Infect Chemother.  2014 Sep;46(3):189-193. 10.3947/ic.2014.46.3.189.

In vitro Antagonism between Cefotaxime and Anti-Rickettsial Antibiotics against Orientia tsutsugamushi

Affiliations
  • 1Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. mhchungid@daum.net, ljinsoo@inha.ac.kr
  • 2Translation Research Center, Inha University School of Medicine, Incheon, Korea.
  • 3Department of Microbiology, Inha University School of Medicine, Incheon, Korea.

Abstract

We have investigated the in vitro antimicrobial effects of antibiotic combinations against Orientia tsutsugamushi, the causative agent of scrub typhus. ECV304 cells were infected with the Boryong strain of O. tsutsugamushi and incubated in a medium containing doxycycline (4 microg/mL), azithromycin (0.5 microg/mL), rifampin (4 microg/mL), ciprofloxacin (25 microg/mL), gentamicin (5 microg/mL), cefotaxime (2 microg/mL), or combinations of these agents for 7 days, after which immunofluorescent staining for O. tsutsugamushi was performed. The percentages of infective foci in cultures containing antibiotics compared to those in cultures without antibiotics were 6.2% for doxycycline, 9.6% for azithromycin, 8.8% for rifampin, 96.6% for cefotaxime, 29.7% for doxycycline plus cefotaxime, 23.6% for azithromycin plus cefotaxime, and 41.4% for rifampin plus cefotaxime. These findings show an in vitro antagonism between anti-rickettsial agents and cefotaxime against O. tsutsugamushi. These results suggest that the efficacy of antibiotic combinations involving cefotaxime for the treatment of patients with scrub typhus, particularly those with severe pneumonia, needs to be investigated.

Keyword

Azithromycin; Cefotaxime; Drug combination; Doxycycline; Drug antagonism; Orientia tsutsugamushi; Scrub typhus

MeSH Terms

Anti-Bacterial Agents*
Azithromycin
Cefotaxime*
Chungcheongnam-do
Ciprofloxacin
Doxycycline
Drug Antagonism
Gentamicins
Humans
Orientia tsutsugamushi*
Pneumonia
Rifampin
Scrub Typhus
Anti-Bacterial Agents
Azithromycin
Cefotaxime
Ciprofloxacin
Doxycycline
Gentamicins
Rifampin

Cited by  1 articles

In vitro Synergism between Chloroquine and Antibiotics against Orientia tsutsugamushi
Dongwook Son, Moon-Hyun Chung
Infect Chemother. 2014;46(3):182-188.    doi: 10.3947/ic.2014.46.3.182.


Reference

1. Im JH, Baek JH, Lee JS, Chung MH, Lee SM, Kang JS. In vitro bacteriostatic effects of rifampin on Orientia tsutsugamushi. J Korean Med Sci. 2014; 29:183–189.
Article
2. Chung MH, Lee JS, Baek JH, Kim M, Kang JS. Persistence of Orientia tsutsugamushi in humans. J Korean Med Sci. 2012; 27:231–235.
3. Im JH, Baek JH, Lee JS, Chung MH, Lee SM, Kang JS. A case series of possibly recrudescent Orientia tsutsugamushi infection presenting as pneumonia. Jpn J Infect Dis. 2014; 67:122–126.
Article
4. Watt G, Kantipong P, Jongsakul K, Watcharapichat P, Phulsuksombati D, Strickman D. Doxycycline and rifampicin for mild scrub-typhus infections in northern Thailand: a randomised trial. Lancet. 2000; 356:1057–1061.
Article
5. Kim ES, Kim MK, Lee HM, Chung MH, Lee JS, Kang JS. In vitro efficacy of antibiotic combinations against Orientia tsutsugamushi. Infect Chemother. 2008; 40:311–315.
Article
6. Kim MS, Baek JH, Lee JS, Chung MH, Lee SM, Kang J. High in vitro infectivity of a doxycycline-insensitive strain of Orientia tsutsugamushi. Infect Chemother. 2013; 45:431–434.
Article
7. Siritantikorn S, Jintaworn S, Noisakran S, Suputtamongkol Y, Paris DH, Blacksell SD. Application of ImageJ program to the enumeration of Orientia tsutsugamushi organisms cultured in vitro. Trans R Soc Trop Med Hyg. 2012; 106:632–635.
Article
8. Jang HC, Choi SM, Jang MO, Ahn JH, Kim UJ, Kang SJ, Shin JH, Choy HE, Jung SI, Park KH. Inappropriateness of quinolone in scrub typhus treatment due to gyrA mutation in Orientia tsutsugamushi Boryong strain. J Korean Med Sci. 2013; 28:667–671.
Article
9. Oh SY, Chung MH, Oh SJ, Son MS, Ahn SW. An open clinical trial to compare the efficacy of ciprofloxacin, pefloxacin, and doxycycline in the treatment of scrub typhus. Korean J Infect Dis. 1995; 27:193–198.
10. Tsai CC, Lay CJ, Wang CL, Ho YH, Wang LS, Chen LK. Levofloxacin versus tetracycline antibiotics for the treatment of scrub typhus. Int J Infect Dis. 2010; 14:e62–e67.
Article
11. Mathai E, Rolain JM, Verghese L, Mathai M, Jasper P, Verghese G, Raoult D. Case reports: scrub typhus during pregnancy in India. Trans R Soc Trop Med Hyg. 2003; 97:570–572.
Article
12. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG. Infectious Diseases Society of America. American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44:Suppl 2. S27.
Article
13. Matsumura Y, Shimizu T. Case of imported scrub typhus contracted in Myanmar. Kansenshogaku Zasshi. 2009; 83:256–260.
Article
14. Gupta N, Mittal V, Gurung B, Sherpa U. Pediatric scrub typhus in South Sikkim. Indian Pediatr. 2012; 49:322–324.
15. Mahajan SK, Rolain JM, Kashyap R, Gupta D, Thakur S, Sharma A, Kaushal SS, Raoult D. Scrub typhus complicating pregnancy. J Assoc Physicians India. 2009; 57:720–721.
16. Kurup A, Issac A, Loh JP, Lee TB, Chua R, Bist P, Chao CC, Lewis M, Gubler DJ, Ching WM, Ooi EE, Sukumaran B. Scrub typhus with sepsis and acute respiratory distress syndrome. J Clin Microbiol. 2013; 51:2787–2790.
Article
17. Bayles KW. The bactericidal action of penicillin: new clues to an unsolved mystery. Trends Microbiol. 2000; 8:274–278.
Article
18. Lai CH, Huang CK, Weng HC, Chung HC, Liang SH, Lin JN, Lin CW, Hsu CY, Lin HH. Clinical characteristics of acute Q fever, scrub typhus, and murine typhus with delayed defervescence despite doxycycline treatment. Am J Trop Med Hyg. 2008; 79:441–446.
Article
19. Watt G, Chouriyagune C, Ruangweerayud R, Watcharapichat P, Phulsuksombati D, Jongsakul K, Teja-Isavadharm P, Bhodhidatta D, Corcoran KD, Dasch GA, Strickman D. Scrub typhus infections poorly responsive to antibiotics in northern Thailand. Lancet. 1996; 348:86–89.
Article
20. Chanta C, Chanta S. Clinical study of 20 children with scrub typhus at Chiang Rai Regional Hospital. J Med Assoc Thai. 2005; 88:1867–1872.
Full Text Links
  • IC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr