Gonzenbach H R, Sonnabend W
Schweiz Med Wochenschr. 1981 Aug 4;111(31-32):1169-83.
Moxalactam, a new beta-lactam antibiotic, was given to 35 patients at the Department of Surgery, Cantonal Hospital, St. Gall. The trial period started in April 1980 and ended in October. Moxalactam was not combined with any other antibiotic. The clinical course was observed closely and extensive bacteriological, mycological, and pharmacokinetic studies were carried out to evaluate the new antibiotic. Most of the patients had an intra-abdominal infectious disease and primary treatment was surgery. The antibiotic therapy was started at surgery. A total of 290 different bacteria could be isolated from the 35 patients. 220 isolates were aerobic and 7 0 anaerobic. The minimal inhibitory concentration was calculated for every isolate. In addition, the serum levels of moxalactam was determined in almost every patient. In 31 patients (88.6%) the therapy was successful, in 2 patients no evaluation was possible and in 2 patients the therapy was unsuccessful, including one patient with a primarily moxalactam-resistant Bacteroides fragilis responsible for sepsis. In some patients a massive increase in Candida was noted in the urine, stool, or wound drainage. Primarily moxalactam-resistant organisms, such as Streptococcus faecalis, were often found alone in the samples taken later in the course of therapy. An extraordinary change in the fecal flora could be observed during therapy, but no clinical complications resulted. No specific antifungal therapy nor any additional antibiotic against Streptococcus faecalis was necessary. Moxalactam was well tolerated and side effects were minimal. No impairment of renal function was noticed.
新的β-内酰胺抗生素羟羧氧酰胺菌素应用于圣加仑州立医院外科的35例患者。试验期从1980年4月开始，至10月结束。羟羧氧酰胺菌素未与任何其他抗生素联合使用。密切观察临床病程，并进行广泛的细菌学、真菌学和药代动力学研究以评估这种新抗生素。大多数患者患有腹腔内感染性疾病，主要治疗方法是手术。抗生素治疗在手术时开始。从这35例患者中共分离出290种不同的细菌。220株为需氧菌，70株为厌氧菌。计算了每株细菌的最低抑菌浓度。此外，几乎对每位患者都测定了羟羧氧酰胺菌素的血清水平。31例患者（88.6%）治疗成功，2例无法评估，2例治疗失败，其中1例患者患有对羟羧氧酰胺菌素原发耐药的脆弱拟杆菌导致败血症。在一些患者的尿液、粪便或伤口引流液中发现念珠菌大量增加。在治疗后期采集的样本中，经常单独发现对羟羧氧酰胺菌素原发耐药的微生物，如粪链球菌。在治疗期间可观察到粪便菌群发生异常变化，但未导致临床并发症。无需进行特异性抗真菌治疗，也无需针对粪链球菌使用任何其他抗生素。羟羧氧酰胺菌素耐受性良好，副作用极小。未发现肾功能损害。
