Is gentamicin necessary in the antimicrobial treatment for group B streptococcal infections in the elderly? An in vitro study with human blood products.

Ruppen, Corinne; Decosterd, Laurent; Sendi, Parham (2017). Is gentamicin necessary in the antimicrobial treatment for group B streptococcal infections in the elderly? An in vitro study with human blood products. Infectious diseases, 49(3), pp. 185-192. Taylor & Francis 10.1080/23744235.2016.1244612

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BACKGROUND According to expert opinions, gentamicin should be administered as an adjunct to penicillin against severe group B streptococcal (GBS) infections. Whether the adjunct is important is of particular interest for elderly patients. Not only is the risk of aminoglycoside nephrotoxicity higher in elderly persons, but their immune defence to bacterial infections may also be impaired. METHOD Time-kill assays with human blood products, such as serum, neutrophilic granulocytes (opsonophagocytic assays) and whole blood from healthy, elderly volunteers were performed to evaluate the effect of gentamicin in combination with penicillin. RESULTS In time-kill assays with human serum and in opsonophagocytic assays, we saw a trend for faster killing with the penicillin-gentamicin combination therapy. This effect was seen 4 and 6 h after antibiotic exposure but not at time points evaluated at ≥8 h. In whole blood killing assays, no difference in killing rates was observed with adjunctive gentamicin therapy. CONCLUSION The criteria for synergism were not fulfilled when the effect of penicillin-gentamicin combinations was compared with that of penicillin monotherapy. Rapid killing of GBS within the first few hours was observed in time-kill assays with human blood products. Considering that elderly people are prone to gentamicin nephrotoxicity and that in severe GBS infection a high penicillin dose is administered every 4-6 h, the prolonged use of adjunctive aminoglycosides in these infections requires caution.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Ruppen, Corinne and Sendi, Parham

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

2374-4243

Publisher:

Taylor & Francis

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

22 Nov 2016 08:57

Last Modified:

03 May 2017 15:14

Publisher DOI:

10.1080/23744235.2016.1244612

PubMed ID:

27766925

Uncontrolled Keywords:

Group B Streptococcus; Streptococcus agalactiae; aminoglycosides; gentamicin; synergism

URI:

https://boris.unibe.ch/id/eprint/89525

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