cefotaxime and Bacterial-Infections

Several pathogenic processes have been implicated in the development of abdominal ascites. Portal hypertension, most usually in the context of liver cirrhosis, can explain about 75% of the cases, whereas infective, inflammatory and infiltrative aetiologies can account for the rest. In this article, we discuss the consensus best practice as published by three professional bodies for the management of ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). The aim of this study was to compare available clinical guidelines and identify areas of agreement and conflict. We carried out a review of the guidance documentation published by three expert bodies including the British Society of Gastroenterology, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD), as well as a wider literature search for ascites, SBP and HRS. Abdominal ultrasonography, diagnostic paracentesis and ascitic fluid cultures are recommended by all three guidelines, especially when there is strong clinical suspicion for infection. EASL and AASLD advocate the use of ascitic amylase and mycobacterial cultures/PCR when there is strong suspicion for tuberculosis and pancreatitis, respectively. Ascitic cytology can be useful when cancer is suspected and has a good diagnostic yield if performed correctly. EASL supports the use of urinary electrolytes for all patients; however, the British Society of Gastroenterology and AASLD only recommend their use for therapy monitoring. All three societies recommend cefotaxime as the antibiotic of choice for SBP and large-volume paracentesis for the management of ascites greater than 5 l in volume. For HRS, cautious diuresis, volume expansion with albumin and the use of vasoactive drugs are recommended. There appears to be good concordance between recommendations by the European, American and British guidelines for the management of ascites and the possible complications arising from it.

Topics: Albumins; Anti-Bacterial Agents; Ascites; Bacterial Infections; Cefotaxime; Consensus; Diuretics; Evidence-Based Medicine; Hepatorenal Syndrome; Humans; Paracentesis; Peritonitis; Plasma Substitutes; Practice Guidelines as Topic; Risk Factors; Treatment Outcome

Bacterial infections are well described complications of cirrhosis that greatly increase mortality rates. Two factors play important roles in the development of bacterial infections in these patients: the severity of liver disease and gastrointestinal haemorrhage. The most common infections are spontaneous bacterial peritonitis, urinary tract infections, pneumonia and sepsis. Gram-negative and gram-positive bacteria are equal causative organisms. For primary prophylaxis, short-term antibiotic treatment (oral norfloxacin or ciprofloxacin) is indicated in cirrhotic patients (with or without ascites) admitted with gastrointestinal haemorrhage (variceal or non-variceal). Administration of norfloxacin is advisable for hospitalized patients with low ascitic protein even without gastrointestinal haemorrhage. The first choice in empirical treatment of spontaneous bacterial peritonitis is the iv. III. generation cephalosporin; which can be switched for a targeted antibiotic regime based on the result of the culture. The duration of therapy is 5-8 days. Amoxicillin/clavulanic acid and fluoroquinolones--patients not on prior quinolone prophylaxis--were shown to be as effective and safe as cefotaxime. In patients with evidence of improvement, iv. antibiotics can be switched safely to oral antibiotics after 2 days. In case of renal dysfunction, iv albumin should also be administered. Long-term antibiotic prophylaxis is recommended in patients who have recovered from an episode of spontaneous bacterial peritonitis (secondary prevention). For "selective intestinal decontamination", poorly absorbed oral norfloxacin is the preferred schedule. Oral ciprofloxacin or levofloxacin (added gram positive spectrum) all the more are reasonable alternatives. Trimethoprim/sulfamethoxazole is only for patients who are intolerant to quinolones. Prophylaxis is indefinite until disappearance of ascites, transplant or death. Long-term prophylaxis is currently not recommended for patients without previous spontaneous bacterial peritonitis episode, not even when refractory ascites or low ascites protein content is present.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ascites; Bacteremia; Bacterial Infections; Cefotaxime; Cephalosporins; Ciprofloxacin; Fluoroquinolones; Gastrointestinal Hemorrhage; Humans; Infusions, Intravenous; Liver Cirrhosis; Norfloxacin; Peritonitis; Pneumonia, Bacterial; Primary Prevention; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Selective decontamination of the digestive tract (SDD) is a strategy designed to prevent or minimize the impact of infections by potentially pathogenic micro-organisms in critically ill patients requiring long-term mechanical ventilation. SDD is a four-component protocol to control the three types of infections occurring in intensive care patients: (a) a parenteral antibiotic, cefotaxime, for a few days to prevent primary endogenous infections that generally occur 'early'; (b) the topical antimicrobial drugs colistine (polymyxin E), tobramycin and amphotericin B (together: PTA) used throughout the stay in the intensive care unit (ICU) to prevent secondary endogenous infections developing in general 'late'; (c) a high standard of hygiene to prevent exogenous infections that may occur throughout the ICU stay; (d) surveillance samples of throat and rectum to distinguish between the three types of infection, to monitor compliance and efficacy of treatment and to detect emergence of resistance at an early stage. The most recent and rigorous meta-analysis examined 33 randomized SDD trials involving 5727 patients. It shows significant reductions, in overall mortality by 20% and in the incidence of lower airway infections by 65%. It failed to detect any report on the emergence of resistance and associated superinfections and/or out-breaks in the 33 studies covering a period of more than 10 years. Using the criterion of cost-per-survivor, four recent randomised trials showed that it is cheaper to produce a survivor using SDD than with the traditional approach.

Topics: Amphotericin B; Bacterial Infections; Cefotaxime; Clinical Protocols; Colistin; Critical Care; Critical Illness; Cross Infection; Decontamination; Digestive System; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Male; Survival Rate; Tobramycin

Topics: Animals; Ascites; Bacterial Infections; Bacterial Translocation; Cefotaxime; Diagnosis, Differential; Drug Therapy, Combination; Humans; Intestine, Small; Liver Cirrhosis; Metronidazole; Norfloxacin; Peritonitis; Prognosis; Risk Factors

Cefotaxime is a parenterally administered third generation cephalosporin with a broad spectrum of antimicrobial activity. After more than a decade of use, cefotaxime continues to play an important role in the treatment of patients with serious infections, particularly those caused by Gram-negative bacteria. Clinical trials of cefotaxime have demonstrated clinical and/or bacteriological success rates usually between 75 and 100% in hospitalised patients with infections such as pneumonia, complicated urinary tract infections and bacteraemia. In general, comparative trials have shown that cefotaxime has equivalent clinical efficacy to ceftriaxone. Although cefotaxime was traditionally administered at 6- or 8-hourly intervals, evaluations of twice daily regimens have demonstrated the feasibility of using this extended dosage interval in selected patients. Like other parenterally administered cephalosporins, cefotaxime is well tolerated. Cefotaxime does not cause a significant incidence of coagulopathies, as observed with some cephalosporins (e.g., cefamandole and cefoperazone), nor is it associated with the development of pseudocholelithiasis as seen with ceftriaxone. Some hospitals have achieved significant cost savings by implementing programmes or policies involving replacement of prescriptions for ceftriaxone with those for cefotaxime; however, other institutions have shown cost savings when cefotaxime is replaced by ceftriaxone. Similarly, conflicting results were seen in studies that assessed only the drug acquisition and administration supply costs (with or without inclusion of labour costs), highlighting the difficulty in applying pharmacoeconomic data from one clinical setting to another. A limited number of detailed pharmacoeconomic analyses of cefotaxime have been conducted. One analysis, in patients with pneumonia or other serious infections, incorporated published clinical trial data as well as published or estimated cost data (from 1992 or earlier) for the US healthcare setting. Total treatment costs per patient-day were $US25.21 for cefotaxime 1 g twice daily and $US37.23 for cefotaxime 1 g 3 times daily, compared with $US69.97 for ceftriaxone 2 g once daily and $US74.57 for ceftriaxone 1 g twice daily. Costs included those associated with drug acquisition, administration and preparation, laboratory monitoring and adverse events. A large retrospective analysis was conducted between 1989 and 1993 in a US hospital. Patients treated with cefotaxime

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Costs and Cost Analysis; Economics, Pharmaceutical; Humans

Cefotaxime is well established as an effective and well tolerated antibacterial drug for 3 times daily parenteral treatment of a variety of moderate to severe infections in hospitalised patients. Its frequency of administration has recently been reassessed with a 12-hourly regimen. Comparative studies in hospitalised patients with nosocomial or community-acquired lower respiratory tract infections, demonstrate the similar clinical and bacteriological efficacy of twice daily cefotaxime 1 or 2 g and the same daily dose of ceftriaxone, usually administered once daily. Cefotaxime 2 g twice daily was also similar in efficacy to ceftriaxone 2 g once daily. Retrospective and post-marketing studies also reveal the similar efficacy of cefotaxime administered twice and 3 times daily, and pharmacoeconomic studies suggest that total direct costs of treatment with cefotaxime compared is similar to that with other third generation cephalosporins in currently used dosage regimens. When administered twice daily, cefotaxime is, thus, an effective antibacterial agent for the treatment of hospitalised patients outside the intensive care unit with a variety of mild to moderate non-CNS infections caused by susceptible organisms. When appropriately administered twice daily there is potential to lower the cost of antibacterial treatment without compromising efficacy.

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Clinical Trials as Topic; Drug Administration Schedule; Humans; Microbial Sensitivity Tests

Cefotaxime has retained its broad-spectrum activity against the key pathogens in surgical infection, despite 15 years of widespread use. It has good activity against a wide range of Gram-positive and Gram-negative aerobes and most anaerobes, except Bacteroides fragilis but, combined with metronidazole, it offers clinically complete coverage of B. fragilis and Escherichia coli, the two most important species involved in intra-abdominal infections. For mixed infections involving B. fragilis, 500 mg metronidazole 12-hourly should be added to the cefotaxime regimen. Cefotaxime therapy is simple, generally inexpensive and has a relatively broad spectrum of activity compared to many other antimicrobials used for postoperative nosocomial pneumonia. Treatment with cefotaxime at 1 g or 2 g can be 12-hourly. Surgical prophylaxis with single-dose cefotaxime (1 g or 2 g) is as effective as with many other agents, with no documented selection of resistance. Clinical experience gained worldwide strongly supports the use of cefotaxime for the treatment of prophylaxis and surgical infections.

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Humans; Surgical Wound Infection

To discuss the pharmacokinetics, spectrum of activity, clinical trials, and adverse effects of cefprozil, cefpodoxime proxetil, loracarbef, cefixime, and ceftibuten, an investigational cephalosporin.. Literature was identified by a MEDLINE search from 1986 to January 1995.. Randomized, controlled studies were selected for evaluation; however, uncontrolled studies were included when data were limited for indications approved by the Food and Drug Administration.. Data were evaluated with respect to in vitro activity, study design, clinical and microbiologic outcomes, and adverse drug reactions.. Cefprozil, cefpodoxime proxetil, loracarbef, cefixime, and cefributen are active in vitro against organisms frequently involved in community-acquired infections such as Streptococcus pneumoniae, Escherichia coli, beta-lactamase-positive or -negative Haemophilus influenzae, and Moraxella catarrhalis. Except for cefixime and ceflibuten, they all are active against methicillin-susceptible Staphylococcus aureus. Even though there were problems in study design (discussed within the text), clinical data demonstrate that these new oral beta-lactam compounds are as efficacious as conventional therapies for a variety of community-acquired infections.. Cefprozil, cefpodoxime, cefixime, loracarbef, and ceftibuten demonstrate in vitro activity against the major organisms that cause community-acquired infections. Clinical trials confirm that these agents are as effective as traditional therapies for the management of acute otitis media, pharyngitis/tonsillitis, sinusitis, bronchitis, pneumonia, urinary tract infections, and skin and skin-structure infections. In addition, cefixime and cefpodoxime are effective therapies for uncomplicated gonococcal infections. Selection of a specific agent will be influenced by susceptibility data and safety, as well as issues of compliance and cost.

Topics: Bacterial Infections; Cefixime; Cefotaxime; Cefpodoxime Proxetil; Cefprozil; Ceftibuten; Ceftizoxime; Cephalosporins; Humans; Microbial Sensitivity Tests; Prodrugs; Randomized Controlled Trials as Topic

Topics: Acyclovir; Ampicillin; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Cefotaxime; Cells, Cultured; Cephalosporins; Cytomegalovirus Infections; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Erythromycin; Female; Fetal Diseases; Herpes Genitalis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Prenatal Diagnosis; Ultrasonography, Prenatal; Virus Diseases

Meropenem is the first of a new class of dehydropeptidase-stable carbapenems which is highly active against the microflora associated with intra-abdominal infection. Three randomised, prospective multicentre studies, have compared meropenem monotherapy with imipenem/cilastatin and cefotaxime plus metronidazole in the treatment of intra-abdominal infections: meropenem (1 g) versus cefotaxime (2 g) plus metronidazole (500 mg); meropenem (1 g) versus imipenem/cilastatin (1 g); meropenem (500 mg) versus imipenem/cilastatin (500 mg), all administered intravenously every 8 hours. Of the 641 patients with intra-abdominal infections randomised to treatment, 555 (87%) were clinically evaluable and 445 (69%) were bacteriologically evaluable. At the end of treatment a majority of the patients in each of the 3 studies was clinically cured or improved (91-100%). There were no clinically significant differences between the treatment regimens. Meropenem was effective over a range of intra-abdominal infections and as well tolerated as imipenem/cilastatin, and cefotaxime plus metronidazole.

Topics: Adult; Bacterial Infections; Carbapenems; Cefotaxime; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Male; Metronidazole; Middle Aged; Multicenter Studies as Topic; Peritonitis; Prospective Studies; Randomized Controlled Trials as Topic

Serious infections in paediatric patients pose some unique challenges to clinicians. Children represent a dynamic group of patients in whom there are age-related changes as well as age-related alterations in the biodisposition of various antimicrobial agents. In infants and children with serious infections multidrug therapy is generally employed. This occurs because most antibiotic therapy in these patients is initiated and continued on an empiric basis and few, if any, of the currently available agents may be employed confidently as monotherapy. When the agents currently available are compared on a pharmacokinetic and pharmacodynamic basis the carbapenems emerge as close to ideal for the treatment of serious infections in infants and children. Imipenem is the only member of this group currently available. It lacks paediatric labelling in the USA and its efficacy has not been compared directly with that of antibiotic regimens commonly employed in children. Meropenem is a new carbapenem currently under evaluation of the treatment of moderate to severe infections in children and adults. In 2 multicentre, randomised evaluations of the treatment of a variety of infections including lower respiratory tract infections, urinary tract infections, intra-abdominal infections, infections of the skin and skin structures, and septicaemia, the efficacy and safety of meropenem monotherapy were compared with those of cefotaxime-based regimens. Meropenem had an overall clinical efficacy rate of 98% compared with a rate of 95% for cefotaxime-based regimens. Neither regimen was associated with any significant clinical or laboratory adverse events. The carbapenem, meropenem, appears to be a reasonable choice for empiric therapy in infants and children with serious infections. Meropenem monotherapy has been evaluated and has been found to be as well tolerated and as effective as cefotaxime-based regimens in these patients.

Topics: Bacterial Infections; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Infant, Newborn; Male; Meropenem; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Thienamycins

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: Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Bacterial Infections; Cefixime; Cefotaxime; Cefpodoxime Proxetil; Cefprozil; Ceftibuten; Ceftizoxime; Cefuroxime; Cephalosporins; Child; Clarithromycin; Fluoroquinolones; Humans

The efficacy and safety of a once-a-day antibiotic in the treatment of sinusitis was studied. Two randomly assigned groups were treated with either once-a-day cefixime, a third generation cephalosporin, or amoxicillin three times a day. One hundred and fourteen patients were evaluated with antral punctures, microbiologic evaluation, and radiographic studies. Cultures revealed 40% gram-negative organisms, 48% gram-positive, and 12% anaerobes. The most common bacteria were Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus and viridans group streptococci. Ninety-four percent of the cefixime group were cured compared with 96% of the amoxicillin group. Staphylococcus resistance was a problem in both groups, necessitating an occasional change to amoxicillin-clavulanate potassium in the amoxicillin group. Once-a-day antibiotics offer the potential for improved compliance in the treatment of sinusitis. Cefixime offers an additional benefit of covering beta-lactamase producing strains of bacteria which are increasing in incidence and resistant to many penicillins.

Topics: Administration, Oral; Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Capsules; Cefixime; Cefotaxime; Clavulanic Acids; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Remission Induction; Sinusitis; Time Factors

Topics: Bacteria; Bacterial Infections; Biological Availability; Cefixime; Cefotaxime; Child; Humans; Microbial Sensitivity Tests

Cefodizime has been shown to possess high in vivo antibacterial activity in a variety of experimental infection models involving different body systems and animal species: systemic infections, pneumonia and urinary tract infections in normal mice, intrauterine infections in normal rats, and meningitis in normal rabbits, as well as systemic infections in immunosuppressed animals. Most investigations found that the therapeutic efficacy of cefodizime frequently exceeded the one expected from its in vitro values and in many cases compared favorably with those of other cephems, even when the in vitro susceptibility of the infecting organism to these drugs was markedly higher. These findings have been attributed either to the superior kinetic profile of cefodizime--prolonged serum half-life and excellent tissue penetration with long-lasting levels--or to a synergy between its high bactericidal activity and host defence mechanisms. The parallel consideration of the MIC90 values of cefodizime and the pharmacokinetic profile of this agent in humans indicate that the vast majority of the relevant respiratory and urinary pathogens are covered by once-a-day cefodizime dosage regimens of either 1 or 2 g.

Topics: Animals; Bacterial Infections; Cefotaxime; Mice; Pneumonia; Rabbits; Rats; Urinary Tract Infections

Cefotaxime has in the past decade proved to be a most useful agent. It has established the efficacy and safety suggested in the early in vitro, pharmacological and clinical papers. It remains an excellent agent to treat many community and hospital-acquired respiratory infections, urinary tract infections, meningitis, particularly in pediatrics, spontaneous bacterial peritonitis and selected abdominal and gynecological infections.

Topics: Bacterial Infections; beta-Lactamases; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Time Factors

The utilization of cephalosporins in serious bacterial infections in children has become more widely accepted by pediatric infectious disease specialists over the past five years. The use of cephalosporins has become increasingly popular in empiric antibiotic regimens. The recognition that age-specific bacterial pathogens in neonates, older infants and children can be effectively treated with cephalosporins alone, or in combination with ampicillin, has led to this increasing popularity. This review will discuss the use of cephalosporins in empiric antibiotic regimens and relate the efficacy and safety of specific cephalosporins in the treatment of serious bacterial infections in children.

Topics: Age Factors; Ampicillin; Bacterial Infections; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Humans; Infant; Infant, Newborn

The third-generation cephalosporins have an increased spectrum of activity against gram-negative bacteria, moderate activity against anaerobic bacteria, and reduced anti-gram-positive activity as compared with earlier cephalosporins. This spectrum allows the drugs to be considered as monotherapy for the treatment of mixed aerobic-anaerobic infections and as prophylaxis in patients in whom such mixed flora are expected. In vitro testing of anaerobes with the third-generation cephalosporins shows susceptibility to be method dependent, with regional differences also observed. The microtube broth dilution method shows the best relationship to in vivo results. Moreover, the apparent in vitro susceptibility or resistance does not always correlate with clinical efficacy. Clinical studies indicate that the expanded-spectrum third-generation cephalosporins may be used in place of combination therapy in patients with polymicrobial infection or as prophylaxis when mixed microflora are expected.

Topics: Bacteria, Anaerobic; Bacterial Infections; Cefotaxime; Cephalosporins; Clinical Trials as Topic; Humans; Microbial Sensitivity Tests

The clinical efficacy of cefodizime has been tested in several open and comparative studies, above all in lower respiratory tract infections (LRTI) and uncomplicated urinary tract infections (UTI), performed in 151 centres in Europe, Latin America, South-Eastern Asia and South Africa. Of 3791 patients, 2260 could be evaluated for efficacy and safety. Comparative studies in LRTI were carried out vs cefotaxime and cefuroxime (301 vs 299 patients); both clinical and bacteriological results were superimposable (range of satisfactory clinical outcomes from 86% to 95%; bacteriological eradication 95% to 100%). In open studies (533 evaluable patients) the percentage of clinical successes ranged from 79.1% to 91.8% and the bacteriological eradication from about 87% to 90%, according to the type of infections. Comparative studies (cefodizime vs cefuroxime or ceftizoxime) in UTI again demonstrated the equivalence of treatment. In open studies (374 evaluable patients) the percentage of satisfactory clinical outcomes ranged from 84.6% in complicated upper UTI to 95.9% in lower uncomplicated UTI, with overall bacteriological eradication of 92.7%. Side effects could be evaluated in 5801 patients (Western and Japanese clinical studies); 3.79% of patients showed side effects (1.99% gastrointestinal disturbances, 0.9% rash or urticaria, 0.9% other effects); 1.13% of patients required discontinuation of treatment. No relevant changes in laboratory parameters were observed. Cefodizime has been shown to be an effective and safe agent in the treatment of LRTI and UTI caused by susceptible pathogens. A dosage regimen of 1 g every 12 h seems to be the most suitable schedule for the treatment of LRTI while 1 g every 12 h or 2 g every 24 h can equally well be adopted for treatment of UTI.

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Humans

Cefotaxime was the first 'third generation' cephalosporin to be marketed and is administered intramuscularly or intravenously. Similar to other agents of this class, it has a broad spectrum of in vitro activity, particularly against Enterobacteriaceae, including beta-lactamase-producing strains. Cefotaxime forms a metabolite, desacetylcefotaxime, which is antibacterially effective against many bacteria per se and acts additively or synergistically with cefotaxime against many strains. Since the first review of cefotaxime in the Journal, further studies have confirmed its value in the treatment of various infections: complicated urinary tract infections, lower respiratory tract infections, bacteraemia, meningitis, uncomplicated gonorrhoea, infections of skin and soft tissue and of bone and joints, and obstetric and gynaecological infections. Cefotaxime is effective as an empirical treatment of suspected infection due to susceptible organisms in immunocompromised patients and is of proven efficacy in serious, life-threatening infections in general. Cefotaxime reduces the incidence of postsurgical infection but the role of third generation cephalosporins in prophylaxis remains to be determined. The indications for which cefotaxime and other 'third generation' cephalosporins would be considered the most appropriate therapy remain largely dependent upon such factors as varied as cost, local medical custom, decisions of regulatory agencies and geographical patterns of bacterial resistance. Cefotaxime nevertheless represents a valuable 'third generation' cephalosporin of great clinical value in certain infectious conditions, in particular those which are serious and life-threatening and where resistance to therapies is creating a clinical problem.

Topics: Bacterial Infections; Cefotaxime; Humans

Third-generation cephalosporins are important additions to the range of antibiotics available for treating children with serious bacterial infections. They are highly active against the common pathogens, which cause bacterial meningitis in children. Strains of Haemophilus influenzae type b resistant to both ampicillin and chloramphenicol, and Streptococcus pneumoniae relatively resistant to penicillin remain susceptible to cefotaxime and ceftriaxone. Escherichia coli, Klebsiella pneumoniae, Citrobacter diversus, as well as the other more common gram-negative bacilli isolated from neonates and children are susceptible to these agents. However, Listeria monocytogenes is not cephalosporin-sensitive. Ceftazidime is the only third-generation cephalosporin useful for treating serious infections due to Pseudomonas aeruginosa in children. As with other beta-lactam antibiotics, the clearance of cephalosporins is prolonged in neonates, particularly premature babies. Cefotaxime and ceftriaxone are equivalent to ampicillin and chloramphenicol for the treatment of bacterial meningitis in children over two to three months of age with respect to neurologic outcome and safety, despite the in vitro activity of cefotaxime and ceftriaxone being much greater than the standard antibiotics for the meningeal pathogens. Cefotaxime and ceftriaxone are effective in the treatment of serious gram-negative infections in children. In many instances, ceftriaxone can be administered once daily, which allows for more convenient therapy, particularly on an outpatient basis. Although controversial, ceftazidime has been used as single-agent therapy for empiric treatment of neutropenic immunocompromised children with fever.

Topics: Bacterial Infections; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Humans; Infant; Infant, Newborn

Cefotaxime, a third-generation cephalosporin, is active against many troublesome gram-negative organisms and anaerobes that now more frequently cause nosocomial infection. Single-dose cefotaxime, 1 g or 2 g administered 30 minutes prior to surgery, has been proven to be effective as prophylaxis for infection following gastrointestinal, biliary, obstetric, gynecologic, and genito-urinary procedures. When published trials are compiled, single-dose cefotaxime is more effective than multiple-dose cefazolin (p less than 0.01) in these types of surgery. Unfortunately, the dramatic increase in cephalosporin use has been accompanied by the emergence of resistant organisms such as enterococci and fungi. In Europe, some centers successfully prevent nosocomial pneumonia in intubated patients by decontaminating gastric contents with a combination of nonabsorbable antimicrobial agents including cefotaxime. Further trials may validate this concept for use in the United States.

Topics: Bacterial Infections; Cefotaxime; Humans; Premedication; Surgical Procedures, Operative

Cefixime is a new orally active third-generation cephalosporin with a broad spectrum of activity against a variety of both gram-positive and -negative bacteria including many beta-lactamase-producing strains of streptococci, Haemophilus influenzae, Neisseria gonorrhoeae, and the majority of the Enterobacteriaceae. Activity of cefixime against Staphylococcus aureus, enterococci, Listeria monocytogenes, and Pseudomonas spp. is poor. The relatively long elimination half-life of cefixime (approximately 3.0 h) has made possible once- to twice-daily administration with the potential added benefit of improved patient compliance. Clinical trials indicate that cefixime is at least as effective as standard agents in the treatment of genitourinary and upper respiratory tract infections. The incidence of resistant organisms reported during clinical trials with cefixime was low. Adverse reactions observed during clinical trials were relatively uncommon and generally mild and transient in nature. The most significant adverse reactions reported were diarrhea and stool changes occurring in up to 20 percent of patients.

Topics: Bacteria; Bacterial Infections; Cefixime; Cefotaxime; Humans

Cefixime, previously designated FK027, FR17027 and CL284635, is an orally active cephalosporin with a broad spectrum of antibacterial activity in vitro. It is particularly active against many Enterobacteriaceae, Haemophilus influenzae. Streptococcus pyogenes, Streptococcus pneumoniae and Branhamella catarrhalis, and is resistant to hydrolysis by many beta-lactamases. Cefixime has little activity against Staphylococcus aureus and is inactive against Pseudomonas aeruginosa. Cefixime is distinguished by its 3-hour elimination half-life which permits twice daily, or in many instances once daily, administration. Comparative trials, though few, indicate that the clinical and bacteriological efficacy of cefixime 200 to 400mg daily administered as a single dose or in 2 divided doses, is comparable with that of multiple daily doses of co-trimoxazole (trimethoprim + sulphamethoxazole) or amoxycillin in acute uncomplicated urinary tract infection, with that of amoxycillin, amoxycillin/clavulanic acid and cefaclor in acute lower respiratory tract infections, and with that of amoxycillin and cefroxidine in adult patients with acute tonsillitis or pharyngitis. Several comparative trials in children with acute otitis media demonstrate the similar effectiveness of cefixime 8 mg/kg daily (in 2 divided doses, or as a single daily dose), cefaclor 20 to 40 mg/kg daily and amoxycillin 40 mg/kg daily in 3 divided doses. The most frequently reported adverse effects, diarrhoea and stool changes, are usually mild to moderate in severity, transient, and mostly occur in the first few days of treatment with cefixime. Thus, cefixime is an effective orally active cephalosporin with a relatively long elimination half-life permitting a simplified treatment regimen. It is a suitable alternative to cefaclor or amoxycillin in acute otitis media and acute upper and lower respiratory tract infections, and to amoxycillin or co-trimoxazole in acute uncomplicated urinary tract infections.

Topics: Anti-Infective Agents; Bacterial Infections; Cefixime; Cefotaxime; Humans

Three days following revascularization of a foot injured in a boating accident, Aeromonas hydrophila cellulitis developed in the victim's foot and leg. The infection resolved with debridement and 10 days of cefotaxime therapy. A. hydrophila infection has not previously been reported in a revascularized extremity. Clinical response of an A. hydrophila cellulitis to cefotaxime is likewise undescribed. Our findings of a cefotaxime-sensitive Aeromonas infection and its successful treatment suggests that the organism should undergo further evaluation of cefotaxime sensitivity and that cefotaxime and other third-generation cephalosporins may have a role as broad-spectrum antibiotic agents in fresh-water trauma.

Topics: Adult; Aeromonas; Bacterial Infections; Cefotaxime; Cellulitis; Foot; Foot Injuries; Humans; Male; Skin Transplantation; Veins; Wounds, Penetrating

Cefotaxime, a third generation cephalosporin, is used throughout the world over a wide range of doses. The purpose of this paper is to discuss the rationale for determination of the optimal dosage and of adequate modes of administration. Among the factors determining in vivo activity, the most important are: (1) the time dependence of the antibacterial effect of cephalosporins, (2) the limited effect of increasing the drug concentration in contact with the bacteria and (3) the absence of a significant post-antibiotic effect. Combined with the rather short elimination half-life of cefotaxime, these factors argue for the use of a unitary dose of 1g in adult patients and for a 6- or 8-hour interval between doses. Information obtained from various animal models of infection are discussed. Clinical and bacteriological studies published in the international literature report a high rate of cure (between 80 and 100%) according to the type of infection and to the criteria of efficacy, with daily doses ranging from 2 to 4g bid or qid. The results obtained with the lowest doses are detailed, particularly for infections permitting the use of a low dosage. The necessity for increasing the dose is discussed in the following situations: (1) in specific infections requiring high local drug concentrations such as meningitis and endocarditis, (2) against micro-organisms exhibiting moderate susceptibility to cefotaxime (MIC greater than or equal to 1 mg/L) and (3) in immunocompromised patients. It is now well established that third generation cephalosporins have to be combined with other antimicrobial agents (e.g. aminoglycosides) for the treatment of patients with infections caused by bacteria able to become resistant. For susceptible strains, it has not been established that a synergistic effect of cefotaxime with another agent allows a reduction of the dosage of each member of the combination.

Topics: Adult; Bacterial Infections; Cefotaxime; Dose-Response Relationship, Drug; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans

Cefmenoxime is an aminothiazolyl cephalosporin administered intravenously or intramuscularly. Like other 'third-generation' cephalosporins it is active in vitro against most common Gram-positive and Gram-negative pathogens, is a potent inhibitor of Enterobacteriaceae (including beta-lactamase-producing strains), and is resistant to hydrolysis by beta-lactamases. Cefmenoxime has a high rate of clinical efficacy in many types of infection and is at least equal in clinical and bacteriological efficacy to several other cephalosporins in urinary tract infections, respiratory tract infections, postoperative infections and gonorrhoea. Cefmenoxime, like latamoxef, cefoperazone and cefamandole, has an N-methyltetrazole side chain at the 3-position of the cephalosporin nucleus and thus possesses the potential for producing hypoprothrombinaemic bleeding and disulfiram-like reactions. However, these reactions have been reported very rarely and the antibacterial is generally well tolerated. It is likely that cefmenoxime will most closely resemble cefotaxime and ceftizoxime in therapeutic profile and usefulness.

Topics: Bacteria; Bacterial Infections; Cefmenoxime; Cefotaxime; Humans; Kinetics

Topics: Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Humans; Male; Suppositories

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftizoxime; Cell Membrane Permeability; Cell Wall; Cephalosporins; Chemical Phenomena; Chemistry; Drug Resistance, Microbial; Drug Tolerance; Kinetics; Tissue Distribution

Ceftizoxime is a 'third generation' cephalosporin administered intravenously or intramuscularly. Like other third generation cephalosporins it has a wide spectrum of in vitro activity against Gram-positive and Gram-negative bacteria, is particularly active against Enterobacteriaceae (including beta-lactamase-positive strains), and is resistant to hydrolysis by beta-lactamases. However, the third generation cephalosporins are less active than earlier cephalosporins against staphylococci and so could not be considered the drugs of choice. Like many currently available third generation cephalosporins, ceftizoxime has limited activity against Pseudomonas aeruginosa, and thus cannot be recommended as sole treatment of known or suspected non-urinary tract pseudomonal infections. Similarly, although favourable clinical results have been obtained in patients treated with ceftizoxime for infections caused by mixed aerobic/anaerobic organisms (such as intra-abdominal, and obstetric and gynaecological infections), the relatively low in vitro activity of ceftizoxime (in common with most other third generation cephalosporins) against Bacteroides fragilis and enterococci may restrict its usage in situations where these organisms are the suspected or proven pathogens. Ceftizoxime appears to be similar in efficacy to several other cephalosporins in lower respiratory tract infections in elderly and/or debilitated patients, and in chronic and/or complicated urinary tract infections, 2 clinical situations in which third generation cephalosporins may have a major role. Ceftizoxime is also effective clinically and bacteriologically in skin, soft tissue, bone and joint infections, septicaemia/bacteraemia, meningitis and neonatal infections. However, a few large, well designed clinical comparisons of efficacy with aminoglycosides are needed before ceftizoxime can be recommended as an alternative in patients in whom potential aminoglycoside toxicity is a concern. Single intramuscular doses of ceftizoxime appear similar in efficacy to aqueous procaine penicillin G in gonorrhoeae due to nonpenicillinase-producing Neisseria gonorrhoea, and ceftizoxime is also highly effective against penicillinase-producing strains. Although only a few infections have been treated to date, ceftizoxime may be useful in the treatment of gonorrhoea in places where penicillinase-producing strains are common. Thus, ceftizoxime appears to be an effective addition to the growing number of third generation

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Biotransformation; Blood Coagulation; Cefotaxime; Ceftizoxime; Drug Synergism; Ethanol; Humans; Intestinal Absorption; Kidney Diseases; Kinetics; Probenecid; Tissue Distribution

The recent literature was reviewed with regard to the risks of superinfection following beta-lactam chemotherapy. The summary publications for the pseudomonas-active penicillins (azlocillin, carbenicillin, mezlocillin, piperacillin and ticarcillin), cefoperazone, cefotaxime, ceftazidime, imipenem and moxalactam show marked variations. Moxalactam was most likely to produce both gram-negative (5-38%) and enterococcal (2.2-12%) superinfections. Ceftazidime or moxalactam therapy was more often associated with anaerobic superinfections, usually by Clostridium spp., than the other beta-lactams. Comparable and lower incidences of superinfections were cited for cefoperazone, ceftazidime, mezlocillin and imipenem. The most common pathogens for the above drugs were the fungi (Candida spp.), Pseudomonas spp. and some beta-lactamase-producing Enterobacteriaceae. Staphylococcal, Escherichia coli and Klebsiella spp. secondary infections were more common in patients receiving the newer penicillins. Cefotaxime had a very low incidence of superinfections (1.1%), especially caused by gram-positive organisms such as enterococci. The reasons for this favorable feature seem to be: excellent inhibitory activity and beta-lactamase stability against a wide variety of bacterial pathogens, synergistic interactions of cefotaxime and its desacetyl metabolite, enhanced anti-enterococcal activity of cefotaxime in the presence of a human serum factor and interactions of cefotaxime and desacetyl cefotaxime to suppress the development of antimicrobial resistance. The most common superinfections following cefotaxime treatment were with Pseudomonas spp., Enterobacter spp. and fungi. Cefotaxime appears to possess physical-chemical characteristics that react favorably with bacteria and the host to minimize gram-positive superinfections, especially with most enteric Streptococcus spp. (Streptococcus faecalis and Streptococcus faecium).

