scholarly journals Pengaruh Penggunaan Antibiotika Terhadap Lama Hari Sakit dan Lama Kehilangan Hari Kerja pada Pasien Infeksi Pernapasan Akut Bagian Atas pada Pelayanan Kesehatan Primer

2017 ◽  
Vol 1 (1) ◽  
pp. 41
Author(s):  
Gunawan Gunawan ◽  
Suhendro Suwarto ◽  
Cleopas Martin Rumende ◽  
Kuntjoro Harimurti
Keyword(s):  
Staphylococcus Aureus ◽  
Clavulanic Acid ◽  
Streptococcus Pyogenes ◽  
Influenza A ◽  
Klebsiella Pneumonia ◽  
Amoxicillin Clavulanic Acid ◽  
Virus Influenza

Pendahuluan. Prevalensi infeksi saluran pernapasan bagian atas akut (ISPA) di komunitas masih tinggi dan menyebabkan morbiditas dan penurunan kualitas hidup masyarakat secara luas. Etiologi tersering dari infeksi pernapasan akut di luar negeri adalah virus, selain itu terdapat etiologi bakteri yang memerlukan terapi antibiotika yang spesifik. Penggunaan antibiotika untuk infeksi pernapasan akut berlebihan, dan hal ini menyebabkan peningkatan resistensi bakteri terhadap antibiotika. Penelitian ini bertujuan untuk mengetahui pola etiologi infeksi pernapasan akut, kesesuaian pemberian antibiotika dan perbedaan rerata lama sakit dan lama kehilangan hari kerja.Metode. Penelitian ini merupakan penelitian observasional analitik dengan pengambilan data secara potong lintang dan kohort prospektif dengan sampel yang diambil secara berurutan dari pasien ISPA yang berobat ke Puskesmas Kecamatan Pulogadung, Jakarta Timur dan KDK “Kayu Putih” serta “Kiara” pada bulan Agustus hingga Desember 2011. Pada 100 pasien ISPA yang berobat dilakukan pemeriksaan kultur resistensi bakteri dan uji antigen influenza melalui swab tenggorok dan nasofaring, dan pemeriksaan darah perifer rutin. Perbedaan lama hari sakit dan lama kehilangan hari kerja dianalisa menggunakan uji beda dua median Mann Whitney karena data berdistribusi bukan normal.Hasil. Hasil kultur bakteri positif pada 34% pasien ISPA, hasil uji antigen influenza positif untuk influenza A pada 3% pasien, dan 63 % pasien belum diketahui penyebabnya. Hasil kultur bakteri terbanyak berturut-turut adalah Klebsiella pneumonia (47,1%), Streptococcus pyogenes (14,7%) dan Staphylococcus aureus (14,7%). Jenis antibiotika terbanyak yang mengalami resistensi adalah ampicillin (20 isolat), tetracycline (8 isolat), benzylpenicillin (4 isolat), amoxicillin/clavulanic acid (3 isolat). Kesesuaian pemberian antibiotika dengan hasil kultur bakteri ditemukan pada 56 pasien ISPA (56%). Median lama hari sakit pada kelompok pasien ISPA yang mendapatkan pengobatan antibiotika tidak berbeda dibandingkan dengan tanpa pengobatan antibiotika (4 hari dengan 3,5 hari; p=0,054). Median lama kehilangan hari kerja pada kelompok pasien ISPA yang mendapatkan pengobatan antibiotika tidak berbeda dibandingkan dengan tanpa pengobatan antibiotika (1 hari dengan 1 hari; p=0,629)Simpulan. Penyebab infeksi saluran pernapasan akut bagian atas pada penelitian ini adalah bakteri sebanyak 34% dengan bakteri Gram negatif terbanyak adalah Klebsiella pneumonia dengan antibiotika yang sensitif dengan antibiotika golongan Penicillin beta laktamase dan golongan aminoglikosida serta makrolid, virus influenza A sebanyak 3% dan etiologi yang belum diketahui sebanyak 63%. Proporsi kesesuaian penggunaan antibiotika di Puskesmas Kecamatan Pulogadung dan Klinik Kedokteran Keluarga Kayu Putih serta Kiara sebesar 56%. Pemberian antibiotika tidak memberikan perbedaan lama hari sakit dan lama kehilangan hari kerja. 

