Using old antibiotics to treat ancient bacterium-β-lactams for Bacillus anthracis meningitis

PLoS One. 2020 Feb 13;15(2):e0228917. doi: 10.1371/journal.pone.0228917. eCollection 2020.

Abstract

As Bacillus anthracis spores pose a proven bio-terror risk, the treatment focus has shifted from exposed populations to anthrax patients and the need for effective antibiotic treatment protocols increases. The CDC recommends carbapenems and Linezolid (oxazolidinone), for the treatment of anthrax, particularly for the late, meningeal stages of the disease. Previously we demonstrated that treatment with Meropenem or Linezolid, either as a single treatment or in combination with Ciprofloxacin, fails to protect rabbits from anthrax-meningitis. In addition, we showed that the failure of Meropenem was due to slow BBB penetration rather than low antibacterial activity. Herein, we tested the effect of increasing the dose of the antibiotic on treatment efficacy. We found that for full protection (88% cure rate) the dose should be increased four-fold from 40 mg/kg to 150 mg/kg. In addition, B. anthracis is a genetically stable bacterium and naturally occurring multidrug resistant B. anthracis strains have not been reported. In this manuscript, we report the efficacy of classical β-lactams as a single treatment or in combination with β-lactamase inhibitors in treating anthrax meningitis. We demonstrate that Ampicillin based treatment of anthrax meningitis is largely efficient (66%). The high efficacy (88-100%) of Augmentin (Amoxicillin and Clavulonic acid) and Unasyn (Ampicillin and Sulbactam) makes them a favorable choice due to reports of β-lactam resistant B. anthracis strains. Tazocin (Piperacillin and Tazobactam) proved inefficient compared to the highly efficient Augmentin and Unasyn.

MeSH terms

  • Amoxicillin-Potassium Clavulanate Combination / therapeutic use
  • Ampicillin / therapeutic use
  • Animals
  • Anthrax / drug therapy*
  • Anti-Bacterial Agents / pharmacology
  • Bacillus anthracis / drug effects*
  • Bacillus anthracis / metabolism
  • Bacillus anthracis / pathogenicity
  • Bacteria / drug effects
  • Disease Models, Animal
  • Dose-Response Relationship, Drug
  • Humans
  • Meropenem / pharmacology
  • Microbial Sensitivity Tests
  • Piperacillin, Tazobactam Drug Combination / therapeutic use
  • Rabbits
  • Sulbactam / therapeutic use
  • beta-Lactamase Inhibitors / therapeutic use
  • beta-Lactams / metabolism
  • beta-Lactams / pharmacology*

Substances

  • Anti-Bacterial Agents
  • beta-Lactamase Inhibitors
  • beta-Lactams
  • Piperacillin, Tazobactam Drug Combination
  • sultamicillin
  • Amoxicillin-Potassium Clavulanate Combination
  • Ampicillin
  • Meropenem
  • Sulbactam

Grants and funding

The authors received no specific funding for this work