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefoperazone; Cefotaxime; Ceftazidime; Gram-Positive Bacteria; Humans; Imipenem; Moxalactam; Penicillin Resistance; Penicillins; Streptococcus; Thienamycins

Ceftriaxone possesses potent activity, both in vitro and in vivo, against a broad range of bacteria. MIC50 and MIC90 geometric means were calculated using the results of broth and agar dilution assays performed worldwide. The MIC90 for ceftriaxone overall was 8 micrograms/ml or less for Enterobacteriaceae and 0.024 microgram/ml or less for Neisseria and Hemophilus species. Moderate activity was noted against Pseudomonas and Acinetobacter species (MIC50 12 to 28 micrograms/ml). Ceftriaxone was extremely active against nonenterococcal streptococci (MIC90 0.07 microgram/ml or less) and quite active against methicillin-susceptible Staphylococcus aureus (MIC90 5 micrograms/ml or less). Ceftriaxone generally was inactive against enterococci and methicillin-resistant staphylococci. Activity against anaerobes was good, except for many strains of Bacteroides fragilis and B. thetaiotaomicron (MIC greater than 64 micrograms/ml). Ceftriaxone exhibited excellent stability to beta-lactamases. The effect of medium and inoculum on in vitro testing was minimal. Excellent activity was demonstrated in vivo. Against Enterobacteriaceae, nonenterococcal streptococci, and H. influenzae, the PD50 in mice generally was less than 1 mg/kg. S. aureus strains responded moderately (mean PD50 6.5 mg/kg), whereas against most P. aeruginosa strains, PD50s ranged from 5 to greater than 250 mg/kg. The superior pharmacokinetic profile of ceftriaxone compared with that of other new cephalosporins was demonstrated by use of a prophylactic treatment schedule. The ability of ceftriaxone to penetrate the cerebrospinal fluid and provide excellent therapeutic coverage was confirmed in experimental meningitis models.

Topics: Aminoglycosides; Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Bacterial Proteins; Carrier Proteins; Cefotaxime; Ceftriaxone; Cell Membrane Permeability; Drug Resistance, Microbial; Hexosyltransferases; Humans; Meningitis; Mice; Microbial Sensitivity Tests; Muramoylpentapeptide Carboxypeptidase; Penicillin-Binding Proteins; Peptidyl Transferases

Cefotaxime is a new 'third generation' semisynthetic cephalosporin administered intravenously or intramuscularly. It has a broad spectrum of activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria, and is generally more active against Gram-negative bacteria than the 'first' and 'second generation' cephalosporins. Although cefotaxime has some activity against Pseudomonas aeruginosa, on the basis of present evidence it cannot be recommended as sole antibiotic therapy for pseudomonal infections. However, cefotaxime has been effective in treating infections due to other 'difficult' organisms, such as multidrug-resistant Enterobacteriaceae. Like other cephalosporins, cefotaxime is effective in treating patients with complicated urinary tract and lower respiratory tract infections, particularly pneumonia caused by Gram-negative bacilli. High response rates have also been achieved in patients with Gram-negative bacteraemia. Although favourable clinical results have been obtained in patients with infections caused by mixed aerobic/anaerobic organisms (such as peritonitis or soft tissue infections), the relatively low in vitro activity of cefotaxime against Bacteroides fragilis may restrict its usage in situations where this organism is the suspected or proven pathogen. In preliminary studies, males and females treated with a single intramuscular dose of cefotaxime for uncomplicated gonorrhoea caused by penicillinase-producing strains of Neisseria gonorrhoeae responded very favourably. Encouraging results have also been reported in open studies in children including neonates, treated with cefotaxime for meningitis and various other serious infections. In some situations, cefotaxime has been given in combination with another antibiotic such as an aminoglycoside, but the merits of such a combination have not been clearly established. Whether cefotaxime alone is appropriate therapy for conditions previously treated with aminoglycosides (other than pseudomonal infections) also needs additional clarification, but if established as equally effective in such conditions cefotaxime offers potentially important clinical and practical advantages in its apparent lack of serious adverse effects and freedom from the need to undertake drug plasma concentration monitoring.

Topics: Animals; Bacteria; Bacterial Infections; Cefotaxime; Humans; Kinetics; Premedication

In vitro susceptibility of Streptococcus pyogenes, Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Serratia marcescens, Hemophilus influenzae, Bacteroides fragilis, and Neisseria gonorrhea to three new second-generation and eight third-generation cephalosporins is tabulated. In general, the newer cephalosporins have an extended spectrum of activity against gram-negative bacteria, including Serratia marcescens, Pseudomonas aeruginosa, and Neisseria gonorrhea. They also tend to be active against anaerobes, including Bacteroides fragilis. However, they generally have less activity against gram-positive bacteria when compared with the first- and second-generation cephalosporins. Clinical summaries are given for each of the cephalosporins, with emphasis on the results of comparative clinical trials. These cephalosporins may prove especially useful in nosocomial infections with resistant organisms, intraabdominal infections, febrile episodes in the granulocytopenic patient, and meningitis.

Topics: Bacteria; Bacterial Infections; Bacteroides fragilis; Cefamandole; Cefoperazone; Cefotaxime; Cefotiam; Cephalosporins; Enterobacteriaceae; Haemophilus influenzae; Humans; Moxalactam; Pseudomonas aeruginosa

Topics: Animals; Bacteria; Bacterial Infections; Bile; Cefmenoxime; Cefotaxime; Drug Evaluation; Drug Evaluation, Preclinical; Drug Resistance, Microbial; Humans; Mice; Time Factors

Topics: Adolescent; Adult; Aged; Animals; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Drug Resistance, Microbial; Female; Humans; Infant; Infant, Newborn; Injections; Lethal Dose 50; Male; Mice; Middle Aged; Rabbits; Rats

Topics: Bacteria; Bacterial Infections; beta-Lactamases; Cefotaxime; Ceftizoxime; Drug Evaluation; Drug Stability; Endocarditis, Bacterial; Female; Genital Diseases, Female; Humans; Respiratory Tract Infections; Urinary Tract Infections

The therapy of gram-negative bacillary meningitis is less than adequate to date; the agents recommended do not achieve bactericidal levels in purulent cerebrospinal fluid. Because optimal antibiotic therapy of meningitis occurs when the cerebrospinal fluid level of an antibiotic is above the concentration needed to kill the offending pathogen, another group of agents needs to be considered. The newer cephalosporins or cehalosporin-type antibiotics (cefotaxime, moxalactam), by virtue of their marked activity against gram-negative bacilli and their ability to achieve significant CSF levels, merit serious consideration as therapy for gram-negative bacillary meningitis. Investigators in Europe and the United States have developed preliminary data demonstrating the efficacy of these agents in a growing number of cases. In the group presented herein, of the 35 cases in which gram-negative bacillary meningitis was treated with the newer cephalosporins, there were only four failures.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Blood-Brain Barrier; Cefamandole; Cefotaxime; Cefoxitin; Cephaloridine; Cephalosporins; Cephalothin; Cephamycins; Child, Preschool; Enterobacteriaceae; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Middle Aged; Moxalactam; Pseudomonas aeruginosa

For the treatment of spontaneous bacterial peritonitis (SBP), cefotaxime, ceftriaxone, and ciprofloxacin were used as first-line agents. However, considering the increasing rate of antibiotic resistance, it is unclear which of these drugs can be initially recommended. This study aimed to compare the current efficacy of the 3 antibiotics, namely cefotaxime, ceftriaxone, and ciprofloxacin, for the treatment of SBP in patients with cirrhosis with ascites, when guided by therapeutic responses.. This study was a multicenter, prospective, randomized controlled trial. The inclusion criteria were 16- to 75-year-old patients with liver cirrhosis with ascites, having polymorphonuclear cell count of >250/mm 3 . We performed a follow-up paracentesis at 48 hours to decide continuing or changing the assigned antibiotics and then assessed the resolution rates at 120 and 168 hours of treatment.. A total of 261 patients with cirrhosis who developed SBP were enrolled. Most of the patients were diagnosed as those with SBP within 48 hours of admission. The resolution rates at 120 hours, which is the primary endpoint, were 67.8%, 77.0%, and 73.6% in the cefotaxime, ceftriaxone, and ciprofloxacin groups, respectively ( P = 0.388), by intension-to-treat analysis. The 1-month mortality was similar among the groups ( P = 0.770). The model for end-stage liver disease score and the SBP resolution were significant factors for survival.. The efficacy of empirical antibiotics, such as cefotaxime, ceftriaxone, and ciprofloxacin, against SBP was not significantly different. In addition, these antibiotics administered based on response-guided therapy were still efficacious as initial treatment for SBP, especially in those with community-acquired infections.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ascites; Bacterial Infections; Cefotaxime; Ceftriaxone; Ciprofloxacin; End Stage Liver Disease; Humans; Liver Cirrhosis; Middle Aged; Peritonitis; Prospective Studies; Severity of Illness Index; Young Adult

During sepsis, optimal plasma antibiotic concentrations are mandatory. Modifications of pharmacokinetic parameters could lead to low drug concentrations and therefore, insufficient therapeutic levels.. The aim of this study was to build a population pharmacokinetic model for cefotaxime and its metabolite desacetylcefotaxime in order to optimize individual dosing regimens for critically ill children.. All children aged < 18 years, weighing more than 2.5 kg, and receiving intermittent cefotaxime infusions were included in this study. Cefotaxime and desacetylcefotaxime were quantified by high-performance liquid chromatography. Pharmacokinetics were described using the non-linear mixed-effect modeling software MONOLIX, and Monte Carlo simulations were used to optimize dosing regimen in order to maintain serum concentrations above the target concentration (defined at 2 mg·L. We included 49 children with a median (range) postnatal age of 23.7 (0.2-229) months, and median body weight (range) of 10.9 (2.5-68) kg. A one-compartment model with first-order elimination adequately described the data. Median (range) values for cefotaxime clearance, desacetylcefotaxime clearance, and volume of distribution were 0.97 (0.3-7.1) L·h. Standard intermittent cefotaxime dosing regimens in critically ill children are not adequate to reach the target. We showed that, for the same daily dose, continuous infusion was the only administration that enabled the target to be attained, for children over 1 month of age. As continuous administration is achievable in the pediatric intensive care unit, it should be considered for clinical practice.. Registered at http://www.clinicaltrials.gov , NCT02539407.

Topics: Adolescent; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Critical Illness; Dose-Response Relationship, Drug; Female; Humans; Infant; Male; Models, Theoretical; Prospective Studies

To compare the effectiveness of two antibiotic regimens among neonates with late onset sepsis (LOS).. This randomized controlled trial conducted in a tertiary care teaching hospital, South India, included 90 babies with LOS. Detailed history, examination and appropriate investigations were done for all the babies. Cloxacillin + Amikacin were administered to 40 and Cefotaxime + Gentamicin to 50 babies. Outcomes including mortality, complications and treatment failure were evaluated. Chi-square test was used for categorical variables and Student's unpaired t-test for continuous variables.. LOS had a male preponderance, and median time of onset was 13 days. Mortality was more among low birth weight babies irrespective of the antibiotics. Predominant bacteria isolated were coagulase-negative staphylococci (26.67%), Escherichia coli (13.33%) and Streptococcus pneumoniae (13.33%). Complications, mortality and cost were similar in both regimens.. There was no significant difference between the two antibiotic regimens with regard to outcome of LOS.

Topics: Amikacin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cloxacillin; Drug Therapy, Combination; Female; Follow-Up Studies; Gentamicins; Hospitals, Teaching; Humans; India; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Length of Stay; Male; Outcome Assessment, Health Care; Sepsis; Single-Blind Method; Time Factors

Tunneled-cuffed catheters (TCC) are often used among the elderly to commence and carry out haemodialysis (HD). Complications like infection and thrombosis frequently reduce the lifespan of TCC. The role of an antibiotic heparin 'lock' in the prevention of thrombotic and infectious complications and enhancement of TCC survival in the elderly has not been investigated previously.. In this prospective, double-blind clinical trial, TCC (n = 119, placed among 113 elderly patients requiring HD during March 2002 - February 2003) were randomised to either group I having TCC (n = 59, placed in 58 elderly patients) locked with cefotaxime (10 mg/mL) and heparin (5000 U/mL), or group II with TCC (n = 60, placed in 55 elderly patients) having catheter-restricted filling of heparin (5000 U/mL) alone. Symptomatic catheter-related blood stream infections (CRBSI) and catheter thrombosis were the primary end points in this study. Thrombosis was defined as an inability to use the catheter at a blood flow of 200 mL/min that did not respond to catheter repositioning and/or intraluminal thrombolysis. The incidence of catheter thrombosis, CRBSI and percentage of catheter survival were estimated and statistically compared between the two groups.. Kaplan-Meier survival analysis using log rank test showed higher thrombosis-free TCC survival (84.7%vs 63.3%, P = 0.021), infection-free survival (68.7%vs 31.3%, P < 0.001) and infection and thrombosis-free survival (65.0%vs 35.0%, P = 0.006) at 365 days in group I compared with group II.. Cefotaxime and heparin locks safely and effectively enhance the lifespan of TCC by lowering the incidence of thrombotic and infectious complications among elderly end-stage renal failure (ESRD) patients.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Anticoagulants; Bacterial Infections; Catheterization; Cefotaxime; Double-Blind Method; Drug Therapy, Combination; Equipment Design; Female; Heparin; Humans; Kidney Failure, Chronic; Male; Prospective Studies; Renal Dialysis; Thrombosis; Time Factors

To compare the efficacy and safety of single daily amikacin vs. cefotaxime in the 5-d treatment of spontaneous bacterial peritonitis (SBP).. Thirty-seven cirrhotic patients with SBP, 19 in group A and 18 in group B, were studied. Group A received 1 g of cefotaxime every 6 h, and group B received 500 mg of amikacin qd. Both antibiotics were administered up to 5 d and the responses were compared.. Infection was cured in 15 of 19 patients (78.9%) treated with cefotaxime and in 11 of 18 (61.1%) treated with amikacin. Four patients of the Cefotaxime group (21.1%) and five patients of the Amikacin group (27.8%) died. Two in each group (10.5% vs 11.1%) had renal impairment during study period. One in each group (5.3% vs 5.6%) may be considered to suffer from nephrotoxicity due to increased urinary beta(2)-microglobulin concentration.. In this study, single daily doses of amikacin in the treatment of SBP in cirrhotics were not associated with an increased incidence of renal impairment or nephrotoxicity. However, a 5-d regimen of amikacin is less effective than a 5-d regimen of cefotaxime in the SBP treatment.

Topics: Amikacin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Humans; Liver Cirrhosis; Peritonitis; Retrospective Studies; Treatment Outcome

Elective laparoscopic cholecystectomy (LC) has a low risk for infective complications, but many surgeons still use prophylactic antibiotics. The use of prophylactic antibiotics for LC is inconsistent and varies widely among surgeons.. We performed a prospective double-blind randomized study of prophylactic antibiotics in elective LC. Antibiotics were was given first before the operation and then again 24 h afterward. Group A ( n = 49) received 2 g of cefotaxime; group B ( n = 43) received 10 ml of isotonic sodium chloride solution. A sample of bile was withdrawn by direct gallbladder puncture for anaerobic and aerobic cultures. Age, sex, weight, duration of surgery (DOS), presence of diabetes mellitus, American Society of Anesthesiologists (ASA) classification, gallbladder rupture, bile and/or stone spillage, gallbladder histological findings, findings from bile cultures positive for bacteria, episodes of colic within 30 days before surgery, length of stay (LOS), and number of septic complications were recorded for both groups.. There was no differences between the two groups in terms of sex, weight, DOS, ASA score, gallbladder rupture, bile and/or stone spillage, gallbladder histological findings, findings from bile cultures positive for bacteria, or LOS. One infection occurred in the antibiotic prophylaxis group (2.04%); in the patients not receiving antibiotics, there was one other infection (2.32%). There was no statistical difference between the two groups in infective complications.. In patients undergoing elective LC, antibiotic prophylaxis is justified only in high-risk patients. In all other patients, antibiotic prophylaxis does not seem to affect the incidence of postoperative infective complications. In low-risk patients, eliminating the unnecessary use of prophylactic antibiotics would result in a cost reduction; moreover, it would lower the risk of adverse reaction and reduce microbial resistance.

Topics: Adult; Antibiotic Prophylaxis; Bacterial Infections; Bile; Cefotaxime; Cholecystectomy, Laparoscopic; Double-Blind Method; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Risk; Treatment Outcome

Amoxicillin/clavulanic acid (amoxicillin 2 g/clavulanic acid 200 mg) has been administered in comparison to cefotaxime (2 g) for antimicrobial prophylaxis in 476 evaluable patients undergoing abdominal surgery at high risk of septic complications. Both antibiotics were administered as a single infusion. 205 evaluable patients (110 in amoxicillin/clavulanic acid group and 95 in cefotaxime group) underwent upper gastrointestinal surgery (including gastroduodenal and biliary surgery). The wound infection rate was 4.5% for amoxicillin/clavulanic acid and 7.4% for cefotaxime, with no significant differences. Intra-abdominal abscesses were observed in 3 patients in the amoxicillin/clavulanic acid group and in 1 patient in the cefotaxime group. 271 evaluable patients (135 in amoxicillin/clavulanic acid group and 136 in cefotaxime group) underwent lower gastrointestinal surgery (including colorectal surgery). The wound infection rate was 11% for amoxicillin/clavulanic acid and 13% for cefotaxime, with no significant differences. A purulent discharge was present in 3 patients in both groups. Intra-abdominal abscesses were observed in 3 patients in the amoxicillin/clavulanic acid group and in 4 patients in the cefotaxime group. No serious adverse events and no cases of diarrhea were observed. In conclusion, in our experience amoxicillin/clavulanic acid proved to be as effective as cefotaxime in protecting patients from surgical infections in abdominal surgery. Its use in surgical prophylaxis may help decrease the cost of treatment and reduce the risk of resistance to antibiotics and superinfections.

Topics: Abdomen; Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefotaxime; Clavulanic Acid; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Postoperative Complications; Surgical Wound Infection

The efficacy of piperacillin/tazobactam at 100/12.5 mg/kg every 8 h (35 patients) was compared to cefotaxime plus metronidazole at 50/7.5 mg/kg every 8 h (35 patients) in 70 children with intra-abdominal infections requiring surgery. Diagnoses were gangrenous or perforated appendicitis (n =56), peritonitis (n =12), and abscess (n =2). Clinical cure was observed in 35 of 35 evaluable patients treated with piperacilin/tazobactam and in 34 of 34 evaluable patients treated with cefotaxime plus metronidazole. Presumed bacteriological eradication was noted in 29 of 30 evaluable patients in the piperacillin/tazobactam group and in 31 of 31 evaluable patients in the cefotaxime plus metronidazole group. In this study, piperacillin/tazobactam was as effective as cefotaxime plus metronidazole for treating children with intra-abdominal infections requiring surgery.

Topics: Abdominal Abscess; Adolescent; Appendicitis; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Intestinal Perforation; Male; Metronidazole; Microbial Sensitivity Tests; Penicillanic Acid; Peritonitis; Piperacillin; Prospective Studies; Tazobactam; Treatment Outcome

Cefotaxime is considered the first-choice antibiotic for empirical treatment in cirrhotic patients developing bacterial infections. It has been suggested that amoxicillin-clavulanic acid could be an alternative to cefotaxime, particularly in patients developing bacterial infections while on prophylactic norfloxacin. The aim of the present study was to compare amoxicillin-clavulanic acid with cefotaxime in the treatment of bacterial infections in cirrhosis.. Ninety-six hospitalized cirrhotic patients with suspicion of bacterial infection were prospectively included and randomized into two groups: one group (n=48) received amoxicillin-clavulanic acid, first intravenously 1 g-0.2 g every 8 h, and then orally 500 mg-125 mg every 8 h, and the other group (n=48) received intravenous cefotaxime 1 g every 6 h. Patients were stratified for previous prophylaxis with norfloxacin and ascitic fluid infection.. Sixteen patients were excluded from the analysis because bacterial infection was not demonstrated or because of secondary peritonitis. Therefore, 38 patients from the amoxicillin-clavulanic acid group and 42 from the cefotaxime group were finally analyzed. There were 24 ascitic fluid infections in each group. Infection resolution (86.8% vs 88%, 95% CI: -0.15 to 0.13, p NS), spontaneous bacterial peritonitis resolution (87.5% vs 83.3%, 95% CI: -0.15 to 0.24, p NS), duration of treatment, incidence of complications, time of hospitalization and hospital mortality were similar in both groups. Considering patients on prophylactic norfloxacin, infection resolution was also similar (100% vs 83.3%, 95% CI: -0.04 to 0.37, p NS). No adverse events were observed in either of the two groups. The cost of antibiotics was statistically lower in the amoxicillin-clavulanic acid group (p<0.001).. Amoxicillin-clavulanic acid is as effective as cefotaxime in the treatment of bacterial infections in cirrhotic patients, but is less expensive and can be administered orally. These results suggest that amoxicillin-clavulanic acid is an effective alternative to cefotaxime for the empirical treatment of bacterial infections in cirrhosis.

Topics: Aged; Amoxicillin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Clavulanic Acid; Drug Therapy, Combination; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Penicillins; Treatment Outcome

Topics: Adult; Aged; Antineoplastic Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Fever; Hematologic Neoplasms; Humans; Infusions, Intravenous; Middle Aged; Neutropenia; Treatment Outcome

In patients with cirrhosis and spontaneous bacterial peritonitis, renal function frequently becomes impaired. This impairment is probably related to a reduction in effective arterial blood volume and is associated with a high mortality rate. We conducted a study to determine whether plasma volume expansion with intravenous albumin prevents renal impairment and reduces mortality in these patients.. We randomly assigned 126 patients with cirrhosis and spontaneous bacterial peritonitis to treatment with intravenous cefotaxime (63 patients) or cefotaxime and intravenous albumin (63 patients). Cefotaxime was given daily in dosages that varied according to the serum creatinine level, and albumin was given at a dose of 1.5 g per kilogram of body weight at the time of diagnosis, followed by 1 g per kilogram on day 3. Renal impairment was defined as nonreversible deterioration of renal function during hospitalization.. The infection resolved in 59 patients in the cefotaxime group (94 percent) and 62 in the cefotaxime-plus-albumin group (98 percent) (P=0.36). Renal impairment developed in 21 patients in the cefotaxime group (33 percent) and 6 in the cefotaxime-plus-albumin group (10 percent) (P=0.002). Eighteen patients (29 percent) in the cefotaxime group died in the hospital, as compared with 6 (10 percent) in the cefotaxime-plus-albumin group (P=0.01); at three months, the mortality rates were 41 percent (a total of 26 deaths) and 22 percent (a total of 14 deaths), respectively (P=0.03). Patients treated with cefotaxime had higher levels of plasma renin activity than those treated with cefotaxime and albumin; patients with renal impairment had the highest values.. In patients with cirrhosis and spontaneous bacterial peritonitis, treatment with intravenous albumin in addition to an antibiotic reduces the incidence of renal impairment and death in comparison with treatment with an antibiotic alone.

Topics: Adult; Aged; Albumins; Bacterial Infections; Cefotaxime; Cephalosporins; Combined Modality Therapy; Female; Humans; Infusions, Intravenous; Kidney Diseases; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Plasma Volume; Renin

To reduce drug acquisition costs, the clinical and bacteriological efficacy of low-dose ceftazidime i.v. (1 g tid) was compared with cefotaxime i.v. (2 g tid). Both regimens were combined with netilmicin i.v. (2 mg/kg bodyweight tid), in an open, randomized, multicentre trial in febrile neutropenic patients. The addition of antibiotics for gram-positive coverage was part of the protocol; alteration in the antibiotics for gram-negative cover or premature discontinuation of the study antibiotics were judged as failure. One hundred and eighty six patients were randomized by nine German centres, the patients matched for age, underlying diseases and duration of neutropenia (median duration 14 days) in both treatment arms. Infections were documented microbiologically in 29% of the patients, clinically in 16% and suspected (fever of unknown origin) in 102/186 patients (55%). The 82 pathogens isolated were predominantly gram-positive bacteria. In an intent-to-treat analysis, the overall response rate without modification at the final evaluation was 58% in the ceftazidime group and 34% in the cefotaxime group (P < 0.01). The success rates with modification were 84% and 64%, respectively. The failure rate in a highly immunosuppressed subgroup of the patients (bone marrow transplant recipients) was higher for cefotaxime (53%) than for the ceftazidime arm (14%) (P < 0.001). Response rates were significantly higher in the ceftazidime group for patients with microbiologically documented and possible infections. No major bacterial superinfections occurred in the low-dose treatment arm. The tolerability was good for both regimens. Low-dose ceftazidime combined with netilmicin proved to be superior to recommended doses of cefotaxime/netilmicin in febrile neutropenic patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftazidime; Cephalosporins; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Fever; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Neutropenia; Superinfection; Treatment Outcome

We have prospectively studied 13 episodes of spontaneous bacterial peritonitis (SBP) in 12 patients treated with cefotaxime (CTX) 2 g intravenously every 8 h (mean duration, 5.3 days). Ascitic fluid was inoculated at the bedside. The cultures were done before, during (day 3 after CTX initiation), and 48-72 h (mean, 56 h) after the end of therapy. All SBP episodes were monomicrobial. During treatment, the concentrations of CTX and desacetyl-cefotaxime (d-CTX) in ascitic fluid were high in all 13 SBP episodes, and d-CTX was still present in 6 patients who had residual ascitic bactericidal titer (ABT) activity after the last dose of CTX. ABTs were >/=1:128 during CTX therapy in 12 episodes and were measurable in 7 patients after the last dose. All patients were cured. The present study provides scientific rationale to the clinical studies that suggest treating SBP episodes with lower doses of antibiotics and shorter treatment duration.

Topics: Adult; Aged; Aged, 80 and over; Ascitic Fluid; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporins; Female; Humans; Male; Middle Aged; Peritonitis; Prospective Studies

Topics: Albumins; Bacterial Infections; Cefotaxime; Combined Modality Therapy; Cost-Benefit Analysis; Hospital Mortality; Humans; Infusions, Intravenous; Liver Cirrhosis; Peritonitis; Plasma Substitutes; Prospective Studies

The empiric antibiotic treatment of intraabdominal infections is in constant evolution. Monotherapy appears to be a desirable goal because of the simplicity of its administration, lack of toxic effects and wide spectrum.. A multicentre, prospective, randomized, open study was carried out to compare two antibiotic regimens in the treatment of intraabdominal infections in patients undergoing surgery. Ninety-eight consecutive patients were randomly allocated into two groups. One group (GM, n = 51) received meropenem (1 g/8 h) and the other (GCM, n = 47) a combination of cefotaxime (2 g/8 h) plus metronidazol (0.5 g/8 h). Clinical and bacteriological responses were assessed at the end of treatment and at 2-4 weeks.. The severity of patients as assessed by the APACHE II score was similar in both groups (GM: 7.2 and GCM: 8.1). Three patients in each group could not be evaluated due to premature interruption of treatment or deviation from the protocol. The mean duration of treatment was 7.4 days in GM and 7.9 days in GCM. A satisfactory clinical response was obtained in 95% of patients in both groups. 31 patients (61%) in GM and 26 patients (55%) in GCM were bacteriologically evaluable. Bacteriological erradication was achieved in 94% of patients in GM and in 92% of patients in GCM.. Meropenem is a good alternative for single antibiotic therapy in intraabdominal infections of moderate severity.

Topics: Abdomen; Abdominal Abscess; Adult; Aged; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Female; Humans; Male; Meropenem; Metronidazole; Middle Aged; Peritonitis; Prospective Studies; Thienamycins

We conducted a randomized, open-label, controlled, multicenter study to compare sulbactam/cefoperazone with cefotaxime in terms of efficacy and safety for the treatment of hospitalized patients with moderate-to-severe bacterial infections. More than two-thirds of the pathogens recovered from these patients produced beta-lactamase. Two hundred-seven (88.1%) of the 235 patients enrolled completed the study and were included in the efficacy and safety evaluations. One hundred-three patients received sulbactam/cefoperazone (2-4 g/d) administered in evenly divided doses every 12 hours by a 30-minute intravenous drip; 104 patients received cefotaxime (6-12 g/d) administered in evenly divided doses every 6 or 8 hours by a 30-minute intravenous drip. The overall efficacy rates (i.e., cure or markedly improved) were 95% for the sulbactam/cefoperazone group and 90% for the cefotaxime group (P = .186), whereas the bacterial eradication rates were 85% for the sulbactam/cefoperazone group and 81% for the cefotaxime group (P = .467). Both drug regimens were well tolerated. Sulbactam/cefoperazone is effective and safe for the treatment of moderate-to-severe bacterial infections caused mainly by beta-lactamase-producing organisms.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; beta-Lactamase Inhibitors; Cefoperazone; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections; Skin Diseases, Bacterial; Sulbactam; Urinary Tract Infections

We conducted a prospective, multi-centre, open, randomized study in 11 UK hospitals to compare iv meropenem 1 g tds with the combination of iv cefotaxime 1 g tds and iv metronidazole 500 mg tds in patients with serious infections. One hundred and sixty-one patients were enrolled, of whom 131 were clinically evaluable (meropenem, n = 68; cefotaxime/metronidazole, n = 63). The most common infections were subsequent to intra-abdominal pathology (meropenem, n = 77%; cefotaxime/metronidazole, n = 75%), and were usually accompanied by septicaemia (meropenem, n = 61%; cefotaxime/metronidazole, n = 53%). The incidence of a satisfactory clinical response was similar in the two groups at the end of treatment (93% for meropenem; 92% for cefotaxime/metronidazole) and up to 8 weeks later (96% for meropenem; 93% for cefotaxime/metronidazole). Satisfactory bacteriological response (success or presumed success) was recorded at the end of therapy in 86% of meropenem and 88% of cefotaxime/metronidazole patients. Adverse events were reported in 32% of meropenem and 25% of cefotaxime/metronidazole patients, and most were mild or moderate and did not require discontinuation of therapy. Twenty-one patients (ten meropenem and 11 cefotaxime/metronidazole) died during the trial, underlining the severity of the infections being treated in this group of patients. None of the deaths was thought to be related to study therapy.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Female; Hospitalization; Humans; Male; Meropenem; Metronidazole; Middle Aged; Prospective Studies; Thienamycins; Treatment Outcome

A randomized controlled clinical study of cefetamet pivoxil (CAT) compared with cefixime (CFX) was conducted to evaluate its safety and efficacy in treating bacterial infections. 99 patients suffering from respiratory and urinary tract infections were enrolled in the study. 10 patients were excluded within the first 72 hrs after initiation of the study. 55 and 54 were evaluated for the safety of CAT and CFX respectively. 51 patients in the CAT group and 48 patients in the CFX group were evaluated for the efficacy. The doage of CAT was 250-500 mg and CFX was 200 mg, twice daily orally for 7-10 days. The results showed that the clinical efficacy rates of CAT and CFX were 94.1% (48/51) and 91.7% (44/48), the bacterial clearance rates were 95.3% and 95.1%, respectively. Adverse drug reactions occurred in 9.1% and 7.4% in the two groups respectively. The study demonstrated that there were no satistical differences between the two groups with respect to clinical efficacy, bacterial clearance and adverse reactions.

