cefmenoxime and Pneumonia

Topics: Adult; Aged; Aged, 80 and over; Ampicillin; Bacterial Infections; Cefmenoxime; Cephalosporins; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Pneumonia

Nephrotoxicity frequently complicates the use of aminoglycosides in severely compromised acute care patients. Therefore, an open clinical trial was initiated to determine if cefmenoxime alone is useful in serious nosocomial pneumonias. Thirty consecutive patients were entered in the trial, and 28 patients with an average age of 66 years were evaluable. Most were malnourished at entry, with serum albumin averaging 2.8 g/dl and prognostic nutritional index values over 70 percent (normal less than 40 percent). One-half the patients had severe chronic obstructive pulmonary disease and 68 percent required ventilators. Fifty-seven percent had concomitant cardiac disease, and 79 percent had previously been treated with antibiotics. Pneumonia was proven to be present by new infiltrate on chest x-ray, new fever, elevated white blood cell count, and gram-negative rods on gram stain and in cultures of tracheal aspirates or sputum. Patients were given cefmenoxime 1 to 2 g every six hours an average of 12 days. Cefmenoxime peak (one hour) and trough concentrations were measured by high pressure liquid chromatography and averaged 58 and 7 micrograms ml, respectively. Pharmacokinetic data in 18 patients were determined from serum profiles. Gram-positive organisms, Escherichia coli, Klebsiella, and Hemophilus influenzae were usually eradicated. Persistence was noted for some Enterobacter, Pseudomonas, Serratia, and Acinetobacter. Persistence in patients with good clinical response was considered colonization rather than superinfection. Overall, a satisfactory clinical response rate was noted in 78.6 percent of evaluable patients, whereas four patients responded satisfactorily with recurrence and two treatments had an unsatisfactory response. No serious adverse effects were observed. Cefmenoxime is a promising agent in the treatment of susceptible pneumonias in critical care patients.

Topics: Aged; Bacteria; Blood Proteins; Cefmenoxime; Cefotaxime; Chromatography, High Pressure Liquid; Clinical Trials as Topic; Critical Care; Cross Infection; Female; Humans; Kinetics; Lung; Male; Middle Aged; Pneumonia; Protein Binding; Radiography; Recurrence

The effect of protein binding on cefmenoxime steady-state kinetics was studied in 20 critical patients with gram-negative pneumonia. Sixteen patients were given 1 gm cefmenoxime every 6 hr, two received 2 gm every 6 hr, and two received 2 gm every 8 hr. Serum protein binding was measured by equilibrium dialysis. Assays were by HPLC. Serum cefmenoxime concentration-time data were characterized by a model-independent method based on statistical moment theory. Despite varying renal function in patients, mean cefmenoxime serum concentration-time curves for all three dosing regimens were closely aligned, reflecting successful empiric dosage adjustment. Terminal phase t 1/2 ranged from 0.8 to 2.9 hr and was significantly related to creatinine clearance. Cefmenoxime total clearance was significantly related to both lambda z (2.303 times the slope of the terminal portion of the log-concentration-time curve) and creatinine clearance (CCr). Plasma clearance of free cefmenoxime was more strongly correlated with CCr than the clearance of total cefmenoxime. Drug recovery from 24-hr urine collections at steady state was 76.9 +/- 19.8% of the daily dose (mean +/- SD, n = 13). Cefmenoxime protein binding in patients differed markedly from normal values. A regression equation derived from data on 11 cephalosporins appeared to predict total volume of distribution in the steady state (Vdss-Total) from the fraction of unbound drug accurately. Since cefmenoxime has a high therapeutic index, no clinical consequences are expected to result from variation in protein binding. Observed differences in protein binding between patients and normal subjects could have clinical consequences for highly bound acidic drugs that, unlike cefmenoxime, have narrow therapeutic indices.

