AU2014200107B2 - Compositions and methods of treatment comprising ceftaroline - Google Patents

Compositions and methods of treatment comprising ceftaroline Download PDF

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AU2014200107B2
AU2014200107B2 AU2014200107A AU2014200107A AU2014200107B2 AU 2014200107 B2 AU2014200107 B2 AU 2014200107B2 AU 2014200107 A AU2014200107 A AU 2014200107A AU 2014200107 A AU2014200107 A AU 2014200107A AU 2014200107 B2 AU2014200107 B2 AU 2014200107B2
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ceftaroline
pharmaceutically acceptable
prodrug
acceptable salt
solvate
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Donald Biek
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Pfizer Anti Infectives AB
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Pfizer Anti Infectives AB
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Abstract

The present invention provides compositions comprising ceftaroline or a pharmaceutically acceptable salt, solvate or a prodrag thereof alone or in combination with an antibacterial agent. The present invention provides methods of treating bacterial infection, which include administering an effective amount of ceftaroline or a pharmaceutically acceptable salt, solvate or a prodrug thereof alone or in combination with an antibacterial agent. IP Australia - 6 JAN 2014 RgEIVED -!EP FAX

Description

Australian Patents Act 1990 - Regulation 3.2A ORIGINAL COMPLETE SPECIFICATION STANDARD PATENT Invention Title "Compositions and methods of treatment comprising ceftaroline" The following statement is a full description of this invention, including the best method of performing it known to us: H:\rec\lntenvoven\NRPortbi\DCC\REC\5927062_. DOC - 6/j/14 COMPOSITIONS AND METHODS OF TREATMENT COMPRISING CEFTAROLINE FIELD OF THE INVENTION The present invention relates to compositions comprising ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) alone or in combination with an antibacterial agent and methods of treating bacterial infections comprising administering ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) alone or in combination with an antibacterial agent. BACKGROUND OF THE INVENTION Ceftaroline is a novel parenteral cephalosporin with a broad spectrum of activity against clinically important community-acquired and hospital-acquired Gram-negative and Gram-positive pathogens including methicillin-resistant Staphylococcus aureus and multidrug-resistant Streptococcus pneumoniae. U.S. Patent No. 6,417,175 discloses compounds having excellent antibacterial activities for a broad range of Gram-positive and Gram-negative bacteria. These compounds are represented by the general formula:
NOR
2
R
3 H N Y RIHN cooe wherein R'-R 4 , Q, X, Y and n are as defined therein. U.S, Patent No. 6,417,175 discloses methods for preparing the compounds, and generically-discloses formulations of the compounds, such as aqueous and saline solutions for injection. One such compound is 7p-[2(Z)-ethoxyimino-2-(5 phosphonoamino-1,2,4-thiadiazole-3-yl)acetamido]-3-[4-(1-methyl-4-pyridinio)-2 thiazolythiol-3-cephem-4-carboxylate.
U.S. Patent No. 6,906,055 discloses a chemical genus which includes compounds of formula:
(HO)
2 PONH S N+ CH N CO 02z(
CH
2
CH
3 C0 2 -X.nI o Ceftaroline fosamil is a sterile, synthetic, parenteral prodrug cephalosporin antibiotic. The N-phosphonoamino water-soluble prodrug is rapidly converted into the bioactive ceftaroline, which has been demonstrated to exhibit antibacterial activity. Ceftaroline fosamil is known as (6R,7R)-7-{(2Z)-2-(ethoxyimino)-2-[5 (phosphonoamino)-I,2,4-thiadiazol-3-yl]acetamido}-3-([4-(I -methylpyridin-l-ium-4 yl)-l,3-thiazol-2-yl]sulfanyl}-8-oxo-5-thia-l-azabicyclo[4.2.0]oct-2-ene-2-carboxylate. Ceftaroline fosamil may be an acetic acid hydrous form. Ha NN N //S OH 0 o 0 CH 3 COOH -H 2 0 U.S. Patent Nos. 6,417,175 and 6,906,055 are incorporated herein by reference, in their entirety. There remains a need in the art for new and improved compositions and methods directed to the treatment of bacterial infections. It has been surprisingly and unexpectedly found that ceftaroline in combination with various antibacterial agents acts synergistically against bacterial strains. Furthermore, the combination of ceftaroline and antibacterial agents does not show evidence of antagonism. Thus, the findings suggest that ceftaroline may be suitable for administration in combination with one or more antibacterial agents. 2 SUMMARY OF THE INVENTION The present invention provides compositions comprising a therapeutically effective amount of ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) alone or in combination with an antibacterial agent. In another aspect, the present invention provides a pharmaceutical composition comprising a therapeutically effective amount of ceftaroline fosamil or a pharmaceutically acceptable salt or solvate thereof, and an antibacterial agent, or a pharmaceutically acceptable salt thereof, selected from the group consisting of meropenem, piperacillin+tazobactam, amikacin, and aztreonam. In addition, the present invention provides methods of treating bacterial infection by administering to a patient in need thereof, a therapeutically effective amount of ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) alone or in combination with an antibacterial agent. BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 shows synergistic combinations (mean values) demonstrated with time-kill curves for clinical isolates (A) 2 ESBL-producing E. coli, (B) 2 ESBL-producing K. pneumoniae, (C) 2 AmpC-derepressed E. cloacae and (D) 3 P. aeruginosa isolates. The legends used are as follows: (-*-) Growth control, (-V-) Ceftaroline, (-o-) Meropenem, (-A-) Ceftaroline plus Meropenem, (-U-) Piperacillin-Tazobactam (4/1), (-D-) Ceftaroline plus Piperacillin Tazobactam, (-+-) Amikacin, (-0-) Ceftaroline plus Amikacin, ("e") Aztreonam, (-o-) Ceftaroline plus Aztreonam and (...) Limit of detection. Figure 2 shows in vitro activity of ceftaroline, vancomycin and tobramycin alone or in combination at MIC against 4 HA-MRSA. Results are presented as time-kill curves for (A) isolate R3875 (hVISA), (B) isolate R2303 (VISA), (C-D) isolates R3804 and R4039. The legends used are as follows: (e) Growth control, (o) Ceftaroline, (T) Tobramycin, (U) Vancomycin, (A) Ceftaroline plus Tobramycin, (0) Vancomycin plus Tobramycin and (...) Limit of detection. 3 DETAILED DESCRIPTION OF THE INVENTION The present invention provides compositions comprising ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) and methods for treating bacterial infections comprising administering a therapeutically 3A effective amount of ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil). In one aspect, the present invention provides pharmaceutical compositions comprising a therapeutically effective amount of ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) alone or in combination with an antibacterial agent. In some embodiments, the compositions may comprise ceftaroline or a pharmaceutically acceptable salt or a solvate thereof. In other embodiments, the compositions may comprise ceftaroline prodrug or a pharmaceutically acceptable salt or a solvate thereof (e.g., ceftaroline fosamil). In exemplary embodiments, the prodrug may be a phosphono prodrug. In some examples, the ceftaroline prodrug may be yeftaroline fosamil. In some embodiments, the ceftaroline fosamil may be a hydrous from, e.g., a monohydrate form, In still other embodiments, ceftaroline fosamil may be in an anhydrous form. In some embodiments, ceftaroline or a prodrug thereof may be a solvate form. For example, ceftaroline or prodrug of ceftaroline may be an acetic acid solvate form. In exemplary embodiments, the compositions comprise ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) alone or in combination with an antibacterial agent for intravenous or intramuscular route of administration. In some embodiments, the antibacterial agent, may include, but is not limited to, p-lactams, aminoglycosides, tetracyclines, sulfonamides, trimethoprim, fluoroquinolones, vancomycin, macrolides, polymyxins, chloramphenicol and lincosamides. In exemplary embodiments, the antibacterial agent may include, but is not limited to, amoxicillin, ampicillin, azlocillin, mezlocillin, apalcillin, hetacillin, bacampicillin, carbenicillin, sulbenicillin, ticarcillin, azlocillin, mecillinam, pivmecillinam, methicillin, ciclacillin, talampicillin, aspoxicillin, oxacillin, cloxacillin, dicloxacillin, flucloxacillin, nafcillin, pivampicillin, cephalothin, cephaloridine, cefaclor, cefadroxil, cefamandole, cefazolin, cephalexin, cephradine, ceftizoxime, cefoxitin, cephacetrile, cefotiam, cefotaxime, cefsulodin, cefoperazone, ceftizoxime, cefmenoxime, cefmetazole, cephaloglycin, cefonicid, cefodizime, cefpirome, ceftazidime, ceftriaxone, cefpiramide, 4 cefbuperazone, cefozopran, cefoselis, cefluprenam, cefuzonam, cefpimizole, cefclidin, cefixime, ceflibuten, cefdinir, cefpodoxime axetil, cefpodoxime proxetil, cefteram pivoxil, cefetamet pivoxil, cefcapene pivoxil cefditoren pivoxil, cefuroxime, cefuroxime axetil, daptomycin, loracarbacef, latamoxef and pharmaceutically acceptable salts, solvates or prodrugs thereof In specific embodiments, the p-lactam nmay be a cephalosporin, such as cefepime or a pharmaceutically acceptable salt, solvate or prodrug thereof In other embodiments, the p-lactam may be a monobactam. For example, the monobactam may be aztreonam or carumonam or a pharmaceutically acceptable salt, solvate or prodrug thereof. In certain embodiments, the antibacterial agent may be a glycylcycline. For example, the glycylcycline may be tigecycline or a pharmaceutically acceptable salt, solvate or prodrug thereof In other embodiments, the antibacterial agent may be an aminoglycoside, including, but not limited to, amikacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, streptomycin, tobramycin and pharmaceutically acceptable salts, solvates or prodrugs thereof. In exemplary embodiments, the aminoglycoside may be amikacin or a pharmaceutically acceptable salt, solvate or prodrug thereof. In other embodiments, the aminoglycoside may be tobramycin or a pharmaceutically acceptable salt, solvate or prodrug thereof. In still other embodiments, the antibacterial agent may be a carbapenem, including, but not limited to, imipenem, biapenem, meropenem, ertapenem, faropenem, doripenem, panipenem, PZ-601 and pharmaceutically acceptable salts, solvates or prodrugs thereof. In exemplary embodiments, the carbapenem may be meropenem or a pharmaceutically acceptable salt, solvate or prodrug thereof In certain embodiments, the antibacterial agent may be a macrolide, including, but not limited to, erythromycin, azithromycin, dirithromycin, telithromycin, clarithromycin and pharmaceutically acceptable salts, solvates or prodrugs thereof. In exemplary embodiments, the macrolide may be azithromycin or a pharmaceutically acceptable salt, solvate or prodrug thereof. In additional embodiments, the antibacterial agent may be a fluoroquinolone, including, but not limited to, levofloxacin, ciprofloxacin, ofloxacin, gatifloxacin, 5 norfloxacin, moxifloxacin, trovafloxacin and pharmaceutically acceptable salts, solvates or prodrugs thereof, In exemplary embodiments, the fluoroquinolone may be levofloxacin or a pharmaceutically acceptable salt, solvate or prodrug thereof. In still other embodiments, the antibacterial agent may be an acylamino-penicillin, such as piperacillin or a pharmaceutically acceptable salt, solvate or prodrug thereof, in further embodiments, the compositions may comprise tazobactam or a pharmaceutically acceptable salt, solvate or prodrug thereof. In certain embodiments, the antibacterial agent may be daptomycin or a pharmaceutically acceptable salt, solvate or prodrug thereof. For example, daptomycin may be used in combination to avoid the emergence of daptomycin-resistant mutants, such as methicillin-sensitive and methicillin-resistant isolates of Staphylococcus aureus. Dosage Forms In some embodiments, a dosage form comprising ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) wherein the dosage form includes information that ceftaroline or prodrug thereof may be used in combination, adjunctively, concomitantly or concurrently with an antibacterial agent is provided. For example, the dosage form may include information that use of ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof in combination, adjunctively, concomitantly or concurrently with an antibacterial agent may affect plasma concentration, bioavailability, safety, efficacy, or a combination thereof. In other embodiments, the dosage form may provide instructions that ceftaroline or prodrug thereof may be safe and/or effective for use in combination, adjunctively, concomitantly or concurrently with an antibacterial agent. For example, the dosage form may provide instructions that ceftaroline has no potential to antagonize or be antagonized by other antibiotics, antimicrobials or antibacterial agents. In further embodiments, the dosage form may provide instructions on antibiotics, antimicrobials or antibacterial agents that could be administered in combination with ceftaroline, a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil). In exemplary embodiments, the antibacterial agent may be a