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Chapter 56 : Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora

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Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, Page 1 of 2

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Abstract:

The present knowledge of the impact of antimicrobial agents on the oropharyngeal and intestinal microflora and the optimal performance of such studies are discussed in this chapter. Disturbances in the oropharyngeal microflora are caused by administration of antimicrobial agents that reach high concentrations in oral tissues. Studies on the impact of antimicrobial agents on the normal microflora should be performed as comparative double-blind studies. Data on the impact of penicillins, cephalosporin, macrolides, ketolides, lincosamides, tetracyclines, nitroimidazoles and quinolones on the oropharyngeal microflora are summarized, as also the influence of monobactams, carbapenems, glycopeptides and streptogramins on the intestinal microflora. Knowledge about the interaction between antimicrobial agents and the normal microflora gives the clinician the possibility to choose agents associated with lesser degrees of ecological disturbances. Consequently, the risk of development of resistant strains and transfer of resistance elements between microorganisms is reduced. Further, consideration of the ecological consequences is also an important step to prevent distribution of resistant strains between patients in hospital settings. Individual pharmacokinetic variations as well as the character of composition and susceptibility of the normal microflora are variables that further influence the interactions.

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
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References

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104. Nord, C.E.,, T. Bergan, and, S. Aase. 1986. Impact of azlocillin on the colon microflora. Scand. J. Infect. Dis. 18:163166.
105. Nord, C.E.,, T. Bergan, and, S.B. Thorsteinsson. 1989. Impact of ticarcillin/clavulanate on the intestinal microflora. J. Antimicrob. Chemother. 24(Suppl. B):221226.
106. Nord, C.E.,, B. Brismar,, B. Kasholm-Tengve, and, G. Tunevall. 1993. Effect of piperacillin/tazobactam treatment on human bowel microflora. J. Antimicrob. Chemother. 31(Suppl. A):6165.
107. Nord, C.E.,, D.A. Gajjar, and, D.M. Grasela. 2002. Ecological impact of the des-F(6)-guinolone, BMS-284756, on the normal intestinal microflora. Clin. Microbiol. Infect. 8:229239.
108. Nord, C.E.,, A. Grahnen, and, S.Å. Eckernäs. 1991. Effect of loracarbef on the normal oropharyngeal and intestinal microflora. Scand. J. Infect. Dis. 23:255260.
109. Nord, C.E.,, A. Heimdahl,, C. Lundberg, and, G. Marklund. 1987. Impact of cefaclor on the normal human oropharyngeal and intestinal microflora. Scand. J. Infect. Dis. 19:681685.
110. Nord, C.E.,, L. Kager,, A. Philipson, and, G. Stiernstedt. 1984. Impact of imipenem/cilastin therapy on faecal flora. Eur. J. Microbiol. 3:475477.
111. Nord, C.E.,, G. Movin, and, D. Stålberg. 1988. Impact of cefixime on the normal intestinal microflora. Scand. J. Infect. Dis. 20:547552.
112. Novelli, A.,, T. Mazzei,, S. Fallani,, R. Dei,, M.I. Cassetta, and, S. Conti. 1995. Betalactam therapy and intestinal flora. J. Chemother. 7(Suppl. 1):2532.
113. Orrhage, K.,, B. Brismar, and, C.E. Nord. 1994. Effect of supplements with Bifidobacterium longum and Lactobacillus acidophilus on the intestinal microbiota during administration of clindamycin. Microb. Ecol. Health Dis. 7:1725.
114. Orrhage, K.,, S. Sjöstedt, and, C.E. Nord. 2000. Effect of supplements with lactic acid bacteria and oligofructose on the intestinal microflora during administration of cefpodoxime proxetil. J. Antimicrob. Chemother. 46:603611.
