[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]
Efficacy of Ceftriaxone, Cefepime, Doxycycline, Ciprofloxacin, and Combination Therapy for Vibrio vulnificus Foodborne Septicemia
Sonya A. Trinh a, Hannah E. Gavin b and Karla J. F. Satchell b*
Author Affiliations: a Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Infectious Diseases, 645 North Michigan Avenue, Suite 900, Chicago, Illinois, 60611, USA; b Northwestern University Feinberg School of Medicine, Department of Microbiology-Immunology, 303 East Chicago Avenue, Ward 6-225, Chicago, Illinois, 60611, USA
Vibrio vulnificus foodborne infections have higher rates of sepsis and mortality compared to wound infections; however, antibiotic efficacy studies have not been performed in foodborne infection models. The efficacy of ceftriaxone, cefepime, doxycycline, ciprofloxacin, and combination therapy was assessed in a V. vulnificus intestinal infection in mice to model foodborne infections. Consistent with prior studies of cefotaxime, cefepime was synergistic with doxycycline and ciprofloxacin in vitro; combination therapy significantly decreased bacterial growth by ≥2log10 compared to antibiotic monotherapy (p<0.01). In vivo, survival in the ceftriaxone (50%), doxycycline (79%), and ciprofloxacin (80%) groups were significantly higher than the control group (0%) (p<0.0001). Survival with ceftriaxone-doxycycline (91%) and ceftriaxone-ciprofloxacin (100%) therapy was significantly higher than with ceftriaxone (50%) (p≤0.05). Survival with cefepime-doxycycline (96%) and cefepime-ciprofloxacin (90%) therapy was significantly higher than with cefepime (20%) (p<0.001). There was no difference in survival between the combination therapy groups. Thus, we conclude that combination therapy was the most effective treatment for V. vulnificus foodborne septicemia. In a septic patient with a recent ingestion of raw seafood, cefepime in combination with doxycycline or ciprofloxacin should be initiated for coverage of resistant Gram-negative organisms and V. vulnificus while awaiting a microbiological diagnosis. Once a diagnosis of V. vulnificus foodborne septicemia is established, treatment can be safely transitioned to ceftriaxone in combination with doxycycline or ciprofloxacin.
*Corresponding Author: Karla J. F. Satchell, Northwestern University Feinberg School of Medicine, Department of Microbiology-Immunology, 303 East Chicago Avenue, Ward 6-205, Chicago, Illinois, 60611, USA, firstname.lastname@example.org
Copyright © 2017 American Society for Microbiology. All Rights Reserved.
Keywords: Antibiotics; Vibrio Vulnificus; Ceftriaxone; Ciprofloxacin; Cefepime; Doxycycline.