p-lactam, an aminoglycoside, a tetracycline, a sulfonamide, trimethoprim, a fluoroquinolone, 6 vancomycin, a macrolide (e.g., azithromycin), a polymyxin, a glycylcycline (e.g., tigecycline), chloramphenicol and a lincosamide. In exemplary embodiments, the antibacterial agent may be a carbapenem selected from the group consisting of imipenem, biapenem, meropenem, ertapenem, faropenem, doripenem, panipenem and PZ-601. In other exemplary embodiments, the antibacterial agent may be an aminoglycoside selected front the group consisting of amikacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, streptomycin, and tobramycin. In yet other exemplary embodiments, the antibacterial agent may be a fluoroquinolone selected from the group consisting of levofloxacin, ciprofloxacin, ofloxacin, gatifloxacin, norfloxacin, moxifloxacin and trovafloxacin. In further embodiments, the ceftaroline or prodrug thereof may be in the form of a pharmaceutically acceptable salt or solvate. In some embodiments, the antibacterial agent may be acylamino-penicillin, such as piperacillin. In other embodiments, the antibacterial agent may be daptomycin or a pharmaceutically acceptable salt, solvate or prodrug thereof The pharmaceutical composition, includes, but is not limited to, dosage forms such as, tablets (including a sugar-coated tablet, a film-coated tablet), pills, capsules (including microcapsule), granules, fine granules, powders, drop infusions, syrups, emulsions, suspensions, injections, aerosols, suppositories, troches, cataplasms, ointments, gels, creams, sustained release preparations, etc. In exemplary embodiments, the dosage forms comprising ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof alone or in combination with an antibacterial agent are suitable for intravenous or intramuscular route of administration These preparations can be prepared by a conventional method. As carriers for injectable preparations, use is made of, for example, distilled water or a physiological saline solution or any other suitable diluent. Carriers for capsules, powdery preparations, granular preparations or tablets are used as a mixture with known pharmaceutically acceptable excipients (for example, starch, maltose, sucrose, calcium carbonate or calcium phosphate), binders (for example, starch, gum arabic, carboxymethyl cellulose, hydroxypropyl cellulose or crystalline cellulose), lubricants (for example, magnesium stearate or talc) and disintegrants (for example, carboxymethyl calcium and talc). 7 In particular embodiments, the compositions may be presented in the form of a powder to be dissolved extemporaneously in an appropriate vehicle, for example, apyrogenic sterile water. The active ingredients may be incorporated with the excipients usually used in these pharmaceutical compositions, such as talc, gum arabic, lactose, starch, magnesium stearate, cocoa butter, aqueous or non aqueous vehicles, fatty matter of animal or vegetable origin, paraffin derivatives, glycols, various wetting, dispersing or emulsifying agents, preservatives, In other embodiments, the pharmaceutical composition may comprise pharmaceutically acceptable carriers, including, but not limited to, diluents and bulking agents, which are selected from excipients, such as, calcium carbonate, kaolin, sodium hydrogen carbonate, lactose, D-mannitol, starch, crystalline cellulose, talc, fine granulated sugar and porous substance; binders, such as, dextrin, gums, c-starch, gelatin, hydroxypropylcellulose, hydroxy propyl methyl cellulose and pullulan; thickeners such as, natural gum, cellulose derivative, acrylic acid derivative; disintegrators, such as, carboxymethylcellulose calcium, crosscarmelose sodium, crospovidone, a low substituted hydroxypropylcellulose and partly pregelatinized starch; solvents such as, water for injection, alcohol, propylene glycol, Macrogol, sesame oil and corn oil; dispersants, such as, Tween 80, HC060, polyethylene glycol, carboxymethylcellulose, and sodium alginate; solubilizing agents, such as, polyethylene glycol, propylene glycol, D-mannitol, benzoic acid benzyl, ethanol, tris amino methane, triethanolamine, sodium carbonate, and citric acid sodium; suspending agents, such as, stearyl triethanolamine, sodium lauryl sulfate, benzalkonium chloride, polyvinyllcohol, and polyvinylpyrolidone, hydroxymethylcellulose; soothing agents, such as, benzyl alcohol; isotonic agents such as, sodium chloride and glycerin; buffer agents, such as, phosphoric acid salt, acetic acid salt, carbonic acid salt and citric acid salt; lubricants, such as, magnesium stearate, calcium stearate, talc, starch and sodium benzoate; coloring agents, such as, tar pigment, caramel, ferric oxide, titanium oxide and riboflavins; corrigents, such as, sweetning agents and perfumes; stabilizers, such as, sodium sulfite and ascorbic acid; and preservatives, such as, paraben and sorbic acid. Numerous standard references are available that describe procedures for preparing various formulations suitable for administering the compounds according to the 8 invention. Examples of potential formulations and preparations are contained, for example, in the Handbook of Pharmaceutical Excipients, American Pharmaceutical Association (current edition); Pharmaceutical Dosage Forms: Tablets (Lieberman, Lachman and Schwartz, editors) current edition, published by Marcel Dekker, Inc., as well as Remington's Pharmaceutical Sciences (Arthur Osol, editor), 1553-1593 (current edition). The mode of administration and dosage forms is closely related to the therapeutic amounts of the compounds or compositions which are desirable and efficacious for the given treatment application. Suitable dosage forms include, but are not limited to oral, rectal, sub-lingual, mucosal, nasal, ophthalmic, subcutaneous, intramuscular, intravenous, transdermal, spinal, intrathecal, intra-articular, intra-arterial, sub-arachinoid, bronchial, lymphatic, and intra-uterille administration, and other dosage forms for systemic delivery of active ingredients. To prepare such pharmaceutical dosage forms, the active ingredient, is intimately admixed with a pharmaceutical carrier according to conventional pharmaceutical compounding techniques. The carrier may take a wide variety of forms depending on the form of preparation desired for administration. In preparing the compositions in oral dosage form, any of the usual pharmaceutical media may be employed. Thus, for liquid oral preparations, such as, for example, suspensions, elixirs and solutions, suitable carriers and additives include water, glycols, oils, alcohols, flavoring agents, preservatives, coloring agents and the like. For solid oral preparations such as, for example, powders, capsules and tablets, suitable carriers and additives include starches, sugars, diluents, granulating agents, lubricants, binders, disintegrating agents and the like. If desired, tablets may be sugar coated or enteric coated by standard techniques. For parenteral formulations, the carrier will usually comprise sterile water, though other ingredients, for example, ingredients that aid solubility or for preservation, may be included. Injectable solutions may also be prepared in which case appropriate stabilizing agents may be employed. In some applications, it may be advantageous to utilize the active agent in a "vedtorized" form, such as by encapsulation of the active agent in a liposome or other encapsulant medium, or by fixation of the active agent, e.g., by covalent bonding, 9 chelation, or associative coordination, on a suitable biomolecule, such as those selected from proteins, lipoproteins, glycoproteins, and polysaccharides. Treatment methods of the present invention using formulations suitable for oral administration may be presented as discrete units such as capsules, cachets, tablets, or lozenges, each comprising a predetermined amount of the active ingredient as a powder or granules. Optionally, a suspension in an aqueous liquor or a non-aqueous liquid may be employed, such as a syrup, an elixir, an emulsion, or a draught. A tablet may be made by compression or molding, or wet granulation, optionally with one or more accessory ingredients. Compressed tablets may be prepared by compressing in a suitable machine, with the active compound being in a free-flowing form such as a powder or granules which optionally is mixed with, for example, a binder, disintegrant, lubricant, inert diluent, surface active agent, or discharging agent. Molded tablets comprised of a mixture of the powdered active compound with a suitable carrier may be made by molding in a suitable machine. A syrup may be made by adding the active compound to a concentrated aqueous solution of a sugar, for example sucrose, to which may also be added any accessory ingredient(s). Such accessory ingredient(s) may include flavorings, suitable preservative, agents to retard crystallization of the sugar, and agents to increase the solubility of any other ingredient, such as a polyhydroxy alcohol, for example glycerol or sorbitol. Formulations suitable for parenteral administration usually comprise a sterile aqueous preparation of the active compound, which preferably is isotonic with the blood of the recipient (e.g., physiological saline solution). Such formulations may include suspending agents and thickening agents and liposomes or other microparticulate systems which are designed to target the compound to blood components or one or more organs. The 'formulations may be presented in unit-dose or multi-dose form. Parenteral administration may be intravenous, intra-arterial, intrathecal, intramuscular, subcutaneous, intramuscular, intra-abdominal (e.g., intraperitoneal), etc., and may be effected by infusion pumps (external or implantable) or any other suitable means appropriate to the desired administration modality. Nasal and other mucosal spray formulations (e.g. inhalable forms) can comprise purified aqueous solutions of the active compounds with preservative agents and isotonic 10 agents. Such formulations are preferably adjusted to a pH and isotonic state compatible with the nasal or other mucous membranes. Alternatively, they can be in the form of finely divided solid powders suspended in a gas carrier. Such formulations may be delivered by any suitable means or method, e.g., by nebulizer, atomizer, metered dose inhaler, or the like. Formulations for rectal administration may be presented as a suppository with a suitable carrier such as cocoa butter, hydrogenated fats, or hydrogenated fatty carboxylic acids. Transdermal formulations may be prepared by incorporating the active agent in a thixotropic or gelatinous carrier such as a cellulosic medium, e.g., methyl cellulose or hydroxyethyl cellulose, with the resulting formulation then being packed in a transdermal device adapted to be secured in dermal contact with the skin of a wearer. In addition to the aforementioned ingredients, formulations of this invention may further include one or more accessory ingredient(s) selected from diluents, buffers, flavoring agents, binders, disintegrants, surface active agents, thickeners, lubricants, preservatives (including antioxidants), and the like. The formulations of the present invention can have immediate release, sustained release, delayed-onset release or any other release profile known to one skilled in the art. Methods of Treatment The present invention provides methods of treating a bacterial infection comprising administering to a patient in need thereof, a therapeutically effective amount of ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) alone or in combination with an antibacterial agent. In some embodiments, the bacterial infection may be due to Gram-positive bacteria, including, but not limited to, methicillin resistant Staphylococcus aureus (MRSA), community-acquired methicillin resistant Staphylococcus aureus (CAMRSA), vancomycin-intermediate-susceptible Staphylococcus aureus (VISA), methicillin resistant coagulase-negative staphylococci (MR-CoNS), vancomycin-intermediate susceptible coagulase-negative staphylococci (VI-CoNS), methicillin susceptible Staphylococcus aureus (MSSA), Streptococcus pneumoniae (including penicillin 11 resistant strains [PRSP]) and multi-drug resistant strains [MDRSP]), Streptococcus agalactiae, Streptococcus pyogenes and Enterococcus faecalis. In other embodiments, the bacterial infection may be due to Gram-negative bacteria, such as, Escherichia coli, Enterobacter cloacae, Klebsiella pneunoniae, Pseudomonas aeruginosa, Haemophilus influenzae (including ampicillin-resistant H influenzae), Moraxella catarrhalis, Proteus mirabilis and Acinetobacter baumanli. In other embodiments, the bacterial infection may be due to a microoraganism, including, but not limited to, Citrobacter freundi, Citrobacter koseri, Enterobacter aerogenes, Enterobacter cloacae, Haemophilus parainfluenzae, Klebsiella oxytoca, Morganella morganii, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, Serratia marcescens, Clostridium clostridioforme, Eubacterium lentum, Peptostreptococcus species, Porphyromonas asaccharolytica, Clostridium perfringens and Fusobacterium species. In particular embodiments, the bacterial infection may include, but is not limited to, complicated skin and skin structure infections (cSSSI); community acquired pneumonia (CAP); complicated intra-abdominal infections, such