Topics: Adolescent; Adult; Bacterial Infections; Cefixime; Cefotaxime; Ceftizoxime; Cephalosporins; Escherichia coli; Female; Humans; Klebsiella; Male; Respiratory Tract Infections; Streptococcus pyogenes; Urinary Tract Infections

Children with sickle cell disease are at increased risk for bacterial sepsis and, when febrile, are usually hospitalized for intravenous antibiotic therapy pending results of blood cultures. In this study, we prospectively identified a group of febrile patients with sickle cell disease who were at low risk for sepsis and treated them with outpatient therapy.. Children identified as low risk for sepsis were treated with an initial dose of intravenous ceftriaxone, followed by outpatient therapy with oral cefixime, and were monitored for 14 days after the initial visit. Compliance was assessed by phone calls to parents and by analysis of urine samples.. In 107 eligible febrile episodes (80 patients) over a 21-month period, no patient developed sepsis. One child developed bacteremia 3 days after completing the course of cefixime, and one had splenic sequestration on the fourth study day. Both patients did well. Side effects of cefixime were modest, and overall compliance was excellent (approximately 95%), although urine samples were returned by only 56% of parents.. We conclude that outpatient therapy is safe and effective in febrile patients with sickle cell disease who meet the criteria for a low risk of sepsis.

Topics: Administration, Oral; Adolescent; Anemia, Sickle Cell; Anti-Infective Agents; Bacteremia; Bacterial Infections; Cefixime; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Humans; Infant; Male; Outpatients; Patient Compliance

Nonabsorbable antibiotics for selective bowel decontamination (SBD) sometimes are administered to liver transplant patients to prevent postoperative infections, but the efficacy of SBD is not known. Accordingly, we prospectively studied 69 patients randomly assigned to receive conventional prophylaxis with systemic antibiotics (control patients) or conventional prophylaxis plus oral nonabsorbable antibiotics for SBD (SBD patients). Overall rates of bacterial and/or yeast infections were nearly equal among control patients (42%) and SBD patients (39%). However, the infection rate at SBD key sites (abdomen, bloodstream, surgical wound, and lungs) was lower among patients who received the SBD regimen > or = 3 days before transplantation (23%) than among control patients (36%). Administration of the SBD regimen was complicated by gastrointestinal intolerance and noncompliance but not by increased stool colonization with antibiotic-resistant gram-negative bacilli. Practical problems associated with administering an SBD regimen to patients awaiting cadaver liver transplants limit the regimen's usefulness, but we found a trend toward reduced key site infection when the regimen was given > or = 3 days before transplantation.

Topics: Ampicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefotaxime; Colistin; Drug Administration Schedule; Evaluation Studies as Topic; Feces; Female; Gentamicins; Humans; Intestines; Liver Transplantation; Male; Mycoses; Nystatin; Risk Factors; Treatment Outcome

Treatment of spontaneous bacterial peritonitis currently involves intravenous antibiotic administration. To test the possibility of treating spontaneous bacterial peritonitis with oral antibiotics, oral ofloxacin was compared with intravenous cefotaxime in this infection.. One hundred twenty-three cirrhotics with uncomplicated spontaneous bacterial peritonitis (no septic shock, grade II-IV hepatic encephalopathy, serum creatinine level of > 3 mg/dL, and gastrointestinal hemorrhage or ileus) were randomly given oral ofloxacin (64 patients) or intravenous cefotaxime (59 patients).. Infection resolution rate was 84% in the ofloxacin group and 85% in the cefotaxime group. Peak serum levels and trough serum and ascitic fluid levels of ofloxacin and cefotaxime measured on days 3 (23 patients) and 6 (11 patients) of therapy were greater than the minimal inhibitory concentration of isolated organisms. Hospital survival rate was 81% in each group of patients. Blood urea nitrogen and hepatic encephalopathy at diagnosis were associated with prognosis. None of the 36 nonazotemic patients with community-acquired spontaneous bacterial peritonitis and without hepatic encephalopathy developed complications during hospitalization, and all were alive at time of discharge.. Oral ofloxacin is as effective as intravenous cefotaxime in uncomplicated spontaneous bacterial peritonitis. Nonazotemic cirrhotic patients with uncomplicated community-acquired spontaneous bacterial peritonitis and without hepatic encephalopathy have an excellent prognosis and may be treated with oral ofloxacin without requiring hospitalization.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Female; Humans; Injections, Intravenous; Male; Middle Aged; Ofloxacin; Peritonitis

Two hundred and two isolates of gram-positive and gram-negative pathogens of urinary tract infection were tested for their susceptibility to cefpirome. In 64 to 97 per cent of the cases the susceptibility was high and exceeded that of other cephalosporins used in the treatment of urological patients. Cefpirome was used in the treatment of 26 patients with signs of urinary tract infection: 19 patients with pyelonephritis and 7 patients with prostatitis. The antibiotic was administered intravenously in a dose of 1 g twice a day for the treatment course of 5-7-10 days. The clinical and bacteriological efficacies amounted to 92 and 87 per cent respectively. The drug tolerance was good. The results demonstrated that cefpirome was useful in the empirical therapy of urinary tract infection.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefpirome; Ceftazidime; Cephalosporins; Cephalothin; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Middle Aged; Treatment Outcome; Urinary Tract Infections

The potential tubulotoxicity of tobramycin and cefotaxim were assessed in neonates by measuring the urinary level of adenosine deaminase binding protein (ABP) and urinary alpha 1-microglobulin and beta 2-microglobulin. In a prospective study, 33 neonates who received tobramycin and cefotaxim for suspected neonatal sepsis were compared with 48 untreated newborns during the first 10 days of life. The urinary concentrations of ABP and its excretion rates, corrected for body weight and body surface area, were significantly increased from the 1st day of treatment. Urinary alpha 1-microglobulin and beta 2-microglobulin were not elevated under tobramycin and cefotaxim during the first 2 days of treatment. We conclude that ABP may be a sensitive marker for the detection of proximal renal tubular injury during tobramycin and cefotaxim treatments of neonates. The increase in urinary ABP which occurs before an elevation of urinary alpha 1-microglobulin and beta 2-microglobulin may reflect earlier structural than functional alterations. However, since none of the treated infants had signs of electrolyte disorders or glomerular dysfunction, the clinical relevance of ABP measurement should be reevaluated.

Topics: Anti-Bacterial Agents; Bacterial Infections; beta 2-Microglobulin; Biomarkers; Cefotaxime; Cephalosporins; Creatinine; Dipeptidyl Peptidase 4; Humans; Infant, Newborn; Prospective Studies; Tobramycin

Fifty-three hospitalized patients suffering from lower respiratory tract infections were evaluated in a randomized, comparative trial studying the safety and efficacy of ampicillin/sulbactam (2 g ampicillin plus 1 g sulbactam intravenously every 6 h) versus cefotaxime (2 g intravenously every 6 h). Thirty-four of the 36 and 16 of the 17 patients treated with ampicillin/sulbactam and cefotaxime, respectively, were evaluable. Clinical and bacteriologic efficacy did not differ significantly between the two treatment groups (p = 0.828 and p = 0.648, respectively). Twenty-one (61.8%) of the ampicillin/sulbactam-treated patients were cured, eight (23.5%) improved and four (11.8%) were treatment failures. Nine (56.3%) of the cefotaxime treated patients were cured, four (25.0%) improved and two (12.5%) failed therapy. All primary pathogens were eradicated in 19 (55.9%) of the ampicillin/sulbactam group and were partially eradicated in seven (20.6%) patients. In the cefotaxime treatment group bacteriologic eradication occurred in 10 (62.5%) and partial eradication in two (12.5%) patients. Both study drugs were well tolerated, as the number of adverse reactions in each treatment group was small and similar between the two groups. Ampicillin/sulbactam appears to be as safe and effective as cefotaxime in the therapy of hospitalized patients with lower respiratory tract infections caused by beta-lactamase positive and beta-lactamase negative pathogens.

Topics: Adult; Aged; Ampicillin; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Female; Hospitalization; Humans; Male; Middle Aged; Respiratory Tract Infections; Sulbactam

Thirty patients with severe bacterial infections were treated with 50 mg of cefodizime per kg of body weight once daily or 50 mg of ceftriaxone per kg once daily for 10 +/- 3 days. The effect of cefodizime and ceftriaxone on the phagocytic capacity and generation of reactive oxygen intermediates after phagocytosis by granulocytes was assessed prior to, during, and after therapy. Flow cytometry was used to study phagocytic capacity by measuring the uptake of fluorescein-labeled bacteria. The generation of reactive oxygen intermediates after phagocytosis was estimated by the quantification of the intracellular conversion of dihydrorhodamine 123 to rhodamine 123. Prior to therapy, patients in both groups exhibited a decreased capacity to phagocytize Escherichia coli and subsequently to generate reactive oxygen intermediates. Granulocyte function increased after the initiation of therapy and normalized within 7 days for the ceftriaxone-treated patients and within 3 days for the cefodizime group (P < 0.05). In the cefodizime group, an enhancement of phagocytic capacity was observed 14 days after the initiation of therapy (P < 0.05). Prior to therapy, phagocytic capacity was significantly correlated with the generation of reactive oxygen products (r = 0.674 and P < 0.005).

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Escherichia coli; Female; Flow Cytometry; Granulocytes; Humans; In Vitro Techniques; Male; Middle Aged; Neutrophils; Phagocytes; Phagocytosis; Reactive Oxygen Species

Cefotaxime (CTX) is considered one of the first-choice antibiotics in the therapy of spontaneous bacterial peritonitis (SBP) in cirrhosis. Because CTX is largely metabolized in the liver, this drug may also be effective in SBP by administering lower doses than those habitually used. To investigate this possibility, a prospective, randomized, multicenter study was performed to compare the therapeutic efficacy of two different dosages of CTX in 143 patients with SBP: 71 (group I) were allocated to receive a high dose (2 g every 6 hours, which is one of the most frequently recommended doses in this infection), and 72 (group II) were allocated to receive a low dose (2 g every 12 hours). At inclusion, both groups were similar in relation to clinical and laboratory data, with the exception of a higher incidence of positive ascitic fluid culture in group I than in group II (59% vs. 40%; P = .029). The rate of infection resolution was similar for both groups (77% vs. 79%). Hospital survival was also similar in both groups (69% vs. 79%). No difference was observed between patients with positive or negative ascitic fluid cultures with regard to infection resolution and patient survival. The duration of antibiotic therapy was similar in both groups (9.0 +/- 3.3 days in group I vs. 8.8 +/- 3.1 days in group II). In a subset of 13 patients from group I and 11 patients from group II CTX levels were determined in serum (peak and trough) and ascitic fluid (concomitantly with trough serum). Peak serum levels were similar in patients from both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Hospital Mortality; Humans; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Prospective Studies

In an open, multicentre, randomised study, the efficacy and safety of meropenem monotherapy as adjuvant antibiotic therapy in the surgical management of intra-abdominal infection was compared with that of the combination of cefotaxime and metronidazole. A total of 160 hospitalised adult patients with intra-abdominal infection requiring surgery were treated intravenously with either meropenem 1 g every 8 h (by bolus injection or infusion; n = 77) or cefotaxime 2 g and metronidazole 500 mg every 8 h (n = 83). Clinical and bacteriological responses to antibiotic therapy were assessed at the end of treatment and at 2-4 weeks' follow-up after treatment. The clinical response rates at the end of treatment and follow-up were 91% and 96%, respectively, for meropenem and 100% and 97%, respectively, for cefotaxime plus metronidazole. The bacteriological response rates were 90% and 93%, respectively, for meropenem and 92% at both time points for cefotaxime plus metronidazole. Both treatments were well tolerated. In this study, meropenem monotherapy was effective and as well tolerated as cefotaxime plus metronidazole. Meropenem monotherapy should, therefore, prove a useful alternative to standard combination therapy for the empirical treatment of intra-abdominal infections.

Topics: Abdomen; Adolescent; Adult; Aged; Anti-Infective Agents; Bacterial Infections; Carbapenems; Cefotaxime; Drug Therapy, Combination; Drug Tolerance; Humans; Meropenem; Metronidazole; Middle Aged; Thienamycins; Treatment Outcome

In this multicentre, randomised study of 170 children hospitalised with bacterial infections, meropenem (10 to 20 mg/kg every 8 h) was found to be as effective and as well tolerated as cefotaxime (100 to 150 mg/kg/day), with or without amikacin or metronidazole. Most drug-related adverse events were mild and self-limiting. Neither regimen was associated with seizures. The overall incidence of clinically significant laboratory changes was similar in the two treatment groups. Satisfactory clinical responses were obtained in 94/96 (98%) patients treated with meropenem monotherapy and 43/46 (93%) children treated with cefotaxime regimens, while satisfactory bacteriological responses were obtained in 25/28 (89%) and 9/10 (90%) patients, respectively. Meropenem monotherapy appears to be a well-tolerated and effective drug for paediatric infections.

Topics: Amikacin; Anti-Bacterial Agents; Bacterial Infections; Carbapenems; Cefotaxime; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Drug Tolerance; Humans; Infant; Meropenem; Metronidazole; Thienamycins

A randomized controlled clinical trial of sulperazone as compared with cefotaxime was conducted. 207 patients with bacterial infections entered the study. The overall clinical efficacy rate of sulperazone and cefotaxime was 95.15% and 90.38% respectively. The bacterial clearance rate in the two groups was 84.7% and 80.6% respectively. The adverse drug reactions in both groups were mild with the rate of 7.77% and 8.65% respectively; there was no statistical difference between the two groups. The results of disc susceptibility test showed that the sensitive rate of the clinical isolates to sulperazone was 90.9%, being significantly higher than that of cefotaxime 69.3% (P < 0.001).

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cefoperazone; Cefotaxime; Drug Combinations; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Sulbactam

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

We administrated cefodizime (40 mg/kg) to 13 patients with simple herniorrhaphy in the pediatric field and determined its concentrations in tissues and serums. The mean serum and tissue levels of cefodizime after administration were 43.1 +/- 13.3 micrograms/ml, and 23.1 +/- 6.4 micrograms/g, respectively, at 3 hours. Cefodizime concentrations of the tissue and serum were maintained at relatively high levels for many hours. The ratio of cefodizime concentrations in tissue to serum became high at 3 hours after administration, and this suggests that tissue concentrations decreased more slowly than serum levels, and cefodizime concentrations in tissue were maintained at fairly high levels over a long period. No side effects caused by cefodizime were observed. From pharmacokinetic and clinical observations, cefodizime appears to be a safe and effective injectable antibiotic for the treatment of infections in children.

Topics: Bacterial Infections; Cefotaxime; Child; Child, Preschool; Female; Herniorrhaphy; Humans; Infant; Male; Peritoneum; Premedication; Tissue Distribution

The purpose of this study was to examine the safety and efficacy of outpatient intravenous antibiotic therapy for skin and soft-tissue infections and determine its effect on length of hospital stay. In this open-label, multicenter, prospective study, 130 adult patients with skin and soft-tissue infections requiring parenteral antibiotic therapy were enrolled as a subgroup. Initial therapy was delivered to hospital inpatients or in outpatient treatment centers, followed by home infusion therapy. Cefotaxime was delivered intravenously using a programmable ambulatory infusion pump. The clinical response rate was 97.5% (n = 118), while the bacteriologic response rate was 94.0% (n = 83). Only 32.2% of patients required hospitalization, and the mean duration of inpatient care for all evaluable patients was only 1.5 days. The mean duration of hospitalization for patients receiving inpatient care was 4.7 days. In conclusion, home intravenous cefotaxime therapy is safe, effective, and may reduce healthcare costs for many patients with skin and soft-tissue infections.

Topics: Abscess; Adult; Bacterial Infections; Cefotaxime; Cellulitis; Diabetes Complications; Female; Home Care Services; Humans; Infusion Pumps; Length of Stay; Male; Middle Aged; Prospective Studies; Skin Diseases, Bacterial

The treatment of bacterial pneumonia commands a large segment of hospital resources, and economic concerns are dictating shorter hospital stays. This study was designed to determine whether outpatient therapy with intravenous (IV) antibiotics (a third-generation cephalosporin, cefotaxime, delivered via an ambulatory delivery system [ADS]) is as effective as traditional hospital management of pneumonia. A subgroup of 62 patients from three centers, with bacterial pneumonia, were enrolled in a multicenter, open-label study of outpatient IV cefotaxime therapy. Doses of cefotaxime were 1 g IV every 12 hours, 1 g IV every 8 hours, or 2 g IV every 8 hours, based on severity of infection. Of 62 patients, 53 (85%) completed the study. All 22 bacteriologically evaluable patients showed eradication of pathogen or clinical cure with no obtainable follow-up culture; no relapses, reinfections, or superinfections were reported. Overall clinical success rate was 94.8% (satisfactory 75.9%; improved 19.0%, n = 58). Average length of hospital stay was 2.3 +/- 4.83 days. In conclusion, clinical success rates with outpatient IV cefotaxime therapy were comparable to previous studies with IV cefotaxime for pneumonia treatment in the hospital. Outpatient IV antibiotic therapy has the potential to significantly reduce length of hospital stay for pneumonia without sacrificing clinical efficacy.

Topics: Adult; Bacterial Infections; Cefotaxime; Female; Home Care Services; Humans; Infusion Pumps; Male; Middle Aged; Pneumonia

The primary objective of this multicenter, prospective trial was to determine the safety, efficacy, and cost effectiveness of cefotaxime delivered via an ambulatory delivery system (ADS) in the treatment of patients with a variety of bacterial infections. The secondary objective was to determine the safety and efficacy of cefotaxime/ADS treatment of infections in a diabetic subgroup. A total of 238 patients (> or = 18 years) in five infection categories were enrolled from 10 sites. All patients received cefotaxime/ADS. Both global analysis and analysis of a subpopulation with diabetes mellitus were performed. Of the 211 patients who completed the study, 201 patients (95.3%) exhibited a satisfactory or improved clinical response following cefotaxime/ADS. Bacteriologic response, evaluable in 134 of 211 patients, was satisfactory in 125 of these patients (93.3%). Within the diabetes mellitus subpopulation, a satisfactory or improved clinical response was identified in 30 of 32 patients (93.8%). In conclusion, administration of cefotaxime via ADS is a well-tolerated, safe, and clinically effective treatment of serious infection and may be less expensive than inpatient intravenous antibiotic therapy.

Topics: Bacterial Infections; Cefotaxime; Diabetes Complications; Female; Home Care Services; Humans; Infusion Pumps; Length of Stay; Male; Middle Aged

Studies have documented the efficacy and safety of antibiotic infusion in the home as a cost-effective alternative to in-hospital infusion. The present analysis focuses on home treatment of pneumonia with cefotaxime delivered via an ambulatory infusion pump and the potential of this therapy to reduce the length of hospital stay. Data presented here and in previously published studies of a variety of serious infections show that admitting patients into home intravenous antibiotic therapy programs can significantly reduce, and sometimes eliminate, hospital stay, while providing efficacy and safety comparable to that expected from hospital treatment. Analysis of hospitalization patterns for pneumonia patients placed on cefotaxime therapy delivered via portable infusion pump revealed that length of stay was only 10% of that for the reference diagnosis-related group. Despite the great potential cost savings, there are reimbursement barriers to the use of home infusion antibiotics. However, healthcare reform may promote greater acceptance, use, and support of home infusion technology.

Topics: Bacterial Infections; Cefotaxime; Cost Savings; Diagnosis-Related Groups; Home Care Services; Humans; Infusion Pumps; Insurance, Health, Reimbursement; Length of Stay; Pneumonia

The purpose of this study was to determine the safety and efficacy of outpatient intravenous (IV) therapy with a third-generation cephalosporin, cefotaxime, in patients > or = 60 years of age and to determine its effect on length of hospital stay. Subset analysis was performed with 62 patients with various infections who had been enrolled in a prospective, multicenter, open-label trial of IV cefotaxime delivered through a computerized ambulatory delivery system (ADS). Initial treatment was given in hospital if required, followed by home therapy. The overall clinical response rate among evaluable patients was 98%, and the overall bacteriologic response rate was 93%. The mean duration of inpatient therapy was 3.6 days less than the mean of 8.2 days allowed under diagnosis-related group (DRG) allotments. Outpatient therapy with cefotaxime via infusion pump is safe and effective and may reduce hospitalization requirements.

Topics: Age Factors; Aged; Bacterial Infections; Cefotaxime; Female; Home Care Services; Humans; Infusion Pumps; Length of Stay; Male; Prospective Studies

The purpose of this study was to determine the safety and efficacy of home intravenous antibiotic therapy in treating secondary bacterial infections in patients infected with the human immunodeficiency virus (HIV). This study was a subset analysis of 22 patients with HIV, enrolled in two centers of a multicenter, open-label, prospective study. When necessary, patients were stabilized as inpatients, followed by home therapy. Enrolled patients had diagnoses of pneumonia, skin and soft-tissue infections, bacteremia/septicemia, or other infections requiring parenteral therapy. A third-generation cephalosporin, cefotaxime, 1-2 g every 8 hours, was delivered intravenously using an ambulatory delivery system (ADS). Home therapy with cefotaxime/ADS produced a clinical response rate of 95% and bacteriologic response of 88.2%. The requirement for and duration of inpatient therapy was markedly reduced compared with diagnosis-related group (DRG) allotments. In conclusion, home intravenous antibiotic therapy with cefotaxime in patients infected with HIV is effective and safe. It may improve quality of life by reducing the length of hospital stay.

Topics: Acquired Immunodeficiency Syndrome; Adult; Bacterial Infections; Cefotaxime; Female; Home Care Services; Humans; Infusion Pumps; Length of Stay; Male; Prospective Studies

Patients with presumed acute gynaecological infections were randomized (2:1) to receive cefepime 2 g every 12 h (n = 159) or cefotaxime 2 g every 8 h (n = 72), both im or by a 30-min i.v. infusion. For evaluation of efficacy, patients were required to have a bacteriologically documented infection, with at least one pathogen isolated susceptible to both drugs. Duration of treatment was 2-8 days in the 95 cefepime-treated patients and 3-10 days in the 36 cefotaxime-treated patients with evaluable infections; approximately three-quarters of the patients in each group were treated for 4-5 days. Clinical response was satisfactory in 81/95 (85%) of the evaluable cefepime recipients and 30/36 (83%) of the evaluable cefotaxime recipients (P = 0.802). In total, 211 (85%) of the 247 pathogens isolated from evaluable cefepime recipients were eradicated, compared with 98 (90%) of 109 pathogens isolated from evaluable cefotaxime recipients. All pathogens were eradicated in 77 (81%) cefepime-treated patients and in 31 (86%) cefotaxime-treated patients (P = 0.379). Overall response to treatment, calculated by combining clinical response and individual patient bacteriological response, was considered effective, partially effective or ineffective in 77%, 13% and 11% of cefepime-treated patients respectively and in 75%, 19% and 6% of cefotaxime-treated patients respectively (P = 0.932 for effective response). Adverse clinical events were reported by 68 (43%) of 159 cefepime recipients and by 26 (36%) of 72 cefotaxime recipients (P = 0.342); adverse events were deemed drug-related in 6% of cefepime recipients (diarrhoea, rash and headache) and in 1% of cefotaxime recipients (diarrhoea, pruritus and rash). Treatment was discontinued prematurely due to adverse events in five cefepime-treated patients and in one cefotaxime-treated patient (P = 0.476). Local intolerance was reported by 33 (21%) of the 159 cefepime-treated patients and by 14 (19%) of the 72 cefotaxime-treated patients receiving drug via the iv route alone; none of the patients discontinued treatment because of local intolerance. Laboratory test abnormalities were observed in a small number of patients in each group (1-8%), but none warranted discontinuation of treatment. Cefepime 2 g bd appears to have efficacy and safety comparable to that of cefotaxime 2 g tid in the treatment of acute obstetric and gynaecological infections.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefepime; Cefotaxime; Cephalosporins; Female; Genital Diseases, Female; Humans; Middle Aged; Pregnancy; Puerperal Infection

Detection of hearing impairment in early childhood is difficult. We serially recorded transient evoked otoacoustic emissions (TEOAEs) to search for signs of ototoxicity in term, healthy newborns and compared the results to a second group of term babies treated for perinatally acquired bacterial infection with ampicillin plus either cefotaxime or plus aminoglycoside. At initial evaluation, in the group of 45 healthy children born at term, well reproducible emissions were observed in all but two children. In each of these two, initially well reproducible TEOAEs were detected in one ear only. At the time of the second recording (mean at day 8.5) excellent emissions were seen in all ears of all children. Similarly, in the second group receiving ampicillin plus either cefotaxime or plus aminoglycoside, the height of emissions as well as TEOAE-reproducibility was equal or even increased at the time of the second evaluation in all 17 patients. In the following group of 59 patients, all receiving ampicillin plus aminoglycoside, again TEOAEs were equal or improved at the time of follow-up examinations. In all patients, a reduced general condition tended to be associated with less reproducible TEOAEs. We conclude that at conventional doses in low-risk infants, aminoglycosides are unlikely to cause ototoxicity and that in early childhood serial TEOAE-recording may be useful for evaluation of inner ear function.

Topics: Ampicillin; Anti-Bacterial Agents; Auditory Perception; Bacterial Infections; Cefotaxime; Cochlea; Evoked Potentials, Auditory; Female; Follow-Up Studies; Humans; Infant, Newborn; Male; Netilmicin; Reflex, Acoustic; Reproducibility of Results; Tobramycin

The efficacy and safety of a once-a-day antibiotic in the treatment of sinusitis was studied. Two randomly assigned groups were treated with either once-a-day cefixime, a third generation cephalosporin, or amoxicillin three times a day. One hundred and fourteen patients were evaluated with antral punctures, microbiologic evaluation, and radiographic studies. Cultures revealed 40% gram-negative organisms, 48% gram-positive, and 12% anaerobes. The most common bacteria were Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus and viridans group streptococci. Ninety-four percent of the cefixime group were cured compared with 96% of the amoxicillin group. Staphylococcus resistance was a problem in both groups, necessitating an occasional change to amoxicillin-clavulanate potassium in the amoxicillin group. Once-a-day antibiotics offer the potential for improved compliance in the treatment of sinusitis. Cefixime offers an additional benefit of covering beta-lactamase producing strains of bacteria which are increasing in incidence and resistant to many penicillins.

Topics: Administration, Oral; Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Capsules; Cefixime; Cefotaxime; Clavulanic Acids; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Remission Induction; Sinusitis; Time Factors

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

In an open, controlled, randomized study the safety and efficacy of imipenem/cilastatin was compared with that of the combination cefotaxime/gentamicin (plus metronidazole in patients with suspected anaerobe infection) in the treatment of 337 patients from 12 German and 5 Austrian centers who had non-life-threatening infections. The evaluation was done on an intention-to-treat basis (i.e. all patients including protocol violators) and according to the protocol (144 patients in the imipenem/cilastatin group and 124 in the cefotaxime/gentamicin group). No significant differences were seen between the two treatment groups in terms of the clinical and bacteriological outcome. The frequency of infusion intolerance and thrombophlebitis was low in both groups (< 2%). The overall rate of adverse events was comparable in the two groups, nausea, vomiting and diarrhea being the most frequent events. Nephrotoxicity, indicated by an increase in serum creatinine, was significantly higher in the cefotaxime/gentamicin group. Imipenem/cilastatin was shown to be as effective as cefotaxime/gentamicin (metronidazole) and appears to be well tolerated.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Cilastatin; Drug Therapy, Combination; Female; Gentamicins; Humans; Imipenem; Male; Middle Aged

In this comparative, randomized, multicenter trial, 273 patients scheduled for gynecologic surgery were studied: 87 received a single 1-g dose of cefotaxime 30 minutes before surgery; 81 were given a 1-g dose of cefoxitin 30 minutes before surgery and 1 g every 6 hours for 24 hours after surgery (total dose 4 g); and 105 received a 1-g dose of cefazolin 30 minutes before surgery, followed by 1 g every 8 hours for 48 hours (total dose 6 g). Patients who received cefotaxime had a significantly lower incidence of postoperative fever compared with those treated with cefoxitin or cefazolin (p < 0.01). The incidence of positive urinary cultures was lower in the cefotaxime and cefazolin groups when compared with the cefoxitin group (p < 0.01 and p < 0.05, respectively). The results of this study confirm the efficacy of cefotaxime as prophylaxis in surgical infections and demonstrate that single-dose cefotaxime is more effective than a four-dose regimen of cefoxitin.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefazolin; Cefotaxime; Cefoxitin; Cephalosporins; Drug Administration Schedule; Female; Genitalia, Female; Humans; Middle Aged; Postoperative Complications; Premedication

There are two critical moments for the development of severe infectious complications following transurethral prostatectomy (TURP): the operative and immediate postoperative periods, and the day that the postoperative drainage catheter is removed. To optimize the timing of antibiotic prophylaxis with cefotaxime, two prospective randomized studies were conducted in patients with preoperatively sterile urine. In Study 1, all patients (n = 50) received cefotaxime 1 g intramuscular (i.m.) 1 hour preoperatively and were then randomized to receive either a second identical dose of cefotaxime 1 hour before catheter removal 24 hours later, or no further antibiotic treatment. In Study 2, patients (n = 89) were randomized to receive either cefotaxime 1 g i.m. 1 hour preoperatively or no preoperative antibiotic, after which all received cefotaxime 1 g i.m. 1 hour before catheter removal. Results were compared using identical evaluation criteria for infection in both studies: incidence of fever (temperature > 38 degrees C), bacteriuria (10(5) organisms/mL) and positive blood cultures, and duration of hospital stay (days). In Study 1, infection was significantly reduced with respect to all parameters in the group receiving two doses of cefotaxime, and total drug treatment costs were halved. In Study 2, the groups did not differ with respect to any parameter. We conclude that a single dose of cefotaxime 1 g i.m. 1 hour preoperatively provides inadequate cover for urethral catheter removal 24 hours later, and that prophylaxis with a single dose of cefotaxime 1 g i.m. 1 hour before catheter removal is just as effective as two doses given 1 hour preoperatively and 1 hour before catheter removal. Prophylactic coverage is essential during the action of removing the catheter and the time immediately following the operation. Long-term antibiotic coverage (24 hours or more) is not necessary. Thus, following TURP in patients with preoperatively sterile urine undergoing continuous bladder irrigation for 24 hours postoperatively, the optimal dose schedule for antibiotic prophylaxis with cefotaxime is a single 1-g dose given i.m. 1 hour before catheter removal.

Topics: Aged; Bacterial Infections; Cefotaxime; Drug Administration Schedule; Humans; Male; Postoperative Complications; Premedication; Prospective Studies; Prostatectomy

Two dose schedules of the antibiotic cefotaxime were compared in a prospective, randomized 226-center study of 3,670 patients undergoing abdominal, gynecologic, and urologic surgery. Schedule A consisted of a single preoperative dose and schedule B consisted of one preoperative dose followed by two postoperative doses. There was no significant difference in the frequency of wound infection or bacteriuria between the two schedules. Schedule B was associated with a significantly higher incidence of postoperative pyrexia, further antibiotic therapy, local side effects, and extended hospital stay. One dose probably has less impact on the intestinal flora. Therefore, single-dose cefotaxime is as effective and less costly when compared with multiple-dose cefotaxime for common surgical procedures lasting less than 3 hours.

Topics: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Administration Schedule; Female; Fever; Humans; Hysterectomy; Length of Stay; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Surgical Wound Infection; Urinary Tract

Four hundred and seventy patients who had undergone neurosurgical operations were studied prospectively. After defining post-operative infection so that is included all the infective complications irrespective of location occurring after surgery, the overall infection rate was 17%. The infection rate in 413 cases without pre-existing infection was 15%. Wound infection was recorded in 5% and meningitis in 6%. Risk factors which lead to a significant increase in the incidence of postoperative infection were found to be altered sensorium, multiple operations, pre-existing infection, emergency surgery, duration of surgery more than 4 hours, urinary catheterisation, cerebrospinal fluid leak, and ventilatory support.

