7432-s and Respiratory-Tract-Infections

Topics: Ceftibuten; Cephalosporins; Enteritis; Humans; Pharmacokinetics; Respiratory Tract Infections; Urinary Tract Infections

Topics: Administration, Oral; Adult; Ceftibuten; Cephalosporins; Child, Preschool; Enterobacteriaceae Infections; Gram-Positive Bacterial Infections; Humans; Infant; Microbial Sensitivity Tests; Respiratory Tract Infections; Urinary Tract Infections

Respiratory infections in children may occur as a consequence of resistant bacterial pathogens. Streptococcus pneumoniae organisms resistant to penicillin, trimethoprim/sulfamethoxazole and macrolides are increasingly prevalent. Amoxicillin- and macrolide-resistant Haemophilus influenzae and Moraxella (Branhamella) catarrhalis are also more commonly seen. Traditional agents such as amoxicillin and trimethoprim/sulfamethoxazole remain acceptable choices for most children with respiratory infections because currently most patients are not infected by resistant pathogens and there is a high spontaneous cure rate associated with these infections.. To analyze the criteria for the selection of extended spectrum antimicrobials as empiric therapy for respiratory infections.. When an extended spectrum antimicrobial is appropriate for empiric therapy, selection should be based on: (1) efficacy; (2) adverse event profile; and (3) compliance-enhancing features (dosing with meals, once or twice daily administration, good palatability in suspension, shortened course of therapy and affordability). A new agent, ceftibuten, has recently joined other extended spectrum cephalosporins and newer macrolides (clarithromycin and azithromycin) as a choice to be considered for empiric therapy for respiratory infections. These antimicrobials are differentiated from each other and traditional agents by differences in activity in vitro against penicillin-resistant pneumococci, relative beta-lactamase stability against Gram-negative bacteria and pharmacodynamic properties. When resistant organisms are isolated or suspected in community-acquired respiratory infections, cautious use of newer antibiotics may have to be considered.

Topics: Anti-Bacterial Agents; Bacterial Infections; beta-Lactamases; Ceftibuten; Cephalosporins; Child; Child, Preschool; Drug Resistance, Microbial; Drug Therapy; Empiricism; Humans; Patient Compliance; Penicillin Resistance; Respiratory Tract Infections; Taste

Ceftibuten, a new orally absorbed cephalosporin with a novel side chain, has broad in vitro activity against most of the important respiratory pathogens including Streptococcus pneumoniae and both beta-lactamase-negative and beta-lactamase-positive Haemophilus influenzae and Moraxella (Branhamella) catarrhalis. Furthermore it has high activity against Enterobacteriaceae, which contain classic TEM-1 beta-lactamases and those containing the new extended spectrum beta-lactamases, which hydrolyze parenteral third generation cephalosporins. Studies have shown that ceftibuten has a postantibiotic effect comparable to that of other beta-lactams against S. pneumoniae, H. influenzae and M. catarrhalis. Blood levels achieved after a single 400-mg dose given once daily or 9 mg/kg/day taken once daily for children yield blood levels and postantibiotic inhibition for the majority of a dosing period. The in vitro and pharmacokinetic data can be correlated to provide reasonable dosing programs for the new oral cephalosporins.

Topics: Bacteria; Bacterial Infections; beta-Lactamases; Ceftibuten; Cephalosporins; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Microbial Sensitivity Tests; Respiratory Tract Infections

