cefotaxime and Acute-Disease

Eikenella corrodens is a facultatively anaerobic gram-negative rod bacterium in the oropharynx and respiratory tract. It is a member of HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, E. corrodens, and Kingella kingae) group commonly associated with endocarditis and craniofacial infections. It is usually susceptible to penicillin, second and third-generation cephalosporins, and carbapenem, but has variable susceptibility to first-generation cephalosporin. We herein provide a description of the first case of pediatric acute dacryocystitis caused by E. corrodens. The patient did not respond to oral cephalexin and required surgical drainage followed by intravenous cefotaxime. Also provided is a brief review of the current literature.

Topics: Acute Disease; Aggregatibacter; Anti-Bacterial Agents; Cardiobacterium; Cefotaxime; Cephalexin; Child, Preschool; Dacryocystitis; Drug Administration Routes; Eikenella corrodens; Female; Gram-Negative Bacterial Infections; Haemophilus; Humans; Kingella; Microbial Sensitivity Tests; Tomography, X-Ray Computed; Treatment Outcome

We describe 3 previously healthy Costa Rican children who had Listeria monocytogenes meningitis, an uncommon cause of bacterial meningitis beyond the newborn period in normal subjects. Two of them had initial normal brain computed tomography, but all 3 developed acute hydrocephalus at days 7, 3, and 5, respectively. All required immediate ventriculostomy placement and only 1 of 3 survived. L. monocytogenes should be considered among the etiologies of bacterial meningitis in children who do not respond initially to conventional antimicrobial treatment or who deteriorate rapidly.

Topics: Acute Disease; Amikacin; Cefotaxime; Child; Child, Preschool; Combined Modality Therapy; Costa Rica; Dexamethasone; Drug Resistance; Drug Therapy, Combination; Emergencies; Fatal Outcome; Female; Humans; Hydrocephalus; Male; Meningitis, Listeria; Meropenem; Rifampin; Thienamycins; Tomography, X-Ray Computed; Vancomycin; Ventriculostomy

This review focuses on antibiotic treatment of acute urinary tract infections (UTIs) in children who are neurologically and anatomically intact. Neonates younger than 28 days with a febrile UTI should be hospitalized, given supportive care and treated with parenteral amoxicillin and cefotaxime. Following a good response to 3 to 4 days of parenteral antibacterial therapy, outpatient treatment with an oral antibiotic should be given to complete 14 days of therapy. Infants from 28 days to 3 months who appear clinically ill with a febrile UTI should be hospitalized, receive supportive care and parenteral administration of a 3(rd) generation cephalosporin or gentamicin. When these infants are clinically improved and afebrile for 24 hours they should be discharged to complete 14 days of therapy with an oral antibiotic. Infants from 28 days to 3 months of age who are not acutely ill with a febrile UTI may be managed as outpatients. Ceftriaxone or gentamicin should be administered parenterally and given each 24 h until the infant is afebrile for 24 hours. Fourteen days of therapy should be completed with an oral antibiotic. Children with complicated pyelonephritis should be hospitalized, receive supportive care and parenteral ceftriaxone or gentamicin each 24 hours until clinically improved and without fever for 24 hours. They should then complete 10 to 14 days of therapy with an oral antibiotic as an outpatient. Children with uncomplicated pyelonephritis should be rehydrated in the outpatient department (if necessary) and receive parenteral ceftriaxone or gentamicin each 24 hours until without fever for 24 hours. If clinically improved they should receive an oral antibiotic to complete 10 to 14 days of therapy. Children with cystitis who are only mildly symptomatic should be managed with supportive care until the result of the urine culture and sensitivity are available. Children with cystitis who are moderately to severely symptomatic should receive an oral antibiotic and supportive care immediately. If the therapy is effective, children with cystitis should show a good clinical response in 2 to 3 days. If the response is satisfactory and the culture shows an organism susceptible to the antibiotic used, complete 5 to 7 days of treatment with the oral antibiotic.

Topics: Acute Disease; Administration, Oral; Adolescent; Age Factors; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Cystitis; Gentamicins; Hospitalization; Humans; Infant; Infant, Newborn; Injections, Intravenous; Outpatients; Pyelonephritis; Time Factors; Urinary Tract Infections

Topics: Acute Disease; Anti-Bacterial Agents; Cefotaxime; Evidence-Based Medicine; Female; Gram-Negative Bacterial Infections; Humans; Middle Aged; Ofloxacin; Peritonitis; Randomized Controlled Trials as Topic

In view of the very great efficacy of 3rd generation cephalosporins and fluoroquinolones used as monotherapy in the treatment of uncomplicated acute pyelonephritis, the addition of an aminoglycoside is not currently recommended, because of the unfavourable balance of the advantages and disadvantages of this antibiotic class. However, a brief course of aminoglycosides may nevertheless be useful during the initial phase of treatment, especially in hospitalised subjects. The authors analyse the contribution of three recently published studies to this debate.

Topics: Acute Disease; Administration, Oral; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Cefadroxil; Cefotaxime; Cephalosporins; Ciprofloxacin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Gentamicins; Humans; Infusions, Intravenous; Inpatients; Male; Norfloxacin; Pyelonephritis; Recurrence; Time Factors; Tobramycin; Urinary Tract Infections

Cefprozil was evaluated in the treatment of acute otitis media with effusion in three open, randomized, multicenter comparative clinical trials. In two trials, 891 pediatric patients were enrolled to either cefprozil or amoxicillin-clavulanate dosage regimens. The treatment groups were comparable in demographic characteristics, and presented with otalgia, middle-ear effusion, or inflamed or bulging tympanic membrane on otoscopic examination. In all patients, tympanocentesis and a culture were required. Two cefprozil oral doses were evaluated, 30 mg/kg/day and 40 mg/kg/day divided into two equal doses (b.i.d.). Amoxicillin-clavulanate was administered at 40 mg/kg/day in three divided doses (t.i.d.). The recommended duration of therapy was ten days. The predominant bacteria isolated were Haemophilus influenzae and Moraxella catarrhalis. The overall satisfactory clinical response rates were similar for cefprozil (83%) and amoxicillin-clavulanate (81%). The bacteriological response rates did not differ significantly, at 84% and 82%. Cefprozil eradicated the most common pathogen, Streptococcus pneumoniae, more often at 91%, vs. 84% for amoxicillin-clavulanate. The eradication rates were similar against Haemophilus influenzae and Moraxella catarrhalis. The patients treated with cefprozil had a lower rate of adverse clinical events (11%) compared to those with amoxicillin-clavulanate (20%). More gastrointestinal adverse experiences, including diarrhea, were reported in the amoxicillin-clavulanate-treated patients. In Study 3, cefprozil 30 mg/kg/day (b.i.d.) was compared to cefaclor 40 mg/kg/day (t.i.d.) and cefixime 8 mg/kg/day (q.d) in the treatment of acute otitis media in 388 pediatric patients. The patients were treated for 10 days, with a follow-up of 18 days. The overall clinical cure rates were 85%, 89% and 85%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Cefaclor; Cefixime; Cefotaxime; Cefprozil; Cephalosporins; Child; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Multicenter Studies as Topic; Otitis Media; Randomized Controlled Trials as Topic

Topics: Acute Disease; Amoxicillin; Anti-Infective Agents; Cefixime; Cefotaxime; Humans; Otitis Media with Effusion; Pneumococcal Infections; Treatment Failure

In two randomized clinical trials in children with otitis media, the efficacy and safety of cefprozil are compared to those of amoxicillin/clavulanate (n = 530) and of cefaclor and cefixime (n = 394). The rate of clinical cure or improvement was similar among patients receiving each drug regimen, ranging from 78% for amoxicillin/clavulanate to 89% for cefaclor; for cefprozil, this rate was 84% and 85% in the two studies, respectively. In the first study, cefprozil was superior to amoxicillin/clavulanate in the satisfactory clinical response rate for Streptococcus pneumoniae (P = .049), but response rates were similar for Haemophilus influenzae and Moraxella catarrhalis. Significantly more patients treated with amoxicillin/clavulanate (P less than .001) in the first study or cefixime (P less than .01) in the second study developed diarrhea than did those treated with cefprozil. We conclude that cefprozil therapy for otitis media in children produces clinical and bacteriologic response rates similar to those seen with amoxicillin/clavulanate, cefixime, or cefaclor. Furthermore, diarrhea was significantly less common with cefprozil than with cefixime or amoxicillin/clavulanate.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Cefaclor; Cefixime; Cefotaxime; Cefprozil; Cephalosporins; Child; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Humans; Infant; Otitis Media with Effusion

The aim of this study was to determine the potential influence of variables such as the cell content in the fluid, and serum levels, on the concentrations of ceftibuten, cefixime and azithromycin in the middle ear fluid of patients suffering from acute otitis media.. This randomized, open study compared the penetration of ceftibuten (9 mg kg(-1) 18 patients), cefixime (8 mg kg(-1), 16 patients) and azithromycin (10 mg kg(-1) 16 patients) into the intracellular and extracellular compartments of middle ear fluid of 50 paediatric patients (aged 8-14 years) with acute otitis media. Middle ear fluid was extracted by tympanocentesis 4, 12 and 24 h after dosing and divided into two fractions: with cells (as collected) (C+) and cell-free (C-). Antibiotics were assayed in C+ and C- samples by h.p.l.c.. Ceftibuten achieved greater penetration into middle ear fluid than cefixime and azithromycin. Higher concentrations of ceftibuten (CTB) and cefixime (CFX) were found in the C- fraction (CTB: 4h 13.3+/-1.86; 12h 4.7+/-1.18; 24h 0.5+/-0.2. CFX: 4h 3.2+/-1.4; 12h 1.5+/-0.5; 24h>(0.1 mgl(-1)) than in the C+ fraction (CTB:4 h 8.4+/-4.3; 12 h 2.88+/-1.19; 24 h 0.3+/-0.27. CFX: 4 h 1.2+/-0.6; 12 h 0.8+/-0.2; 24 h>0.1 mg l(-1)) at the each time point, while the opposite was true for azithromycin (C-: 4 h 0.11+/-0.04; 12 h 0.12+/-0.08; 24 h 0.23+/-0.12. C+: 4 h 0.38+/-0.24; 12 h 0.9+/-0.03; 24 h 1.05+/-0.3 mg l(-1)).. This study demonstrates that the penetration of antibiotics into the middle ear fluid is influenced by its serum concentrations as well as by the cell content in the fluid. Ceftibuten achieved higher middle ear fluid concentrations than cefixime in C+ and C- fractions at all time points. Both ceftibuten and cefixime concentrations are negatively influenced by the cell content in the fluid. In contrast the concentration of azithromycin to the middle ear fluid is positively influenced by the cell content in the fluid.

Topics: Acute Disease; Administration, Oral; Adolescent; Anti-Bacterial Agents; Azithromycin; Cefixime; Cefotaxime; Ceftibuten; Cephalosporins; Child; Exudates and Transudates; Female; Humans; Male; Otitis Media with Effusion; Time Factors

The standard recommendation for treatment of young, febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials. The availability of potent, oral, third-generation cephalosporins as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy.. In a multicenter, randomized clinical trial, we evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection, in terms of short-term clinical outcomes (sterilization of the urine and defervescence) and long-term morbidity (incidence of reinfection and incidence and extent of renal scarring documented at 6 months by 99mTc-dimercaptosuccinic acid renal scans). Children received either oral cefixime for 14 days (double dose on day 1) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days.. Treatment groups were comparable regarding demographic, clinical, and laboratory characteristics. Bacteremia was present in 3.4% of children treated orally and 5.3% of children treated intravenously. Of the short-term outcomes, 1) repeat urine cultures were sterile within 24 hours in all children, and 2) mean time to defervescence was 25 and 24 hours for children treated orally and intravenously, respectively. Of the long-term outcomes, 1) symptomatic reinfections occurred in 4.6% of children treated orally and 7.2% of children treated intravenously, 2) renal scarring at 6 months was noted in 9.8% children treated orally versus 7.2% of children treated intravenously, and 3) mean extent of scarring was approximately 8% in both treatment groups. Mean costs were at least twofold higher for children treated intravenously ($3577 vs $1473) compared with those treated orally.. Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection. Use of cefixime will result in substantial reductions of health care expenditures.

Topics: Acute Disease; Administration, Oral; Cefixime; Cefotaxime; Cephalosporins; Cost-Benefit Analysis; Female; Humans; Infant; Infusions, Intravenous; Logistic Models; Male; Patient Compliance; Pyelonephritis; Recurrence; Urinary Tract Infections

Community-acquired non-complicated acute pyelonephritis (APN) is a frequent, occasionally serious infection (around 20% of the cases are bacteremic) that usually requires hospital admission. The third generation oral cephalosporins which are active against more than 95% of E. coli strains should allow the outpatient management of these patients.. To evaluate the bacteriological and clinical efficacy of oral cefixime in comparison to amoxicilin plus netilcilin in the treatment of APN.. Patients older than 18 years affected by APN were included in a fourteen month prospective study. According to a random numbers chart, the patients received cefixime (400 mg/24 h in a single daily dose for 12 days) or amoxicilin (1 g/8 h per os) plus netilmicin (4 mg/kg/24 h in a single intramuscular daily dose) during five days followed by 7 days of an oral treatment chosen according to the susceptibility pattern of isolated microorganism.. Sixty-one patients received cefixime and 65 amoxicillin plus retilmicin. There were no significant differences between both groups of patients. Thirty-two patients presented bacteremia (25.4%). The mean (SD) eak and trough concentrations of netilmicin were 11.4 (2.8) mg/l and 0.38 (0.4) mg/l, respectively. Clinical response was favorable in 97% of patients treated with cefixime and in 98% of those treated with amoxicilin plus netilmicin (p = NS). The infection recurred in 10 out of 59 patients (16.9%) in the cefixime arm of the study and in 9 out of 64 patients (14%) treated with amoxicillin plus netilmicin (p = NS). Tolerance to the study drugs was good in both arms of the study, and renal function remained normal.. Cefixime seems to be an acceptable alternative to the regimens containing an aminopenicillin and an aminoglycoside for the treatment of community-acquired non-complicated APN.

Topics: Acute Disease; Adult; Aged; Amoxicillin; Bacteremia; Cefixime; Cefotaxime; Cephalosporins; Communicable Diseases; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Netilmicin; Pyelonephritis

Use of a beta-lactamase stable antibiotic is called for in cases of acute otitis media (AOM) likely to be caused by beta-lactamase-producing Haemophilus influenzae or Moraxella catarrhalis. Two beta-lactamase-stable agents commonly used for empirical treatment of AOM are amoxicillin/clavulanate and cefixime.. A multicenter, randomized clinical trial compared cefixime (CFX; 8 mg/kg once daily) with amoxicillin/clavulanate (A/C; 40 mg/kg/day in three divided doses) for the treatment of children with AOM. Three hundred thirteen children were randomly assigned to a 10-day course of either CFX (n = 158) or A/C (n = 155). Based on history, physical examinations and otoscopic and tympanometric assessments, clinical responses were evaluated as cure, improvement, failure, relapse or nonevaluable. Compliance and patient/parent acceptability were also analyzed.. Overall favorable clinical responses (cure plus improvement) were comparable post-therapy for the two treatments (CFX = 76%; A/C = 77%). Significant differences in response rates for both treatments were noted among different geographic regions, with the highest response rates observed in the Northeast and South. Acceptability of CFX was significantly better than that of A/C (P = 0.0001), and the adverse experience rate was lower (P = 0.001). The most frequently reported adverse experiences were diarrhea (CFX 15.2%, A/C 29.7%) and vomiting (CFX 3.2%, A/C 10.32%). Relapse rates were 26% for CFX and 29% for A/C.. This study demonstrated that CFX has comparable clinical efficacy and a better adverse events profile than A/C when used to treat AOM of childhood.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Cefixime; Cefotaxime; Cephalosporins; Child; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Female; Humans; Infant; Male; Otitis Media; Prospective Studies; Treatment Outcome

In a prospective controlled study the effect of antibiotics as the only treatment in acute appendicitis was evaluated. Of 40 patients admitted with a duration of abdominal pain of less than 72 h, 20 received antibiotics intravenously for 2 days followed by oral treatment for 8 days and 20 considered as controls were randomized to surgery. All patients treated conservatively were discharged within 2 days, except one who required surgery after 12 h because of peritonitis secondary to perforated appendicitis. Seven patients were readmitted within 1 year as a result of recurrent appendicitis and underwent surgery, when appendicitis was confirmed. The diagnostic accuracy within the operated group was 85 per cent. One patient had perforated appendicitis at operation. Antibiotic treatment in patients with acute appendicitis was as effective as surgery. The patients had less pain and required less analgesia, but the recurrence rate was high.

Topics: Acute Disease; Adolescent; Adult; Aged; Appendicitis; Cefotaxime; Female; Humans; Male; Middle Aged; Ofloxacin; Pain Measurement; Pilot Projects; Prospective Studies; Tinidazole; Treatment Outcome

Changes in nasopharyngeal flora were investigated in children with acute otitis media and with acute exacerbations of chronic sinusitis in whom antibiotic therapy of relatively long duration was required until substantial improvement in clinical findings was achieved. 1. The antibiotics used were two cephalosporins, i.e., cefaclor (CCL) and cefixime (CFIX), administered to 18 patients each for 1 week and to 26 and 20 patients, respectively, for 2 weeks. Bacteriologic examination of the nasopharyngeal mucosa was performed at the first visit and at 1 week in those who underwent antibiotic therapy for 1 week, and at the first visit and at 1 and 2 weeks in those treated with antibiotics for 2 weeks. 2. The elimination rates for the infecting microorganisms in the patients in the CCL-treated group were 30% for Haemophilus influenzae, 83% for Staphylococcus aureus, 100% for Streptococcus pyogenes and 100% for Streptococcus pneumoniae at 1 week, and 18% for H. influenzae, 100% for S. aureus and 100% for S. pyogenes at 2 weeks of antibiotic therapy. Replacement of S. aureus and S. pyogenes by H. influenzae was observed. 3. The elimination rates for infecting bacteria in the patients in the CFIX-treated groups were 61% for H. influenzae, 50% for S. aureus, 75% for S. pyogenes, 80% for S. pneumoniae and 100% for Moraxella catarrhalis at 1 week, and 72% for H. influenzae, 0% for S. aureus, 100% for S. pyogenes, and 0% for S. pneumoniae at 2 weeks of antibiotic therapy. The elimination rate for H. influenzae at 2 weeks was significantly higher than the corresponding value for the CCL-treated group. Replacement of H. influenzae by S. aureus and S. pneumoniae and of S. pyogenes by S. aureus was detected. 4. There was one patient with acute otitis media in the CFIX-treated group in whom a clinical relapse occurred due to H. influenzae persisters in the nasopharynx. Thus the diagnosis in this patient was so-called "recurrent otitis media". 5. H. influenzae tended to persist after exposure to therapeutically adequate concentrations of CCL, as did S. aureus and S. pneumoniae following treatment with CFIX. Thus, it would seem that ample heed must be given to persistence, particularly of H. influenzae and S. pneumoniae, the most common causative agents of acute otitis media in childhood. 6. A significant rise in the MICs of the cephalosporins was observed in 4 of 43 patients in whom the same type of organism was isolated from the nasopharynx at weekly intervals during antibi

Topics: Acute Disease; Anti-Bacterial Agents; Bacteria; Cefaclor; Cefixime; Cefotaxime; Child; Child, Preschool; Chronic Disease; Female; Humans; Male; Nasopharynx; Otitis Media; Sinusitis

We conducted a large, multicenter, randomized, open-label study throughout France comparing the efficacy and safety of cefixime suspension (8 mg/kg/day, b.i.d., for 10 days) versus amoxicillin-clavulanate suspension (80 mg/kg/day, t.i.d., for 10 days) in 510 children (ages 6 to 36 months) with acute otitis media. The most frequent microorganisms colonizing the nasopharynx at the start of treatment were Streptococcus pneumoniae (51.5%), Haemophilus influenzae (45%) and Moraxella catarrhalis (30.2%). Rates of beta-lactamase positivity were 32.1% and 95.3% for H. influenzae and M. catarrhalis, respectively. Decreased susceptibility of S. pneumoniae to penicillin was found in 39.7% of isolates. Clinical efficacy was 87.8% (223/254) for cefixime and 87.0% (215/247) for amoxicillin-clavulanate. At the 5-week follow-up visit, relapse had occurred in 15.7% (31/197) of cefixime-treated patients and in 15.6% (32/205) of those treated with amoxicillin-clavulanate. We conclude that these two regimens are equally effective in acute otitis media in children.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacteria; Cefixime; Cefotaxime; Cephalosporins; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Humans; Infant; Nasopharynx; Otitis Media

Two hundred and thirty-eight in-patients with signs and symptoms of acute purulent bronchitis or purulent exacerbation of chronic bronchitis at stage 1 and 2 of Anthonisen's classification were enrolled in 11 Centers and randomly assigned to one of the following 3 treatment groups: group A, cefodizime 1 g i.m. qD; group B, cefodizime 1 g i.m. BID; group C, ceftriaxone 1 g i.m. qD. Bacteriological results after treatment were satisfactory in 64 patients (91.4%) of group A, 64 (92.8%) of group B and 74 (94.9%) of group C. Global clinical results after treatment showed satisfactory efficacy in 57 patients (79.2%) of group A, 59 (85.5%) of group B and 63 (80.8%) of group C. There was no statistically significant difference in improvement in single symptoms, global bacteriological or clinical results between the 3 groups. Mild adverse events occurred in only 3 patients (one per group).