Topics: Aged; Blood Proteins; Cefmenoxime; Cefotaxime; Clinical Trials as Topic; Creatinine; Female; Humans; Kinetics; Male; Middle Aged; Pneumonia; Protein Binding

To determine if dual individualization of cefmenoxime dosing is cost-effective.. Retrospective, pharmacoeconomic decision analysis of two consecutively conducted prospective clinical studies.. Patients with documented gram-negative nosocomial pneumonia were evaluated. Thirty-three patients received cefmenoxime at standard dosing and 28 patients received doses according to dual individualization methodology.. Antibiotic and infection-related costs were compared between groups. The number of hospital antibiotic days and costs incurred on those days were also evaluated. A decision model was constructed to characterize differences in treatment outcome. Probabilities within the decision tree were derived from 61 evaluable patients. Cost-effectiveness and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed by varying outcome probabilities, antibiotic prices, and hospital room costs.. Antibiotic and infection-related costs (mean +/- SEM) were $848 +/- 78 for standard cefmenoxime dosing and $1123 +/- 128 for dual individualization (p < 0.05). Total hospital costs were $10,660 +/- 1432 for standard dosing and $11,709 +/- 1900 for dual individualization (p > 0.05). Median antibiotic length of stay (ALOS) was 15.2 and 12.7 days for standard and dual individualization methodologies, respectively (p > 0.05). Incremental analysis of cost-effectiveness indicated that a similar reduction in length of stay for 259 dual individualization patients would save $321,808 annually.. Sensitivity analysis indicates that, by reducing ALOS, dual individualization could be a cost-effective method of beta-lactam dosing for patients with pneumonia. A prospective study should be conducted to validate these findings.

Topics: Cefmenoxime; Cost-Benefit Analysis; Cross Infection; Decision Trees; Drug Administration Schedule; Drug Costs; Gram-Negative Bacterial Infections; Hospital Costs; Humans; Length of Stay; Pilot Projects; Pneumonia; Time Factors; United States

Topics: Acetylmuramyl-Alanyl-Isoglutamine; Adjuvants, Immunologic; Amphotericin B; Animals; Aspergillosis; Aspergillus fumigatus; Cefmenoxime; Disease Models, Animal; Immunocompromised Host; Klebsiella Infections; Klebsiella pneumoniae; Lung Diseases, Fungal; Male; Mice; Pneumonia; Rats

In order to quantitatively express the important, time-related aspects of response to antimicrobial therapy in patients with pneumonia, we required validated measures of the time course of events during the infection. To quantitate the changes in clinical status in relation to changes in cultures, we developed a scoring system to be used for patient assessment during therapy.. Retrospective data collection, prospective analysis of factors.. Intensive care unit, Millard Fillmore Hospital.. Twenty-eight patients with nosocomial pneumonia.. Clinical parameters were assessed daily for the duration of antimicrobial therapy. Using linear regression, the rate of clinical change in each patient treated was quantified. Eradication of the pathogen was determined by serial cultures of the infection site.. Seventeen of the patients demonstrated eradication of the organism, and 11 demonstrated persistence of the pathogen (7 were considered colonization). The system described the patients at baseline in that the mean baseline scores were similar in both groups of patients (p = 0.79). Patients in whom the pathogen was eradicated showed a rate of clinical improvement significantly different from those who had persistence of the organism (p = 0.04). In patients demonstrating eradication, the time to eradication inversely correlated with the rate of clinical improvement (p < 0.05). Of the ten parameters descriptive of the disease, those most sensitive to change after eradication of bacteria were body temperature, bacterial Gram stain, white blood cell Gram stain, and volume of sputum.. In this set of pneumonia patients, the scoring system effectively quantified both baseline and time-related changes in clinical status. The system distinguished between the clinical course of the patient with organism eradication versus organism persistence. A shorter time to eradication was associated with a better clinical response. Prospective study of the system will determine its sensitivity.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefmenoxime; Female; Gram-Negative Bacterial Infections; Humans; Male; Mathematics; Middle Aged; Pneumonia; Retrospective Studies

Two beta-lactam antibiotics, cefazolin and cefmenoxime, were administered for 7 days to mice with pneumonia caused by Klebsiella pneumoniae by using dosage regimens that would simulate multiple dosing in usual clinical treatments at dosing intervals of 8 or 12 h. Viable numbers of the bacteria in the lungs were measured at 12- or 24-h intervals. The mathematical model established in a previous single-dose study was applied in this study to explain the time courses of the changes in bacterial count over 7 days. However, because the error in viable count measurements was larger than that in the previous study, the time course of the changes in mean viable count was not regular and the viable count reduction rate changed during multiple dosing, and therefore it was difficult to explain the time course by repeated application of the mathematical model described previously. This study suggests that the changes in pharmacokinetic and pharmacodynamic parameters during multiple dosing need to be considered.