as, complicated appendicitis, peritonitis, complicated cholecystitis and complicated diverticulitis; uncomplicated and complicated urinary tract infections, such as, pyelonephritis; and respiratory and other nosocomial infections. In some embodiments, the methods include administering ceftaroline or a pharmaceutically acceptable salt or a solvate thereof. In other embodiments, the methods include administering a ceftaroline prodrug or a pharmaceutically acceptable salt or a solvate thereof (e.g., ceftaroline fosamil). In exemplary embodiments, the prodrug may be a phosphono prodrug. In some examples, the ceftaroline prodrug may be ceftaroline fosamil. In some embodiments, the ceftaroline fosamil may be a hydrous from, e.g., a monohydrate form. In still other embodiments, ceftaroline fosamil may be in an anhydrous form. In some embodiments, ceftaroline or a prodrug thereof may be a solvate form. For example, ceftaroline or prodrug of ceftaroline may be an acetic acid solvate form. In some embodiments, ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and an antibacterial agent may be administered conjointly, preferably, 12 simultaneously, and, more preferably, in one composition as described above. In exemplary embodiments, ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and the antibacterial agent may be administered in singular dose. In other embodiments, ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and the antibacterial agent may be administered in two to six divided doses for example, every 4 hours, 6 hours, 8 hours or 12 hours. In other embodiments, the two drugs may be administered sequentially. In exemplary embodiments, the antibacterial agent may be administered separately in a composition or a dosage form that may be administered prior to, simultaneously or after the administration of a dosage form comprising ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof. In some embodiments, methods of treating complicated skin and skin structure infections or community acquired pneumonia in a patient in need thereof are provided. For example, methods of treating complicated skin and skin structure infections or community acquired pneumonia may comprise providing a dosage form comprising ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) wherein the dosage form includes information that ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof may be used in combination, concomitantly, adjunctively or concurrently with an antibacterial agent. In yet other embodiments, the methods comprise using cefiaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) for treating a patient's condition, comprising providing a patient with ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil); and informing the patient or a medical care worker that ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) may be used in combination, adjunctively, concomitantly or concurrently with an antibacterial agent. For example, the dosage form may include information that use of ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof in combination, adjunctively, concomitantly or concurrently with a bacterial agent may affect plasma concentration, bioavailability, safety, efficacy, or a combination thereof. In other embodiments, the dosage form may provide instructions that instruct that ceftaroline or prodrug thereof may be safe and/or effective 13 for use in combination, adjunctively, concomitantly or concurrently with an antibacterial agent. In still other embodiments, the dosage form may provide instructions on drug interactions with other antimicrobials, antibiotics or antibacterial agents. For example, the dosage form may provide instructions that cefiaroline has no potential to antagonize or be antagonized by other antibiotics, antimicrobials or antibacterial agents. In further embodiments, the dosage form may provide instructions on other antibiotics, antimicrobials or antibacterial agents that could be administered in combination with ceftaroline, a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g, ceftaroline fosamil). In exemplary embodiments, the antibacterial agent may be a p-lactam, an aminoglycoside, a tetracycline, a sulfonamide, trimethoprim, a fluoroquinolone, vancomycin, a macrolide (e.g., azithromycin), a polymyxin, a glycylcycline (e.g., tigecycline), chloramphenicol and a lincosamide, In exemplary embodiments, the bacterial agent may be a carbapenem such as, imipenem, biapenem, meropenem, ertapenem, faropenem, doripenem, panipenem and PZ-601. In other exemplary embodiments, the bacterial agent may be an aminoglycoside such as, amikacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, streptomycin, and tobramycin. In yet other exemplary embodiments, the bacterial agent may be a fluoroquinolone such as, levofloxacin, ciprofloxacin, ofloxacin, gatifloxacin, norfloxacin, moxifloxacin and trovafloxacin. In further embodiments, the ceftaroline or prodrug thereof may be in the form of a pharmaceutically acceptable salt or solvate. In some embodiments, the antibacterial agent may be acylamino-penicillin, such as piperacillin. In other embodiments, the antibacterial agent may be daptomycin or a pharmaceutically acceptable salt, solvate or prodrug thereof. In some embodiments, a container comprising a dosage form comprising ceftaroline, or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) and information on drug interaction with other antibacterial or antimicrobial agents is provided. For example, the container may include information that ceftaroline has no potential to antagonize or be antagonized by other antibiotics, antimicrobials or antibacterial agents. The container may further provide information on antibacterial agents that can be combined with ceftaroline. In exemplary embodiments, 14 the container may include information that the dosage form can be administered concurrently, concomitantly, or adjunctively with an antibacterial agent. In other embodiments, the method comprises obtaining cefiaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) from a container providing infonnation on drug interaction with other antibacterial, antimicrobial or antibacterial agents. In some embodiments, the method comprises providing a pharmaceutical product comprising a dosage form comprising ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g, ceftaroline fosamil) and published material. The published material may include information on drug interaction of ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) with other antibacterial, antimicrobial or antibacterial agents. For example, the published material may provide information that ceftaroline has no potential to antagonize or be antagonized by other antibiotics, antimicrobials or antibacterial agents. The published material may further provide information on antibiotics, antimicrobials or antibacterial agents that could be administered in combination, concomitantly, adjunctively or concurrently with ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil). Ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) and the antibacterial agent may be administered in therapeutically effective dosages, which may vary according to the type of infection, the patient in question, the administration route and the antibacterial agent. Ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and the antibacterial agent may be administered non-orally or orally, for example, as injectable preparations, capsules, tablets or granular preparations. In exemplary embodiments, the methods comprise administering ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) alone or in combination with an antibacterial agent by intravenous or intramuscular route of administration. According to some embodiments, ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceflaroline fosamil) and the antibacterial agent may 15 be administered in a combined dose of about 1 mg to 20 g/day in single or multiple administrations. In other embodiments, the combined dose may range from about 10 mg to 10 g/day. In still other embodiments, the combined dose may range from about 20 mg to 5 g/day. In certain embodiments, the combined dose may range from about 30 mg to 2 g/day. In exemplary embodiments, the combined daily dose may be about 20 mg, 50 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, 500 mg, 550 mg, 600 mg, 650 mg, 700 mg, 750 mg, 800 mg, 850 mg, 900 mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300 mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg, 1600 mng, 1650 mng, 1700 mg, 1750 mg, 1800 mg, 1850 mg, 1900 mg, 1950 mg, 2000 mg, 2050 mg, 2100 mng, 2150 mg, 2200 mg, 2250 mg, 2300 mg, 2350 mg, 2400 ing, 2450 mg, 2500 mg, 2550 mg, 2600 mg, 2650 mg, 2750 mg, 2800 mg, 2850 mg, 2900 mg, 2950 mg, 3000 mg, 3.5 g, 4 g, 4.5 g, 5 g, 5.5 g, 6 g, 6.5 g, 7 g, 7.5 g, 8 g, 8.5 g, 9 g, 9.5 g and 10 g. In certain embodiments, ceflaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) may be administered in a daily dose ranging from about 0.5 mg/kg to about 400 mg/kg, preferably from about 2 mg to 40 mg/kg of body weight of a man or an animal infected with pathogenic bacteria, In still other embodiments, the daily dose may range from about 5 to 30 mg/kg of body weight. In some embodiments, the daily dose mxay be about 20 mg/kg of body weight. In some embodiments, the daily dose may be administered in a singular dose, for example, every 24 hours. In other embodiments, the daily dose may be administered in two to six divided doses, for example, every 4 hours, 6 hours, 8 hours or 12 hours. In some embodiments, ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (e.g., ceftaroline fosamil) may be administered in doses ranging from about I mg to about 3000 mg per day in single or multiple administrations. In exemplary embodiments, ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof may be administered in single or multiple doses of about 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, 500 mg, 550 mg, 600 mg, 650 mg, 700 mg, 750 mg, 800 mg, 850 mg, 900 mng, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300 mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg, 1600 mg, 1650 mug, 1700 mg, 1750 mg and 1800 mg per day. 16 For example, the daily dose of ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof (eg, ceftaroline fosamil) is about 400 mg, about 600 mg, about 800 mg or about 1200 mg. In some embodiments, about 400 mg of ceftaroline or a prodrug thereof (e.g., ceftaroline fosamil) may be administered every 8 hours, 12 hours or 24 hours. In other embodiments, about 600 rng of ceftaroline or a prodrug thereof may be administered every 8 hours, 12 hours or 24 hours. The duration of treatment is between five to seven days, five to ten days, or five to fourteen days. In some embodiments, the methods comprise administering ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and an antibacterial agent, including, but not limited to, p-lactams, aminoglycosides, tetracyclines, sulfonamides, trimethoprim, fluoroquinolones, vancomycin, macrolides, polymyxins, chloramphenicol and lincosamides. In certain embodiments, the antibacterial agent may include, but is not limited to, amoxicillin, ampicillin, azlocillin, meziocillin, apalcillin, hetacillin, bacampicillin, carbenicillin, sulbenicillin, ticarcillin, azlocillin, mecillinam, pivmecillinam, methicillin, ciclacillin, talampicillin, aspoxicillin, oxacillin, cloxacillin, dicloxacillin, flucloxacillin, nafcillin, pivampicillin, cephalothin, cephaloridine, cefaclor, cefadroxil, cefamandole, cefazolin, cephalexin, cephradine, ceftizoxime, cefoxitin, cephacetrile, cefotiam, cefotaxime, cefsulodin, cefoperazone, ceftizoxime, cefmenoxime, cefmetazole, cephaloglycin, cefonicid, cefodizime, cefpirone, ceftazidime, ceftriaxone, cefpiramide, cefbuperazone, cefozopran, cefoselis, cefluprenam, cefuzonam, cefpimizole, cefelidin, cefixime, ceftibuten, cefdinir, cefpodoxime axetil, cefpodoxime proxetil, cefteram pivoxil, cefetamet pivoxil, cefcapene pivoxil cefditoren pivoxil, cefuroxime, cefuroxime axetil, daptomycin, loracarbacef, latamoxef and pharmaceutically acceptable salts, solvates or prodrugs thereof. In some embodiments, the antibacterial agent may be a p-lactam. In further embodiments, the p-lactam may be a cephalosporin, such as cefepime or a pharmaceutically acceptable salt, solvate or prodrug thereof. In some embodiments, cefepime may be administered in a daily dose of about 0.5 to 500 mg/kg of body weight. 17 In other embodiments, cefepime may be administered in a daily dose of about 5 to 100 mg/kg of body weight. In specific embodiments, the daily dose of cefepime may range from about 10 mg to 6 g. In exemplary embodiments, the daily dose of cefepime may be about 20 mg, 50 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, 500 mg, 550 mg, 600 mg, 650 mg, 700 mg, 750 mg, 800 mg, 850 ng, 900 mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300 mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg, 1600 mg, 1650 mg, 1700 mg, 1750 mg, 1800 mg, 1850 mg, 1900 mg, 1950 mg, 2000 mg, 2050 mng, 2100 mg, 2150 mg, 2200 mg, 2250 mg, 2300 mg, 2350 mg, 2400 mg, 2450 mg, 2500 mg, 2550 mg, 2600 mg, 2650 mg, 2750 mg, 2800 mg, 2850 mg, 2900 mg, 2950 nmg, 3000 mg, 3050 mg, 3100 mg, 3150 mg, 3200 mg, 3300 mg, 3350 mg, 3400 mg, 3450 mg, 3500 mg, 3550 mg, 3600 mg, 3650 mg, 3700 mg, 3750 mg, 3800 mg, 3850 mg, 3900 mg, 3950 mg, 4000 mg, 4050 mg, 4100 mg, 4150 mg, 4200 mg, 4250 mg, 4300 mg, 4350 mg, 4400 mg, 4450 mg, 4500 mg, 4550 mg, 4600 mg, 4650 mg, 4700 mg, 4750 mg, 4800 mg, 4850 mg, 4900 mg, 4950 mg, 5000 mg, 5050 ing, 5100 mg, 5150 mg, 5200 mg, 5250 mg, 5300 mg, 5350 mg, 5400 mg, 5450 mg, 5500 mg, 5550 mg, 5600 ng, 5650 mg, 5700 mg, 5750 mg, 5800 mg, 5850 mg, 5900 mg, 5950 mg and 6000 mg. In other embodiments, the p-lactam may be a monobactam, such as, aztreonam and carumonam. In other embodiments, aztreonam may be administered in a daily dose of about 0.1 to 200 mg/kg of body weight. In particular embodiments, the daily dose of aztreonam may be about 1 to 100 mg/kg of body weight. In some embodiments, the daily dose of aztreonam may range from about 10 mg to 8 g. In exemplary embodiments, the daily dose of aztreonam may be about 20 mg, 50 nig, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, 500 mg, 550 mg, 600 mg, 650 mg, 700 mg, 750 mg, 800 mg, 850 mg, 900 mg, 950 mg, 1000 mg, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300 mg, 1350 mg, 1400 mg, 1450 mg, 1500 mg, 1550 mg, 1600 mg, 1650 mg, 1700 mg, 1750 mg, 1800 mg, 1850 mg, 1900 mg, 1950 mg, 2000 mg, 2050 mg, 2100 mg, 2150 mg, 2200 mg, 2250 mg, 2300 mg, 2350 mg, 2400 mg, 2450 mg, 2500 mg, 2550 mg, 2600 mg, 2650 mg, 2750 mg, 2800 mg, 2850 mg, 2900 mg, 2950 mg, 3000 mng, 3050 mg, 3100 mg, 3150 ug, 3200 mg, 3300 mg, 3350 mg, 3400 mg, 3450 18 mg, 3500 mg, 3550 mg, 3600 mg, 3650 mg, 3700 mg, 3750 mg, 3800 mg, 3850 mg, 3900 mg, 3950 mg, 4000 mg, 4050 mg, 4100 mg, 4150 mg, 4200 mg, 4250 mg, 4300 mg, 4350 mg, 4400 mg, 4450 mg, 4500 mg, 4550 mg, 4600 mg, 4650 mg, 4700 mg, 4750 mg, 4800 mg, 4850 mg, 4900 mg, 4950 mg, 5000 mg, 5050 mg, 5100 mg, 5150 mg, 5200 mg, 5250 mg, 5300 mg, 5350 mg, 5400 mg, 5450 mg, 5500 mg, 5550 mg, 5600 mg, 5650 mg, 5700 mg, 5750 mg, 5800 ing, 5850 mg, 5900 mg, 5950 mg, 6000 mg. In yet other embodiments, the antibacterial agent may be a glycylcycline. In some embodiments, the glycylcycline may be tigecycline or a pharmaceutically acceptable salt, solvate or prodrug thereof. In some embodiments, tigecycline may be administered in a daily dose of about 0.001 to 100 mg/kg of body weight. In other embodiments, the daily dose of tigecycline may be about I to 50 mg/kg of body weight. In still other embodiments, the daily dose of tigecycline may be about 0.01 to 10 mg/kg of body weight. In further embodiments, the daily dose of tigecycline may be about 0.1 to 5 mg/kg of body weight. In some embodiments, the daily dose of tigecycline may range from about 0.1 mg to 500 mg. In other embodiments, the daily dose of tigecycline may range from about I mg to 200 mg. In exemplary embodiments, the daily dose of tigecycline may be about I mg, 2 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7 mg, 8 mg, 9 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg, 100 mg, 110 mg, 120 mg, 130 mg, 140 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg and 500 mg. In some embodiments, the methods may comprise administering ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and an aminoglycoside, including, but not limited to, amikacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, streptomycin, and tobramycin. In particular embodiments, the aminoglycoside may be amikacin or a pharmaceutically acceptable salt, solvate or prodrug thereof In some embodiments, the daily dose of amikacin may be about 0.001 to 50 mg/kg of body weight. In other embodiments, the daily dose of amikacin may be about 0.01 to 20 mg/kg of body weight. In further embodiments, the daily dose of amikacin may be about I to 15 mg/kg of body weight. In some embodiments, the daily dose of amikacin may range from about 0.1 mg to 2000 mg. In other embodiments, the 19 daily dose of amikacin may range from about I mg to 1500 mg. In exemplary embodiments, the daily dose of amikacin may be about 1 mg, 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg 100 mg, 105 mg, 110 mg, 115 mg, 120 mg, 125 mg, 130 mg, 135 mg, 140 mg, 145 mg, 150 mg, 155 mg, 160 mg, 165 mg, 170 mg, 175 mg, 180 rmg 185 mg, 190 mg, 195 mg, 200 mg, 205 mng, 210mg, 215 mg, 220 mg, 225 mg, 230 mg, 235 mg, 240 mg, 245 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, 500 mg, 550 mg, 600 rg, 650 mng, 700 mg, 750 mg, 800 mg, 850 mg and 900 mg. In other embodiments, the aminoglycoside may be tobramycin or a pharmaceutically acceptable salt, solvate or prodrug thereof. In some embodiments, the daily dose of tobramycin may range from about 0,001 to 20 mg/kg of body weight. In other embodiments, the daily dose of tobramycin may be about I to 10 mg/kg of body weight. In some embodiments, the daily dose of tobramycin may range from about I mg to 800 mg. In other embodiments, the daily dose of tobramycin may range from about 10 mg to 600 mg. In exemplary embodiments, the daily dose of tobramycin may be about 1 mg, 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg, 80 mg, 90 mg, 100 mg, 110 mg, 120 mg, 130 mg, 140 mg, 150 mg, 160 mg, 170 mg, 180 mng, 190 mg, 200 mng, 250 mg, 275 mg, 300 mg, 325 mg, 350 mg, 375 mg, 400 mg, 425 mg, 450 ng, 475 mg, 500 mg, 525 mg, 550 mg, 575 mng and 600 mg. In some embodiments, the methods may comprise administering ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and a carbapenem, including, but not limited to, iripenem, meropenem, ertapenem, faropenem, doripenem, panipenem and PZ-601. In particular embodiments, the methods may provide administering meropenem or a pharmaceutically acceptable salt, solvate or prodrug thereof. In some embodiments, meropenem may be administered in a daily dose of about I mg to 5 g. In other embodiments, the daily dose of meropenem may range from about 100 mg to 3 g. In exemplary embodiments, the daily dose of meropenem may be about 20 mg, 50 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 rg, 450 mg, 500 mg, 550 mg, 600 mg, 650 mg, 700 mg, 750 rug, 800 mg, 850 mg, 900 mg, 950 mg, 1000 mug, 1050 mg, 1100 mg, 1150 mg, 1200 mg, 1250 mg, 1300 mg, 1350 mg, 1400 mg, 1450 mug, 1500 mg, 1550 mg, 1600 mg, 1650 mng, 1700 mg, 1750 ing, 1800 mg, 1850 mg, 1900 20 mg, 1950 mg, 2000 mg, 2050 mg, 2100 mg, 2150 ng, 2200 mg, 2250 mg, 2300 mg, 2350 mg, 2400 mg, 2450 mg, 2500 mg, 2550 mg, 2600 mg, 2650 mg, 2750 mg, 2800 mg, 2850 mg, 2900 mg, 2950 mg and 3000 mg. In yet other embodiments, the methods may comprise administering ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and a fluoroquinolone, including, but not limited to, levofloxacin, ciprofloxacin, ofloxacin, gatifloxacin, norfloxacin, moxifloxacin and trovafloxacin. In particular embodiments, the fluoroquinolone may be levofloxacin or a pharmaceutically acceptable salt, solvate or prodrug thereof. In some embodiments, the daily dose of levofloxacin may range from about I mg to 1000 mg. In other embodiments, the daily dose of levofloxacin may range from about 10 mg to 800 mg. In exemplary embodiments, the daily dose of levofloxacin may be about I mg, 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg 100 mg, 105 mg, I10 mg, 115 mg, 120 mg, 125 mg, 130 mg, 135 mg, 140 mg, 145 mg, 150 mg, 155 mg, 160 mg, 165 mg, 170 mg, 175 mg, 180 mg 185 mng, 190 mg, 195 mg, 200 mg, 205 mg, 210mg, 215 mg, 220 mg, 225 mg, 230 mg, 235 mg, 240 mg, 245 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mng, 500 mg, 550 mg, 600 mug, 650 mg, 700 mg, 750 mg and 800 mg. In other embodiments, the methods may comprise administering cefiaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and an acylamino-penicillin, such as piperacillin or a pharmaceutically acceptable salt , solvate or prodrug thereof.s In particular embodiments, the methods may further comprise administration of p-lactamase inhibitors in combination with piperacillin, such as tazobactam. In some embodiments, the daily dose of piperacillin may range from I to 500 mg/kg of body weight. In other embodiments, the daily dose of piperacillin may range from I to 500 mg/kg of body weight. In specific embodiments, the daily dose of piperacillin may range from about 100 rmg to 20 g. In other embodiments, the daily dose of piperacillin may range from about I g to 16 g. In exemplary embodiments, the daily dose of piperacillin may be about 20 mg, 50 mg, 100 mg, 150 mg, 200 mg, 300 mg, 400 mg, 500 mg, 600 mg, 700 mg, 800 mg, 900 mg, 1000 mg, 1500 mg, 2000 mug, 2500 mg, 3000 mg, 3500 mg, 4000 mg, 4500 mg, 5000 mg, 5500 ing, 6000 mg, 6500 mg, 7000 mg, 7500 mg, 8000 mg, 8500 mg, 9000 21 mg, 9500 mg, 10 g, 10.5 g, 11 g, 11.5 g, 12 g, 12.5 g, 13 g, 13.5 g, 14 g, 14.5 g, 15 g. 15.5 g and 16 g. In other embodiments, the methods may comprise administering ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and a macrolide, including, but not limited to, erythromycin, azithromycin, dirithromycin, telithromycin, clarithromycin and pharmaceutically acceptable salts thereof. In particular embodiments, the macrolide may be azithromycin or a pharmaceutically acceptable salt, solvate or prodrug thereof. In some embodiments, azithromycin may be administered in a daily dose of about 0.001 to 20 mg/kg of body weight. In other embodiments, the daily dose of azithromycin may be about 1 to 10 mg/kg of body weight. In some embodiments, the daily dose of azithromycin may range from about I mg to 800 mg. In other embodiments, the daily dose of azithromycin may range from about 100 mg to 500 mg. In exemplary embodiments, the daily dose of azithromycin may be about I mg, 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg, 80 mg, 90 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 rng, 450 mg, 500 mg, 550 mg and 600 mg. In some other embodiments, the methods may comprise administering ceftaroline or a pharmaceutically acceptable salt, solvate or prodrug thereof and daptomycin or a pharmaceutically acceptable salt, solvate or prodrug thereof. For example, daptomycin may be used in combination to avoid the emergence of daptomycin-resistant mutants, such as methicillin-sensitive and methicillin-resistant isolates of Staphylococcus aureus. In some embodiments, the daily dose of daptomycin may range from about 0.1 to 100 mg/kg of body weight. In other embodiments, the daily dose of daptomycin may range from about I to 50 mg/kg of body weight. In still other embodiments, the daily dose of daptomycin may range from about I to 10 mg/kg of body weight. In exemplary embodiments, the daily dose of daptomycin may be about 2 or 4 mg/kg of body weight. In other exemplary embodiments, the daily dose of daptomycin may be about 3 or 6 mg/kg of body weight. The duration of treatment may depend on the type, severity and site of infection, the patient's clinical and bacteriological progress, the administration route and the antibacterial agent. In some exemplary embodiments, the treatment may last between five to fourteen days. In other exemplary embodiments, the treatment may last between about 22 five to ten days. In still other exemplary embodiments, the treatment may last between about five to seven days. Definitions The term "pharmaceutically acceptable" means biologically or pharmacologically compatible for in vivo use in animals or humans, and preferably means approved by a regulatory agency of the Federal or a state government or listed in the U.S. Pharmacopeia or other generally recognized pharmacopeia for use in animals, and more particularly in humans. The term "prodrug" means a compound that is a drug precursor, which upon administration to a subject undergoes chemical conversion by metabolic or chemical processes to yield a compound, which is an active moiety. Suitable prodrugs of ceftaroline include, but are not limited to phosphonocepehem derivatives, such as, e.g., 70-[2(Z)-ethoxyimino-2-(5-phosphonoamino- 1,2,4-thiad iazol-3-yl)acetamido]-3-(4-(1 methyl-4-pyridinio)-2-thiazolythio]-3-cephem-4-carboxylate. Solvates of a compound may form when a solvent molecule(s) is incorporated into the crystalline lattice structure of ceftaroline or a prodrug thereof molecule during, for example, a crystallization process. Suitable solvates include, e.g., hydrates (monohydrate, sesquihydrate, dihydrate), solvates with organic compounds (e.g.,
CH
3
CO
2 H-, CH 3
CH
2
CO
2 H, CH 3 CN), and combinations thereof. The terms "treat," "treatment," and "treating" refer to one or more of the following: relieving or alleviating at least one symptom of a bacterial infection in a subject; relieving or alleviating the intensity and/or duration of a manifestation of bacterial infection experienced by a subject; and arresting, delaying the onset (i.e., the period prior to clinical manifestation of infection) and/or reducing the risk of developing or worsening a bacterial infection. An "effective amount" means the amount of a composition according to the invention that, when administered to a patient for treating an infection or disease is sufficient to effect such treatment. The "effective amount" will vary depending on the 23 active ingredient, the state, infection, disease or condition to be treated and its severity, and the age, weight, physical condition and responsiveness of the mammal to be treated. The term "therapeutically effective" applied to dose or amount refers to that quantity of a compound or pharmaceutical composition that is sufficient to result in a desired activity upon administration to a mammal in need thereof. A subject or patient in whom administration of the therapeutic compound is an effective therapeutic regimen for an infection or disease is preferably a human, but can be any animal, including a laboratory animal in the context of a trial or screening or activity experiment. Thus, as can be readily appreciated by one of ordinary skill in the art, the methods, compounds and compositions of the present invention are particularly suited to administration to any animal, particularly a mammal, and including, but by no means limited to, humans, domestic animals, such as feline or canine subjects, farm animals, such as, but not limited to, bovine, equine, caprine, ovine, and porcine subjects, wild animals (whether in the wild or in a zoological garden), research animals, such as mice, rats, rabbits, goats, sheep, pigs, dogs, cats, etc., avian species, such as chickens, turkeys, songbirds, etc., i.e., for veterinary medical use. The term "about" or "approximately" means within an acceptable error range for the particular value as determined by one of ordinary skill in the art, which will depend in part on how the value is measured or determined, Le., the limitations of the measurement system. For example, "about" can mean within 1 or more than I standard deviations, per practice in the art. Alternatively, "about" with respect to the compositions can mean plus or minus a range of up to 20%, preferably up to 10%, more preferably up to 5%. Alternatively, particularly with respect to biological systems or processes, the term can mean within an order of magnitude, preferably within 5-fold, and more preferably within 2-fold, of a value. EXAMPLES The following examples are merely illustrative of the present invention and should not be construed as limiting the scope of the invention in any way as many variations and equivalents that are encompassed by the present invention will become apparent to those skilled in the art upon reading the present disclosure. EXAMPLE 1 24 Ceftaroline combinations using broth microdilution method The activity of ceftaroline with other antimicrobials against target species was evaluated using a broth microdilution checkerboard technique. The broth microdilution checkerboard technique was used to generate fractional inhibitory concentration (FIC) and FIC index (FICI) values. The FICI of ceftaroline (CPT) in combination with vancomycin (VA), linezolid (LZD), levofloxacin (LVX), azithromycin (AZM), daptomycin (DAP), amikacin (AN), aztreonam (ATM), tigecycline (TGC), and meropenem (MEM) was determined against multiple isolates of clinically important target species using plates prepared in a semi-automated fashion. Material and Methods Ceftaroline (ceftaroline fosamil; PPI-0903M; Lot No. M599-R1001) was provided by Cerexa, Inc. Other agents were obtained as follows: vancomycin (Lot No. 016K 1102), amikacin (Lot No. 044K1473), aztreonan (Lot No. 124K1448), amoxicillin (Lot No. I 12KO481), clavulanic acid (Lot No. I 15K1493) and chloramphenicol (Lot No. 123K0588) were obtained from Sigma-Aldrich; azithromycin (Lot No. HOC212), meropenern (Lot No. GOF100) and ciprofloxacin (Lot No. 10C265) were obtained from USP; daptomycin (Lot No. CDXOI#1007-1), levofloxacin (Lot No. 446423/1); linezolid (Lot No. LZD05003); tigecycline (Lot No, RB5603 Way 156936-9) were obtained from Cubist, Fluka, Pfizer and Wyeth respectively. Stock solutions of all antibacterial agents were prepared at 80-fold (80X) the final target concentration in the appropriate solvent and the solution was allowed to stand for 60 minutes. All antibacterial agents were in solution under these conditions. The final drug concentrations in the FIC assay plates were set to bracket the MIC value of each agent for each test organism, unless the strain was totally resistant to the test agent. The concentration ranges tested are displayed in Table 1. Test Organisms The test organisms were originally received from clinical sources, or from the American Type Culture Collection. Upon receipt, the isolates were streaked onto the appropriate growth medium: Chocolate Agar for H. influenzae, Tryptic Soy Agar 11 (Becton Dickinson, Sparks, MD) supplemented with 5% defibrinated sheep blood for streptococci, and unsupplemented Tryptic Soy Agar 11 for all other organisms. Colonies 25 were harvested from these plates and a cell suspension was prepared in Tryptic Soy Broth (Becton Dickinson) containing cryoprotectant. Aliquots were then frozen at -80"C. On the day prior to assay, the frozen seeds of the organisms to be tested in that session were thawed and streaked for isolation onto the appropriate agar medium plates and incubated overnight at 35*C. Test Media The test medium for H. influenzae was Haemophilus Test Medium. Streptococci were tested in Mueller Hinton 11 Broth (Becton Dickinson; Lot 6235472) supplemented with 2% lysed horse blood (Cleveland Scientific, Bath, OH; Lot H88621). All other organisms were tested in Mueller Hinton 11 Broth (Becton Dickinson, Lot 6235472). The broth was prepared at 1.05X normal weight/volume to offset the 5 % volume of the drugs in the final test plates. Minimal Inhibitory Concentration (MIC) Assay In order to select the proper test concentrations for each drug combination, minimal inhibitory concentration (MIC) values were first determined using the broth microdilution method previously described (Clinical and Laboratory Standards Institute. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard-Seventh Edition. Clinical and Laboratory Standards Institute document M7-A7 [ISBN 1-56238-587-9]. Clinical and Laboratory Standards Institute, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087-1898 USA, 2006). FIC Assay Methodology FIG values were determined using a broth microdilution method previously described (Sweeney and Zurenko, 2003; Antimicrob. Agents Chemother. 47:1902-1906). Automated liquid handlers (Multidrop 384, Labsystems, Helsinki, Finland; Biomek 2000 and Multimek 96, Beckman Coulter, Fullerton CA) were used to conduct serial dilutions and liquid transfers. The wells of standard 96-well microdilution plates (Falcon 3918) were filled with 150fiL of 100% DMSO using the Multidrop 384. These plates were used to prepare the drug "mother plates" which provided the serial drug dilutions for the drug combination 26 plates. The Biomek 2000 was used to transfer 150 ptl of each stock solution (80X) from the wells in Column 1 of a deep well plate to the corresponding wells in Column 1 of the mother plate and to make seven 2-fold serial dilutions, Two mother plates, one for each drug, were combined to form a "checkerboard" pattern by transfer of equal volumes (using a multi-channel pipette) to the drug combination plate. Row H and Column 8 each contained serial dilutions of one of the agents alone for determination of the MIC. The "daughter plates" were loaded with 180 pL of test medium using the Multidrop 384. Then, the Multimek 96 was used to transfer 10 iL of drug solution from each well of the drug combination mother plate to each corresponding well of the daughter plate in a single step. Finally, the daughter plates were inoculated with test organism. Standardized inoculum of each organism was prepared per published guidelines (Clinical and Laboratory Standards Institute. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard-Seventh Edition. Clinical and Laboratory Standards Institute document M7 A7 [ISBN 1-56238-587-9]. Clinical and Laboratory Standards Institute, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087-1898 USA, 2006). The inoculum for each organism was dispensed into sterile reservoirs divided by length (Beckman Coulter), and the Biomek 2000 was used to inoculate the plates. The instrument delivered 10 gL of standardized inoculum into each well to yield a final cell concentration in the daughter plates of approximately 5 x 105 colony-forming-units/mL. The test format resulted in the creation of an 8 x 8 checkerboard where each compound was tested alone (Column 8 and Row H) and in combination at varying ratios of drug concentration. Assay reproducibility was monitored using S. aureus 0100 and the combination of amoxicillin-clavulanate, which yields a synergistic result with this test strain due to its 0-lactamase-positive status. Chloramphenicol and quinolones are recognized as a combination that may be antagonistic. Accordingly, the combination of chloramphenicol and ciprofloxacin was tested to demonstrate either no interaction or an antagonistic interaction of a drug combination. On two of the assay dates, an additional strain (E. faecalis 0101) was tested with chloramphenicol-ciprofloxacin. Plates were stacked 3 high, covered with a lid -on the top plate, placed in plastic bags, and incubated at 35*C for approximately 20 hours. Following incubation, the 27 microplates were removed from the incubator and viewed from the bottom using a ScienceWare plate viewer. Prepared reading sheets were marked for the MIC of drug I (row H), the MIC of drug 2 (column 8) and the wells of the growth-no growth interface. FIC Calculations The FIC was calculated as: (MIC of Compound I in combination/MIC of Compound 1 alone) + (MIC of Compound 2 in combination/MIC of Compound 2 alone). The FIC index (FICI) for the checkerboard was calculated from the individual FICs by the formula: (FIC + FIC2 + ... FIGQ)/n, where n = number of individual wells per plate for which FICs were calculated. In instances where an agent alone yielded an off-scale MIC result, the next highest concentration was used as the MIC value in the FIC calculation. FICI values have been interpreted in a variety of ways (Eliopoulos and Moellering, 1991; Antimicrobial combinations. In Antibiotics in Laboratory Medicine, Third Edition, edited by V Lorian. Williams and Wilkins, Baltimore, MD, 432-492). Most commonly, FICI values have been defined as follows: 5 0.50, synergism; >0.50-2, indifference; >2, antagonism. More recently (Odds, 2003; J. Antimicrob. Chemother. 52(1):1), FICI values have been interpreted as follows. A "synergistic interaction" was evidenced by inhibition of organism growth by combinations that are at concentrations significantly below the MIC of either compound alone, resulting in a low FICI value (50.50). The interpretation of "no interaction" results in growth inhibition at concentrations below the MICs of the individual compounds, but the effect is not significantly different from the additive effects of the two compounds, resulting in an FICI value of >0.50 but less than or equal to 4.0. The interpretation "no interaction" has previously been referred to as "additivity" or "indifference"- An "antagonistic interaction" results when the concentrations of the compounds in combination that are required to inhibit organism growth are greater than those for the compounds individually, resulting in an FIC value of >4.0. Thus, while the definition of synergism has remained constant, the definition of additivity/indifference has been broadened and re-named to "no interaction". In addition, the FICI value indicative of antagonism has been re-defined as >4. While there is no, officially-sanctioned set of FICI criteria, the literature has been consistent in the use of 0.50 to define synergism. 28 Results The test concentrations for each pair of test agents for each test organism are shown in Table 1. All of the agents alone or in combination were soluble at all final test concentrations. Several control drug combinations were included in each FIC assay (Table 2). The control combination of amoxicillin and clavulanic acid demonstrated the expected synergistic interaction (FICI value 50.50) for the control organism S. aureus 0100 in all FIC assays. The control combination of chloramphenicol and ciprofloxacin, which was expected to demonstrate a negative interaction for S. aureus or E faecalis, yielded relatively high FICI values that would be categorized as either antagonism or no interaction, depending upon the FICI cut-off criteria applied. The MIC and FICI values are shown in Tables 3 to 11. The interpretation listed in the tables for each test organism and drug combination is based upon the recently published FICI criteria (Odds, 2003). The combination of ceftaroline and vancomycin, linezolid, daptomycin, and tigecycline (Tables 3, 4, 5, and 6, respectively) yielded a result of no interaction for the staphylococci, enterococci, and streptococci, and Gram negative organisms tested. For the combination of ceftaroline and meropenem (Table 7), two instances of synergy were detected (S. aureus 2202 and K. pneunoniae 1468), and there was no interaction for the rest of the test organisms. Ceftaroline in combination with levofloxacin (Table 8) yielded a result of no interaction for a broad range of Gram positive and Gram-negative organisms. The combination of ceftaroline and amikacin (Table 9) resulted in two instances of synergy [E. coli 2273 (ESBL) and P. aeruginosa 2559], and notably, the FICI values for all other strains tested were < 1. Ceftaroline combined with aztreonam (Table 10) demonstrated no interaction for all of the strains tested, though three of the strains had relatively low FICI values. The combination of ceftaroline and azithromycin (Table I1) yielded no interaction for pneumococci and H. influenzae. The testing of ceftaroline in combination with various antibacterial agents against individual representative bacterial strains surprisingly and unexpectedly demonstrated several incidences of synergism and a result of no interaction for all of the other organisms tested. Furthermore, no evidence of antagonism was observed for the drug 29 combinations tested. Thus, ceftaroline may be successfully combined with an antibacterial agent to provide compositions for the treatment of bacterial infections. 