MICs of 407 Oral Streptococci

strainsodontogenic

isolatedfrom closedabscessofinfection

Akihiro Kaneko1) and Jiro Sasaki2)1) Department of Dentistry and Oral Surgery , Ashikaga Red Cross Hospital,
3-2100 Honjo, Ashikaga, Tochigi 326, Japan2)Department of Oral Surgery, Tokai University School of Medicine(Received March 25, 1993 Accepted June 10, 1993)
The MICs of 407 strains of Oral Streptococci,
collected and measured in clinical tests of
new antimicrobial agents conducted during the period from September,1989 to June, 1991,
were studied.
cefteram
cefiximeThefollowing

9 antimicrobial

agentswereused:

ampicillin(ABPC),(CFTM),
cefuroxime(CXM),
cefpodoxime(CPDX),
cefdinir(CFDN),(CFIX)
cefaclor(CCL), ofloxacin (OFLX) and levofloxacin(LVFX).
We

have come to the conclusion that ampicillin has a higher MICs than previously.
other hand, ester-type cephems, cefteram pivoxil (cefteram)cefuroxime axetil

On the(cefur-oxime) and cefpodoxime
proxetil(cefpodoxime),
proved to have low and excellent
MICs. Cefdinir (non-ester-type)also showed a low, and excellent,MICs.
Key words: Oral Streptococci,odontogenic

infection,

MIC

We have already submitted a study on measurement of the MICs of 1,024 strains of causative

These

strains

organisms from odontogenic infectious diseases forwhich oral administrationof drugs is appropriate.

2.
Thefollowing

9 antimicrobial

This study focuses on measurement
Oral Streptococci which constitute1)

ampicillin(ABPC,Fororaltion of the above mentioned
1.

of the MICs ofsignificant por-causative

organisms.

I. Materialstrains

Bacterial

The strainsof causative
organisms
wereidentified from samples obtained from closed abscesses by the needle aspiration
method.
Thestrains studied here were isolated at the institutes
which conductedclinical tests of new antimicrobial

agents from September,
multi centric isolation

1989 to June, 1991 by themethod.
A streptococcal

identification kit, Api-STREP
system P was used
for biochemical analysis , with special reference tothe carbohydrate metabolism of test strains. A totalof 1024 strainsof bacteria

abscesses.
Oral
these strains.

were isolated from closed

Streptococci

Table 1 shows the details

constituted

407 ofof the 407 strains.

80•Žuntil

werestoredthemeasurement.

Antimicrobial

agentsinand

bacampicillin

crobialactivity

wasTable

1. Details

skimmilk

at-agents
Meiji

wereused:used.

Theantimi-thesameSeika)

administration,

mpicillin

10%

lenampicillin,
weremeasuredof Oralintala-Streptotococci

way

as

CHEMOTHERAPY

1050

that of ampicillin.
2) cefteram (CFTM, Toyama Kagaku)
For oral administration, an ester-type cefterampivoxil was used, The antimicrobial activity wasmeasured in the same way as that of cefteram.
3) cefuroxime (CXM, Glaxo)
For oral administration, an ester-type, cefuroxime axetil was used, The antimicrobial activity wasmeasured in the same way as that of cefuroxime.
4) cefpodoxime (CPDX , Sankyo Seiyaku)
For oral administration, an ester-type, cefpodoxime proxetil was used. The antimicrobial activity
was measured in the same way as that of cefpodoxime.
5) cefdinir (CFDN , Fuzisawa Seiyaku)
Because it does not change in internal organs, theantimicrobial activity was measured as was that ofcefdinir.
6) cefixime (CFIX, Fuzisawa Seiyaku)
Because it does not change in internal organs, theantimicrobial activity was measured as was that ofcefixime.
7) cefaclor (CCL, Shionogi Seiyaku)
Because it does not change in internal organs, theantimicrobial activity was measured as was that ofcefaclor.
8) ofloxacin (OFLX, Daiichi Seiyaku)
This is a typical pyridonecarboxylic acid agent.