Ceftibuten is an extended-spectrum, cephem antimicrobial agent formulated for oral administration. Ceftibuten is absorbed by carrier-mediated processes and passive diffusion. The absorption of ceftibuten is described adequately by a first-order process. Following oral administration, peak serum ceftibuten concentrations are reached within 2 to 3 hours. Although the absolute bioavailability of ceftibuten in humans is not known, its relative bioavailability indicates that there is relatively rapid and complete absorption of the drug. Administration of ceftibuten with food may decrease the rate of absorption and, in the case of high fat meals, may decrease the extent of absorption by approximately 20 to 30%. The results of limited studies indicate that the drug distributes well into various body tissues and fluids, with relatively high concentrations being achieved in organs that receive a significant portion of the cardiac output. In adults with normal renal function or chronic renal failure, the apparent volume of distribution (Vd/F) for ceftibuten ranges from 0.2 to 0.4 L/kg and the total plasma clearance (CL/F) ranges from approximately 61 to 75 ml/min (3.7 to 4.5 L/h). Studies of ceftibuten elimination in adults have demonstrated positive linear correlation between CL/F and creatinine clearance. Following administration of a single dose of ceftibuten, approximately 67 to 94% of the drug has been recovered in the urine unchanged. The elimination half-life (t1/2 beta) of ceftibuten in adults with normal renal function is approximately 2.5 hours. Significant accumulation of ceftibuten does not occur with repeated administration. Despite the fact that the mean time taken to achieve maximal serum concentration (tmax) [1.1 to 2 hours] and t1/2 beta (2.1 hours) following administration of a single dose of ceftibuten to infants and children were similar to values previously reported in adults, the Vd/F (0.42 L/kg) and CL/F (3.1 ml/h/kg) were considerably greater in children younger than 5 years. Additionally, the apparent nonrenal clearance of ceftibuten in paediatric patients (52% of CL/F) was greater than reported for adults (approximately 32% of CL/F) with normal renal function. Thus, developmental differences appear to affect the pharmacokinetic profile of ceftibuten. Ceftibuten has a wide spectrum of antimicrobial activity against both Gram-positive and Gram-negative pathogens, and is stable to hydrolysis by a large number of beta-lactamases. Notable excep

Topics: Adolescent; Adult; Aging; Animals; Bacteria; Biological Availability; Ceftibuten; Cephalosporins; Child; Child, Preschool; Drug Interactions; Humans; Infant; Intestinal Absorption; Microbial Sensitivity Tests; Otitis Media; Pediatrics; Respiratory Tract Infections; Tissue Distribution

Topics: Adult; Aged; Animals; Bacterial Infections; Ceftibuten; Cephalosporins; Female; Humans; Male; Mice; Mice, Inbred Strains; Microbial Sensitivity Tests; Respiratory Tract Infections; Urinary Tract Infections

The study was conducted to evaluate patient compliance to antibiotic therapy in respiratory tract infections. The main aim of the study was to establish whether dosing frequency (1 vs 2 or 3 times daily) and other factors influence compliance. Patients aged 18 and over attending selected primary health facilities in Lódź region were enrolled. Patients were randomly assigned to receive ceftibuten, 400 mg once daily or other antibiotic on physician's choice with 2 or 3 times daily dosing. On the 5th day during the home visit the questionnaire study was performed and the compliance was measured by a pill count. Four hundred and six patients (205 in ceftibuten and 201 in other antibiotics group, respectively) were fully evaluable. Overall compliance was 76.6% with 97.6% for ceftibuten, 66.0% for antibiotics with b.i.d. dosing and 23.5% for antibiotics with t.i.d. dosing. Using a logistic regression analysis with a stepwise variable selection, dosing frequency was found to be a major variable associated with patient compliance (p = 0.00000, odds ratio 0.09, 95% confidence interval 0.057-0.165). Non-compliance with antibiotics is a common phenomenon in respiratory tract infections therapy. Once-daily antibiotic dosing leads to the best possible compliance in such circumstances. Due to its once-daily dosing and rare side effects, ceftibuten ensures nearly perfect compliance in respiratory tract infections therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftibuten; Cephalosporins; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Patient Compliance; Respiratory Tract Infections

