Bacteroides fragilis endocarditis, bacteremia and other infections treated with oral or intravenous metronidazole

John N Galgiani, David F. Busch, Corstiaan Brass, Lawrence W. Rumans, James I. Mangels, David A. Stevens

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Current drugs are not always effective in severe anaerobic infections, especially those involving Bacteroides fragilis, even when the organism appears susceptible by in vitro testing. Five persons with severe and/or refractory anaerobic infections were treated with metronidazole administered either orally or intravenously. Of the four with Bacteroides fragilis group infections, three were bacteremic and two had not responded to prior treatment with clindamycin. In one patient aortic valvulitis was documented by a new murmur and echocardiographic findings. In all patients clinical and/or bacteriologic cures of their infections were attained without concomitant surgical procedures. In one patient removal of his penile prosthesis was required for complete clinical resolution. In all persons, metronidazole was tolerated well. Serum drug levels were measured in the bacteremic patients. New pharmacokinetic information is presented from patients treated intravenously by continuous and by intermittent infusion. In addition, a method of measuring serum bactericidal concentrations is described, and these measurements are correlated with both drug levels and responses to treatment. Serum bactericidal concentrations of ≥1:8 were associated with response whereas lower concentrations were associated with persistent infection. Metronidazole, which has rapid bactericidal activity in vitro against B. fragilis and other anaerobes, appears to be safe and effective intravenously as well as orally in the treatment of severe anaerobic infections.

Original languageEnglish (US)
Pages (from-to)284-289
Number of pages6
JournalAmerican Journal of Medicine
Volume65
Issue number2
DOIs
StatePublished - 1978
Externally publishedYes

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Bacteroides fragilis
Metronidazole
Bacteremia
Endocarditis
Infection
Serum
Pharmaceutical Preparations
Penile Prosthesis
Clindamycin
Therapeutics
Pharmacokinetics

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Bacteroides fragilis endocarditis, bacteremia and other infections treated with oral or intravenous metronidazole. / Galgiani, John N; Busch, David F.; Brass, Corstiaan; Rumans, Lawrence W.; Mangels, James I.; Stevens, David A.

In: American Journal of Medicine, Vol. 65, No. 2, 1978, p. 284-289.

Research output: Contribution to journalArticle

Galgiani, John N ; Busch, David F. ; Brass, Corstiaan ; Rumans, Lawrence W. ; Mangels, James I. ; Stevens, David A. / Bacteroides fragilis endocarditis, bacteremia and other infections treated with oral or intravenous metronidazole. In: American Journal of Medicine. 1978 ; Vol. 65, No. 2. pp. 284-289.
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