Table

ABPC:

ampicillin,

CCL: cefaclor,

CFTM:

OFLX:

cefteram,ofloxacin,2, MICs

CXM:

LVFX:

forTheantimicrobial

samewayactivity
that

levofloxacin

This

agent

component
wasof(LVFX,consistsofwasDaiichi

oflasemi

ofloxacin.

measuredinII.

Methods

measuredin

theofloxacin.

ThetheSeiyaku)
bodies,aantimicrobial

same

way

as

major
activity

thatoflevoflo-xacin.

The
the

minimaltest

in theof

susceptibility

inhibitory

agentsagainstfollowing

tests

concentrationsorganisms

manner:A Mueller

5%

serum

Hintonmediumdilutionof eachantimicrobial

strain,previously

incubation

at

35•Ž

forat

which

no

bacterial

growthas

theofthebytheml.

each
After

imalconcentration

wasnoted,

wasandofdeterminedwithwithhorse(MIC)

werecombined

a 2-foldagent

wasadjusted

designatedto24

serialinoculated
Ur

hours,CFU/

theMIC

min-agent".
The,ƒÀ-lactamase
acidometricTable

2ginosus.

cus

activity

wasandnitorocefin
III.

Results

shows

MICs

against

Table

constellatus.

3 shows
Tableintermedius.

determined

methods.

MICs

4 shows

Streptococcus
against

MICs

Streptococ-Table

5 shows

MICs

againstTable

6 shows

MICs

againstmilleri.

tococcusmitis.

Table

7 shows

MICs

againstcoccussanguis.

Table8 shows

MICsof

CFDN:cefdinir,

allanginosus

cefpodoxime,

CFIX:

an-Streptococcus

againsttococcus

CPDX:.

as9)

Streptococcus

cefuroxime,

levofloxacin

OCT.1993

cefixime,

StrepStrepStreptothe

Oral

MICs of Oral Streptococci

VOL. 41 NO. 10

in odontogenic

infection

1051

Table 3. MICs for Streptococcus constellatus

ABPC: ampicillin, CFTM: cefteram, CXM: cefuroxime,
CCL: cefaclor, OFLX: ofloxacin, LVFX: levofloxacin.

Table

ABPC:ampicillin,

CCL: cefaclor,

Streptococci

examinedwellasime,

cefpodoxime

lowCFTM:

OFLX:

fourkinds

atofandCXM:

LVFX:time.

MICs

for Streptococcus

cefuroxime,

Ampicillin,(cefteram,cefdinir),

CPDX:

CFDN: cefdinir, CFIX: cefixime,

intermedius

cefpodoxime,

CFDN:

cefdinir,

as

to

have

in

these

DNA hybridyzation

techniques,

object to this classification4).
was

not

susceptibility
agents,Streptococci.
IV.
theUnitedS.

intermedius

lectively

calledDiscussion

States,S.

anginosus,(includingS.

SMG2WithS.
milleri)recentcefixime,

however,efforts

are being made to group them under the name of S.
anginosus3). Researchers
in the United Kingdom

cefurox-provedcapacity

CFIX:

levofloxacin.

MICs.

OralInthiscephem-lactamase-producingƒÀ

andcefteram,ofloxacin,

4.

CPDX: cefpodoxime,

constellatus,
werecol-advances

inIn view of the diverseof these organisms

in Japan,to antimicrobial

we do not think it appropriate

togroup them under the single heading of S. anginosue.
When compared with the results of 1989 compilation,

ampicillin

resistanceof Oral

Streptococci

CHEMOTHERAPY

1052

OCT

1993

Table 5, MICe for Streptococcus milleri

ABPC:

ampicillin,

CCL: cefaclor,

ABPC:

ampicillin,

CCL: cefaclor,

appeared

tohavereported

thatthestrains

offrom1987

tothatOral

Streptococci

TheMIC.

