The concentration of cefotiam (CTM), a newly synthesized cephem derivative antibiotic in serum and cerebrospinal fluid after single intravenous treatment was determined and its utility in the field of cerebral neurosurgery was studied.
1. One gram or 2g of CTM was intravenously administered for 1 time to 10 patients admitted to our department. Dose dependency was observed in the progress of the mean serum concentration. There was no difference in the specific rate of constant, and the ratio of AUC between the group treated with 1g and the one with 2 g was 1: 1.9. The biological half-lives of the elimination phase for both dose levels were about 1.1 hours.
2. Disparity was recognized in the cerebrospinal fluid concentration in spite of the dose dependency. Although a case with comparatively high value of 1.37μg/ml at 60 minutes after administration were seen in the 1g treatment group, generally the migration concentration was low. Good cerebrospinal fluid concentration was attained in all of the cases in the 2g treatment group, and the peak values ranged from 0.59 to 10.16μg/ml.
3. The concentration ratio of cerebrospinal fluid to serum in the 2g treatment group elevated till 360 minutes after administration, and the maximum values ranged from 15.8 to 89.8%.
4. The migration to the cerebrospinal fluid was faster in cases with slight inflammation than those without inflammation in the 2g treatment group.
5. It was assumed that the prophylactic effect of CTM 2g administration against staphylococci, streptococci and Klebsiella pneumoniae which are the major causative organisms can be expected in postoperative infection in the field of cerebral neurosurgery.

View full abstract

All subjects were patients with malignant tumors on the gastroenterological system and in whose cases there were marked ascites (Table 1).
In the study, each patient was subjected to the intravenous drip infusion of CTM 1g for a period of 1 hour.
Samples of peripheral venous blood and ascites were taken 4 times, at 1 hour after completion of infusion, and at 2, 3 and 4 hours. The test samples were kept at-80°C until the CTM contents were determined (Fig. 1).

View full abstract

Cefmetazole (CMZ) was intravenously injected to 12 patients with acute prostatitis as well as 3 patients with acute epididymitis.
Good clinical results were obtained in 10 patients (91.7%) with acute prostatitis and 2 patients (100%) with acute epididymitis.
No side effects were reported in all of 23 patients. Thus, CMZ could be expected to reveal good response in the treatment of male genital infections.

View full abstract

Latamoxef (LMOX), a newly developed antibiotic of the oxacephem group, was used for treatment of pertussis in 66 patients of 26 days to 7 years and 9 months old. The clinical and biological effects of LMOX could be evaluated in 60 of them (20 serious cases, 39 moderate cases and 1 slight case). The dose of LMOX, which varied from 37.5 to 200mg/kg and averaged 68.0mg/kg, was injected or infused by intravenous drip method in 2 to 4 divided doses daily for the period ranging from 4 to 21 days and averaging 7.7 days.
1. Of 49 cases treated with LMOX alone, the drug was evaluated to be effective in 48.9% on day 7 of treatment and in 85.1% on day 14. Of 11 cases treated with LMOX and r-globulin in combination, the drug was evaluated to be effective in 10 on day 7 and in all on day 14. Thus, of all cases LMOX was evaluated to effective in 56.9% on day 7 of treatment and in 87.9% on day 14.
2. The clinical effect of LMOX was analysed by the number of days from the onset of the disease until the start of treatment. The proportion of effective cases on day 7 of treatment was 70, 52.9% and 30.8%, when the treatment was started days 0-7, days 8-14, and days 15-21 of disease, respectively. LMOX was effective in 3 of 7 cases in which its administration was started on day 22 or later. Generally, the drug appeared to be more effective when its administration was started earlier. In addition, the proportion of effective cases on day 14 of treatment was 90.0, 88.2, 76.9 and 85.7% respectively. A similar tendency to that in the evaluation on day 7 was observed in these cases. Although the number of cases treated with LMOX and γ-globulin in combination was a few, the result appeared to be more favorable in them than in those treated with LMOX alone.
3. LMOX was administered at a daily dose of 40-80mg/kg to 40 of 49 cases treated with it alone. The drug was evaluated to be effective in 44.7% of them on day 7 of treatment and in 86.8% on day 14. Many of the cases treated with LMOX at a daily dose higher than 80mg/kg were in a serious condition. The drug was evaluated to be effective in 66.7% of them on day 7 of treatment and in 77.8% on day 14.
4. Bordetella pertussis was detected before starting LMOX in 9 cases. It was removed by the treatment in 87.5% of them. Fifty-five strains including isolated and conserved ones were examined for sensitivity to 4 antibiotics. These agents were more effective in the order of CPZ>LMOX>EM>ABPC.
5. No clinically significant side effects were found in 66 cases treated with LMOX. Laboratory tests demonstrated a slight rise of GOT level in only 1 case.
The results suggest that LMOX is superior to ordinary antibiotics in effectiveness. In addition, LMOX seems to be a useful drug for cases in a serious condition or in which oral medication is difficult, since it is an intravenous administration drug.

