Gram negative rod uti11/13/2023 ![]() Clinicians base antibiotic selection on serum-based susceptibility reports. aeruginosa is desired, most clinicians resort to parenteral therapy. ![]() If treatment of nosocomial cystitis/CAB due to non-fermentative Gram negative uropathogens, e.g., P. Treating nosocomial non-systemic UTIs due to aerobic Gram negative uropathogens is a common therapeutic challenge. aeruginosa antibiotics available for the treatment of Gram negative nosocomial cystitis/CAB (Table 2). At the present time, the clinical significance of these findings is more important than ever due to the limited number of oral anti- P. aeruginosa but was somewhat less effective against E. Interestingly, clinical effectiveness of tetracyclines was highest with P. Their study was done in humans as opposed to an in vitro or animal study and remains the largest published study of treating Gram negative aerobic uropathogens in non-systemic UTIs orally with tetracycline, doxycycline or minocycline. The use of doxycycline and minocycline yielded similar results to conventional tetracycline with a slightly lower rate of eradication. Interestingly, in the Musher study, tetracycline was compared to doxycycline and minocycline. showed that oral tetracyclines eliminated Pseudomonas aeruginosa from the urine in most patients, i.e., 85 % with intact renal function. Oral antibiotics in particular should be viewed as having a urinary spectrum which may be different from its serum spectrum (Table 1). coli from the urine using oral penicillin based on this pharmacokinetic principle. He and subsequently others showed that it was easy to eradicate “resistant” E. Clinicians have long pondered why some Gram negative uropathogens are eradicated from urine even when reported as “resistant.” Stamey stressed that serum bases susceptibility testing is relevant only for pathogens in the blood. Since antimicrobial susceptibility is in large part “concentration dependent,” Stamey reasoned it would be possible to eradicate aerobic Gram negative uropathogens from urine if achievable urinary concentrations exceeded the minimal inhibitory concentration (MIC) of the uropathogen. His concept was based on the principle that renally eliminated antibiotics are concentrated to high levels, i.e., supra-serum in urine in patients with intact renal function. Stamey was the first to introduce the concept of “urinary spectrum” of orally administered antibiotics to treat non-systemic urinary tract infections (UTIs), i.e., cystitis or catheter associated bacteriuria (CAB).
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