scholarly journals Novel Antibiotic Combinations of Diverse Subclasses for Effective Suppression of Extensively Drug-Resistant Methicillin-Resistant Staphylococcus aureus (MRSA)

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Shumyila Nasir ◽  
Muhammad Sufyan Vohra ◽  
Danish Gul ◽  
Umm E Swaiba ◽  
Maira Aleem ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clavulanic Acid ◽  
Antimicrobial Agents ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Multidrug Resistant ◽  
Methicillin Resistant ◽  
Development Of Resistance ◽  
Amoxicillin Clavulanic Acid ◽  
Combination Antibiotics ◽  
Time Kill

The emergence of multidrug-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), the chief etiological agent for a range of refractory infections, has rendered all β-lactams ineffective against it. The treatment process is further complicated with the development of resistance to glycopeptides, primary antibiotics for treatment of MRSA. Antibiotic combination therapy with existing antimicrobial agents may provide an immediate treatment option. Minimum inhibitory concentrations (MICs) of 18 different commercially available antibiotics were determined along with their 90 possible pairwise combinations and 64 triple combinations to filter out 5 best combinations. Time-Kill kinetics of these combinations were then analyzed to find collateral bactericidal combinations which were then tested on other randomly selected MRSA isolates. Among the top 5 combinations including levofloxacin-ceftazidime; amoxicillin/clavulanic acid-tobramycin; amoxicillin/clavulanic acid-cephradine; amoxicillin/clavulanic acid-ofloxacin; and piperacillin/tazobactam-tobramycin, three combinations were found to be collaterally effective. Levofloxacin-ceftazidime acted synergistically in 80% of the tested clinical MRSA isolates. First-line β-lactams of lower generations can be used effectively against MRSA infection when used in combination. Antibiotics other than glycopeptides may still work in combination.

Multidrug-resistant pathogens isolated from ready-to-eat salads available at a local market in Pakistan

2016 ◽  
Vol 118 (8) ◽  
pp. 2068-2075 ◽  
Author(s):  
Sana Ilyas ◽  
Muhammad Usman Qamar ◽  
Muhammad Hidayat Rasool ◽  
Nazia Abdulhaq ◽  
Zeeshan Nawaz
Keyword(s):  
Staphylococcus Aureus ◽  
Clavulanic Acid ◽  
Antimicrobial Susceptibility ◽  
National Level ◽  
Multidrug Resistant ◽  
Effective Control ◽  
Local Market ◽  
Content Type ◽  
Amoxicillin Clavulanic Acid ◽  
Multidrug Resistant Pathogens

Purpose – The purpose of this paper is to evaluate the frequency and antimicrobial susceptibility pattern of pathogens present in ready-to-eat salads available at a local market. Design/methodology/approach – A 100 salad samples were collected aseptically. Each sample (25 g) was homogenized in 225 ml of sterile peptone water and was serially diluted up to 1×106. Dilutions were inoculated on nutrient agar by surface spread plate technique. Aerobic colony count (ACC) was estimated by counting the colonies. Bacterial isolates were cultured on blood and MacConkey agar and identified on the basis of their morphology, culture characteristics and confirmed by API 20E and 20NE. Antimicrobial susceptibility was determined as per CLSI 2014. Findings – ACC range was 1.1×103 cfu/g to 5.8×109 cfu/g. Among these the highest ACC was found in channa chat (4.9×104 to 5.8×109 cfu/g). A total of 127 microorganisms were identified; 73 were gram negative rods (GNRs) and 24 were gram positive cocci (GPC). Among GNRs; Klebsiella spp. (n=18) was the predominant whereas among GPC, Staphylococcus aureus (n=6) were the chief pathogen. Klebsiella spp. showed 100 percent resistance to ampicillin, 89-78 percent to amoxicillin/clavulanic acid and 33 percent to imipenem, however, Enterobacter spp. were resistant to ampicillin (100 percent) amoxicillin/clavulanic acid (77 percent) and imipenem (23 percent). Staphylococcus aureus showed resistance to co-amoxiclav (83 percent) and penicillin (75 percent). Practical implications – This study revealed that effective control measures must been implemented and respected by throughout the entire food chain and better surveillance studies should be performed at national level to reduce the spread of bacteria by fresh salads. Originality/value – This paper explore the high prevalence of multidrug-resistant pathogens in different salads and most of the salads were found to be unhygienic for consumption.