Topics: Administration, Oral; Bacterial Infections; Cefotaxime; Central Nervous System Diseases; Cephalexin; Cerebrospinal Fluid Shunts; Cross Infection; Female; Gentamicins; Humans; Injections, Intramuscular; Male; Meningitis, Bacterial; Middle Aged; Penicillins; Premedication; Prospective Studies; Risk Factors; Surgical Wound Infection

Bacteriological, pharmacokinetic and clinical studies on cefdinir (CFDN, FK482), a new oral cephalosporin, 5% and 10% granules, were performed in the field of pediatrics. The results are summarized below. 1. Antibacterial activities Antibacterial activities of CFDN against Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, Escherichia coli and Klebsiella pneumoniae were studied in comparison with those of cefaclor (CCL), cefixime (CFIX) and amoxicillin (AMPC). MIC80's of CFDN against S. aureus, S. pneumoniae, S. pyogenes, H. influenzae, B. catarrhalis, K. pneumoniae and E. coli were 0.78, 0.20, less than or equal to 0.025, 0.39, 0.10, 0.20 and 0.10 micrograms/ml, respectively. These results show that CFDN has high antibacterial activities against these organisms. MIC80's of CFDN against Gram-positive bacteria were similar to those of AMPC, and was lower than those of CCL and CFIX. As for antibacterial activities against Gram-negative bacteria (GNB), the MIC80 of CFIX against H. influenzae was 0.05 micrograms/ml, which was slightly lower than that of CFDN. THe MIC80's of CFDN against other GNB were similar to those of CFIX. 2. Absorption and excretion Blood concentrations and urinary excretion rates of CFDN 5% and 10% granules and 100 mg capsule were determined. The data on CFDN 10% granules were similar to those on CFDN 5% granules. At a dose of 3 mg/kg, peak blood concentrations (Cmax's) of CFDN ranged from 0.20 to 2.12 micrograms/ml with 5% granules and from 0.50 to 1.15 micrograms/ml with 10% granules at 2 to 3 hours after dosing. At a dose of 6 mg/kg, peak concentrations were 0.66-2.06 micrograms/ml and 0.70-1.52 micrograms/ml with 5% granules and with 10% granules, respectively. At 8 hours after dosing, blood concentrations were 0.04-0.54 micrograms/ml at 3 mg/kg and 0.06-0.27 micrograms/ml at 6 mg/kg. Blood half-lives were 1.33-4.36 hours at 3 mg/kg and 1.14-3.27 hours at 6 mg/kg. AUC's were 1.7-11.0 micrograms.hr/ml with 3 mg/kg and 2.4-8.7 micrograms.hr/ml with 6 mg/kg. With administration of single 100 mg capsule, Cmax's, blood concentrations after 8 hours, T1/2's and AUC's were 0.79-1.88 micrograms/ml, 0.20 micrograms/ml, 1.54-2.72 hours, and 5.2 micrograms.hr/ml, respectively. Urinary recovery rates in the first 8 hours ranged from 6.85 to 39.2% with 3 mg/kg and 6.08-25.5% with 6 mg/kg.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adolescent; Amoxicillin; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefaclor; Cefdinir; Cefixime; Cefotaxime; Cephalosporins; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Humans; Infant; Male; Microbial Sensitivity Tests

In a prospective randomized double-blind trial, the efficacy and safety of cefotaxime and ceftriaxone were compared in intensive care unit (ICU) patients with serious infections requiring systemic antimicrobial therapy. Patients were randomly assigned to receive either cefotaxime 1 g i.v. t.i.d. or ceftriaxone 2 g every 24 hr. Clinical and bacteriologic assessments were made before treatment, at 48 hr and 5 days during treatment, and 48 hr after treatment. At the time of reporting, a total of 34 patients had been entered into the trial, 27 of whom were evaluable; 23 patients (85%) completed a minimum of 5 days antibiotic treatment. At the end of treatment, using current statistics 67% of cefotaxime and ceftriaxone patients demonstrated clinical cure or improvement. Bacteriologic responses appeared greater in the cefotaxime group (55% vs 42%). The incidence of adverse effects, which were usually minor, was similar in each group. From these preliminary results, it would appear that at the doses used in this study, cefotaxime and ceftriaxone are equally effective in the treatment of infections in the ICU.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Double-Blind Method; Female; Humans; Intensive Care Units; Male; Middle Aged; Prospective Studies; Treatment Outcome

To evaluate the use of selective decontamination of the digestive tract (SDD) (polymyxin, amphotericin, tobramycin, and intravenous cefotaxime) in a mixed intensive care unit, we performed a stratified, randomized, prospective study. The 331 patients were recruited over an 18-month period, with 256 patients remaining more than 48 hours. Stratification by acute physiology and chronic health evaluation (APACHE II) preceded randomization to control (standard antibiotic therapy) or treatment (SDD) groups. Nosocomial infection was significantly reduced in the SDD group (16.7%; 21 of 126 patients) compared with the control group (30.8%; 40 of 130 patients; p = 0.008). No difference was found in overall mortality rate or length of stay between the two groups. Those patients with admission APACHE II scores 10 to 19 demonstrated the most significant reduction in nosocomial infection (23 of 70 control vs 13 of 76 SDD; p = 0.03) and mortality (15 of 70 control vs 8 of 76 SDD; p = 0.07). Emergence of multiresistant microorganisms was not a clinical problem, but a definite change occurred in the ecology of environmental and colonizing bacteria. With the exception of cefotaxime, a reduction was noted in systemic antibiotic usage in the SDD group. We conclude that SDD is useful in selected patients in a mixed intensive care unit.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Bacterial Infections; Cefotaxime; Cost-Benefit Analysis; Critical Care; Cross Infection; Digestive System; Drug Therapy, Combination; Female; Humans; Length of Stay; Male; Middle Aged; Polymyxins; Prospective Studies; Tobramycin

The effectiveness of cefazolin or cefotaxime as antibiotic therapy was compared with that of ceftriaxone in a multicentre prospective randomized trial involving 1,254 consecutive patients operated upon for abdominal diseases. Patients about to undergo surgery of the colon or who had localized or generalized peritonitis at the time of operation were excluded from the study. The patients entered were divided into 4 strata according to the degree of operative contamination and to risk factors. In each stratum, the patients were allocated at random to one or the other of 2 treatment groups. Group 1 patients received cefazolin or cefotaxime in 3 doses of 1 g administered 8-hourly, the first dose being injected during induction of general anaesthesia. Group 2 patients received one single 1 g dose of ceftriaxone injected during induction of anaesthesia. There was no significant difference between the two groups in the wound infection rate and in the frequency of post-operative intra-abdominal abscesses. Although the percentage of post-operative pulmonary and urinary tract infections was lower in the ceftriaxone group than in the cefazolin/cefotaxime group, no significant difference was observed between the two groups in the number of patients who required curative antibiotic therapy. This study shows that one single dose of ceftriaxone is as effective as three doses of cefazolin or cefotaxime in preventing would infections and post-operative intra-abdominal abscesses, and that it is more effective in preventing extra-abdominal infections complicating surgery.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefazolin; Cefotaxime; Ceftriaxone; Child; Digestive System Diseases; Drug Therapy, Combination; Female; France; Genital Diseases, Female; Humans; Male; Middle Aged; Postoperative Care; Postoperative Complications; Prospective Studies; Urologic Diseases; Vascular Diseases

The pharmacokinetic profile of amikacin was analysed by a two-compartment model in 100 critically-ill adult and paediatric patients with normal renal function. In addition the serum amikacin levels in 200 patients randomized to receive a once- or twice-daily dosing regimen are reported. The mean volume of distribution (Vdt) was 0.33 l/kg in the adult patients, 0.50 l/kg in patients 6 to 12 months of age and 0.58 l/kg in patients less than 6 months old. The elimination half-life was prolonged, being 3.45, 2.86 and 5.02 h for the respective age groups (normal 2 h). The clearances dose/AUC) were 0.051, 0.068 and 0.063 l/h/kg respectively. Within each group of patients there was a large variation in the pharmacokinetic parameters, with the Vdt varying by a factor of 6 and the elimination half-life by a factor of 10. All patients receiving a once-daily dose of amikacin had therapeutic peak concentrations. In comparison, therapeutic concentrations were achieved in only 48% of adult and 44% of the paediatric patients receiving the twice-daily dosing regimen. Furthermore the amikacin trough concentrations were significantly higher in the patients who received a divided daily dose. As a consequence of the pharmacokinetic profile of amikacin in critically ill patients a once-daily dosing regimen may be more effective and less toxic than the conventional twice-daily dosing regimen.

Topics: Adolescent; Adult; Aged; Amikacin; Bacterial Infections; Cefotaxime; Ceftazidime; Child; Child, Preschool; Creatinine; Drug Administration Schedule; Female; Gram-Negative Aerobic Bacteria; Humans; Infant; Kidney; Male; Microbial Sensitivity Tests; Middle Aged

In a multicentre non-randomized open prospective study, 124 patients hospitalized in medical infectious disease or intensive care units, with severe community and hospital-acquired bacterial infections were treated with 15 mg/kg body weight amikacin in a once-daily dose given as a 30 min iv infusion, combined with other antibiotics. Infections were bacteriologically proven in 101 patients. The clinical responses showed 83.1% primary success and 83.9% definitive cure predominantly in intensive care patients with hospital-acquired infections and pneumonia. Bacteriological eradication was achieved in 67.3%. Bacteria associated with true failures and colonizations were predominantly Pseudomonas, Acinetobacter and Staphylococcus spp. The risk of nephrotoxicity may be decreased with such a regimen of amikacin, but no conclusions could be drawn with regard to ototoxicity. In summary, a once-daily dosing regimen of amikacin 15 mg/kg is practical and probably efficacious and safe in severely infected patients.

Topics: Adult; Aged; Amikacin; Bacterial Infections; Cefotaxime; Ceftazidime; Cross Infection; Drug Administration Schedule; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Imipenem; Male; Middle Aged; Ofloxacin; Piperacillin; Prospective Studies

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

A two-stage intervention programme was performed to enable the effective substitution of ceftriaxone for cefotaxime in a teaching hospital with large numbers of transient prescribers. One hundred and sixteen patients with a variety of bacterial infections were randomized to an open, historical control comparative study to determine if ceftriaxone was an acceptable replacement for cefotaxime. For 6 months prior to the intervention, both cephalosporins were available on formulary. Following an initial informational stage, a therapeutic interchange programme was implemented to convert prescriptions for cefotaxime to ceftriaxone. Ceftriaxone and cefotaxime were equivalent in terms of microbiological and clinical efficacy and patient tolerance in 77 evaluable patients. No changes in prescriber service occurred after the changeover. Post-intervention treatment courses required a ceftriaxone/cefotaxime interchange in 28% of the cases. Ceftriaxone appeared to be a suitable and cost-effective alternative to cefotaxime in this hospital. The intervention programme successfully invoked the formulary change with minimal expense and prescriber opposition.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Cost-Benefit Analysis; Drug Administration Schedule; Drug Resistance, Microbial; Drug Utilization; Female; Hospitals, Teaching; Humans; Injections, Intravenous; Male; Middle Aged; Prospective Studies; Retrospective Studies

In a prospective randomised study, the effects of two different colonisation prophylaxis techniques on colonisation and pulmonary infection were investigated in 40 critically ill patients with long-term ventilatory support (greater than or equal to 4 days). 20 patients were selectively decontaminated with 4 x 100 g polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and with an antimicrobial sticky paste in the oropharynx (group I). 20 patients received 50 mg of polymyxin B and 80 mg of gentamicin dissolved in 10 ml of 0.9% saline at 6 h intervals into nose, oropharynx and stomach as well as 300 mg of amphotericin B in the oropharynx only (group II). All patients received cefotaxime systemically in the first 3 days. In group I gram-negative aerobic bacteria in the pharynx decreased from 35% to 0%, in group II from 40% to 10% and in the rectum from 80% to 61% (10% in the second week) in Group I and from 100% to 73% (33% in the second week) in group II. The decrease in gram-negative microorganisms was accompanied by an increase in the frequency of Staphylococcus epidermidis. In group I, two patients developed pneumonia and two patients urinary tract infections, in group II two patients suffered from pneumonia and 3 patients urinary tract infections. Both regimes are effective methods of prophylaxis for lowering colonisation with gram-negative aerobic bacteria and the frequency of pneumonia in patients requiring long-term mechanical ventilation. A possible selection of gram-positive bacteria must be appropriately monitored.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Colistin; Critical Care; Female; Gentamicins; Humans; Male; Middle Aged; Pneumonia; Polymyxin B; Prospective Studies; Respiration, Artificial; Time Factors; Tobramycin

An open multicenter study on inpatients of 12 german hospitals was performed to investigate efficacy and safety of sulbactam in combination with mezlocillin, piperacillin or cefotaxim in severe bacterial infections. In total 155 patients were enrolled. The following infections were diagnosed: 48 lower respiratory tract infections, 66 intraabdominal infections, 34 skin/soft tissue infections including post operative wound infections and 5 complicated urinary tract infections. 55 patients received 3 daily doses of 4 g mezlocillin + 1 g sulbactam, 52 patients received 3 daily doses of 4 g piperacillin + 1 g sulbactam and 48 patients received 3 daily doses of 2 g cefotaxim + 1 g sulbactam. Antibiotics and sulbactam were administered concomitantly via intravenous short infusion. Mean duration of therapy was 8 days. Endpoints for assessment of therapeutic efficacy were cure (complete resolution of pretreatment signs and symptoms of the infection) or improvement (marked reduction or partial disappearance or pretreatment signs and symptoms, no further antibiotic therapy required) as well as eradication of pretreatment pathogens. 141 (92%) of 153 evaluable patients were successfully treated (98 cures and 43 improvements), therapy failed in 12 patients (7.8%). Success rates of the 3 sulbactam combinations were almost identical: 91% for mezlocillin/sulbactam, 92% for piperacillin/sulbactam and 93% for cefotaxim/sulbactam. 106 patients (68.4%) were also bacteriologically evaluable. In these patients 192 bacterial pathogens were isolated prior to study therapy, 55 patients had mixed infections. In 96 patients (90%) pretreatment pathogens were eradicated (180 strains = 94%).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Mezlocillin; Middle Aged; Piperacillin; Sulbactam

In an attempt to determine the optimal duration of therapy of spontaneous bacterial peritonitis, 100 patients with neutrocytic ascites and suspected spontaneous bacterial peritonitis were randomized to short-course vs. long-course treatment groups. Empiric therapy was initiated before the results of ascitic fluid culture were available. Of the 90 patients who met strict criteria for spontaneous bacterial peritonitis or culture-negative neutrocytic ascites, 43 were randomized to a group receiving 5 days and 47 to a group receiving 10 days of single-agent cefotaxime, 2 g IV every 8 hours. Infection-related mortality (0% vs. 4.3%), hospitalization mortality (32.6% vs. 42.5%), bacteriologic cure (93.1% vs. 91.2%), and recurrence of ascitic fluid infection (11.6% vs. 12.8%) were not significantly different between the 5- and 10-day treatment groups, respectively. Recurrence rates were comparable to the values reported in the literature. The cost of antibiotic and antibiotic administration were significantly lower in the short-course group. Short-course treatment of spontaneous bacterial peritonitis is as efficacious as long-course therapy and significantly less expensive.

Topics: Bacterial Infections; Cefotaxime; Costs and Cost Analysis; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Peritonitis; Time Factors

In experimental models of meningitis and in children with meningitis, dexamethasone has been shown to reduce meningeal inflammation and to improve the outcome of disease.. We conducted a placebo-controlled, double-blind trial of dexamethasone therapy in 101 infants and children admitted to the National Children's Hospital, San José, Costa Rica, who had culture-proved bacterial meningitis or clinical signs of meningitis and findings characteristic of bacterial infection on examination of the cerebrospinal fluid. The patients were randomly assigned to receive either dexamethasone and cefotaxime (n = 52) or cefotaxime plus placebo (n = 49). Dexamethasone (0.15 mg per kilogram of body weight) was given 15 to 20 minutes before the first dose of cefotaxime and was continued every 6 hours thereafter for four days.. The demographic, clinical, and laboratory profiles were similar for the patients in the two treatment groups. By 12 hours after the beginning of therapy, the mean opening cerebrospinal pressure and the estimated cerebral perfusion pressure had improved significantly in the dexamethasone-treated children but worsened in the children treated only with cefotaxime (controls). At 12 hours meningeal inflammation and the concentrations of two cytokines (tumor necrosis factor alpha and platelet-activating factor) in the cerebrospinal fluid had decreased in the dexamethasone-treated children, whereas in the controls the inflammatory response in the cerebrospinal fluid had increased. At 24 hours the clinical condition and mean prognostic score were significantly better among those treated with dexamethasone than among the controls. At follow-up examination after a mean of 15 months, 7 of the surviving 51 dexamethasone-treated children (14 percent) and 18 of 48 surviving controls (38 percent) had one or more neurologic or audiologic sequelae (P = 0.007); the relative risk of sequelae for a child receiving placebo as compared with a child receiving dexamethasone was 3.8 (95 percent confidence interval, 1.3 to 11.5).. The results of this study, in which dexamethasone administration began before the initiation of cefotaxime therapy, provide additional evidence of a beneficial effect of dexamethasone therapy in infants and children with bacterial meningitis.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Cerebrospinal Fluid Pressure; Child; Child, Preschool; Dexamethasone; Double-Blind Method; Female; Hearing Disorders; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Nervous System Diseases; Tumor Necrosis Factor-alpha

Aztreonam and cefotaxime were compared in 44 cirrhotic patients who had 52 episodes of gram-negative spontaneous peritonitis. Patients were randomized into two therapeutic groups of similar characteristics. Group A (28 episodes) received 0.5 gm of aztreonam every 8 hr, and group B (24 episodes) received 1 gm of cefotaxime every 6 hr, for a planned 14-day period. Peak and trough serum and ascitic fluid levels of both antibiotics were several times higher than the minimum inhibitory concentrations of causative microorganisms. Eleven patients (21%) died within the first 48 hr after beginning therapy, which included seven in the aztreonam group and four in the cefotaxime group. In the remaining patients, signs and symptoms of infection were promptly controlled, and ascitic fluid cultures became negative after 48 hr in all cases, except in one patient from the aztreonam group, who was a clinical failure. Two patients from the aztreonam group and one from the cefotaxime group relapsed after treatment. The overall mortality rate was 50%, which was lower than classically reported: 12 patients (43%) died in the aztreonam group, and 14 (58%) died in the cefotaxime group (p = 0.265, NS). Hepatorenal syndrome and digestive tract hemorrhage were the most frequent causes of death occurring after the first 48 hr of treatment. Streptococcal superinfections developed in three patients (14.2%) in the aztreonam group. We conclude that both antibiotics at the low doses used in this study are similarly well tolerated and effective in controlling this infection. Because the use of aztreonam as the initial empirical treatment requires a concomitant antibiotic against gram-positive infections and the possibility of streptococcal superinfections, cefotaxime seems to be a more advantageous therapeutic alternative for this patient population.

Topics: Adult; Aged; Ascitic Fluid; Aztreonam; Bacterial Infections; Cefotaxime; Female; Gram-Negative Bacteria; Humans; Kidney; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Prospective Studies; Superinfection

The clinical efficacy of cefodizime has been tested in several open and comparative studies, above all in lower respiratory tract infections (LRTI) and uncomplicated urinary tract infections (UTI), performed in 151 centres in Europe, Latin America, South-Eastern Asia and South Africa. Of 3791 patients, 2260 could be evaluated for efficacy and safety. Comparative studies in LRTI were carried out vs cefotaxime and cefuroxime (301 vs 299 patients); both clinical and bacteriological results were superimposable (range of satisfactory clinical outcomes from 86% to 95%; bacteriological eradication 95% to 100%). In open studies (533 evaluable patients) the percentage of clinical successes ranged from 79.1% to 91.8% and the bacteriological eradication from about 87% to 90%, according to the type of infections. Comparative studies (cefodizime vs cefuroxime or ceftizoxime) in UTI again demonstrated the equivalence of treatment. In open studies (374 evaluable patients) the percentage of satisfactory clinical outcomes ranged from 84.6% in complicated upper UTI to 95.9% in lower uncomplicated UTI, with overall bacteriological eradication of 92.7%. Side effects could be evaluated in 5801 patients (Western and Japanese clinical studies); 3.79% of patients showed side effects (1.99% gastrointestinal disturbances, 0.9% rash or urticaria, 0.9% other effects); 1.13% of patients required discontinuation of treatment. No relevant changes in laboratory parameters were observed. Cefodizime has been shown to be an effective and safe agent in the treatment of LRTI and UTI caused by susceptible pathogens. A dosage regimen of 1 g every 12 h seems to be the most suitable schedule for the treatment of LRTI while 1 g every 12 h or 2 g every 24 h can equally well be adopted for treatment of UTI.

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Humans

In a prospective open clinical trial 20 patients with the diagnosis bacterial respiratory tract infection and underlying chronic obstructive lung disease were treated for 13 to 17 days with 200 mg cefixime b. i. d. 14 of 16 evaluable patients were treated successfully. In one patient the clinical symptoms remained unchanged and in another patient cefixime treatment failed. Ten of the 16 evaluable patients showed a positive baseline culture. In nine of these patients the initially isolated pathogens could be eliminated. In one patient, in whom cefixime therapy failed, change of pathogens was noticed after the end of treatment. Four of the 20 patients treated with cefixime reported side effects (gastritis, three; fungal dermatitis, one). In the patient with fungal dermatitis cefixime therapy was stopped.

Topics: Adult; Aged; Anti-Infective Agents; Bacterial Infections; Cefixime; Cefotaxime; Female; Humans; Male; Middle Aged; Prospective Studies; Respiratory Tract Infections

In a prospective, open clinical trial 21 patients suffering from lower respiratory tract infections were treated with the new oral cephalosporin cefixime. The antibiotic was given at a dosage of 200 mg b. i. d. for seven to eleven days. Seventeen of 18 evaluable patients were cured or distinctly improved at the end of therapy as well as two days after the end of treatment. Clinical results correlated well with the results of the lung function tests, especially with the significant decrease of resistance. At the end of therapy all initially isolated pathogens were eradicated. The tolerability of cefixime was good, only in two patients treated mild and transient side effects were noticed (1 x diarrhea, 1 x epigastric pain).

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Bronchitis; Bronchopneumonia; Cefixime; Cefotaxime; Citrobacter; Drug Resistance, Microbial; Drug Tolerance; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Haemophilus Infections; Humans; Male; Middle Aged; Pneumonia; Pneumonia, Pneumococcal; Prospective Studies; Proteus Infections

Clinical efficacy and tolerance of cefixime were investigated in an open, uncontrolled trial. 200 mg of cefixime were applied twice daily, duration of therapy was between eight and 14 days (mean value 10.1 days, standard deviation +/- 1.4 days). Ten male patients (mean age 42.7 years) and 19 female patients (mean age 34.4 years) were enrolled. Cure or improvement was observed in all 27 patients evaluable for efficacy of treatment. Bacteriological results based on 15 bacteriologically evaluable patients were: elimination of the initial pathogen 60%, persistence 40%. Unwanted side effects and their incidence among the 29 patients evaluable for tolerance were: diarrhoea eight patients (mild to moderate, limited to three to four days on average), nausea and vomiting one patient, discharge and pruritus one patient.

Topics: Adult; Anti-Infective Agents; Bacterial Infections; Cefixime; Cefotaxime; Drug Tolerance; Female; Humans; Male; Otitis Media; Respiratory Tract Infections

The clinical efficacy and tolerance of cefixime were evaluated in an open uncontrolled clinical trial including 37 patients suffering from ENT-infections. The MIC90 values of this new oral cephalosporin against gram-negative pathogens are less than 1 mg/l. The antibacterial activity of cefixime against gram-negative pathogens is stronger than that of other oral cephalosporins. Cefixime was administered for five to twelve days twice daily in a dose of 200 mg. In one patient the treatment with cefixime was discontinued after five days due to perioral dermatitis. In 33 of 36 patients cure or distinct improvement was observed after cefixime treatment, showing a clinical success rate of 91.7%. Causative organisms were isolated in 17 of 37 patients (47.2%). After the cefixime therapy the causative organisms were eradicated in 13 of 17 patients (76.5%). The tolerance of cefixime is comparable with that of other oral cephalosporins.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Cefixime; Cefotaxime; Drug Tolerance; Female; Gram-Negative Bacteria; Humans; Male; Middle Aged; Otitis Media; Sinusitis; Tonsillitis

In order to compare the efficacy of antibiotic therapy using Cefalozin or Cefotaxime, 3,137 patients operated with an abdominal approach were included into a multidepartmental prospective study by lot. The patients were distributed into 4 levels according to the degree of intraoperative contamination and to the risk factors they presented. The patients in each level were distributed by lot into three treatment groups: 1) Cefalozin, 2) Cefotaxime, 3) no treatment. The antibiotics were delivered perioperatively in 3 doses of 1 g every eight hours. The patients having had colic surgery or operated for peritonitis were excluded from the study. The number of intestinal wall abscesses was significantly lower in the treated groups, except in level 3 (contaminated surgery). The percentage of postoperative peritonitis was twice lower in the treated groups than in the control group. There was no difference between the treated groups. The patients included in the treated groups were given significantly less antibiotics than the patients of the control group. As far as costs are concerned, antibiotic prophylaxis with Cefalozin is effective in all procedures of abdominal surgery in which the degree of contamination by anaerobes is low.

Topics: Abdomen; Bacterial Infections; Cefazolin; Cefotaxime; Humans; Postoperative Complications; Prospective Studies; Surgical Wound Infection

The effectiveness of antibiotic prophylaxis was evaluated in the immediate postoperative period of renal transplantation (RT). Before RT, the patients were randomly assigned to one of the following groups: 1) cefotaxime (intravenous infusion of 1 g one hour before the operation). 2) Ceftriaxone (1 g i.v. given in a similar way). 3) Control (without antibiotics). Patients who required antibiotic therapy during the first 3 postoperative weeks were excluded. 20 recipients of cadaveric renal grafts were included in each group. There were 39 males and 21 females with a mean age of 39.9 years. One patient from the cefotaxime group (5%), 2 from the ceftriaxone group (10%) and 2 from the control group (10%) developed infection of the surgical wound, all due to grampositive organisms. 19 patients had urinary tract infections: 7 from the control group (35%), 7 from the cefotaxime group (35%), and 5 from the ceftriaxone group (25%). The development of wound infection was not correlated with urea, creatinine, hemoglobin or total protein levels, or with urinary tract infection or fistula, diabetes or fever. The mean packed red cell volume of the patients who developed wound infection was 24.7 +/- 1.2 vs 28.6 +/- 6.6 in those who did not (p less than 0.01). All patients with visible hematoma and 3 of 10 with perirenal blood collection had wound infection. It was concluded that antibiotic prophylaxis for renal transplantation was useless in our patients.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Kidney Transplantation; Male; Postoperative Complications; Premedication

Aztreonam/metronidazole and cefotaxime/metronidazole were compared in a prospective trial in 154 patients undergoing elective colorectal surgery. Three antibiotic doses were given over 16 hours. A significant excess of wound sepsis in the aztreonam group was seen (23/71 vs 9/70 chi 2 6.60; P less than 0.01). Sepsis was almost invariably due to Gram-positive organisms and, in particular, Staphylococcus aureus.

Topics: Aztreonam; Bacterial Infections; Cefotaxime; Colon; Drug Therapy, Combination; Gram-Positive Bacteria; Humans; Metronidazole; Multicenter Studies as Topic; Postoperative Complications; Randomized Controlled Trials as Topic; Rectum

Cefodizime (CDZM), a newly developed injectable cephem antibiotic, was given via bolus intravenous injection at each of 3 dose levels of 10, 20 and 40 mg/kg to each 3 children, and serum and urinary levels and urinary recovery rates were followed. A total of 57 patients received CDZM in the following regimen via bolus intravenous injection, and clinical efficacies, and microbial responses were evaluated. Mean dosage per application: 20.9 mg/kg, number of application per day: between 2 and 4 (2 times for 3 patients, 3 for 26 patients and 4 for 28 patients), mean duration of the therapy: 1 week. Patients consisted of 1 case of peritonsillar abscess, 2 acute bronchitis, 38 pneumonia, 8 urinary tract infection, 1 staphylococcal scalded skin syndrome, 2 cellulitis, 4 purulent lymphadenitis and 1 typhoid fever. In addition to the patients mentioned above 6 patients who dropped out were involved in the evaluation of adverse reactions and influence of the drug on laboratory test data, and the following results were obtained. 1. Five minutes after bolus intravenous injection in doses of 10, 20 and 40 mg/kg, serum levels determined by the bioassay method were at their maxima, i.e. 114.0, 264.6 and 461.6 micrograms/ml, respectively. Serum levels of drugs were dose-dependent throughout all the dosage levels tested. Mean serum half-lives of the drug were 1.757, 1.552 and 1.668 hours, respectively, for the 3 dose levels. Serum levels of the drug determined by the HPLC method were similar to those by the bioassay method: The maximum serum levels occurred at 5 minutes after administration, mean maximum concentrations were 105.5, 264.0 and 461.7 micrograms/ml for the 3 dose levels, and a dose response was noted for the 3 dose levels. The half-lives were 1.755, 1.598 and 1.668 hours, respectively. 2. Mean maximum concentrations in urine determined by bioassay for 2 of 3 cases received 10 mg/kg and 3 cases each given 20 and 40 mg/kg of CDZM were 884.3, 3,061 and 7,352 micrograms/ml, respectively, in the first 2 hours after administration. These levels were also dose-dependent. Mean recovery rates were 74.4, 78.4 and 71.5%, respectively, in the first 8 hours after administration. Mean maximum concentrations in urine measured by HPLC were similar to those determined by bioassay, i.e. 962.3, 3,404 and 7,899 micrograms/ml in the first 2 hours. They were, also, dose-dependent. Mean recovery rates were 82.1, 86.0 and 76.5%, respectively, in the first 8 hours after administration.

Topics: Age Factors; Bacterial Infections; Cefotaxime; Child; Drug Evaluation; Female; Humans; Injections, Intravenous; Male; Multicenter Studies as Topic

Fifty patients with chronic osteomyelitis due to aerobic or facultative Gram-negative bacilli, alone or in mixed infections with Gram-positive cocci, were treated with cefotaxime. The diagnosis of osteomyelitis was made on the basis of clinical, roentgenographical, isotopic, microbiological and histopathological evidence of infection. Only those patients with infection sensitive to cefotaxime were treated. Most patients received 2 g cefotaxime qid iv for 30-60 days (mean 40 days). Some patients received metronidazole in addition. The following results were obtained at the six month follow-up: 40 patients cured, six improved, no failures and four relapses. The surgical technique had an impact on these results. No clinically important side-effects were encountered, nor were any cefotaxime resistant strains found.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Chronic Disease; Female; Gram-Negative Bacteria; Humans; Male; Middle Aged; Osteomyelitis

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

In the early 1980's parenteral third generation cephalosporins changed the hospital use of antibiotics. The MICs of these cephalosporins are several dozen times lower than those of first or second generation cephalosporins for Enterobacteriaceae and they are much more beta-lactamase stable than second generation cephalosporins. After years of research, is has finally been possible to develop orally active compounds possessing the same antibacterial activity as parenteral third generation cephalosporins, either through the use of prodrugs, or by modifying the molecular structure of drugs. Cefixime is an example of the latter. The vinyl group at the 3-position of the cephem nucleus is responsible for the intestinal absorption of the intact molecule, primarily by a carrier-mediated transport mechanism. The aminothiazole ring and the R-oxyimino group on the side-chain at the 7-position are associated with an antibacterial activity similar to that of third generation cephalosporins. Thousands of adults have been treated by cefixime for lower respiratory tract, ear-nose-throat and urinary tract infections, showing that cefixime is a safe and effective antimicrobial agent. The major clinical indications for cefixime in adults are bronchial and pulmonary infections, acute otitis or sinusitis, acute pyelonephritis with no underlying uropathy, and complicated or uncomplicated lower urinary tract infections excluding prostatitis. In all cases, the dosage is 200 mg b.i.d.

Topics: Administration, Oral; Bacterial Infections; Cefixime; Cefotaxime; Cephalosporins; Chemical Phenomena; Chemistry; Clinical Trials as Topic; Double-Blind Method; Gram-Negative Bacteria; Humans; Prodrugs; Random Allocation

In a multicentre study, 220 consecutive cases of bacterial meningitis in children older than 3 months were randomised to treatment with chloramphenicol, ampicillin (initially with chloramphenicol), cefotaxime, or ceftriaxone. The drugs were given in four equal daily doses for 7 days, except ceftriaxone which was given only once daily. 200 cases could be assessed; the causative organisms were Haemophilus influenzae type b (Hib) in 146; meningococci (Mnc) in 32; pneumococci (Pnc) in 13; and other or unknown in 9. In patients with Hib meningitis, sterilisation of the cerebrospinal fluid occurred most rapidly with ceftriaxone. Otherwise, in terms of overall clinical recovery, normalisation of laboratory indices, clinically significant adverse reactions, toxic effects, sequelae, and mortality rate, the treatment groups were very similar. However, there were 4 bacteriological failures, all in the chloramphenicol group. Also, the treatment was extended or changed in more cases in the chloramphenicol group than in the other groups. Chloramphenicol was thus inferior to the other three antimicrobials. Ampicillin is a good and cheap alternative, but there are difficulties with resistance. Easy administration tempts the use of ceftriaxone rather than cefotaxime but it causes diarrhoea. A 7-day course of ampicillin, cefotaxime, or ceftriaxone is sufficient in Hib, Mnc, or Pnc meningitis.

Topics: Adolescent; Ampicillin; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Finland; Follow-Up Studies; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Multicenter Studies as Topic; Random Allocation; Recurrence

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Ciprofloxacin; Double-Blind Method; Humans; Infusions, Intravenous; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Urethra

Topics: Aged; Bacterial Infections; Cefotaxime; Ciprofloxacin; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Urethra

The objectives of this open, prospective, randomized and comparative study were to evaluate and compare the efficacy and safety of intravenous ceftriaxone (active ingredient of Rocephin) and cefotaxime in treatment of bacterial pneumoniae. Forty-three patients were enrolled in the study and in 40 (21 in the ceftriaxone group and 19 in the cefotaxime group) we were able to make an evaluation. Bacteriological results were essentially based on a positive culture obtained with transtracheal aspirate (TTA) - 34 out of 40 cases; in the remaining patients, at least an initial positive sputum culture was obtained. Most of the lower respiratory tract infections were secondary to previous chronic respiratory diseases or were nosocomial infections; 25 out of 40 cases were considered to be severe or critical situations. The overall efficacy (bacteriological eradication plus clinical cure or clear improvement) of ceftriaxone and cefotaxime were 90.5% (19/21) and 73.7% (14/19), respectively (p less than 0.05). The tolerability of both drugs was good: 16 (76.2%) patients in the ceftriaxone group and 12 (63.2%) in the cefotaxime group had no adverse events, while in 5 and 7 patients, respectively, tolerability was considered satisfactory (minor side effects, none of which required discontinuation or even reduction of dosage).

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Respiratory Tract Infections

Sixty patients with lower respiratory tract infections, mainly acute bronchitis were treated for 14 days with either cefixime 200 mg twice daily (plus placebo once daily) or amoxicillin/clavulanic acid 500 mg/125 mg thrice daily in a double-blind manner. The sputum cultures indicated that all isolated pathogens (notably Hemophilus species, S. pneumoniae and B. catarrhalis, including the beta-lactamase producing species) were sensitive to cefixime, with the exception of Pseudomonas species. The bacteriological eradication rates were 54% and 52% for cefixime and amoxicillin/clavulanic acid, respectively. The positive clinical response (cured or improved) was 71% for the cefixime treated group and 74% in the amoxicillin/clavulanic acid group. There were no side effects and no significant adverse laboratory changes in both groups. The results indicate that cefixime twice daily is comparable in safety and efficacy with amoxicillin/clavulanic acid, thrice daily in acute bronchitis.

Topics: Adult; Amoxicillin; Bacterial Infections; Cefixime; Cefotaxime; Clavulanic Acid; Clavulanic Acids; Clinical Trials as Topic; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections

A multi-center open study was conducted to investigate cefodizime (CDZM), a newly developed cephem antibiotic, from pharmacokinetic, bacteriological and clinical aspects, in the pediatric field with the participation of 17 institutions and their related facilities. The results are summarized as follows: 1. Serum concentrations and urinary excretion: The pharmacokinetics in pediatric patients was investigated with a dose of 20 mg/kg, via a bolus intravenous injection or intravenous drip infusion over 30 or 60 minutes. The results were nearly the same as those in adult patients. Mean serum concentrations 5 minutes after a bolus intravenous injections were: 105.5, 264.0 and 461.7 micrograms/ml with 10, 20 and 40 mg/kg, respectively, and T 1/2 (beta)'s for the 3 dosages were 1.75, 1.92 and 1.88 hours, respectively. With 30-minute intravenous drip infusion, mean serum concentrations at the end of infusion were: 90.5 micrograms/ml with a dose level of 10 mg/kg, 178.3 micrograms/ml with 20 mg/kg, and 322.8 micrograms/ml with 40 mg/kg, and T 1/2 (beta)'s for these dosages were 1.90, 2.15 and 1.93 hours, respectively. With 60-minute intravenous drip infusion, mean serum concentrations at the end of infusion were: 66.3 micrograms/ml with a dose level of 10 mg/kg, 136.0 micrograms/ml with 20 mg/kg and 259.2 micrograms/ml with 40 mg/kg, and T 1/2 (beta)'s for these dosages were 1.43, 2.05 and 1.46 hours, respectively. In 8 hours after administration of CDZM, urinary excretion rates were 82.1, 77.7 and 76.5% for bolus intravenous injections of 10 mg/kg, 20 mg/kg and 40 mg/kg, respectively, and 83.3, 71.3 and 68.1% for 30-minute intravenous drip infusions of 10 mg/kg, 20 mg/kg and 40 mg/kg, and 84.4 and 84.3% for 60-minute intravenous drip infusions of 20 mg/kg and 40 mg/kg, respectively. 2. Concentrations in cerebrospinal fluid: Penetrations into cerebrospinal fluid in patients with purulent meningitis reached levels of 1.96-9.48 micrograms/ml with administration of CDZM at 50 mg/kg in acute cases within 6 days after onset. The penetration rates of CDZM were about a median range among injectable beta-lactam agents. 3.. Of 457 cases treated with CDZM, 53 cases were excluded from the clinical evaluation. Clinical efficacies were evaluated as "excellent" in 126 and "good" in 78 out of 221 case from which causative agents were isolated, with an efficacy rate of 92.3%. Efficacies were "excellent" in 97 and "good" in 69 out of 183 cases from which pathogens were not isolated giving an efficacy rate of 90.7%.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adolescent; Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Male; Multicenter Studies as Topic; Respiratory Tract Infections; Urinary Tract Infections

Topics: Adult; Bacteria; Bacterial Infections; Cefixime; Cefotaxime; Child; Clinical Trials as Topic; Humans

A randomized, double-blind study was done to compare the efficacy and toxicity of daily single-dose therapy with intravenous ceftriaxone (2 g every 24 h) with daily multiple-dose therapy with cefotaxime (2 g every 6 h) for treatment of serious bacterial infections in nonneutropenic patients. Of the 325 patients who were evaluable for toxicity, 241 (74.2%) were evaluable for efficacy. Infection sites included lung (106), urinary tract (42), skin and soft tissue (43), bone and joint (23), bacteremia (21), and hepatobiliary (5). Definite infections were present in 173 cases (71.8%) and possible infections in 68 (28.2%). Analysis of clinical and bacteriologic responses and adverse drug reactions showed no significant differences between the regimens. Values for 95% confidence limits on the differences between regimens for positive clinical and bacteriological outcomes in definite infections were -0.8% to 3.0% and -1.9% to 9.1%, respectively. Thus, daily single-dose therapy with ceftriaxone was comparable to daily multiple-dose therapy with cefotaxime in treating these bacterial infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Middle Aged; Multicenter Studies as Topic; Random Allocation

Ceftriaxone was compared with cefotaxime for the treatment of serious bacterial infections in a prospective, randomized, double-blind clinical trial. The dose of ceftriaxone was 2 g once a day, and the dose of cefotaxime was 2 g every 4 h. Metronidazole was added if anaerobic infection was suspected. Explicit criteria were used to define infections, clinical response, and adverse effects. Ceftriaxone was given to 88 patients and cefotaxime to 83. The two treatment groups did not differ in types of infection, infecting organisms, and severity of underlying disease. The response rate was 81% (71/88) for ceftriaxone and 80% (66/83) for cefotaxime. The power of the study to detect a 15% difference in response rate at P less than .1 was 90%. The frequency of diarrhea, thrombophlebitis, prothrombin time, prolongation, colonization, and superinfection did not differ between treatment groups. Ceftriaxone 2 g once a day was as safe and effective as cefotaxime 2 g every 4 h for suspected serious bacterial infections.

Topics: Adult; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Male; Middle Aged

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

In a prospective study on infectious morbidity after vaginal hysterectomy we examined the clinical symptoms of an infection and partly also the microbial conditions of the vaginal wound. With a group of 49 patients without antibiotic prophylaxis we tried to find out if the type of vaginal occlusion might have any influence on the microbial situation and the healing process. The results of this first group were compared to those of a second group consisting of 31 patients, who had received antibiotic prophylaxis before the operation with a cephalosporin. Though it was not possible to make any microbial analyses in the second group, the clinical evaluation showed distinctly that antibiotic prophylaxis is an important contribution to the prevention of infections after vaginal hysterectomy. The careful consideration of septic-surgical precautions, however, and this was proved by the first part of the study, contributes as well to the prevention of infections.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefotaxime; Cefuroxime; Cephalosporins; Clinical Trials as Topic; Drainage; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Middle Aged; Premedication; Prospective Studies; Risk Factors; Surgical Wound Infection

A prospective, randomized, double-blind, multicenter study was conducted of hospitalized patients to compare the efficacy and safety of oral ciprofloxacin (dosage, 750 mg every 12 hours) with intravenous cefotaxime (dosage, 2.0 g every 8 hours) as monotherapy for difficult skin and skin structure infections requiring hospitalization. Five hundred seventy patients were assessed for an analysis of safety and 461 patients were assessed for an analysis of efficacy. The most common infections were infected ulcers and abscesses. At the end of therapy, there was a higher incidence of recurrent or persistent organisms in the cefotaxime group compared with ciprofloxacin. Adverse reactions related to either therapy were rare. By pathogens, there were no differences in activity, except the higher rate of recurrent or persistent Pseudomonas aeruginosa infection in the cefotaxime group. By diagnosis, the two drugs had comparable efficacy, except for the higher incidence of bacteriologic failure in patients with polymicrobial infected ulcers in the cefotaxime group. Larger studies are needed to evaluate emergence of resistance to ciprofloxacin. Oral ciprofloxacin therapy is as safe and effective as parenteral cefotaxime in the treatment of difficult infections of the skin and skin structure, and affords the prospect of early discharge from the hospital and significant cost savings.

Topics: Administration, Oral; Bacterial Infections; Cefotaxime; Ciprofloxacin; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Multicenter Studies as Topic; Prospective Studies; Randomized Controlled Trials as Topic; Skin Diseases, Infectious; Wound Infection

Ceftriaxone is a new, third-generation cephalosporin that, because of its long half-life, offers potential advantages of cost and convenience over similar agents such as cefotaxime. We compared the two drugs in a prospective, randomized study of the treatment of chest infections in seriously ill patients. Fifty-one patients (90 percent of whom were mechanically ventilated) received either ceftriaxone, 2g IV once daily, or cefotaxime, 2 g IV thrice daily, for five days. The two groups of patients appeared demographically comparable. Ceftriaxone in a single daily dose of 2 g once daily may not be satisfactory for the treatment of serious chest infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged; Prospective Studies; Randomized Controlled Trials as Topic; Severity of Illness Index; Thoracic Diseases

Intravenous ciprofloxacin has been investigated in the treatment of serious infections, including those of the urinary tract. In this double-blind, randomized study, its effectiveness as a prophylactic agent in men undergoing transurethral surgical procedures was compared with that of another intravenous agent, cefotaxime. One hundred six men with genitourinary tract obstruction were enrolled in the study. The 102 men evaluable for determination of efficacy (53 in the ciprofloxacin group and 49 in the cefotaxime group) received a single intravenous infusion of either 300 mg ciprofloxacin or 1,000 mg of cefotaxime prior to resection of the prostate for benign prostatic hypertrophy and prostatic carcinoma or internal urethrotomy for urethral stricture. A mean of 32.1 and 40.3 minutes for the ciprofloxacin and cefotaxime groups, respectively, elapsed between the end of the intravenous infusion and the onset of surgery; all but one patient in the ciprofloxacin group underwent catheterization after surgery, of which the mean duration was 3.7 days for both groups. At the time of hospital discharge, patients were evaluated clinically; 50 patients in the ciprofloxacin group (94 percent) and 45 in the cefotaxime group (92 percent) had no bacteriologic evidence of genitourinary tract infection. At follow-up two to six weeks after surgery for the patients with no bacteriologic evidence of genitourinary tract infection, fewer patients in the ciprofloxacin group (8 percent) than in the cefotaxime group (16 percent) remained without evidence of infection. Both drugs were well tolerated. This study demonstrated that a single intravenous dose of ciprofloxacin was as effective as a single dose of cefotaxime in reducing the incidence of infection following transurethral surgical procedures.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ciprofloxacin; Clinical Trials as Topic; Double-Blind Method; Humans; Infusions, Intravenous; Male; Middle Aged; Postoperative Complications; Premedication; Random Allocation; Urethra

Clinical usefulness of cefixime (CFIX), a new oral cephalosporin antibiotic, in pediatric field was investigated. The results obtained were summarized as follows. 1. The clinical efficacy of CFIX was investigated in a total of 138 children including 49 with upper respiratory tract infections (RTI), 22 with acute bronchitis, 18 with pneumonia, 19 with scarlet fever and 21 with urinary tract infections (UTI). 2. Clinical effectiveness was excellent in 58, good in 60, fair in 14 and poor in 3, with an overall efficacy rate of 87.4%. The efficacy rate classified according to types of infection were 85.7% in upper RTI, 89.5% in acute bronchitis, 94.4% in pneumonia, 78.9% in scarlet fever, and 90.5% in UTI. 3. Out of the suspected causative organisms, 43 strains of a total of 50 strains isolated were eradicated. The bacteriological eradication rate was 86.0%. (Haemophilus influenzae 100%, Haemophilus parainfluenzae 100%, Streptococcus pyogenes 88.5%, Escherichia coli 85.7%). 4. One hundred forty four children were analyzed for side effect. Side effects were observed in 2 children (1.4%) with diarrhea in 1 and anorexia in another. Abnormal laboratory test results were recorded in 4 children (3.3%). The above results suggest that CFIX is a very useful new oral cephalosporin for the treatment of bacterial infections in children.

Topics: Adolescent; Bacterial Infections; Bronchitis; Cefixime; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male; Multicenter Studies as Topic; Pneumonia; Respiratory Tract Infections; Urinary Tract Infections

The aim of this research was to collect precise data on the antibacterial activity of ceftriaxone and cefotaxime in the respiratory tract. The diffusion into pulmonary tissue and bronchial secretion and the antibacterial activity of the two antibiotics were evaluated in vivo by means of the inhibitory quotient. Ceftriaxone administered at a dosage of 1 g (i.m.) every 24 h resulted in antibacterial levels against the sensitive pathogens over a period of 24 h after each dose. The antibacterial protection afforded by cefotaxime, given at the dosage of 1 g (i.m.) every 12 h, was not as marked and did not extend over the interval between two administrations.

Topics: Aged; Bacterial Infections; Bronchi; Cefotaxime; Ceftriaxone; Female; Humans; Injections, Intramuscular; Lung; Male; Middle Aged; Respiratory System

One hundred and fourteen hospitalized patients with moderate or severe infections were assigned at random, in four medical centers, to receive either ceftizoxime or cefotaxime, administered intravenously in a dosage of 1 to 2 g every 8 h. Of 96 patients evaluable for efficacy, 24 (25%) had bacteremia, 46 (48%) had urinary tract infections and 9 (9%) had pneumonias. Half the patients had been treated ineffectively by other antibiotics prior to the study drug treatment. The overall clinical efficacy was 90% in both treatment groups and 83% in both groups with bacteremia. All patients with urinary tract infection were cured by both agents. Bacteriological eradication rate was 95% in both groups. Adverse reactions, though mild, were more frequent in the cefotaxime group (13.5%) than in the ceftizoxime group (6.8%); superinfection rate was higher in the ceftizoxime group. Both antibiotics were highly and equally efficacious in the therapy of severe infections in hospitalized patients.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Escherichia coli; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Prospective Studies; Random Allocation; Sepsis; Urinary Tract Infections

Because of the frequency of Haemophilus influenzae and Staphylococcus aureus in joint and bone sepsis in children, a prospective study of first line antibiotic therapy was performed. In a series of 23 cases, including 8 osteomyelitis and 15 arthritis, Gram stain on joint fluid or antigen detection was helpful in reaching a decision about initial therapy in only 3 cases (Haemophilus influenzae). In 20 of the 23 patients, the first line antibiotic therapy was cefotaxime (100 mg/kg/day) and fosfomycin (100 mg/kg/day) in combination. In 6 of them, the bacteriologic culture was positive (3 Staphylococcus aureus, 1 Haemophilus influenzae and 2 Streptococcus pneumoniae) and the initial antibiotic therapy was changed according to the antibiotic susceptibility testing. In the others 14 cases, from whom no agent was isolated, this combination was continued during about 15 days, then followed by pristinamycin and amoxicillin-clavulanic acid in combination during one month. The C. reactive protein dosage was performed in each patient. All children cured. In view of these first results, cefotaxime and fosfomycin in combination seems to us to be interesting in first line antibiotic treatment without initial orientation.

Topics: Adolescent; Anti-Bacterial Agents; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Drug Therapy, Combination; Fosfomycin; Humans; Infant; Infant, Newborn; Osteomyelitis

A prospective randomized study of severe open tibial fractures (Type II and III) was performed. Individual fractures were randomized to treatment groups according to initial antibiotic therapy: One consisted of a first-generation cephalosporin, and the other consisted of a third-generation cephalosporin. Initial antibiotic therapy was given in all patients for 48 h and then specific antibiotic treatment was used as indicated by culture. The purpose of this study was to determine whether or not additional gram-negative coverage had an effect on the overall infection rate or the type of infection in severe open tibial fractures. Additional factors, such as the timing of bone grafts and soft tissue coverage, were evaluated in this study as well. Although there was no statistical difference in the rate of infection with the use of a first- versus a third-generation cephalosporin, there was a trend toward a decreased infection rate as well as toward less morbid infections with the use of a third-generation cephalosporin. The study also confirms that early bone graft should not be performed prior to 6 weeks post injury or after successful soft tissue coverage has been achieved. On the other hand, soft tissue coverage procedures should be performed at the earliest possible date to decrease the overall infection rate.

Topics: Adolescent; Adult; Bacterial Infections; Cefazolin; Cefotaxime; Child; Clinical Trials as Topic; Combined Modality Therapy; Female; Fracture Fixation, Internal; Fractures, Open; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Surgical Wound Infection; Tibial Fractures; Wound Healing

Seventy-one neutropenic patients under cytostatic treatment for malignant hemopathies (neutrophil granulocytes less than or equal to/mm3 with feverish episodes in progress (T greater than or equal to 38.5 degrees C) which were probably of an infectious nature were treated according to two antibiotic protocols (piperacillin + amikacin [P + A] or cefotaxime + amikacin [C + A] in a randomized, comparative, prospective study. Of the 71 patients enrolled, 65 could in the end be evaluated for the purposes of this study (36 treated according to the P + A protocol, 29 according to the C + A protocol). In 16 patients the infection was documented bacteriologically. In these cases the percentages of response were, respectively, 77.7% with the P + A and 71.4% with the C + A protocol. The positive clinical results of the two protocols being studied were, considering the entire survey (bacteriologically documented, clinically documented and FUO infections), respectively, 69.4% in the patients treated with P + A and 62.0% in those treated with C + A. The results of the study seem to indicate that the severity of the neutropenia (N.G. less than 500 or greater than 500) does not affect the response to the antibiotic therapy. Modest and transient side effects (hypokalemia and increase of the ClCr) were noted above all in the patients subjected to the therapy with C + A. The results of this study show, therefore, a superimposable effectiveness of the two therapeutic protocols (P + A and C + A) in the empirical treatment of infections in neutropenic patients with malignant hemopathies.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Agranulocytosis; Amikacin; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Female; Fever; Humans; Leukemia; Lymphoma; Male; Middle Aged; Neutropenia; Piperacillin; Prospective Studies

In an open, randomised comparative study, 23 patients with bone, joint or soft tissue infections were treated with ampicillin 2g plus sulbactam 1g 3 times a day or cefotaxime 2g 3 times a day as an initial 2-week therapy. Monoinfections with Staphylococcus aureus were the most common bone or joint infections. Clinical cure or improvement 2 weeks after the end of therapy was observed in all 13 patients treated with sulbactam/ampicillin and in 7 of the 8 patients evaluated for efficacy after treatment with cefotaxime. Most organisms identified before the onset of therapy were susceptible to the antibiotic randomly selected for therapy, although the majority of infections due to beta-lactamase-producing staphylococci could not have been treated with ampicillin without sulbactam. Treatment failed to eradicate S. aureus in 1 patient from each group. In addition, S. aureus infection recurred in 2 patients in the cefotaxime group within 2 weeks after the end of therapy. No serious side effects were observed.

Topics: Adolescent; Adult; Aged; Ampicillin; Bacteria; Bacterial Infections; beta-Lactamases; Bone Diseases; Cefotaxime; Drug Combinations; Female; Humans; Joint Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Sulbactam

In an open prospective study performed in 2 neonatal units, infants with suspected neonatal sepsis (SNS) of unknown microbial cause were randomly allocated to receive treatment with either cefotaxime (CTX) or netilmicin plus penicillin (N + P). 236 patients were entered into the trial, of whom 222 were evaluable. The number of 'definitely' and 'probably' infected babies was similar in both groups. There was no difference in clinical outcome between patients in the 2 treatment groups and no side effects were recorded for either of the antibiotic regimens. Antibiotic sensitivity testing of bacterial isolates from peripheral sites showed almost universal sensitivity of potential pathogens to both antibiotic regimens at the start of treatment in all infants. Thereafter, organisms resistant to CTX were isolated from patients in both treatment groups, possibly reflecting the antibiotic sensitivity profile of the colonising bacteria in both neonatal units. The results of this study indicate that either CTX or N + P are suitable, in our units, for the 'blind' treatment of early SNS. In units where listerial infections are prevalent, specific cover should be added to CTX. For SNS developing after admission, the choice of antibiotics will depend upon the background antibiotic sensitivity profile of the colonising bacteria.

Topics: Bacterial Infections; Birth Weight; Cefotaxime; Drug Therapy, Combination; Escherichia coli; Humans; Infant, Newborn; Injections, Intravenous; Netilmicin; Penicillins; Prospective Studies; Pseudomonas; Random Allocation; Streptococcus agalactiae

In this open, prospective, comparative study, 75 patients who sustained penetrating abdominal trauma were randomised to receive 1 of 3 antibiotic regimens preoperatively and for 3 to 5 days postoperatively. Group I received cefotaxime 2g 8-hourly, group II received cefoxitin 2g 6-hourly and group III received clindamycin (900 mg 8-hourly) and gentamicin 3 to 5 mg/kg/day in divided doses 8-hourly. The 3 groups were not statistically different in terms of age, sex, severity of injury, number of organs injured, colon injuries, shock, blood transfusions or positive intra-operative cultures. Septic complications occurred in 8% of patients in group I, in 4% of group II patients and in 8% of group III patients. Cefotaxime was the least costly regimen, followed by cefoxitin, then clindamycin and gentamicin. It may be concluded that single agent therapy with a broad spectrum cephalosporin is preferable to combination therapy on the basis of equivalent effectiveness, less toxicity and lower costs.

Topics: Abdominal Injuries; Bacterial Infections; Cefotaxime; Cefoxitin; Cephalosporins; Clindamycin; Costs and Cost Analysis; Drug Therapy, Combination; Gentamicins; Humans; Prospective Studies; Random Allocation; Wounds, Penetrating

Topics: Bacterial Infections; Cefotaxime; Gram-Negative Bacteria; Humans; Middle Aged; Prospective Studies; Random Allocation; Respiration, Artificial

The efficacy, safety and effect of a single, 1-g dose of ceftizoxime on the return of vaginal flora were compared to those of the standard regimen of three 2-g doses of cefoxitin for prophylaxis in 99 randomized women undergoing vaginal hysterectomy. Thirty-four were studied in Dallas and 65 in Los Angeles. Surgical procedures were comparable for all the antibiotic groups, although proportionately more simple hysterectomies were performed in Dallas. The patients received a povidone-iodine vaginal preparation immediately before surgery; vaginal packs, when used, contained no antimicrobial agents. Primary prophylactic failure (operative site infection) occurred in 1 of 52 (1.9%) and 4 of 47 (8.5%) of the ceftizoxime- and cefoxitin-treated patients, respectively, for a nonsignificant difference. All five primary prophylactic failures occurred in the Los Angeles patients. One patient in each antibiotic group developed a urinary tract infection and was classified as a secondary prophylactic failure. Febrile morbidity, length of hospital stay and incidence of adverse effects did not differ by antibiotic. The enterococcus was commonly found in the postoperative vaginal flora and was of no value in predicting operative-site infection. Enterobacter species and Pseudomonas aeruginosa were isolated more commonly in patients who received cefoxitin. Diphtheroids, Staphylococcus epidermidis and Peptostreptococcus species were isolated more commonly in patients treated with ceftizoxime.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Bacterial Infections; Cefotaxime; Cefoxitin; Ceftizoxime; Drug Administration Schedule; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Postoperative Complications; Random Allocation

In a randomised and coordinated multicentre study, 143 patients with severe infections received treatment with either imipenem/cilastatin (72; I/C group) or cefotaxime combined with metronidazole and optional cloxacillin (71; CX/M/CL group). 67 patients in the I/C group and 65 in the CX/M/CL group were evaluable for clinical efficacy. 35 (I/C) and 44 (CX/M/CL) patients had bacteriologically documented infections. The clinical cure rate was 91% for I/C and 94% for CX/M/CL, and the bacteriological efficacy (eradicated strains) was 86% and 81%, respectively. Local reactions (phlebitis) were frequent in each group (I/C 18% and CX/M/CL 25%). Clinical side effects other than phlebitis (I/C 17% vs. CX/M/CL 13%) were mostly mild. Diarrhoea did not occur in I/C group. Laboratory untoward effects were mild and infrequent in each group. Reinfections of the urinary tract and superinfections at all sites prevailed in the CX/M/CL group (9 vs. 6 and 6 vs. 2, respectively). The superinfections were mostly mild. The efficacy and safety of I/C in severe infections were comparable to those of CX/M/CL.

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Clinical Trials as Topic; Cloxacillin; Cyclopropanes; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Male; Metronidazole; Random Allocation; Thienamycins

In a randomized controlled, clinical study the efficacy of ceftazidime at a dosage of 2 g b. i. d. was compared to that of cefotaxime at a dosage of 2 g t. i. d. or more in the treatment of pneumonia or peritonitis in intensive care patients. 61 of 67 assessable cases were evaluable. In the ceftazidime group ten out of 11 patients with pneumonia and 17 out of 20 with peritonitis showed a clinical success. In the cefotaxime group 15 out of 19 patients with pneumonia and eight out of 11 with peritonitis were clinically cured or improved. With ceftazidime an overall success was achieved in 87% of the patients (27 out of 31) and with cefotaxime in 77% of the patients (23 out of 30). Two patients in the cefotaxime group developed a reinfection. Five of the patients treated with cefotaxime and four of those treated with ceftazidime were therapeutical failures. Escherichia coli, Pseudomonas, Klebsiella, Enterobacter and Proteus species as well as Staphylococcus aureus and enterococci were the most frequent organisms isolated prior to therapy. Following ceftazidime therapy 30 of the 32 gram-negative species were eliminated, whereas in the cefotaxime group the number of gram-negative species isolated was reduced from 28 to ten. Gram-positive species isolated in ten cases prior to therapy, were still present in seven cases after ceftazidime therapy and the number of gram-positive organisms was reduced from 19 to ten following treatment with cefotaxime. In one patient therapy with ceftazidime was stopped due to urticaria. Reversible leukopenia was observed in a patient treated with ceftazidime and a cholestatic reaction in a patient treated with cefotaxime. In both groups a slight elevation of transaminases was seen.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftazidime; Clinical Trials as Topic; Critical Care; Humans; Opportunistic Infections; Peritonitis; Pneumonia; Random Allocation

The efficacy and safety of ceftizoxime and cefoxitin were compared in a randomized, double-blind study of therapy for lower extremity infections in patients with diabetes mellitus or peripheral vascular disease. Overall clinical responses were satisfactory in 82% (23/28) of patients treated with ceftizoxime and in 68% (17/25) of patients treated with cefoxitin. The difference was not statistically significant. Ceftizoxime had superior in vitro activity against Enterobacteriaceae, especially Enterobacter cloacae, whereas cefoxitin had better activity against the Bacteroides fragilis group. Relapses of infection were common in both groups during long-term follow-up; only about one third of patients in either group maintained satisfactory outcomes after one year. More than half of the patients in both groups responded to one or more courses of medical therapy and avoided major amputations for one year following entry into the study.

Topics: Aged; Bacterial Infections; Cefotaxime; Cefoxitin; Ceftizoxime; Clinical Trials as Topic; Diabetes Complications; Double-Blind Method; Female; Follow-Up Studies; Foot; Foot Diseases; Humans; Ischemia; Male; Middle Aged; Prospective Studies; Random Allocation; Recurrence

Topics: Bacterial Infections; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Foot Diseases; Humans

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

Topics: Bacterial Infections; Cefotaxime; Cefotetan; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Surgical Wound Infection; Wounds and Injuries

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Drug Administration Schedule; Female; Fracture Fixation, Internal; Hip Fractures; Humans; Male; Random Allocation; Surgical Wound Infection

Cefmenoxime plus amikacin was compared in a prospective randomized trial with our standard regimen of piperacillin plus amikacin as an empiric therapy for fever in patients with granulocytopenia. Initial profound granulocytopenia (fewer than 100/mm3 mature granulocytes) was present in approximately 45% of the patients in trial of both treatment groups. Of 53 microbiologically and clinically documented infections treated with piperacillin plus amikacin, 36 (68%) showed improvement. Of 48 microbiologically and clinically documented infections treated with cefmenoxime plus amikacin, 23 (48%) showed improvement. The response rate for gram-negative infections treated with cefmenoxime plus amikacin was lower than that for infections treated with piperacillin plus amikacin. Toxicity was minimal, with an equivalent incidence of skin rash, diarrhea and hepatic dysfunction. Although clinical efficacy of the combination of piperacillin plus amikacin may be superior to cefmenoxime plus amikacin therapy, this study demonstrated no statistically significant differences.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Bacterial Infections; Cefmenoxime; Cefotaxime; Drug Therapy, Combination; Female; Fever; Humans; Male; Middle Aged; Neoplasms; Piperacillin; Prospective Studies; Random Allocation

One hundred and thirty-five patients with bacterial pneumonia who had risk factors (alcoholism, chronic obstructive pulmonary disease, corticosteroid therapy diabetes mellitus, advanced age, solid tumours) were randomly allocated in a double-blind fashion to receive either ceftizoxime (2-4 g every 8 h), cefotaxime (1-2 g every 4 h), or latamoxef (2-4 g every 8 h). Of the 84 patients evaluable for efficacy, clinical cure was achieved in 91%, 85%, and 89% of ceftizoxime- (20/22), cefotaxime-(23/27), and latamoxef-treated (31/35) patients, respectively. Adverse reactions occurred in one of 45 ceftizoxime-treated patients, one of 43 cefotaxime-treated patients, and seven of 47 latamoxef-treated patients. Abnormal laboratory values during therapy were seen in 50% of latamoxef-treated and 43% of cefotaxime-treated patients and in 29% of ceftizoxime-treated patients. Hypoprothrombinaemia occurred in five latamoxef-treated patients and one of these patients experienced an episode of haematemesis. In this study, ceftizoxime, cefotaxime, and latamoxef were similarly effective; however, the incidence of side effects was most frequent with latamoxef.

Topics: Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Moxalactam; Pneumonia; Random Allocation; Risk

A prospective, double-blind, randomized study of hospitalized patients with skin and skin structure infections was conducted to compare orally administered ciprofloxacin and conventional intravenous cefotaxime therapy. Fifty-six patients, predominantly elderly women, were randomly assigned to receive either ciprofloxacin (24 patients, 25 infected sites) or cefotaxime (32 patients, 36 sites). Patients in the ciprofloxacin group received 750 mg of orally administered ciprofloxacin every 12 hours plus a placebo infusion while the other group received 2.0 g of cefotaxime intravenously every eight hours plus a placebo tablet every 12 hours. The average duration of treatment was seven to 10 days, with a maximum of 21 days. Clinical response per infected site in the ciprofloxacin group was as follows: resolution in 88 percent, improvement in 8 percent, and failure in 4 percent. In the cefotaxime group, there was resolution in 69 percent, improvement in 25 percent and failure in 6 percent. Bacteriologic response per site in the ciprofloxacin group was eradication in 88 percent and persistence in 12 percent. With cefotaxime there was 69 percent eradication, 3 percent marked reduction, 6 percent recurrence, and 22 percent persistence. Clinical and bacteriologic responses were combined using an algorithm to derive a cure rate, which was 91 percent for ciprofloxacin and 61 percent for cefotaxime (p = 0.0214).

Topics: Administration, Oral; Aged; Bacterial Infections; Cefotaxime; Ciprofloxacin; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Random Allocation; Skin Diseases, Infectious

The effectiveness and safety of orally administered ciprofloxacin and intravenously administered cefotaxime were compared in a double-blind study of 60 men with infections of skin and soft tissue, including cellulitis, ulcers, abscesses, cellulitis with ulcers or abscesses, wound infections, and post-traumatic infections. Patients in the ciprofloxacin group received 750 mg orally every 12 hours for a mean duration of 9.6 days (six to 18 days), and those in the cefotaxime group received 2.0 g intravenously every eight hours for a mean duration of 9.3 days (five to 14 days). Infection was documented bacteriologically in 78 percent of the patients in the ciprofloxacin group and in 83 percent of the patients in the cefotaxime group. Pathogens included Staphylococcus aureus, enterococci, group B streptococci, Escherichia coli, Proteus mirabilis, and Klebsiella and Pseudomonas species. Half of the infections were mixed infections. Ninety percent (19 of 21) of the infections were bacteriologically eradicated with ciprofloxacin, and 82 percent (18 of 22) were eradicated with cefotaxime. Treatment was completely successful in 79 percent (22 of 28) of the patients in the ciprofloxacin group and in 68 percent (19 of 28) in the cefotaxime group (p greater than 0.1). The side effects in both treatment groups were comparable. This study demonstrates that orally administered ciprofloxacin is comparable in effectiveness and safety to cefotaxime administered intravenously in the treatment of infections of skin and soft tissue, and that it can offer an alternative in the treatment of such infections.

