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Original Research Article

The effect of inoculum size on the activity of different ratios of Ceftriaxone – Sulbactam [(1:1) vs. (2:1)] against ESBL producing organisms

M. Maladkar*

President - Medical and Regulatory Affairs, Aristo Pharmaceuticals Private Limited
Mumbai – 400053

Ind.J.Applied.Microbiol. 2021 .23(2) : 47-55

*Corresponding author


Antibiotic resistance has become the most importunate health issue
and remains a major public health concern worldwide. Production of extended spectrum
β-lactamases (ESBL) is one of the major causes of resistance to β-lactam antibiotics. Several
in-vitro studies have demonstrated the significant impact of inoculum size on the effectiveness of
β-lactam-β-lactamase inhibitor combination. Higher concentration of β-lactamase inhibitor
(Sulbactam) will be needed to combat the increased production of ESBLs in infections with high
inoculum. The primary objective of the present study is to evaluate Minimum Inhibitory
Concentration (MICs) of ESBL producing Enterobacteriaceae, against Ceftriaxone alone and
Ceftriaxone with Sulbactam combination (1:1 and 2:1) in presence of normal and higher inoculum
of these bacteria. The secondary objective of the study is to demonstrate the in-vitro efficacy of
Ceftriaxone-Sulbactam (CS) in presence of higher inoculum of bacteria.

Keywords: Ceftriaxone-Sulbactam combination, Extended-spectrum β-lactamases (ESBL),
Inoculum effect, Antibiotic resistance, Escherichia coli, Klebsiella pneumonia

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