Topics: Acute Disease; Bronchitis; Cefotaxime; Ceftriaxone; Cephalosporins; Chronic Disease; Drug Administration Schedule; Female; Humans; Injections, Intramuscular; Male

Cefprozil was evaluated in the treatment of acute otitis media with effusion in three open, randomized, multicenter comparative clinical trials. In two trials, 891 pediatric patients were enrolled to either cefprozil or amoxicillin-clavulanate dosage regimens. The treatment groups were comparable in demographic characteristics, and presented with otalgia, middle-ear effusion, or inflamed or bulging tympanic membrane on otoscopic examination. In all patients, tympanocentesis and a culture were required. Two cefprozil oral doses were evaluated, 30 mg/kg/day and 40 mg/kg/day divided into two equal doses (b.i.d.). Amoxicillin-clavulanate was administered at 40 mg/kg/day in three divided doses (t.i.d.). The recommended duration of therapy was ten days. The predominant bacteria isolated were Haemophilus influenzae and Moraxella catarrhalis. The overall satisfactory clinical response rates were similar for cefprozil (83%) and amoxicillin-clavulanate (81%). The bacteriological response rates did not differ significantly, at 84% and 82%. Cefprozil eradicated the most common pathogen, Streptococcus pneumoniae, more often at 91%, vs. 84% for amoxicillin-clavulanate. The eradication rates were similar against Haemophilus influenzae and Moraxella catarrhalis. The patients treated with cefprozil had a lower rate of adverse clinical events (11%) compared to those with amoxicillin-clavulanate (20%). More gastrointestinal adverse experiences, including diarrhea, were reported in the amoxicillin-clavulanate-treated patients. In Study 3, cefprozil 30 mg/kg/day (b.i.d.) was compared to cefaclor 40 mg/kg/day (t.i.d.) and cefixime 8 mg/kg/day (q.d) in the treatment of acute otitis media in 388 pediatric patients. The patients were treated for 10 days, with a follow-up of 18 days. The overall clinical cure rates were 85%, 89% and 85%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Cefaclor; Cefixime; Cefotaxime; Cefprozil; Cephalosporins; Child; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Multicenter Studies as Topic; Otitis Media; Randomized Controlled Trials as Topic

To compare the use of once-a-day cefpodoxime proxetil to once-a-day cefixime in the treatment of acute suppurative otitis media.. Randomized, multicenter, investigator-blinded.. Outpatient.. A total of 368 patients (age 2 months to 17 years) were randomized to receive either cefpodoxime or cefixime in a 2:1 ratio (245 cefpodoxime, 123 cefixime); 236 patients (155 cefpodoxime, 81 cefixime) were evaluable for drug efficacy.. Patients received either cefpodoxime proxetil oral suspension (10 mg/kg/day, once daily for 10 days) or cefixime oral suspension (8 mg/kg/day, once daily for 10 days).. Clinical evaluations were performed before treatment (study day 1), at an interim visit (study day 3 through 6), at the end of therapy (study day 12 through 15), and at final follow-up (study day 25 through 38). Microbiologic evaluations were performed at enrollment and whenever appropriate thereafter.. End-of-therapy clinical cure rates in evaluable patients were 56% for the cefpodoxime group and 54% for the cefixime group. Clinical improvement rates were 27% for both groups. Clinical response rates were not significantly different between treatment groups (P = .541; 95% confidence interval = -8.1%, 15.2%). At long-term follow-up, 17% of patients in the cefpodoxime group and 20% in the cefixime group had a recurrence of infection. Drug-related adverse events (eg, diarrhea, diaper rash, vomiting, rash) occurred in 23.3% of cefpodoxime-treated patients and 17.9% of cefixime-treated patients (P = .282).. These findings suggest that cefpodoxime proxetil administered once daily is as effective and safe as cefixime given once daily in the treatment of acute suppurative otitis media in pediatric patients.

Topics: Acute Disease; Adolescent; Anti-Infective Agents; Cefixime; Cefotaxime; Cefpodoxime Proxetil; Ceftizoxime; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Otitis Media, Suppurative; Prodrugs; Statistics as Topic; Treatment Outcome

Factors affecting outcome were analyzed from 3 antibiotic clinical trials that had identical case definition and outcome criteria. Overall 102 subjects with acute otitis media had an initial tympanocentesis, were enrolled in one of the clinical trials, were randomized to receive 10 days of oral treatment and had a posttherapy visit. The antibiotics used were cefixime (38), cefaclor (25), loracarbef (14), amoxicillin plus clavulanate (16) or amoxicillin (9). Fifty-five of the 102 (54%) study subjects were classified as cured or improved at the 21- to 28-day posttherapy visit. Factors analyzed in relation to outcome included antibiotic administered, isolation of a pathogen from the middle ear aspirate, study subject age and sex, history of recurrent otitis media, unilateral vs. bilateral involvement, season of enrollment and history of antibiotic administration in the month before enrollment. Univariate analysis identified the following four factors associated with higher posttherapy visit failure rates: a history of recurrent otitis media; enrollment during winter respiratory season (December through March); a history of being treated with an antibiotic during the month before enrollment; and administration of cefaclor compared with other antibiotics. However, only a history of recurrent otitis media and enrollment during the winter respiratory season met the 0.05 significance level for entry into a model derived from logistic regression to assess interactions among factors. Clinical guidelines for the management of otitis media should take into consideration that children with a prior history or recurrent otitis media and infection during the winter season more often fail to respond to antibiotic treatment and have a higher risk of developing a persistent middle ear effusion.

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Cefaclor; Cefixime; Cefotaxime; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Follow-Up Studies; Humans; Infant; Male; Otitis Media; Regression Analysis; Risk Factors; Treatment Outcome

In this randomized, investigator-blinded multicenter study, tympanocentesis for acute otitis media with effusion in 137 ears from 108 children, 6 months to 12 years of age, revealed 84 definite pathogens and 32 potential pathogens. Twenty-nine aspirates from 23 subjects were sterile. Of the 116 isolates 42 (36%) were Streptococcus pneumoniae, 24 (21%) were Haemophilus influenzae, 9 (8%) were Moraxella catarrhalis, 9 (8%) were Streptococcus pyogenes and 1 (1%) was Staphylococcus aureus. Twenty-two (19%) definite pathogens produced beta-lactamase. Patients were randomized to cefixime (8 mg/kg/day daily) or cefaclor (40 mg/kg/day divided into two doses). Efficacy was determined by pneumatic otoscopy and tympanometry at the end of therapy visit on Days 11 to 14 and up to 4 weeks of follow-up. At end of therapy subjects with definite pathogens exhibited a satisfactory clinical outcome in 26 of 36 (72%) ears for cefaclor and 40 of 48 (83%) ears for cefixime recipients (P = 0.12). For ears with beta-lactamase-producing isolates there were no (0 to 12) cefixime failures but 4 of 10 cefaclor failures (P = 0.03). Diarrhea/loose stools were more frequent in cefixime (16 of 58) than cefaclor (4 of 50) recipients. One cefixime subject required discontinuation of drug. Overall efficacy for treatment of acute otitis media with effusion was not different; however, cefixime appeared more effective for infections caused by beta-lactamase-producing organisms.

Topics: Acute Disease; Anti-Infective Agents; Cefaclor; Cefixime; Cefotaxime; Child; Child, Preschool; Double-Blind Method; Drug Administration Schedule; Drug Resistance, Microbial; Female; Humans; Infant; Male; Otitis Media with Effusion

The efficacy of cefixime was compared with that of cefaclor in the treatment of 63 patients with acute otitis media. Patients received either a single dose of cefixime (8 mg/kg/day) or 3 divided doses of cefaclor (40 mg/kg/day). On the basis of otoscopic and tympanometric results at 10 to 14 days after the start of treatment, 28 (97%) of 29 cefixime-treated patients and 25 (78%) of 32 cefaclor-treated patients had resolution of acute otitis media. The clinical cure rate associated with all organisms was 94% for cefixime (16 of 17 isolates) and 68% (13 of 19 isolates) for cefaclor. The cure rate for Streptococcus pneumoniae was 12 of 12 (100%) for cefixime and 7 of 7 (100%) for cefaclor; the cure rate for Haemophilus influenzae (which includes 2 patients with mixed infections) was 3 of 4 (75%) for cefixime and 2 of 7 (29%) for cefaclor. One clinical relapse occurred among 29 cefixime-treated patients; however, at 28 days 9 recurrences were observed. Three of 25 (9%) cefaclor-treated patients failed and 4 (13%) relapsed at 10 to 14 days, an additional 2 (10%) experienced recurrence by Day 28. Eight (28%) cefixime-treated patients experienced adverse events (7 gastrointestinal and 1 diarrhea and rash); 8 (25%) cefaclor-treated patients experienced adverse events (all gastrointestinal). Our data suggest that both at end of therapy and for 14 days thereafter, cefixime given once a day for acute otitis media is clinically equivalent to cefaclor given 3 times a day.

Topics: Acute Disease; Cefaclor; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Male; Otitis Media with Effusion; Prospective Studies; Single-Blind Method

To compare the efficacy of cefixime with amoxicillin in the treatment of acute otitis media in children.. Randomized, nonblinded study.. General pediatric clinic at a university hospital in Texas.. A volunteer sample of 201 children, aged 2 months through 6 years.. A 10-day oral course of cefixime (8 mg/kg per day administered once daily) or amoxicillin (40 mg/kg per day administered in three divided doses [every 8 hours]).. Tympanocentesis for bacterial culture was performed on all affected ears on enrollment and after 4 to 6 days of therapy. The patients were evaluated clinically 4 to 6 days after starting therapy, at the end of therapy, and 3 to 4 weeks after therapy was completed. Using Fisher's Exact Test, no significant difference was found between the two treatment groups for rate of clinical improvement or rate of eradication of Haemophilus influenzae and Streptococcus pneumoniae. However, combining the results from this study and two previously reported studies, cefixime was found to be more effective in eradication of H influenzae and less effective in eradication of S pneumoniae.

Topics: Acute Disease; Administration, Oral; Amoxicillin; Anti-Infective Agents; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Male; Otitis Media; Outpatient Clinics, Hospital; Patient Compliance; Texas; Treatment Outcome

The efficacy and safety of cefixime, the first oral third-generation cephalosporin, were evaluated in a multicenter clinical trial involving 118 adult patients with acute sinusitis or acute exacerbations of chronic sinusitis. Patients received a single daily dose of 400 mg of cefixime for a mean duration of 10 days; 106 patients completed a course of therapy. Clinical cure and improvement were achieved in 90% of these patients (61% cured and 29% improved). Among the patients evaluated again 2 weeks after therapy, 91% had a sustained clinical cure or improvement. Sinus exudate specimens were obtained from all patients by transantral puncture before therapy. Pathogens were isolated from 76 patients (66%), the most common pathogens being Haemophilus influenzae, alpha-hemolytic streptococci, and Streptococcus pneumoniae. Eighty-six percent of pathogens were presumed eradicated. Three patients discontinued therapy because of side effects. The most frequently reported adverse effects were gastrointestinal, with 20% of patients reporting diarrhea. Cefixime was effective in the treatment of bacterial sinus infections in adults and was well tolerated.

Topics: Acute Disease; Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Bacterial Infections; Cefixime; Cefotaxime; Chronic Disease; Female; Follow-Up Studies; Gastrointestinal Diseases; Humans; Incidence; Male; Maxillary Sinusitis; Microbial Sensitivity Tests; Middle Aged; Outpatient Clinics, Hospital; Patient Dropouts; Radiography; Recurrence; Suction; Treatment Outcome

Topics: Acute Disease; Administration, Oral; Anti-Infective Agents; Cefixime; Cefotaxime; Clinical Protocols; Colony Count, Microbial; Cystitis; Fluoroquinolones; Ofloxacin; Quinolones; Recurrence; Treatment Outcome; Urine

A comparative study of cefixime (CFIX), a new oral cephem antibiotic, was carried out at the Department of Urology, Nagoya University Hospital and its four affiliated hospitals to evaluate the clinical efficacy and safety of two dosage regimens of CFIX, given either in twice daily doses (BID group) or once daily dose (UID group), in the treatment of acute uncomplicated cystitis. Forty six female patients (BID group) were administered the daily dose of 200 mg in two divided doses for 3 days, 30 female patients (UID group) were administered 200 mg once daily for 3 days. The clinical efficacy was evaluated in 33 cases from the BID group and in 22 cases from the UID group, respectively, according to the criteria recommended by the Japan UTI Committee. In the BID group, the clinical efficacy was evaluated as excellent in 18 cases, moderate in 13 and poor in 2, with an overall clinical effectiveness rate of 94%. In the UID group, it was evaluated as excellent in 9 cases, moderate in 12 and poor in 1, with an overall clinical effectiveness rate of 96%. Safety was monitored in 71 patients, and only one case of stomatitis was seen in the UID group. This findings suggest that 200 mg once daily dosing regimen of cefixime is as effective as 100 mg twice daily dosing regimen in treatment of acute uncomplicated cystitis, and is well tolerated in terms of safety.

Topics: Acute Disease; Administration, Oral; Adult; Aged; Cefixime; Cefotaxime; Cystitis; Drug Administration Schedule; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Middle Aged

In two randomized clinical trials in children with otitis media, the efficacy and safety of cefprozil are compared to those of amoxicillin/clavulanate (n = 530) and of cefaclor and cefixime (n = 394). The rate of clinical cure or improvement was similar among patients receiving each drug regimen, ranging from 78% for amoxicillin/clavulanate to 89% for cefaclor; for cefprozil, this rate was 84% and 85% in the two studies, respectively. In the first study, cefprozil was superior to amoxicillin/clavulanate in the satisfactory clinical response rate for Streptococcus pneumoniae (P = .049), but response rates were similar for Haemophilus influenzae and Moraxella catarrhalis. Significantly more patients treated with amoxicillin/clavulanate (P less than .001) in the first study or cefixime (P less than .01) in the second study developed diarrhea than did those treated with cefprozil. We conclude that cefprozil therapy for otitis media in children produces clinical and bacteriologic response rates similar to those seen with amoxicillin/clavulanate, cefixime, or cefaclor. Furthermore, diarrhea was significantly less common with cefprozil than with cefixime or amoxicillin/clavulanate.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Cefaclor; Cefixime; Cefotaxime; Cefprozil; Cephalosporins; Child; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Humans; Infant; Otitis Media with Effusion

In randomized, double-blind trials of antibiotic therapy for acute otitis media that determined both clinical and bacteriologic outcomes, clinical success rates were (93%) 236 of 253 for patients with bacteriologic success, (62%) 25 of 40 for those with bacteriologic failure, and (80%) 124 of 155 for those with nonbacterial acute otitis media. These rates were used to calculate the effectiveness of three strategies for assessing drug efficacy: (1) tympanocentesis and culture before and during therapy (bacteriologic efficacy), (2) tympanocentesis before therapy and assessment of clinical efficacy in bacterial acute otitis media, and (3) no tympanocentesis and assessment of clinical efficacy in clinical (total) acute otitis media. For a drug with a bacteriologic efficacy of 100%, calculated clinical efficacy was 93% for bacterial acute otitis media and 89% for clinical acute otitis media. For a drug with bacteriologic efficacy of 27%, a rate consistent with no antibacterial therapy, efficacy was 71% for bacterial acute otitis media and 74% for clinical acute otitis media. We conclude that if efficacy is measured by symptomatic response, drugs with excellent antibacterial activity will appear less efficacious than they really are and drugs with poor antibacterial activity will appear more efficacious than they really are. The predominant phenomenon is that drugs with poor antibacterial activity will appear to be clinically effective in the treatment of acute otitis media.

Topics: Acute Disease; Amoxicillin; Ampicillin; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Cefaclor; Cefixime; Cefotaxime; Clavulanic Acid; Clavulanic Acids; Double-Blind Method; Drug Combinations; Efficiency; Enzyme Inhibitors; Female; Haemophilus influenzae; Humans; Infant; Male; Moraxella catarrhalis; Otitis Media; Punctures; Streptococcus pneumoniae; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tympanic Membrane

Pathogenic bacteria were isolated from 90% of patients with acute otitis media. This higher-than-expected rate of positive cultures was probably related to the meticulous bacteriologic techniques used.

Topics: Acute Disease; Adolescent; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacteria; Bacteriological Techniques; Cefixime; Cefotaxime; Cefpodoxime Proxetil; Ceftizoxime; Cephalosporins; Child; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Haemophilus influenzae; Humans; Infant; Moraxella catarrhalis; Otitis Media; Prodrugs; Punctures; Recurrence; Single-Blind Method; Streptococcus pneumoniae; Tympanic Membrane

A placebo-controlled prospective randomised double-blind study was performed in 80 consecutive female outpatients with acute cystitis. Single dose oral antibiotic treatment was successful in 89.4% of patients treated with cefixime 400mg or ofloxacin 200mg and in 84.2% of those receiving cotrimoxazole (160/800mg). Bacteriuria was eradicated in 26.3% of patients in the placebo group. Two noncomparative clinical trials involving a total of 43 male patients with acute gonococcal urethritis reported a 100% cure rate after administration of a single 400mg dose of cefixime. Such single dose regimens offer the advantages of reduced expense, good tolerability, minimal alteration of normal bacterial flora, and the potential for improved patient compliance, compared with multiple dose antibacterial therapy.