A prospective, comparative, multicentre trial was performed to study the efficacy and safety of ceftibuten in respiratory and complicated urinary tract infections. Patients (n = 152) requiring parenteral 2nd or 3rd generation cephalosporine therapy were randomly assigned to continue parenteral therapy (Group A) or to receive oral ceftibuten 400 mg, or 9 mg/kgbw/day (Group B) from the 3.-5. days on. The patients, whose conditions have not improved significantly at day 3-5, were omitted from the study, so the number of evaluated patients was 131. In Group A, out of 59 patients 51 were clinically cured, the bacteriological eradication rate was 47/54. In Group B, out of 72 patients 67 were cured and 62 out of 66 pathogens were eradicated. The cost of step-down therapy was 44.3% less than the parenteral one. No adverse effect was observed that could surely be attributed to ceftibuten. According to these data, ceftibuten can be used in step-down therapy in respiratory and urinary tract infections requiring parenteral therapy at first and that offers a safe and less expensive therapeutic approach.

Topics: Ceftibuten; Cephalosporins; Humans; Respiratory Tract Infections; Urinary Tract Infections

A group of 66 patients with acute inflammatory upper respiratory tract diseases were examined in the ENT Department of Poznań Medical Academy between November 1996 and November 1997. Specimens for bacteriological cultures were collected from the ear, nose and throat. The subjects were treated with ceftibuten. Clinical improvement was reported in all cases. In 44 patients, ceftibuten treatment eliminated pathogenic bacteria (as evidenced by microbiological analysis).

Topics: Acute Disease; Adolescent; Adult; Aged; Ceftibuten; Cephalosporins; Child; Child, Preschool; Humans; Middle Aged; Respiratory Tract Infections; Retrospective Studies

Some new features of the in vitro activity of ceftibuten, an oral third generation cephalosporin, have been studied in reference to respiratory and urinary tract pathogens included in its antibacterial spectrum. At 0.25XMIC (minimum inhibitory concentration) and 0.5XMIC levels, ceftibuten was able to affect the biofilm production in 2/3 of both Escherichia coli and Proteus mirabilis strains, and reduced the number of strains capable of adhering to epithelial cells by about 35% in comparison to the control. Surface hydrophobicity was also influenced by ceftibuten and the other drugs at 0.25-0.5XMIC. In general, no marked variation in the virulence traits of the pathogens studied were found by exposing bacteria to sub-MICs of ceftibuten. Plasmid loss (from 1.8 to 37.2%), and Flac transfer inhibition (about 30-50% reduction in the number of recombinants) were detected under the experimental conditions used. This study confirms the excellent antibacterial properties of ceftibuten by adding new information about the effects of this antibiotic against pathogens often involved in respiratory and urinary tract infections that may be treated with this compound, supporting the appropriate use of this cephalosporin.

Topics: Anti-Bacterial Agents; Biofilms; Ceftibuten; Cell Physiological Phenomena; Cells, Cultured; Cephalosporins; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Respiratory Tract Infections; Urinary Tract Infections

In a multicentric study at several leading hospitals of this country, microbiological assessment was carried out in 500 specimens from patients suffering from respiratory tract infections (RTIs; both upper and lower) for a period of 6 months from January, 1999 to June, 1999. The antibiotic sensitivity study was done in 201 isolates from 500 different specimens of throat swab, postpharyngeal swab, sinusitis drainage fluid, sputum, broncho-alveolar lavage (BL), etc. Ceftibuten, an orally active third generation cephalosporin showed encouraging results when compared with seven other selected antibiotics used for RTI. The majority of the patients with acute or chronic RTIs showed an excellent in vitro response to ceftibuten in the analysis of the isolates. Seventy to ninety per cent of the isolated respiratory pathogens were found to be sensitive to ceftibuten in vitro; which offers a promising alternative to other antibiotics included in this study.

