The semisynthetic penicillins, the carboxypenicillins (carbenicillin and ticarcillin), and ureido-penicillins (piperacillin, azlocillin, and mezlocillin) are generally administered in large quantities to achieve high serum concentration. These drugs are effective against Enterobacter-iaceae and have good activity against most anaerobes in these concentrations. However, they are not absolutely resistant to beta-lactamase produced by AGNB, and up to 30% of the B. fragilis group are resistant to these agents (13).
Carbenicillin has good in vitro activity against most strains of the B. fragilis group, as well as against other penicillin-sensitive anaerobes (13,21), and is effective in the treatment of clinical infections (25). Ticarcillin is similar in structure to carbenicillin and has also good in vitro activity against many anaerobic organisms (13) and was found to be effective in the treatment of anaerobic infections.
Carbenicillin was effective in the treatment of pulmonary and intra-abdominal anaerobic infections in adults (26,27) and active alone or in combination with an aminoglycoside in treatment of aspiration pneumonia (28) and chronic otitis media (29) in children. Carbenicillin has a particular advantage in these infections because of its synergistic quality with aminoglycosides against Pseudomonas aeruginosa, which was also present in these infections.
It was shown to be effective in vitro as well as in the treatment of B. fragilis infections (22,27,28,30).
Ticarcillin also has been shown to be active against B. fragilis (31), and clinical trials suggest that it is effective in the treatment of anaerobic infections. Ticarcillin is similar in pharmacology and spectrum of activity to carbenicillin, and it is effective at only half of the daily dose of carbenicillin. Because of the high sodium content in both of these drugs, the ability to give ticarcillin disodium at a lower dose is an advantage. Another adverse effect of these drugs is the induction of a thrombocytic malfunction noted especially with carbenicillin.
Because of the need to achieve high serum levels, the daily dosage of these drugs is high.
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