Topics: Animals; Biological Assay; Cefazolin; Cefmenoxime; Colony Count, Microbial; Drug Evaluation, Preclinical; Klebsiella Infections; Klebsiella pneumoniae; Lung; Male; Mice; Mice, Inbred Strains; Models, Biological; Models, Statistical; Pneumonia

In vitro, antibiotics are known to kill bacteria in predictable relationships to their broth concentrations. It was our hypothesis that serum concentration was an important determinant of the rate of bacterial eradication in patients. This contention was reinforced by animal studies, which have clearly demonstrated concentration-related antibacterial activity. The animal models rely on reduction of bacterial colony counts as an endpoint of effect, and demonstrate that colony count reductions are related to antibiotic dose and probably to serum concentration. We adapted these methods for use in intubated patients with Gram-negative pneumonia. Briefly, each patient had extensive staging of the pneumonic process, and the Gram-negative organism was isolated and its minimal inhibitory concentration (MIC) was determined. In each patient measurement of the antibiotic serum concentrations in the interval between two doses of the drug was also performed. The pharmacokinetic profile of the drug was then superimposed on the bacterial MIC, and we then derived the patients individual peak to MIC ratio, area above MIC, and time above MIC. Each of these pharmacokinetic parameters was then related to the time required to eradicate the bacterial pathogens in the patient. For beta-lactams and quinolones, time above MIC was the most predictive of bacterial eradication times. Clearly, these methods can be used to develop dosing strategies for patients, as well as to determine clinically relevant doses and dosing strategies in clinical trials. Further work is needed, however, to assess whether these concepts hold for other types of bacteria (such as Gram-positive) or apply as accurately to other infection sites in addition to pneumonia.

Topics: Aged; Aged, 80 and over; Bacterial Infections; Cefmenoxime; Ciprofloxacin; Cross Infection; Female; Gram-Negative Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Prospective Studies; Reproducibility of Results

Two beta-lactam antibiotics, cefazolin and cefmenoxime, were administered in an experimental model of murine pneumonia caused by Klebsiella pneumoniae in a way which enabled us to approximate the serum antibiotic concentration time course in humans. Bacterial counts during the experiments were subjected to nonlinear least-squares analyses by using a mathematical model that explained the bacterial killing by the antibiotic concentration time course and other factors associated with antimicrobial potency and bacterial growth. Cefazolin gave a killing curve that changed synchronously with the drug levels in serum; in contrast, cefmenoxime gave a curve that was prolonged as compared with the change in the drug levels in serum. Multiple correlation coefficients were about 0.9, and the model worked well for bacterial count data. Parameters relating to antimicrobial potency of the drugs, bacterial growth rate, and drug distribution into the tissue were estimated numerically.

Topics: Animals; Cefazolin; Cefmenoxime; Cephalosporins; Klebsiella Infections; Klebsiella pneumoniae; Male; Mice; Mice, Inbred Strains; Models, Biological; Pneumonia

Serum concentrations and urinary recovery rates of cefmenoxime (CMX) were determined in 41 mature and premature infants (with ages 0-24 days) after one shot intravenous injection of 10, 20 (1-hour intravenous drip infusion was also carried out) or 30 mg/kg for treatment and prophylaxis of various infections. Because the number of cases included was small, a comparison study was conducted by classifying them into 3 groups; 3 days or younger, 4 to 7 days, and 8 days or older, rather than dividing them into groups of mature and premature infants. Clinical evaluation was conducted in 7 male and 1 female cases 1 to 29 days old, whose diseases comprised 1 case each with septicemia, purulent otitis media and phlegmonous cellulitis, 3 with pneumonia and 2 with urinary tract infection. 1. Changes in serum concentrations and urinary recovery rates (1) Intravenous bolus injection of 10 mg/kg: Serum concentrations of the drug in the 3 age groups peaked at 28.9, 29.5 and 29.1 micrograms/ml, respectively, all at 30 minutes after the drug administration, and thereafter gradually declined. The mean level in the 3rd group was the lowest at 1.9 micrograms/ml at 6 hours. Average serum half-lives of CMX were shorter in older subjects, 3.0, 1.9 and 1.4 hours, respectively in the 3 groups. Urinary recovery rates were relatively high, 68.9 to 84.9% in the 3 cases examined during the first 6 hours, and 15.4 to 66.2% during the first 2 hours. (2) Intravenous bolus injection of 20 mg/kg: Serum concentrations of the drug in the 3 groups peaked at 65.2, 60.5 and 65.8 micrograms/ml, respectively, all at 30 minutes after the drug administration, with no significant differences noted among the groups. The levels gradually declined thereafter in all groups, but remained rather high at 20.1, 6.5 and 9.5 micrograms/ml, respectively, at 6 hours. Average serum half-lives of CMX were 3.5, 1.7 and 1.9 hours, respectively. The inversion of values obtained between the 2nd and 3rd groups appears to be attributable to that all of the 3rd group were premature infants, and the body weight of 2 cases of them were less than 2,000 g each. Urinary recovery rates ranged widely from 37.0 to 89.4% in the 4 cases examined during the first 6 hours. (3) One-hour intravenous drip infusion of 20 mg/kg: Serum concentrations of the drug in the 3 groups peaked at 57.7, 60.2 and 72.4 micrograms/ml, respectively, all at the termination of the drug infusion.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacterial Infections; Cefmenoxime; Cellulitis; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Otitis Media, Suppurative; Pneumonia; Sepsis; Urinary Tract Infections

1. Cefmenoxime (CMX) was administered with a dosage regimen of 20-25 mg/kg, 2-3 times daily (40-75 mg/kg/day) by intravenous drip over 30 minutes to 9 neonates with bacterial infections including purulent meningitis and septicemia. Clinical responses to the treatment were excellent in 7 and poor in 2. Bacteriological responses were "eradication of pathogens" from 8 of them except another patient with an infection due to Staphylococcus aureus. 2. Adverse reactions to CMX were observed in 6 of 18 neonates treated with the drug: diarrhea, oral thrush, and the elevation of S-GOT, S-GPT, LDH and alkaline phosphatase. None of the reactions, however, necessitated the discontinuation of the treatment. 3. Changes in blood concentrations of CMX in neonates with ages between 0 and 30 days were followed. These subjects included 16 mature neonates and 10 neonates with low birth weights. Intravenous drip infusion of 20 mg/kg of CMX over 30 minutes was immediately followed by peak blood CMX concentrations of 34.6-72.7 mcg/ml (mean +/- S.D.: 50.4 +/- 11.3 mcg/ml) in the mature neonates, and 22.3-78.2 mcg/ml (55.5 +/- 16.5 mcg/ml) in the neonates with low birth weight. Blood half-lives of the drug in the mature neonates were in the range from 1.7 to 20.7 hours (5.9 +/- 6.6 hours) in subjects with ages of 0-3 days, and 1.1-3.5 hours (2.0 +/- 0.8 hours) in subjects of 4-25 days. In neonates with low birth weight, they were 3.4-10.2 hours (7.2 +/- 2.7 hours) in subjects of 0-2 days, and 1.4-5.5 hours (3.0 +/- 1.5 hours) in subjects of 4-30 days. In other words, the blood half-lives of the drug tended to be longer in younger subjects. 4. Concentration of CMX in cerebrospinal fluid (CSF) were determined in a patient in acute stage with purulent meningitis caused by Mycoplasma hominis. Intravenous drip infusion of 80 mg/kg of CMX over 30 minutes was followed by CSF concentrations of 7.7-15.5 mcg/ml. 5. MICs of CMX for clinical isolates were determined. The drug was proved to have excellent antibacterial activities against Escherichia coli (3 strains) and group B hemolytic streptococci (2 strains) and these MICs were comparable to those of cefotaxime. The MIC of CMX for S. aureus (1 strain) was high at 25 mcg/ml with an inoculum size of 10(8) CFU/ml. This MIC value of CMX was higher than that of cefmetazole.

Topics: Bacterial Infections; Cefmenoxime; Drug Evaluation; Female; Humans; Infant, Newborn; Male; Meningitis; Pneumonia; Sepsis; Urinary Tract Infections

Cefmenoxime (CMX) was administered by intravenous bolus injection to a total of 23 neonates and premature babies with aged 1 to 26 days at a dose of 10 or 20 mg/kg and their plasma and urine concentrations and urinary recovery rates were determined up to 6 hours after administration. In addition, for the treatment of bacterial infections, diagnosed or suspected, or for the prophylaxis of bacterial infections, the drug was administered to a total of 27 neonates, premature babies and infants, with ages of 0 day to 3 months. It was possible to evaluate therapeutic efficacy and prophylactic efficacy in 15 cases and 7 cases, respectively. In these cases, side effects and bacteriological effects and, in some of them, changes in laboratory test values were also investigated. The obtained results are summarized below. 1. At a dose level of 10 mg/kg (n = 7), peak plasma concentrations at 5 minutes after administration, were 42.6 microns/ml in neonates with ages of 15 to 21 days and 45.9 microns/ml in those with ages of 22 to 28 days in a group of less than 2,500 g b.w. (birth weight), and 36.9 microns/ml in neonates with ages of 4-7 days and 38.9 microns/ml in those of 8-14 days in the other group of greater than of equal to 2,500 g b.w., indicating no large differences among the 4 subgroups (each of the above concentration values is either the value for an individual when only one neonates was involved or a mean value when 2 or more neonates were involved. The same applies hereinafter). Though 1 exceptional case showed a biphasic change, its cause is unknown. Half-lives in the above-mentioned 4 subgroups were 1.5, 1.6, 2.4 and 1.9 hours, respectively. The half-life of 2.4 hours in 1 patient with an age of 5 days of the greater than or equal to 2,500 g b.w. group was longer than in any of the other 3 subgroups. 2. At 20 mg/kg (n = 16) dosage level, mean peak plasma concentrations were 63.8 microns/ml in the infants of 0-3 days, 68.1 microns/ml in those of 8-14 days and 59.4 microns/ml in those of 15-21 days in the group of less than 2,500 g b.w., and 109.9 microns/ml in the neonates aged 8-14 days and 79.7 microns/ml in those of 15-21 days in the group greater than or equal to 2,500 g b.w.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacterial Infections; Cefmenoxime; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Maxillary Sinusitis; Pneumonia; Sepsis; Urinary Tract Infections

Clinical evaluation of cefmenoxime (CMX, Bestcall) was performed against infections associated with hematological, respiratory tract and other disorders. Clinical effectiveness of CMX against severe infections with hematological disorders including sepsis, pneumonia, pyelitis and so on was 74.4% for good responses and against the respiratory tract infections, 96.2% for good responses was obtained. Neither objective or subjective side effects nor extreme abnormalities in laboratory tests were observed in these patients. It can be concluded, therefore, that CMX is one of the most useful drugs against infectious diseases associated with hematological disorders, respiratory tract and other disorders.

Topics: Bacterial Infections; Biliary Tract Diseases; Cefmenoxime; Cefotaxime; Hematologic Diseases; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Neutropenia; Pneumonia; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

T-2588 was used on 55 patients with respiratory tract infections and 44 cases were evaluated; 23 patients with pneumonia, 12 patients with acute bronchitis, 2 patients with chronic bronchitis, 1 patient with diffuse panbronchiolitis and 6 patients with bronchiectasis with infection. Clinical effects of T-2588 were as follows; excellent in 6 and good in 28 patients. The efficacy rate was 77.3% (34/44). Bacteriological effects of T-2588 were prominent in 8 patients infected with B. catarrhalis, H. influenzae, K. pneumoniae and E. coli, but not in a patient infected with P. putida. The elimination rate was 90.0% (9/10 strains). As side effects, stomatitis, anorexia, diarrhea X vomiting and pruritus were observed in one patient each. Abnormal laboratory findings were observed in 4 patients with elevated GOT and/or GPT. These side effects and abnormal laboratory findings were not serious. The usefulness of T-2588 was 68.2% (30/44). Therefore, T-2588 is a useful drug and its effects are promising in clinical management of respiratory tract infections.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Bronchitis; Cefmenoxime; Cephalosporins; Female; Humans; Male; Middle Aged; Pneumonia; Respiratory Tract Infections