View full abstract

The clinical effects of antibiotics (lincomycin, cefotaxime, ceftizoxime, piperacillin, fosfomycin, cefmenoxime, cefotetan, cefbuperazone, cefpiramide and ceftazidime) were evaluated in gynecologic infections.
1. A total of 161 patients with gynecologic infections was treated with each antibiotic and an overall response rate was 150/161 (93.2%). The efficacy rate was 72/78 (92.3%) in intrauterine infection, 29/31 (93.5%) in uterine adnexitis, 22/25 (88.0%) in intrapelvic infection and 27/27 (100%) in external genital infection.
2. Each antibiotic proved bacteriologically effective in 94.3% of the patients with simple intrauterine infection, in 84.0% of patients with mixed intrauterine infection, in 100% of 6 patients with uterine adnexitis, in 100% of 11 with intrapelvic infection and in 100% of 25 with external genital infection. There were 160 isolated organisms with clinical effective rate of 93.8%. Eleven (6.8%) of 161 patients had infections caused by anaerobic bacteria and all of them showed clinical response to therapy.

View full abstract

A study of the antibacterial action of cefoperazone (CPZ) and piperacillin (PIPC)against E. coli demonstrated clear differences between these 2 drugs.
CPZ showed higher bactericidal and lytic activity which was dose dependent and not greatly influenced by inoculum size. In contrast, the activity of PIPC was strongly influenced by inoculum size and showed high bactericidal activity only against a low inoculum size.
The activity of CPZ was not related to the pH of the culture medium, whereas PIPC showed increased activity in an acid medium.
In a study of the drug sensitive phase of a synchronous culture, CPZ was highly effective during the period of cell division showing strong bactericidal activity at that time. The bactericidal action of CPZ was inhibited by the addition of chloramphenicol. In contrast, PIPC which by itself demonstrated only weak bactericidal activity was not effective during the period of cell division.
Although CPZ and PIPC both activate autolysin activity, CPZ was more active in this regard.

View full abstract

During the period from May through July 1981, a comparative study was carried out on the antibacterial activities of cefotaxime (CTX) and ceftizoxime (CZX), cefoperazone (CPZ), latamoxef (LMOX), cefotiam (CTM), cefmetazole (CMZ) and cefazolin (CEZ). CTX and these other cephem antibiotics were tested against fresh clinical isolates which had been obtained from clinical materials by the laboratories of 14 participating medical institutions.
1. The clinical isolates were obtained from various clinical materials in the following decreasing order; urine, sputum and pus/discharge; 85.7% of the isolates came from these materials.
2. Concerning the sources of each species of clinical isolates, it was found that P. aeruginosa was isolated from the greatest number-9-of different clinical materials. This was followed by E. coli and E. cloacae, each isolated from 8 different clinical materials, and C. freundii and E. aerogenes, each found in 7 different clinical materials.
3. In relation to S. pyogenes, S. agalactiae and S. pneumoniae, CTX showed the best antibacterial activity; the second most potent antibiotic was CZX. CMZ and LMOX were found to show relatively high MIC values for those species. Against S. aureus, CEZ showed the best antibacterial activity, but 3 resistant strains had MICs of>100 μg/ml.
4. With regard to Gram-negative bacteria, CTX and CZX showed the best antibacterial activities for all of the species, except for P. aeruginosa. These were followed, in order, by LMOX and CPZ. Compared with these 4 antibiotics, CTM, CMZ and CEZ were found to have inferior antibacterial activities against these bacteria. In relation to P. aeruginosa, the peak of the MIC distribution for CPZ was 6.25μg/ml, and this was the best antibacterial activity detected with the various antibiotics tested. This was followed by CTX (25μg/ml) LMOX (25μg/ml) and CZX (50μg/ml). CTM had an MIC of 100μg/ml for 1 strain, and MICs of>100μg/ml for all of the other strains of P. aeruginosa, indicating them to be resistant to this antibiotic. All of the strains were resistant to CMZ and CEZ, showing MICs of>100μg/ml.
5. For each of the tested antibiotics, no correlation was found between the MIC and the serogroup for either P. aeruginosa or S. marcescens.