While

thehaveandMIC100,Table

8).

to

compilation

cephemsyieldedofcefteram:

MICs

ofwas

in

Streptococcus

CPDX:

dataandandand225

0.05

andcefixime,

CFDN:

cefdinir,

CFIX:

cefixime,

cefuroxim:

0.1

the

presentiig/ml,

3 .13ƒÊg/and0 .39ƒÊg/ml;of cefaclor:

and
1.56

0.39 ƒÊg/ml;
and12.5ƒÊg/isathewere

reportstrains

cephem,strains
ities

study,
cefaclor

MIC.
0.10,

ofcefteram,

0.39

and3.13respectively.

There

ing
data:

ofMIClooml.

cefuroxime,
to.

following
andCFIX:

MIClooMIC80

In

revealresistanceunchangedthecefdinir,mitis

resistant
is

CFDN:

cefpodoxime,

MIC80

examinedcurrent

0.20

for

ampicillin

weregained

cefpodoxime,

levofloxacin.

it

MICioothat

19896).

MICloocefuroxime,

Streptococci

resistance

and

CXM:

LVFX:

Specifically,andCPDX:

6.

respectively,(MIC801989

cefteram,

cefuroxime,

levofloxacin.

Table

0.10ƒÊg/ml,

respectively,
Their

CXM:

LVFX:

ofloxacin,increased.

andampicillin

CFTM:

MIC80

0.025

Oralcefteram,ofloxacin,

OFLX:

wereml,

CFTM:

OFLX:

ofofarethat

somehighlyalsoresistanttoantimicrobial
S.

sanguis12.5 ƒÊg/ml

agents7).
showedandinclud-Specifically,

ampicillin

6 showed

ampicillinother,3

susceptibil-susceptibilitiesofVOL.41

MICs of Oral Streptococci

NO.10

ABPC:

ampicillin,

CCL: cefaclor,

ABPC:

CFTM:

OFLX:

ampicillin,

CCL: cefaclor,

cefteram,ofloxacin,

CFTM:

OFLX:

7. MICs for Streptococcus sanguis

CXM:

cefuroxime,

cefteram,CPDX:

cefpodoxime,

Table

8. MICs

CXM:

cefuroxime,

LVFX:

for

Oral

Streptococci

MICs

ofstrains

were

12.5

clor,

for

These

resistanttheance

tocephalothin,against

andThesame

25ƒÊg/ml.

strainswerestrains

also

50

CPDX:

cefpodoxime,of drug

resistanceIndeed,

PBP

have

been

indevelopment

infoundtomechanismofthe100ƒÊg/ml.

beprotein
themechanism

streptococci8-10)
underlic

aforementioned

cefdinir,

CFIX:

cefixime

CFDN:

cefdinir,

CFIX:

cefixime,,

theS.

thesanguis11).

Itampicillin-resistantsusceptibilities

wasthusstrainstoeachcephem.

the

MICsofconcluded.

showeddiffer-Conclusionthatconsideredwasentreported

penicillin-binding

arecefa-ofbeenof(PBP)

that

resist..

theaffinitysame

notable

has

in

MICs
and

It

changestheshowedmacrolides.

CFDN:

levofloxacin.

drug-resistant

The

1053

levofloxacin.

25ƒÊg/ml.

resistanceinfection

Table

LVFX:

ofloxacin,in odontogenic

Afterstudying

Streptococci,
tests

of

theperiod

have
drug

highermulti-MIC

collected
newfromcometo

MICsofS.

andantibacterialconclusion

thanpreviously.
wasof
attothatJune,

during1991,

ampicillinWe

1.56ƒÊg/ml

Oralclinicalconducted

1989,

thestrains

measured

agents

Septemberconstellatus

407

we
has

noted

that

and

that

atheofS.