scholarly journals STUDY OF ANTIBIOTIC-RESISTANCE AND SENSITIVITY PATTERN IN A TERTIARY CARE TEACHING HOSPITAL

2021 ◽  
Vol 9 (12) ◽  
pp. 161-168
Author(s):  
Sailajapriyadarsini Parlapalli ◽  
◽  
V.V Padmavathy ◽  
Gunapati Rama Mohan Reddy ◽  
◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Resistance ◽  
Clavulanic Acid ◽  
Body Fluid ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Study Data ◽  
Urine Samples ◽  
Sensitivity Pattern ◽  
Amoxicillin Clavulanic Acid

Introduction: Antibiotics are helpful in bacterial infection control and management. Irrational antibiotic use leads to resistance, which puts modern medicines achievements at risk. This study aims to know antibiotic resistance and sensitivity patterns and to assess possible factors that favor the development of antibiotic resistance. Methods: It is a retrospective observational study. Data collected from June 2019 to May 2020 from the culture & sensitivity records of various clinical isolates at the Microbiology department of SMC, Vijayawada, and analyzed by descriptive statistics. Results: Total samples collected 2905. Only746 samples showed significant growth. Most commonly, isolated organisms were from Pus and Body fluids Staphylococcus aureus (31.16%), Klebsiella (23.02%), from blood samples Staphylococcus aureus (44%,) Klebsiella (32%), from urine samples Escherichia coli (27.31%),Staphylococcus aureus (16.66%). Bacteria isolated from, Blood and Pus & body fluid samples showed more resistance to Amoxicillin + Clavulanic acid, 60% &58.60%, and urine samples showed more resistance to Norfloxacin69.44%. Conclusion: In this study, bacteria isolated from, blood, pus, and body fluid samples showed more resistance to Amoxicillin + Clavulanic acid, from urine samples showed more resistance to Norfloxacin. Parenterally used drugs like aminoglycosides and vancomycin have retained their sensitivity but bacteria also showed resistance to Imipenem, Vancomycin, new combinations like Cefoperazone + Sulbactam. A culture & sensitivity test and following antibiotic stewardship guidelines before prescribing antibiotics will give good results to prevent antibiotic resistance.

Prevalence of Nasal Carriage of Staphylococcus aureus and its Antibiotic Susceptibility among Healthcare Workers (HCWs) in Ukraine

2018 ◽  
Vol 2 (1) ◽  
pp. 30-41 ◽  
Author(s):  
A.G. Salmanov ◽  
O.M. Verner ◽  
N.G. Shelkova ◽  
O.I. Nicolska ◽  
V.M. Blahodatny ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clavulanic Acid ◽  
Fusidic Acid ◽  
Antibiotic Susceptibility ◽  
Healthcare Workers ◽  
Nasal Carriage ◽  
Hospital Environment ◽  
Significant Difference ◽  
Amoxicillin Clavulanic Acid ◽  
Hospital Acquired

