Skip to main content
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1987 Feb;31(2):202–206. doi: 10.1128/aac.31.2.202

Effect of broad-spectrum parenteral antibiotics on composition of intestinal microflora of humans.

M Giuliano, M Barza, N V Jacobus, S L Gorbach
PMCID: PMC174692  PMID: 3566249

Abstract

We compared the effects of four beta-lactam drugs with widely differing antibacterial and pharmacological properties on the composition of the intestinal flora. Cefoxitin, piperacillin, cefoperazone, and aztreonam were given intravenously for 9 days to healthy volunteers. Cefoperazone reduced the numbers of aerobic and anaerobic bacteria to undetectable levels. At the other extreme, cefoxitin had little effect on the normal flora. Aztreonam markedly reduced the numbers of aerobes, whereas piperacillin had a variable effect on both aerobic and anaerobic bacteria. There was extensive overgrowth of enterococci in subjects given cefoxitin or aztreonam, which have little activity against this species, and of yeasts in subjects given cefoperazone or piperacillin. Cefoperazone reached concentrations of 2,727 to 8,840 micrograms/g in the feces, whereas the other agents were generally undetectable. These results show that the new beta-lactam antibiotics produce widely varying effects on the fecal microflora after parenteral administration and that these effects are consistent with the antibacterial and pharmacological properties of the drugs.

