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Journal of Antimicrobial Chemotherapy (2000) 45, 123-127
© 2000 The British Society for Antimicrobial Chemotherapy

Brief reports

Serum bactericidal and inhibitory titres in the management of melioidosis

Andrew J. H. Simpsona,b,*, David A. B. Dancea,b,{dagger}, Vanaporn Wuthiekanuna and Nicholas J. Whitea,b

a Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand; b Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK

A retrospective evaluation of the relationship between serum bactericidal and inhibitory titres and treatment outcome in 195 adult Thai patients with severe melioidosis was conducted. Drug regimens included ceftazidime (52% of patients), co-amoxiclav (24%), imipenem (11%) or the conventional four-drug combination (11%). Pre- and 1 h post-dose serum samples were collected after 48–72 h of therapy, and serum inhibitory and bactericidal titrations determined. Median post-dose titres were: bactericidal 1:8 (range 0–1:128) and inhibitory 1:16 (range 0–1:128). Overall mortality was 26% and outcome was not influenced by either inhibitory or bactericidal titres. Pre-dose titres correlated with renal function; renal function was the most important predictor of mortality. Determination of serum inhibitory or bactericidal titres is unhelpful in the management of severe melioidosis.

* Corresponding author. Tel: +66-2-246-0832; Fax: +66-2-246-7795; E-mail: fnajs{at}diamond.mahidol.ac.th

{dagger} Present address. Public Health Laboratory, Derriford Hospital, Plymouth, UK


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