Topics: Acute Disease; Administration, Oral; Cefixime; Cefotaxime; Cystitis; Double-Blind Method; Female; Gonorrhea; Humans; Male; Urethritis

In a noncomparative trial, 73 adults with acute sinusitis confirmed by x-ray received cefixime 400mg once daily for approximately 10 days. At the end of treatment, 60 patients (82%) were cured, 2 (2.7%) had improved and 7 (9.6%) had failed therapy; 4 patients were not evaluable. No relapses were observed at follow-up. Haemophilus influenzae, Streptococcus pneumoniae and Branhamella (Moraxella) catarrhalis were the main pretreatment pathogens, accounting for 65% of all bacterial isolates. Overall, 84% of pathogens were eradicated after treatment. Cefixime was well tolerated, moderate gastrointestinal disturbances being the most frequent adverse effects noted (3 of 4 patients with adverse effects). These results are comparable to those obtained with cefixime 400mg administered orally in 2 divided doses.

Topics: Acute Disease; Adult; Aged; Cefixime; Cefotaxime; Drug Tolerance; Female; Humans; Male; Middle Aged; Sinusitis

Cefixime is a new oral cephamycin antibiotic with a broad spectrum of antibacterial activity in vitro. It is resistant to hydrolysis by most beta-lactamases and has pharmacokinetic characteristics which allow administration in a single daily dose for the treatment of some bacterial infections. The aim of this study was to compare the clinical efficacy of cefixime with that of amoxicillin in the treatment of acute otitis media in 40 children. Cefixime 8 mg/kg was given once daily at bedtime, whereas amoxicillin 50 mg/kg/day was administered in 3 divided doses; both drugs were given for 10 days. 15 days after starting the trial, a favourable clinical response was demonstrated in 18 of 20 children in both treatment groups. Cure rates, recurrences and persistent middle ear effusions were not significantly different in the 2 study groups during a 3-month follow-up. It was concluded that cefixime is clinically effective and well tolerated in the treatment of children with acute otitis media.

Topics: Acute Disease; Amoxicillin; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Otitis Media

A large scale multicentre clinical study was undertaken to assess the efficacy and tolerability of cefixime in the treatment of acute otitis media in children. A total of 25,863 evaluable children with acute otitis media received cefixime 8 mg/kg once daily for at least 10 days. At the end of treatment, 86% of patients were considered to be either cured or improved. These results are consistent with those achieved with cefixime in controlled clinical trials. Adverse effects were reported in 11.5% of patients, but were judged to be related to cefixime therapy in only 9.4% of patients. The results of this study demonstrate that cefixime is an effective and well tolerated treatment for acute otitis media in children.

Topics: Acute Disease; Cefixime; Cefotaxime; Child; Child, Preschool; Drug Tolerance; Female; Humans; Infant; Infant, Newborn; Male; Otitis Media

Cefixime was compared with amoxicillin for treatment of acute otitis media in a randomized trial. Results of tympanocentesis on day 3 to 5 of therapy were used as the major outcome. Total daily doses were 8 mg/kg of cefixime and 40 mg/kg of amoxicillin. One hundred twenty-six patients were randomly assigned to receive treatment; 64 cultures grew pathogens. Pathogens were eradicated from the middle ear after 3 to 5 days of therapy in 27 (79.4%) of 34 children given amoxicillin and 26 (86.7%) of 30 children given cefixime (p = 0.47). When Streptococcus pneumoniae cases were analyzed, bacteriologic cure occurred in 14 (93.3%) of 15 children given amoxicillin and 12 (75%) of 16 given cefixime (p = 0.333). When cases of Haemophilus influenzae infection were analyzed, significantly more cures occurred with cefixime (10/10, 100%) than amoxicillin (8/13, 62%) (p = 0.046). Pathogens associated with failure of amoxicillin therapy were H. influenzae (five cases, two beta-lactamase-positive), S. pneumoniae (one case), and Moraxella catarrhalis (one case, beta-lactamase-positive). The four failures with cefixime therapy were all in patients infected with S. pneumoniae. Rates of rash, diarrhea, and vomiting were the same in both groups and did not necessitate stopping therapy. We conclude the following: (1) Cefixime and amoxicillin were equivalent in overall clinical and bacteriologic efficacy for otitis media. (2) Cefixime was more efficacious than amoxicillin in treating H. influenzae otitis media and should be preferred when H. influenzae is the suspected etiologic agent. (3) Side effects of both drugs were mild and equivalent.

Topics: Acute Disease; Adolescent; Amoxicillin; Bacterial Infections; Cefixime; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Haemophilus influenzae; Humans; Infant; Male; Moraxella catarrhalis; Otitis Media; Streptococcus pneumoniae

In a double-blind study cefixime, an oral cephalosporin of the third generation, was compared to cefaclor in the treatment of acute otitis media in 397 children aged 6 months to 12 years. Clinical evaluation was carried out at the beginning, at day 10-12 and day 28-35 after the start of the treatment. Specimens for bacterial culture and sensitivity testings were taken from the nasopharynx at the initial visit. Patients were randomized either to cefixime in a dose of 8 mg/kg/day or cefaclor in a dose 40 mg/kg/day in the proportion of 2 cefixime patients to 1 cefaclor patient. Two daily doses were administered for 7 days. At day 10-12, 93.5% in the cefixime group and 90.5% in the cefaclor group (p = 0.08) were clinically cured or improved. At day 28-35 the rate of cured or improved patients had decreased, mostly due to reinfections, to 90.1% in the cefixime group and to 86.6% in the cefaclor group (p = 0.12), respectively. 375 patients (69.9%) had positive bacterial culture in the nasopharynx of at least one strain of Haemophilus influenzae, Streptococcus pneumoniae, Branhamella (Moraxella) catarrhalis or combinations of these 3.73.6% of the B. catarrhalis strains were beta-lactamase producing and 11.4% of the H. influenzae strains, respectively. All isolated bacteria were sensitive to cefixime. Adverse events were reported in 17.9% in the cefixime and 10.6% in the cefaclor group. Most reactions were of moderate or mild nature and mostly affected skin or the gastrointestinal region. No serious adverse experiences occurred. In view of the good clinical results obtained cefixime seems to be at least as effective as cefaclor in the treatment of acute otitis media in children.

Topics: Acute Disease; Anti-Bacterial Agents; Cefaclor; Cefixime; Cefotaxime; Child; Child, Preschool; Diarrhea; Double-Blind Method; Female; Haemophilus influenzae; Humans; Infant; Male; Moraxella catarrhalis; Otitis Media with Effusion; Streptococcus pneumoniae

The efficacy and tolerance of cefodizime in the treatment of acute pyelonephritis were evaluated in an open, international, multicentre study. In total, 128 patients were treated with 1 g cefodizime bd iv or im for a mean of 8.3 days. Underlying urinary tract abnormalities were present in 35% of cases. The most frequently isolated bacteria were Escherichia coli (79/97 evaluable cases) and Proteus mirabilis (8/97 evaluable cases). The overall clinical and bacteriological success rate was 89.7% (87/97). The drug was well tolerated, with only a few mild and transitory adverse events. Tolerance at the site of injection was good in 97.5% (78/80) of those treated iv, and 79% (38/48) of those treated im. Three patients had skin reactions which were probably related to cefodizime. Alterations of laboratory parameters were seen transiently in five patients (3.9%). Cefodizime is effective and well tolerated in the treatment of acute pyelonephritis.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Cefotaxime; Female; Humans; Male; Middle Aged; Pyelonephritis

In a prospective, open clinical study, 50 urological patients with acute pyelonephritis were treated with the oral cephalosporin cefixime. The medication (2 x 200 mg/day) was given for seven to ten days. Clinical, bacteriological as well as hematological examinations were carried out prior to, during and immediately after therapy. A late check-up was performed five to nine days after the end of therapy. 46 of the 50 cases were evaluable for efficacy, and all 50 patients were included in safety evaluation. The most frequent pathogens isolated prior to therapy were Escherichia coli (34 times), Proteus mirabilis (six times), Klebsiella pneumoniae (twice) and coagulase-negative staphylococci (twice). Immediately after the end of therapy the pathogens were eradicated in 44 (97.5%) patients. At the late check-up the urine was sterile in 29 (63%) patients. A relapse was observed in 11 patients, a reinfection in four and the initially isolated pathogens had persisted in two. Immediately after the end of therapy 44 (95.7%) patients were clinically cured and two patients had improved. At the late check-up 41 patients were classified as clinically cured, three showed improvement, and two improvement with relapse. Adverse reactions (one case nausea and exanthem, and one case of meteorism) occurred in two patients. No changes in the blood counts or in the liver and kidney functions were observed. In the study described here cefixime proved to be an effective and well tolerated antibiotic for the treatment of upper urinary tract infections; it is of particular interest that 16 of the 50 patients presented with underlying disease favoring infection.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Body Temperature; Cefixime; Cefotaxime; Drug Tolerance; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Leukocyte Count; Male; Middle Aged; Prospective Studies; Proteus Infections; Pyelonephritis; Recurrence; Staphylococcal Infections

Patients with purulent exacerbation of chronic bronchitis were randomized to receive either a single 400-mg daily dose of cefixime or 250 mg of cephalexin, orally, four times a day. Patients were males with a mean age of 63 years. Of the 86 patients, 71 (82%) had bronchitis caused by a single organism (29 by Haemophilus influenzae, 27 by Branhamella catarrhalis, 9 by gram-negative enteric organisms, 6 by Streptococcus pneumoniae), while more than one pathogen was implicated in 15 patients (18%). A total of 70.8% of the cefixime group and 50% of the cephalexin group were clinically cured (chi 2 = 3.89, P less than 0.05); however, when the categories of cured and improved were combined, no significant difference was noted between treatment groups (chi 2 = 3.39, P = 0.06). Analysis of side effects included all 130 evaluable and nonevaluable patients: diarrhea was noted in six patients in the cefixime group and none of the patients in the cephalexin group (P = 0.013 by the Fisher exact test). The diarrhea was mild and self-limited in all cases. B. catarrhalis has emerged as a major cause of exacerbation of bronchitis in our experience; there is an increased need to emphasize the examination of sputum samples by Gram staining if cost-effective antibiotic choices are to be made; any empirically chosen antibiotic should have activity against beta-lactamase-producing strains of B. catarrhalis as well as S. pneumoniae and H. influenzae.

Topics: Acute Disease; Bronchitis; Cefixime; Cefotaxime; Cephalexin; Chronic Disease; Gram-Negative Bacteria; Haemophilus Infections; Haemophilus influenzae; Humans; Moraxella catarrhalis; Pneumococcal Infections; Randomized Controlled Trials as Topic; Respiratory Tract Infections

In a double-blind prospective study, 180 patients admitted to hospital with acute purulent exacerbations of chronic bronchitis were treated for seven days with twice daily 1 g intramuscular injections of either cefodizime or cefotaxime. Sputum cultures performed before, during and immediately after treatment showed complete eradication of the infection in 89/90 given cefodizime and 86/90 receiving cefotaxime. Some symptomatic Pseudomonas aeruginosa superinfections occurred with each agent. During the follow-up week, recurrences or reinfections after apparent clearance occurred in 15 patients given cefodizime and in 21 receiving cefotaxime. Pharmacokinetic studies in blood showed mean Cmax values of 50.8 mg/l for cefodizime and 36.5 mg/l for cefotaxime, corresponding values in the sputum being 1.61 and 0.62 mg/l. Mean AUC values in both blood and sputum were 2 1/2- to 3-fold higher for cefodizime. Some features suggested better performance by cefodizime than by cefotaxime, but the clinical results were not statistically significantly different.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bronchitis; Cefotaxime; Chronic Disease; Double-Blind Method; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Randomized Controlled Trials as Topic; Sputum

This randomized, multicentre prospective study was undertaken to compare the efficacy and tolerance of a one day course of injectable cefotaxime with a five day oral course of co-amoxyclav (amoxycillin plus clavulanic acid) in the treatment of acute otitis media in children. The study was conducted in 116 patients between the ages of three months and 12 years. No significant difference in efficacy was observed between the two treatment groups, but tolerance to the treatments differed significantly. There were no unwanted side-effects in the cefotaxime group whereas 22% of children in the amoxycillin plus clavulanic acid group suffered side-effects (P 0.0007). Short-course antibiotic therapy with cefotaxime appears to be a valuable alternative to conventional treatment regimens for acute otitis media in children.

Topics: Acute Disease; Amoxicillin; Cefaclor; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Clavulanic Acid; Clavulanic Acids; Drug Therapy, Combination; Female; Humans; Infant; Male; Otitis Media

Fifty-eight infants and children with acute otitis media were prospectively studied for bacterial and viral pathogenesis and response to antibiotic therapy. Tympanocentesis for bacterial and viral cultures of middle ear fluids (MEF) was done before and 2-4 days after beginning treatment. Patients were followed until the end of antibiotic course. Bacteria were cultured from the preantibiotic MEF in 43 cases (74%). Viruses were cultured from the preantibiotic MEF in 11 cases (19%); all of these MEFs also contained bacterial pathogens. A significantly higher proportion of patients with both virus and bacteria (50%) failed to respond with clearing of bacteria 2-4 days into therapy compared with the group with bacteria alone (13%). The patients with persistently positive viral cultures of the MEF seemed to have purulent otitis of longer duration. Presence of virus in the MEF may interfere with bacteriologic and clinical responses to antibiotic. The mechanism of interference deserves further investigation.

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Bacterial Infections; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Otitis Media with Effusion; Prospective Studies; Random Allocation; Virus Diseases

Cefixime is a new oral cephalosporin with the same activity as that of third generation cephalosporins, particularly against organisms responsible for lower respiratory tract infections. The effectiveness and safety of cefixime were evaluated in the multicentre study reported here. Cure was obtained in 54 of 61 assessable patients suffering from bronchopneumonia (40/44), acute bronchitis (3/5) or acute exacerbations of chronic bronchitis (11/12). The causative agents were eradicated in 35 of 41 assessable cases. No clinical side-effect was observed. Thrombocytosis without clinical manifestations was reported in 14 cases. Administered in doses of 200 mg twice daily, cefixime proved effective and safe in the treatment of lower respiratory tract infections.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Cefixime; Cefotaxime; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Multicenter Studies as Topic; Respiratory Tract Infections

Cefixime (CFIX) was administered 200 mg (2 divided doses) per day to 154 female patients with acute uncomplicated cystitis. Ninety four of the 154 patients who satisfied the criteria proposed by the UTI Committee, Japan were examined for the efficacy of the treatment, but 151 of 154 patients were included in the study of the side effects of the drug. The overall clinical efficacy was excellent in 80.8% and moderate in 18.1% of the patients. Ninety five (97.9%) of 97 strains which were isolated from the patients were eradicated in the urinary specimens by the treatment. Subjective side effects were observed in only one (0.7%) of the 151 patients, who complained of a sensation of heaviness in the head. No drug-related aggravation in the laboratory test was observed except for three patients who showed mild elevation glutamic pyruvic transaminase, alkaline phosphatase and blood urea nitrogen. These results showed that the oral administration of CFIX was excellent and satisfactory in the treatment for acute uncomplicated cystitis.

Topics: Acute Disease; Bacterial Infections; Cefixime; Cefotaxime; Clinical Trials as Topic; Cystitis; Female; Humans; Multicenter Studies as Topic

We randomly assigned 21 patients with painful Lyme neuroborreliosis radiculitis (Bannwarth's syndrome) and neuroborreliosis meningitis to a 10-day treatment with either penicillin G. 4 x 5 million U/d (n = 10) or cefotaxime sodium, 3 x 2 g/d (n = 11), intravenously. We were not able to demonstrate clinical differences between groups, either during the 10-day treatment period or at follow-up examination a mean of 7.7 months after antibiotic therapy. Cerebrospinal fluid cefotaxime concentrations reached the minimum inhibitory concentration at the 90% level for Borrelia burgdorferi in all patients, while none of the patients treated with penicillin G had cerebrospinal fluid concentrations above the minimum inhibitory concentration at the 90% value. We conclude that patients with acute neurologic manifestations of Lyme borreliosis may benefit from a 10-day treatment with cefotaxime or penicillin G. Cerebrospinal fluid antibiotic concentrations above the minimum inhibitory concentration at the 90% value, as observed in all patients treated with cefotaxime, offer the most hope for long-term prognosis.

Topics: Acute Disease; Aged; Cefotaxime; Female; Humans; Lyme Disease; Male; Middle Aged; Nervous System Diseases; Penicillin G; Prospective Studies; Radiculopathy

A total of 325 eligible paediatric patients were entered into an open, randomised, multicentre general practice study to assess the comparative efficacy of a new third-generation oral cephalosporin, cefixime, with respect to that of amoxycillin in the treatment of acute otitis media. The dose of cefixime was 100 mg once daily (six months to five years), 200 mg once daily (five to 10 years) and 300 mg once daily (10 to 16 years). The dose of amoxycillin was as currently used by the participating general practitioners: 62.5 mg tds (six months to one year), 125 mg tds (one to seven years) and 250 mg tds (seven to 16 years). Both were in the form of an oral suspension. The two groups (160 patients on cefixime and 165 on amoxycillin) were comparable at study entry with respect to all parameters assessed. Overall there was a 95 per cent favourable clinical response seen in both groups (95 per cent confidence limits: 92 and 98 per cent respectively). Adverse events were comparable in both groups, except that there were more gastrointestinal side effects seen with cefixime (13 per cent) compared with amoxycillin (4 per cent), but only three patients in each group had to be withdrawn because of side effects. These results demonstrate that cefixime given once daily is a safe and effective alternative to amoxycillin in the treatment of acute otitis media in children, and also has the advantage of less frequent dosing.

Topics: Acute Disease; Adolescent; Amoxicillin; Cefixime; Cefotaxime; Child; Child, Preschool; Family Practice; Female; Humans; Infant; Male; Multicenter Studies as Topic; Otitis Media; Random Allocation

In this 31-site multicenter trial, 565 adult patients with urinary tract infections were randomly assigned to receive either a 10-day course of cefixime 400 mg once daily (n = 279) or amoxicillin 250 mg three times daily (n = 286). Although all patients were included in the safety analysis, only 93 (33 percent) cefixime-treated and 99 (35 percent) amoxicillin-treated patients were fully evaluable for the efficacy analysis. One week after therapy, the evaluable patients treated with cefixime demonstrated a 90 percent clinical cure rate and a 92 percent eradication rate of the baseline pathogen. This compared with an 83 percent clinical cure rate and an 84 percent bacterial eradication rate in the amoxicillin-treated group. The most frequently isolated pathogen was Escherichia coli (80 percent) followed by Proteus mirabilis (10 percent). One hundred thirty-seven (49 percent) of the 279 cefixime-treated and 126 (44 percent) of the 286 amoxicillin-treated patients reported at least one adverse experience during the study. Adverse reactions associated with cefixime were similar to those reported for other beta-lactam antibiotics. The most frequent adverse experiences reported by cefixime-treated patients were diarrhea (15 percent) and stool changes (12 percent). Headaches (11 percent) and diarrhea (9 percent) were the most frequently reported adverse reactions by the amoxicillin-treated patients. Eleven cefixime-treated patients (3.9 percent) and 10 amoxicillin-treated patients (3.5 percent) discontinued therapy because of adverse experiences. Results of this study demonstrate that a once-daily regimen of cefixime is as safe and effective as a three-times-daily regimen of amoxicillin in the treatment of acute urinary tract infections. Although the incidence of bowel changes was somewhat higher in the cefixime treatment group, these events usually resolved when therapy was discontinued.

Topics: Acute Disease; Adolescent; Adult; Aged; Amoxicillin; Cefixime; Cefotaxime; Clinical Trials as Topic; Double-Blind Method; Drug Tolerance; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Random Allocation; Urinary Tract Infections

A double blind study was carried out to compare the efficacy and safety of cefixime (CFIX), a new oral cephem with cefaclor (CCL) in the treatment of 245 children weighing 10 approximately 30 kg, with acute suppurative otitis media. The daily dosages of CFIX and CCL were 3 approximately 6 mg/kg in 2 divided portions, and 20 approximately 40 mg/kg in 3 divided portions, respectively, and the drugs were administered for 7 days. The results obtained in this study are summarized as follows. Analyzed subjects were 211 patients (CFIX group: 108 patients, CCL group: 103 patients) for clinical efficacy. Efficacy rates judged by the doctor in charge were 88.9% and 83.5% in CFIX and CCL group, respectively, without significant difference between the 2 groups. Similar results were also obtained by the committee. When clinical effects were classified by clinical isolates, the efficacy rates against monomicrobial infections with Gram-negative bacteria were judged by the doctor in charge to be 100% in the CFIX group and 84.6% in the CCL group. Thus CFIX was judged to be significantly superior to CCL (P less than 0.05). The overall eradication rates of bacteria were 97.1% in the CFIX group and 90.3% in the CCL group. The eradication rate of CFIX was significantly superior to that of CCL (P less than 0.05). When improvements of individual symptoms were evaluated, regarding redness of the tympanic membrane and the tympanic cavity on the 3rd day of dosing, CFIX group (improvement in 84.1% of the cases) was significantly superior (P less than 0.05) to the CCL group (67.6%). Regarding purulent secretion on the 7th day of dosing, the CFIX group (improvement in 98.1% of the cases) was also significantly superior (P less than 0.05) to the CCL group (91.3%). Two hundred thirty eight patients were analyzed for side effects (CFIX group: 120 patients, CCL group: 118 patients). The incidence rates of side effects were 0.8% (1/120) in the CFIX group and 1.7% (2/118) in the CCL group, and there was no significant difference between the 2 drugs. From the above results, it is concluded that CFIX is a useful oral antibiotic in the treatment of acute suppurative otitis media in children. Furthermore, CFIX is expected to be equal or superior to CCL in clinical effects.

Topics: Acute Disease; Age Factors; Cefaclor; Cefixime; Cefotaxime; Cephalexin; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Humans; Infant; Otitis Media; Otitis Media, Suppurative

The clinical efficacy and safety of cefixime (CFIX), a new oral cephalosporin, were compared with those of cefroxadine (CXD) in patients suffering from acute lacunar tonsillitis in a double blind study. Two hundred and fifty two patients were given each orally 100 mg of CFIX b.i.d. or 250 mg of CXD t.i.d. for, in principle, 7 days. Number of patients evaluated for clinical efficacy was 202 (103 treated with CFIX and 99 treated with CXD). As for the backgrounds of patients, more severe cases were found in the CFIX group than in the CXD group (P less than 0.01). Efficacy rates evaluated by individual doctors were 88.3% in the CFIX group and 91.9% in the CXD group. There was no significant difference between the 2 groups. Efficacy rates on the third day after the initiation of treatment evaluated by the committee were 40.8% in the CFIX group and 47.9% in the CXD group with no significant difference. Efficacy rate on the 7th day, however, was 79.8% in the CFIX group and 93.4% in the CXD group, showing a significant difference (P less than 0.05). Bacteriological effectiveness were satisfactory for both groups with eradication rates of 93.4% for the CFIX and 96.9% for the CXD group. Number of patients evaluated for safety was 226 (110 treated with CFIX and 116 treated with CXD). No significant difference was observed between the 2 drug groups in incidences of side effects; gastrointestinal disturbances or rashes were noted in 6 patients (5.5%) of the CFIX group and in 5 patients (4.3%) of the CXD group. As for the abnormal laboratory findings, elevation of GOT & GPT was observed in 1 patients of the CFIX group. From these results, it was concluded that 100 mg b.i.d. of CFIX was as useful as 250 mg t.i.d. of CXD in the treatment of acute lacunar tonsillitis.

Topics: Acute Disease; Cefixime; Cefotaxime; Cephalosporins; Cephradine; Clinical Trials as Topic; Double-Blind Method; Humans; Tonsillitis

Cefixime, a new third generation cephalosporin antibiotic for oral use, was evaluated for safety and efficacy in the treatment of children with acute otitis media with effusion. Fifteen United States clinical investigators participated in the multicenter clinical trial. One hundred twenty children were randomly assigned to a 10-day course of either cefixime, 8 mg/kg, given daily (qd) (60 patients) or amoxicillin, 40 mg/kg/day, administered in three divided doses (60 patients). Tympanocentesis was performed on each patient before therapy was initiated. Pathogens were isolated from a middle ear aspirate in 88% of the cases. Of the specimens from which pathogens were cultured, 33% yielded Haemophilus sp., 41% Streptococcus pneumoniae and 6% Branhamella catarrhalis. Of the 120 patients, 64 (30 cefixime and 34 amoxicillin) were evaluable for assessment of efficacy. Favorable clinical responses (cure or improvement) were obtained in 93% of cefixime-treated patients and in 94% of amoxicillin-treated patients. Overall, bacteriologic eradication rates (as determined by clinical criteria) were 94 and 95%, respectively. Clinical failure or relapse was documented in 2 of 30 (7%) patients treated with cefixime and in 2 of 34 (6%) patients treated with amoxicillin. Gastrointestinal disturbance and rash were significantly more common in children treated with cefixime (22 and 15%, respectively) than in those taking amoxicillin (8 and 2%, respectively), but in only one case was it necessary to discontinue medication because of these adverse effects (rash). Results of this study demonstrate that cefixime given once daily is as safe and effective as amoxicillin in the treatment of acute otitis media with effusion in children and has the possible advantage of less frequent dosing.

Topics: Acute Disease; Amoxicillin; Cefixime; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Male; Otitis Media with Effusion; Random Allocation

Topics: Acute Disease; Aged; Bacterial Infections; Cefotaxime; Cefotetan; Clinical Trials as Topic; Female; Humans; Male

Topics: Acute Disease; Cefaclor; Cefixime; Cefotaxime; Cephalexin; Child; Child, Preschool; Female; Humans; Infant; Male; Otitis Media with Effusion; Patient Compliance

We have attempted to clinically define the therapeutic usefulness of ceftizoxime suppository (CZX-S) in children with bacterial pneumonia, in a randomized trial. Intravenous injection of ceftizoxime (CZX) was used as the control. The results are summarized below. Subjects were inpatients with bacterial pneumonia, ranging in age from 9 months to 7 years and 10 months. As a rule, the daily dose was either four 250 mg (in potency) suppositories given at 6-hour intervals or 60 mg/kg body weight intravenous CZX (control) given in 4 injections at 6-hour intervals over a period of 7 days. The number of children in the study was 67. These children were divided into 2 dosage groups (suppository, 35; injection, 32) with matching pretreatment background factors. The severity of the target disease in the majority of the children was "moderate". The rate of therapeutic effectiveness was 97.1% for the suppository and 93.8% for the injection, and did not differ significantly between the 2 groups. Rates of efficacy by severity, presence or absence of underlying diseases, daily dose and/or complications were high without exception, and did not differ significantly between the 2 groups. Eradication rates for causative microorganisms, as studied in 16 children of each group, were both 93.8%. The 2 most frequently isolated causative organisms were Haemophilus influenzae and Streptococcus pneumoniae. Side effects were examined for 36 children of each group. The frequency of side effects did not differ significantly between the suppository group (2 with diarrhea and 1 with abdominal pain) and the injection group (1 with urticaria), and 8.3% and 2.8%, respectively. The frequency of abnormal laboratory test findings differed significantly (P less than 0.01) with respect to eosinophilia which occurred in 7 (20.6%) of the injected subjects but was not encountered in the subjects treated with suppositories. Other abnormal laboratory findings included thrombocytosis in 3 (14.3%) of the injection group and increased GOT in 1 (3.2%) of the suppository group. The suppository formulation of CZX appears to be a highly useful substitute for the injectable form, and should find a special use in children whose treatment with injections experiences some difficulty.

Topics: Abdomen; Acute Disease; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Humans; Infant; Injections, Intravenous; Pain; Pneumonia; Suppositories; Urticaria

Topics: Acute Disease; Adult; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Clinical Trials as Topic; Female; Humans; Male; Respiratory Insufficiency

Topics: Acute Disease; Adult; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Female; Humans; Time Factors; Urinary Tract Infections

ABO blood type incompatibility hemolytic disease of newborn (ABO-HDN) and drug-induced immune hemolytic anemia (DIIHA) due to non-immunologic protein adsorption (NIPA) mainly cause extravascular hemolysis. All the reported severe DIIHA were caused by drug-induced antibodies, and rare report of acute intravascular hemolysis was caused by the NIPA mechanism or ABO-HDN.. We report the first case of acute intravascular hemolysis induced by cefotaxime sodium - sulbactam sodium (CTX - SBT) in a case of ABO-HDN which resulted in death at 55 h after birth. The mother's blood type was O and RhD-positive, and the newborn's blood type was B and RhD-positive. No irregular red blood cell (RBC) antibodies or drug-dependent antibodies related to CTX or SBT was detected in the mother's plasma and the plasma or the RBC acid eluent of the newborn. Before the newborn received CTX - SBT treatment, the result of direct antiglobulin test (DAT) was negative while anti-B was positive (2 +) in both plasma and acid eluent. After the newborn received CTX - SBT treatment, the results of DAT for anti-IgG and anti-C3d were both positive, while anti-B was not detected in plasma, but stronger anti-B (3 +) was detected in acid eluent.. The NIPA effect of SBT promoted the specific binding of mother-derived IgG anti-B in newborn's plasma to the newborn's RBC B antigens and formed an immune complex, and then activated complement, which led to acute intravascular hemolysis. Drugs such as SBT with NIPA effect should not be used for newborns with HDN.

Topics: ABO Blood-Group System; Acute Disease; Adsorption; Anemia, Hemolytic; Antigen-Antibody Reactions; Blood Group Incompatibility; Cefotaxime; Complement Activation; Coombs Test; Erythroblastosis, Fetal; Erythrocyte Membrane; Fatal Outcome; Female; Hemolysis; Humans; Immunoglobulin G; Infant, Newborn; Isoantibodies; Male; Maternal-Fetal Exchange; Pregnancy; Sulbactam; Young Adult

Topics: Acute Disease; Anti-Bacterial Agents; Cefotaxime; Child; Clindamycin; Drug Therapy, Combination; Edema; Female; Humans; Magnetic Resonance Imaging; Mastoiditis; Myringoplasty; Osteomyelitis; Temporal Bone

Topics: Acute Disease; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Ciprofloxacin; Combined Modality Therapy; Drainage; Drug Therapy, Combination; Female; Humans; Metronidazole; Parotitis; Self Medication; Streptococcal Infections; Tomography, X-Ray Computed; Viridans Streptococci

The aim of the current study was to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility. We conducted an observational study that included all consecutive episodes of acute pyelonephritis (APN) in adults during 2014 at a Spanish university hospital. From each episode, demographic data, comorbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define the variables associated with antimicrobial resistance. A total of 607 patients, 503 (82.9%) with CA-APN and 104 (17.1%) with HCA-APN, were included in the study. Patients with HCA-APN were older than patients with CA-APN (70.4 versus 50.6 years;

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Ciprofloxacin; Cohort Studies; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Empirical Research; Escherichia coli; Escherichia coli Infections; Female; Hospitals, University; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Pyelonephritis; Risk Factors; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

This study sought to compare the antimicrobial susceptibility rates between acute uncomplicated cystitis patients with failed initial antimicrobial treatment, who were considered unresolved cases, and newly presenting acute uncomplicated cystitis patients without recent antimicrobial use within 3 months and to determine whether different treatment strategies should be applied according to recent antimicrobial exposure (RAE). Female acute uncomplicated cystitis patients with Escherichia coli growth, who visited our hospital's urology department from 2010 to 2014, were divided according to RAE. The antimicrobial susceptibility of E. coli was compared between the group with RAE and the group with no antimicrobial exposure (NAE) within 3 months. The total number of acute uncomplicated cystitis patients with E. coli growth was 259: 40 patients comprised the RAE group and 219 patients formed the NAE group. The mean age was significantly older and previous recurrent cystitis history was higher in the RAE group (p < 0.05). Furthermore, the antimicrobial susceptibility of E. coli to amoxicillin-clavulanic acid, cefotaxime, cefoxitin, ciprofloxacin, and trimethoprim-sulfamethoxazole was significantly lower in the RAE group, with susceptibility results of 64.7%/88.0% (RAE/NAE), 77.5%/89.0%, 79.4%/95.3%, 31.3%/64.2%, and 42.5%/70.6%, respectively. RAE was an independent factor for antimicrobial resistance. This study showed that antimicrobial susceptibilities were significantly lower in acute uncomplicated cystitis patients with failed initial antimicrobial treatment, who are defined as unresolved cases. Our results suggest that first-line antimicrobials might show poor efficacy in cases of unresolved, acute uncomplicated cystitis and alternative or secondary antimicrobials should be considered in these cases.

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefoxitin; Ciprofloxacin; Cystitis; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Recurrence; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Cefotaxime; Child; Drug Hypersensitivity Syndrome; Eosinophilia; Fever; Humans; Hypersensitivity, Delayed; Male; Osteomyelitis; Tibia; Urticaria

Megalocytic interstitial nephritis is a rare form of kidney disease caused by chronic inflammation. We report a case of megalocytic interstitial nephritis occurring in a 45-yrold woman who presented with oliguric acute kidney injury and acute pyelonephritis accompanied by Escherichia coli bacteremia. Her renal function was not recovered despite adequate duration of susceptible antibiotic treatment, accompanied by negative conversion of bacteremia and bacteriuria. Kidney biopsy revealed an infiltration of numerous histiocytes without Michaelis-Gutmann bodies. The patient's renal function was markedly improved after short-term treatment with high-dose steroid.

Topics: Acute Disease; Acute Kidney Injury; Anti-Bacterial Agents; Azithromycin; Bacteremia; Cefotaxime; Creatinine; Escherichia coli; Escherichia coli Infections; Female; Humans; Kidney; Methylprednisolone; Middle Aged; Nephritis, Interstitial; Pyelonephritis; Renal Dialysis; Shock, Septic

This study was performed to compare the therapeutic efficacy of cefuroxime with that of cefotaxime as initial antimicrobial therapies in women with complicated nonobstructive acute pyelonephritis (APN) caused by Enterobacteriaceae infections. The clinical characteristics and outcomes of a cefuroxime-treated group (n = 156) were compared with those of a cefotaxime-treated group (n = 166). Of these 322 women, 90 from each group were matched by propensity scores. The defervescence rates were not significantly different in the cefuroxime and cefotaxime groups at 72 h after the start of antimicrobial therapy (81.1% versus 78.9%, P = 0.709). The clinical and microbiological cure rates during the follow-up visits that were 4 to 14 days after the end of the antimicrobial therapies were not significantly different in the cefuroxime versus cefotaxime groups, which were 97.8% (87/89) versus 97.8% (87/89) (P > 0.999) and 89.5% (68/76) versus 90.7% (68/75) (P = 0.807), respectively. The median hospital stay duration and the median times to defervescence in the cefuroxime versus cefotaxime groups were 8 days (interquartile range [IQR], 7 to 10 days) versus 9 days (IQR, 7 to 11 days), respectively, and 55 h (IQR, 37 to 70 h) versus 55 h (IQR, 35 to 69 h), respectively. Bacteremia, extended-spectrum-β-lactamase-producing Enterobacteriaceae, C-reactive protein levels of ≥ 15 mg/dl, and white blood cell counts of ≥ 15,000/mm(3) of blood had independent effects on the rates of early clinical failure. Our data suggest that the effects of cefuroxime are not different from those of cefotaxime when they are used as an initial antimicrobial treatments for community-onset complicated nonobstructive APN in women.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Community-Acquired Infections; Enterobacteriaceae Infections; Female; Humans; Middle Aged; Pyelonephritis; Retrospective Studies; Treatment Outcome

Acute suppurative parotitis is a rare disease in childhood. Its incidence is higher in premature newborns. Parotid swelling and pus drainage from Stenson's duct is pathognomonic, and Staphylococcus aureus is the causative agent in most cases. Here, a 33-day-old patient with acute suppurative parotitis is presented.

Topics: Acute Disease; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Female; Humans; Infant; Infant, Newborn; Parotid Gland; Parotitis; Staphylococcal Infections; Staphylococcus aureus; Suppuration; Teicoplanin; Treatment Outcome; Ultrasonography

High rates of antimicrobial resistance in Escherichia coli isolated from patients with urinary tract infections have been reported worldwide. The aim of this study was to identify risk factors for resistance to ciprofloxacin (CIP) and cefotaxime (CTX) in E. coli isolated from patients with acute pyelonephritis (APN).. We prospectively identified women over 18 y of age who visited the emergency department of one of 10 hospitals with APN and whose urine culture grew E. coli. The study was conducted from April 16 to June 10, 2012.. Of the 229 patients identified, 173 (75.5%) had community-associated (CA) infections and 56 (24.5%) had healthcare-associated (HCA) infections. Sixty-seven isolates (29.3%) were resistant to CIP, 45 (19.7%) to CTX, and 29 (12.7%) to both CIP and CTX. Multivariate analyses revealed that hematologic disease, chronic kidney disease, a bed-ridden state, indwelling urinary catheter, antibiotic treatment in the preceding 3 months, and isolation of CIP-resistant E. coli in the urine within the preceding 3 months, were significantly associated with resistance to both CIP and CTX.. Chronic conditions and healthcare-associated factors were related to resistance to both fluoroquinolones and third-generation cephalosporins in women with APN. Continued and vigilant surveillance is necessary to monitor the dissemination of antimicrobial resistance in uropathogens.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Cefotaxime; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Emergency Service, Hospital; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Middle Aged; Multivariate Analysis; Prospective Studies; Pyelonephritis; Republic of Korea

Information regarding acute otitis media (AOM) aetiology is important for developing effective vaccines. Here, bacterial aetiology and antimicrobial susceptibility of AOM were determined in young Saudi children.. Children aged 3-60months with a new episode of AOM, who had not received antibiotics or had received antibiotics for 48-72h but remained symptomatic, were enrolled in this prospective, observational, epidemiological study in Riyadh. Middle ear fluid (MEF) samples were collected by tympanocentesis or from spontaneous otorrhea, and tested for the presence of Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes and Moraxella catarrhalis. Antimicrobial susceptibility of the identified pathogens was assessed using E-tests.. Between June 2009 and May 2011, 66 children were enrolled. S. pneumoniae was detected in 6 episodes and non-typeable H. influenzae (NTHi) in 8 episodes. Moreover, Staphylococcus aureus, which is an uncommon cause of AOM, was detected in 17 episodes. Pneumococcal serotypes were 7F (n=2), 23F (n=2), 19F (n=1) and 15F (n=1). Susceptibility to cefotaxime was observed in all pneumococcal and H. influenzae isolates, to cefuroxime in 4/6 pneumococcal and 8/8 H. influenzae isolates, and to penicillin in 5/6 pneumococcal isolates.. S. pneumoniae and NTHi were major bacterial contributors for AOM in Saudi children.

Topics: Acute Disease; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Child, Preschool; Drug Resistance, Multiple, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Microbial Sensitivity Tests; Moraxella catarrhalis; Moraxellaceae Infections; Otitis Media; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Prospective Studies; Saudi Arabia; Streptococcus pneumoniae; Streptococcus pyogenes; Treatment Failure; Treatment Outcome; Tympanic Membrane

Active surveillance on nasopharygeal carriage of Streptococcus pneumoniae in children was conducted in 5581 children under 16 years old admitted with respiratory illness to the pediatric wards in a Hong Kong teaching hospital during 2008-2010. The isolation rate of S. pneumoniae was 14.5%. The most common serotypes/groups from 911 isolates were 19F, 6B, 23F, 14, 6C, 6A, and 3. Considering only children under 2 years old, the percentage serotype belonging to that of the 7-, 10- and 13-valent conjugate pneumococcal vaccines in S. pneumoniae were 56.0% (115/205), 57% (117/205), and 80.5% (165/205), respectively. The prevalence of penicillin-nonsusceptibility (MIC ≥4.0 μg/mL) was 9.1% and for cefotaxime (MIC ≥2.0 μg/mL) was 14.7%. A high prevalence of non-6B serotype, including 6A, 6C, and 6D was noted after the introduction of PCV7 conjugate pneumococcal vaccines in Hong Kong.

Topics: Acute Disease; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Female; Hong Kong; Humans; Male; Microbial Sensitivity Tests; Nasopharynx; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Prospective Studies; Serotyping; Streptococcus pneumoniae; Vaccination; Vaccines, Conjugate

The treatment of complicated urinary tract infection in children is still a matter of debate. In our hospital, antimicrobial treatment is initiated intravenously, and the duration of this treatment is adapted according to the results of a Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy.. This study was conducted to evaluate retrospectively the frequency and the importance of late renal sequelae when treating intravenously for 7 days those patients with an abnormal acute DMSA.. A review was conducted of the medical charts of all patients consecutively admitted between 2005 and 2008 with positive urine culture and clinical and biological evidence of complicated urinary tract infection (UTI).. There were 144 patients (59 %) with abnormal early DMSA scintigraphy and 98 (41 %) with normal scintigraphy. The median duration of intravenous treatment was 7.0 days in the children with DMSA lesions and 5.0 days in those without lesions. Obvious renal sequelae were observed on late DMSA scintigraphy in 4 (6 %) out of the 65 patients with an abnormal early DMSA who came back for control scintigraphy.. Sequelae of acute DMSA lesions observed during complicated UTI treated 7 days intravenously were infrequent. Whether the mode and duration of antimicrobial treatment might explain the low rate of sequelae remains to be demonstrated.

Topics: Acute Disease; Administration, Intravenous; Adolescent; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Penicillins; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Dimercaptosuccinic Acid; Treatment Outcome; Urinary Tract Infections

Acute phlegmonous gastritis is an uncommon disease, often fatal condition characterized by suppurative bacterial infection of the gastric wall. It has a high mortality rate mainly because the diagnosis is usually made late. Until recently, gastrectomy in combination with antibiotics was recommended. We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. At upper gastrointestinal endoscopy, the gastric lumen was narrow, and the mucosa was severely inflamed, which was erythematous, swelled, and showed necrotic areas covered with purulent exudate. Klebsiella oxytoca and Acinetobacter lwoffii were isolated in the gastric tissue culture. Contrast-enhanced computerized tomography scan of abdomen demonstrated diffuse gastric wall thickening and an intramural abscess in the gastric antral wall. Although delayed gastric emptying by gastroparesis prolonged the in-hospital period, the only medical treatment with antibiotics alone successfully cured the patient without gastrectomy.

Topics: Acinetobacter; Acute Disease; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Gastritis; Gastroparesis; Gastroscopy; Humans; Imipenem; Klebsiella oxytoca; Male; Ofloxacin; Pneumonia; Tomography, X-Ray Computed

It is crucial that nephrologists correctly identify acute focal bacterial nephritis, as timely and adequate treatment with appropriate antibiotics can prevent unnecessary investigations, invasive surgical procedures, and renal complications such as renal abscess or renal scar. An urgent kidney ultrasonography should be performed if there is a delayed response to appropriate antibiotic treatment in patients with urinary tract infection. Serial kidney ultrasonography plays a significant role in confirming the diagnosis and monitoring the progression of acute focal bacterial nephritis. We presented a patient with acute focal bacterial nephritis and showed that a serial kidney ultrasonography could prevent the use of invasive investigations and inappropriate surgical procedures.

Topics: Acute Disease; Cefotaxime; Child, Preschool; Ciprofloxacin; Disease Progression; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Female; Follow-Up Studies; Humans; Monitoring, Physiologic; Nephritis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Ultrasonography, Doppler

We report the first case of acute meningitis caused by a rare, atypical pathogen. An 11-month-old infant was admitted to hospital with clinical symptoms typical of acute meningitis. Cerebrospinal fluid analysis revealed an elevated neutrophil cell count and high proteins. Microbiological examination of the fluid confirmed an atypical cause of meningitis--Staphylococcus intermedius. Antibiotic therapy with cefotaxime was successful and the child made a full recovery.

Topics: Acute Disease; Anti-Bacterial Agents; Cefotaxime; Humans; Infant; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus intermedius

Acute interstitial nephritis accounts for about 10 % of the cases of acute renal failure. An adverse drug reaction caused by an immunoallergic mechanism is suggested when fever, skin rash, eosinophilia, and eosinophiluria are associated. The outcome is favorable after withdrawal of drug therapy in most cases. We report a case of acute interstitial nephritis induced by immunoallergic drug mechanisms, in a 3-week-old infant who presented with acute renal failure associated with eosinophilia and hepatitis and who had received cefotaxime and gentamicin. The patient's progression was favorable with normalization of renal and liver function 1 week after suspension of antibiotic drugs.

Topics: Acute Disease; Anti-Bacterial Agents; Cefotaxime; Eosinophilia; Gentamicins; Hepatitis; Humans; Infant, Newborn; Male; Nephritis, Interstitial

Primary subacute haematogenous osteomyelitis is one of the causes of limp. It usually involves tubular bones. Flat and small bones are affected less commonly. Diagnosis is difficult and usually takes weeks together for completion. Salmonella spp. can be isolated as a cause of primary subacute haematogenous osteomyelitis, if a usually underlying disorder, such as sickle cell anemia is associated. In this study, we present a child with normal immunity diagnosed as Salmonella primary subacute haematogenous osteomyelitis of the navicular bone, which is a rare condition. Primary subacute haematogenous osteomyelitis must be considered as a cause of limp for timely diagnosis and treatment.

Topics: Acute Disease; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Child, Preschool; Foot Diseases; Humans; Immunity; Immunocompetence; Magnetic Resonance Imaging; Male; Osteomyelitis; Salmonella; Salmonella Infections; Tarsal Bones

Acute isolated sphenoid sinusitis is a relatively uncommon entity. Because its symptoms and clinical findings are nonspecific, it can be easily misdiagnosed. Left unrecognized and untreated, it can lead to several well-known and severe complications, including meningitis, cerebral abscess, cavernous sinus thrombosis, and epidural or subdural empyema. We report the case of a 28-year-old woman with acute sphenoid sinusitis complicated by ischemic stroke in the left caudate nucleus, lentiform nucleus, and posterior part of the internal capsule. The stroke was diagnosed on magnetic resonance imaging. Also, magnetic resonance angiography showed a narrowing of the internal carotid artery and a narrowing of the first part of the left anterior and middle cerebral arteries (A1 and M1 segments). The patient was treated with medical therapy, including antibiotics, and surgical drainage of the sphenoid sinus via an endoscopic approach. Her outcome was good, and she experienced minimal neurologic sequelae. We discuss the possible explanations for this rare complication.

Topics: Acute Disease; Acyclovir; Adult; Anti-Bacterial Agents; Anticoagulants; Antiviral Agents; Carotid Artery Diseases; Cefotaxime; Dalteparin; Dexamethasone; Female; Glucocorticoids; Humans; Magnetic Resonance Angiography; Sphenoid Sinusitis; Stroke; Tomography, X-Ray Computed; Vancomycin

To present a case of acute septic arthritis due to Streptococcussanguis, a member of the viridans group streptococci.. A 73-year-old woman presented with fever and increasing swelling and pain of the right knee several weeks after she had been treated for severe periodontal disease. Arthrocentesis yielded purulent synovial fluid. S. sanguis was isolated in synovial fluid cultures, and the patient was treated with intravenous cefotaxime for 3 weeks and repeated aspiration of the knee joint with gradual resolution of fever, joint swelling and effusion.. Although S. sanguis is believed to be a rare cause of septic arthritis in native joints, it should be considered in the differential diagnosis of this disorder, especially in patients with recent treatment of severe dental caries and periodontal disease.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Arthritis, Infectious; Cefotaxime; Female; Greece; Humans; Knee Joint; Streptococcal Infections; Streptococcus sanguis

Epididymitis, or epididymo-orchitis, and infected hydrocele are unusual in the neonatal period. It is critical to differentiate them rapidly from testicular torsion to salvage the affected testis and avoid unnecessary surgical exploration. Escherichia coli is an important gram-negative bacteria causing diverse neonatal infections and is also the common bacteria causing epididymo-orchitis from an ascending route. We report the case of a preterm infant affected with epididymo-orchitis and infected hydrocele caused by early-onset E. coli sepsis. We highlight the importance of sampling proper cultures and using suitable antibiotics after excluding testicular torsion in a neonate with an acute scrotum.

Topics: Acute Disease; Bacteremia; Cefotaxime; Diagnosis, Differential; Epididymitis; Escherichia coli Infections; Humans; Infant, Newborn; Infant, Premature; Male; Orchitis; Scrotum; Sepsis; Spermatic Cord Torsion; Testicular Hydrocele; Tomography, X-Ray Computed; Ultrasonography

Typhoid fever complicated by multiple organ involvement has been rarely mentioned in the literature. We reported two cases of typhoid fever with several unusual manifestations, including acute renal failure, acute hepatitis, acute pancreatitis, disseminated intravascular coagulation, and lower gastrointestinal bleeding. A renal biopsy in the first case showed no pathological change. Bone marrow biopsy showed focal necrosis of matrix, which might have been due to severe illness. A liver biopsy in the second case showed a predominantly histiocytic proliferation with occasional neutrophilic infiltration in the portal areas and hepatic sinusoids. Focal necrosis, bile duct injury, and multiple eosinophilic bodies were also noted. After appropriate antimicrobial therapy, both patients recovered without any sequelae. The potential of multiple organ involvement is highlighted in typhoid fever, which, on rare occasions, may occur simultaneously in the same patient.

Topics: Acute Disease; Acute Kidney Injury; Adult; Cefotaxime; Disseminated Intravascular Coagulation; Gastrointestinal Hemorrhage; Hepatitis; Humans; Male; Pancreatitis; Salmonella typhi; Treatment Outcome; Typhoid Fever

To evaluate retrospectively the response of preseptal and orbital cellulitis in children to empiric antibiotic treatment.. We included nine patients (five male and four female) admitted to our hospital between October 2002 and October 2003 because of preseptal or orbital cellulitis.. Four patients (44.4%) responded to empiric antibiotic treatment (R); five (55.5%) did not respond (NR) and required a second antibiotic to resolve the infection. The presence of an upper respiratory infection was the most common associated disease in both groups, R and NR. However we also found two cases of acute dacryocystitis in the NR. Four patients (44.4%) were treated with cefotaxime intravenously with the infection resolving in three of these. Five patients (55.6%) were treated with cefuroxime intravenously as first empiric option, however only one patient responded.. We found a high prevalence of acute dacryocystitis as a potential cause of the cellulitis. Children with preseptal and orbital cellulitis responded better to cefotaxime than to cefuroxime. The presence of acute dacryocystitis was associated with a lack of response to cefuroxime.

Topics: Acute Disease; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Cellulitis; Child; Child, Preschool; Dacryocystitis; Female; Humans; Infant; Injections, Intravenous; Male; Orbital Diseases; Respiratory Tract Infections; Retrospective Studies; Treatment Outcome

Over the last decade Streptococcus pneumoniae has emerged as the most common bacterial pathogen for meningitis in all age groups, beyond the neonatal period.. To determine the epidemiological and clinical characteristics; and risk factors for mortality of pneumoccocal meningitis in children in a developing transitional country.. A retrospective study that included patients<15 years of age admitted at the Instituto de Medicina Tropical of Paraguay, from January 1990 until December 2003 with the diagnosis of bacterial meningitis caused by S. pneumoniae. Clinical and laboratory data were collected and analysed in order to identify risk factors associated with morbidity and mortality outcomes of this infection.. Seventy-two patients (between the ages of 35 days and 14 years) were identified. Forty-two per cent of patients had seizures prior to or at the time of admission, 36% were admitted in a comatose state, and 19% with shock. Mortality was 33% (24/72), and 18% of the survivors (11/60) developed severe sequelae. Upon admission, the following variables were strongly correlated with mortality: age<12 months (P=0.007), the presence of seizures (P=0.0001) or development of seizures 48 h after admission (P=0.01), a cerebrospinal fluid (CSF) glucose level of <10 mg/dl (P=0.01), CSF albumin>200 mg/dl (P=0.0003), an absolute blood neutrophil count<2000/mm3 (P=0.006) and a haemoglobin value of <9 g/dl (P=0.0001).. This study confirms the high morbidity and mortality associated with S. pneumoniae meningitis in Paraguay. Certain clinical parameters and laboratory findings in blood and CSF at the time of admission could be used as predictors for mortality or severe sequelae among survivors.

Topics: Acute Disease; Adolescent; Age Distribution; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Coma; Female; Humans; Infant; Male; Meningitis, Pneumococcal; Paraguay; Penicillins; Retrospective Studies; Risk Factors; Seizures; Streptococcus pneumoniae; Treatment Outcome

To review the bacteriological features and treatment of suppurative cervical lymphadenitis in children in order to achieve optimal treatment.. Forty-five children were hospitalized. Time of hospitalization was evenly distributed over Year and between Years. Age ranged from 2.5 Months to 13.5 Years (median 1 Year 10 Months). Twenty-nine patients had received prior antibiotic treatment. Bacteriological samples were sterile in 15 out of 45 children and were positive for Staphylococcus (all meti-S) in 20. Cefotoxim and fosfomycin were prescribed and was sufficient in 14 children (with needle aspiration). Surgical drainage was performed in the other cases.. Staphylococcus aureus is the predominant causal agent for acute suppurative lymphadenitis in children. Antibiotic therapy in the outpatient setting does not always prevent abscess formation and surgical drainage may be required.

Topics: Acute Disease; Adolescent; Age Factors; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Drainage; Female; Fosfomycin; Hospitalization; Humans; Infant; Lymphadenitis; Male; Neck; Sex Factors; Staphylococcal Infections; Suppuration; Ultrasonography

Acute meningitis caused by Escherichia coli is a rare disease in adulthood. Medical procedures, e.g. surgical interventions, have been described as a cause. Infection by blood transmission of fecal E. coli is also known. We report a case of acute meningitis after transrectal prostate biopsy. E. coli could be identified both in the cerebrospinal fluid and in the blood culture. A broad initial antibiotic therapy was administered. After cultural isolation of E. coli the therapy was switched to cefotaxime. The initially comatose patient recovered swiftly.

Topics: Acute Disease; Biopsy, Needle; Cefotaxime; Escherichia coli; Humans; Male; Meningitis, Escherichia coli; Middle Aged; Prostate; Rectum

The authors report a fatal case of acute bacterial myocarditis in a nonneutropenic child with acute lymphoblastic leukemia. She was admitted to the hospital with a urinary tract infection resulting from and remained persistently febrile despite resolution of the infection. On hospital day 4 signs of acute cardiac failure developed. Despite aggressive resuscitation measures, she died. Pathologic examination revealed the cause of death to be bacterial myocarditis. In addition, she was found to have a generalized decrease in her serum immunoglobulin levels. Acute bacterial myocarditis in patients with malignancy has been rarely reported. The rapid clinical deterioration and death in the patient in this report is particularly interesting.

Topics: Acute Disease; Agammaglobulinemia; Antineoplastic Combined Chemotherapy Protocols; Cefotaxime; Child; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Immunocompromised Host; Klebsiella Infections; Klebsiella pneumoniae; Myocarditis; Oxacillin; Pericarditis; Pleurisy; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Shoulder Pain; Tobramycin; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Eikenella corrodens is a gram-negative, facultative anaerobic rod that frequently exists as part of normal human flora in the upper respiratory tract and gastrointestinal tract. Recently, E. corrodens is reported as a rare causative agent of empyematic lesion. We report a case of 10-year-old girl with acute subdural abscess. She developed a high grade fever, swelling of the left periorbital area, right sided partial seizure and hemiplegia. Brain CT and MRI showed left parietal subdural abscess. Because intravenous antibiotic therapy was not effective enough and her neurological symptoms progressed, surgical drainage was performed in order to decompress the brain and to determine the causative agents. Through careful bacterial cultures, E. corrodens and Streptococcus constellatus were detected from the subdural abscess. After the drainage operation and a three week course of appropriate chemotherapy, the abscess completely disappeared and no sequela remained.

Topics: Acute Disease; Brain; Cefotaxime; Cephalosporins; Child; Eikenella corrodens; Empyema, Subdural; Female; Gram-Negative Bacterial Infections; Humans; Magnetic Resonance Imaging; Streptococcal Infections

Topics: Abscess; Acute Disease; Cefotaxime; Cephalosporins; Combined Modality Therapy; Disease Progression; Exudates and Transudates; Female; Humans; Infant; Injections, Intravenous; Mastoiditis; Middle Ear Ventilation; Streptococcal Infections; Streptococcus pneumoniae; Suction; Tomography, X-Ray Computed; Treatment Outcome

To determine the proportion of children with acute otitis media (AOM) presenting in our catchment area in New York City who were infected with nonsusceptible Streptococcus pneumoniae and to determine the susceptibility of these organisms to penicillins and other antibiotics commonly used to treat AOM.. Ambulatory clinics and the emergency department of a tertiary care, inner-city medical center.. During a 2-year period from 1993 to 1995, 115 children (aged 6 months to 12 years) with AOM underwent tympanocentesis. Patients did not receive antibiotics for at least 1 week before tympanocentesis.. Thirty-one children were infected with S pneumoniae, and 83.9% of isolates were susceptible to penicillin. Of the 16.1% strains that were nonsusceptible, most (4 of 5 strains) were intermediately resistant, and only 1 exhibited high-level resistance to penicillin. Of all the cephalosporins tested, only cefotaxime had consistent activity against the intermediately resistant strains. Notably, all nonsusceptible pneumococci were inhibited by macrolides.. This study provides unique reference data for nonsusceptible Streptococcus pneumoniae in children with AOM and documents that newer cephalosporin agents are not active against all of these strains.