Full text

PDF
202

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abrams G. D., Bishop J. E. Effect of the normal microbial flora on the resistance of the small intestine to infection. J Bacteriol. 1966 Dec;92(6):1604–1608. doi: 10.1128/jb.92.6.1604-1608.1966. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alestig K., Carlberg H., Nord C. E., Trollfors B. Effect of cefoperazone on faecal flora. J Antimicrob Chemother. 1983 Aug;12(2):163–167. doi: 10.1093/jac/12.2.163. [DOI] [PubMed] [Google Scholar]
  3. Arvidsson A., Alván G., Angelin B., Borgå O., Nord C. E. Ceftriaxone: renal and biliary excretion and effect on the colon microflora. J Antimicrob Chemother. 1982 Sep;10(3):207–215. doi: 10.1093/jac/10.3.207. [DOI] [PubMed] [Google Scholar]
  4. Barza M. Imipenem: first of a new class of beta-lactam antibiotics. Ann Intern Med. 1985 Oct;103(4):552–560. doi: 10.7326/0003-4819-103-4-552. [DOI] [PubMed] [Google Scholar]
  5. Bodey G. P., Fainstein V., Garcia I., Rosenbaum B., Wong Y. Effect of broad-spectrum cephalosporins on the microbial flora of recipients. J Infect Dis. 1983 Nov;148(5):892–897. doi: 10.1093/infdis/148.5.892. [DOI] [PubMed] [Google Scholar]
  6. Chang T. W., Lauermann M., Bartlett J. G. Cytotoxicity assay in antibiotic-associated colitis. J Infect Dis. 1979 Nov;140(5):765–770. doi: 10.1093/infdis/140.5.765. [DOI] [PubMed] [Google Scholar]
  7. Eliopoulos G. M., Moellering R. C., Jr Azlocillin, mezlocillin, and piperacillin: new broad-spectrum penicillins. Ann Intern Med. 1982 Nov;97(5):755–760. doi: 10.7326/0003-4819-97-5-755. [DOI] [PubMed] [Google Scholar]
  8. Freter R., Abrams G. D. Function of various intestinal bacteria in converting germfree mice to the normal state. Infect Immun. 1972 Aug;6(2):119–126. doi: 10.1128/iai.6.2.119-126.1972. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hentges D. J., Stein A. J., Casey S. W., Que J. U. Protective role of intestinal flora against infection with Pseudomonas aeruginosa in mice: influence of antibiotics on colonization resistance. Infect Immun. 1985 Jan;47(1):118–122. doi: 10.1128/iai.47.1.118-122.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Jacobus N. V., Ferreira M. C., Barza M. In vitro activity of azthreonam, a monobactam antibiotic. Antimicrob Agents Chemother. 1982 Nov;22(5):832–838. doi: 10.1128/aac.22.5.832. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jones P. G., Bodey G. P., Swabb E. A., Rosenbaum B. Effect of aztreonam on throat and stool flora of cancer patients. Antimicrob Agents Chemother. 1984 Dec;26(6):941–943. doi: 10.1128/aac.26.6.941. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kager L., Brismar B., Malmborg A. S., Nord C. E. Effect of aztreonam on the colon microflora in patients undergoing colorectal surgery. Infection. 1985 May-Jun;13(3):111–114. doi: 10.1007/BF01642868. [DOI] [PubMed] [Google Scholar]
  13. Kager L., Ljungdahl I., Malmborg A. S., Nord C. E., Pieper R., Dahlgren P. Antibiotic prophylaxis with cefoxitin in colorectal surgery: effect on the colon microflora and septic complications--a clinical model for prediction of the benefit and risks in using a new antibiotic in prophylaxis. Ann Surg. 1981 Mar;193(3):277–282. doi: 10.1097/00000658-198103000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kager L., Malmborg A. S., Nord C. E., Sjöstedt S. The effect of piperacillin prophylaxis on the colonic microflora In patients undergoing colorectal surgery. Infection. 1983 Sep-Oct;11(5):251–254. doi: 10.1007/BF01641255. [DOI] [PubMed] [Google Scholar]
  15. Koopman J. P., Welling G. W., Huybregts A. W., Mullink J. W., Prins R. A. Association of germ-free mice with intestinal microflora. Z Versuchstierkd. 1981;23(3):145–154. [PubMed] [Google Scholar]
  16. Mulligan M. E., Citron D. M., McNamara B. T., Finegold S. M. Impact of cefoperazone therapy on fecal flora. Antimicrob Agents Chemother. 1982 Aug;22(2):226–230. doi: 10.1128/aac.22.2.226. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Mulligan M. E., Citron D., Gabay E., Kirby B. D., George W. L., Finegold S. M. Alterations in human fecal flora, including ingrowth of Clostridium difficile, related to cefoxitin therapy. Antimicrob Agents Chemother. 1984 Sep;26(3):343–346. doi: 10.1128/aac.26.3.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Neu H. C. The new beta-lactamase-stable cephalosporins. Ann Intern Med. 1982 Sep;97(3):408–419. doi: 10.7326/0003-4819-97-3-408. [DOI] [PubMed] [Google Scholar]
  19. Noble J. T., Barza M. Pharmacokinetic properties of the newer cephalosporins. A valid basis for drug selection? Drugs. 1985 Sep;30(3):175–181. doi: 10.2165/00003495-198530030-00001. [DOI] [PubMed] [Google Scholar]
  20. Nord C. E., Kager L., Heimdahl A. Impact of antimicrobial agents on the gastrointestinal microflora and the risk of infections. Am J Med. 1984 May 15;76(5A):99–106. doi: 10.1016/0002-9343(84)90250-x. [DOI] [PubMed] [Google Scholar]
  21. Sakata H., Fujita K., Yoshioka H. The effect of antimicrobial agents on fecal flora of children. Antimicrob Agents Chemother. 1986 Feb;29(2):225–229. doi: 10.1128/aac.29.2.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Swabb E. A., Singhvi S. M., Leitz M. A., Frantz M., Sugerman A. Metabolism and pharmacokinetics of aztreonam in healthy subjects. Antimicrob Agents Chemother. 1983 Sep;24(3):394–400. doi: 10.1128/aac.24.3.394. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Veringa E. M., van der Waaij D. Biological inactivation by faeces of antimicrobial drugs applicable in selective decontamination of the digestive tract. J Antimicrob Chemother. 1984 Dec;14(6):605–612. doi: 10.1093/jac/14.6.605. [DOI] [PubMed] [Google Scholar]
  24. Welling G. W., Groen G., Tuinte J. H., Koopman J. P., Kennis H. M. Biochemical effects on germ-free mice of association with several strains of anaerobic bacteria. J Gen Microbiol. 1980 Mar;117(1):57–63. doi: 10.1099/00221287-117-1-57. [DOI] [PubMed] [Google Scholar]
  25. de Vries-Hospers H. G., Welling G. W., Swabb E. A., van der Waaij D. Selective decontamination of the digestive tract with aztreonam: a study of 10 healthy volunteers. J Infect Dis. 1984 Nov;150(5):636–642. doi: 10.1093/infdis/150.5.636. [DOI] [PubMed] [Google Scholar]
  26. van der Waaij D., Berghuis-de Vries J. M., Lekkerkerk Lekkerkerk-v Colonization resistance of the digestive tract in conventional and antibiotic-treated mice. J Hyg (Lond) 1971 Sep;69(3):405–411. doi: 10.1017/s0022172400021653. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. van der Waaij D., Berghuis J. M. Determination of the colonization resistance of the digestive tract of individual mice. J Hyg (Lond) 1974 Jun;72(3):379–387. doi: 10.1017/s0022172400023615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. van der Waaij D., Berghuis J. M., Lekkerkerk J. E. Colonization resistance of the digestive tract of mice during systemic antibiotic treatment. J Hyg (Lond) 1972 Dec;70(4):605–610. doi: 10.1017/s0022172400022464. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. van der Waaij D. Colonization resistance of the digestive tract: clinical consequences and implications. J Antimicrob Chemother. 1982 Oct;10(4):263–270. doi: 10.1093/jac/10.4.263. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES