This document discusses the role of the antibiotic combination Cefoperazone+Sulbactam (2SUM) in treating infections caused by Acinetobacter baumannii. It provides background on A. baumannii, noting its increasing drug resistance and role in healthcare-associated infections. The document then summarizes evidence that 2SUM exhibits low resistance against A. baumannii and is effective in treating respiratory tract infections. It provides dosage and administration guidelines for 2SUM in adults, children, and neonates. The document highlights the broad-spectrum activity and tolerability of 2SUM, making it an effective option for treating multidrug-resistant bacterial infections.

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Role of 2SUM in treating infections
caused by
Acinetobacter baumannii

3. Acinetobacter baumannii…
An Emerging Multidrug-resistant Threat
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4. Acinetobacter baumannii…
in Healthcare Settings
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Outbreaks of Acinetobacter infections typically occur in intensive care
units (ICU)and healthcare settings housing very ill patients.
Acinetobacter infections rarely occur outside of healthcare settings

5. Symptoms of Acinetobacter
infection
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Acinetobacter causes a variety of diseases, ranging from pneumonia to
serious blood or wound infections, and the symptoms vary depending
on the disease.
Acinetobacter may also “colonize” or live in a patient without causing
infection or symptoms, especially in tracheostomy sites or open wounds

6. Transmissionof Acinetobacter
infection
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Hospitalized patients, especially very ill patients on a ventilator, those
with a prolonged hospital stay, those who have open wounds, or any
person with invasive devices like urinary catheters are also at greater
risk for Acinetobacter infection
People who have weakened immune systems, chronic lung disease, or
diabetes may be more susceptible to infections with Acinetobacter

7. Acinetobacterbaumannii…
The last two decades have seen an increase in both the incidence and
seriousness of A. baumannii infection, with the main targets being
patients in Intensive-Care Units. The increase in A. baumannii
infections has paralleled the alarming development of resistance
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8. Inspite of having low virulence Acinetobacter can cause infection in those
who are immunocompromised, have chronic disease, have surgical
wounds, or have prolonged hospital admissions. Infections caused by
Acinetobacter can include:
 Bacteremia
 Hospital-acquired pneumonia
 Meningitis
 Urinary tract infections
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Acinetobacterbaumannii…

9. A great challenge for physicians
Dealing with Multidrug-resistant Acinetobacter
baumannii is a great challenge for physicians not only
due to its ability to survive in a hospital setting but also
because of the increasing mortality and morbidity
associated with this pathogen
Adapted: Int.J.Curr.Microbiol.App.Sci (2014) 3(2): 9-13
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10. Cefoperazone+Sulbactam
in treatinginfections causedby
Acinetobacterbaumannii…
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11. Alogicalnewapproachtothewidespreadproblemofantibiotic
resistanceduetoβ-lactamaseproducingpathogens
The combination of Sulbactam and the third-generation cephalosporin
Cefoperazone represents a logical new approach to the widespread
problem of antibiotic resistance due to β-lactamase producing
pathogens
Cefoperazone+Sulbactam is effective against β-lactamase producing
strains of the numerous plasmid-mediated β- lactamases produced by
gram-negative organisms & gram-positive staphylococci as well
Adapted: From the Department of Medical Microbiology,
The London Hospital Medical College, London, England
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12. Exhibitslowresistance againstNosocomial
Acinetobacter baumannii
Acinetobacter baumannii showed high level of resistance to all
studied antimicrobials except Cefoperazone+Sulbactam, which
possessed the lowest MIC50 & MIC90 values for a relatively small
percent of all hospital-acquired infections
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Adapted: Antimicrobial Resistance among Nosocomial Acinetobacter
Baumannii from Russian intensive care units

13. Exhibitslow resistanceagainstNosocomial
Acinetobacterbaumannii
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Adapted: Antimicrobial Resistance among Nosocomial Acinetobacter
Baumannii from Russian intensive care units

14. Cefoperazone+Sulbactam
Aneffectiveandwelltoleratedoptionforthetreatmentof
RespiratoryTractInfections
Cefoperazone+Sulbactam is an effective and well tolerated
option for the treatment of respiratory tract infections
caused by beta-lactamase producing as well as beta-
lactamase non-producing bacteria
Overall clinical efficacy rates were 79% in pneumonia and
80% in respiratory tract infections
Adapted: Jpn J Antibiot. 1996 Aug;49(8):800-7
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15. ®
Powerful antibacterial to treat variety
of severe infections
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16. Semi Synthetic
3rd generation cephalosporin antibiotic
Peptidoglycan synthesis inhibitor
Cefoperazone + Sulbactam
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Powerful antibacterial to treat
variety of severe infections

