cefdinir and Gram-Negative-Bacterial-Infections

Cefdinir (Omnicef) is an oral third-generation cephalosporin with good in vitro activity against many pathogens commonly causative in community-acquired infections. The drug provides good coverage against Haemophilus influenzae, Moraxella catarrhalis and penicillin-susceptible Streptococcus pneumoniae, the most common respiratory tract pathogens. Cefdinir is stable to hydrolysis by commonly occurring plasmid-mediated beta-lactamases and retains good activity against beta-lactamase-producing strains of H. influenzae and M. catarrhalis. The drug distributes into various tissues (e.g. sinus and tonsil) and fluids (e.g. middle ear), and has a pharmacokinetic profile that allows for once- or twice-daily administration.Cefdinir, administered for 5 or 10 days, has shown good clinical and bacteriological efficacy in the treatment of a wide range of mild-to-moderate infections of the respiratory tract and skin in adults, adolescents and paediatric patients in randomised, controlled trials. In adults and adolescents, cefdinir is an effective treatment for both lower (acute bacterial exacerbations of chronic bronchitis [ABECB], community-acquired pneumonia) and upper (acute bacterial rhinosinusitis, streptococcal pharyngitis) respiratory tract infections, and uncomplicated skin infections. Its bacteriological and clinical efficacy in patients with lower respiratory tract infections was equivalent to that of comparator agents (cefprozil [bacteriological only], loracarbef, cefuroxime axetil and cefaclor). In one trial in patients with ABECB, cefdinir produced a higher rate of clinical cure than cefprozil (95% CIs indicated nonequivalence). Cefdinir also produced good clinical and bacteriological responses equivalent to responses with amoxicillin/clavulanic acid in patients with acute bacterial rhinosinusitis. In addition, it was at least as effective as penicillin V (phenoxymethylpenicillin) in streptococcal pharyngitis/tonsillitis and as effective as cefalexin in uncomplicated skin infections. In paediatric patients aged > or =6 months, cefdinir showed similar efficacy to that of amoxicillin/clavulanic acid or cefprozil in acute otitis media, and cefalexin in uncomplicated skin infections. Cefdinir given for 5 or 10 days was at least as effective as penicillin V for 10 days in patients with streptococcal pharyngitis/tonsillitis. Cefdinir is usually well tolerated. Diarrhoea was the most common adverse event in trials in all age groups. Although the incidence of diarr

Topics: Anti-Bacterial Agents; Cefdinir; Cephalosporins; Child; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Randomized Controlled Trials as Topic; Treatment Outcome

In clinical settings, bacterial infections are usually diagnosed by isolation of colonies after laboratory cultivation followed by species identification with biochemical tests. However, biochemical tests result in misidentification due to similar phenotypes of closely related species. In such cases, 16S rDNA sequence analysis is useful. Herein, we report the first case of an Achromobacter-associated buckle infection that was diagnosed by 16S rDNA sequence analysis. This report highlights the significance of Achromobacter spp. in device-related ophthalmic infections.. A 56-year-old woman, who had received buckling surgery using a silicone solid tire for retinal detachment eighteen years prior to this study, presented purulent eye discharge and conjunctival hyperemia in her right eye. Buckle infection was suspected and the buckle material was removed. Isolates from cultures of preoperative discharge and from deposits on the operatively removed buckle material were initially identified as Alcaligenes and Corynebacterium species. However, sequence analysis of a 16S rDNA clone library using the DNA extracted from the deposits on the buckle material demonstrated that all of the 16S rDNA sequences most closely matched those of Achromobacter spp. We concluded that the initial misdiagnosis of this case as an Alcaligenes buckle infection was due to the unreliability of the biochemical test in discriminating Achromobacter and Alcaligenes species due to their close taxonomic positions and similar phenotypes. Corynebacterium species were found to be contaminants from the ocular surface.. Achromobacter spp. should be recognized as causative agents for device-related ophthalmic infections. Molecular species identification by 16S rDNA sequence analysis should be combined with conventional cultivation techniques to investigate the significance of Achromobacter spp. in ophthalmic infections.

Topics: Achromobacter; Anti-Bacterial Agents; Betamethasone; Cefdinir; Cephalosporins; Device Removal; DNA, Bacterial; DNA, Ribosomal; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Fluoroquinolones; Glucocorticoids; Gram-Negative Bacterial Infections; Humans; Middle Aged; Moxifloxacin; Polymerase Chain Reaction; Prosthesis-Related Infections; Retinal Detachment; RNA, Ribosomal, 16S; Scleral Buckling

Cost savings are possible if oral cephems of equivalent efficacy can be substituted for parenteral cephems. An in vitro study was performed to compare the activity of cefdinir, cefoxitin, cefazolin, ceftriaxone, ceftazidime, and cefepime against 243 clinical isolates of human pathogens. Activities were determined by National Committee for Clinical Laboratory Standards microbroth dilution methodology using an inoculum of approximately 5 x 10(5) CFU/mL. Cefdinir was the single or equally most potent agent against Streptococcus pyogenes, penicillin-susceptible Streptococcus pneumoniae, methicillin-susceptible Staphylococcus aureus, and Klebsiella pneumoniae isolates that produced a variety of beta-lactamase types. Cefdinir was less potent than ceftriaxone, ceftazidime, and cefepime against Haemophilus influenzae, but was 2- to 8-fold more potent than cefoxitin and 8- to 32-fold more potent than cefazolin. Cefdinir was slightly less potent than ceftazidime, against beta-lactamase-positive Moraxella catarrhalis. These data support clinical consideration of cefdinir as an alternative to parenteral cephems in infections where adequate tissue levels can be safely assured.

Topics: Administration, Oral; Anti-Bacterial Agents; Cefdinir; Cephalosporins; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Microbial Sensitivity Tests