Topics: Acute Disease; Cefotaxime; Cephalosporins; Child; Child, Preschool; Drug Resistance, Microbial; Humans; Infant; Microbial Sensitivity Tests; New York City; Otitis Media; Penicillins; Streptococcus pneumoniae

Topics: Acute Disease; Cefotaxime; Cephalosporins; Child, Preschool; Epiglottitis; Female; Humans; Infant; Infusions, Intravenous; Male

To assess the clinical outcome and risk of failure after oral vs. intravenous treatment in otitis media caused by penicillin-resistant pneumococci. To determine the possible correlations between pneumococcal minimal inhibitory concentration (MIC) to penicillin and clinical outcome.. Retrospective study of 156 cases collected between 1993 and 1995. Mean follow-up: 5 months. Setting. Two tertiary academic medical centers in Paris, France.. Pneumococcus was isolated from 191 of 570 ear samples obtained from children with otitis media and shown to be penicillin-resistant in 156. Medical history, antibiotic therapy during the previous 3 months and day-care center attendance were reviewed. For the current episode microbiologic characteristics of the isolated strains, type of treatment, therapy efficacy and clinical outcome were analyzed. Patients were predominantly young (76.3% were <1 year old) and bacteriologic samples were taken mainly because of previous treatment failure.. Among 156 children with pneumococcal penicillin-resistant otitis media, 72.2% attended day-care centers, 71.8% had been previously treated with aminopenicillin and 52.5% with cephalosporins. Failure of previous empirical oral therapy was noted in 84% (one-third of these had been receiving amoxicillin-clavulanate). Patients treated intravenously had had a more protracted otitis but no greater number of previous episodes of acute otitis media than those receiving oral therapy. Acute mastoiditis occurred in 4 infants resulting in mastoidectomy. Oral treatment (mainly with high dose amoxicillin,120 to 150 mg/kg/day) and intravenous therapy (cephalosporin or glycopeptide) had been used in 59 and 41%, respectively. Mean duration of therapy was 10.7 days. Three failures (1.9%) and 10 recurrences (6.4%, average 28 days) occurred. No statistical difference was found between intravenous and oral therapy with respect to risk of recurrence. A high penicillin MIC value was correlated with previous antibiotic treatment but not with clinical outcome.. Oral therapy appears to be as effective as intravenous therapy for the treatment of penicillin-resistant pneumococcal otitis media. Intravenous treatment should not necessarily be dictated by the penicillin susceptibility value but should be considered in cases of failure to thrive, persistent otitis or other complications.

Topics: Acute Disease; Administration, Oral; Amoxicillin; Cefotaxime; Ceftriaxone; Cephalosporins; Humans; Infant; Injections, Intravenous; Microbial Sensitivity Tests; Otitis Media; Penicillin Resistance; Penicillins; Pneumococcal Infections; Retrospective Studies; Streptococcus pneumoniae; Treatment Failure

The ability of an antibiotic to reach bactericidal concentrations in tissue depends on numerous factors including tissue composition and regional perfusion. Although necrotising pancreatitis is characterised by progression of pancreatic necrosis over at least 96 hours and microcirculatory alterations, the impact of these changes on the concentration of antibiotics in the pancreas has not yet been investigated.. To determine and compare pancreatic tissue concentrations of imipenem and cefotaxime at different stages of acute necrotising pancreatitis in an animal model that has been shown to mimic closely the pathomorphological and bacteriological features of severe human pancreatitis.. Acute necrotising pancreatitis was induced in rats by a standardised intraductal infusion of glycodeoxycholic acid and intravenous cerulein. Six hours (n = 16) and 48 hours (n = 16) after induction of pancreatitis, the animals were randomised for intravenous therapy with either imipenem or cefotaxime. Fifteen minutes after injection of the antibiotic, the animals were killed. Blood and the head of the pancreas were collected for determining imipenem or cefotaxime in serum and tissue; the splenic portion of the pancreas was prepared for histological examination. In an additional set of identically treated animals, pancreatic capillary blood flow (PCBF) was assessed by intravital microscopy before induction of acute necrotising pancreatitis and at the time of antibiotic therapy.. Imipenem accumulates in the pancreas in the initial phase of acute necrotising pancreatitis characterised by pronounced oedema and decreased PCBF, and tends to decrease with resolution of the oedema and the progression of acinar cell necrosis in the later course of the disease. Concentrations of cefotaxime are low in oedematous pancreatic tissue early after induction of acute necrotising pancreatitis and increase with the resolution of oedema and normalisation of PCBF.. Concentrations of antibiotics in the pancreas vary in acute necrotising pancreatitis, depending on changes in pancreatic tissue morphology and capillary blood flow. This suggests that antibiotic tissue concentrations may not be consistent from one agent to another and that efficacy of antibiotics in acute pancreatitis cannot be estimated solely on the basis of their pharmacological and microbiological properties.

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Capillaries; Cefotaxime; Cephalosporins; Disease Progression; Imipenem; Male; Necrosis; Pancreas; Pancreatitis, Acute Necrotizing; Rats; Rats, Sprague-Dawley; Regional Blood Flow; Thienamycins

Topics: Acute Disease; Cefixime; Cefotaxime; Cephalosporins; Child, Preschool; Ear, Middle; Humans; Infant; Otitis Media with Effusion

Enrichment culture in modified buffered peptone water followed by immunomagnetic separation (IMS) with magnetic beads coated with an antibody against Escherichia coli O157 was compared with direct culture on cefixime rhamnose sorbitol MacConkey agar (CR-SMAC) and cefixime tellurite sorbitol MacConkey agar (CT-SMAC) for the isolation of E. coli O157 from human faeces. In total, 690 samples were examined; E. coli O157 was isolated from 25 samples by IMS but from only 15 and 12 by direct culture on CT-SMAC and CR-SMAC, respectively. The difference in sensitivity of detection was at its most marked on screening repeat faecal samples from known cases and samples from asymptomatic contacts, when of 12 strains of E. coli O157 isolated by IMS, only five were isolated by direct culture. IMS is a sensitive and simple technique for the isolation of E. coli O157 from human faecal samples and should prove useful in elucidating further the epidemiology of this micro-organism.

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Bacterial Toxins; Bacteriophage Typing; Cefixime; Cefotaxime; Chlorocebus aethiops; Culture Media; Cytotoxins; Diarrhea; DNA Probes; DNA, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Gastrointestinal Hemorrhage; Humans; Immunomagnetic Separation; Plasmids; Rhamnose; Shiga Toxin 1; Sorbitol; Vero Cells

Topics: Acute Disease; Adult; Cefotaxime; Cephalosporins; Cystitis; Female; Humans; Kidney; Nephritis, Interstitial; Pregnancy; Pregnancy Complications; Recurrence; Risk Factors

Topics: Acute Disease; Aztreonam; Cefotaxime; Cephalosporins; Child; Diagnosis, Differential; Female; Humans; Middle Aged; Monobactams; Parotitis; Serratia Infections; Serratia marcescens; Time Factors; Tomography, X-Ray Computed

Topics: Acute Disease; Antibiotic Prophylaxis; Cefotaxime; Cefuroxime; Cephalosporins; Humans; Pancreatitis; Randomized Controlled Trials as Topic

Topics: Acute Disease; Adult; Cefotaxime; Cephalosporins; Humans; Kidney; Male; Nephritis, Interstitial; Renal Dialysis

Acute bacterial peritonitis is a common surgical disease treated with fluid resuscitation, surgery and antibiotics. The choice and use of antibiotics is an important supplement of therapy. Cephalosporins are among the most frequently used drugs for this condition. Although there is evidence that these agents reach the peritoneal cavity under normal conditions, no data are available regarding their delivery and concentration during acute secondary bacterial peritonitis. In order to determine the effectiveness of these agents in such cases, we studied the diffusion of three generations of cephalosporins--cefazolin, cefonicid and cefotaxime--into the peritoneal cavity during controlled bacterial peritonitis in rats. Our results show that all three drugs reached therapeutic concentrations in the peritoneal fluid; the highest concentration was obtained by the third-generation cefotaxime.

Topics: Acute Disease; Animals; Bacterial Infections; Cefazolin; Cefonicid; Cefotaxime; Cephalosporins; Drug Evaluation, Preclinical; Drug Monitoring; Peritoneal Cavity; Peritonitis; Random Allocation; Rats; Rats, Wistar; Tissue Distribution

The authors test antibiotic strategies aimed at either mitigating bacterial translocation from the gut or delivering antibiotics specifically concentrated by the pancreas for prevention of early secondary infection after acute necrotizing pancreatitis.. Infection currently is the principal cause of death after severe pancreatitis. The authors have shown that the risk of bacterial infection correlates directly with the degree of tissue injury in a rodent model of pancreatitis. Bacteria most likely arrive by translocation from the colon.. Severe acute necrotizing pancreatitis was induced in rats by a combination of low-dose controlled intraductal infusion of glycodeoxycholic acid superimposed on intravenous cerulein hyperstimulation. At 6 hours, animals were randomly allocated to five treatment groups: controls, selective gut decontamination (oral antibiotics and cefotaxime), oral antibiotics alone, cefotaxime alone, or imipenem. At 96 hours, surviving animals were killed for quantitative bacterial study of the cecum, pancreas, and kidney.. The 96-hour mortality (35%) was unaffected by any treatment regimen. Cecal gram-negative bacteria were significantly reduced only by the oral antibiotics. Pancreatic infection was significantly reduced by full-gut decontamination and by imipenem, but not by oral antibiotics or by cefotaxime alone. Renal infection was reduced by both intravenous antibiotics.. Early pancreatic infection after acute necrotizing pancreatitis can be reduced with a full-gut decontamination regimen or with an antibiotic concentrated by the pancreas (imipenem) but not by unconcentrated antibiotics of similar spectrum (cefotaxime) or by oral antibiotics alone. These findings suggest that 1) both direct bacterial translocation from the gut and hematogenous seeding interplay in pancreatic infection while hematogenous seeding is dominant at extrapancreatic sites and 2) imipenem may be useful in clinical pancreatitis.

Topics: Acute Disease; Administration, Oral; Amphotericin B; Animals; Bacteria; Bacterial Infections; Bacterial Physiological Phenomena; Cecal Diseases; Cefotaxime; Colistin; Disease Models, Animal; Drug Therapy, Combination; Imipenem; Injections, Intravenous; Kidney Diseases; Male; Necrosis; Pancreas; Pancreatic Diseases; Pancreatitis; Rats; Rats, Sprague-Dawley; Survival Rate; Tobramycin

An investigation examined the efficacy of antibiotics in a novel feline model of pancreatic infection in acute pancreatitis. Acute pancreatitis was induced in cats using an established technique. In control animals (no pancreatitis) and cats with pancreatitis, Escherichia coli (10(4) in 0.1 ml) was placed in the pancreatic duct. Reoperation was performed after 24 h in six controls and six cats with pancreatitis. E. coli was cultured from the pancreas in five control animals and five cats with pancreatitis. Reoperation was performed after 1 week in ten controls, in 11 cats with pancreatitis and in nine with pancreatitis that were treated with cefotaxime (50 mg/kg intramuscularly three times daily) started 12 h after the induction of pancreatitis and administration of E. coli. Pancreatic infection developed in eight cats with pancreatitis compared with none of the cefotaxime-treated animals and none of the controls (P < 0.05). Cefotaxime reached bactericidal levels in pancreatic tissue and juice. In conclusion, ductal administration of E. coli caused pancreatic infection only in cats with acute pancreatitis. Early administration of an appropriate antibiotic was effective in treating pancreatic infection in acute pancreatitis.

Topics: Acute Disease; Animals; Cats; Cefotaxime; Disease Models, Animal; Escherichia coli; Escherichia coli Infections; Opportunistic Infections; Pancreas; Pancreatitis

Previous studies using the chinchilla animal model demonstrated that the third generation cephalosporin cefixime (Suprax) with split dosing was as effective as ampicillin in sterilizing the middle ear cleft when infected with S. pneumoniae. In this investigator-blinded, randomized trial, a single daily dose of cefixime (8 mg/kg per day) performed as well as split dosing of cefixime (8 mg/kg every 8 h) and ampicillin (150 mg/kg every 8 h) in the time to sterilization of the middle ear cleft. No statistically significant differences were noted between groups in otoscopy or tympanometry. All antibiotic regimens performed better than saline control (P < 0.0001) with regard to time to sterilization of the middle ear cleft. The results of this study support the daily administration of cefixime as an effective agent for the treatment of otitis media due to its extended half-life and broad antibiotic spectrum.

Topics: Acoustic Impedance Tests; Acute Disease; Ampicillin; Animals; Anti-Infective Agents; Cefixime; Cefotaxime; Chinchilla; Ear, Middle; Endoscopy; Injections, Intramuscular; Otitis Media; Placebos; Pneumococcal Infections; Single-Blind Method; Time Factors

The work is based on lymphogenous methods of treatment, i.e. direct endolymphatic therapy with antibiotics and other agents in complications of acute appendicitis. On the basis of information in the literature, among the antibiotics we chose gentamicin, claforan, and a new antibiotic fortum. In addition to antibiotics, for the correction of disturbed blood rheological properties we gave endolymphatic infusions of trasylol, aspisol, and trental. The purpose of our study was the development of methods and treatment of complications of acute appendicitis. In view of this, we chose the patients according to the nosological groups with appendicular infiltrate, appendicular abscesses, and localized peritonitis of appendicular origin.

Topics: Abscess; Acute Disease; Anti-Bacterial Agents; Appendicitis; Aprotinin; Aspirin; Cefotaxime; Ceftazidime; Drug Therapy, Combination; Gentamicins; Humans; Infusions, Intravenous; Lymphatic System; Lysine; Pentoxifylline; Peritonitis; Platelet Aggregation Inhibitors; Premedication

Topics: Acute Disease; Amoxicillin; Anti-Infective Agents; Cefixime; Cefotaxime; Child; Chronic Disease; Humans; Otitis Media

Ceftibuten is a new oral cephalosporin with an unusual stability to beta-lactamases that can hydrolyze other extended-spectrum cephalosporins. Using the chinchilla animal model, we compared the efficacy of ceftibuten (n = 33) with that of saline (n = 34), ampicillin (n = 32), and cefixime (n = 31) for the treatment of acute otitis media caused by beta-lactamase-producing nontypeable Hemophilus influenzae. Ceftibuten was superior to ampicillin regarding the time necessary to sterilize the middle ear (p < .001) and eliminate effusion (p < .001). The mean days of therapy required for bacteriologic cure were 2.57 for ceftibuten, 2.95 for cefixime, 7.95 for ampicillin, and 8.16 for saline. At the conclusion of therapy, chinchillas treated with ceftibuten had a significantly lower prevalence of positive cultures and middle ear effusion than did animals treated with ampicillin. No significant differences were observed between ceftibuten and cefixime. The results of this randomized, investigator-blinded experiment warrant further consideration of ceftibuten as a second-line agent for acute otitis media caused by ampicillin-resistant H influenzae.

Topics: Acute Disease; Ampicillin; Animals; Anti-Bacterial Agents; Cefixime; Cefotaxime; Ceftibuten; Cephalosporins; Chinchilla; Haemophilus Infections; Haemophilus influenzae; Otitis Media; Random Allocation

Urinary tract infections in the elderly are common, often asymptomatic and usually benign. We report three patients who presented with acute renal failure due to acute pyelonephritis in the absence of clinical findings of infection or urinary tract obstruction. Blood and urine cultures grew Escherichia coli in two of the patients and in two patients renal biopsy confirmed acute pyogenic pyelonephritis. Antimicrobial therapy and haemodialysis led to improvement, though one patient subsequently died from an unrelated cause. We suggest that acute bacterial pyelonephritis should be considered as a cause of acute renal failure in the elderly. Clinical features of infection may be absent despite bacteraemia. Prompt diagnosis and intervention may avoid chronic renal failure in a group that has a less favourable outcome with long-term dialysis.

Topics: Acute Disease; Acute Kidney Injury; Aged; Cefotaxime; Female; Humans; Male; Pyelonephritis; Renal Dialysis

The influence of cefodizime (CDZ) on CD4 and CD8 lymphocytes was investigated in patients with lower respiratory tract infection and underlying respiratory diseases. Ten men and one woman were treated with CDZ 1 g i.m. b.i.d. for ten days. The infecting organisms were Haemophilus influenzae (5), Streptococcus pneumoniae (2) and Escherichia coli (1). No adverse events were reported. Nine patients were clinically cured; two required further antibiotic therapy. Leucocyte counts decreased significantly during treatment. Lymphocyte counts and CD4 cells both increased significantly in absolute and relative numbers, while there was a much smaller increase in CD8 cells. This resulted in a significant increase in the CD4/CD8 ratio. These effects of CDZ might be of benefit for immunocompromised patients with bacterial infections.

Topics: Acute Disease; CD4-CD8 Ratio; Cefotaxime; Female; Humans; Immunologic Factors; Male; Respiratory Tract Infections; T-Lymphocyte Subsets

Topics: Acute Disease; Blood; Cefixime; Cefotaxime; Child, Preschool; Humans; Infant; Otitis Media, Suppurative

There is concern that third-generation cephalosporins may not be effective in the treatment of acute otitis media due to Streptococcus pneumoniae. Using the chinchilla animal model, we compared two third-generation cephalosporins, cefixime (Suprax) and ceftibuten (investigational), with ampicillin and saline controls in an investigator-blinded, randomized trial. Whereas the saline controls performed worse than all other groups, no significant differences were detected among the three antibiotics regarding the time required to sterilize the middle ear cleft, or the prevalence of positive cultures after 10 days of therapy. The statistical power of the comparisons of cefixime and ceftibuten with ampicillin were 98% and 67%, respectively. The results of this in vivo animal study fail to support the contention that the two third-generation cephalosporins investigated are not effective in the treatment of pneumococcal acute otitis media. Caution is advised when extrapolating these results to the general clinical setting.

Topics: Acoustic Impedance Tests; Acute Disease; Ampicillin; Animals; Cefixime; Cefotaxime; Ceftibuten; Cephalosporins; Chinchilla; Drug Evaluation, Preclinical; Otitis Media with Effusion; Pneumococcal Infections

In a Tunisian hospital 27 babies, including 12 who were premature, in a single intensive care unit suffered acute gastroenteritis in the period from January to May 1988. The mean age at the onset of gastroenteritis was 8.4 days; nine babies died. Salmonella wien was isolated from stools (all babies) and blood (4 babies). It was also isolated from the stools of one nurse and from a mattress. Twelve of the babies had received cefotaxime, which was successfully replaced by oral colimycin. The outbreak was stopped by the implementation of infection control measures. All isolates of Salmonella wien were of the same biotype, and had the same antibiotic resistance pattern (third generation cephalosporins, monobactams, aminoglycosides, chloramphenicol, trimethoprim and sulphonamides) and plasmid DNA restriction pattern. The isolates were all susceptible to a combination of cefotaxime and clavulanic acid (a beta-lactamase inhibitor), which displayed synergy, suggesting the presence of a beta-lactamase (geometric mean MICs 11.24 micrograms/ml for cefotaxime alone and 0.24 micrograms/ml in combination with 0.1 micrograms/ml potassium clavulanate). All isolates produced TEM-1 and SHV-2 beta-lactamase which was not transferable to Escherichia coli by conjugation. The presence of the SHV-2 enzyme in Salmonella wien may allow it to adapt to newer beta-lactams which is a cause for concern in this hospital.

Topics: Acute Disease; beta-Lactamases; Cefotaxime; Clavulanic Acid; Clavulanic Acids; Colistin; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Drug Synergism; Feces; Gastroenteritis; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Microbial Sensitivity Tests; Salmonella; Salmonella Infections; Tunisia

Topics: Acute Disease; Anti-Infective Agents; Cefixime; Cefotaxime; Child; Child, Preschool; Humans; Infant; Otitis Media

In a clinical study, 40 patients suffering from acute, recurrent or chronic sinusitis were treated with cefixime. The duration of therapy ranged from seven to 15 days. The dosage was 200 mg bid. In all patients cure or a marked improvement of clinical symptoms was noticed. Ten patients suffered gastrointestinal side effects which were classified as mild to moderate; however, all the patients received a full treatment course.