BACKGROUND. Nasal carriage of Staphylococcus aureus among hospital personnel is a common cause of hospital acquired infections. Emergence of drug resistant strains especially methicillin resistant S. aureus (MRSA) is a serious problem in hospital environment. Therefore, the aim of this study was to determine the prevalence of nasal carriage of Staphylococcus aureus its antibiotic susceptibility among healthcare workers (HCWs) in Ukraine. METHODS. This cross-sectional study was conducted from January to December 2017. The study included medical workers from 19 hospitals in different Ukrainian regions. Nasal swabs were taken from 755 randomly selected HCWs. The mean age of participants was 32.41 ± 8.29 years (range 19—74 years) with a male-to- female ratio of 0.47. The isolates were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test, and mannitol salt agar fermentation. The sensitivity patterns of S. aureus strains were determined by disk diffusion method (Kirby — Bauer). The panel of antibiotics used in sensitivity tests included: penicillin, oxacillin, cefoxitin, amoxicillin/clavulanic acid, gentamicin, tobramicin, ciprofloxacin, levofloxacin, moxifloxacin, mupirocin, nitrofurantoin, vancomycin, teicoplanin, fosfomycin, clindamycin, erythromycin, rifampicin, linezolid, tetracycline, tigecycline, trimethoprim/sulphamethoxazole, and fusidic acid. Interpretative criteria were those suggested by the CLSI (Clinical and Laboratory Standards Institute). MRSA were confirmed by detection of the mecA gene by polymerase chain reaction. RESULTS. Nasal screening identified 31.1 % (235/755) S. aureus carriers. Of the 235 nasal carriers of S. aureus, 4 % (196/755) carried MSSA (methicillin-sensitive S. aureus) and 39/755 (16.6 %) carried MRSA. The frequency of MRSA and MSSA carriage also varied according to the department/ward. The highest prevalence of nasal carriage of MRSA was in the surgical wards. The staff of the general, pediatric, cardiovascular, neuro and orthopedic surgery wards together with the emergency department accounted for 56.4 % of all MRSA carriers. There was no significant difference between the sexes (p = 0.247), age (p = 0.817), and years of healthcare service (p = 0.15) with regard to the nasal carriage of MRSA and MSSA. In univariate analysis we divided the hospital departments into: emergency, internal medicine, pediatrics, ICUs, surgery, and non-medical units and found no significant difference between MSSA and MRSA carriers (p = 0.224). In the multivariate analysis, the occupation «nurse» was independently associated with MRSA carriage (p = 0.012, odds ratio 3.6, 95 % confidence interval 1.3—9.7). All the S. aureus isolates recovered from nasal carriers, were susceptible to linezolid, tigecycline, vancomycin, teicoplanin, and mupirocin. Susceptibility to the other antimicrobials was also on a high level: 98.3 % of strains were found susceptible to trimethoprim/sulphamethoxazole, 96.2 % — to nitrofurantoin, 95.3 % — to fusidic acid, 92.3 % — to fosfomicin, 88.5 % — to amoxicillin/clavulanic acid, 87.2 % — to tobramycin, 86.8 % — to clindamycin. Resistance to oxacyllin came up to 16.6 %. CONCLUSIONS. Nasal carriage of S. aureus appears to play a key role in the epidemiology and pathogenesis of infection. HCWs who are at interface between the hospital and the community may serve as agents of cross contamination of hospital acquired and community acquired MRSA. It is of importance to follow the evolution of resistance to antibiotics in this species, especially to β-lactams.

Antimicrobial Use Prior to the Acquisition of Multiresistant Bacteria

2002 ◽  
Vol 23 (3) ◽  
pp. 155-158 ◽  
Author(s):  
Matthieu Eveillard ◽  
Jean-Luc Schmit ◽  
François Eb
Keyword(s):  
Staphylococcus Aureus ◽  
Prospective Study ◽  
Clavulanic Acid ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Antimicrobial Use ◽  
Third Generation ◽  
Multiresistant Bacteria ◽  
Amoxicillin Clavulanic Acid ◽  
Third Generation Cephalosporins

AbstractWe assessed whether patients who acquired methicillin-resistantStaphylococcus aureus(MRSA) had less exposure to antimicrobial agents than did those who acquired Enterobacteriaceae that produced extended-spectrum β-lactamase (ESβL). In a 6-month, prospective study, ESβL carriers had received antimicrobial therapy more often than had MRSA carriers. Amoxicillin-clavulanic acid, fluoroquinolones, and third-generation cephalosporins, especially ceftazidime, had been prescribed more often for ESβL carriers than for MRSA carriers.

scholarly journals Sensitivity to Antibiotics of Staphylococcus Aureus Strains, Able to Biofilm Formation

2021 ◽  
Vol 6 (3) ◽  
pp. 226-231
Author(s):  
A. O. Vashchenko ◽  
◽  
Yu. S. Voronkova ◽  
A. I. Vinnikov ◽  
T. N. Shevchenko ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Resistance ◽  
Clavulanic Acid ◽  
Rapid Determination ◽  
Diffusion Method ◽  
Upper Respiratory Tract ◽  
Isolation And Identification ◽  
Methicillin Resistant ◽  
Opportunistic Bacteria ◽  
Amoxicillin Clavulanic Acid