17. • Acts by inhibiting biosynthesis of cell wall
mucopeptide
• Sulbactam acts a beta-lactamase inhibitor, thus
restoring Cefoperazone activity against
beta-lactamase producing strains
Mechanism of Action
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Powerful antibacterial to treat
variety of severe infections

18. Cefoperazone+Sulbactam is indicated for the treatment of the following
infections when caused by susceptible organisms:
• Treatment of infections caused by multidrug-resistant
Acinetobacter baumannii
• Lower respiratory tract infections
• Urinary tract infections
• Bloodstream infections / Septicemia
• Skin and Soft Tissue Infections
• Intra-Abdominal Infections
• Bone and Joint Infections/Surgical Site Infections (SSIs)
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Powerful antibacterial to treat
variety of severe infections
Indications

19. Other Indications:
• Peritonitis
• Cholecystitis & Cholangitis
• Meningitis
• Pelvic Inflammatory Disease
• Also effective in Endometritis, Gonorrhea, and Other
Infections of the Genital Tract
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Powerful antibacterial to treat
variety of severe infections
Indications

20. Combination Therapy
Because of the broad spectrum of activity of
Cefoperazone+Sulbactam, most infections can be treated
adequately with this antibiotic alone
However, Cefoperazone+Sulbactam may be used
concomitantly with other antibiotics if such combinations are
indicated e.g. aminoglycosides (renal function should be
monitored) 20
Powerful antibacterial to treat
variety of severe infections
Indications

21. 2SUM 500mg/1g/2g Injection
For IM/IV use
Adults
2-4g/day IV or IM every 12 hourly
Maximum 8g/day in equally divided doses every 12 hourly
Children
40-80mg/kg/day in 2-4 equally divided doses
Maximum 160mg/kg/day
Neonates
For neonates in the first week of life, the drug should be given every 12
hours
The maximum daily dosage of Sulbactam in paediatrics should not exceed
80 mg/kg/day. If more than 80 mg/kg/day of Cefoperazone activity are
necessary, additional Cefoperazone should be administered separately 21
Powerful antibacterial to treat
variety of severe infections
Dosage & Administration

22. • For neonates in the first week of life, the drug should be given every
12 hours
• The maximum daily dosage of sulbactam in pediatrics should not
exceed 80 mg/kg/day
• For doses of sulbactam/cefoperazone requiring more than 80
mg/kg/day cefoperazone activity, the 1:2 ratio product must be used
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Powerful antibacterial to treat
variety of severe infections
Dosage & Administration in Neonates

23. • Doses should be administered every 6 to 12 hours in equally
divided doses
• In serious or refractory infections, these dosages may be increased
up to 160 mg/kg/day
• Doses should be administered in two to four equally divided doses
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Powerful antibacterial to treat
variety of severe infections
Dosage & Administration in Children

24. • Doses should be administered every 12 hours in equally divided
doses
• In severe or refractory infections the daily dosage of
Cefoperazone+Sulbactam may be increased up to 8 g of the 1:1
ratio (i.e., 4 g cefoperazone activity)
• The recommended maximum daily dosage of sulbactam is 4 g
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Powerful antibacterial to treat
variety of severe infections
Dosage & Administration in Adults

25. Pregnancy:
Cefoperazone should be used during pregnancy only if clearly needed
Nursing Mothers:
Although cefoperazone passes poorly into breast milk of nursing mothers,
caution should be exercised when cefoperazone is administered to a
nursing woman
Geriatric Use:
In general, dose selection for an elderly patient should be cautious,
usually starting at the low end of the dosing range, reflecting the greater
frequency of decreased hepatic, renal, or cardiac function, and of
concomitant disease or other drug therapy
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Powerful antibacterial to treat
variety of severe infections
Precautions

26. • Effective against resistant pathogens including Acinetobacter
baumanii, Enterobacteriaceae & Pseudomonas aeruginosa
• Broad spectrum of activity ensuring better efficacy
• An effective treatment of respiratory tract infection (nosocomial
infections)
• Effective against common infecting pathogens such as
Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus
influenzae, Klebsiella pneumoniae,
• Empirical monotherapy of Bacterial Sepsis
• Better Tolerable 26
Powerful antibacterial to treat
variety of severe infections
Benefits

27. Powerful antibacterial to treat
variety of severe infections
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Availability

28. Cefeperazone+Sulbactam 500g
Product Company MRP/Vial
2SUM® 500g SAMI 146.88
Cefeperazone+Sulbactam 2g
Products Company MRP/Vial
Cost
Saving/Vial
2SUM® 2g SAMI 330 350
Other Brands - 680 -
Cefeperazone+Sulbactam 1g
Products Company MRP/Vial
Cost
Saving/Vial
2SUM® 1g SAMI 235 165
Other Brands - 400 - 28
Price economy

29. Thank You
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