30 Table 1 Minimal Inhibitory Concentration (MIC, jig/n-iL) Values and Concentration Ran .es esed in FractionalInhibitoryConcentration Assays _________ conc, Map ~ colic. 16age Onim Nfiscivnyx PhQovpr DUhug A DrugA TOOd Drug 8 Drug h Telited __________ IND. NIC (;IehTL) )M___________ SIOATO-ChOspfCO-170= 0753 I( T Ceftwtofihe 0.5 0.0"4 VALICMyif0 1 0.064 0.3 0.06-4 Liooid -1 0.12-8 _______________0.5 0.06.4 D~ptornycia 0.5 0.06-4 SIPhylecorrcs wrots 2063 NISSA Ceflaoloine 0.5 0.06-4 vadcooiyC41 1 0,06 5.5 0Q00,4 Lintzolid 4 0.12-8 0.5 0.06-4 DNptonvyw -1 0.06-4 Slaphy4ococxc'ts ellfrfi~s 0765 MRSA Ceflaroiume 1 0.06-4 VofeCOnhYCrn 2 0.0" I 0.0i:4 Linezolid 4 0.12-A F- 0.00-4 D);stoni)'e 0.5 0.0&-4 2 0.064 1geychne 0.25 0.91511 Sla~pit/'.Oc"Us £JIfrells 2053 U\RSA Cefti.oline 2 0.0"- NrancQdycifl 1 0.06-4 1 0.06-4 Uno~ld 2 0.12-8 2 0.0-4 ptonryew 0.5 0,06-4 2 0.06-4 Tigcc~oe -0.5 0.01 5 1 SkI(PIj'1oroccusoawcus 2296 CAMRA Cefamlind 1 0.06-4 Me1op .nea% :'Id 0.25-16 Sfraphylodoccll all)-ots 2202 CA-MRSA ctsoiue 1 0.0"- Mcivpcaicm 4 0.25,16 cc~icl~ 0795 VSE NN'oito. 8 0.5-32 Vsnlco~ucin 2 0.06 A 0.5-31 1JinezOhd 2- 0.12,5 ________ o.5-32 Pwptonwcul 1 0.06-4 mlIvtweoccsfocoft 0796 VSE ce~brof;Q0 1 0.06-4 vm~co"myif 2 0.0641 4 0.0-4 Linczolid 4 012-A 2 0.064 jDoptonini 2 0,06A4 ,rc-swriy 0947 Cefiaroline_ 2 0.5-32 Litiezlid 2 0. 12-8 Cone ax. C'otRO 10aov~ hfkrnlny fteq DI mg A DrIog A Tcalrcl D 1)*u II SN TOW F1v@an3I10f n4 S O VRE cafhtyhit 4 9.3-12 L40.zold 2 0.12-S goo6 PSV - coWUMin SIMI 0.fm-032 Vhprqm' 0.2S 0.03-2 0.1.0 0.002I-0)3 1 LowftA4i 1 9,0 0.005 0CO0A112 Axifirmxim 0,6 "D X-f- 1hw~w 0346 POSP Caetiolil 0COOS a.m".12 vaaaa.vy 0.5 t.0312 0008 ~ 0Q20J ~T~ 9605-4 CMs PRIP Cw'rqUlt OY 0.05~-1 vadcotayis 0.5 O.03 Spu. tgaar M03-50 PPR6 e I.1 v22- 1aAOO. 0..1 0.03--z 0.12 00)1 i Loermuf 1 9,96-4 0. ke) 5-1 Iipeyiiai OMS 0.02-0.17 Ar 0515opf 10041 - CI PJ-SP Caftwoli& , o0-- AAW ~dn--w 2 0.5-32 S 03!77 M~-P C4 0UZ 0.12 0,M1-1 Miasomy-izz 3 0.5-42 0117 ir1i. 0.001 0.00-0O)2 Limnloid ____ 12-8 0.009 0.0MU Dptoakwin lO Q0$ _______ -& To'22O,2 L~vf~c G0 0.06-1 67yz W3r)~ 01 0.60-0.)) An~1L 0.12-9 ~~F* ~ ~ O via-.1 5~nm~. * W 0.015-1 31 Conc. Riehge Conc. Range Orp~nilill fiucriyx Phenotype Drog A Dilig A Tested Des g B Pnig a T.,I~d No. _____ _______ MC ______ C £seorc---7ol 2-73 ~ ~ 1 F 20.5,)2 Lf1d1 4 0,06A4 2 0,S-32 Atuac 0.5.32 2 0.5-32 Azueoroia 16 0.5-32 Esclwnchbo coll 151 S8a7ln 0.12 0.002-0.12 Levofloxacin 0.06 (9,004-0.25 0.12 0.002-0.12 Ainiain 4 0.5132 0.12 0.002-0.12 A-treorim 0.2 0.015-1 pWc~qhftaIVcmf16WMPa 1224 Ceftroliioc 0.06 0-.015-I 1xjox~cin 0.015 0.008-0.S _______ ________ 0.12 0.015-I AzIitumcin I Moll maomnophils 1)01/s000 2797 BY-NAR! cediaoicu 0.06 0.015-1 Lei'oflomcin 0.015 0.003-0.5 _______, F_____ 2 0.015-I ArMihxmYci 1 0.06.4 m3aelpopiffis t"JIwny.ixa 2793 BLNA3P CofIodiie 0.03 0.Ols-I Lin-oflowain 0.0)5 0.009-0.5 _______ ________ 0.03 0.0)5-1 Azithtrooycia 2 0.06-4 Hanophillis infliamufe 2799 EILNAR CdAtoline 0.03 0.015-3 1,evo~iomw~i 008. ______ ________ 0.03 0. 015 -I AcilhcoMyCinl 0.25 0,06.4 riobitlU4P71CnIM1v,1 1408 ESBIL Ccftarolinc 32 0.S-32 l-ctpenezn 0.06 0.015.1 ______32 0.54a2 It~ecyclic 0.25 0,03 -Y Klekiselfopflvwiflion~c 1461 Ceufivoine 0.2 0.06-16 LtVoflOXRC~n :,-4 0.06-4 0.5 0.06-- Anikcr 1 0.5-32 0.25 0.06-4 Acxcom 0.25 0.015-1 ~p~n~ 1340 Ceftarolimo 0.12 0.015-1 Levofloxacin 0.06 0.0014..25 0.12 0.)1 1j~kcn1 0.5S-32 0.12 0.015-1 Aziccon 0,12 0.01511 P~~d,~n~ ~n~t~oo 55 ehmoliutv 32 0.5-32 Meropencilt 4 02-16 i Cone. Rmilge Oag.s1m Allkrolulyz Phenotype Drifg A D) ug. A Thled DMug B DIrlg 0 Teted) No, IU ,1' MIC OVL Pscdwono.t emighs 25o CefiarloIflc 16 0.5-32 Mcrefonemo 0.12 0.015-i' Id 0.5-32 Arilikamn 4 0.5.32 SVdphyloeoceo ativi 0100 Azmoxicilinf 4 0.12-8 Cla~i,)aaDI* 1~6 0.25-16 (PIG Contro Flare.) (..Tcc Choouhaicl 16 1-64 Cilpoofmiraci. 025.. 0.25-16 0 2 23)hoiproio -4 ~~o~on .. .51 Eocsbc~s 0101 c~r vmclaml i .1 .51 01IC con" ol aIt.) (ATCG 0 ~29212) _______ _____ I NSSA. aiotbicillin-siuccytiblc Sw -ovcr)* ato0mis 1 MRSA. inthiciffin-mt~any Stajihylococat uxOfrolls 3' CA-MR.A, communnity-acquircd mcshiciu-iesihtOnt Srophylotoccia oncerco 4 VSE, \'ancofnyciti-Fusceptible E~mwaremooc~ 5 VRE, BC~~C~OitJt£icaoracds PILSP. peaicim~n-lesisIlt nepoouT)~~h0l o ESBL, ekwnded opecirun P-lactmumeo prodcqir 32 Table 2 Summitry of Control Results for the Combinations Amoxicillin-Clavulanie Acid and Chloraimplenicol-Ciprofloxaciin 1opow I_______ Con d 2 OraiiNamne (pglmL) Name (pmgIhL) TI Cl -~Alone Alonec S. allrejes 0100 0.25 (ATCC 29213) Arnoxicillin 4 Claaate > 16 0.27 0.25 _________ ~ 0.2 3______ ____ .32 'IM4C., )Nifimkl Iabibiuory Conce'nIVAUGOu P1C]. PjActioal Inhibitesiy Ovaceti'Afion Imidex Table 3 Summary of Minimum Inhibitory Concentration and Fractional Inhibitory Concentration Results for Ceftaroline and Vancomycin Compoiind I COMPOwiil 2 Alic" MIC Organism (Phenotypie 1 ) Nae (Pag/knL) NDine (p/mL) FICI) Inteirctation 4 Alone Alone, S anon 0753 (ASSA) 0.5 1 1.05 No icract ion S. au)watf ( 2063 (MSSA) 0.5 1 0.96 No Ytrfatibn S. cou,'ers 0765 (NIKSA) 1 2 1.17 No Iktenction S. awreits 2053 2M(A 1 1.38 No 4aieracvion E.Aefti~~s 795 (VS) Ceftacoline 3 vancomycin 2 1 5 No bijteraction _LfaerahIs 796 (VSE) 2 1.34 No Wneraction . prwiuriniat? 866 (PSSP) ! 0.002 0.2S 2.95 No Iteriction S. Pletarnonia 89(SP 0.008 .5 0.79 No Ynteraction S~ azmnfe 80 PSP0.12 05 .86 No Interaction' S. Pneinnvonie 884 TLRSP) ______ 0.12 ________ 0,5 0.66 No Tteractin ]Footnotes for Table~s 3 - I I 'Phnotypv: MSSA, inethicUfin~suscepti-blc Staphylococciss ourous; MRSA. thlicillin-tc sitaznt Stap/wilococcii atregils CA-NMSA, commrnnity-acquired mruiI-vtsn Smphlococcis avretts, VS, vaxnconmycin-susceptible Epmew~coccris 'VRiE, vancomycin-icsistaut Enrelvcoccus ; PSSP, pvcibmiisceptible Streplococcuspriewihrniae; PRSP, pemcI-eirla*It Sreptococcuspuionjacyv; ESBL, extended-specrum frt-Iactnace producer: BtNAR.& -ar s-crce rpc1r~eItw MIc, Miniuuni Iniitory Collerbia-Alioil 3 F16, Fractional Inibitozy Conceriafion Index PICI inteteietan: 5 0.5, fyarrgiwu; ,' 4, Antagonin;> 0.5 to 4.0, ii n eac 33 Table 4 Summary of Minimum Inhibitory Concentration and Fractional Inhibitory Concentration Results for Ceftaroline and Linezolid Corn ond I cm d 2 MW1C AM Orgaiin (Pheuo1type) Name (jig/mL) Na me (jig/mL) FICI Interpr'etationi Alone ________ Alone ____ S awems, 0753 (?vISSA) 0.5 4 0.80 No Interaction S ouretu 2063 (MssA) 0.5 4 0.72 NoD Interaction S. aureius 0765 cMRSA) 1 __4 1.11 No Interactionl 5'. au t 2.053 (MRSA) 2 2 1.05 No Interaction E. faecalis 795 (VSE) ceflaro1ne 8 Linezolid 2 1.23 NO InteAMCtOU g .aecalis 796 'NSE) 4 4 0.77 No Interaction E faecalts 847 (V'RE) 2 2 1.14 No Inlefactio E. faicalis 849 (NX'RE) 4 2 1.26 No Interaction 5. pyogenes 717 0.008 1 1.32 No Interactioa IS pyogeties 722 ______ 0. 008 a ______ 1 1.32 1No 1interaction Table 5 Suminary of Minimum Inhibitory Concentration and Fractional Inhibitory Concentration Results for Ceftaroline and Daptornycin ______ Compoiind I Compound 2 hficMC Organism (Plienohy Pe) Niame (lig/InL) Name (pag~mL) FICI Interprotation _____________ _______ Alone ________ Aoe ____ _______ ,5 arvit 075-3 (MSSA) 0.S 0.5 0.93 No Interactioil I aureus 2063 IMSSA) 0.5 1 0.70 No Interaclion S. awurs0765 (1ARSA)_ 1 0.5 0.96 No Interatiion S. aureus 2053 OIRSA) Ceftaroline 2 Daipromycin 0.5 0.72 No Intcraction E. fagicalts 795 CVSE) 8 1 0.57 No Intepictio IEfaecalis 796 (VSE) 2 2 0.63 No hiteraction S -pyogendsv 7!17 0.008 0.06 0.75 No teicfion 5 pyenes 72_______ 0.008 ____ 0.06 1.17 No Interaction Table 6 Summary of Minimumj Inhibitory Concentration and Fractional Inhibitory Concentration Results for Ceftaroline and Tigecycline Compoiud I coupolld 2 IC '.%tic Organisml (Phenotype) Name (Pg/nL) Name (i/L) FICI 1nfesrPrefillion Alone Alout_______ S: auretts 0765 (ARSA) 2 0.25 1.05 No hintesaction S, artrela 2053 (MRSA) 2 0.5 1.10 No hiteraction S pfI01111niae 880 (tPRsp) 0.12 0.03 1.42 No Interaction S. pneranoniae? S84 (PRSP) Cefiroline 0.12 Tigecycibi 0.03 1.26 No Irntenvion K pneumninue 1468 (.PSfL) 32 0.2S 1.36 No Inkretchion A. batinannii 2601 2 0.06 1.42 No Ix"tczction A. batonanpay 2602 _______ 2 1.42_____ .6 A No Inkoction 34 Table 7 Summary of Minimumw Inhibitory Concentration and Fractional Inhibitory Concentration Results for Ceftaroline and Meropciiem ao~td I Comyou d 2 Organism (Phenotype) Name (jIlnL NNnie (J70WL 11 nterpmi'tfon ____________ _______ Alone ________ Alone ____________ $ooroas 2296 (CA-ISA) 1 6 0.62 'No Izfleraction S.. artras 2202 CA4MRSA) 1 4 0.44 Synergy K, pnelironitao 1468 (ESBL) ICeflaroie 32 Mcropvui 0.06 0.49 Synergy P. acniginosa 2555 32 4 .60o No Intmrcfiou A. a&rllg7nosa 2559 1_____ 6 ________ 032 1.65 No ntafacioll Valve of 32 jiginl, used for 1F1C cRlCULition. Table 8 Summary of Minimum Inhibitory Concentration and Fractional Inhibitory Concentration Results for Ceftaroline and Levofloxacin Compound I Compound 2 IC MIC Organism (Phenotype) Namie 0;ag/mL Name (pi4L) FICI Interpretation Alone Alone S.Pne q; riae866 (P851') 0.008 1 1.14 No Inkieitioii S, pnewnon-0 1iae 869 (PSSP) 01008 1 1.04 No Ithetaction S. jmmninf 880 (PRSP) 0.32- > 4m 1.19 No hinefactionl $ ramoIe884 RSP) 0.32 1 1.13 No Interation. S. pyoRg??Cs 717 0.008 0.5 1.15 No Intetactioai S. pyogenuve 722 Cefflte 0.008 Leolxcn 0.5 0.90 No 141tefaclionl K. pneumonfae 1461 0.25 > 48 1.75 No Interac6ion K pieumonmae 1340 0. 12 0.06 1.14 No Intewfcion . colt 2273 (ESBL) 2 - i-g- No~ b~Intcol . colt 1587 0.12 0.06 1.05 No Interiction Y,. influence 3224 0.00 0.015 1.76 No Inwtetion II. I~iwnzae 2797 (BLINAR) 0,06 0.01 S 1.43 No Inkrcactlowi H Ifluemese 2799 (NAR) 0.03 0.015 1.52 No Jntrctiroran H. iwflwmzae 2799 (BLNAR) __________ 003 ______ 0.01 S 1.52 No nraio' V31luc of 8 jr~/zrL uted for FIC calculation Table 9 Summary of Minimum Inhibitory Concentration and Fractional Inhibitory Concentration Results for Ceftaroline and Amikacin Compound I Compou d 2 Organismn (Pbeflolyp) Namne (Pg/mI,) Name (pig/WL) FICI Interpretation _________ Alone _______ Alone_______ K pncuinontae 1461 0.5 1 0.79 No Iteraction K pneumonfae 1340 0.12 1 0.96 No interaclsonl . cohl 2273 (ESBL) CC-0310awle 2 Axnikacin 8 0.50 Sy-fgY E. col 1587 0.12 4 0.96 No intetactioll P. aeruginosa 2555 32 8 0.83 No hiter~chlon R ae;vuginosa 2559 _________ 16 _______ 4 0.42 Synergy 35 Table 10 Summary of Minimum Inhibitory Concentration and Fractional Inhibitory Concentration Results for Ceftaroline and Aztreonam Comopound 1 Compoumd 2 Orgianisn (Phenotype) Name (pg/mL) Name (pg/mL) FICI Interpretation Alone Alone K. pnenwinao 1461 0.25 0.25 1.27 No Iitra tion K pneumoniae 1340 Ce0aroln.12 Azteomn 0.12 0.83 No Interacton E colt 2273 (BSBL) 2 16 0.64 No iuttractio E. coft 1587 0.12 0.25 0.60 No intraction Table 11 Summary of Minimum Inhibitory Concentration and Fractional Inhibitory Concentration Results for Ceftaroline and Azithromycin Compound I Compou d 2 MlIC MIC Organism (Pltenoiype) Name (pgmL) Name (pg/mL) F"CI Interpretation Alone Alone S. pnemnontae $66 (PSSP) 0.008 0.06 1.16 No Interiaction S pnemnoniae 869 (PSSP) 0.008 0.06 1.16 No Interaction S. pleWnoniae 876 (PRSP) 0.12 2 1.11 No Interaction S. pnemnoniae 877 (PRSP) 0.12 -> 32 - 0.99 No Interaction Ceftaroline Azithromnycia __________ H nfiienzae 1224 0.12 1 ,26 No hIneraction H Ifluenwe 2797 (BLNAR) 0.12 1.13 No Interaction H. inflerrzaa 2798 (BLNAR) 0.03 2 .24 No Interaction H. hifenzae 2799 (BLNAR) 0.03 . 0.25 1.3 No Interaction Value of 64 pig/mL used for FIC calculation EXAMPLE 2 Ceftaroline combinations using time kill curve method The in vitro activity of ceftaroline combined with meropenem, piperacillin-tazobactam, cefepime, amikacin, levofloxacin, aztreonam and tigecycline was evaluated. Susceptibility testing was performed for 20 clinical P. aeruginosa, 10 ESBL-producing Escherichia coli, 10 ESBL-producing Klebsiella pneumoniae and 10 AmpC-derepressed Enterobacter cloacae. Time-kill experiments were run for 10 randomly selected isolates with antimicrobials at '% MIC. Materials and Methods Bacterial strains Twenty clinical P. aeruginosa from the Anti-infective Research Laboratory (ARL, Detroit, Ml, USA), 10 ESBL-producing E. coli, 10 ESBL-producing Klebsiella pneumoniae, as well as 10 AmpC-derepressed Enterobacter cloacae were selected from ARL and JMI Laboratories (North Liberty, IA, USA) clinical isolate collections for susceptibility testing. Ten 36 strains (2 E. coli, 2 K pneumoniae, 2 E. cloacae and 4 P. aeruginosa) with various susceptibility levels for ceftaroline were randomly selected to be run in time-kill experiments. Antimicrobial agents Ceftaroline (ceftaroline fosamil) was provided by Cerexa, Inc (Alabama, CA, USA). Piperacillin, tazobactam, tigecycline (Wyeth Pharmaceuticals, Inc., Pearl River, NY, USA), meropenem (AstraZeneca Pharmaceuticals LP, Wilmington, DE, USA) and cefepime (Elan Pharmaceuticals, Inc., San Diego, CA, USA) were commercially purchased. Levofloxacin, amikacin and aztreonan were obtained from Sigma-Aldrich Co. (St Louis, MO, USA). Medium Mueller-Hinton broth (MHB; Difco Laboratories, Detroit, MI, USA) supplemented with magnesium (12.5 jig/mL total concentration) and calcium (25 [tg/mL total concentration) (SMHB) was used forall microdilution susceptibility testing and time-kill analysis. Tryptose soya agar (TSA; Difco Laboratories, San Jose, CA, USA) was used for growth and to quantify colony counts. Susceptibility testing Minimum inhibitory concentrations (MICs) as well as minimum bactericidal concentrations (MBCs) of the tested drugs were determined using broth microdilution methods according to clinical and laboratory institute (CLSI) guidelines (Clinical and Laboratory Standards Institute. 