The problem of respiratory diseases associated with staphylococcal carriers is considered to be one of the most acute in modern society due to its high prevalence and problems with treatment due to the high resistance of these bacteria to antibiotics. The purpose of the study was to determine the sensitivity of Staphylococcus aureus strains, able to form biofilm, isolated from the upper respiratory tract of human. Materials and methods. Bacteriological methods of isolation and identification of staphylococci, the method of rapid determination of the ability to form biofilm on a tablet and the disk-diffusion method of determining the susceptibility to antibiotics were used to perform the research. As a result of the conducted researches it was established that in the structure of pathogens of exacerbations of seasonal rhinitis S. aureus prevailed. It was isolated from 34 samples of biological material from the nose, which accounted for 69.4% of all examined cases of rhinitis. Staphylococcus spp. (6.1%) and Streptococcus spp. (24.5%) among the isolated strains of S. aureus, 27 (79.4%) had the ability to form a biofilm. A feature associated with antibiotic resistance is the ability of strains of microorganisms to form a biofilm, in which they acquire enhanced ability to survive under adverse environmental factors, including the use of drugs. Results and discussion. In our research we showed that more than 80% of film-forming strains were found to be susceptible to ciprofloxacin, amoxicillin / clavulanic acid and azithromycin. 4 (14.8%) are methicillin-resistant. Resistance to methicillin was detected simultaneously with resistance to ciprofloxacin (3 cases) and to azithromycin (2 cases), 1 strain was resistant to gentamicin and 2 – to tetracycline. 1 of the methicillin-resistant strains of S. aureus was multidrug-resistant (showed resistance to all studied antibiotics). Among non-biofilm strains, more than 80% of the strains were also sensitive to ciprofloxacin, amoxicillin / clavulanic acid and azithromycin. Sensitivity to tetracycline was low in both groups (42-63% sensitive). Conclusion. The prevalence of antibiotic resistance among clinical strains of opportunistic bacteria, unfortunately, shows an increasing trend. This requires constant monitoring of susceptibility to antimicrobial drugs in order to develop schemes of rational antibiotic therapy, taking into account the individualized approach to patients. In this sense, it is promising when studying the biological properties of clinical isolates to determine not only the resistance to antibiotics, but also their ability to form a biofilm

scholarly journals Bacteriological Analysis of Beef Production Chain in Birnin Kebbi Metropolis of Kebbi State, Nigeria

2020 ◽  
pp. 64-76
Author(s):  
Famubo, Joseph A. ◽  
Isiaka, Aishatu ◽  
Abbas, Yusuf B.
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Streptococcus Pyogenes ◽  
Micrococcus Luteus ◽  
Klebsiella Pneumonia ◽  
Proteus Vulgaris ◽  
Production Chain ◽  
Retail Outlets ◽  
Retail Meat

The hygiene status of most abattoirs and retail outlets in Nigeria is very poor, and it contributes to the unacceptable level of bacteria load in beef, and poses a health risk to consumers. This study examined the bacteriological analysis of beef production chain in Birnin Kebbi metropolis. A total of 100 samples of meat, water and surface swab in Main Market, GRA, Badariya, Bayan Kara and Rafin Atiku, Birnin Kebbi Central abattoir and retail meat shops were collected aseptically, processed and analyzed. Meat from retail outlets were mostly contaminated by Staphylococcus aureus (24.4%), followed by Escherichia coli (17.3%), Klebsiella pneumonia (9.8%), Salmonella typhimurium (9.1%), Entrobater aerogenes (8.5%), Streptococcus pyogenes (8.1%), Proteus vulgaris (7.8%), Micrococcus luteus (7.8%) and Pseudomonas aeruginosa (7.2%). In the abattoirs contact surfaces, contamination occurred mostly by Staphylococcus aureus (23.4%), Salmonella typhimurium (18.2%), Escherichia coli (16.9%), Entrobater aerogenes (9.1%), Streptococcus pyogenes (7.8%), Klebsiella pneumonia, Proteus vulgaris, and Pseudomonas aeruginosa (6.5% each) and Micrococcus luteus (5.2%). The findings revealed a high bacterial load in both abattoir and retail meat outlets. In order to safeguard the health of the public against the risks of food borne infections, there is a need to educate and advocate good sanitation and meat handling practices in the abattoir and beef retail outlets.