Topics: Aged; Cefmenoxime; Cefotaxime; Humans; Male; Middle Aged; Piperacillin; Pneumonia; Radiography

Nephrotoxicity frequently complicates the use of aminoglycosides in severely compromised acute care patients. Therefore, we initiated an open clinical trial to determine if cefmenoxime alone is useful for serious Gram-negative pneumonias in this population. Thirty consecutive patients were studied. Average age was 66 years. Most were malnourished at entry, with serum albumin averaging 2.8 g/dl and prognostic nutritional index values over 70% (normal less than 40%). One-half of the patients had severe COPD and 67.9% were on ventilators. Fifty-seven per cent suffered concomitant cardiac disease, and 78.6% had been previously treated with antibiotics. Pneumonia was proven by new infiltrates on chest X-ray, new fever, elevated WBC count and Gram-negative rods on Gram's stain and in cultures of tracheal aspirate or sputum. Patients were given cefmenoxime 1-2 g every 6 h for an average of 12 days. Cefmenoxime peak (1 h) and trough concentrations were measured by HPLC and averaged 58 and 7 mg/l respectively. Gram-positive organisms, Escherichia coli, Klebsiella spp. and Haemophilus influenzae were usually eradicated. Persistence was noted for Enterobacter, Pseudomonas and Acinetobacter spp. Persistence in patients with good clinical response was considered colonization rather than superinfection. Overall, satisfactory clinical response rate was noted in 78.6%, while four patients responded satisfactorily with recurrence, and two treatments were unsatisfactory. No serious adverse effects were observed. Cefmenoxime is a promising agent for treatment of susceptible pneumonias in critical care patients.

Topics: Aged; Cefmenoxime; Cefotaxime; Critical Care; Cross Infection; Female; Humans; Male; Middle Aged; Pneumonia; Radiography

Cefmenoxime concentration/effect relationships were retrospectively explored for gram-negative bacteria isolated from 14 critical care patients treated for nosocomial pneumonia. The effects of cefmenoxime concentrations on in vitro growth kinetics of 21 isolated pathogens were studied using the Abbott MS-2 Research System, from which a dynamic response concentration was derived. Serum pharmacokinetic profiles were obtained in each patient. These data were used to calculate the in vivo total area under the curve over dynamic response concentration and the time that cefmenoxime concentrations exceeded the dynamic response concentration for each bacteria. The same determinations were made in 18 patients prospectively treated, except that dosage was optimized on the basis of previous mathematical relations to achieve bacterial eradication in four days. This method of dosage optimization is termed dual individualization. Serial cultures of infected tissues were evaluated to determine the number of days to the eradication of bacteria, and the pharmacokinetic and pharmacodynamic variables were used to describe the bacteriologic response of the original pathogen isolated in pretreatment culture. Bacterial eradication rates could be described from cefmenoxime pharmacokinetics in the patient and from the relation between concentration and bacterial inhibition. Patients who were prospectively treated using these retrospectively derived relationships had a predictable day of bacterial eradication. This, in turn, was associated with a shorter duration of treatment (p less than 0.05). The success of prospective dual individualization is encouraging and suggests that more precise optimization of antibiotic dosage can yield a predictable rate of bacterial eradication from the infection site.

Topics: Aged; Cefmenoxime; Cefotaxime; Computers; Cross Infection; Female; Gram-Negative Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Prospective Studies; Retrospective Studies