2006. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard, 7th ed. Wayne, PA: CLSI) All susceptibility testing were performed in duplicate, at a starting inoculum of -5.5 x 10 CFU/mL and concentrations ranged up to 1024 Rg/mL for ceftaroline alone or combined to tazobactam (4/1); up to 256 ig/mL for amikacin and tigecycline and up to 64 tg/mL for aztreonam, meropenem, cefepime, piperacillin/tazobactam and levofloxacin. Time-kill curve analysis Time-kill experiments were performed in duplicate with an initial inoculum of ~I06 CFU/mL. Ten randomly chosen strains, including 2 E. coli, 2 K pneumoniae, 2 E cloacae and 4 P. aeruginosa, harboring various susceptibility levels for ceftaroline, were exposed to each tested drug alone or in combination at %A MIC, Regimens included aztreonam, meropenem, cefepime, amikacin, piperacillin/tazobatam, levofloxacin, tigecycline and ceftaroline alone or combined to each of the listed antimicrobials. Aliquots (0. 1 mL) were removed from cultures at 0, 1, 2, 4, 8 37 and 24-h and serially diluted in cold 0.9% sodium chloride. Synergy, additive effect and indifference were defined as >2 logo kill, <2 but >1 logo kill and ±1 log kill, respectively, compared to the most efficient agent at 24-h. Antagonism was defined as >1 log10 growth compared with the least active single agent at 24-h. Bacterial counts were determined by spiral plating appropriate dilutions using an automatic spiral plater (WASP; tW Scientific, West Yorkshire, UK) and by counting colonies using the protocol colony counter (Synoptics Limited, Frederick, MD, USA). The lower limit of detection for colony count was 2 logio CFU/mL. Time kill curves were constructed by plotting mean colony counts (logio CFU/mL) versus time. Bactericidal activity of drug alone was defined as a >3 logio CFU/mL (99.9 %) reduction at 24-h from the starting inoculum although bactericidal activity of drug combination was defined as a >.3 logo CFU/mL (99.9 %) reduction compared to the most efficient drug at 24-h. Results Except for 4 E. cloacae (MIC 1), ceftaroline exhibited a MIC range of 2-1024 p4g/mL, reduced from 2 to 128 fold by combination with tazobactam for ESBL-producing strains. In time-kill experiments, no antimicrobial alone was bactericidal. Combinations of ceftaroline plus tigecycline, levofloxacin or cefepime were mainly indifferent. Whereas, ceftaroline plus amikacin was synergistic for 9 isolates, ceflaroline plus piperacillin-tazobactam was synergistic for E. coli and K. pneumoniae, indifferent for E. cloacae and indifferent/additive for P. aeruginosa. Ceftaroline plus meropenem or aztreonam was synergistic for E. coli and E. cloacae respectively, but indifferent against all other isolates, except I P. aeruginosa (additivity). No antagonism was observed with any combination. Ceftaroline in combination with amikacin appeared synergistic against 90% of the tested strains. Susceptibility Selected clinical Enterobacteriaceae represented a large panel of strains, harboring various susceptibility levels for ceftaroline and other tested antimicrobials (Table 12). Ceftaroline MIC values ranged from 2 to 1024 Vtg/mL. According to the ceftaroline susceptibility break points recently proposed (Brown and Traczewski, 2007; Abstr. D-240, 47th intersci. Conf. Antimicrob. Agents Chemother.) selected isolates included: 8 susceptible strains (MIC 54 ftg/mL): 3 E. coli, 1 K pneumoniae, 4 E. cloacae ; 8 intermediate strains (MIC = 8 pg/mL): 2 E. coli, 2 K pneumoniae and 4 P. aeruginosa, and 34 resistant strains (MIC > 16pg/mL): 5 E. coli, 7 K pneumoniae, 6 E cloacae and 16 P. aeruginosa. In combination with tazobactam (in 38 proportion of 4/1), ceflaroline MIC was decreased from 2 to 128-fold for ESBL-producing E. coli and K. pneumoniae strains. Thus, 9 E. coli isolates became susceptible and I exhibited intermediate susceptibility to ceftaroline. For the K pneumoniae isolates, 6 isolates were susceptible to ceftaroline after addition of tazobactam, 2 were intermediate and only 2 strains still exhibited resistance to ceftaroline (but with a decrease of MIC of 8 and 16-fold). Addition of tazobactam decreased ceftaroline MIC 2--fold for some AmpC-derepressed E. cloacae and for some P. aeruginosa isolates (Table 12). Thus, tazobactam did not change the susceptibility profile of E cloacae and P. aeruginosa strains, which still were resistant or intermediate. MBC values of ceftaroline (alone or combined to tazobactam) were found similar or one dilution higher than MIC values (Table 12). Other antimicrobials exhibited various levels of susceptibility against selected clinical strains, with MIC ranges from 0.03 to > 32 tg/mL. However, Enterobacteriacae appeared susceptible to meropenem and tigecycline with MIC values <4 and 8 sg/mL, respectively. All tested P. aeruginosa were susceptible to amikacin with a MIC range of 2 to 16 pg/mL. Furthermore, except I isolate (MIC = 0.5 Ag/mL), all K. pneumoniae were resistant to aztreonam, with MIC values ; 8 pg/mL (Table 12). Table 12 Susceptibility profiles (MIC/MBC ranges) of the 30 tested clinical Enterobacteriacae and 20 P. aeruginosa isolates Anti icrobiiAs MIC/MBC ranger (pg/mL) K. coi (10) K pneumonia (10) E. c/oacae (10) P. aeruginosa (20) Ceftaro-in 2-512/4-1024 8- 1024 /32 -1024 0.125 -512 / 0.125 - 8-2i6/16-256 1024 Ceftaroline- 1 -8/I - 16 1-64/4 -64 0.125 - 256 / 0.125 - 8 - 128 /6 - 256 Tawobactan (4/1) 256 Meropenem 0.03 - 0.06 /0.06 - 0.125 0.03 - 0.06 /0.06 - 0.125 0,03 - 0,25 /0,03 - 0.5 0.125 - 16 / 0,125 32 Cefepimc 0.125 - 256 /0.25 - 512 0.5 - 16 /0.5 ->64 0,06 - 32 /0.125 - 64 2- 32 /4 - 64 Piperacillin- 2-64/2-128 2->256/4->256 2-128/4-256 2-256/4-256 Tazobac m (4/1) Awzlconam 0.125 ->64/0.125->64 0.25 - >64 /0.5 - >64 0,125 - >64 /0,125 - 2-64/8-64 >64 Amikacin 1 - 16/4-64 1-32/1 - 128 0.5-4/ -8 2 - 6/24 Levofloxacin 0.03 - 32 /0,06 - 32 0.25 ->32 /0.25 - >32 0.03 - 64 / 0,03 - 128 0.25 -32 / 0.5 >32 Tigecycline 0.06 - 0.5 /0.06 - 4 0.125 - I / 0.5 -8 0.25. 2 /0.5 - 4 2-32/8-256 39 Time-kill analysis Potential of synergy was evaluated for 10 randomly selected isolates, harboring various susceptibility levels for each tested antimicrobials, including ceftaroline (Tables 13 and 14). In time-kill experiments, ceftaroline and the other agents alone were not bactericidal at /4 MIC. In combination, ceftaroline with tigecycline, levofloxacin and cefepime were mainly indifferent (mean decrease from 0.01 to 0.20 * 0.30 logio CFU/mL). Additive effect was demonstrated with ceftaroline plus levofloxacin against K pneumoniae isolate n. 5427 (mean decrease at 1.7 + 0.20 logo CFU/mL). Combination of ceftaroline plus cefepime was additive against I P. aeruginosa (isolate n.1037), with a decrease of 1.8 + 0.40 logio CFU/mL. In contrast, ceftaroline plus amikacin demonstrated synergistic effect against all tested strains. Mean differences were - 5.65, 4.4, 5.1 and 3.6 logo CFU/mL for E. coli, E. cloacae, K pneumoniae and P. aeruginosa, respectively (Figure 1). Ceftaroline combined with meropenem, aztreonam or piperacillin tazobactam led to various antimicrobial effects. Ceflaroline plus piperacillin-tazobactam (4/1) was synergistic against both E. coli and K pneumoniae isolates, with similar mean differences ( 5.82 and 5,33 logio CFU/mL) (Figures Ia-b). In contrast, ceftaroline plus piperacillin-tazobactam (4/1) was indifferent against the 2 E. cloacae isolates (5417 and 4073) and I P. aeruginosa (isolate n. 956). An additive effect was observed with P. aeruginosa isolate n. 1037, with ceflaroline plus piperacilin-tazobactam (1.81 ± 0.42 logo CFU/mL) as well as plus azireonam (1.01 ± 0.54 logo CFU/mL). Finally, combination of ceftaroline with meropenem was synergistic against ESBL producing E. coli (- 4.45 logio CFU/mL), as well as ceftaroline plus aztreonam against AmpC-derepressed E. cloacae isolates (- 3.03 logo CFU/mL) (Figures Ia and Ic). No antagonism was observed in the study. Several drug combinations surprisingly and unexpectedly extended ceftaroline broad spectrum of activity to most of MDR Gram-negative organisms. Several antimicrobials led to synergistic effect in combination with ceftaroline. 40 Table 13 In vitro activity of celtaroline and tested antimicrobials (MIC/MBC) against the 10 selected clinical isolates . ... .MIC/MDC (pg/mL) E. co/i K. pieurmonla E. c/oaca P. aeruginosa Isolate no. Isolate no. Isolate no. Isolate no. 5401 5411 5427 5436 4073 5420 796 956 1019 1037 Cellaroline 4/8 64/128 4/16 1024/102 256/512 64/128 16/32 128/256 32/6 8/16 4 4 Ceflaroline- 1/2 0.5/4 1/1 8/8 256/256 64/128 8/16 64/128 32/6 4/16 Tazobactam 4 (4/1) Meropenen 0.06/0.06 0.06/0.06 0.06/0.06 0.06/0,06 0.25/0.5 0.125/0.125 1/2 0.25/2 1/2 0.5/1 Cefepime 1/4 2/4 0.5/1 16/32 4/16 0.25/1 8/16 8/32 2/4 1/2 Piperacillin- 64/128 16/32 2/4 4/4 64/64 64/64 4/16 4/32 4/8 4/16 Taxobactam (4/1) Atreonam 0.25/0.25 8/32 0.5/ 64/64 32/64 8/16 4/32 8/64 4/4 4/8 Anikacin 2/4 8/16 2/2 1/2 1/8 1/2 16/32 4/64 4/4 214 ILevolloxacin 32/32 8/16 0.25/2 4/4 0.06/0.06 0.06/0.06 1/2 75/1 0.5/1 0.25/0.5 Tigecycline 0.5/1 0.125/0,5 0.5/2 0.125/1 0.5/2 0,5/2 32/32 16/128 2/8 8/2 41 Table 14 In vitro activity of combinations against the 10 randomly selected clinical isolates Drug combinations Specics IsolatC Deccase ofthe bacterial couni (mean logio k SD) a:; Iiflect 2-h 4-h 8-h 24-h E. coil 5401 0.87 * 0.20 3.12 * 0.14 4.20 3:0.72 4.93 t 0,75 S 5411 0.08 * 0,58 1,7810.15 3.91 * 0.13 4.17 10.47 S Kpnewnoniae 5427 0.06±0.13 1.13 0.46 0.12*0.05 0.12 *0.03 I 5436 0.59* 0.05 1.16 0,15 3.66*0..32 0.04 ±0.12 I Ceftaroline+ E. c/oacae 4073 0.86* 0.13 1.39*0.28 1.2120.09 0.72*0.20 1 5420 0.1020.02 1.03*0.73 1.44*0.74 0.12*0.11 I P. aerginasa 796 0.07*0.08 0.03* 0.04 0.05 * 0.03 0.14 T 0,16 1 956 0.02*0.03 0.21 0.27 0,10:0.01 0.31 * 0.31 1 1019 0.01*0,01 0,27 0.10 0.04*0,05 0.05±001 1 1037 0.20* 0.04 0.32 *0.27 0,28T0.15 1.71 * 0.14 1 *. co/i 5401 0,290.01 2.24*0.12 4.490.16 5.79±0.57 S 5411 0.81* 038 2,68 * 0.58 4.38 ± 0.81 5.85 * 0,40 S K. pngtmonla4 5427 0.10 0.00 1.52*0.18 4.11 ±0.07 5.39*0.62 S Ceftaroline+ 5436 0.26±0.36 0,87:0.13 3.31 *0.01 5.2810.11 S .f .. Ec/cae 4073 0.04 * 0.02 0,04 *0,16 0.17 0.19 0.02+0.02 1 Piperacihlln 5420 0.1520,15 0.80 0.74 0.08*D.10 0.04 2 0.05 1 TAobactam P.arogIno 796 0.52 * 0.31 0.17 0,17 0.08* 0.02 0.00*0.06 1 956 0.00T0.20 0.19 0.10 0.05*0.10 0.1020.06 1 1019 0,0720.03 0.07-0.23 0.01*0.10 0.12±0.00 1 1037 0.52*0.18 1.17*0.19 1.66x0.47 1.81 *0.42 A I". Coli 5401 1,01 m0.00 4.78±0.08 5.30*0.08 5,3220.02 S 5411 0.93+0.80 2.88+*0.32 5.10 * 0.06 1.98 * 0.37 S K. paeroOon/ae 5427 0.65 ±0,24 3.42 *0.08 4.43*.0.38 4.81 ±0.34 S 5436 0.26 *0.36 0.87 *0.14 3.31 T0.01 5.31 *0.14 S CoAnroline+ RZ cloacae 4073 1.38 *0.01 1.68+0.01 3,1920.16 4.65 *0.02 -S Amikacin 420 0,02 & 0.02 1.12 t 0.80 3.27 * 0.36 4.44 * 0.72 S P. aruglnosa 796 0.07* 0.0 0.63 *0.31 2.14*0.41 5.23*0.32 S 956 0,3620.05 2.61 * 0.02 2.66*0.50 3.60 10.44 S 1019 0.16 *0.11 1,32a0.07 3.84*0.81 0.67/*0.28 1 1037 0.09*0.08 2.13 0.07 2,71i0.30 3.51 v0.27 S /t.coi 1401 0.1120,11 1.00*0.21 0.0 *0.02 0.0420.06 1 5411 0.63t0.58 0.58*0.01 0,0810.14 0.0120.05 1 Ceftarolin+ K. P"r"noiae 1427 0,1520.05 0.18*0.07 1.68*0.22 1.7*0,20 A 5436 0.09*0.07 1,05 x 0,00 0.47* 0.08 0.08 * 0.01 1 Lev±0lNcin R. cloacae 4073 0.10*0.07 0.24 *0.02 0.1010.02 0.16x0.01 1 5420 0.01t0.10 0.41 ±0,38 0.05*0.14 0.04 * 0.06 I i. aerlig/lngpa 796 0.03 0.02 0.21 *0.42 0.35T0.09 0.04*0.14 1 956 0,08T0.09 0.25 *0.23 0.14 *0.00 0,9810.06 I 1019 0.21 t0.15 0.03 ±0.01 1.21 t0.13 0.00 0.00 I 1037 0.02 ±0,10 0.10*0.15 0.04 *0.01 0.10±0.36 I E. coll 5401 0.32*0.06 1.36t0.01 0.12*0.03 0.08*0.01 1 5411 0.63 * 0.25 0.99 * 0.04 0,16 2 0,03 0.33 r o.08 I Ceflaroline + K. pneuonTIOe 5427 0.01 1 0.07 0.64 * 0.02 0.06 t 0.08 0.02 * 0.09 I 5436 0.44 * 0.01 0.37 * 0.02 2.00 - 0.09 0.14 * 0.07 I Aareonam P. doacae 4073 0.6910.32 1.71* 0.25 1,73 *0,29 3.08 *0,13 S 420 0.03*0.04 0.90±0.88 3.33*0.91 2.99*0.12 S P.A ergino'a 796 0.06 0.11 0,04* 0.26 0.97 20.18 0.85. 0.15 1 956 0.18 * 0,15 0.12 * 0.17 0.20 t 0.53 0.73.*0.68 I 1019 0.03 *0,05 0.15±0.22 0.15 *0.03 0.26*0.27 1 1037 0.17 * 0.09 0.12 0.36 0.22 ± 0,16 1.0 1 T 0.54 A .coli 5401 0.12±0.08 0.45*0.78 0.02 *0.11 0.13 *0.07 I 5411 0.23*0.11 0.17±0.00 0.08:0.15 0.01 T0.02 I Ceflarolinet K, pleumlniae 5427 0.32 & 0.07 0.59 * 0.02 0.62*0.59 0,25* 0.31 1 5436 0.13 *0.16 0.40 0.52 0,22T0.17 0.0310.02 1 Tigecycline E 4clofoe 4073 0,05 ± 0.06 0.43 * 0.00 0.95 * 0.00 0.14 *0,03 1 5420 0.13*0.11 0,15 ±0.11 0.08 0.08 0.10*0.12 i P. aerugino.ta 796 0.05±0,03 0.48 *0.08 0.01 *0.03 0.17+0.28 1 956 0.12 0.06 0.22 ± 0,28 0.28 * 0.07 0.33±0.38 I 1019 0.00±0.02 0.10 *0.11 0.11a0.01 0.14*0.16 I 1037 0.10 *0.03 0,06±0.31 1.07 *0.25 0.54 *0.12 I E. cali 5401 0.37 * 0.04 1.54 * 0,12 0.04 0.01 0.03 * 0.02 I +411 0,56 m 0.51 0.38 0.01 0.07 *0.00 0.01 *0.00 1 Ceharolin + K. pIlnuimona 5427 0.08 0.03 0.8220.19 0.38 *0.32 0.20 2 0.30 I CerepimeAc 5436 0.01 20.07 0.51 * 0. 