115. Pecquet, S.,, A. Andremont, and, C. Tancrède. 1986. Selective antimicrobial modulation of the intestinal tract by norfloxacin in human volunteers and in gnotobiotic mice associated with human faecal microflora. Anrimcrob. Agents Chemother. 29:10471052.
116. Pecquet, S.,, A. Andremont, and, C. Tancrède. 1987. Effect of ofloxacin on fecal bacteria in human volunteers. Antimicrob. Agents Chemother. 31:124125.
117. Pecquet, S.,, E. Chachaty,, C. Tancrède, and, A. Andremont. 1991. Effects of roxithromycin on fecal bacteria in human volunteers and resistance to colonization in gnotobiotic mice. Antimicrob. Agents Chemother. 35:548552.
118. Pecquet, S.,, S. Ravoire, and, A. Andremont. 1990. Faecal excretion of ciprofloxacin after a single oral dose and its effect on faecal bacteria in healthy volunteers. J. Antimicrob. Chemother. 26:125129.
119. Ritz, M.,, H. Lode,, M. Fassbender,, K. Borner,, P. Koeppe, and, C.E. Nord. 1994. Multiple-dose pharmacokinetics of sparfloxacin and its influence on fecal flora. Antimicrob. Agents Chemother. 38:455459.
120. Rozenberg-Arska, M.,, A.W. Dekker, and, J. Verhoef. 1985. Ciprofloxacin for selective decontamination of the alimentary tract in patients with acute leukemia during remission induction treatment: the effect on the fecal flora. J. Infect. Dis. 152:104107.
121. Salyers, A.A., and, C.F. Amábile-Cuevas. 1997. Why are antibiotic resistance genes so resistant to elimination. Minireview. Antimicrob. Agents Chemother. 41:23212325.
122. Scanvic-Hameg, A.,, E. Chachaty,, J. Rey,, C. Pousson,, M.L. Ozoux,, E. Brunel, and, A. Andremont. 2001. Impact of quinupristin/dalfopristin (RP59500) on the fecal microflora in healthy volunteers. J. Antimicrob. Chemother. 49:135139.
123. Stark, C.A.,, I. Adamsson,, C. Edlund,, S. Sjöstedt,, R. Seensalu,, B. Wikström, and, C.E. Nord. 1996. Effects of omeprazole and amoxycillin on the human oral and gastrointestinal microflora in patients with Helicobacter pylori infection. J. Antimicrob. Chemother. 38:927939.
124. Sullivan, Å.,, C. Edlund, and, C.E. Nord. 2001. Effect of antimicrobial agents on the ecological balance of human microflora. Lancet Infect. Dis. 1:101114.
125. Sullivan, Å.,, C. Edlund,, B. Svenungsson,, L. Emtestam, and, C.E. Nord. 2001. Effect of perorally administered pivmecillinam on the normal oropharyngeal, intestinal and skin microflora. J. Chemother. 13:299308.
126. Summanen, P.,, E. Baron,, D. Citron,, C. Stong,, H. Wexler, and, S. Finegold. 1993. Wadsworth Anaerobic Bacteriology Manual, 5th ed., p. 1–159. Veterans Administration, Wadsworth Medical Center, Los Angeles, Calif.
127. Tang, Y.W., and, D.H. Persing. 1999. Molecular detection and identification of microorganisms, p. 215244. In P.R. Murray,, E.J. Baron,, M.A. Pfaller,, F.C. Tenover, and, R.H. Yolken (ed.), Manual of Clinical Microbiology, 7th ed. ASM Press, Washington, D.C.
128. Tannock, G.W. 1999. The normal microflora: an introduction, p. 123. In G.W. Tannock (ed.), Medical Importance of Normal Microflora. Kluwer Academic Publishers, London. 129.
129. Van der Auwera, P.,, N. Pensart,, V. Korten,, B.E. Murray, and, R. Leclercq. 1996. Influence of oral glycopeptides on the fecal flora of human volunteers: selection of highly glycopep-tide-resistant enterococci. J. Infect. Dis. 173:11291136.
130. van der Leur, J.J.J.P.M.,, E.J. Vollaard,, A.J.H.M. Janssen, and, A.S.M. Dofferhoff. 1997. Influence of low dose ciprofloxacin on microbial colonization of the digestive tract in healthy volunteers during normal and during impaired colonization resistance. Scand. J. Infect. Dis. 29:297300.