CHEMOTHERAPY

1054

intermedius
otherwas
hand,

as

high

ester-typeas

0.78ƒÊg/ml.

cephems,

cefteram(cefteram),

cefuroxime

axetilcefpodoxime

proxetil(cefpodoxime)

have

low-type)

andexcellent,

also

afor

futureAssignment
We

have

lowalreadyto(non-estera report

A,

Takai

Michi

K

Ishibashi

here.

of

the

antimicrobial

Therefore,

research

weon

which

we

Postontheagents

intendtoAntibiotic

phar-expecttobeexamined

conductEffect

able

to

Morishima

T,

YamazakiH,

ShiikiK

Sakamoto

further7)

with

the

break

K:

Bacteriological,H,

evaluation

organisms

isolatedfroma collaborativeof

cefditoren

pivoxil(ME1207).

11:

KanekoA,

clinicalisolates

124•`440,

Ueno

KanekoK,

Biologicalchracteristics

Streptococcus

JinThera!)

Sasaki,theandTherapandsanguis
dental19: 241•`248,

J: Theinfections
Oral

1986

abscess

Dent

K,

odontogenic

susceptibilities,onclosedWatanabe

5: 121-134,
A:

tolerancestudy

Oral

1992

from

antibiotic

Phamacol(PAE)

clarify

J,
H,

of

their
macokinetics

SasakiK,

PhamacolMICs.
6)submitted

KanekoKannoandprovedexcellent,

1993

1991
5)

pivoxil

Cefdinir, andthe(cefuroxime)

MICs.

had

On

OCT.

multipleisolatedinfection.

,

from

Ohn

Univ1992

point.
8)

FarberB F,

Eliopouls

G

M,

Ward

J I,

R

Multiply

Ruoff

K L

Acknowledgments
Syriopoulou
I would
Ms.

like

Junko

ing

and

to

express

Yamazakisortingforout

themysincere

her

hard

gratitude
work

measurement

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intoant

collect-results.

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ofviridans

Cited

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antibiotics

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hydratePoxtonutilization

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Hutchison

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theA,

SprattAgentsB G: Extensive

transpeptidase

domainClinbinding

protein2 B

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Streptococcuspneu-carbomoniae.

Mol

DowsonG

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3: 95-102, 1989Streptococ10)

cus

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15-

penicillin-ofcillin

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Distinct

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B: Emended

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later
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Descriptions
constellatus,

Syst.

streptococci
proteinhave

genes

from

obtained

pen-penicillin-resist-Bacteriol

strainsofStreptococcus

pneumoniae.

Mi-synonyms
crobiol

StreptococcusJ.

binding

constellatus,antandviridans

B:11)
and

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5858-5862,

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1990
F,

Yamadaresistantisolatedfromodontogenic

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as
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1992

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Kobayashi

Streptococcus

Chemotherapy

sanguis, 3 rd WesternandInfectious

I:

MICs of Oral Streptococci

VOL.41 NO.10

in odontogenic

歯 性 感 染 症 の 閉 塞 膿 瘍 か ら 検 出 さ れ たOral

金infection

Streptococci1055

407株の薬 剤感 受 性子明寛 三)・
佐 々 木 次 郎2)1)足利 赤 十 字病 院 歯 科 口腔 外 科 喩2)東海 大 学 医 学部 口腔 外科

1989年9月
ptococciのか ら1991年6月

ま で,新し い抗 菌 剤 の 臨 床 試 験 を行 い,407菌株 のOral

Stre‑

薬 剤 感 受 性 の検 討 を行 っ た。 抗 菌 剤 はampicillin(ABPC),cefteram(CFTM),

cefuroxime(CXM),cefpodoxime(CPDX),Cefdinir(CFDN),ce6xime(CFIX),cefa‑clor(CCL),onoxacin(OFLX)およ びlevonoxacin(LVFX)の9薬剤 に つ い て 検 討 を行っ た。 近 年,ampicminの耐 性 化 傾 向 が認 め られ る が エ ス テ ル 型 セ フ ェ ム のcefteram(cefteram),cefuroxime

axetil(cefuroxime)お非 エ ス テ ル 型 セ フ ェ ム のefdinirの*栃木 県足 利 市本 城3‑2100

よ びcefpodoxime

感 受 性 は良 好 で あ っ た、

pivoxilproxetil(cefpodoxime)