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a Ratio amoxicillin/clavulanic acid 2/1.

Abbreviations'. +, mild to moderate effect, increase or decrease 2-41ogl0 cfu/g feces; + +, strong impact >41ogl0 cfu/g feces; —, no significant changes; d, the detection limit; n.e., not examined.

a Ratio amoxicillin/clavulanic acid 2/1.

Abbreviations'. +, mild to moderate effect, increase or decrease 2-41ogl0 cfu/g feces; + +, strong impact >41ogl0 cfu/g feces; —, no significant changes; d, the detection limit; n.e., not examined.

volunteers (10,15,17,18) and in infants (7). In patients, in contrast to in healthy persons, amoxicillin has also a suppressive effect on the anaerobic microbiota (13,14,19).

Amoxicillin/Clavulanic Acid

Administration of amoxicillin/clavulanic acid has been shown to induce increased numbers of amoxocillin-resistant enterobacteria both in healthy adults (15,20-23) and in child patients (24). In some of the mentioned studies, there were also disturbances in the numbers of aerobic cocci, mainly observed as increased numbers of enterococci.

Bacampicillin, Pivampicillin, and Talampicillin

Bacampicillin, pivampicillin and talampicillin are esters of ampicillin that are better absorbed than ampicillin, and thereby a more favorable ecological effect on the intestinal microbiota is expected.

No major changes in the intestinal microbiota have been observed during long-term treatment of patients with bacampicillin (14) or in connection with shorter administration to healthy volunteers (25). However, the anaerobic microbiota was affected in some of the subjects in the latter study. Subjects receiving bacampicillin in tablets had an undisturbed intestinal microbiota in contrast to subjects receiving bacampicillin in syrup.

Pivampicillin and talampicillin have been shown to give rise to increased numbers of enterobacteria in healthy volunteers (10,26) and increased numbers of Candida species have been observed in a few subjects during administration with pivampicillin.

Azlocillin

The impact of azlocillin on the intestinal microbiota has been studied in connection with treatment of patients suffering from skin and soft tissue infections (27). Suppressed numbers of both aerobic and anaerobic species were observed and overgrowth of resistant enterobacteria occurred in some patients.

Piperacillin and Piperacillin/Tazobactam

Piperazillin is excreted in bile leading to high fecal concentrations. Short-term administration to patients undergoing colorectal surgery has resulted in marked effects on both the aerobic and anaerobic intestinal microbiota (28). Addition of tazobactam to piperazillin in treatment of patients reduced the ecological disturbances in the anaerobic microbiota while the aerobic microbiota was still suppressed (29).

Pivmecillinam

Pivmecillinam has a spectrum including in particular Gram-negative aerobic rods and the main impact during administration to healthy volunteers has been seen as reduced numbers of gastrointestinal Escherichia coli (30,31). More pronounced changes have been observed to occur at higher doses with decreasing numbers of anaerobic species like lactobacilli and bacteroides and increasing numbers of enterococci (30).

Ticarcillin/Clavulanic Acid

The effect of ticarcillin/clavulanate on the gastrointestinal microbiota has been evaluated in healthy subjects. Only minor disturbances were detected, such as decreased numbers of enterobacteria and a concomitant increase of aerobic cocci (32).

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