Comparative evaluation of orally active antibiotics against community-acquired pathogens: results of eight European countries.

In this multicenter study conducted in eight European countries, 13,173 pathogens--all isolated from community-acquired infections in 1992 and 1993--were evaluated for their susceptibility to the following orally active antibiotics: penicillin G, ampicillin, amoxycillin plus clavulanic acid, cefaclor, cefuroxime, cefetamet, doxycycline and erythromycin. Ten centers in Italy, five in Germany, in the Netherlands and Switzerland, four in Greece and Spain, three in Hungary and one in Finland contributed to this study; ready-to-use standardized microtiter panels (Sceptor system, BBL, Heidelberg, Germany) were used throughout all assays. The most frequently encountered species were: Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae and non-typhoid Salmonella spp., Enterobacter cloacae, Streptococcus agalactiae, Haemophilus influenzae, Citrobacter freundii, Staphylococcus pyogenes, Streptococcus pneumoniae, Proteus vulgaris, Moraxella catarrhalis and Shigella spp. The percentage of susceptible isolates was assessed for each of the above-mentioned countries and European-wide with all the data available. For many species, the percentage of resistant isolates did not differ markedly between the countries considered. However, one of the most striking exceptions was the high prevalence of high-level penicillin-G-resistant S. pneumoniae isolates in Hungary and Spain; some of the low-level penicillin-G-resistant strains remained susceptible to cefuroxime, whereas complete cross-resistance occurred for all other beta-lactams studied. The high frequency of ampicillin-resistant H. influenzae isolates in Spain deserves mentioning; this could be attributed mainly to the prevalence of a beta-lactamase, as the addition of clavulanic acid rendered these strains susceptible to ampicillin. The penicillin compounds exhibited the greatest activity against Gram-positive pathogens, whereas cefetamet was the most active agent against Gram-negative pathogens with a well-balanced spectrum of activity.