{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T02:38:10Z","timestamp":1761100690745,"version":"build-2065373602"},"reference-count":53,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2012,1,17]],"date-time":"2012-01-17T00:00:00Z","timestamp":1326758400000},"content-version":"vor","delay-in-days":4460,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[1999,11]]},"abstract":"<jats:p><jats:bold>Study Objectives<\/jats:bold>. To determine the frequency of reduced susceptibility to penicillin, and to compare the in vitro activity and pharmacodynamics of oral \u03b2\u2010lactam antibiotics against clinical isolates of <jats:italic>Streptococcus pneumoniae<\/jats:italic> from southeast Missouri.<\/jats:p><jats:p><jats:bold>Setting<\/jats:bold>. Cape Girardeau, Missouri (population 35,500).<\/jats:p><jats:p><jats:bold>Interventions<\/jats:bold>. Minimum inhibitory concentrations (MICs) were determined for penicillin, amoxicillin, amoxicillin\u2010clavulanic acid, cefprozil, cefuroxime, cefpodoxime, cefaclor, and loracarbef by E test for 108 isolates of <jats:italic>S. pneumoniae<\/jats:italic>. The MIC<jats:sub>50<\/jats:sub>, MIC<jats:sub>90<\/jats:sub>, and percentage susceptibility were calculated for each agent. Pharmacokinetic variables were obtained from the literature, and serum concentration\u2010time profiles were simulated for a 25\u2010kg child taking pediatric dosages commonly administered to treat otitis media. The average time above MIC (T &gt; MIC) was calculated as percentage of the dosing interval using free concentrations and the MIC for each individual isolate. Analysis of variance (Scheffe post hoc test) was used to determine differences among agents for in vitro activity and T &gt; MIC (level of significance, p&lt;0.05).<\/jats:p><jats:p><jats:bold>Measurements and Main Results<\/jats:bold>. The frequency of penicillin\u2010nonsusceptible <jats:italic>S. pneumoniae<\/jats:italic> was 28.7% (31\/108). For 25 penicillin\u2010intermediate isolates, amoxicillin and amoxicillin\u2010clavulanic acid were significantly more active than cefprozil, cefaclor, and loracarbef. The T &gt; MIC for amoxicillin and amoxicillin\u2010clavulanic acid, simulated at 13.3 mg\/kg every 8 hours, was significantly longer than that for all other (\u03b2\u2010lactams.<\/jats:p><jats:p><jats:bold>Conclusion<\/jats:bold>. Amoxicillin and amoxicillin\u2010clavulanic acid have superior in vitro activity and longer T &gt; MIC for penicillin\u2010intermediate isolates than the other oral \u03b2\u2010lactams.<\/jats:p>","DOI":"10.1592\/phco.19.16.1308.30869","type":"journal-article","created":{"date-parts":[[2004,4,27]],"date-time":"2004-04-27T04:26:20Z","timestamp":1083039980000},"page":"1308-1314","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["In Vitro Activity and Pharmacodynamics of Oral \u03b2\u2010Lactam Antibiotics Against <i>Streptococcus pneumoniae<\/i> from Southeast Missouri"],"prefix":"10.1002","volume":"19","author":[{"given":"Michael B.","family":"Kays","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karriann K.","family":"Wood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald 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