Topics: Administration, Oral; Adult; Aged; Bacterial Infections; Cefotaxime; Ciprofloxacin; Clinical Trials as Topic; Double-Blind Method; Humans; Infusions, Intravenous; Male; Middle Aged; Skin Diseases, Infectious; Therapeutic Equivalency

Oral ciprofloxacin (750 mg twice daily) was compared with intravenous cefotaxime (2 g three times daily) as therapy for 61 episodes of skin and skin structure infections occurring in adult patients. A variety of infections including cellulitis, infected ulcers, abscesses, and other miscellaneous infections were treated. Clinical cure was achieved in 77 percent (24 patients) of 31 patients treated with ciprofloxacin and in 76 percent (22 patients) of 28 patients treated with cefotaxime. The response was slower in infected diabetic patients than in non-diabetic patients in both groups. Side effects were minimal and appeared only in the cefotaxime group. Ciprofloxacin taken twice daily was as effective as cefotaxime administered intravenously three times daily in the treatment of skin and skin structure infections.

Topics: Administration, Oral; Adult; Aged; Bacterial Infections; Cefotaxime; Ciprofloxacin; Clinical Trials as Topic; Diabetes Complications; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Skin Diseases, Infectious

In this report, we summarize 929 surgical cases (812 evaluable) receiving preoperatively prophylaxis with either cefoperazone (1 g), or cefotaxime (1 g). The patients were randomized to one of the two single-dose cephalosporin regimens and by operative procedure groups that included hysterectomies, genitourinary procedures, gastrointestinal operations, and the "other procedures" category that was dominated by orthopedic cases, such as total joint replacements and open fracture reductions. The postoperative wound infectious morbidity rates were: cefoperazone 2.2% and cefotaxime 3.0% (overall rate, 2.6%). Most wound infections were superficial, with more than half discovered after patient discharge and unrelated to the surgical prophylaxis. The wound infections associated with colorectal surgery cases given a single-dose of cefoperazone were twofold higher than the control regimen. Non-wound infectious morbidity was 5.8% (p greater than 0.05) for cefoperazone, mostly urinary tract infections causes by Escherichia coli, Streptococcus faecalis, and Staphylococcus spp. Side effects were not considered severe and occurred at a very low rate. Abnormally elevated prothrombin times of patients receiving cefoperazone were not any more frequent than the control regimens. The two prophylaxis regimens were not different statistically (p greater than 0.05) as to the infectious morbidity or adverse reactions. By using either studied single-dose schedule in our prepaid group practice setting, compared with the previously used multi-dose schedules, we could predict an annualized cost savings of $50,000 (cefazolin) and greater than $200,000 (cefoxitin). We propose a single 1-g dose of cefoperazone or cefotaxime (FDA approved) as a cost-effective prophylaxis alternative.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoperazone; Cefotaxime; Costs and Cost Analysis; Female; Health Maintenance Organizations; Humans; Male; Middle Aged; Pneumonia; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection; Urinary Tract Infections

93 patients were enrolled into a prospective randomised study to determine the efficacy and safety of netilmicin, cefotaxime or their combination in the treatment of sepsis caused by susceptible strains of Enterobacteriaceae or staphylococci. 83 patients were evaluable for safety, 74 for clinical efficacy and 63 for microbiological response including 36 patients (57%) with positive blood cultures. There were significantly more clinical failures with cefotaxime than with netilmicin even when urinary tract sepsis was excluded. Microbiological failures occurred more frequently in the cefotaxime arm and were associated with Klebsiella and Enterobacter spp. Four cefotaxime failures were subsequently successfully treated with netilmicin. More mixed infections were however enrolled by chance into the cefotaxime arm. The statistical difference between netilmicin and cefotaxime is not significant if mixed infections are excluded. There was no difference in efficacy between the netilmicin and combination groups although superinfection was seen in the latter group. The incidence of nephrotoxicity was greater in the netilmicin group but not significantly so. Only one minor case of ototoxicity was detected in the 41 patients receiving netilmicin who had serial audiograms. The results suggest that netilmicin is a more effective agent than cefotaxime for treating life-threatening infections with susceptible Enterobacteriaceae or staphylococci particularly with infections in non-urinary tract sites. If dosage of netilmicin is closely monitored by measuring serum concentrations, toxicity is minimal.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Cross Infection; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Netilmicin; Random Allocation; Sepsis; Staphylococcal Infections

To evaluate the cost-effectiveness of cefotaxime sodium at a dosage of 12 g/day vs nafcillin sodium and tobramycin sulfate for the treatment of serious infection, the hospital and physician charges of patients enrolled in a prospective, randomized, clinical trial were analyzed. For 187 patients receiving therapy empirically, mean hospital charges for the interval in which the trial antibiotics were used were $3,550 +/- $1,740 for cefotaxime and $3,160 +/- $1,990 for nafcillin and tobramycin. After adjusting for cost-generating factors, charges for cefotaxime were greater than for nafcillin and tobramycin, but the difference was not significant. For 107 patients with clinically or bacteriologically documented infection, mean charges were $3,980 +/- $1,800 for cefotaxime and $4,170 +/- $1,780 for nafcillin and tobramycin. Adjusted charges did not differ. Incremental charges for cefotaxime per additional response were $1,630 in all patients and -$820 in patients with clinically or bacteriologically documented infections.

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Cost-Benefit Analysis; Double-Blind Method; Fees and Charges; Humans; Kidney; Maryland; Nafcillin; Random Allocation; Regression Analysis; Time Factors; Tobramycin

We analysed the bacteriological findings in 261 patients undergoing transurethral prostatic resection (TUR) and receiving either an oral course of pivampicillin/pivmecillinam (PAPM) or parenteral cefotaxime (CFT) in a randomized clinical trial. 123/261 patients had bacteriuria before TUR; 80% of the bacteria were gram-negative strains and 20% gram-positive. 88% of the strains were sensitive to PAPM and 93% to CFT but only 58% to ampicillin. The sensitivity of recurring bacteria was not influenced by the short course of PAPM or CFT. The faecal flora was influenced by the treatment with PAPM in terms of growth of Pseudomonas aeruginosa and fungi in some patients, but no resistant strains of Enterobacteriaceae were observed. The peak serum concentrations of ampicillin and mecillinam were obtained 2 hours after intake of the drug and were 4.5 micrograms/ml and 1.7 micrograms/ml respectively. The prostate tissue concentration of ampicillin and mecillinam (AM) was low.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Amdinocillin; Amdinocillin Pivoxil; Ampicillin; Bacterial Infections; Cefotaxime; Drug Combinations; Feces; Humans; Infusions, Parenteral; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Pivampicillin; Premedication; Prostatectomy; Random Allocation

A prospective randomized study was undertaken in 100 patients undergoing cesarean section to evaluate the efficacy of cefotaxime when given as a single-dose versus the more traditional triple-dose regimen for prophylaxis. Analysis of the results demonstrated no significant differences in febrile morbidity (14 versus 20%) or postoperative endometritis (10 versus 14%) between the single- and triple-dose groups, respectively. Pretherapy aerobic and anaerobic placental cultures were positive in 60% of the overall study population. In those patients who subsequently developed endometritis, seven (58%) had a positive placental culture, suggesting that this technique is relatively nonspecific as a screening procedure. Results of transcervical culture in the endometritis patients most often demonstrated a polymicrobial picture. Several of the organisms cultured were found to be resistant to cefotaxime, supporting the need to better guide antimicrobial therapy by routine endometrial culturing in patients who fail prophylaxis. The results of the present study suggest that single-dose administration of cefotaxime is equally effective as triple-dose therapy in reducing postcesarean section endometritis.

Topics: Adult; Bacterial Infections; Cefotaxime; Cesarean Section; Clinical Trials as Topic; Drug Administration Schedule; Drug Resistance, Microbial; Endometritis; Female; Humans; Pregnancy; Premedication; Prospective Studies; Random Allocation

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Clinical Trials as Topic; Female; Humans; Male

Seventy-nine children were enrolled in a study to compare seven vs ten days of ceftriaxone therapy for bacterial meningitis. On the basis of a computer-generated list of therapy assignments, 35 children with Haemophilus, pneumococcal, or group B streptococcal meningitis each were assigned to seven- or ten-day treatment regimens; nine children with meningococcal meningitis received seven days of therapy. The population characteristics and etiologic agents were similar for the two treatment groups, as were also the findings on examination and culture of cerebrospinal fluid at completion of therapy. There were no significant differences in the frequency and types of neurological complications between the two treatment groups; four patients in each group had two or more neurological abnormalities. The rates of nosocomial infections and prolonged and secondary fever were similar in those who received seven days of therapy compared with patients treated for the conventional ten days. Diarrhea occurred in 44% of those receiving the drug. Patients treated with the seven-day regimen were discharged from the hospital approximately two days earlier than those with the ten-day regimen.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Child, Preschool; Female; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Streptococcal Infections; Streptococcus agalactiae

One hundred sixty-five men and women undergoing open or transurethral urologic surgery participated in a study designed to compare the prophylactic efficacy and safety of piperacillin with those of cefotaxime when administered perioperatively. The piperacillin-treated group received 2 Gm one hour before surgery and 2 Gm three hours later, and the cefotaxime-treated group was administered 1 Gm on the same schedule. In 9 per cent of the piperacillin-treated patients and in 11 per cent of the cefotaxime-treated patients postoperative urinary tract infections developed, although no patient in either group had sepsis. The most frequently isolated pathogens were Escherichia coli and Enterococcus sp. As expected, the females in both surgical groups had a greater incidence of postoperative infections than did the males. No significant drug-related clinical reactions or changes in the results of the laboratory tests were encountered in either treatment group. Thus, a two-dose perioperative prophylactic regimen of piperacillin was as safe and as effective as a two-dose regimen of cefotaxime in preventing postoperative urinary tract infections or sepsis in these patients.

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Female; Humans; Male; Piperacillin; Premedication; Surgical Wound Infection; Urinary Tract Infections; Urogenital System

The effect on bacteriologically documented postoperative infection of flash prophylaxis using two intravenous injections of 20 mg/kg cefotaxime each was evaluated in a double blind, randomized trial against placebo. 181 participants free of urinary tract infection prior to surgery had either transurethral prostatic resection (TUR) (n = 90) or open prostatectomy (OP) (n = 91). Urine samples, blood samples, prostate specimens and skin swabs were investigated for pathogens. Rate of urinary tract infection was significantly reduced by cefotaxime (CTX) prophylaxis in both groups. CTX lowered the incidence of early postoperative urinary tract infection from 30% to 4% in TURs and from 46% to 4.5% in OPs. Similarly, a significant difference was demonstrated for incidences of intra and postoperative bacteremia. In open prostatectomy patients, a reduced rate of wound infection and shorter hospital stay were noted in the treated group. Pathogens recovered in this study were Streptococcus (29%), Staphylococcus (20.5%), Enterobacteriaceae (45.75%), Pseudomonas (1.25%), Acinetobacter (3%), and Bacteroides fragilis (0.5%). CTX prophylaxis apparently has no bearing on postoperative emergence of resistant pathogens. Percentage of resistance to CTX in delayed postoperative infections was 33% in the control group and 35% in the treated group. We conclude that flash CTX prophylaxis in transurethral or open prostatectomy is of benefit in reducing morbidity and hospital costs.

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Double-Blind Method; Humans; Male; Postoperative Complications; Prostate; Prostatectomy; Prostatic Diseases; Random Allocation; Sepsis; Urinary Tract Infections; Wound Infection

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Gram-Positive Bacteria; Humans

In Japan, new antibiotics under development are compared with conventional antibiotics in Phase III controlled studies. Since the patients' demographic data, dosage, treatment period, etc. are made as uniform as possible in these studies, the results obtained are suitable for evaluating the characteristics of the new antibiotics. Most patients developing clinical superinfections suffer from complicated urinary tract infections due to underlying diseases. In order to avoid clinical superinfections, clinicians have to try to eradicate or alleviate these underlying diseases. The predominant microorganisms that may cause clinical superinfections to develop following therapy with broad-spectrum beta-lactam antibiotics include enterococci, Pseudomonas aeruginosa, other Pseudomonas spp. and fungi. Enterococci may frequently be detected in patients with mixed infections and can easily be dealt with by changing the antibiotics.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Humans; Urinary Tract Infections

Ceftizoxime, a new, semisynthetic, beta-lactamase-resistant cephalosporin, is not metabolized in man and is excreted almost entirely as the original active compound in the urine. The efficacy and safety of ceftizoxime were assessed in 80 patients with acute and chronic urinary infections, with and without associated pathological conditions, in comparison with cefotaxime. Two dosage schedules, 1 g or 0.5 g every 12 h, i.v. or i.m. for 10 days, were adopted according to the severity of each case and to separate randomization tables for each schedule; causal agents were all sensitive to both drugs in vitro. The overall results were excellent. Safety was excellent in almost all cases. In this trial ceftizoxime proved at least as effective and well tolerated as the reference antibiotic.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Drug Tolerance; Female; Humans; Male; Middle Aged; Random Allocation; Safety; Urinary Tract Infections

Fifty patients with acute non-lymphocytic leukaemia were treated by random allocation with either ceftazidime alone or a combination of piperacillin, netilmicin and cefotaxime for 65 febrile neutropenic episodes. Nineteen of 33 patient episodes (58%) responded to ceftazidime alone compared with 21 of 32 episodes (66%) treated with the combination. There was one infective death in a patient given the combination; rates of documented superinfection were low. The treatment groups appeared identical in terms of patient demography, underlying disease and other risk factors, though patients with a clinical site of infection responded more slowly than those without. Bacteraemia per se did not appear to influence outcome. Bactericidal serum concentrations greater than or equal to 8 X the minimum bactericidal concentration were predictive of a rapid response (within 4 days) to antibiotics. Furthermore, serum from patients treated with ceftazidime maintained adequate cidal activity against Pseudomonas aeruginosa for longer than that obtained from patients treated with the three-drug combination. Ceftazidime was shown to be a safe and effective alternative to the three-drug combination for the initial management of febrile neutropenic episodes in leukaemic patients.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Ceftazidime; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Male; Middle Aged; Netilmicin; Neutropenia; Penicillin Resistance; Piperacillin; Random Allocation; Sepsis

Forty-six females with pelvic soft tissue infections (recurrent salpingitis [n = 14], salpingitis with intrauterine contraceptive device [IUD] [n = 9], salpingitis with adnexal mass [n = 14], post-partum endomyoparametritis [n = 9]) were randomized for three antibiotic treatment regimens: cefotaxime (CTX) (n = 23), clindamycin and gentamicin (C + Gen) (n = 13), and clindamycin, gentamicin and penicillin (C + Gen + P) (n = 10). Patients were evaluated by diagnosis for clinical response to the three regimens and by pre-treatment bacterial susceptibility to the individual as well as the combination antibiotics. All 14 recurrent salpingitis patients responded satisfactorily to the assigned antibiotic regimen (CTX, n = 8; C + Gen, n = 3; C + Gen + P, n = 3). One of four patients with the diagnosis of salpingitis/IUD treated with CTX was a treatment failure, while three of three patients treated with C + Gen and two of two patients with C + Gen + P responded satisfactorily. Two of three patients with the diagnosis of salpingitis/adnexal mass failed therapy with C + Gen while the seven patients treated with CTX and the four patients with C + Gen + P responded satisfactorily. All nine patients with endomyoparametritis responded to their treatment regimen. Overall, there were no statistically significant differences in the responses by diagnosis and regimen, with the exception that C + Gen was significantly different (p less than 0.05) from CTX and C + Gen + P for the treatment of salpingitis with mass. Of the 141 bacterial isolates in all groups, 57 were aerobic or anaerobic gram-positive organisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Cefotaxime; Endometritis; Enterococcus faecalis; Female; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Salpingitis

A single-blind, prospective, randomized comparison of cefotaxime and cefazolin was conducted in 356 patients with gram-positive pneumonias. Clinical cure was achieved in 95.9% of patients receiving cefotaxime and 94% of patients receiving cefazolin. In a sub-group of patients with Staphylococcus aureus pneumonia, clinical cure was obtained in 31 of 37 patients treated with cefotaxime and all of six patients treated with cefazolin. Cefotaxime was well tolerated, safe, and efficacious. These data support the use of cefotaxime as an initial single antibiotic in treating patients with gram-positive pneumonias due to susceptible organisms.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Female; Gram-Positive Bacteria; Humans; Male; Middle Aged; Pneumonia

Clinical trials with cefotaxime have demonstrated that this antibiotic is effective and safe in a wide range of dosage schedules. Because of uncertainty about the most appropriate dosage regimen, physicians may be inclined to prescribe cefotaxime in higher doses and greater frequencies of administration than are required or economical (eg, dosing every six hours for an infection caused by a highly susceptible microorganism). To demonstrate that cefotaxime offers the physician great flexibility in dosing to achieve successful treatment with optimal cost-effectiveness, efficacy data from comparative and noncomparative studies in the United States were analyzed. Cases reviewed were those in which both the initial and final dosage regimens corresponded to one of several predetermined dosing schedules. These schedules included doses of 0.5 to 2.0 gm administered from two to six times a day. Patients were categorized according to severity of infection, and clinical and bacteriological responses were summarized according to frequency of administration. The analysis yielded 2,096 clinically evaluable cases and 1,755 bacteriologically evaluable cases. Uniformly good clinical and bacteriological success rates were achieved in all dosage regimens, indicating that in many circumstances the most appropriate regimen is every eight hours or, for highly susceptible pathogens, every 12 hours. Giving cefotaxime every six hours or more often is justified only when high concentrations of antibiotic are needed at the site of infection. Prescribing cefotaxime in the most appropriate dosage regimen will have a significant impact on the cost-effectiveness of antimicrobial therapy.

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Microbial Sensitivity Tests

In a prospective, randomized, double-blind study, we compared cefotaxime with nafcillin plus tobramycin in the treatment of serious bacterial infections. Of 195 patients with suspected or proven infections who were not neutropenic, definite bacterial infections were identified in 81; 34 of 38 patients given cefotaxime and 26 of 43 given nafcillin plus tobramycin (p less than 0.01) responded to treatment. The difference in response rates occurred primarily in patients with rapidly fatal underlying disease or with an infection outside the urinary tract. A logistic regression analysis showed that treatment with cefotaxime was still associated with a higher response rate after adjusting for several potential confounding factors. Among patients treated for 3 days or more, our criteria for nephrotoxicity were met in 2 of 68 (2.9%) given cefotaxime and 16 of 57 (28.1%) given nafcillin plus tobramycin (p less than 0.001). Prolongation of the prothrombin time and enterococcal colonization did not occur more frequently with cefotaxime. We conclude that cefotaxime may be more effective and less toxic than nafcillin plus tobramycin for patients with serious bacterial infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Enterobacter; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Humans; Infusions, Parenteral; Kidney Diseases; Male; Middle Aged; Nafcillin; Penicillin Resistance; Prognosis; Pseudomonas Infections; Random Allocation; Tobramycin; Urinary Tract Infections

Seventy-seven patients with acute bacterial infections were treated with ceftriaxone (1 gm administered intravenously every 12 hours). The 58 patients evaluable for efficacy had 60 infections, including 39 of the respiratory tract, 14 of the urinary tract, and seven of soft tissue. Five patients were bacteremic. The mean duration of ceftriaxone treatment was eight days for patients with respiratory and urinary tract infections and 13 days for patients with other types of infections. A satisfactory clinical response occurred in 56 (93%) of the infections. Eighty-four (94%) of the 89 pretherapy pathogens were bacteriologically eradicated. Included were all 19 isolates of Haemophilus influenzae, all 15 of Streptococcus pneumoniae, all 12 of Escherichia coli, 22 of the 23 isolates of other Enterobacteriaceae species, three of five isolates of Pseudomonas aeruginosa, and three of four isolates of Staphylococcus aureus. Two cases of superinfection (one with bacteremia) occurred with P aeruginosa. There were two cases each of reinfection and colonization with Streptococcus faecalis. One patient developed manifestations of culture-documented S pneumoniae meningitis eight hours after the first dose was administered. Peak and trough plasma levels of ceftriaxone were 142 and 64 micrograms/ml. Ceftriaxone achieved therapeutic levels in infected cerebrospinal fluid and in the abscess fluid of selected patients. Adverse effects, which were mild, included diarrhea in 4% of the patients and elevated transaminase levels in 10%.

Topics: Adult; Aged; Alanine Transaminase; Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Connective Tissue Diseases; Diarrhea; Escherichia coli Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Pneumococcal Infections; Respiratory Tract Infections; Sepsis; Streptococcus pneumoniae; Time Factors; Urinary Tract Infections

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Humans; Infant, Newborn; Infant, Newborn, Diseases; Virus Diseases

During a 7 month trial for therapy of polymicrobial surgical sepsis, intravenous antibiotic treatment was randomized between gentamicin (1 mg/kg every 8 hours) plus clindamycin (8 mg/kg every 6 hours), and the cephalosporin, ceftriaxone (1 g every 12 hours) in 197 patients, of whom 99 were being treated for peritonitis, 93 for soft tissue sepsis, and 5 for other forms of infection. No significant differences were noted in patient demographics, type of sepsis, associated disease states, surgical procedure, or causative aerobic or anaerobic pathogens. Results demonstrated approximately equivalent efficacy, although cure rates obtained with ceftriaxone in patients with soft tissue sepsis or intraabdominal abscess were superior to those achieved with combination gentamicin and clindamycin. There were no significant side effects with ceftriaxone therapy, such as the renal failure noted in six of the patients treated with gentamicin and clindamycin. We conclude that single agent treatment with ceftriaxone is preferable because of the greater safety and the longer dosing intervals.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Clindamycin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Gentamicins; Humans; Kidney Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Postoperative Complications; Random Allocation; Recurrence

In 512 patients undergoing major cardiovascular surgery, this prospective, randomized study compared the effectiveness of perioperative prophylaxis with either ceftriaxone or cefuroxime. In the ceftriaxone group, 254 patients received a single 2 g dose given intravenously at the start of anesthesia followed by a 1 g dose 24 hours later. In the cefuroxime group, 258 patients received 1.5 g at the start of anesthesia, followed by 1.5 g given intravenously every 12 hours for 2 days postoperatively. Postoperative infectious complications developed in only 12 patients in each group (4.7 percent). In 53 patients the mean serum concentration of ceftriaxone 24 hours after administration of the 2 g dose was 37.4 micrograms/ml, a level far in excess of the minimal inhibitory concentrations of usual cardiovascular pathogens with the exception of Bacteroides species and Pseudomonas species. We conclude that a single 2 g dose of ceftriaxone given at the time of cardiovascular surgery should provide adequate prophylaxis.

Topics: Bacterial Infections; Cardiac Surgical Procedures; Cefotaxime; Ceftriaxone; Cefuroxime; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Male; Pneumonia; Postoperative Complications; Random Allocation; Sepsis; Surgical Wound Infection; Time Factors; Urinary Tract Infections; Vascular Surgical Procedures

Ceftriaxone is a promising antimicrobial agent in the therapy of bacterial meningitis. The rationale for the clinical evaluation of ceftriaxone in patients with meningitis is based on the following favorable characteristics: ceftriaxone has excellent in vitro activity (MBC90 0.25 microgram/ml or less) against the major meningeal pathogens including meningococci, pneumococci, group B streptococci, Hemophilus influenzae, and Escherichia coli, but it is inactive against Listeria monocytogenes; ceftriaxone is rapidly bactericidal within purulent cerebrospinal fluid in experimental animal models of meningitis induced by pneumococci, group B streptococci, H. influenzae, and E. coli; against most of the major meningeal pathogens, the activity attained in cerebrospinal fluid in human subjects with bacterial meningitis is high (1:512 or greater) and active concentrations of ceftriaxone persist in cerebrospinal fluid for prolonged periods compared with those of other cephalosporins; the results of clinical trials reported to date in patients with meningitis are encouraging. Ceftriaxone deserves further clinical evaluation in the treatment of bacterial meningitis; the optimal dose, frequency of administration, and duration of therapy remain to be determined.

Topics: Animals; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Clinical Trials as Topic; Haemophilus influenzae; Humans; Kinetics; Meningitis; Microbial Sensitivity Tests

A randomized trial to compare the efficacy and safety of 1 g of ceftriaxone daily and 3 to 4 g of cefazolin daily was conducted in 84 hospitalized adults with skin and soft tissue infections. A variety of infections including bacteriologically proven cellulitis, suppurative diabetic foot ulcer, soft tissue abscess, and other miscellaneous infections were treated. Side effects were minimal. Colonization with various microorganisms was observed during therapy with both agents. Clinical cure with or without surgery was achieved in 81 percent (34) of 42 patients treated with ceftriaxone and 77 percent (32) of 42 patients treated with cefazolin. The major difference between antibiotics was the rate of failure in infections caused by multiple organisms: five failures among 13 patients treated with cefazolin compared with no failures among 12 patients treated with ceftriaxone. Ceftriaxone appears to be an effective agent when given once daily as therapy for many serious skin and soft tissue infections.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefazolin; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Skin Diseases, Infectious

The clinical and bacteriologic efficacy of ceftriaxone given once or twice daily was evaluated in 153 studies. A total of 2,635 patients received ceftriaxone given intramuscularly or intravenously, 930 received comparative antibiotics, and 81 received placebo. For the 10 major categories of infections treated (central nervous system, upper and lower respiratory tract, intraabdominal, skin and skin structure, bone and joint, urinary tract, gynecologic, and bacterial sepsis), the clinical response rates were 89 percent or greater. Bacteriologic cure rates were 84 percent or greater overall and 90 percent or greater for seven of 10 categories. Ceftriaxone achieved a satisfactory clinical response (cure or improvement) for 89 (intraabdominal) to 99 percent (urinary tract) of the infections treated. Additionally, pediatric central nervous system infections responded to twice-daily ceftriaxone injection; ceftriaxone, in a single dose as low as 250 mg, cured gonorrhea, and a single dose of ceftriaxone was as effective as multiple doses of cefazolin in surgical prophylaxis.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Middle Aged; Premedication

A single-blind therapeutic trial, using randomly either cefotaxime or a benzyl-penicillin-gentamicin combination, was carried out in 68 hospitalised paediatric patients with 72 episodes of severe infection, which were, in the main, septicaemia, pneumonia, neonatal meningitis and a few other miscellaneous infections. The cefotaxime group showed a cure rate of 94.4% compared with 72.2% in the other group. One patient with bacterial meningitis treated initially with cefotaxime died a month later; however, penicillin and chloramphenicol had been added due to clinical deterioration. In the penicillin-gentamicin group there were five deaths, all from suspected neonatal septicaemia, and three cases required a change in antibiotic regimen before a cure could be effected. The results indicate that cefotaxime should be considered a drug of choice in many neonates with life-threatening sepsis.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Female; Gentamicins; Humans; Infant; Infant, Newborn; Male; Penicillin G

Thirty children with bacterial meningitis were randomized to receive either ampicillin and chloramphenicol in standard doses or cefotaxime (50 mg/kg/dose every 6 h) for 10 to 14 days. Eighteen patients received ampicillin and chloramphenicol and 12 patients received cefotaxime. Cerebrospinal fluid isolated included: Haemophilus influenzae (20), Streptococcus pneumoniae (4), Neisseria meningitidis (3), Group B streptococcus (2), and Salmonella enteritidis (1). Five of the H. influenzae isolates were ampicillin resistant but no isolates were resistant to cefotaxime. The minimum inhibitory concentrations of cefotaxime for 30 isolates ranged from 0.0004 to 0.06 mg/l, while the minimum bactericidal concentrations ranged from 0.007 to 0.12 mg/l. The cerebrospinal fluid bactericidal titres for the cefotaxime-treated group ranged from 1:64 to 1:1024. On the second day of therapy the mean cefotaxime serum concentrations were 56.9 +/- 28.7 mg/l at 1 h and 3.66 +/- 5.65 mg/l at 6 h after administration of the drug whilst mean desacetyl-cefotaxime serum concentrations were 12.31 +/- 7.56 mg/l at one hour and 7.96 +/- 8.26 mg/l at 6 h respectively. Cerebrospinal fluid concentrations of cefotaxime and desacetylcefotaxime measured one hour after drug administration were 3.72 +/- 5.57 mg/l and 4.35 +/- 7.12 mg/l, respectively. No adverse drug reactions were noted in either treatment group. Cefotaxime proved to be both as safe and as efficacious as standard therapy for the treatment of bacterial meningitis in children.

Topics: Adolescent; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kinetics; Male; Meningitis; Microbial Sensitivity Tests

We evaluated a single 1-g dose regimen of cefotaxime versus the standard three to five 2-g cefoxitin regimen for prophylaxis in vaginal or abdominal hysterectomy to determine whether acceptable rates of morbidity could be achieved. The antibiotics were administered as follows: cefotaxime, 1 g im or iv on call to the operating room; cefoxitin, 2 g im or iv on call to the operating room, followed by 2 g intravenously at 6 hourly intervals for up to 24 h. The patients received a povidone-iodine vaginal preparation immediately before surgery; vaginal packs, when used, contained no antimicrobial agents. Surgical procedures were comparable for each antibiotic and surgery group. The results showed that among cefotaxime treated subjects who underwent hysterectomy only 1 of 37 (2.7%) vaginal cases and 5 of 60 (8.3%) abdominal cases developed operative site infections requiring parenteral antibiotics. For cefoxitin, 3 of 41 (7.3%) vaginal cases and 6 of 41 (14.6%) abdominal cases, similarly, required antibiotics. The incidence of postoperative infections was not different between regimens, irrespective of the type of hysterectomy, but considerable cost-savings by reduced drug and administration expenses were realized with the single-dose cefotaxime regimen.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Middle Aged; Postoperative Complications; Premedication

The role of prophylactic cefotaxime and a combination of ampicillin and tinidazole was assessed in 201 patients undergoing hysterectomy. One hundred and twenty-five patients were evaluated in the abdominal hysterectomy group and 46 patients completed the protocol after vaginal hysterectomy. Patients were allocated randomly to receive either (1) no prophylactic antibiotic, (2) cefotaxime peroperatively for 24 h or (3) ampicillin/tinidazole peroperatively for 24 h. Both cefotaxime and ampicillin/tinidazole reduced the septic complication rate in abdominal and vaginal hysterectomy. Efficacy was most evident in reducing early urinary infections after abdominal hysterectomy (0.001 less than P less than 0.01). Cefotaxime and ampicillin/tinidazole were equally effective and no significant side-effects were demonstrated. Cefotaxime is recommended as a safe and effective agent for hysterectomy prophylaxis.

Topics: Adult; Ampicillin; Bacterial Infections; Cefotaxime; Drug Combinations; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Middle Aged; Nitroimidazoles; Postoperative Complications; Premedication; Tinidazole

In a randomized, single-blind study, the efficacy of single-dose cefotaxime was compared with multiple dose cefoxitin in genitourinary surgery prophylaxis. Patients received either 1.0 g cefotaxime before surgery; or 2.0 g cefoxitin pre-operatively and every 8 h for no more than 24 h post-operatively. Of the evaluable patients receiving cefotaxime 3 of 35 (8.6%) became infected post-operatively, compared to 12 of 37 (32.4%) patients receiving cefoxitin (P less than 0.01). It is concluded that single-dose genitourinary surgical prophylaxis with cefotaxime may be more effective than a longer dosing schedule with cefoxitin in the prevention of post-operative urinary tract infections, and that a single-dose regimen may represent significant cost containment advantages for hospitals.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefoxitin; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Urogenital System

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Cellulitis; Clinical Trials as Topic; Humans; Osteomyelitis; Pneumonia

Fifty-nine patients with serious infections were assigned at random in a two-to-one ratio to receive either cefmenoxime or cefoxitin given intravenously in a dosage of 0.5 to 2.0 g every six hours. Of 44 patients evaluable for efficacy, eight had concomitant bacteremia and all but 10 had serious underlying disease. The average duration of therapy was seven days. All patients with skin and soft tissue infections were cured after treatment with either antibiotic. Cefmenoxime achieved clinical and bacteriologic cures in 92 and 83 percent, respectively, of 12 patients with pneumonia and in 100 and 82 percent of 11 patients with urinary tract infections. Cefoxitin therapy resulted in clinical and bacteriologic cures in all four patients with pneumonia. Among 10 patients with urinary tract infection, respective cure rates were 90 and 50 percent. Both antibiotics were well tolerated. One cefmenoxime-treated patient discontinued treatment because of a rash.

Topics: Adult; Bacterial Infections; Cefmenoxime; Cefotaxime; Cefoxitin; Drug Administration Schedule; Drug Evaluation; Female; Humans; Infusions, Parenteral; Male; Random Allocation; Respiratory Tract Infections; Skin Diseases, Infectious; Urinary Tract Infections

A comparative study was conducted using cefmenoxime, a new extended spectrum cephalosporin, versus cefoxitin. Entry into the study was based on a computer-generated randomization (two cefmenoxime to one cefoxitin). An intravenous dose of cefmenoxime (0.5 to 1 g every six hours) or cefoxitin (1 to 2 g every six hours) was administered to patients suspected of having serious bacterial infections. Six patients had urinary tract infections. Four who received cefmenoxime, including two with positive blood cultures, had eradication of bacteremia. One of the two who received cefoxitin had significant bacteriuria, and the urine was clear after treatment. Twenty-four patients were treated for lower respiratory tract infections. All 15 patients who received cefmenoxime had clinical and bacteriologic cures. Two of the nine patients who received cefoxitin continued to have the pathogens at the end of the treatment period. Both patients had a neoplasm of the lung. All 11 patients who had soft tissue infections (nine of whom received cefmenoxime) responded well. Both antibiotics were well tolerated.