Topics: Acute Disease; Adult; Aged; Anti-Infective Agents; Cefixime; Cefotaxime; Chronic Disease; Drug Administration Schedule; Drug Tolerance; Female; Humans; Male; Middle Aged; Recurrence; Sinusitis

Cefixime is a new third generation oral cephalosporin that exhibits excellent antibacterial activity against Neisseria gonorrhoeae, including beta-lactamase-positive strains. In an open uncontrolled clinical trial 14 male patients suffering from acute gonorrhea, aged 23 to 48 years, were treated with a single dose of 400 mg of cefixime. All 13 fully evaluable patients were clinically and bacteriologically cured. Side effects were not reported.

Topics: Acute Disease; Adult; Anti-Infective Agents; Cefixime; Cefotaxime; Drug Tolerance; Gonorrhea; Humans; Male; Middle Aged

Topics: Acute Disease; Adolescent; Cefotaxime; Child; Child, Preschool; Humans; Infant; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

To 63 critically sick patients on account of serious infection Claforan was administered. Forty-six patients were hospitalized at the intensive care and resuscitation unit and 17 patients suffered from oncological conditions. Claforan treatment was successful in 69.56% of the patients treated at the intensive care and resuscitation unit and in 30.44% in the group of oncological patients.

Topics: Acute Disease; Adolescent; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male

25 patients of acute urinary tract infection with E. coli received Omnatax, 1 gm. b.d. 80% patients had bacteriologic cure on second day and 96% on fourth day of treatment. When assessed in light of the disappearance or decrease in pyuria and bacteriuria, 72% patients showed excellent response and 28% moderate response at the end of treatment. Clinical cure was achieved in 84% of patients. Mean number of days required for the patients to become symptom-free was 3.5 and mean time to achieve complete bacterial elimination was 1.96 days.

Topics: Acute Disease; Adult; Cefotaxime; Cystitis; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Urinary Tract Infections

A 35-year-old woman developed pharyngitis with high fever and painful joint swellings. A severe cholestatic hepatitis occurred 40 days later with a rise of bilirubin to 32 mg/dl. "Nuclear dot" antibodies were demonstrated in the immunofluorescence test on cell cultures, confirming a diagnosis of primary biliary cirrhosis which had followed an atypical course. After nine days of cefotaxime administration, commenced because of persistent fever of 40 degrees C, an agranulocytosis was demonstrated, which regressed within a week of discontinuing the drug. The allergic genesis of the agranulocytosis was proven by repeated lymphocyte stimulation tests in the presence of cefotaxime. The autoimmune hepatitis was probably a predisposing factor in the genesis of the allergically induced agranulocytosis.

Topics: Acute Disease; Adult; Agranulocytosis; Autoantibodies; Cefotaxime; Drug Hypersensitivity; Female; Fluorescent Antibody Technique; Humans; Liver Cirrhosis, Biliary

Topics: Acute Disease; Cefazolin; Cefotaxime; Female; Humans; Male; Middle Aged; Nephritis, Interstitial

Topics: Acute Disease; Adult; Cefotaxime; Humans; Leptospirosis; Male

Endocarditis secondary to Hemophilus parainfluenzae is an uncommon entity that appears to be increasing in frequency, perhaps due to improved laboratory isolation techniques. Although controversial, most of the published literature recommends a penicillin, with or without concomitant gentamicin, as definitive therapy. We report the first successful use of the third-generation cephalosporin ceftizoxime in an ampicillin-allergic patient. A 55-year-old white female was hospitalized after 5 days of experiencing fever, chills, nausea, and vomiting. A cardiac echocardiogram revealed a large mitral valve vegetation, and the patient was treated with intravenous ampicillin, gentamicin, and clindamycin. Two weeks after emergency mitral valve replacement the patient developed spiking fevers and a macular, erythematous rash while receiving ampicillin. Ceftizoxime was initiated and continued to complete a 4-week period of intravenous antibiotics. Follow-up at 14 months showed no further evidence of infection. Ceftizoxime appears efficacious in eradicating H. parainfluenzae in patients allergic to penicillin.

Topics: Acute Disease; Ampicillin; Cefotaxime; Ceftizoxime; Drug Hypersensitivity; Endocarditis, Bacterial; Female; Haemophilus Infections; Humans; Microbial Sensitivity Tests; Middle Aged

The ability of cefixime or amoxicillin to eradicate causative pathogens was evaluated in 140 infants and children with acute otitis media with effusion. When pretherapy and on-therapy bacteriologic cultures were used, success was defined as elimination of pathogens regardless of clinical improvement. Parent compliance with administration instructions was closely monitored. Cefixime was administered daily or twice daily and because results on the two dosage regimens did not differ, data were combined for analysis. Results suggested that cefixime was somewhat more effective than amoxicillin for acute otitis media with effusion caused by Haemophilus influenzae but less effective for infections caused by Streptococcus pneumoniae. The study agents were equally effective against Branhamella catarrhalis.

Topics: Acute Disease; Amoxicillin; Bacteria; Cefixime; Cefotaxime; Humans; Microbial Sensitivity Tests; Otitis Media with Effusion; Patient Compliance

Ciprofloxacin was tested in the acute and chronic experimental E.coli pyelonephritis in rats. Its therapeutic efficacy was compared with that of cefotaxime. In the acute pyelonephritis increasing doses resulted in increasing elimination of bacteria from the kidneys. Ciprofloxacin and cefotaxime showed no difference in the efficiency in therapy of the acute pyelonephritis. In chronic pyelonephritis ciprofloxacin proved to be more effective than cefotaxime in spite of identical in vitro activity. Pharmacokinetic data showed that ciprofloxacin was eliminated more slowly than cefotaxime. The long serum half-life and the high volume of distribution could be responsible for the high therapeutic efficacy and could outweigh the disadvantage of metabolic instability.

Topics: Acute Disease; Animals; Anti-Infective Agents, Urinary; Cefotaxime; Chronic Disease; Ciprofloxacin; Escherichia coli Infections; Female; Pyelonephritis; Quinolines; Rats; Rats, Inbred Strains

Pharmacokinetic and clinical studies were carried out regarding the use of cefotiam (CTM) in the treatment of infections in newborn infants. Absorption and excretion: CTM was administered by bolus intravenous injection at a dose of 20 mg/kg to 9 newborns ranging in age from 1 to 28 days (gestational age, 34-40 weeks; birth weight, 2,000-3,380 g) and 6 infants aged 30 to 87 days (gestational age, 33 approximately 40 weeks; birth weight, 2,100-3,600 g) and its serum concentration and urinary excretion were determined. In the newborns, mean serum concentrations were 43.3 micrograms/ml at 1/4 hour, 36.7 microgram/ml at 1/2 hour, 27.8 micrograms/ml at 1 hour, 17.7 micrograms/ml at 2 hours, 8.8 micrograms/ml at 4 hours and 4.8 micrograms/ml at 6 hours, and in the infants, they were 44.5 micrograms/ml, 31.2 micrograms/ml, 19.1 micrograms/ml, 7.6 micrograms/ml, 2.2 micrograms/ml and 0.7 micrograms/ml at the above sampling times, respectively. Mean half-lives were 1.92 hours for the newborns and 0.96 hour for the infants, and mean urinary recoveries within 6 hours were 41.2% and 50.1% for the newborns and the infants, respectively. Taking individual differences into account, serum peak levels (at 1/4 hour) in newborns were very similar to each other irrespective of age (days after birth), and did not appear to be greatly different from those in infants. Half-lives, however, became shorter with aging, and the half-life of the serum CTM level in infants of about 1 month old should be close to those in young children or school-age children. From these observations, it is suggested to establish a standard regimen in which CTM is administered at a dose of 20 mg/kg once or twice a day to newborns within 3 days after birth, twice or 3 times a day to those aged 4 to 7 days, and 3 or 4 times a day to those aged 8 days or older. Clinical study: The CTM was administered to 11 patients with acute pneumonia, 2 patients each with suspected septicemia and with bullous impetigo, 1 patient with purulent lymphadenitis, 3 patients with idiopathic respiratory distress syndrome and 1 patient with pneumothorax, and its clinical effect was investigated. Excellent responses were observed in 12 of the 15 evaluated cases,good responses in 2, and a poor response in 1, thus an overall clinical effectiveness was 93.3%.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Absorption; Acute Disease; Cefotaxime; Cefotiam; Female; Half-Life; Humans; Infant, Newborn; Kinetics; Male; Pneumonia

20 patients suffering from severe lower respiratory tract infections were included in the study. 10 patients were given ceftriaxone (1-2 g/day) and the other 10 cefotaxime (2-4 g/day) for a week. The results of microbiological findings and both local and systemic tolerance were found to be similar for both drugs. This indicates that 7-14 g of ceftriaxone and 14-28 g of cefotaxime are equivalent quantities in the treatment of severe respiratory tract infections.

Topics: Acute Disease; Adult; Aged; Bronchitis; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Drug Tolerance; Haemophilus influenzae; Humans; Middle Aged; Pneumonia; Respiratory Tract Infections; Staphylococcus aureus; Streptococcus; Streptococcus pneumoniae

Therapeutic effects on cefmenoxime hemihydrochloride (CMX, Bestcall), a new synthetic cephem antibiotic, were examined in the treatment of various infections complicated with hematological diseases. The number of patients treated with CMX was 37 including 5 cases of sepsis or suspected sepsis, 14 cases of pneumonia or suspected pneumonia, 5 cases of upper respiratory diseases, 2 cases of urinary tract infections and 11 cases of other infections. All of these infections were complicated with hematological diseases: Acute leukemia, 13 cases; chronic myelocytic leukemia, 1 case; adult T cell leukemia, 3 cases; malignant lymphoma, 8 cases; Hodgkin's disease, 2 cases and myeloma, 3 cases. CMX were administered by a single intravenous injection or by a drip infusion. The dose was between 2 and 6 grams per day. Good to excellent clinical results were obtained in 25 out of 37 cases, total effective rate of 67.6%. No clinical side effects or abnormal laboratory findings attributable to CMX were observed except for light diarrhea in 2 cases. By the clinical investigation, it was demonstrated that CMX was one of safe and effective antibiotics for treating infections in the compromised hosts complicated with hematological diseases.

Topics: Acute Disease; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Hematologic Diseases; Hodgkin Disease; Humans; Immune Tolerance; Leukemia; Lymphoma; Male; Middle Aged; Multiple Myeloma; T-Lymphocytes

Pharmacokinetic and clinical studies of cefixime (CFIX) in children were done and the following results were obtained. Serum and urinary concentrations of CFIX were determined in 6 children aged 5 to 14 years given single doses of 1.5 or 6.0 mg/kg. Mean serum concentrations peaked at 4 hours after the administration of either 1.5 or 6.0 mg/kg, and respective peak values were 0.71 and 4.46 micrograms/ml. Biological half-lives for the low and the high doses were 5.28 and 4.45 hours, respectively. The 12-hours urinary recovery ranged from 7.0 to 13.8% after administration of 1.5 mg/kg, and the 8-hours urinary recovery was 18.1% after administration of 6.0 mg/kg. Therapeutic responses were recorded as excellent or good in 43 (97.7%) of the children, comprising 13 with tonsillitis and 31 with scarlet fever. The microbiological effectiveness of CFIX on identified pathogens comprising 29 strains of S. pyogenes and 2 strains of S. aureus was satisfactory as evidence by a high eradication rate of 93.5%. No clinical side effects were observed. Abnormal laboratory findings were elevation of GOT and/or GPT in 4 patients and eosinophilia in 1 patient. In conclusion, CFIX was found to be efficacious and safe for the treatment of bacterial infections in children.

Topics: Acute Disease; Adolescent; Cefixime; Cefotaxime; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Eosinophilia; Female; Humans; Infant; Male; Scarlet Fever; Staphylococcus aureus; Streptococcus pyogenes; Tonsillitis

Fundamental and clinical studies on cefixime (CFIX), a new oral cephem antibiotic, were carried out in the pediatric field. The results were as follows: Serum concentrations and urinary recovery rates were determined after oral administration of CFIX at doses of 3 mg/kg and 6 mg/kg in 2 cases each (4 cases in total). The mean serum concentrations of CFIX were 0.52 and 0.58 micrograms/ml at 2 hours, 0.80 and 1.42 micrograms/ml at 4 hours, 0.73 and 1.36 micrograms/ml at 6 hours, 0.54 and 1.12 micrograms/ml at 8 hours, respectively. The mean peak serum concentration of CFIX was obtained at 4 hours after administration, with serum half-lives (T1/2) of 3.77 and 5.30 hours, respectively. The mean cumulative urinary recovery rates within 12 hours after administration of CFIX at doses of 3 mg/kg and 6 mg/kg were 8.4% and 6.8%, respectively. Antibacterial activities of CFIX against clinically isolated strains of S. pyogenes, S. pneumoniae. E. faecalis, S. aureus, E. coli, H. influenzae, H. parainfluenzae were compared with those of amoxicillin (AMPC), cefaclor (CCL), and cephalexin (CEX). It was observed that CFIX was a little less active than AMPC against S. pyogenes and S. pneumoniae, but CFIX was more active than CCL and CEX. CFIX was the most active against E. coli, H. influenzae and H. parainfluenzae. Twenty-one pediatric patients with bacterial infections (10, tonsillitis; 4, pharyngitis; and 7, urinary tract infections) were treated with CFIX at doses of 1.5-6.0 mg/kg in 2 or 3 times daily for 4-10 days. The efficacy rate was 95.2% clinically and 91.3% bacteriologically. No adverse reactions were observed. An abnormal laboratory finding (slight elevation of S-GOT and S-GPT) was observed in 1 case.

Topics: Acute Disease; Bacteria; Bacterial Infections; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Kinetics; Male; Pharyngitis; Species Specificity; Tonsillitis; Urinary Tract Infections

We used cefixime (CFIX), a newly developed oral cephalosporin antibiotic, to treat 21 children with various infections. The results are summarized as follows. The serum half-lives of CFIX after an administration of 6 mg/kg to each of 2 children were 2.56 and 2.79 hours. The serum concentrations were high enough to ensure the therapeutic response. The clinical response was "excellent" in 16 children and "good" in 5, with a 100% efficacy rate. No side effects were recorded. The only abnormal finding was slight eosinophilia in 1 child.

Topics: Acute Disease; Adolescent; Bronchitis; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Half-Life; Humans; Infant; Kinetics; Male; Pneumonia; Respiratory Tract Infections; Tonsillitis; Urinary Tract Infections

Cefixime (CFIX) was given orally to 25 children with acute bacterial infections including 13 with acute tonsillitis, 1 with acute tonsillitis and cervical lymphadenitis, 1 with acute bronchitis, 5 with bronchopneumonia and 5 with urinary tract infection. Good to excellent clinical response was obtained in 23, and bacteriological response was obtained in 14 of the 16 children who underwent bacteriological tests. Side effects with soft stool or eosinophilia were observed in 1 child each. The flavor and odor of CFIX appeared to be well accepted by children. Our clinical experience has suggested the usefulness of this antibiotic for the treatment of various bacterial pediatric infections.

Topics: Acute Disease; Adolescent; Bacterial Infections; Bronchopneumonia; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Male; Respiratory Tract Infections; Tonsillitis; Urinary Tract Infections

Cefixime (CFIX) was evaluated for pharmacokinetics, therapeutic effectiveness on infection, safety, and bacteriological effectiveness in pediatrics. The following is a summary of the results. Pharmacokinetics in 4 children, 2 each receiving a single dose of 1.5 mg or 6.0 mg per kg body weight, were examined. Peak serum CFIX concentrations after the dose of 1.5 mg/kg were 1.12 and 1.34 micrograms/ml, and the serum half-lives were 1.83 and 3.53 hours. For the children administered with 6.0 mg/kg of CFIX, the respective figures were 2.50 and 7.46 micrograms/ml, and 6.77 and 6.64 hours. The 12-hour urinary recoveries were 4.9 and 34.1% and 9.4 and 25.4% for the small and the large doses, respectively. Therapeutic effectiveness in 19 children with infections was "excellent" in 14 and "good" in 5, with an effectiveness rate of 100%. Bacteriological effectiveness was evaluated in 10 children. Classified by causative organisms, 5 cases had H. influenzae, 2 each H. parainfluenzae and S. pyogenes, and 1 mixed infection by H. influenzae and S. pneumoniae. Only the H. influenzae in the child with mixed infection resisted the therapy, and all the other pathogens were successfully eradicated. No side effects were recorded. The only abnormal laboratory test finding attributed to CFIX was eosinophilia in 2 children.

Topics: Acute Disease; Bacterial Infections; Cefixime; Cefotaxime; Child; Child, Preschool; Enteritis; Female; Humans; Infant; Kinetics; Male; Pharyngitis; Respiratory Tract Infections; Tonsillitis; Urinary Tract Infections

Pharmacokinetics and clinical effects of cefixime (CFIX), a new oral cephalosporin antibiotic, in pediatric field were investigated. The result obtained were summarized as follows. CFIX (5% granules) was given to each of 5 children twice in a single dose of 1.5 or 3.0 mg/kg in a cross-over trial. The mean peak serum concentration of CFIX was 0.64 micrograms/ml at 4 hours after given the dose of 1.5 mg/kg and 1.15 micrograms/ml at 4 hours after the dose of 3.0 mg/kg. The mean half-life and the mean AUC values were 2.72 hours and 4.10 micrograms X hr/ml, respectively after the dose of 1.5 mg/kg, and 2.77 hours and 8.26 micrograms X hr/ml after the dose of 3.0 mg/kg. The urinary recovery was investigated in 5 children after the dose of CFIX of 1.5 mg/kg and in 4 children after the dose of 3.0 mg/kg. The mean peak urinary concentrations of CFIX and the mean 12-hour urinary recovery rates were 10.6-67.9 micrograms/ml at 2-10 hours and 15.7% after the dose of 1.5 mg/kg, and were and were 6.16-230 micrograms/ml at 2-8 hours and 18.9% after the dose of 3.0 mg/kg, respectively. CFIX was given to 6 children twice in a single dose of 50 mg either in the form of 5% granules or in capsules in a cross-over trial. The mean peak serum concentrations, half-life and AUC values were 1.26 micrograms/ml at 4 hours, 3.09 hours and 9.63 micrograms X hr/ml, respectively after the dose of 50 mg CFIX in 5% granules, and were 1.16 micrograms/ml at 4 hours, 2.87 hours, and 7.82 micrograms X hr/ml, respectively after the dose of 50 mg in capsules. The urinary recovery was investigated in 5 children. The mean peak urinary concentrations and the mean 12-hour urinary recovery rates were 19.1-114 micrograms/ml at 4-10 hours and 15.7%, respectively after the dose of 50 mg in 5% granules, and were 8.16-89.0 micrograms/ml at 4-10 hours and 11.3%, respectively after the dose of 50 mg in capsules. Clinical efficacy of CFIX was investigated in a total of 26 children including 2 with tonsillitis, 2 with acute bronchitis, 2 with scarlet fever and 20 with urinary tract infection. Each of children were given orally a dose of 2.6 mg/kg CFIX 2-3 times a day for 11 days in average.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Acute Disease; Adolescent; Bacterial Infections; Bronchitis; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Intestinal Absorption; Kinetics; Male; Scarlet Fever; Tonsillitis; Urinary Tract Infections

In a study of 20 acutely ill elderly patients treated with cefotaxime (1 g, 2 X daily) the pharmacokinetics in serum and tissue fluid were examined. Patients with impaired renal function showed increased values for the area under the curve and half-life in both serum and tissue fluid. Patients with pathological peripheral circulation manifested delayed peak concentrations in tissue fluid. Although the passage of cefotaxime into tissue fluid was slow in the elderly, its concentration was higher than the minimal inhibitory concentration for most bacterial species of clinical importance and lasted for 5.5-7h in tissue fluid and for more than 10h in serum. Thus, this study clearly illustrates that the twice-daily dosage regimen used was quite adequate in elderly patients.