11 0.1.58* 0.06 0.31 A0.01 1 E. cloacae 4073 0.17*0.12 0.57T0.14 0.55*0.14 0.03 *0.02 1 5420 0.41 *0.33 0.12* 1.09 0,0310,06 0.07 *0.11 I P.aertginosa 796 0.02 ±0.04 0.27* 0.30 0.08 *0.01 0.02*0.01 I 956 0.25 * 0.24 0.0 ±0.19 0.35 10.37 0.52* 0.38 I 1019 0.13t0.11 0.08*0.08 0.03*0.01 0.05*0.29 1 1037 0.52 * 0.18 1.17 x0.19 1.66*0.47 1.81 ±0.41 A 42 Example 3 In vitro activity and aminoglycoside synergy of ceftarolina against hospital acquired MRSA The in vitro activity of ceftaroline and its potential for synergy in combination with tobramycin against a collection of hospital-acquired MRSA recovered from various clinical samples and exhibiting different level of resistance for vancomycin was evaluated. Materials and Methods Bacterial strains Two hundred clinical HA-MRSA isolates, harboring the SCCmecIV type, were evaluated for susceptibility testing. All isolates, selected from the Anti-Infective Research Laboratory (ARL, Detroit, MI) collection, were isolated from patients at the Detroit Medical Center and were previously characterized on a molecular basis. Four strains, including I hVISA and I VISA, characterized by population analysis profile and Macro Etest were selected for time-kill analysis. Antimicrobial agents Ceftaroline (ceflaroline fosamil) was provided by Cerexa Inc. Linezolid, vancomycin and tobramycin were commercially purchased (Pfizer Inc., New York, NY and Sigma Chemical Company, St Louis, MO, respectively). Media Except for daptomycin, Mueller-Hinton broth (Difco, Detroit, MI) supplemented with calcium (25 mg/L) and magnesium (12.5 ng/L) (SMHB) was used for all susceptibility testing and time-kill experiments. For daptomycin experiments, SMHB was supplemented with 50 mg/L calcium and 12.5 mg/L magnesium, Trypose soy agar (TSA; Difco, Detroit, MI) was used for colony counting. Susceptibility testing Minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) were determined by broth microdilution for all antimicrobials, according to the Clinical and Laboratory Standards Institute (CLSI) guidelines (Clinical and Laboratory Standards Institute. 2006. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard. 7th ed. Wayne, PA: CLSI). MBC values were determined by plating of aliquots of 5 piL from clear wells onto TSA. All susceptibility testing were performed in duplicate. 43 Time-kill curves Four randomly selected HA-MRSA isolates were evaluated in time-kill experiments, using a starting inoculum at ~106 CFU/mL and antimicrobials at %1 and 2 MIC. Regimens included ceftaroline, vancomycin and tobramycin alone or combination of tobramycin with ceftaroline or vancomycin. Briefly, aliquots (0.1 mL) were removed from cultures at 0, 1, 2, 4, 8 and 24-h and serially diluted in cold 0.9% sodium chloride. Appropriate dilutions were plated using an automatic spiral plater (WASP; DW Scientific, West Yorkshire, UK) and bacterial counts were achieved using the protocol colony counter (Synoptics Limited, Frederick, MD, USA). Timo-kill curves were constructed by plotting mean colony counts (logio CFU/mL) versus time. The lower limit of detection for colony count was 2 logio CFU/mL. Synergy was defined as a 2 logo CFU/mL increase in kill in comparison with the most effective antimicrobial alone at 24-h; bactericidal activity was defined as a 3 logo CFU/mL reduction at 24 h from the starting inoculum. Additivity, antagonism and indifference were defined as <2 but >1 logio kill, >I logio growth and ±1 log kill, respectively. Statistical analysis Differences between regimens were analyzed by T-test or ANOVA with Tukey's post hoc test. All statistical analysis was performed using SPSS statistical software (Release 15.0, SPSS, Inc., Chicago, IL). A P value <0.05 was considered significant. Results Ceftaroline was efficient against the collection of 200 HA-MRSA isolates recovered from various clinical samples. Susceptibility values and origin of the isolates are reported in Tables 15 and 16, respectively. Based on the CLSI susceptibility breakpoints and breakpoints recently proposed for ceftaroline (Brown and Traczewski, 2007; Program and Abstracts of the forty seven Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, IL, USA, 2007. Abstract D-239), all HA-MRSA, except one strain (isolate R2303), were susceptible to all tested antimicrobials. For vancomycin and linezolid, MIC values were similar and ranged from 0.25 to 4 pg/mL. MICso and MIC 90 were one-fold higher for linezolid compared to vancomycin (I and 2 pg/mL for vancomycin versus 2 and 4 pig/mL for linezolid, respectively). Daptomycin MIC range was lower (0.125 to 2 pg/mL), with MICso at 0.25 tg/mL and MIC 9 c at 0.5 tg/mL. 44 MBC values were similar to the MICs, except for linezolid, which exhibited a MBC range from 0.5 to 64 ptg/mL (Table 15). Ceftaroline exhibited MIC values ranging from 0.25 to 4 tg/mL, with MIC 5 0 and MIC 9 0 at I ig/mL. A slight variability was observed since only 4 % of the strains exhibited an MIC at 0.25 jig/mL and 1.5 % at 2 pig/mL. MBC values were equal or one time higher than MICs (Table 15). Among the 200 isolates, 36 % were recovered from respiratory tract samples, 17 % from blood, 13.5 % from skin and 2 % from urine (Table 16). Thirty one percent were uncharacterized due to a lack of clinical information. Isolates removed from urine exhibited a lower MIC 5 o value at 0.5 pig/mL, but the number of isolates in that group was not sufficient to make a reliable statement. Therefore, no difference was found in MIC values regarding the specimen sites as well as the susceptibility to vancomycin. Time-kill analysis and potential for synergy Four HA-MRSA were selected to be run in time-kill experiments, using ceftaroline and vancomycin alone or combined with tobramycin. Two of these isolates (R2303 and R3578) presented a reduced susceptibility to vancomycin, and were previously characterized VISA (vancomycin MIC at 4 ftg/mL) and hVISA (vancomycin MIC at 2 pg/mL). Two others HA MRSA, susceptible to vancomycin, were randomly selected. MIC and MBC of these 4 strains are reported in Table 17. In this study, MBC values were found equal or one time higher than MICs (Table 15). Bactericidal activity was therefore closed to the inhibitory concentration. To assess to ceftaroline potential for synergy, time-kill experiments were therefore performed at '% and 2 MIC. Since no activity as well as no synergy, additivity, antagonism or indifference was found in time-kill experiments at %/ MIC, the results are reported at 2 MIC, Under those experimental conditions, none of the tested antimicrobial alone was bactericidal, except ceftaroline which displayed a persistent bactericidal activity against the hVISA (isolate R3875) (Figure 2a). Against the 2 vancomycin-susceptible MRSA, ceftaroline exhibited a lower activity compared to the hVISA, with 1.5 logo kill at 4 hours, followed by a bacterial regrowth (Figures 2c-d). Same phenomenon was observed with ceftobiprole, which demonstrated a potent killing activity alone at M/ MIC, against CA- (community-acquired) and HA- MRSA (Leonard and Rybak, 2008; Antimicrob Agents Chemother 52: 2974-2976). In contrast, vancomycin did not display 45 bactericidal activity against none of the tested strains, including those without reduced susceptibility, and appeared therefore less efficient than ceftaroline alone (Figures a-d). In combination with tobramycin at 2 MIC, a synergistic effect was observed with ceftaroline against both vancomycin-susceptible MRSA (isolates R3804 and R4039), with a bactericidal activity at 6.1 and 4.8 hours, respectively (Figures 2a-b). Vancomycin plus tobramycin was indifferent and the difference of activity between vancomycin plus tobramycin and ceftaroline plus tobramycin was statistically significant with P values of 0.001 against R3804 and 0.006 against R4039 (Figures 2a-b). Vancomycin plus tobramycin was synergistic against the hVISA isolate, demonstrating bactericidal activity at 5.8 hours. However, activity of the combination appeared non significantly different to that of ceftaroline alone or combined with tobramycin (P value of 0.061) (Figure 2c). Neither tested antimicrobials alone nor combinations with tobramycin demonstrated bactericidal activity or synergy effect against the VISA strain R2303 (Figure 2b). Table 15 Repartition of Minimal Inhibitory/Bactericidal Concentrations of 200 HA-MRSA isolates % of Isolates MIC(pg/mL) Range MBC(pg/mL) Range 0.125 0.25 0,5 1 2 >4 0.125 0.25 0.5 1 2 2:4 Ceflaroline - 4 35.5 57 1.5 - 0.25-2 - - 22 62.5 15.5 0.5-2 Vancomycin - 1.5 14.5 62 21.5 ' 0.5 0.25-4 - 0.5 6 52.5 36.5 4.5 0.25-4 Daptomycin 19.5 58.5 20.5 1 - 0.5 0.125-4 9.5 47.5 35 5 2.5 0.5 0.125 4 Linozolid - 9.5 16 15.5 47.5 1.5 0.25-4 - L L5 12 13.5 73 0,5-64 46 Table 16 Susceptibility results for ceftaroline in function of the origins of the isolates Origin Number of Susceptibility (pg/mL) isolates MICs 0 Range MBC 0 Range Skin" 27 1 0.5-2 1 0.5-2 Lungb 72 1 0.25-2 1 0.5-2 Blood 34 1 0.25-2 1 0.5-2 Urine 4 0.5 0.5-1 1 0.5-2 Unknown 63 1 0,5-1 1 0.5-2 "abscess, tissue and swab samples baspirate, bronchial washing, lavage, endotracheale secretion and sputum *blood and catheter Table 17 Susceptibility results for 4 HA-MRSA isolates (including 1 hVISA and 1 VISA) selected to be run in time-kill experiments Isolate n. Susceptibility (pg/mL) Ceftaroline Vancomycin Tobramycin MIC MBC MIC MBC MIC MBC R2303 0.25 0.25 4 8 0.125 0.5 R3875 1 1 2 2 0.5 0.5 R3804 0.25 0.25 0.5 1 0.5 1 R4039 0.5 0.5 1 1 1 1 Thus, the present examples establish that ceftaroline and prodrugs thereof (e.g., ceftaroline fosamil) are surprisingly and unexpectedly synergistic in combination with antibacterial agents and are not antagonized or antagonistic when used in combination with antibacterial agents. The present invention is not to be limited in scope by the specific embodiments described herein. Indeed, various modifications of the invention in addition to those described herein will become apparent to those skilled in the art from the foregoing description and the accompanying figures. Such modifications are intended to fall within the scope of the appended claims. It is further to be understood that all values are approximate, and are provided for description. 47 All patents, patent applications, publications, product descriptions, and protocols are cited throughout this application, the disclosures of which are incorporated herein by reference in their entireties for all purposes. The reference in this specification to any prior publication (or information derived from it), or to any matter which is known, is not, and should not be taken as an acknowledgment or admission or any forn of suggestion that that prior publication (or information derived from it) or known matter forms part of the common general knowledge in the field of endeavour to which this specification relates. Throughout this specification and the claims which follow, unless the context requires otherwise, the word "comprise", and variations such as "comprises" and "comprising", will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps. 48

Claims (7)

1. A pharmaceutical composition comprising a therapeutically effective amount of ceftaroline fosamil or a pharmaceutically acceptable salt or solvate thereof, and an antibacterial agent, or a pharmaceutically acceptable salt thereof, selected from the group consisting of meropenem, piperacillin+tazobactam, amikacin, and aztreonam.
2. The composition according to claim 1, wherein the composition comprises ceftaroline fosamil monoacetate monohydrate.
3. The composition according to claim 1, wherein the ceftaroline fosamil is anhydrous.
4. The composition according to any one of claims 1 to 3, wherein the monobactam is aztreonam or a pharmaceutically acceptable salt thereof.
5. The composition according to any one of claims 1 to 3, wherein the antibacterial agent is meropenem or a pharmaceutically acceptable salt thereof.
6. The composition according to any one of claims 1 to 3, wherein the antibacterial agent is amikacin or a pharmaceutically acceptable salt thereof.
7. The composition according to any one of claims 1 to 3, wherein the antibacterial agent is piperacillin or a pharmaceutically acceptable salt thereof. 49
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Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20070249577A1 (en) * 2005-05-10 2007-10-25 Hopkins Scott J Method for reducing the risk of or preventing infection due to surgical or invasive medical procedures
WO2008056151A1 (en) * 2006-11-08 2008-05-15 Helperby Therapeutics Limited Topical formulations

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20070249577A1 (en) * 2005-05-10 2007-10-25 Hopkins Scott J Method for reducing the risk of or preventing infection due to surgical or invasive medical procedures
WO2008056151A1 (en) * 2006-11-08 2008-05-15 Helperby Therapeutics Limited Topical formulations

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
SCHAADT R. et al.: "The In Vitro Activity of Ceftaroline in Combination with Other Antibacterial Agents" Abstracts of the ICAAC, 2007, vol. 47, pp. 190, E-279 *

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