Mezlocillin Cefotaxime

The combination of cephalothin wifh an aminoglycoside was more nephrotoxic than methicillin plus aminoglycoside [143]. There is good evidence that concurrent administration of cephalothin and gentamicin are additive nephrotoxins in humans, especially in patients over 60 years of age as wells as in rabbits [144], and renal injuries are intensified in the presence of mild renal ischemia or endotoxemia [108]. The results of prospective randomized comparative studies of the combination mezlocillin/cefotaxime versus gentamicin/cefoxitin showed that the concurrent administration of mezlocillin/cefotaxime has low renal toxicity and can be recommended for the rational and empirical treatment of serious systemic infections [145]. 

Kosmidis J, Daikos GK. Prospective randomized comparative studies of mezlocillin/cefotaxime vs. gentamicin/cefoxitin. J Anti-microb Chemother 1983 11 (SuppI C) 91 -95. 

Early clinical trials showed no benefit from antibiotic prophylaxis, but studies were flawed, as they included patients with all degrees of disease severity and did not have a sufficient number of patients with severe necrotizing AP. " In addition, the studies utilized ampicillin, which does not penetrate well into pancreatic tissue." Imipenem-cilastatin, metronidazole, cefotaxime, piperacillin, mezlocillin, ofloxacin, and ciprofloxacin all achieve satisfactory bactericidal tissue concentrations, whereas aminoglycosides have poor penetration." " However, the importance of antibiotic penetration into pancreatic tissue has been debated, as it is the peripancreatic retroperitoneal necrotic fat and debris, not the pancreas itself, that becomes infected. 

The capacity to generate, and the amount of superoxide produced by a in vitro renal microsome system is dependent on the molecular structure of the specific P-lactam. Superoxide production is a function of exposure time and P-lactam concentration (Figure 5). The rank order of the magnitude of superoxide production by P-lactams in vitro is as follows cephaloridine > cefsulodin > mezlocillin > aztreonam > ceftazidime > cefotaxime [10]. 

A fluoroquinolone a tetracycline gentamicin A fluoroquinolone amikacin a tetracycline trimethoprim-sulfamethoxazole cefotaxime, ceftizoxime, ceftriaxone, cefepime, or ceftazidime Gentamicin, tobramycin or amikacin trimethoprim-sulfamethoxazole ciprofloxacin, ticarcillin, mezlocillin, or piperacillin aztreonam cefotaxime ceftizoxime ceftriaxone cefepime or ceftazidime Ampicillin gentamicin, tobramycin, or amikacin carbenicillin, ticarcillin, mezlocillin, or piperacillin gentamicin, tobramycin, or amikacin amoxicillin/clavulanic acid ticarcillin/clavulanic acid piperacillin/tazobactam ampicillin/sulbactam trimethoprim-sulfamethoxazole imipenem or meropenem aztreonam a fluoroquinolone another cephalosporin... 

Gentamicin or amikacin cefotaxime, ceftizoxime, ceftriaxone, cefepime, or ceftazidime aztreonam trimethoprim-sulfamethoxazole carbenicillin, ticarcillin, mezlocillin, or piperacillin a fluoroquinolone... 

Also analyzed azlocillin, aztreonam, cefmenoxime, cefoperazone, cefotaxime, cefsulodin, ceftazidime, ceftriaxone, cloxadllin, desacefylcefotaxime, mezlocillin, penicillin G, piperacillin, ticarcillin... 

Noninterfering acetaminophen, N-acetylprocainamide, amikacin, amitriptyline, ampicil-lin, carbamazepine, cefamandole, cefazolin, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftizoxime, cephalexin, cephalothin, cephapirin, chloramphenicol, ciprofloxacin, clonazepam, (yclosporine, desipramine, digoxin, disopyramide, ethosuximide, gentamicin, haloperidol, imipramine, kanamycin, lidocaine, mezlocillin, netilmicin, nortriptyline, phenobarbital, phenytoin, primidone, procainamide, propranolol, quinidine, salicylic acid, streptomycin, sulfamethoxazole, theophylline, thiamphenicol, ticarcillin, tobramycin, trimethoprim, vancomycin... 

Binding of (3-lactam antibiotics to PBP-1A and PBP-1 B (transpeptidase) of Escherichia coii leads to cell lysis to PBP-2 (transpeptidase) leads to oval cells deficient in rigidity and to inhibition of cell division to PBP-3 (transpeptidase) leads to abnormally long, filamentous shapes by failure to produce a septum and to PBP-4 through PBP-6 (carboxypeptidases) leads to no lethal effects. Approximately 8% of a dose of benzylpenicillin binds to PCP-1, 0.7% to PCP-2, 2% to PBP-3, 4% to PBP-4, 65% to PBP-5, and 21% to PBP-6. Thus, the majority of the penicillin dose bonds to PBPs for which the function remains obscure. Binding to PBP-1 is lethal. Other (3-lactam antibiotics display different binding patterns. Amoxicillin and the cephalosporins bind more avidly to PBP-1, methicillin and cefotaxime to PBP-2, and mezlocillin and cefuroxime to PBP-3. All these drugs are lethal to susceptible bacteria. 

When intravenous cefotaxime 30 mg/kg and mezlocillin 50 mg/kg were given together over 30 minutes in 8 healthy subjects, the pharmacokinetics of the mezlocillin were unchanged but the clearance of the cefotaxime was reduced by about 40%. However, in a series of 5 patients with end-stage renal disease no significant decrease in cefotaxime clearance was seen when mezlociUin was given. ... 

Doses of cefotaxime may need to be reduced in the presence of either azlocillin or mezlocillin. One report suggests a dosage reduction of cefotaxime is advisable if the glomerular filtration rate is 20 to 40 mL/minute and azlocillin is also given. ... 

Also analyzed ampicillin, eizlodllin, aztreonam, cefmenoxime, ceioperazone, cefsulodin, cefotaxime, ceftriaxone, cloxadllin, desacetylcefotaxime, mezlocillin, penicil G, piperacillin, ticardllin... 

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