Table 1: In Vitro Comparative Activities of Antibiotics Against Y. enterocolitica Clinical Isolatesa 

Antibiotic

MIC50b

MIC90b

Range

 

 

 

 

Ampicillin

32

64

4-128

Amoxicillin plus clavulanic acid

4

16

1 ­> 16

Ticarcillin

128

128

0.5 - 128

Piperacillin

2

4

0.25-8

Cephalothin

256

256

8 - 512

Cefoxitin

16

64

1 - 64

Cefamandole

4

8

0.5 - 16

Ceftazidime

0.125

0.5

0.06 - 1

Cefmenoxime

0.125

0.25

< 0.016 - 0.5

Ceftizoxime

0.06

0.25

< 0.016 - 1

Cefotaxime

0.06

0.25

0.03 - 5

Ceftriaxone

0.06

0.125

0.03 - 0.25

Aztreonam

0.5

2

0.06 - 2

Imipenem

0.25

0.5

0.06 - 0.5

Gentamicin

1

2

0.5 - 4

Tobramycin

1

1

0.25 - 4

Netilmicin

1

1

0.5 - 4

Amikacin

2

2

1 -4

Pefloxacin

0.125

0.25

0.06 - 0.5

Ofloxacin

0.06

0.125

0.06 - 0.125

Ciprofloxacin

0.015

0.03

0.015 - 0.03

Levofloxacin

0.03

0.06

< 0.008 -1

Gatifloxacin

0.015

0.06

< 0.008 - 0.5

Moxifloxacin

0.03

0.06

< 0.008 - 1

Tetracycline

2

4

1 - 4

Doxycycline

0.5

1

< 0.25 - 1

Cotrimoxazole

0.5

4

0.25 - 16 

a  Data from references 32, 43, 57, 72, 74, 82

b  MIC for 50 and 90% of strains, expressed in mg/L

 

Table 2: Outcome of Antibiotic Treatment of Y. enterocolitica Septicemia in 43 Patientsa

 No. of Patients with Indicated Outcome

Regimenb  

Failure     

Success

Benzylpenicillin  

5

0

Amoxicillin 

11

0

Amoxicillin plus aminoglycoside    

2

0

Amoxicillin/clavulanic acid 

6

0

Amoxicillin/clavulanic acid plus cotrimoxazole  

1

0

Amoxicillin/clavulanic acid plus aminoglycoside  

0

1

Piperacillin plus aminoglycoside 

0

1

Imipenem plus aminoglycoside 

1

0

Third-generation cephalosporin only 

1

3

Third-generation cephalosporin plus aminoglycoside

3

14

Fluoroquinolone plus third-generation cephalosporin 

0

6

Fluoroquinolone plus aminoglycoside 

0

5

Fluoroquinolone only 

 0

4

Doxycycline   

0

 6c

Doxycycline plus aminoglycoside  

2

0

Cotrimoxazole plus aminoglycoside 

0

1

Rifampicin plus aminoglycoside    

0

1

TOTAL 

32d

42

a  Data from reference 33.

b According to the results of in vitro tests, all strains were categorized as intermediately susceptible or resistant to amoxicillin (MICs, 4-128 mg/L) and as susceptible, intermediately susceptible, or resistant to amoxicillin/clavulanic acid (MICs, 2-64 rng/L). All strains were resistant to benzylpenicillin. All other drugs tested were active in vitro.

c  Apparently moderate severity of infections.

d  Two regimens failed in four patients and four in one patient.

 

Table 3:  Antibiotics and Dosages Proposed for the Treatment of Y. enterocolitica Infections in Adults [Download PDF]

Antibiotic

Dosage/day

Fluoroquinolones

 

   Pefloxacin a,b

 800 mg

   Ofloxacin a,b,c

 400 mg

   Ciprofloxacin a,b,c

 1g

   Levofloxacin a,b,c

 500 mg

   Gatifloxacin a,b,c

 400 mg

   Moxifloxacin a,b

 400 mg

Third-generation cephalosporins

 

   Cefotaximea, Ceftriaxonea

 2-6 g

   Ceftazidimea, Ceftizoximea

 2-6 g

    Cefiximeb

 800 mg

Aminoglycosidesa,c

   Gentamicin, Tobramycin

 3 mg/kg

    Netilmicin

 4-6 mg/kg
   Amikacin  15 mg/kg

Doxycyclinea,b

 200 mg

 a      Drugs are administered iv and/or im.

b      Drugs are administered orally.

c      Dosages are adapted to the renal function if necessary. Needs to be modified for renal dysfunction