The Goal of Antimicrobial Therapy

The Captain

“The most effective strategy against antimicrobial

resistance is to get the job done right first time –
Resistance to unequivocally destroy microbes – thereby
Recurrence defeating resistance before it starts.”

WHO press release, June 2000:

Drug resistance threatens to reverse medical progress
The Captain
• Competent

• Consistent

• Convenient
 Competent
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Extensive spectrum against gram-positive and gram-negative micro-

organisms (including anaerobes).

Excellent bioavailability of 93%.

Well distributed in the body.

Rapidly bactericidal.

Anthony R. White; Journal of Antimicrobial Chemotherapy 2004

Peter Ball; International Journal of Antimicrobial Agents 2007
Michael D. Reed; The Pediatric Infectious Disease Journal 1998
When choosing an antimicrobial …
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When choosing an antimicrobial it is important that all the major pathogens are considered,
including the possibility of resistant strains.
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90

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40

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20

10

0
Penicillin-Susceptible Penicillin-Intermediate Penicillin-Resistant Beta-Lactamase Moraxella
Pneumococci Pneumococci Pneumococci Positive H, influenzae Catarrhalis

Curam Cefprozil Cefdinir Azithromycin

Mihaela Peric; Clinical Therapeutics 2003, Vol. 25 (1): 169-177

 Susceptibility of major RT pathogens
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Objectives :To determine the antimicrobial susceptibility (S) patterns for S.pneumoniae
(SPN), H. influenzae (HI) and M. catarrhalis (MCAT) from 1997–2006 in 13 European
nations.

Worldwide Susceptibility (%)

Agent SP HI MC
Amoxicillin/ clavulanic 96.1 97.5 99.3
Ceftriaxone 96.5 100 100
Cefprozil 76.9 15.5 14.8
Azithromycin 69 0.9 100

Curam® is ideal empirical therapies for infections involving:

S. pneumoniae, H. influenzae and/or M. catarrhalis

Jones, M. Stilwell, T. Fritsche, H. Sader; International Journal of Antimicrobial Agents,

Volume 29, Supplement 2, March 2007, Pages S7-S8R.
Curam® in Acute Otitis Media

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16 Penicllin-susceptible S.pneumoniae

14 Penicllin relatively resistant S.pneumoniae Curam® is the only oral

B-lactamase positive H. influenzae antibacterial that achieved MEF
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B-lactamase negative H. influenzae concentrations greater than the
10 MIC90 against common otitis media
M.Catanhalis
pathogens.
8 Horizontal lines, peak middle ear fluid
concentrations of the various drugs
6

0
Curam Azithromycin Cefprozil
S. pneumoniae is the most common causative pathogen in paediatric AOM.
Curam has the highest overall coverage of any oral agent for penicillin intermediate strains of S.pneumoniae
and is the only oral agent to provide adequate coverage for penicillin resistant S.pneumoniae.
Well distributed into most body tissues and extracellular fluids, including middle ear mucosa and middle ear
effusions.

Figure adapted from: Harrison et al. Pediatr Infect Dis J 1997;16:S12–S16

 Journal of Antimicrobial Chemotherapy
2009

AOM pathogen prevalence have produced higher rates of antibiotic resistance among
S. pneumoniae and H. influenzae.

The most active drugs across the board against all isolates in this
study were ceftriaxone and high-dose amoxicillin plus clavulanic
acid.

Journal of Antimicrobial Chemotherapy,

Advance Access published January 27, 2009
 Consistent
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Consistently included in recommendations.

Extensive clinical use in patients of all ages.

Established safety profile.

( Published clinical trials including 32,440 patients show that the incidence of
diarrhea is only 3.4%)

Anthony R. White; Journal of Antimicrobial Chemotherapy 2004

Michael D. Reed, Pharmd; The Pediatric Infectious Disease Journal 1996
 Consistent Efficacy

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Extensively used in patients of all ages including infants,

children and adults.

In Lower respiratory tract infections 92% n=3325

97% n=594

In Skin soft tissue infections 96% n=772

In Genito-urinary tract infections 97% n=126

In Tonsillopharyngitis 92% n=1672

100% n=100

In Otitis media
H.C. NEU; Journal of Chemotherapy (1993)
In Odontogenic abscesses
 Convenient
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Friendly packages.

Unique taste of fruits.

Simple and optimal dosage regimen.

Can be taken without regard to meals.

Jane Easton; Drugs 2003

Preferred choice
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 Competent
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In recent years, an important factor affecting the management

of Acute Otitis Media ( AOM) has been the increasing
development of antimicrobial resistance.

Among the common pathogens that cause AOM ,

particularly the worldwide prevalence of resistant
streptococcus pneumoniae.

The development of new dosage forms of Curam allows it to

continue to fill its important role in therapy.
 Why 642?
The Captain

Curam 642 allows dosing with 90/6.4 mg/ kg

Oral dosing regimen of 90/6.4 mg /kg amoxicillin/clavulanic acid

per day in Two divided doses
produces serum concentration of 4 mg/L for at least 40% of
dosing interval

Consequently pathogens ( mainly Strept. Pneumoniae ) with

MIC up to 4 mg/L are susceptible and likely to be eradicated
with Curam 642
Curam 642 doses

Volume of amoxicillin and clavulanate

Body weight (Kg) potassium for oral suspension 600 mg/ 42.9
mg per 5ml providing 90 mg / kg /day

8 3 ml twice daily
12 4.5 ml twice daily
16 6 ml twice daily
20 7.5 twice daily
24 9 ml twice daily
28 10.5 ml twice daily

¾ body weight daily divided on 2 doses

Convenient
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High bacteriological & clinical cure

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Optimal dosage regimen LE

Unique taste of fruits

Excellent safety profile

Twice daily forms
Curam forms
Preferred choice
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Thanks