Cefmenoxime was evaluated in an open trial consisting of 41 patients. Forty infections in 36 patients could be evaluated. Thirteen patients had pyelonephritis due to Escherichia coli (two bacteremic), Pseudomonas aeruginosa, Klebsiella pneumoniae, or Streptococcus faecalis; all improved and 12 of 13 were clinically cured, but one relapse (S. faecalis) occurred at two weeks. Six patients with cystitis due to E. coli, Citrobacter freundii, Serratia marcescens, P. aeruginosa, or S. faecalis all improved, but relapse or reinfection, or both, occurred in five due to P. aeruginosa, S. faecalis, C. fruendii, or E. coli. Neurogenic bladder or other complications were present in five of 13 patients with pyelonephritis and five of six with cystitis. Ten patients with pneumonia and one with tracheobronchitis due to Hemophilus influenzae, S. pneumoniae, S. agalactiae, or Neisseria meningitidis all improved and seven had resolution without relapse, but P. aeruginosa emerged in two patients, one of whom died. Eight soft tissue infections due to Staphylococcus aureus, Peptococcus prevotti, Streptococcus species, or infections of mixed origin resolved in six. Sterility of blood cultures was obtained in one patient with endocarditis due to S. anginosus, but other therapy was substituted. Clinical resolution of the toxic shock syndrome and subsequent negative endocervical cultures for S. aureus occurred in one. Granulocytopenia of unverified cause in four (with less than 1,500 mm3) and two (with less than 2,000 mm3) was reversible. Headache during treatment occurred in six patients and a possible disulfiram-like effect in three. Elevations of serum glutamic oxalacetic transaminase and alkaline phosphatase occurred in five, Coombs' positivity in two, and diarrhea in three. Clinical efficacy of cefmenoxime was significant. Possible side effects require further study.

Topics: Abscess; Adolescent; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Cellulitis; Cystitis; Drug Resistance, Microbial; Enterobacteriaceae Infections; Female; Humans; Leukopenia; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Urinary Tract Infections

The efficacy and safety of cefmenoxime was evaluated in 50 patients with serious bacterial infections. These included 26 pneumonias, 18 urinary tract infections, 2 soft tissue infections, 2 bacteremias, 1 renal abscess, and 1 peritonitis. A satisfactory clinical response was seen in 47 patients (94%). Eosinophilia and thrombocytosis were seen in several patients but were generally mild and transient.

Topics: Bacterial Infections; Cefmenoxime; Cefotaxime; Humans; Pneumonia; Sepsis; Urinary Tract Infections

Cefmenoxime is a new syn-methoxyimino cephalosporin antibiotic derived from cefotiam, which has been proved to be a very effective and useful antibiotic for the treatment of respiratory infections. This bacteriological and pharmacokinetic study was therefore performed in order to evaluate the potency of cefmenoxime in the treatment of respiratory infections. The minimum inhibitory concentrations of cefmenoxime against 179 isolates of respiratory pathogens (Streptococcus pneumoniae 53, Haemophilus influenzae 64, Klebsiella pneumoniae 43, Escherichia coli 9, Enterobacter spp. 10) were less than 0.20 micrograms/ml, and 43 (73%) of 60 Pseudomonas aeruginosa were inhibited by 12.5 micrograms/ml. In vitro antibacterial activity of cefmenoxime was superior to 18 other antibiotics, including cefotiam and cefotaxime tested in this study. Pharmacokinetic studies on tissue distribution in rats, serum levels and urinary excretion in 3 healthy volunteers, and penetration into bronchial secretes of 9 patients with respiratory infections, revealed that cefmenoxime has a higher penetration into the lung and bronchial secretes compared with cefotiam and cefotaxime. In 1 patient with chronic bronchiolitis, the concentration of cefmenoxime in the intra-bronchial secrete reached 12.5 micrograms/ml. From these results, it is concluded that cefmenoxime is a highly potent and useful antibiotic, and may be more effective in the treatment of respiratory infections than many other cephalosporins, including cefazolin, cefotiam and cefotaxime.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Cefmenoxime; Cefotaxime; Cefotiam; Humans; Kinetics; Microbial Sensitivity Tests; Pneumonia; Rats; Respiratory Tract Infections; Sputum; Tissue Distribution

This is a simple, precise liquid-chromatographic procedure for determining cefmenoxime in patients' serum and urine. p-Anisic acid is used as the internal standard. Protein is precipitated from 0.5 mL of serum or dilute urine with 100 microL of perchloric acid. The clear supernate is injected directly onto a mu-Bondapak CN reversed-phase column. The mobile phase is acetate buffer, pH 3.8 (25 degrees C). The flow rate is 2.5 mL/min. Column effluent is monitored at 254 nm. Extraction recovery from serum averaged 74.6%. Calibration curves were linear from 0.5 mg/L, the lower limit of quantification, to 100 mg/L. We present cefmenoxime concentrations in serum from a patient being treated for pneumonia. The procedure was evaluated in the clinical setting to determine its applicability to the study of cefmenoxime pharmacokinetics in critically ill patients.