View full abstract

Susceptibilities of 737 strains of 19 species of bacteria to cefotaxime (CTX) were determined based on the inhibition zone diameter obtained by the single-disc method. Four categories were assessed.
1. Susceptibility of clinical isolates to CTX and 6 other antibiotics
Against most strains, CTX showed higher antibacterial activity than other drugs (CET, ABPC, SBPC, CMZ, GM, AMK), especially for S. pneuinoniae, S. pyogenes and S. agalactiae. Furthermore, CTX was more active than the other antibiotics against E. coli, Indole (+) Proteus, P. mirabilis, Klebsiella sp., S. marcescens, H. influenzae and E. cloacae.
2. Susceptibility of strains isolated from different clinical materials
CTX showed the highest antibacterial activity against most strains isolated from sputum, urine, pus, blood and cerebrospinal fluid. However, CTX was occasionally less than potent AMK and GM against strains isolated from bile. Against P. aeruginosa strains derived from clinical materials, the following results were obtained:
AMK> CFS, FOM > CTX> GM> SBPC
3. Susceptibility of clinical isolates in 7 different fields CTX was the most active antibiotic tested in the fields of internal medicine, pediatrics, urology, obstetrics & gynecology, dermatology and otorhinolaryngology. But in surgery, CTX was less potent than GM and AMK.
4. Susceptibility of clinical isolates of inpatients and outpatients
CTX showed excellent activity against many β-lactamase resistant strains isolated from patients.

View full abstract

The findings in a statistical survey of drug-resistant sensitivity of causative bacteria isolated from pyoderma in the Dermatological Clinic of Mie University Hospital durings the years from 1965 to 1981 are reported.
The incidence of sensitivity to PCG, ABPC and EM tend to decline year after year.
Recently, DOXY-resistant Staphylococcus aureus is not exist but CEX-resistant strain make appearence in 1981.

View full abstract

Serum concentrations of gentamicin (GM) were monitored after intravenous drip infusion of 60 mg over 30 minutes, 1 hour and 2 hours. These concentrations were compared with those after intramuscular injection.
The mean peak serum concentration obtained at 30 minutes after intramuscular injection (5.09μg/ml) and those obtained at the end of intravenous drip infusion (5.17-6.66μg/ml) were comparable. Serum concentrations decreased to less than 2.0μg/ml at 6 to 8 hours after injection or infusion in all cases except 1 with less body weight than others.
Pharmacokinetic analysis showed that the T 1/2 of GM ranged from 2.49 to 4.33 hours and that the AUC ranged from 19.66 to 27.09 hr·μg/ml.
Results obtained in this study suggested that the usefulness of intravenous drip infusion over the time from 30 minutes to 2 hours is equal to that of intramuscular injection in the GM therapy.

View full abstract

A part of our continuous investigation on the clinical effect of cefaclor against urinary tract infections was reported herein. Cefaclor, a daily dose of 0.75g t. i. d., has been applied for the treatment of (I) 26 cases with the simple UTI and (II) 41 cases with the complicated. Rates of effectiveness were obtained 100% in (I) and 80% in (II). Side effects were noted in 8 cases (8.4%) out of total 95 cases.

View full abstract

Fosfomycin (FOM) was administered intravenously to 65 cases of severe infections complicated with 62 cases of several haematological disorders. Out of 65 cases, 45 were treated with high dosis FOM, i. e., 8g per day or more. Another 20 cases were treated in usual dosis of 4-6g per day.
Causative organisms were isolated from 52 cases of which 32 cases were Gram-negative bacilli and 19 cases were Gram-positive cocci.
The effective rate of FOM was 57.8% in the high-dose treatment group (26/45) and 45.0% in the usual-dose treatment group (9/20), but the significant difference was not defined.
Among 32 cases with Gram-negative bacilli infections, including Pseudomonas aeruginosa or Serratia marcescens, 15 cases were effective (47%). On the contrary, 14 out of 19 cases with Gram-positive cocci infections were effective (74%).
Thirteen cases (50.0%) were effective even in which neutrophils were less than 500/cmm before FOM administration.
Severe side effects were not observed, without 2 cases. One was skin eruption due to drug allergy and the other was suspected to be interstitial pneumonitis, but not confirmed pathologically.
These data suggest that high dose treatment of FOM were useful for the severe infections even in neutropenic state in haematological disorders.

