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Antimicrobial interactions of trovafloxacin and extended-spectrum cephalosporins or azithromycin tested against clinical isolates of Pseudomonas aeruginosa and Stenotrophomonas maltophilia.

strains). Although interpretative criteria for cefpodoxime when tested alone against pneumococci with reduced susceptibilities to penicillin have not been published to date, 11 of the 25 strains would be categorized as resistant to cefpodoxime if the criteria recommended for parenteral -lactams, such as ceftriaxone and cefotaxime (susceptible, MICs 0.5 mg/L; resistant, MICs 2 mg/L), are used. However, in the presence of amoxycillin, the MICs for three of these isolates were markedly reduced (fourfold in one case and 16-fold in two). Of the 14 strains that were either of intermediate susceptibility or resistant to amoxycillin (MICs 1 mg/L), ten, including two of the six resistant strains (MICs 2 mg/L), were susceptible to this agent (MICs 0.5 mg/L) when combined with cefpodoxime at a concentration 1 mg/L. The percentage of pneumococcal isolates exhibiting intermediate susceptibility or resistance to penicillin has increased dramatically in recent years. Antibiotics that are suitable as treatment of patients with infections caused by these organisms include novel -lactams and some of the older penicillins such as amoxycillin. Previous in-vitro studies have shown cefpodoxime and amoxycillin each to be more active than cefixime, cefadroxil and cefaclor. In the present study, the MICs of either amoxycillin or cefpodoxime or a combination of the two for 88% of pneumococcal isolates exhibiting reduced susceptibility to penicillin were 0.5 mg/L; included amongst these were three strains classified as resistant to amoxycillin (MICs 2 mg/L). Recently, Chavanet et al. similarly reported in this journal synergy between a potent parenteral cephalosporin (ceftriaxone) and amoxycillin against S. pneumoniae strains with reduced susceptibilities to both penicillin and third-generation cephalosporins. In conclusion, this and previous in-vitro studies have demonstrated the potent activities of cefpodoxime and amoxycillin against one of the principal bacterial causes of community-acquired respiratory tract infections. As antibiotics are often prescribed without knowledge of either the pathogen or its susceptibility in these clinical settings, there is a need for clinical trials comparing single agents with combinations of -lactams, particularly in regions where pneumococci with reduced susceptibilities to penicillin are common.