Topics: Bacterial Infections; Cefmenoxime; Cefotaxime; Cefoxitin; Clinical Trials as Topic; Humans; Random Allocation; Respiratory Tract Infections; Urinary Tract Infections

This controlled multicenter study on 407 evaluable patients demonstrates the equal efficacy of two short-term antimi crobial prophylactic regimens in urological surgery involving a single dose of a long-acting cephalosporin, ceftriaxone, in comparison with a multiple dose of cefotaxime. Fifty-three of the 196 patients (27%) on the cefotaxime regimen and 47 of the 211 patients (22.3%) who received ceftriaxone showed postoperative infectious complications. There were no differences in these results.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Drug Administration Schedule; Humans; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Urinary Catheterization; Urinary Tract

This multicenter, prospective and randomized study on 355 patients demonstrates the equal efficacy of two short-term antimicrobial prophylactic regimens in gynecologic and obstetrical surgery involving a single dose of a long-acting cephalosporin, ceftriaxone, in comparison with a multiple cefotaxime dose. Among the cefotaxime and ceftriaxone groups which underwent abdominal hysteroctomy, 15 of 112 (13.4%) and 20 of 97 (20.6%) patients developed infections respectively. Four vaginal hysterectomy patients out of 20 (20%) on cefotaxime regimen and 4 of 25 (16%) who received ceftriaxone, became infected (febrile morbidity, wound infections, bacteriuria and infectious complications at a non-surgical site). Also among the cefotaxime and ceftriaxone groups of emergency or elective cesarean sections the differences on the incidence of infections are not statistically significant.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Cesarean Section; Clinical Trials as Topic; Female; Humans; Hysterectomy; Middle Aged; Postoperative Complications; Pregnancy; Premedication; Prospective Studies; Random Allocation

In a prospective randomized study of 192 patients, the effect of a short course of cefotaxime in connection with transurethral prostatic resection was analyzed. The antibiotic was given to 98 patients, while 94 were assigned to a control group without antibiotic. The frequency of bacteriuria in the cefotaxime group was 43% preoperatively and 18% six weeks postoperatively. In the control group the corresponding figures were 40 and 42% (p less than 0.01). Complicated postoperative infection did not occur in the cefotaxime group, but in the control group there was one case of septicemia and seven patients had upper urinary tract infections (p less than 0.01). In the cefotaxime group, patients with preoperatively negative urine culture were prevented from acquiring bacteriuria, and 67% of preoperatively present infections were eliminated at six weeks after the operation, as compared with 30% in the control group. There were essentially no side effects of cefotaxime. Renal function was not influenced by the combination of cefotaxime and furosemide.

Topics: Aged; Bacterial Infections; Bacteriuria; Cefotaxime; Drug Evaluation; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prostatectomy; Prostatic Hyperplasia; Urinary Tract Infections

A multicentre clinical trial was organized by the International Antimicrobial Therapy Project Groups of the European Organisation for Research on the Treatment of Cancer (E.O.R.T.C.) to compare the effectiveness of three combinations of antibiotics (azlocillin + amikacin; cefotaxime + amikacin and ticarcillin + amikacin) in patients with malignant leukopenic and febrile diseases (polymorphonuclears less than 1000/mm3; temperature greater than 38.5 degrees C). Some 800 patients from 20 centres entered the study. Preliminary results in 421 assessable patients showed a 62% positive response rate. The response rate in patients with bacteraemia was twice as high in the azlocillin group than in the other groups, the difference being significant at p less than 0.02. This difference does not seem to be due to a distribution bias, since the responsible micro-organisms, the severity of granulopenia, the incidence of bacterial-resistant strains, etc., were similar in all three groups. Similarly, the death rate was 12% in the azlocillin-amikacin group as against 15% and 17% respectively in the other groups. It would appear from this trial that the azlocillin-aminoglycoside treatment is superior to the other antibiotic combinations tested in this category of patients.

Topics: Agranulocytosis; Amikacin; Azlocillin; Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Drug Therapy, Combination; Humans; Neoplasms; Penicillins; Ticarcillin

The efficacy of the third generation cephalosporins, ceforperazone and cefotaxime, was evaluated in a provincial hospital in a small group of patients with severe infections. In one study, patients with severe sepsis were randomly allocated to a group receiving either cefoperazone or ampicillin (ticarcillin or cloxacillin) and gentamicin. In the other trial, a selected group of ill patients was given cefotaxime. Clinical and laboratory analyses showed that these two drugs are safe, well tolerated and effective in the blind treatment of severe infections.

Topics: Adolescent; Adult; Aged; Ampicillin; Bacterial Infections; Cefoperazone; Cefotaxime; Clinical Trials as Topic; Cloxacillin; Female; Gentamicins; Humans; Male; Middle Aged; Random Allocation; Ticarcillin; Vitamin K

Cefotiam was evaluated by a comparative open-label randomized trial with cephalothin in the therapy of skin and soft tissue infections in 39 patients. The most common organism isolated was Staphylococcus aureus (78%). We established evidence of primary infection with gram-negative bacilli in four patients, three of whom were diabetic. Eight patients had mixed infections or superinfections. No patient was evaluated as a treatment failure; for 10 of 39 patients we were unable to recover an etiological agent but demonstrated a clinical cure. Cefotiam was found to be as effective as cephalothin in the therapy of skin and soft tissue infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Cellulitis; Cephalothin; Drug Evaluation; Humans; Impetigo; Male; Microbial Sensitivity Tests; Middle Aged; Random Allocation

In 300 reconstructive arterial operations of the abdominal aorta and the lower limbs, a randomized prospective study of the effect of perioperative infection prophylaxis with antibiotics was performed. The evaluation was carried out with regard to the frequency of severe postoperative wound infections. As prophylactic antibiotic Cefuroxime was initially used, Cefotaxim was later administered. Cefotaxim has been proven to be the appropriate antibiotic against the special microbial spectrum of our clinic. Side effects or complications due to the antibiotics were not found. Wound infections of all grades of seriousness occurred in the group without infection prophylaxis in 15.1%, in the antibiotic group in 3% (p less than 0.001). Serious wound infection endangering or involving the transplant were found in the group without prophylaxis in 7.2%, whereas in the antibiotic group in 1.5%. Infections of the vascular prosthesis were observed in 2.4% and 0.8% respectively. Most wound infections occurred in the groin. The most common infecting organisms were Staphylococcus aureus or epidermidis. A higher risk of wound infections due to old age or gangrene could not be observed. Although wound infections in peripheral vascular surgery are relatively rare, they have severe consequences. It is therefore advisable to administer perioperative infection prophylaxis which significantly reduces this complication, especially in patients with synthetic implants.

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Blood Vessel Prosthesis; Cefotaxime; Cefuroxime; Humans; Middle Aged; Prospective Studies; Random Allocation; Surgical Wound Infection; Vascular Surgical Procedures

During 31 months of study, 808 patients with polymicrobial surgical infection were randomized for antibiotic therapy between a third-generation cephalosporin (moxalactam disodium [149], cefotaxime sodium [125], and cefoperazone sodium [141]) and the combination of gentamicin sulfate plus clindamycin (393). Results based on antibiotic therapy included the following: cure in 83% given cephalosporin, 73% with antibiotic combination; control but recurrent sepsis in 7% and 15%; and failure in 4% and 8%, respectively. Such data support the tenet that third-generation cephalosporins are at least equal, if not superior, to the combination of gentamicin plus clindamycin for treatment of polymicrobial surgical sepsis.

Topics: Abscess; Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefoperazone; Cefotaxime; Cephalosporins; Cephamycins; Child; Clindamycin; Clinical Trials as Topic; Female; Gentamicins; Humans; Kidney Diseases; Male; Middle Aged; Moxalactam; Peritoneal Diseases; Peritonitis; Postoperative Complications; Random Allocation; Surgical Wound Infection

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Clinical Trials as Topic; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Random Allocation

Ceftriaxone, a broad-spectrum cephalosporin with a markedly extended half-life, was administered to 100 patients with 56 bone and 44 soft tissue infections. Sixty-eight received 1 g twice daily, and 32 received 2 g once daily intravenously. Overall, 91% had a satisfactory clinical response, with similar efficacies in both treatment regimens. In six patients, failure to achieve a cure correlated well with the development of resistance to ceftriaxone during therapy in Enterobacter and Pseudomonas species (two cases) and with superinfection with Bacteroides fragilis (four cases). In 41 patients, intravenous drug therapy was continued after discharge from the hospital. In this group, 1,093 patient-days of hospitalization were saved, amounting to $150,020 in cost savings. The prolonged half-life facilitated the administration of ceftriaxone in this setting.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bone Diseases; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Costs and Cost Analysis; Cross Infection; Female; Humans; Male; Middle Aged; Skin Diseases, Infectious

A prospective, randomized trial comparing treatment of 61 febrile episodes with cefotaxime (CTX) versus a combination of ampicillin, methicillin, and netilmicin (AMN) was carried out in 58 patients with leukaemia or malignant lymphoma, of whom 28 had a granulocyte count of less than or equal to 500 X 10(6)/l. The overall response frequency was 63% for CTX against 49% for the AMN combination, the latter figure being lower than generally reported in the literature. The difference was not statistically significant. In 21 episodes pathogens were isolated, 16 of them from the blood. All isolated bacteria but one, a strain of Bacteroides fragilis, were fully sensitive to at least one of the three antibiotics in the combination, and all but one, a strain of Listeria monocytogenes, were fully sensitive to CTX. These results indicate that CTX seems to be a promising alternative as monotherapy for empiric treatment of febrile episodes in patients with haematologic malignancies. Further investigations will, however, be required before completely rational choices between mono and combination therapy of febrile episodes in immunosuppressed patients can be made.

Topics: Adolescent; Adult; Aged; Ampicillin; Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Drug Therapy, Combination; Female; Fever; Humans; Leukemia; Lymphoma; Male; Methicillin; Middle Aged; Netilmicin; Penicillins; Prospective Studies; Random Allocation

In 54 patients suffering from a variety of severe systemic infections the combination of mezlocillin (4 g iv 6-hourly) plus cefotaxime (2 g iv 8-hourly) was compared to that of gentamicin (1.5 mg/kg im or iv 8-hourly) plus cefoxitin (2 g iv 6-hourly). In the gentamicin/cefoxitin group metronidazole (500 mg iv 8-hourly) was added for anaerobic infections. Treatment assignment was randomized. The patients' diagnoses were: pyelonephritis (24), pneumonia (14), infected burns (9), osteomyelitis (2), and abdominal infections (5). Pathogens included: Escherichia coli (31), other Enterobacteriaceae (21), Pseudomonas aeruginosa (13), anaerobes (4), and others (2). Treatment with mezlocillin/cefotaxime cured 20 (74%) of 27 patients and caused improvement in 5, while in 19 (70%) patients the pathogens were eradicated. In the gentamicin/cefoxitin group 17 (63%) of 27 patients were cured and 6 improved, while in 15 (56%) pathogens were eradicated. One patient in the first group developed a rash, while in the second group two patients developed thrombophlebitis and another two transient nephrotoxicity. The combination of mezlocillin and cefotaxime can be recommended for the rational and empirical treatment of serious systemic infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Mezlocillin; Middle Aged; Random Allocation

A randomized study of gentamicin plus cefotaxime versus ceftazidime alone was performed in 87 patients, with a neutrophil count of less than 1000/mm3 at the start of the treatment. The overall cure rate for the ceftazidime group was 71% and for the gentamicin plus cefotaxime 47%. This difference was shown to be statistically significant at a level of P less than 0.05. The cure rates for the microbiologically proven infections were 90 and 63% respectively. Serious adverse effects, causing preliminary withdrawal of therapy, have not been observed.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Bacterial Infections; Cefotaxime; Ceftazidime; Cephalosporins; Drug Therapy, Combination; Female; Fever; Gentamicins; Humans; Male; Middle Aged; Random Allocation

Ceftriaxone sodium, a new cephalosporin with a very broad spectrum of action and a very long serum half-life, was administered to 127 patients in the treatment of 133 severe infections at our institution in Lausanne, Switzerland. Eighty infections had previously been treated unsuccessfully with other antimicrobials to which the pathogens were most often resistant. Sixty-five episodes were treated with two daily injections until there was an improvement in the patient's clinical condition, while 67 infections were treated from the start by a single daily injection. The results in the two groups were similar. One hundred fifteen infections (86%) were cured or improved, ten (8%) did not respond to therapy or recurred, and eight (6%) were not evaluable. The treatment was well tolerated, even by the 18 patients who received the drug for more than four weeks. The administration of a single daily dose instead of four doses as with standard antibiotic regimens produced a saving of Sfr 84,000 (+42,000) in the 127 patients. The single daily dose also made it possible to treat 25 of the 127 severely ill patients as outpatients, with a saving of Sfr 388,500 (+195,000) with respect to the hospital costs that would have been incurred for the same time period.

Topics: Adolescent; Adult; Aged; Ambulatory Care Facilities; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Clinical Trials as Topic; Cost-Benefit Analysis; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged

We performed a survey of clinical experience of cefotiam (CTM: Pansporin) as postmarketing surveillance (PMS), and evaluated the efficacy and safety of CTM in 10,499 cases of data which were collected during the first 2 years after approval. The following results were obtained. The efficacy rate of CTM in the treatment of various infections was 83.2%, which was equal or superior to the clinical results obtained before approval. A total of 472 adverse drug reactions was reported by 10,499 patients (4.50%). The commonest adverse drug reactions was liver function abnormality (230 cases), followed by dermal symptoms (103 cases), gastrointestinal symptoms (53 cases) and renal function abnormality (20 cases) in the order mentioned. All of these adverse drug reactions had already been known for cephem antibiotics, and no remarkable adverse drug reactions specific to CTM was found. The above PMS results indicate the same efficacy of CTM that obtained from premarketing studies. As regards safety, there was no remarkable unexpected adverse drug reaction and their profile was also the same as that found in premarketing studies. Thus, the utility of CTM was confirmed.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Clinical Trials as Topic; Drug Hypersensitivity; Evaluation Studies as Topic; Female; Hematologic Tests; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Middle Aged; Neurotic Disorders; Product Surveillance, Postmarketing; Skin; Skin Tests

Forty patients with severe bacterial infections due to micro-organisms known or presumed to be sensitive to both study antibiotics, were randomized to receive either imipenem with cilastatin, 500 mg/500 mg iv tid (20 patients), or cefotaxime, 2 g iv tid (20 patients). The types of infections observed were equally distributed between the 2 groups, and consisted of 18 complicated urinary tract infections, 9 pneumonia, 7 bone and soft tissue infections, 4 septicaemia of unknown origin and 2 intravenous-catheter-related septicaemia. In the imipenem group, 12 patients were bacteraemic, compared to 10 in the cefotaxime group. The micro-organisms observed were evenly distributed with Escherichia coli (22 cases) and Klebsiella pneumoniae (6 cases) being the most frequent. Sixteen patients were cured in the imipenem group and 15 in the cefotaxime group, while 2 and 2 improved, 2 and 1 relapsed and 0 and 2 did not respond to the therapy, respectively. In the imipenem group, no clinical side effects were observed while 5 patients had mild reactions in the cefotaxime group (2 fever, 1 skin rash, 1 oral candidiasis and 1 diarrhoea). Imipenem thus appeared as effective and well tolerated as cefotaxime in the treatment of severely infected patients.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cilastatin; Clinical Trials as Topic; Cyclopropanes; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Random Allocation

Topics: Adolescent; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Infant, Newborn; Male

Seventeen neonates with clinical signs of infection who would otherwise have received gentamicin with penicillin were treated with cefotaxime (50 mg/kg bd) for a period of 5 days. One hundred eleven bacteriological cultures were collected and those from 6/17 neonates yielded pathogenic or potentially pathogenic bacteria. Biochemical investigations undertaken before, during, and after the treatment revealed no adverse effects on renal or hepatic function associated with cefotaxime therapy. In addition to manual methods, a computer program was used to determine six pharmacokinetic variables. The mean peak serum level was 87.4 +/- 36.2 mg/liter, the mean trough level 8.0 +/- 6.9 mg/liter and the serum half life 3.1 +/- 0.8 hours. All the neonates showed clinical improvement following cefotaxime treatment with no adverse clinical signs and were discharged well from hospital. It is concluded that cefotaxime may be safely used in neonates and is a suitable alternative to gentamicin and penicillin for primary treatment in units that do not have a persistent and serious problem with infections due to Pseudomonas aeruginosa.

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Kinetics; Male; Time Factors

Topics: Adolescent; Adult; Aged; Animals; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Drug Resistance, Microbial; Female; Humans; Infant; Infant, Newborn; Injections; Lethal Dose 50; Male; Mice; Middle Aged; Rabbits; Rats

The study group was organized to evaluate the usefulness of cefmenoxime (CMX) injection, a new synthetic cephalosporin, for the treatment of infections in the field of obstetrics and gynecology. Fundamental and clinical studies were made by the society and the following results were obtained. 1. The peak distribution of CMX's MIC for E. coli, Klebsiella sp., Enterobacter sp., Bacteroides sp. and Peptococcus sp. isolated from obstetrical and gynecological infections with relatively high frequencies area 0.1, less than or equal to 0.05, 0.2, 3.13, 1.56 micrograms/ml, respectively, with an inoculation of 10(6) cells/ml. 2. When 1 g of CMX is administered by intravenous drip infusion for 1 hour, the maximum concentrations in various tissues of female genital organs were as follows: 14.2 and 13.2 micrograms/g in ovary and oviduct, respectively, at 1.20 hours after the start of administration, and 16.9 and 26.3 micrograms/g in corpus uteri and cervix uteri, respectively, after 1 hour. As for the transfer to the exudate in the pelvic dead cavity, the peak concentration was 15.6 micrograms/ml after 2.13 hours. 3. In the clinical studies, CMX was given to 258 cases with female genital organ infections and others. As for the clinical effects, with exclusion of 3 cases in which other antibiotics are concomitantly used, responses were excellent in 76 cases, good in 162 cases and poor in 17 cases, among 255 cases in total. The efficacy rate was 93.3%. The efficacy rates by diseases were 97.1% (68/70) for intrauterine infections, 88.8% (79/89) for intrapelvic infections, 98.4% (62/63) for adnexitis, and 100% (23/23) for infections of external genital organs. As for the clinical effects on causative bacteria, the efficacy rates were 100% (19/19) for single infections due to Gram-positive bacteria, 94.8% (55/58) for single infections due to Gram-negative bacteria, and 88.2% (15/17) for single infections due to anaerobic bacteria. And its efficacy rates were 89.6% (69/77) for mixed infection cases. Side effects were observed in 2 cases (0.8%); 1 case with eruption, and 1 case with diarrhea and vomiting. As for abnormal laboratory findings, lower white blood cell count was observed in 2 cases and elevation of the values regarding hepatic functions in 9 cases. All cases were returned to the normal after the completion of the administration. Cefmenoxime showed a satisfactory clinical efficacy and a potent bacteriological effect in treatment of the infections in the field of

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Clinical Trials as Topic; Drug Resistance, Microbial; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged

One hundred fifty-one patients with presumed aerobic-anaerobic mixed peritoneal infections were treated in a prospective, randomized trial with either cefotaxime alone (76) or the combination of gentamicin-clindamycin (75). Primary and complicating foci of sepsis were cultured for both aerobic and anaerobic pathogen identification and antibiotic susceptibility. In vitro aerobic disk sensitivities (114 isolates) to cefotaxime were 82% and to gentamicin, 88%; anaerobic agar-diffusion sensitivities (227 isolates) to cefotaxime were 87% and to clindamycin, 98%. Only enterococci and Pseudomonas sp were consistently resistant to cefotaxime. Infection was eliminated in 82% of those treated with cefotaxime and in 87% of those treated with the gentamicin-clindamycin combination, yet sepsis recurred in 11% of those treated with cefotaxime and in 13% for those given gentamicin-clindamycin. Five patients (7%) demonstrated nephrotoxicity for gentamicin. (Serum creatinine increased greater than 1.5 mg/100 ml over pretreatment levels.) Otherwise, incidence and severity of adverse reactions were identical for the two groups and consisted primarily of phlebitis and diarrhea. One patient in each treatment group died of uncontrolled sepsis. Although results suggested a laboratory superiority of gentamicin-clindamycin, there was a clinical equality in therapeutic benefit and a greater safety following the use of cefotaxime alone.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Clindamycin; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis

Topics: Abdomen; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftizoxime; Clindamycin; Drug Therapy, Combination; Humans; Pelvis; Tobramycin

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Female; Humans; Male; Middle Aged; Random Allocation

Topics: Bacterial Infections; Biliary Tract Diseases; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Endocarditis, Bacterial; Female; Genital Diseases, Female; Humans; Japan; Kinetics; Meningitis; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Topics: Abdomen; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Gonorrhea; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Osteitis; Respiratory Tract Infections; Sepsis; Skin Diseases, Infectious; United States; Urinary Tract Infections

Topics: Age Factors; Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Male

Topics: Adult; Animals; Bacteria; Bacterial Infections; Cefmenoxime; Cefotaxime; Chemical Phenomena; Chemistry; Chemistry, Physical; Clinical Trials as Topic; Humans; Injections; Rabbits; Rats

A multicentre study was carried out to assess the efficacy and tolerance of the wide-spectrum cephalosporin, cefotaxime, in the treatment of 411 hospitalized patients, most of whom were seriously ill with severe infections, including septicaemia, lower respiratory tract infection, urinary tract infections and soft tissue infection. Almost half the patients had failed to respond to previous antibacterial therapy and, in general, prognoses were poor. Patients received cefotaxime by intramusclar or/and intravenous injection in unit doses ranging from 0.5 to 2.0 g, 6 to 12 hourly, for periods up to 10 days or more. The results of clinical response in those who could be assessed showed a cure rate of 75% in 103 patients with septicaemia and over 80% in all other conditions.The bacteriological findings after treatment showed a similarly high eradication rate in a wide range of pathogens, particularly so in infections caused by E. coli, Klebsiella, H. influenzae, Proteus, Staph, aureus, staph. epidermis and Strep. pneumoniae. Useful clinical activity was also demonstrated in infections caused by moderately sensitive pathogens such a Pseudomonas and Strep. faecalis. Cefotaxime was well tolerated by the majority of patients, the commonest side-effects reported being moderate pain of short duration or phlebitis on injection, rash and diarrhoea, as with other cephalosporins. It is concluded that cefotaxime should be considered as a first line antibiotic for patients with severe infections caused by susceptible pathogens.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; United Kingdom

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Clinical Trials as Topic; Humans

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Sepsis; Urinary Tract Infections

A second-generation cephalosporin (cephotaxime) with a marked resistance to beta-lactamase, a very broad spectrum, and remarkably low renal toxicity was used to treat 47 patients with respiratory, urinary and other infections. The results were excellent in 89.2% and good in 8.5%. The antibiotic proved effective even against germs that are usually resistant to cephalosporins (Pseudomonas, Proteus, Serratia and Enterobacteriaceae). Bacteriuria disappeared in all cases of urinary infection. Local and general tolerance was excellent in all cases but one. Renal tolerance was also excellent in patients with chronic renal failure, for whom the daily dose can be usefully reduced and a check on renal function should be kept.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Urinary Tract Infections

Bacterial infection is common in acute cholecystitis (AC). To identify appropriate empirical antibiotics, we investigated AC-associated microorganisms and their susceptibilities to antibiotics. We also compared preoperative clinical findings of patients grouped according to specific microorganisms.. Patients who underwent laparoscopic cholecystectomy for AC between 2018 and 2019 were enrolled. Bile cultures and antibiotic susceptibility tests were performed, and clinical findings of patients were noted.. A total of 282 patients were enrolled (147 culture-positive and 135 culture-negative). The most frequent microorganisms were Escherichia (n = 53, 32.7%), Enterococcus (n = 37, 22.8%), Klebsiella (n = 28, 17.3%), and Enterobacter (n = 18, 11.1%). For Gram-negative microorganisms, second-generation cephalosporin (cefotetan: 96.2%) was more effective than third-generation cephalosporin (cefotaxime: 69.8%). Vancomycin and teicoplanin (83.8%) were the most effective antibiotics for Enterococcus. Patients with Enterococcus had higher rates of CBD stones (51.4%, p = 0.001) and biliary drainage (81.1%, p = 0.002), as well as higher levels of liver enzymes, than patients with other microorganisms. Patients with ESBL-producing bacteria had higher rates of CBD stones (36.0% vs. 6.8%, p = 0.001) and biliary drainage (64.0% vs. 32.4%, p = 0.005) than those without.. Preoperative clinical findings of AC are related to microorganisms in bile samples. Periodic antibiotic susceptibility tests should be conducted to select appropriate empirical antibiotics.

Topics: Anti-Bacterial Agents; Bacterial Infections; Bile; Cefotaxime; Cholecystitis, Acute; Enterococcus; Humans

In older adults, few studies confirm that adequate concentrations of antibiotics are achieved using current dosage regimens of intravenous β-lactam antibiotics. Our objective was to investigate trough concentrations of cefotaxime, meropenem, and piperacillin in older adults hospitalized with infection. We included 102 patients above 70 years of age. Total trough antibiotic concentrations were measured and related to suggested target intervals. Information on antibiotic dose, patient characteristics, and 28-day outcomes were collected from medical records and regression models were fitted. Trough concentrations for all three antibiotics exhibited considerable variation. Mean total trough concentrations for cefotaxime, meropenem, and piperacillin were 6.5 mg/L (range 0-44), 3.4 mg/L (range 0-11), and 30.2 mg/L (range 1.2-131), respectively. When a target range of non-species-related breakpoint - 5× non-species-related breakpoint was applied, only 36% of patients had both values within the target range. Regression models revealed that severe sepsis was associated with varying concentration levels and increasing age and diminishing kidney function with high concentration levels. The study was not powered to demonstrate consequences in clinical outcomes. Conclusively, in older adults treated with cefotaxime, meropenem, or piperacillin-tazobactam, trough antibiotic concentrations varied considerably. Better predictors to guide dosing regimens of β-lactam antibiotics or increased use of therapeutic drug monitoring are potential ways to address such variations.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Bacterial Infections; beta-Lactams; Cefotaxime; Drug Monitoring; Female; Humans; Length of Stay; Male; Meropenem; Patient Readmission; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prospective Studies; Sepsis; Sweden; Thienamycins

Topics: Age Factors; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; C-Reactive Protein; Cefotaxime; Child, Preschool; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Infant; Leukocytosis; Male; Mucocutaneous Lymph Node Syndrome; Pyuria; Republic of Korea; Retrospective Studies; Sulbactam

Topics: Amoxicillin; Anemia, Sickle Cell; Anti-Bacterial Agents; Bacterial Infections; beta-Lactams; Cefotaxime; Humans; Prospective Studies

Spontaneous bacterial peritonitis (SBP) is one of critical complications in liver cirrhosis patients with ascites. We aimed to review clinical course of SBP patients in a 10-year period from single center.. This study enrolled SBP patients between 2005 and 2015. Their medical records were reviewed. The laboratory findings of serum and ascites were examined, and characteristics of isolated microorganisms in ascites were analyzed.. Total 51 patients were enrolled. Male patients were predominant (64.7%), and mean age was 59.20 years. The most common etiology of cirrhosis was alcohol (41.2%), followed by hepatitis B (39.2%). Microorganism was isolated from the ascites in 31 patients (60.78%). The proportions of Gram negative and Gram positive were 80.64% and 19.36%. The proportions of. SBP is still a critical complication in cirrhosis patients with ascites, and the clinical features of SBP have not been altered much compared with those in 1990's. The effective treatment of SBP is still very important for a better prognosis of cirrhosis patients.

Topics: Adult; Aged; Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Bilirubin; Cefotaxime; Creatinine; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Leukocytes; Male; Middle Aged; Peritonitis; Prothrombin Time; Recurrence; Retrospective Studies

The emergence of multidrug-resistant bacteria emphasizes the urgent need for novel antibacterial compounds targeting unique cellular processes. Two-component signal transduction systems (TCSs) are commonly used by bacteria to couple environmental stimuli to adaptive responses, are absent in mammals, and are embedded in various pathogenic pathways. To attenuate these signaling pathways, we aimed to target the TCS signal transducer histidine kinase (HK) by focusing on their highly conserved adenosine triphosphate-binding domain. We used a structure-based drug design strategy that begins from an inhibitor-bound crystal structure and includes a significant number of structurally simplifiying "intuitive" modifications to arrive at the simple achiral, biaryl target structures. Thus, ligands were designed, leading to a series of thiophene derivatives. These compounds were synthesized and evaluated in vitro against bacterial HKs. We identified eight compounds with significant inhibitory activities against these proteins, two of which exhibited broad-spectrum antimicrobial activity. The compounds were also evaluated as adjuvants for the treatment of resistant bacteria. One compound was found to restore the sensivity of these bacteria to the respective antibiotics.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Drug Design; Enzyme Inhibitors; Histidine Kinase; Humans; Microbial Sensitivity Tests; Models, Molecular; Signal Transduction; Thiophenes

(99m)Tc-cefotaxime sodium ((99m)Tc-CEF) was developed and standardized under varying conditions of reducing and antioxidant agent concentration, pH, radioactivity dose, and reducing agent type. Labeling studies were performed by changing the selected parameters one by one, and optimum labeling conditions were determined. After observing the conditions for maximum labeling efficiency and stability, lyophilized freeze dry kits were prepared accordingly. Simple method for radiolabeling of CEF with (99m)Tc has been developed and standardized. Labeling efficiency of (99m)Tc-CEF was assessed by both radio thin-layer chromatography and radio high-performance liquid chromatography and found higher than 90%. The labeled compound was found to be stable in saline and human serum up to 24 h. Two different freeze dry kits were developed and evaluated. Based on the data obtained from this study, both products were stable for 6 months with high labeling efficiency. The prepared cold kit was found sterile and pyrogen free. The bacterial infection and sterile inflammation imaging capacity of (99m)Tc-CEF was evaluated. Based on the in vivo studies, (99m)Tc-CEF has higher uptake in infected and inflamed thigh muscle than healthy thigh muscle.

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Escherichia coli; Humans; Muscle, Skeletal; Positron-Emission Tomography; Radiopharmaceuticals; Rats; Rats, Wistar; Serum; Technetium; Tissue Distribution

Two different series of N-substituted imidazolium oximes and their monoquaternary salts were synthesized and biologically tested with respect to their ability to inhibit growth a diverse panel of antibiotic susceptible Gram-positive and antibiotic resistant Gram-negative bacteria as well fungal strains. The newly synthesized compounds were analyzed by spectral studies to confirm their structure. The preliminary results showed that all compounds tested possess promising antimicrobial potential against both susceptible Gram-positive and antibiotic resistant Gram-negative isolates, exhibiting a wide range of MIC values from 0.14 to 100.0 μg/mL. The structure-activity relationship demonstrates that the p-methylphenyl and p-fluorophenyl groups in monoquaternary salts 6 and 7 attached directly to the imidazolium ring could be essential for observed remarkable inhibitory profiles against clinically important pathogens Pseudomonas aeruginosa (MIC=0.14 μg/mL) and Klebsiella pneumoniae (MIC=1.56 μg/mL). Furthermore, the broth microdilution assay was then used to investigate the antiresistance efficacy of compound 7 against fourteen extended-spectrum β-lactamase (ESBL)-producing strains in comparison to eight clinically relevant antibiotics. Compound 7 exhibited a remarkable antiresistance profiles ranging between 0.39 and 12.50 μg/mL against all of ESBL-producing strains, which leads to the suggestion that may be interesting candidate for development of new antimicrobials to combat multidrug resistant Gram-negative bacteria.

Topics: Anti-Infective Agents; Bacterial Infections; Drug Resistance, Multiple; Fungi; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Imidazoles; Microbial Sensitivity Tests; Mycoses; Oximes

Spontaneous bacterial peritonitis (SBP) is a significant cause of mortality in cirrhosis. Reducing toxic burden of infected ascitic fluid through paracentesis needs further studies as adjunctive therapy of SBP. We aimed to evaluate different therapies for SBP.. Thirty-six cirrhotic ascitic patients with SBP were examined and classified according to treatment modality (5-7 days) into: Group A received cefotaxime, group B received cefotaxime and albumin 1.5 g/kg body weight within 6h of SBP being diagnosed and 1g/kg body weight on day 3, group C received cefotaxime and paracentesis with volume dependent albumin infusion. Control group of 12 cirrhotic ascitic patients free from SBP were included. Routine laboratory tests, ascitic fluid analysis for leucocytes and culture were done, inflammatory mediators such as nitric oxide and tumour necrosis factor alpha were measured in serum and ascitic fluid. Duplex-Doppler assessment of portal flow volume and renal resistive index, Echocardiography to measure end diastolic and end systolic volumes, stroke volume and cardiac output were done. Tests were carried out before and after therapy.. Treatment response was assessed by, cardiac haemodynamics, portal and renal flow and NO and TNF. All studied parameters; laboratory, cardiac, Doppler exhibited a significant improvement in group B in contrast to the other groups as demonstrated by post therapy reduction of (blood and ascitic fluid WBCs & PNLS, serum and ascitic NO & TNF and renal resistive index), elevation of (serum albumin and portal flow volume) and improvement of cardiac haemodynamic.. Treatment of spontaneous bacterial peritonitis by cefotaxime and body weight based albumin infusion gave most favourable results compared to other regimens. Postulation of removing toxic burden through paracentesis has not been confirmed.

