin and dicloxacillin are not reported and implied based on oxacillin and cefoxitin. The objective of the current study was to determine whether susceptibilities among S. aureus isolates are predictable when comparing commonly used IV and oral beta-lactams. Methods: Cefazolin, cephalexin, dicloxacillin, and oxacillin broth microdilution minimum inhibitory concentrations (MICs) were determined for 100 clinical isolates of methicillin-sensitive S. aureus by broth microdilution following CLSI guidelines. Results: Among these isolates, median MICs for cephalexin were eight-fold higher than cefazolin MICs and median MICs for dicloxacillin were four-fold less than oxacillin MICs. Ten percent of more strains studied had a major or very major error in its susceptibility reporting when cephalexin was compared to its surrogate marker oxacillin. Discussions/Conclusions: The variations in MICs observed compounded with the dosing and pharmacokinetic differences of oral versus IV β-lactam suggests that establishing breakpoints for oral β-lactam antibiotics is necessary to ensure adequate therapy is selected for the treatment of complex S. aureus infections.

© 2022 S. Karger AG, Basel

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First-Page Preview

Received: May 12, 2022
Accepted: August 11, 2022
Published online: August 24, 2022

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 1

ISSN: 0009-3157 (Print)
eISSN: 1421-9794 (Online)

For additional information: https://www.karger.com/CHE

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