131. van der Waaij, D. 1985. Selective decontamination of the digestive tract with oral aztreonam and temocillin. Rev. Infect. Dis. 7 (Suppl. 4):628634.
132. van der Waaij, D., and, C.E. Nord. 2000. Development and persistence of multiresistance to antibiotics in bacteria; an analysis and a new approach to this urgent problem. Int. J. Antimicrob. Agents 16:191197.
133. van Nispen, C.H.M.,, A.I.M. Hoepelman,, M. Rozenberg-Arska,, J. Verhoef,, L. Purkins, and, S.A. Willavize. 1998. A double-blind, placebo-controlled, parallel group study of oral trovafloxacin on bowel microflora in healthy male volunteers. Am. J. Surg. 176 (Suppl. 6A):2731.
134. Van Saene, J.J.,, H.K. Van Saene,, J.N. Geitz,, N.J. Tarko-Smit, and, C.F. Lerk. 1986. Quinolones and colonization resistance in human volunteers. Pharm. Weekbl. Sci. 8:6771.
135. Vogel, F., and, H. Knothe. 1985. Changes in aerobic faecal bacterial flora of severely ill patients during antibiotic treatment. Klin. Wochenschr. 63:11741179.
136. Vogel, F.,, H.R. Ochs,, K. Wettich,, S. Kalich,, I. Nilsson-Ehle,, I. Odenholt, and, C.E. Nord. 2001. Effect of step-down therapy of ceftriaxone plus loracarbef versus parenteral therapy of ceftriaxone on the intestinal microflora in patients with community-acquired pneumonia. Clin. Microbiol. Infect. 7:376379.
137. Vollaard, E.J., and, H.A.L. Clasener. 1994. Colonization resistance. Minireview. Antimicrob. Agents Chemother. 38:409414.
138. Vollaard, E.J.,, H.A.L. Clasener, and, A.J.H.M. Janssen. 1992. Influence of pefloxacin on microbial colonization resistance in healthy volunteers. Eur. J. Clin. Microbiol. Infect. Dis. 11:257260.
139. Welling, G.W.,, G.J. Meijer-Severs,, G. Helmus,, E. van Santen,, R.H.J. Tonk,, H.G. de Vries-Hospers, and, D. van der Waaij. 1991. The effect of ceftriaxone on the anaerobic bacterial flora and the bacterial enzymatic activity in the intestinal tract. Infection 19:313316.
140. Whiley, R.A., and, D. Beighton. 1998. Current classification of the oral streptococci. Oral Microbiol. Immunol. 13:195216.
141. Whittaker, C.J.,, C.M. Klier, and, P.E. Kolenbrander. 1996. Mechanisms of adhesion by oral bacteria. Annu. Rev. Microbiol. 50:513552.
142. Wise, R.,, S.A. Bennet, and, J. Dent. 1984. The pharmacokinetics of orally absorbed cefuroxime compared with amoxycillin/ clavulanic acid. J. Antimicrob. Chemother. 13:603610.
143. Wistrom, J.,, L.O. Gentry,, A.C. Palmgren,, M. Price,, C.E. Nord,, A. Ljungh, and S.R. Norrby. 1992. Ecological effects of short-term ciprofloxacin treatment of travellers diarrhoea. J. Antimicrob. Chemother. 30:693706.

Tables

Generic image for table
Table 1

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
Generic image for table
Table 2

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
Generic image for table
Table 3

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
Generic image for table
Table 4

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
Generic image for table
Table 5

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
Generic image for table
Table 6

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
Generic image for table
Table 7

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
Generic image for table
Table 8

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
Generic image for table
Table 9

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
Generic image for table
Table 10

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56
Generic image for table
Table 11

Citation: Sullivan Å, Edlund C, Erik Nord C. 2005. Interaction between Antimicrobial Agents and the Oropharyngeal and Intestinal Normal Microflora, p 1357-1370. In Bryskier, M.D. A (ed), Antimicrobial Agents. ASM Press, Washington, DC. doi: 10.1128/9781555815929.ch56

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