Antibiotic Molecules Efficacy in Pediatric Bacterial Infections

2018 ◽  
Vol 69 (4) ◽  
pp. 915-920
Author(s):  
Petronela Cristina Chiriac ◽  
Vladimir Poroch ◽  
Alina Mihaela Pascu ◽  
Mircea Daniel Hogea ◽  
Ileana Antohe ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Resistance ◽  
Streptococcus Pneumoniae ◽  
Klebsiella Pneumoniae ◽  
Clavulanic Acid ◽  
Bacterial Infections ◽  
Multidrug Resistant ◽  
Penicillin G ◽  
Acute Therapy ◽  
Amoxicillin Clavulanic Acid

The antibiotic resistance of microorganisms involved in pediatric infections represents a significant cause of healthcare-associated infections (HAIs), and is also a matter of management, requiring specific intervention. The aim of the study was to evaluate the efficacy of some antibiotic molecules on pathogens isolated from patients admitted in a pediatric hospital. We carried out a descriptive study on a group of 411 patients admitted to the Sf. MariaClinical Emergency Hospital for Children Iasi, between January 1st and March 31st, 2016. Bacterial infections were most prevalent in the age group of 0-1 year (54.98% of the total isolates). Most affected by multidrug-resistant bacterial infections services were: general pediatrics (24.08% of the total isolates), then the intensive care unit (19.95%), surgical wards (14.84%), and acute therapy (11.43%). The germs were isolated from pathological samples: most often pus (23.85%), hypo-pharyngeal aspiration (21.65%), conjunctival secretion (12.42%), and ear secretion (9.48%). Penicillin G and oxacillin were inefficient in 30.26% of the Staphylococcus aureus strains, while erythromycin in 18.42%. Antibiotic resistance of Streptococcus pneumoniae was observed for penicillin G in 7.14% of the strains, while for erythromycin in 13.09%. Klebsiella pneumoniae strains were resistant to amoxicillin + clavulanic acid in 35.85% of the cases, and to cefuroxime, ceftazidime, ceftriaxone, cefepime in 33.96%. Our study highlighted that Staphylococcus aureus was resistant to penicillin G and oxacillin in more than one-third of the isolates, Streptococcus pneumoniae was resistant to penicillin G and erythromycin, and Klebsiella pneumoniae to amoxicillin + clavulanic acid and 1st, 2nd and 3rd generation cephalosporins. Continuing antibioresistance monitoring is crucial in order to promote appropriate guidelines in antibiotic prescription, which could result in decreasing HAIs� rates.

scholarly journals In vitro assessment of the effect of clavulanic acid at concentrations achieved in human serum on the bactericidal activity of amoxicillin at physiological concentrations against Staphylococcus aureus: implications for dosage regimens.

1997 ◽  
Vol 41 (6) ◽  
pp. 1403-1405 ◽  
Author(s):  
L Aguilar ◽  
M Martín ◽  
I P Balcabao ◽  
M L Gómez-Lus ◽  
R Dal-Ré ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Human Serum ◽  
Clavulanic Acid ◽  
Beta Lactamase ◽  
Postantibiotic Effect ◽  
Initial Inoculum ◽  
Dosage Regimens ◽  
Amoxicillin Clavulanic Acid ◽  
In Vitro Assessment

The effects on Staphylococcus aureus viability and beta-lactamase activity of concentrations that simulated those in human serum after a combined dose of 875 mg of amoxicillin and 125 mg of clavulanic acid were studied in an in vitro pharmacodynamic model. Six hours of preexposure to concentrations of the amoxicillin-clavulanic acid combination that were higher than the amoxicillin-clavulanic acid MIC led to a reduction of the initial inoculum of >90% and to a significant decrease of beta-lactamase activity versus those of the control even from 6 h, when concentrations were subinhibitory. The postantibiotic effect and post-beta-lactamase inhibitor effect contributed to these results.

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