ANAEROBIC ACTIVITY OF CEFOPERAZONE SULBACTAM

ANAEROBIC ACTIVITY OF CEFOPERAZONE SULBACTAM

Sulbactam is added with Cefoperazone in order to increase the anaerobic activity of Cefoperazone. Individually sulbactam has shown activity against anaerobic bacteria including those producing beta lactamases

Antagonistic activity between the Cefoperazone and sulbactam has not been noted.(1)
In a study done for assessing the anaerobic activity of sulbactam in combination with Cefoperazone against Bacteroides fragilis it was found that out of 42 % of Bacteroides fragilis which was found initially resistant to Cefoperazone alone, 94% among them were converted to susceptible on the addition of sulbactam.(1) Out of all the strains of Bacteroides fragilis studied 67% was susceptible to Cefoperazone sulbactam and 27%was moderately susceptible.(1)

One more invitro study where the activity of the Cefoprazone alone and in combination with sulbactam was compared , it was shown that Cefoprazone sulbactam has anaerobic activity and inhibited 90-100% of all bacteria but Cefoperazone has activity of 63%. The percent susceptible against Bacteroides fragilis group is 99 to 100% for cefoperazone-sulbactam and for Cefoperazone, 49%.(2)

In one more study where 374 selected beta-lactamase-producing gram-negative anaerobes (including 22 cefoxitin-resistant strains and 36 strains refractory to the enhancing effect of beta-lactamase inhibitors) and 20 beta-lactamase-negative strains were tested against antimicrobials. The organisms included in the study consists of 217 Bacteroides fragilis group strains, 137 non-B. fragilis group Bacteroides spp., and 40 fusobacteria. (3)

The study showed that in Bacteroides fragilis group 95% were susceptible to cefoperazone-sulbactam. For the beta-lactamase-positive non-B. fragilis group Bacteroides spp., greater than or equal to 94% were susceptible cefoperazone-sulbactam. . For the beta-lactamase-positive fusobacteria, greater than or equal to 97% were susceptible cefoperazone-sulbactam.(3)

DRAWBACK:
Cefoperazone-sulbactam lacked activity against some cefoxitin-resistant B. fragilis group strains but had excellent activity against other organisms.

CONCLUSION:
Adddition of Metronidazole to Cefoperazone -sulbactam routinely is not needed. As Cefoperazone -sulbactam itself will cover most of anaerobe, addition of Metronidazole will add to unnecessary cost of treatment to the patient without any increase in benefit and also will lead to development of resistance to the Cefoperazone-sulbactam.

REFERENCES
1. D'Amato RF, Hochstein L, Frankel H. In vitro activity of cefoperazone/sulbactam and other antimicrobials against anaerobic bacteria. Diagnostic microbiology and infectious disease. 1990 Jan-Feb;13(1):51-5. PubMed PMID: 2331850. Epub 1990/01/01. eng.
2. Wexler HM, Finegold SM. In vitro activity of cefoperazone plus sulbactam compared with that of other antimicrobial agents against anaerobic bacteria. Antimicrobial agents and chemotherapy. 1988 Mar;32(3):403-6. PubMed PMID: 3364960. Pubmed Central PMCID: PMC172186. Epub 1988/03/01. eng.
3. Appelbaum PC, Spangler SK, Jacobs MR. Susceptibilities of 394 Bacteroides fragilis, non-B. fragilis group Bacteroides species, and Fusobacterium species to newer antimicrobial agents. Antimicrobial agents and chemotherapy. 1991 Jun;35(6):1214-8. PubMed PMID: 1929264. Pubmed Central PMCID: PMC284313. Epub 1991/06/01. eng