Topics: Aged; Cefmenoxime; Cefotaxime; Chromatography, Liquid; Female; Humans; Hydroxybenzoate Ethers; Hydroxybenzoates; Kinetics; Pneumonia; Reference Standards

Two to 6 g of CMX was administered daily to 9 patients who were admitted to ICU, i.e. 5 cases with pneumonia and 4 with sepsis. In all cases, CMX was administered concomitantly with aminoglycoside which had been administered, and additional administration of other antibiotics was avoided. Bacteriologically, P. aeruginosa was isolated from 4 cases, K. pneumoniae from 4 cases, S. marcescens, P. mirabilis and P. cepacia respectively from 1 case. The CMX treatment was considered effective in 4 of 5 pneumonia cases and in 3 of 4 sepsis cases. In total, 7 of 9 cases responded effectively. The clinical effective rate was 77.8%. Elevation of GOT and GPT values was noticed in 1 case, however, the causality with CMX administration was unclear.

Topics: Adult; Aged; Bacteria; Cefmenoxime; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infusions, Parenteral; Intensive Care Units; Male; Middle Aged; Pneumonia; Sepsis

Cefmenoxime (CMX) is a newly developed cephalosporin. Basic and clinical studies on this drug was carried out and the results were as follows. 1. Serum level and urinary recovery A 7 years old male was administered 10 mg per kilogram of CMX by one shot intravenous injection. Serum levels were 23.3 micrograms/ml at the time of 15 minutes after injection, 12.0 micrograms/ml at 30 minutes, 3.9 micrograms/ml at 1 hour, 2.0 micrograms/ml at 2 hours, and 0.3 micrograms/ml at 4 hours. In this same patient, 6-hour urinary recovery was 54.7%. 2. Clinical evaluation and adverse reaction Thirty-seven patients (upper respiratory infection 4, pneumonia 20, pyothorax 1, purulent lymphadenitis 1, cellulitis 2, sepsis 1 and urinary tract infection 8) were treated with CMX in doses of 30 approximately 212 mg/kg divided 3 approximately 4 times per day for 1.5 approximately 21 days intravenously. The overall efficacy rate was 94.6%. As to adverse reaction, exanthema and drug fever were observed in 1 patient respectively. Abnormal laboratory data noted were eosinophilia in 2.3%, and elevation of serum transaminase in 9.8%.

Topics: Cefmenoxime; Cefotaxime; Child; Child, Preschool; Empyema; Female; Humans; Infant; Lymphadenitis; Male; Pneumonia; Urinary Tract Infections

A new cephalosporin antibiotic, cefmenoxime (CMX) was administered to 22 patients aged 5 days to 8 years, and who had moderate or severe pediatric infections, to examine its clinical effect. The infections were 3 of acute bronchitis, 2 cases of asthmatic bronchitis, 6 of acute pneumonia, 1 of Mycoplasma pneumonia, 2 of sepsis (1 accompanied with pneumonia), 3 of vacterial meningitis, 2 of urinary tract infection, 1 of acute appendicitis, 1 of aseptic meningitis and 1 of fever of undetermined origin. The drug was administered by one shot intravenous injection 4 times daily at the dose of 40 approximately 200 mg/kg/day. The drug was administered for 3 approximately 15 days, the total dosage administered being 0.7 approximately 43.5 g. Clinically, excellent, good and fair response was obtained in 2, 11 and 4 cases, respectively, the drug being effective in all cases excluding the 5 cases in which judgement was unknown. The 6 strains of bacteria isolated from the lesion as the assumed causative bacteria (1 strain of S. pneumoniae, 2 of H. influenzae, 2 of E. coli, 1 of K. pneumoniae) were all eradicated after drug administration. No notable side effects were produced.

Topics: Bronchitis; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Injections, Intravenous; Male; Meningitis, Aseptic; Pneumonia; Pneumonia, Mycoplasma; Respiratory Tract Infections