View full abstract

Using the double-blind comparative trial method, we conducted a multicenter cooperative study at 52 institutions throughout Japan on the efficacy and the safety of cefotetan (CTT) at a dose of 2g/day and cefmetazole (CMZ) at a dose of 4g/day in treating bacterial pneumonia and other lower respiratory tract infections and achieved the following results.
1. The patients were classified according to severity of symptoms and based on the judgment of the committee, it was concluded that in regard to clinical efficacy CTT proved to be significantly superior to CMZ in bacterial pneumonia cases of moderate severity. Even in all cases, CTT tend to show a superior clinical effectiveness on cases moderate severity. No other significant differences in regard to clinical efficacy were observed between these 2 drugs either by the committee or the attending physicians.
2. An analysis of all cases accepted by the committee showed that CTT was significantly superior in effectively relieving fever, and CMZ was significantly superior in relieving cough symptom.
3. No significant difference was observed between 2 drugs in regard to bacteriological effectiveness.
4. No significant difference was observed between 2 drugs in regard to the nature or frequency of side effects or abnormal clinical laboratory findings.
5. No significant difference was observed between 2 drugs in regard to clinical usefulness.
From the above findings we concluded that 2g/day of CTT was equal or superior in some cases to 4g/day of CMZ in the treatment of respiratory tract infections.

View full abstract

A clinical study of daily administrations of CTT (2g) and CMZ (4g) was performed by randomized double blind techniques in order to compare the clinical efficacy, side effects and usefulness.<BR>The 150 cases studied were as follows; Purulent peritonitis due to perforated gastrointestinal tracts (122 cases), traumatic peritonitis (4 cases), biliary peritonitis (7 cases), postoperative peritonitis (7 cases), intraabdominal abscess (6 cases); 4 cases were excluded from the statistical evaluation because of protocol deviation.<BR>1. No significant differences in background parameters were found between the 2 groups.<BR>2. Clinical evaluation of the efficacy rate by the attending physician revealed no significant differences between the 2 groups (CTT 82%, CMZ 74%). However, in severely perforated duodenal and/or gastric ulcer cases, greater clinical effectiveness was obtained in the CTT group than in the CMZ group (P <0.05).<BR>3. Clinical evaluation of the efficacy rate by the committee revealed no significant differences between the 2 groups; 86% and 82% for the CTT and CMZ groups, respectively. However, in cases which showed marked effectiveness, although statistical significant differences were not found between the 2 groups (P<0.1), the CTT group (53%) was superior to the CMZ group (38%). In 122 cases of the purulent peritonitis, the efficacy rate was 92% in the CTT group and 86% in the CMZ group; this difference was also statistically significant by U-test (P <0.05).<BR>4. The effectiveness was also evaluated by microbiological study in 90 cases. No significant differences were found in the ratio of eradication of isolated bacteria between the 2 groups; 30 of 44 cases (68%) in the CTT group and 34 of 46 cases (74%) in the CMZ group.<BR>5. With regards to this eradication of bacterial strains; 115 of 119 strains (96.6%) were eradicated in the CTT group and 115 of 126 strains (91.3%) in the CMZ group.<BR>6. Side-effects were noted in 2 cases in the CTT group: one case of nausea with chest discomfort and the other case of drug eruption. In the CMZ group, only 1 case of drug eruption was noted. Moreover, no significant differences were found in the laboratory findings between the 2 groups.<BR>Based on these results it was concluded that the clinical effectiveness of CTT (1g twice daily) against peritonitis is as excellent as that of CMZ (2g twice daily), both drugs being administered by drip infusion.

View full abstract

Seventy-six patients with severe infection accompanying hematologic disorders including leukemia and lymphoma were treated with intravenous drip infusion of cefotetan (CTT).
Of the 66 cases in whom the efficacy could be evaluated, 22 cases responded markedly and 16 cases moderately, the effective rate being 57.6%. It is impressed that more cases responded markedly to CTT than to any other antibiotics previously studied.
None of the cases revealed serious side effects attributable to CTT
These results indicate that CTT is an effective and safe antibiotic for the treatment of severe infection accompanying hematologic disorders.
As CTT was administered to special cases under marked decrease of neutrocyte, the importance of neutrocyte in the treatment of infection was also indicated.