Topics: Acute Disease; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Female; Half-Life; Humans; Injections, Intravenous; Kinetics; Male; Middle Aged; Pneumonia; Regression Analysis; Sepsis; Urinary Tract Infections

Cefotiam dihydrochloride (CTM) in a dose of 2 g was given by intravenous bolus injection to 15 patients operated upon for acute or subacute abdominal organs. They were included to 5 cases of acute localized peritonitis due to perforative appendicitis, 3 of diffuse peritonitis due to perforative duodenal ulcer, 1 of diffuse peritonitis with intestinal obstruction, 1 of perforative sigmoid colon cancer, 2 of gastric cancer or polyp with cholelithiasis, and 3 of cholangitis with cholecyst-choledocholithiasis. The materials of exudate from drain were taken at intervals by sterilized paper disc and determined by paper disc bioassay method with Proteus rettgeri ATCC 9250 or Proteus mirabilis ATCC 21100 as the test organisms to CTM concentrations. CTM concentrations in purulent exudate from drain of patients with acute peritonitis, they were increased quickly after intravenous bolus injection, and reached higher levels at early time after injection in cases 2 or 3 days after operation. CTM concentration in purulent exudate from drain was tended to increase in proportion to the severity of the inflammation. The CTM levels in infected exudate were higher than the MICs against clinically isolated organisms for a long time after administration. Therefore, CTM was very useful drug when used for chemotherapy of postoperative peritonitis.

Topics: Acute Disease; Adolescent; Adult; Aged; Cefotaxime; Cefotiam; Child; Drainage; Exudates and Transudates; Female; Humans; Injections, Intravenous; Male; Middle Aged; Peritonitis; Postoperative Complications

The treatment of the patients with ruptured cerebral aneurysm in acute stage is performed by direct neck clipping and cisternal drainages for preventing vasospasm. The cisternal drainage is carried out for 1 to 2 weeks' duration. The cisternal drainage has higher risk for bacterial infections in the cerebrospinal fluid (CSF). In this paper, penetration characteristics of cefotiam (CTM) in CSF were studied. CTM concentrations in CSF were measured at 1, 3 and 6 hours after intravenous drip infusion of CTM (2 g). CTM concentration in cisternal CSF was higher than that of ventricular CSF. The peak concentration in CSF was higher than 0.78 micrograms/ml and obtained at 3 hours after intravenous drip infusion. Our data suggest that CTM is a useful cephalosporin for treatment of meningitis (Staphylococcus aureus, Streptococcus pneumoniae et al.). Apart from meningitis, the higher concentration of CTM in CSF was obtained in the cases with the vasospasm. The result may support that the breakdown of blood brain barrier is induced by the peroxidative substance from the cisternal subarachnoid clots which has the vasospastic activity.

Topics: Acute Disease; Adult; Aged; Cefotaxime; Cefotiam; Drainage; Female; Humans; Intracranial Aneurysm; Ischemic Attack, Transient; Kinetics; Male; Meningitis; Middle Aged; Rupture, Spontaneous

12 patients with acute bacterial infections were treated with ceftriaxone, 1.5 g intravenously twice daily for 7-13 days. Pharmacokinetic variables were studied in 11 patients. In older subjects, serum half-lives were longer and serum clearances lower than in younger individuals. After the last dose, a larger increase in AUC compared to the first dose was observed in older patients and a biphasic elimination curve appeared in all patients but 2, with a terminal half-life of 15.6 h and 11.4 in old and young subjects, respectively. Estimated biliary clearances showed large individual variation, with a range of 0-16 ml/min X 1.73 m2. Changes in the colonic microflora were pronounced. Almost total disappearance of staphylococci, streptococci and enterobacteria was found, and there was a marked tendency to overgrowth of yeasts and enterococci. One patient with the highest estimated biliary clearance of ceftriaxone developed diarrhoea after 7 days of therapy. A toxin-producing Clostridium difficile was isolated from the stool.

Topics: Acute Disease; Adult; Aged; Bacteria; Bacterial Infections; Bile; Cefotaxime; Ceftriaxone; Colon; Female; Humans; Kinetics; Male; Middle Aged; Pneumonia; Sepsis; Staphylococcus; Streptococcus; Yeasts

One hundred and sixty cases of acute bacterial meningitis were treated with cefotaxime. Patients were between 9 days and 79 years old: 7 new borns, 37 infants, 43 children, 19 adolescents and 54 adults. Fifty-eight patients (36%) were in coma when admitted. Aetiology was determined in 110 patients (68.8%): Neisseria meningitidis in 42, Streptococcus pneumoniae in 36, Haemophilus influenzae in 16, Salmonella spp. in 7, Staphylococcus aureus in 2, Enterobacter spp. in 2 and Haemophilus parainfluenzae, pseudomonas aeruginosa, Escherichia coli, Citrobacter freundii and Klebsiella pneumoniae in one patient each. All isolates were sensitive to cefotaxime, with MIC's for 26 strains ranging from 0.01 to 0.50 mg/l. One hundred and fifty-six of the 160 patients were treated with cefotaxime alone and the four others with cefotaxime in association with an aminoglycoside in three and rifampicin in one. Cefotaxime was administered by intravenous infusion, in a daily dose 100 to 300 mg/kg. Duration of treatment ranged from 8 days to 6 weeks, with a mean of 15 days. One hundred and forty-nine patients (93.1%) were cured, two after a relapse. Three patients had sequelae. Most (88.5%) had sterile CSF within 72 h after starting treatment. Eleven patients (6.9%) died, eight within the first 48 h. The only side-effects observed were mild transient eosinophilia in some patients and rash and leukopenia in 2 each. The study demonstrates that cefotaxime is effective in the treatment of acute bacterial meningitis.

Topics: Acute Disease; Adolescent; Adult; Aged; Ampicillin; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Microbial Sensitivity Tests; Middle Aged

A group of 36 patients, admitted to hospital because of acute purulent exacerbations of chronic bronchitis, were treated with once daily injections of ceftriaxone for 10 days, 17 receiving 1 g injections and 19 patients 2 g doses. At the end of treatment (day 11) six patients remained infected (three with Branhamella catarrhalis and three with Pseudomonas aeruginosa) but during the 7 follow-up days 12 patients developed infections with beta-lactamase producing strains of Bran. catarrhalis, Ps. aeruginosa was cultured from 2 patients and Streptococcus pneumoniae from 3 more. Kinetic studies confirmed the long half-life of ceftriaxone (13 to 14 h in this patient group) and showed average peak serum concentrations of 31 mg/l after 1 g and 43 mg/l after the 2 g dose. The comparable sputum concentrations were 3.5 and 4.8 mg/l, respectively. However, four patients failed to show any ceftriaxone in the sputum despite simultaneous blood concentrations of between 32 and 50 mg/l and in two patients ceftriaxone only appeared in the sputum 12 h after the injection. All except one harboured beta-lactamase-producing Bran. catarrhalis in the sputum, and the possibility of breakdown of ceftriaxone by branhamella beta-lactamases is suggested.

Topics: Acute Disease; Bronchitis; Cefotaxime; Ceftriaxone; Chronic Disease; Haemophilus influenzae; Humans; Kinetics; Microbial Sensitivity Tests; Micrococcus; Pseudomonas Infections; Respiratory Tract Infections; Sputum

Ceftriaxone (Ro 13-9904, CTRX), developed by F. Hoffmann-La Roche Ltd. in Switzerland, was used for the pediatric infections and the following results were obtained. The mean blood level of CTRX in 2 children after a 60-minute intravenous drip infusion with 20 mg/kg was 58.6 micrograms/ml at 30 minutes, 75.0 micrograms/ml at 1 hour, 39.85 micrograms/ml at 2 hours, 27.74 micrograms/ml at 4 hours, 20.71 micrograms/ml at 6 hours, 11.72 micrograms/ml at 12 hours and 3.91 micrograms/ml at 24 hours while the half-life time was 5.9 hours in one child and 7.6 hours in the other. CTRX was used in 22 children with acute infections consisting of 3 with acute pharyngeal tonsillitis, 4 with acute bronchitis, 8 with bronchopneumonia, 6 with infections of skin soft tissue and 1 with salmonellosis. The results were excellent in 5 cases and good in 17, indicating an efficacy rate of 100%. Out of 10 cases where the causative strains were detected, 4 cases were followed about the activities of the respective bacteria, i.e., H. influenzae, Streptococcus group A, S. aureus and Salmonella group B, all of which were eradicated after the end of administration. The daily dose of CTRX ranged from 30 to 50 mg/kg and generally a larger dose was used for serious infections. CTRX was administered twice daily in 20 out of 22 cases, by an intravenous injection in 4 and an intravenous drip infusion in 18, for 2 to 4 days in 16 and 5 to 8 1/2 days in 6. No clinical adverse reactions were observed while the laboratory test found a slight elevation of GOT in one and that of GOT and GPT in another. From the above results, CTRX was judged to be a highly useful drug for treatment of pediatric infections.

Topics: Acute Disease; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male

Cefotiam (CTM) was administered to female patients suffering from acute cystitis to examine its clinical efficacy and changes in form of the bacteria in urine. CTM was administered to 15 female patients with acute cystitis once a day for three consecutive days (1 g/time in 13 cases, and 0.5 g/time in 2 cases). The overall clinical efficacy was 100%. Bacteriological examination, revealed 13 cases of single infection by E. coli, and one case of E. coli and S. epidermidis (MIC: 0.78 micrograms/ml). MIC of E. coli ranged from 0.05 to 0.78 micrograms/ml. All of the strains were eradicated, the eradication efficacy being 100%. The forms of bacteria in the urine after the administration of CTM were examined in 8 cases (all due to E. coli). Bacteria in urine disappeared or formed a spherical form 5 minutes after the administration of CTM. Disappearance of E. coli was observed in 7 cases at 15 or 30 minutes after drug administration, and with the disappearance, improvements were also observed in the urinary findings. Of these cases, the urinary concentration of CTM was measured in 4 cases. It ranged from 296 to 6,893 micrograms/ml at 5 minutes after the administration. In one case of deficient excretion in urine, filamentation was observed, and with the rise in CTM concentration in urine, granular changes were observed in the shape of bacteria. CTM's excellent clinical efficacy was substantiated by the changes in the form of bacteria in urine.

Topics: Acute Disease; Adult; Aged; Cefotaxime; Cefotiam; Cystitis; Escherichia coli; Female; Humans; Middle Aged; Urine

Prophylaxis effect and clinical therapy of combination use of cefotiam (CTM), sulbenicillin (SBPC) and cefsulodin (CFS) have been investigated, and the results were as follows. 1. Prophylaxis effect of CTM-SBPC combination therapy was very useful. CTM-SBPC combination therapy was performed to patients who are at high risk for infectious complications. Prophylaxis effect of CTM-SBPC was judged by fever over 38 degrees C, and was better than usual antibiotic treatment. 2. CTM-SPBC-CFS combination therapy was performed against severe infections during early remission, and the overall effectiveness rate was 83.3% (5/6). 3. No remarkable side effect was observed in this investigation.

Topics: Acute Disease; Adult; Bacterial Infections; Cefotaxime; Cefotiam; Cefsulodin; Cephalosporins; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Leukemia; Male; Middle Aged; Penicillin G; Sulbenicillin

A new antibiotic drug of cephalosporin group, with marked resistance of beta-lactamase, cefmenoxime (CMX) for parenteral use was tested in 15 patients with acute peritonitis. CMX in a dose of 500 mg was given intramusculary before the operation, to 8 cases with appendicitis, and 2 cases with intestinal obstruction. In 3 cases with appendicitis and a case with intestinal perforation, CMX in a dose of 500-1,000 mg was given by intravenous injection before or during the operation. And in a case with appendicitis, CMX in a dose of 1 g was given by intravenous drip infusion before the operation. Tissue specimens of different sites or body fluids were taken during the operation and from the removed organs. The materials of purulent ascites were subsequently taken at intervals. Determination of CMX concentration was performed according to cup bioassay method with Proteus mirabilis ATCC 21100 strain. The peak of CMX concentration in purulent ascites of patient with panperitonitis for intestinal perforation was 39.5 microgram/ml at 41 minutes after 1 g intravenous administration. Concentration of CMX in pus in the appendix was 52.5 microgram/ml at 20 minutes after 1 g intravenous administration. In 15 patients with acute peritonitis, 11 patients were given CMX in a dose of 500 mg by intramuscular administration twice a day, and the serious 4 patients were given in a dose of 500 mg to 1 g by intravenous drip infusion twice a day. Clinical response was excellent in 10 cases, good in 5 cases, fair and poor were none.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Adolescent; Adult; Aged; Cefmenoxime; Cefotaxime; Child; Drug Evaluation; Female; Humans; Male; Middle Aged; Peritonitis; Tissue Distribution

A new antibiotic drug of cephalosporin, with marked resistance to beta-lactamase, cefmenoxime (CMX) for parenteral use was used in 14 patients with acute or subacute cholecystitis and cholangitis. CMX was given by intramuscular or intravenous drip infusion at a daily dose of 500 mg to 2 g. Clinical response was excellent in 3 cases, good in 10 cases, fair in 1 case and poor in none. Any clinical adverse effect was not recognized. CMX in a dose of 500 mg was given by intramuscular administration before the operation to 8 patients, and in 7 cases CMX in a dose of 1 g was given by intravenous administration before or during the operation. Tissue specimens of different sites were taken from the removed organs. The materials of A-bile and B-bile were subsequently taken at intervals. CMX concentrations in the A-bile increased after intramuscular injection and reached to peak 2 hours, then declined very slowly. CMX concentrations in the A-bile after intravenous administration reached to peak at 1 hour, then declined very slowly, too. CMX concentration in the B-bile reached to high level of the concentration comparative quickly after intramuscular and intravenous administration, and it was thought to be excreted through the gallbladder wall. CMX concentration in the gallbladder wall was directly proportional to the degree of pathological changes of the inflammation. On the CMX concentration in patients with cholecystitis and cholangitis, the concentration in A-bile, B-bile and gallbladder wall were observed higher than the MIC of CMX for pathogenic Gram-negative bacilli. CMX therefore will be a very useful drug when used for chemotherapy of the infectious diseases of the biliary tract.

Topics: Acute Disease; Adult; Aged; Bile; Cefmenoxime; Cefotaxime; Cholecystitis; Drug Evaluation; Female; Gallbladder; Humans; Infusions, Parenteral; Injections, Intramuscular; Male; Middle Aged

Ceftizoxime (CZX) and latamoxef (LMOX), new synthetic cephems, are stable against various types of beta-lactamase and highly active against Gram-negative rods, such as H. influenzae, Serratia, Enterobacter and indole (+) Proteus. In this study, we evaluated clinical effects of CZX and LMOX in the clinical management of infections in acute leukemia. Sixteen episodes of infections were treated with CZX or LMOX. Four causative organisms, P. aeruginosa, S. faecalis, K. pneumoniae and A. faecalis, were identified in 2 episodes of infections. Clinical effects were recognized at 75% in 8 episodes treated with CZX and at 71% in 7 episodes treated with LMOX, respectively. The transient evaluation of GOT, GPT and Al-P, recognized in several cases. In conclusion, the clinical effects of CZX and LMOX are promised in clinical management of infections in acute leukemia.

Topics: Acute Disease; Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Drug Evaluation; Female; Humans; Leukemia; Leukocyte Count; Male; Middle Aged; Moxalactam; Neutrophils

Cefotaxime, a cephalosporin drug, has been shown to be active in vitro against nocardiae, a finding confirmed in this study. Pharmacokinetic studies were performed in mice to define regimens which provided peak serum levels comparable to that achieved in man with currently used doses. These regimens were shown to be effective with only short courses of therapy of rapidly progressive and highly lethal N. asteroides infection, produced by pulmonary challenge of mice. This suggests the possible utility of this drug in human nocardiosis.

Topics: Acute Disease; Animals; Cefotaxime; Dose-Response Relationship, Drug; Female; Kinetics; Lung Diseases; Mice; Mice, Inbred BALB C; Nocardia asteroides; Nocardia Infections

Clinical investigation of cefotiam and aminoglycosides combination use against infections complicated by acute leukemia was performed, and the results obtained were as follows. 1) Sixteen patients were treated with cefotiam in doses 4--6 grams per day parenterally. The clinical effectiveness were excellent 47.6%, good 14.3%, fair 9.5% and poor 28.6%. No significant differences in therapeutic efficacy was observed between the patients given CTM 4 g/day and CTM 6 g/day. 2) It was considered that the clinical effectiveness of CTM has not been influenced by the difference of a number of maturation granulocyte. CTM has showed a certain, though not distinctive, efficacy compared with CFX. 3) As side effects with CTM, eruption appeared in 1 case, and no remarkable laboratory findings was observed. Cefotiam is thus considered to be a useful drug for the treatment of infections complicated by acute leukemia.

Topics: Acute Disease; Adolescent; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Leukemia; Male; Middle Aged

Topics: Acute Disease; Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Bronchiectasis; Bronchitis; Cefazolin; Cefotaxime; Chronic Disease; Doxycycline; Female; Humans; Lung Abscess; Lung Diseases; Male; Middle Aged; Pneumonia; Premedication; Preoperative Care

Topics: Abdominal Injuries; Acute Disease; Adult; Ascitic Fluid; Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Humans; Male; Microbial Sensitivity Tests; Peritonitis; Wounds, Penetrating

Topics: Acute Disease; Adult; Cefotaxime; Ceftizoxime; Chronic Disease; Female; Humans; Male; Middle Aged; Osteomyelitis

In view of the clinical results obtained in severe septicaemia due to Gram-negative organisms, cefotaxime and amikacin combination was used in leukaemic patients with chemotherapeutic aplasia. 30 infectious episodes were treated in 22 cases of acute myeloid leukaemia, one case of acute flare-up in chronic leukaemia and 7 cases of acute lymphoid leukaemia. Cefotaxime was administered at daily doses of 100 mg/kg to the first 4 patients and of 60 mg/kg to the remaining 26 patients by infusion every 6 hours. Amikacin was administered at a daily dose of 15 mg/kg by the same route. 24 excellent results, 4 failures and 1 doubtful result were observed. Tolerance was very good. A new infection appeared in 9 patients during prolonged treatment (mean: 13,7 days). Cefotaxime appears to be a treatment of choice for infective conditions observed in chemotherapeutic aplastic leukaemia. A cure rate of 80% with amikacin combination can be obtained, but, in vivo, resistant pathogens (Streptococcus, group D) or poorly sensitive organisms (Pseudomonas aeruginosa + Bacteroides fragilis: 1 case) may be selected. Then, a new antibiotic treatment, based on accurate bacteriological results, could be given with success.

Topics: Acute Disease; Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Bacterial Infections; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Humans; Kanamycin; Leukemia; Middle Aged

Topics: Acute Disease; Adult; Aged; Cefotaxime; Cephalosporins; Female; Humans; Male; Middle Aged; Respiratory Tract Diseases; Sepsis; Urinary Tract Infections