Topics: Administration, Oral; Bacteria; Bacterial Infections; Ceftibuten; Cephalosporins; Humans; India; Microbial Sensitivity Tests; Respiratory Tract Infections

Ceftibuten is an orally active third generation new cephalosporin. Its antibacterial activity in vitro was tested to many clinical isolates and was compared to the activity of ceftazidime, cefuroxime and ampicillin, by twofold serial dilution method in Müller-Hinton agar--detection of minimum inhibitory concentrations (MIC) and by the disc-diffusion method of Kirby-Bauer. The new cephalosporin demonstrated great activity against the different clinical important strains. Many resistant strains to ampicillin were high susceptible to ceftibuten. The majority of Gram-negative organisms, including Enterobacteriaceae, the respiratory pathogens M.(B.) catarrhalis and H. influenzae are highly susceptible to Ceftibuten, however Pseudomonas, Acinetobacter are resistant. The majority of methicillin-susceptible strains of Staphylococcus are resistant too. New cephallosporin was also active against S. pyogenes (Streptococcus gr. A) and penicillin-susceptible pneumococci, but was inactive against S. agalactiae (Streptococcus gr. B), S. pneumoniae penicillin-resistant strains and enterococci, similar to the other cephalosporins. The activity of ceftibuten was higher than that of ampicillin and cefuroxime against beta-lactamases positive strains of H. influenzae and M.(B) catarrhalis, also against tested strains of Enterobacteriaceae. The major priority of the new antibacterial agent over other cephalosporins and ampicillin is its stability to hydrolysis by the main broad-spectrum beta-lactamases producing E. coli and K. pneumoniae sp.

Topics: Ampicillin; beta-Lactamases; Ceftazidime; Ceftibuten; Cefuroxime; Cephalosporins; Drug Resistance, Microbial; Gram-Negative Aerobic Bacteria; Gram-Positive Bacteria; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Penicillins; Respiratory Tract Infections; Sensitivity and Specificity

The postantibiotic effect (PAE) of ceftibuten, a novel beta-lactamase-stable cephem, was determined for Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. The ceftibuten PAE after a 2-hour exposure to 2 micrograms/ml (4 x minimum inhibitory concentration) for S. pyogenes was 2.7 to > 10 hours. The PAE for S. pneumoniae after a 2-hour exposure to 15 micrograms/ml, concentrations that are achieved in man after usual therapeutic doses, was 1.1 to 3.4 hours and the PAE for H. influenzae was 1 to 1.1 hours. M. catarrhalis had a PAE of 1.5 to 1.8 hours after exposure to 15 micrograms/ml of ceftibuten. The ceftibuten PAE was not affected by serum. The ceftibuten PAE was prolonged by exposure to a sub-minimum inhibitory concentration concentration of ceftibuten as would occur in the clinical situation. The PAE of ceftibuten was not affected by the copresence of erythromycin as would occur when treating infections in which atypical organisms are suspected. There was no correlation between bacterial reduction in colony-forming units and the duration of PAE. A level of 6 micrograms/ml of ceftibuten had a similar bacterial killing activity compared with a 6-hour exposure to 15 micrograms/ml of ceftibuten against S. pneumoniae, H. influenzae and M. catarrhalis. This study suggests that ceftibuten can be administered orally, once daily in an adult dose of 400 mg or a pediatric dose of 9 mg/kg, to treat respiratory infections caused by the most common pathogens.

Topics: Bacterial Infections; Ceftibuten; Cephalosporins; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Moraxella catarrhalis; Respiratory Tract Infections; Streptococcus pneumoniae; Streptococcus pyogenes