View full abstract

The concentrations of cefotetan (CTT) in serum, uterus, ovary and oviduct tissues were determined in 30 patients after single intravenous drip infusion of 1g over 1 hour.
1. Peripheral blood level of cyr was determined from 3 to 24 hours after injection. The maximum level was observed at 3 hours after injection and the concentration went down gradually with time.
2. The tissue concentrations of CTT in intrapelvic organs also tended to decrease with time and hardly detected 24 hours after injection.
3. From 3 to 12 hours after injection, mean penetration rate of CIT into intrapelvic organs was 40% and more.
4. Among intrapelvic organs, penetration rate into portio was highest, and others were ovary, uterine cervix, oviduct, endometrium, myometrium and uterine myoma in order of lowering penetration rate.
5. The penetration rate into uterine myoma was approximately half that into normal tissue.
Considering above results, CET is expected to show sufficient effects against Gram-negative bacilli and Bacteroides sp. when reasonably dosed.

View full abstract

Amoxicillin (AMPC), a widely used oral penicillin exhibites a strong bactericidal activity and a high level of safety. In the present study we administered L-AMPC, long acting AMPC granule, to 18 cases with urinary tract infections and obtained the following clinical results.
1. In all cases with acute simple cystitis, the effect was excellent.
2. Of 12 cases with chronic complicated UTI, the effect was excellent in 1 case, good in 4 cases and no effect was noted in 7 cases. The efficacy rate was 41.7%.
3. No side effects nor abnormal values in the laboratory examinations were noted.
4. Sixteen of 18 cases reported that this preparation was very agreeable to take compared with other powder type drugs, capsules and tablets.
From these results we can confidently state that L-AMPC is a highly useful drug combining the excellent properties of AMPC, the convenience of b. i. d. dosage which improves patients compliance and satisfactory efficacy.

View full abstract

Long acting amoxicillin (L-AMPC) was studied in the treatment of 40 patients with urinary tract infections. The dosage administered was 1,000 mg/day (b. i. d.) consecutively for 3 days in acute simple UTI and 5 days in chronic complicated UTI. Clinical efficacy was assessed according to the criteria established by the UTI Committee in Japan. Accordingly the response to therapy in 27 patients with acute simple cystitis was excellent in 17, moderate in 8 and poor in 2 cases and for chronic complicated UTI was excellent in 2, moderate in 3 and poor in 6 cases. Thus the overall clinical efficacy ratios for acute simple cystitis and chronic complicated UTI were 93% and 45% respectively. The bacteriological elimination ratios were 25 out of 27 of the causative organisms (93%) for acute simple cystitis and 6 out of 11 for chronic complicated UTI (55%).
No side effects of significance were observed.
The results obtained demonstrated the usefulness of the b. i. d. administration of L-AMPC and were considered, in the light of previous experience to be similar to those obtained with conventional amoxicillin dosage schedules.

View full abstract

The distribution of L-AMPC, a newly developed long acting amoxicillin granules, was studied in oral tissues using New Zealand White rabbits.
The antibiotic was dosed at 20mg/kg and the tissue concentrations were measured in the tongue, gingiva, submaxillary gland, cervical lymphnode and the parotid gland. Amoxicillin concentrations in liver and kidney were monitored for reference and urinary recovery was measured over 5 hours.
All tissue concentrations were both high and persistent whereas amoxicillin concentrations in kidney and liver were high and low, respectively, the observation consistent with the published data for amoxicillin.

View full abstract

The long-acting amoxicillin granules (L-AMPC) was administered to 12 patients with respiratory tract infections and the following results were obtained.
1. L-AMPC was administered to 6 cases of acute upper respiratory tract infection, 2 of lower respiratory infection with lung cancer, 2 of bronchiectasis, 1 of lower respiratory infection with diffuse interstitial fibrous pneumonia and 1 of chronic bronchitis, and the overall efficacy rate was 83.3% (10/12), excellent in 2, good in 8, fair in 1 and poor in 1.
2. Bacteriologically, H. influenzae (5 strains), S. aureus (3 strains), S. pneumoniae (1 strain) and S. faecalis (1 strain) were eradicated and each 2 strains of K. pneumoniae and C. diversus appeared after treatment.
3. No side effect was observed and a slightly transient elevation of GPT was observed in only 1 case.
From the above, L-AMPC seems to be a useful and safety drug in respiratory tract infections.

