{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T06:22:28Z","timestamp":1785219748993,"version":"3.55.0"},"reference-count":38,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Extended-spectrum beta-lactamase-producing\n                      <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                      (ESBL-EC) is increasing worldwide. The drugs of choice for treatment of ESBLs are parenteral carbapenems. The aim of this study was to evaluate the\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">in vivo<\/jats:italic>\n                      efficacy of a new combination of oral cephalosporins and amoxicillin\/clavulanate in treatment of ESBL-EC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A total of 150 ESBL-EC samples were collected over 1 year from two referral centers. Synergistic studies of cephalosporins and amoxicillin\/clavulanate were performed\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      using disk approximation and disk replacement methods. Combination treatment was assessed\n                      <jats:italic toggle=\"yes\">in vivo<\/jats:italic>\n                      on 20 ESBL-EC urinary tract infection (UTI) patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      ESBL-EC isolates were confirmed in 150 patients with a mean age of 46.67 years, 75.2% of them being women. Antibiotic susceptibility testing of isolates indicated high resistance rate to oral antibiotics. The frequency of positive synergy and mean distance of synergy between cephalosporins and amoxicillin\/clavulanate was significantly higher with cefotaxime and cefixime compared with cefpodoxime, cefdinir, and ceftazidime using disk approximation and disk replacement methods (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05). Addition of amoxicillin\/clavulanate enhanced the susceptibility rate with cefixime from 8.6% to 86.3%, significantly higher than with other cephalosporins (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0005). Cefixime and amoxicillin\/clavulanate synergy was not affected by age, gender, hospital, department, sample type, or bacterial load. Eighteen of 20 ESBL-EC-positive UTI patients had a positive\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      synergy test and complete clinical and microbiological resolution after completion of cefixime and amoxicillin\/clavulanate oral treatment course.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      Cefixime and amoxicillin\/clavulanate combination therapy could be an effective oral outpatient treatment option for ESBL-EC.\n                      <jats:italic toggle=\"yes\">In vitro<\/jats:italic>\n                      synergistic testing is simple and predictive of successful treatment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/mdr.2019.0065","type":"journal-article","created":{"date-parts":[[2019,5,20]],"date-time":"2019-05-20T10:49:21Z","timestamp":1558349361000},"page":"1132-1141","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":34,"title":["Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-Producing\n                    <i>Escherichia coli<\/i>"],"prefix":"10.1177","volume":"25","author":[{"given":"Mohammad","family":"Al-Tamimi","sequence":"first","affiliation":[{"name":"Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jumana","family":"Abu-Raideh","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadeel","family":"Albalawi","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan","family":"Shalabi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saiel","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,10,11]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2016.08.007"},{"key":"e_1_3_4_3_2","unstructured":"expert committee WHO. 2014. 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