A survey aimed at assessing the ability of ceftibuten, a new oral third-generation cephalosporin, to eradicate in vitro selected bacterial pathogens was conducted in 1991 in 17 microbiology laboratories evenly distributed in Italy. Over 8700 organisms collected from in- and outpatients affected mainly by respiratory and urinary tract infections were analyzed. This collection of bacteria did not include staphylococci, enterococci, Pseudomonas and other oxidative species naturally refractory to the action of most antibiotics employed. Susceptibility to ceftibuten, cefaclor, cefuroxime, amoxicillin, amoxicillin-clavulanate, cotrimoxazole and erythromycin was assessed using a standardized agar-diffusion method. Production of beta-lactamases was confirmed by the nitrocefin test. Among the microorganisms studied E. coli (32.1%) prevailed, followed by P. mirabilis (17.1%), K. pneumoniae (10.9%), S. pyogenes (6.6%), E. cloacae (5.1%), Serratia spp. (4.5%), Enterobacter spp. (4.2%), H. influenzae (3.6%), S. pneumoniae (2.2%) and M. catarrhalis (2%). Within this group of pathogens amoxicillin resistance, often mediated by synthesis of beta-lactamases, was widely diffused (46.2%). The overall inhibitory activity of the drugs tested decreased as follows: ceftibuten (90.4%), cefuroxime (80.4%), amoxicillin-clavulanate (77.4%), cotrimoxazole (75.3%), cefaclor (72.6%), amoxicillin (53.8%) and erythromycin (32.8%). When the efficacy of the antibiotics was assessed against the collection of respiratory isolates producing beta-lactamases only ceftibuten maintained the same overall potency manifested against the general population while the comparative agents were far less effective. The results of this national survey indicate that, given the low incidence of resistance among the most prevalent causative agents of respiratory and urinary tract infections, ceftibuten can be safely used at present in the empiric therapy of these conditions especially when they occur in community settings.

Topics: Ceftibuten; Cephalosporins; Drug Resistance, Microbial; Escherichia coli; Humans; Italy; Microbial Sensitivity Tests; Respiratory Tract Infections; Streptococcus; Urinary Tract Infections

We evaluated the therapeutic efficacy of ceftibuten (CETB, 7432-S), a new cephem antibiotic for oral use, in chronic respiratory tract infections. A daily dose of 400 mg (b.i.d.: 15 cases) or 600 mg (t.i.d.: 5 cases) of CETB was given orally for 3-14 days (mean: 10.6 days) to 20 patients: 9 with infected bronchiectasis, 3 with infection supervened on pulmonary emphysema, 3 with acute pneumonia (supervened on bronchiectasis in 2 of 3 cases), 2 with infected bronchial asthma, 1 each with infection supervened on old pulmonary tuberculosis, chronic bronchitis and pulmonary fibrosis. The clinical effects were excellent in 3, good in 11, fair in 3 and poor in 3. Eighteen strains were identified as causative organisms. Eight of 15 strains for which bacteriological responses were evaluable were eradicated by the use of CETB. Eosinophilia in 2 patients and an elevation of S-GPT value was observed in 1 patient. These adverse reactions disappeared after the completion of the therapy. From the above results, we conclude that CETB is one of the most useful antibiotics for oral use as a first choice in chronic respiratory tract infections.

Topics: Adult; Aged; Aged, 80 and over; Bacteria; Capsules; Ceftibuten; Cephalosporins; Chronic Disease; Drug Evaluation; Eosinophilia; Female; Humans; Male; Middle Aged; Respiratory Tract Infections

FCE 22101 is a new penem with broad antibacterial spectrum, excluding the pseudomonads, and has stability to many beta-lactamases. FCE 22101 and imipenem were very potent against the bacteria studied, including beta-lactamase producing strains, which can be isolated from patients with respiratory tract infections (MIC less than or equal to 8 mg/l). No strains were found to be resistant to FCE 22101. FCE 22101 was rapidly bactericidal and more stable to inactivation by beta-lactamases from Branhamella catarrhalis, Haemophilus influenzae, Enterobacter cloacae and Klebsiella pneumoniae than imipenem and ceftibuten. The other antibiotics tested varied in their activities against the respiratory tract pathogens.

Topics: Anti-Bacterial Agents; Bacteria; beta-Lactamases; Carbapenems; Ceftibuten; Cephalosporins; Imipenem; Microbial Sensitivity Tests; Respiratory Tract Infections

Topics: Anti-Bacterial Agents; Ceftibuten; Cephalosporins; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Moraxella catarrhalis; Respiratory Tract Infections; Streptococcus pneumoniae; Streptococcus pyogenes