View full abstract

Clinical studies with long acting amoxicillin (L-AMPC) have been carried out and the following results were obtained.
1. Forty-two patients with acute bacterial infections in the oral region were administrated orally L-AMPC at a daily dose of 1 gram. The clinical results obtained were classified as excellent in 3 cases, good in 28 cases, and the overall efficacy was 75.6%.
2. The antibacterial activity of AMPC was determined for 66 strains isolated from patients with oral infections. Of the strains tested, Gram positive cocci showed high sensitivity with MIC's less than 1.56mcg/ml, while the sensitivity of PC resistance strains of S. aureus, K. pneumoniae and P. vulgaris was lower.
3. There was 1 case of transaminase elevation in the laboratory finding.
4. Five patients reported the following side effects, eruption 3, diarrhea 2, nausea 1, anorexia 1 and malaise 1.
From the results of the present study, it is considered that L-AMPC is a useful antibiotic in the treatment of acute bacterial infections in oral region.

View full abstract

Long acting amoxicillin granules (L-AMPC), a newly developed presentation of amoxicillin (AMPC), maintains an effective blood level for an extended period. The following results were obtained from fundamental and clinical studies of L-AMPC.
Serum and gingiva levels of AMPC were measured in 5 patients at 2 (Patient 1), 3 (Patient 2), 4 (Patient 3), 5 (Patient 4) and 6 (Patient 5) hours. Serum levels were 4.1, 5.2, 3.0, 1.7μg/ml and 1.2μg/ml respectively, and gingiva levels were 1.3, 2.6, 2.1, 1.1μg/g and 1.1μg/g respectively.
Twenty-five patients with oral and maxillofacial infections containing maxillary or mandibular osteitis were treated with L-AMPC. Clinical efficacy was assessed according to the criteria of numerical judgement established by the Japanese Society of Oral Surgery (1973) and also by the global evaluation of the clinician. In numerical judgement there were 1 excellent case, 19 good cases and 5 poor cases (efficacy ratio; 80%). The clinician's assessment was 4 excellent cases, 17 good cases, 3 fair cases and 1 poor case (84%).
Although 2 slight side effects, diarrhea and black hairy tongue were observed, both treatments were completed without problem. L-AMPC therapy (b. i. d.) showed good prolonged tissue levels and satisfactory clinical results.

View full abstract

Clostridium difficile has been implicated as the major cause of antimicrobial associated colitis or diarrhea. C. difficile was found in stools from 21 of 120 healthy subjects. C. difficile was found in stools from 8 of 9 patients with antimicrobial associated pseudomembranous colitis and in stools from 16 of 96 patients with antimicrobial associated diarrhea. The cytopathic toxin to HeLa cell neutralized by antitoxin to C. difficile was found in stools from all patients with antimicrobial associated colitis or diarrhea.
Of 21 strains isolated in the stools from healthy subjects, 19 strains were toxigenic. Some of them were highly toxigenic strains. Such highly toxigenic strains, however, did not give rise to any clinical symptoms probably because of the limited number of this organisms in the normal flora of human intestines; the number of C. difficile ranged between<10 and 10²level per gram of stool when the organism was found.
Of the 24 isolates from antimicrobial associated colitis or diarrheal patients, 4 were highly toxigenic.
The susceptibilities of 65 isolates to various antimicrobial agents were determined by the agar dilution technique. All of the 65 strains were inhibited by low concentration of rifampicin, metronidazole, vancomycin, ampicillin and amoxicillin. The isolates were highly resistant to gentamicin, cefoxitin, cefotaxime and cefmenoxime. Wide variations in susceptibility of C. difficlle strains to erythromycin, clindamycin and lincomycin were found.
The studies have shown that subinhibitory concentrations of clindamycin, cephalothin and amoxicillin cause an increase in cytotoxin levels of C. difficile during broth culture. The increase in supernatant toxin levels occurs concomitant with a decrease in sonicated cell extract toxin levels. The data suggest that a number of factor can cause a release of toxin from C. difficile into the surrounding medium or the intestine.

View full abstract