Topics: Adult; Albumins; Analysis of Variance; Anti-Bacterial Agents; Ascites; Ascitic Fluid; Bacterial Infections; Cefotaxime; Humans; Kidney; Liver Circulation; Liver Cirrhosis; Male; Middle Aged; Nitric Oxide; Paracentesis; Peritonitis; Portal System; Renal Artery; Stroke Volume; Tumor Necrosis Factor-alpha; Ultrasonography

A collection of 3-substituted indole derivatives was prepared using nucleophilic addition of indoles to nitrones. The compounds were then tested for their antibacterial activity against almost thirty bacterial strains representative of common human pathogens. Two types of indolic molecules inhibit the growth of Staphylococcus aureus, including MRSA and VISA strains, with MIC values ranging from 8 to 16 mg/L.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Humans; Indoles; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus aureus; Structure-Activity Relationship

Thirteen compounds, based on benzofuran skeleton bearing aryl substituents at its C-3 position through methanone linker, were synthesized and screened for their antibacterial and antifungal activities against four bacteria Escherichia coli, Staphylococcus aureus, Methicillin-resistant S.aureus, Bacillus subtilis, and a fungus Candida albicans. Four hydrophobic benzofuran analogs were found to exhibit favorable antibacterial activities (MIC(80) = 0.39-3.12 μg/mL), which were better than the control drugs.

Topics: Anti-Bacterial Agents; Antifungal Agents; Bacillus subtilis; Bacterial Infections; Benzofurans; Candida albicans; Candidiasis; Cell Proliferation; Escherichia coli; Humans; Hydrophobic and Hydrophilic Interactions; Methicillin Resistance; Microbial Sensitivity Tests; Staphylococcus aureus; Structure-Activity Relationship

Spontaneous bacterial peritonitis (SBP) has been typically described in hospitalized patients. There are little data on ascitic fluid infection in asymptomatic outpatients. The present study was aimed at determining the prevalence and risk factors for asymptomatic ascitic fluid infection among patients with liver cirrhosis attending an outpatient clinic.. Between January 2008 and December 2009, consecutive patients with cirrhosis (n = 110) undergoing therapeutic paracentesis in an outpatient setting were studied. Patients with fever, abdominal pain, hepatic encephalopathy, recent gastrointestinal bleeding, impaired renal function, previous history of SBP and on antibiotic treatment were excluded. Baseline demographic details, and etiology and severity of liver disease were recorded. Ascitic fluid cell count, culture and biochemical tests were done using standard laboratory techniques.. The causes of cirrhosis were alcohol (55.5%), hepatitis B (21.8%), hepatitis C (9.1%) and others (13.6%). A total of 278 paracenteses were done in them (average 2.5 [1.1] times per patient). Spontaneous ascitic fluid infection was found in 7 (2.5%) paracentesis, including spontaneous bacterial peritonitis in one (0.4%), monomicrobial nonneutrocytic bacterascites (MNB) in two (0.7%) and culture-negative neutrocytic ascites (CNNA) in four (1.4%). Escherichia coli, Klebsiella spp. and Staphylococcus aureus were grown. There was no difference between cirrhotic outpatients with and without infection in age, gender, alcohol consumption, etiology of cirrhosis, Child-Pugh score, serum albumin and ascitic fluid total protein. There was no death due to spontaneous ascitic fluid infection.. Asymptomatic ascitic fluid infection was very infrequent in patients with cirrhosis attending an outpatient clinic and undergoing therapeutic paracentesis.

Topics: Adult; Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Ofloxacin; Outpatients; Paracentesis; Peritonitis; Prevalence; Risk Factors

The aim of this research is to evaluate the recent changes in microorganisms causing spontaneous bacterial peritonitis in cirrhotic patients, antibiotic resistance, and response to empirical cephalosporin therapy. A total of 218 patients with ascites secondary to cirrhosis were enrolled. Parenteral cefotaxime or cefepime was given to patients who had a neutrophil count of 250/mm(3) or more or a positive bacterial culture of ascitic fluid. Antibiotic failure was defined by an absence of clinical improvement and an insufficient decrease in neutrophil count of ascites (<25% of initial value) by the third day of therapy. Of all the patients, 44.6% had culture-negative neutrocytic ascites, 24.8% had spontaneous bacterial peritonitis, and 10.1% had monomicrobial nonneutrocytic bacterascites. Growth in culture was observed in 76 patients (34.9%). The two most common isolated bacteria were Escherichia coli (33.8%) and coagulase-negative Staphylococcus (CoNS; 19.7%). The two cephalosporins were effective against E. coli (82%) and but not against CoNS (44%), while levofloxacin showed reasonable activity against both E. coli (71%) and CoNS (90%) in vitro. We confirmed a recent increased incidence of spontaneous bacterial peritonitis caused by Gram-positive bacteria. Levofloxacin seems to be a good alternative treatment for patients with uncomplicated spontaneous ascites infections.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Cefepime; Cefotaxime; Cephalosporins; Drug Resistance, Bacterial; Enterococcus; Escherichia coli Infections; Female; Humans; Infusions, Intravenous; Klebsiella Infections; Klebsiella pneumoniae; Leukocyte Count; Levofloxacin; Liver Cirrhosis; Male; Microbial Sensitivity Tests; Middle Aged; Neutrophils; Ofloxacin; Peritonitis; Pneumococcal Infections; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections

In concert with the development of novel beta-lactams and broad-spectrum cephalosporins, bacterially encoded beta-lactamases have evolved to accommodate the new agents. This study was designed to identify, at the sequence level, the genes responsible for the extended-spectrum-beta-lactamase (ESBL) phenotypes of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis isolates collected during the global tigecycline phase 3 clinical trials. PCR assays were developed to identify and clone the bla(TEM), bla(SHV), bla(OXA), and bla(CTX) genes from clinical strains. Isolates were also screened for AmpC genes of the bla(CMY), bla(ACT), bla(FOX), and bla(DHA) families as well as the bla(KPC) genes encoding class A carbapenemases. E. coli, K. pneumoniae, and P. mirabilis isolates with ceftazidime MICs of > or =2 microg/ml were designated possible ESBL-producing pathogens and were then subjected to a confirmatory test for ESBLs by use of Etest. Of 272 unique patient isolates, 239 were confirmed by PCR and sequencing to carry the genes for at least one ESBL, with 44% of the positive isolates harboring the genes for multiple ESBLs. In agreement with current trends for ESBL distribution, bla(CTX-M)-type beta-lactamase genes were found in 83% and 71% of the ESBL-positive E. coli and K. pneumoniae isolates, respectively, whereas bla(SHV) genes were found in 41% and 28% of the ESBL-positive K. pneumoniae and E. coli isolates, respectively. Ninety-seven percent of the E. coli and K. pneumoniae isolates were tigecycline susceptible (MIC(90) = 2 microg/ml), warranting further studies to define the therapeutic utility of tigecycline against strains producing ESBLs in a clinical setting.

Topics: Anti-Bacterial Agents; Bacterial Infections; beta-Lactamases; Clinical Trials, Phase III as Topic; DNA Primers; Drug Resistance, Bacterial; Escherichia coli; Humans; Isoelectric Focusing; Klebsiella pneumoniae; Microbial Sensitivity Tests; Minocycline; Proteus mirabilis; Reverse Transcriptase Polymerase Chain Reaction; Tigecycline

To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice.. All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was > 250 cells/mm3, and empirically treated with cefotaxime.. Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women; mean age: 58.6 +/- 11.2 years). Prevalence of SBP, in our population, was 17%. Ascitic fluid culture was positive in nine (24%) cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime.. In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated.

Topics: Aged; Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Cefotaxime; Drug Resistance, Bacterial; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Neutrophils; Peritonitis; Practice Guidelines as Topic; Treatment Failure; Treatment Outcome

CTX-M-type extended-spectrum beta-lactamases (ESBLs) have become increasingly common worldwide, with the notable exception of the United States, where TEM- and SHV-type ESBLs have appeared to predominate. We have noted the emergence of ESBLs in our health care system (the University Health System in San Antonio, TX), especially in Escherichia coli isolates, that preferentially hydrolyze cefotaxime rather than ceftazidime, suggesting the possibility of CTX-M-type enzymes. Microbiology laboratory records were reviewed to identify ESBL-producing isolates and to compare the diameters of ceftazidime disk diffusion zones of inhibition to cefotaxime zone diameters. All isolates had been initially detected and confirmed using the procedures recommended by the Clinical and Laboratory Standards Institute. A total of 94 stored ESBL-producing isolates recovered between January 2000 and June 2006 (predominately from blood and normally sterile fluids) were retrieved for further study and screened using PCR primers specific for the presence of CTX-M, TEM, and SHV ESBLs. Only small numbers of retained ESBL-producing isolates were available for study in 2000 and 2002. The percentages of available ESBL-producing organisms in the following years were found to produce CTX-M enzymes: 2000, 25%; 2001, 10%; 2002, 0%; 2003, 60%; 2004, 69%; 2005, 89%; and 2006, 70%. The most common CTX-M-type ESBL was CTX-M-15, followed by CTX-M-16, CTX-M-8, and CTX-M-14. Comparing the disk diffusion zone diameters of cefotaxime and ceftazidime was helpful with the initial recognition of CTX-M-producing E. coli, which had an average cefotaxime zone diameter 7 mm smaller than the ceftazidime zone. However, comparing ceftazidime and cefotaxime zones for CTX-M-producing Klebsiella spp. was not helpful with initial recognition. CTX-M enzymes were also identified in Proteus mirabilis, Enterobacter spp., and Morganella morganii. Based on pulsed-field gel electrophoresis typing of the E. coli isolates, the CTX-M-producing isolates did not represent the spread of a single clone in the institution or in the community. In conclusion, CTX-M-type ESBLs are now the most common ESBL type isolated from patients in our health care system and may also be present but unrecognized in other U.S. locales.

Topics: Bacterial Infections; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Ceftazidime; Cluster Analysis; Enterobacteriaceae; Escherichia coli; Humans; Isoenzymes; Klebsiella; Klebsiella pneumoniae; Microbial Sensitivity Tests; Phylogeny; Polymerase Chain Reaction; Texas

The causative agents for spontaneous bacterial peritonitis (SBP) and antibiotic resistance rate vary according to the regions and time. This study evaluated the recent changes in the profiles of microorganisms and antibiotic resistance rate for the choice of effective antibiotics in treating SBP.. The clinical records of 1,018 episodes of SBP from November, 1994 to December, 2005, were analyzed retrospectively. The profiles of the causative agents for SBP and the rate of antibiotic resistance were compared in every 4-year-term.. The microorganisms were isolated in 394 out of 1018 episodes (38.7%). Gram negative and positive organisms constituted 71.6% and 21.3%, respectively. The five most commonly isolated organisms were E. coli (35.8%), K. pneumoniae (15.5%), viridans Streptococci (10.4%), S. pneumoniae (4.8%) and Aeromonas group (4.6%). The rate of E. coli resistant to cefotaxime (0%, 5.4%, 7.4%) and ciprofloxacin (4.3%, 21.6%, 28.4%) were increased in recent years. In the gram positive organisms, all isolates of viridans Streptococci and Pneumococci were sensitive to cefotaxime and ciprofloxacin. Recently, methicillin-resistant Staphylococcus aureus (MRSA) (28%) and vancomycin-resistant Enterococci (VRE) (31%) have been isolated. In each period, the overall antibiotic resistance rates to cefotaxime were 12.5%, 14.0%, 14.8%, to ciprofloxacin were 3.1%, 16.7%, 18.0%, and to imipenem were 4.7%, 7.0%, 4.2%.. Cefotaxime may still be the choice of primary empirical antibiotics for the treatment of SBP in Korea because the rate of resistance is acceptable. However, it is important to be aware of the recent increase in ciprofloxacin-resistant E. coli, extended spectrum beta-lactamase (ESBL)-producing gram negative bacilli, MRSA and VRE.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Drug Resistance, Bacterial; Female; Gram-Negative Bacteria; Humans; Male; Methicillin Resistance; Middle Aged; Peritonitis; Retrospective Studies; Severity of Illness Index; Time Factors; Vancomycin Resistance

Neonatal osteoarticular infections remain rare, with an estimated incidence of 1 to 3 cases per 1000 admissions to Neonatal Intensive Care Units. It usually results from bacteraemia and may thus be induced by IV catheters. More rarely it is due to direct inoculation secondary to cutaneous damage, or extension of soft tissue infection. The particularity of bone vascularization in the newborn explains the frequency of abscess formation in the periosteum or in soft tissues. The main pathogen involved is S. aureus (3/4 of cases), followed by group B streptococci and enterobacteriacae. Infection consists mainly of localised and slowly progressing abscesses. However, multifocal and severe infection is possible, in particular when caused by an IV catheter. Ultrasonography is the best initial investigation, possibly leading to surgical care. Medical treatment must include 2 synergistic antistaphyloccocal antibiotics, possibly associated with cefotaxime. The outcome is generally favorable, but orthopaedic consequences may emerge if the growth plate is involved. Rare specific causes, such as syphilis or tuberculosis, should also be evoked, but the clinical context is generally helpful for the diagnosis.

Topics: Age Factors; Anti-Bacterial Agents; Bacterial Infections; Catheterization; Cefotaxime; Cross Infection; Drug Therapy, Combination; Enterobacteriaceae; Escherichia coli Infections; Humans; Incidence; Infant, Newborn; Intensive Care Units, Neonatal; Osteoarthritis; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

Topics: Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Gentamicins; Humans; Infant Mortality; Infant, Newborn; Risk Factors

Spontaneous bacterial peritonitis (SBP) is an ascitic fluid infection as a complication of end stage liver disease. The outcome is related to the severity of hepatorenal function, gastrointestinal bleeding, and many others; however it is not well known whether the infection acquisition sites have an effect on the prognosis of SBP. In order to identify the prognostic significance of the acquisition sites, we studied 106 patients who were diagnosed as culture positive SBP between October 1998 and August 2003. Thirty-two episodes were nosocomial and 74 were community acquired. Gram-negative bacilli such as Escherichia coli were dominant in both of the nosocomial and community-acquired SBPs. Despite significantly higher resistance to cefotaxime in nosocomial isolates compared to community-acquired isolates (77.8% vs. 13.6%, p=0.001), no difference was found regarding short or long term prognosis. Infection acquisition sites were not related to short or long term prognosis either. Shock, gastrointestinal bleeding and renal dysfunction were related to short term prognosis. Only Child-Pugh class C was identified as an independent prognostic factor of long-term survival.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ciprofloxacin; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Escherichia coli; Female; Gastrointestinal Hemorrhage; Humans; Kidney Diseases; Klebsiella pneumoniae; Male; Middle Aged; Multivariate Analysis; Peritonitis; Prognosis; Shock; Survival Rate; Time Factors

Topics: Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Cefotaxime; Humans; Leukocyte Count; Male; Middle Aged; Neutrophils; Peritonitis

Nitric oxide (NO) is a molecule involved in vascular dilatation and pathogen suppression. It also has immunologic and regulatory functions. Liver cirrhosis is characterized by an increased risk for bacterial infections, including spontaneous bacterial peritonitis (SBP). The role of NO in SBP which develops in cirrhosis has not been clearly established. The aim of this study was to investigate the role of NO in the pathogenesis of SBP and its clinical usefulness for prediction of disease prognosis.. This study was designed to investigate the changes of ascites NO in the course of treatment. Nitric oxide metabolite (nitrites+nitrates [NOx]) was measured by chemiluminescence in 84 ascites samples obtained from 84 cirrhotic patients. Among them, the 38 patients with SBP were treated with cefotaxime 2.0 g, q 12hr for 7 days. In 24 of SBP patients, ascites was obtained consecutively before treatment (day 0), during treatment (day 2), and after treatment (day 7).. Ascites NO levels in the patients with SBP (n=38; 82.3 +/- 14.4 microM) were not different from those in patients with sterile ascites (n=46; 54.6 +/- 13.0 microM). There was no significant change of NO levels in sequential ascites samples during antibiotic treatment. Ascites NO level before treatment was significantly higher in SBP patients who responded to antibiotics (n=26; 101.86 microM/L) than that in SBP patients who did not respond to antibiotics (n=12; 40.03 microM/L, P=0.044). A significant direct correlation was found between ascites and serum NO levels before treatment (Pearson correlation, r2=0.86, P=0.001). Among the SBP patients, treatment response rate to antibiotics were significantly higher in those patients with pretreatment NO level > or = 80 microM/L in multivariate analysis.. Ascites NO level was not different between ascites from SBP patients and ascites from cirrhotic patients with sterile ascites. There were no changes of ascites NO in SBP patients during treatment. Therefore ascites NO was not useful to predict the progress of SBP. Ascites NO levels reflect serum NO levels, and the patients with higher NO level may have better response to antibiotics.

Topics: Adult; Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Cefotaxime; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Nitric Oxide; Peritonitis; Prognosis

To achieve sustained improvement in use of cefotaxime and ceftriaxone (CEFX) in a major teaching hospital, as measured against national antibiotic guidelines.. Pre- and post-intervention survey of CEFX use in the Royal Melbourne Hospital, a tertiary hospital in Melbourne, Victoria.. Web-based antimicrobial approval system linked to national antibiotic guidelines was developed by a multidisciplinary team and implemented in March 2001.. Change in rate of CEFX use (defined daily doses [DDDs] per 1000 acute occupied bed days) over 8 months pre- and 15 months post-intervention; concordance of indication for CEFX with national antibiotic guidelines pre- and post-intervention.. CEFX use decreased from a mean of 38.3 DDDs/1000 bed days pre-intervention to 15.9, 18.7 and 21.2 DDDs/1000 bed days at 1, 4 and 15 months post-intervention. Concordance with national antibiotic guidelines rose from 25% of courses pre-intervention to 51% within 5 months post-intervention (P < 0.002). Gentamicin use also increased, from a mean of 30.0 to 48.3 DDDs/1000 bed days (P = 0.0001).. The web-based antimicrobial approval system achieved a sustained reduction in CEFX use over 15 months as well as increased prescribing concordance with antibiotic guidelines. It has potential for linking to electronic prescribing and for wider use for other drugs, as well as for research into the epidemiology of antibiotic use.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Therapy, Computer-Assisted; Drug Utilization Review; Formularies, Hospital as Topic; Guideline Adherence; Hospitals, Teaching; Humans; Internet; Practice Guidelines as Topic; Program Evaluation; Software Design

Intrapartum antibiotic prophylaxis against group B Streptococcus (GBS) has reduced the occurrence of serious bacterial infections (SBI) in young infants caused by GBS. Recommendations for initial antibiotic therapy for the febrile infant 1 to 90 days old were developed when infections with GBS were common and antibiotic resistance was rare.. To document the pathogens responsible for SBI in recent years in febrile infants 1 to 90 days old and the antibiotic susceptibility of these organisms.. The results of bacterial cultures from infants 1 to 90 days old evaluated for fever at Primary Children's Medical Center in Salt Lake City, Utah, between July 1999 and April 2002 were analyzed. Antibiotic susceptibility profiles were collected and patient records were reviewed to determine if initial antibiotic therapy was changed following the identification of the organism.. Of 1298 febrile infants enrolled from the Primary Children's Medical Center emergency department, 105 (8%) had SBI. The mean age of the infants with SBI was 39 days (range 2-82 days) and 2 (2%) were <7 days. SBI included urinary tract infection (UTI; 67%), bacteremia (16%), bacteremia and UTI (6%), bacteremia and meningitis (5%), meningitis (2%), abscess (2%), meningitis and UTI (1%), and meningitis and gastroenteritis (1%). Eighty-three (79%) of 105 episodes of SBI were caused by Gram-negative bacteria, including 92% of UTI, 54% of bacteremia, and 44% of meningitis cases. The most common pathogen was Escherichia coli (61%). Other Gram-negative pathogens were responsible for 19% of SBI. Staphylococcus aureus was the most common Gram-positive pathogen, causing 8% of SBI. GBS accounted for 6% of SBI. Of the 105 pathogens, 56 (53%) were resistant to ampicillin. Of the pathogens causing meningitis, UTI, and bacteremia, 78%, 53%, and 50%, respectively, were resistant to ampicillin. Antibiotic therapy was changed in 54% of cases of SBI following identification of the organism.. In Utah, ampicillin-resistant Gram-negative bacteria are the most common cause of SBI in febrile infants <90 days old. This finding impacts antibiotic selection, especially in cases of meningitis. Local surveillance of pathogens and antibiotic susceptibility patterns is critical to determine appropriate antibiotic therapy.

Topics: Ampicillin Resistance; Bacteremia; Bacterial Infections; Cefotaxime; Drug Resistance, Bacterial; Fever; Gastroenteritis; Gentamicins; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Health Planning Guidelines; Health Status; Humans; Infant; Infant, Newborn; Meningitis; Microbial Sensitivity Tests; Urinary Tract Infections

Two protocols are used by French neonatologists for the treatment of suspected maternofetal infection (SMFI). Three groups of premature and term neonates were included to study the impact of antibiotics on fecal flora: 10 infants with SMFI treated with amoxicillin and netilmicin (group BI), 10 infants with SMFI treated with amoxicillin, cefotoxime and netilmicin (group TRI) and 10 infants without antibiotic therapy as controls (group C). Group BI samples were colonized with Klebsiella oxytoca and Escherichia coli resistant to amoxicillin and by Eneterococcus faecium and coagulase-negative staphylococci. In group TRI biodiversity of the intestinal flora was low, with rapid growth of staphyloccoci and occurrence of Candida spp. These modifications of the intestinal flora should encourage us to use antibiotic treatment as targeted as possible.

Topics: Amoxicillin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Colony Count, Microbial; Drug Resistance, Bacterial; Enterococcus faecium; Escherichia coli; Feces; Humans; Infant, Newborn; Infant, Premature; Infectious Disease Transmission, Vertical; Klebsiella oxytoca; Netilmicin; Staphylococcus

Topics: Actinomyces; Adult; Anti-Bacterial Agents; Bacterial Infections; Brain Abscess; Capnocytophaga; Cefotaxime; Female; Heart Defects, Congenital; Humans; Metronidazole; Penicillin G; Penicillin V; Streptococcus

To determine patterns of use of ceftriaxone and cefotaxime (CEFX) in Victorian hospitals and to identify areas for improvement.. A concurrent, observational evaluation of CEFX use in patients commencing a course of these drugs between 8 and 14 September, 1999, in 51 Victorian hospitals.. Proportion of patients treated with CEFX; indications; duration of use; concordance with recommendations of national antibiotic guidelines (Therapeutic guidelines: antibiotic, 10th edition [AG10]).. 671 patients were treated with CEFX. The overall rate of use was 43 patients per 1000 inpatient separations. Treatment of respiratory tract infection accounted for 352 patients (52%) and surgical prophylaxis for 99 patients (15%). Treatment of skin/soft tissue, urinary tract and gastrointestinal tract infections accounted for about 7% of patients each. The median duration of CEFX courses was 3.0 days. The overall rate of concordance with indications recommended in AG10 was 27%. The rate of concordance for empirical treatment of respiratory tract infection was 24%. Of the 195 patients treated empirically with CEFX for community-acquired respiratory tract infection and assessed as non-concordant, 64% did not have radiological evidence of pneumonia, and a further 30% did not fulfill the criteria for severe pneumonia. All courses given for surgical prophylaxis were non-concordant.. CEFX is widely used in Victorian hospitals, mostly to treat lower respiratory tract infection and in surgical prophylaxis of infection. The rate of concordance with AG10 is low. Potential areas for intervention include empirical treatment of respiratory tract infection and use in surgical prophylaxis.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Cross Infection; Drug Utilization Review; Guideline Adherence; Hospitals; Hospitals, Teaching; Humans; Logistic Models; Practice Guidelines as Topic; Victoria

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Humans; Kidney Diseases; Peritonitis; Randomized Controlled Trials as Topic; Serum Albumin

Secondary infection of pancreatic necrotic tissue and peripancreatic fluid is a serious complication of acute pancreatitis resulting in significant morbidity and mortality. The aim of this study was to find out the spectrum of bacterial infections, and their antibiotic sensitivity pattern in patients with acute pancreatitis.. All consecutive patients with acute pancreatitis were studied prospectively. Detailed investigations were carried out to identify bacterial infections and their antibiotic sensitivities in patients with suspected infection. These investigations included cultures of various body fluids, throat swabs, indwelling cannula and catheter tips. Pancreatic tissue was obtained by using needle aspiration or at surgery for Gram's stain, culture and sensitivity. All cultures were repeated until the presence of infection was confirmed or excluded.. A total of 169 patients with acute pancreatitis were studied during the period between January 1997 and June 2000 (mean age 41.3 years; 116 males and 53 females). Of the 169 patients, 63 had infections at various sites. A total of 80 cultures were positive, and 12 different bacterial isolates were cultured from samples taken from these 63 patients. Polymicrobial infection was seen in 32% of patients. Twenty-four patients had a confirmed pancreatic infection. Blood cultures had a growth of organisms in 19 patients, with evidence of ongoing or worsening pancreatitis, thus raising a strong suspicion of infected necrosis in them. The commonest organisms were Escherichia coli from 20 cultures and Pseudomonas aeruginosa from 18 cultures. The antibiotic sensitivity pattern showed that most bacteria were sensitive to third generation cephalosporins and quinolones; notably among them were cefotaxime, ceftazidime, and ciprofloxacin.. Bacterial infections were seen in 37% of patients with acute pancreatitis. The commonest organisms were Pseudomonas aeruginosa and Escherichia coli. Most bacterial isolates were sensitive to third generation cephalosporins and quinolones.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftazidime; Ciprofloxacin; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pancreatitis, Acute Necrotizing; Pseudomonas Infections

Orbital cellulitis is an uncommon complication resulting from a spectrum of disorders commonly found in pediatric practice. It usually occurs as a complication of infection of the paranasal sinuses, although it also can be caused by eyelid or dental juries, dental infection and external ocular infection. We studied the clinical, microbiological, and therapeutic features of 152 children diagnosed as periorbital cellulitis and 27 children with orbital cellulitis admitted to our hospital in a 16-year period from January 1983 to December 1998. Twenty-four percent of patients (43 cases) had positive cultures. Thirty children with septal or preseptal cellulitis developed neurological or ophthalmological complications. Intravenous or oral antibiotic administration was effective in 150 patients, but a significant proportion required surgery of the paranasal sinus or orbit (16%).

Topics: Algorithms; Bacterial Infections; Cefotaxime; Cellulitis; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Male; Orbital Diseases; Prospective Studies; Retrospective Studies

A full-term neonate with a history of umbilical venous catheterization followed by coagulase-negative staphylococcal sepsis is presented. The infant developed a solitary hepatic abscess with saprophytic organisms. Her liver abscess resulted in acute glomerulonephritis characterized by hypertension, proteinuria, oliguria, and azotemia. Surgical drainage and antibiotic treatment of the abscess was associated with resolution of the glomerulonephritis. Glomerulonephritis due to solitary liver abscess in a neonate has not been reported previously. Acute onset of glomerulonephritis should prompt a search for occult sources of infection.

Topics: Abscess; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Drainage; Drug Therapy, Combination; Female; Glomerulonephritis; Humans; Infant, Newborn; Liver Diseases; Magnetic Resonance Imaging; Micrococcus; Staphylococcal Infections; Vancomycin

Topics: Albumins; Bacterial Infections; Cefotaxime; Cephalosporins; Combined Modality Therapy; Humans; Infusions, Intravenous; Kidney Diseases; Liver Cirrhosis; Paracentesis; Peritonitis; Plasma Volume

Recent studies indicate clinical value of intra-venous to oral switch therapy. The aim of this study was to analyze our results i.v. Cefotaxime to oral Cefetamet Piroxil switch therapy in lower respiratory tract infections. Group consists 35 patients in whom 27 has bacterial pathogen definitely established. Cefotaxim (Tarcefoksym-Polfa) i.v. has been used for 3-4 days followed with oral Cefetamet Pivoxil (Tarcevis-Polfa). Patients has been treated for 7 days in hospital and then as an out-patients afterwards. Excelent result has been observed in 27 cases (77% of the study group). Mild symptoms of medication intolerance has been observed in 8 patients (23% of all patients). Results of our experience with third generation cefalosporin i.v. to oral switch therapy are satisfactory. This method reduced total cost of treatment, reduced in-hospital days and was very well accepted by patients.

Topics: Adult; Bacterial Infections; Cefotaxime; Cephalosporins; Community-Acquired Infections; Humans; Pneumonia, Bacterial

Topics: Albumins; Bacterial Infections; Cefotaxime; Central Venous Pressure; Cephalosporins; Fluid Therapy; Humans; Infusions, Intravenous; Kidney Diseases; Liver Cirrhosis; Paracentesis; Peritonitis

Third-generation cephalosporins in oral formulations have become an increasingly important first-line choice against common bacterial infections. Cefixime is one such agent, which possesses excellent efficacy against a broad spectrum of pathogens, including Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Clinical success rates are similar to cefaclor, clarithromycin, and other cephalosporins. Importantly, cefixime also possesses excellent activity against beta-lactamase-producing strains. The pharmacodynamic features of the drug include a half-life of 3-4 h and a Cmax of 4.4 microg/ml, well above the MIC90 for susceptible pathogens, permitting once-daily dosing. In this brief overview, the bacteriological and clinical efficacy of cefixime is discussed, as well as its indications.

Topics: Bacterial Infections; Cefixime; Cefotaxime; Cephalosporins; Chemistry, Pharmaceutical; Drug Administration Schedule; Humans

To investigate the prevalence of spontaneous ascitic infection (SAI) in different cirrhotic groups, the risk factors for development of SAI, and the efficacy of cefotaxime therapy.. A prospective study.. In-patient clinic of a university hospital.. Eighty cirrhotic patients with ascites were assigned to four groups: hepatitis B or D virus-related 34, alcoholic 18, hepatitis C virus-related 14, miscellaneous 14.. Paracentesis was performed on 80 patients during 92 consecutive hospitalizations. Ascitic fluid was cultured by the method of bedside inoculation of blood culture bottles with ascites. The patients with SAI were treated with cefotaxime (2 g, three times daily, intravenously) for 5 days.. Frequency of SAI in cirrhotic groups; clinical, bacteriological and biochemical findings of SAI; rate of recovery-from infection.. Twenty SAI episodes (22%) were found in 16 patients; 8 episodes were spontaneous bacterial peritonitis, 2 bacterascites, and 10 culture-negative neutrocytic ascites. SAI occurred more frequently in patients with hepatitis B or D virus-related liver cirrhosis (32%) than in the alcoholic (6%, P < 0.05), hepatitis C virus-related (14%) or miscellaneous (14%) cirrhotic groups in multivariate analysis, independent predictive factors associated with the development of SAI are chronic hepatitis B virus infection, ascitic fluid total protein and serum bilirubin. Escherichia coli was obtained in 5 of 10 positive ascitic fluid cultures. Cure of the infection was achieved in 95% of episodes. Hospitalization mortality rate in infected patients was 20%.. Spontaneous ascitic infection occurs in approximately 20% of cirrhotic patients hospitalized with ascites. The patients with low ascitic protein concentration, high serum bilirubin level or hepatitis B virus cirrhosis are more predisposed to SAI. Cefotaxime may be an effective first-choice antibiotic for ascitic fluid infection.

Topics: Adult; Ascitic Fluid; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporins; Female; Hospital Mortality; Humans; Infusions, Intravenous; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Prevalence; Prospective Studies; Recurrence; Risk Factors; Treatment Outcome; Turkey

In a prospective protocol 25 consecutive patients with diffuse peritonitis were treated in the Surgical Clinic of the RWT-University in Aachen, Germany, from January to December 1995. According to the "Mannheim Peritonitis Score" three different stages were treated with different surgical procedures and a selective antibiotic regimen. Group-A patients with prognostically favorable peritonitis (MPS 0-20) were treated with the so-called standard procedure, group-B patients (MPS: 21-29) with closed postoperative lavage. The antibiotic regimen was cefotaxime (2 x 2 g) and metronidazole (2 x 500 mg) for both group-A and group-B patients. Severe group-C cases (MPS > 29) were treated with the so-called Etappenlavage (multiple reexplorations and intra-operative lavage) and received a combination of three antibiotics (2 x 2 g cefotaxime; 2 x 500 mg metronidazole and 2 x 200 mg ofloxacin).. Eight patients belonged to group A, 10 to group B, and 7 to group C. The mortality was 0% (group A), 20% (group B), and 29% (group C), respectively. The actual overall mortality of the whole group was 16% (4/25). The statistically expected mortality was 36%, according to the APACHE-II-Score (P = 0.0982).

Topics: Anti-Infective Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Combined Modality Therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Humans; Metronidazole; Ofloxacin; Peritoneal Lavage; Peritonitis; Prognosis; Prospective Studies; Surgical Wound Infection; Survival Analysis

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Erythromycin; Gram-Negative Bacteria; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Neutropenia; Penicillins; Pneumonia, Mycoplasma; Pneumonia, Staphylococcal; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Drug Administration Schedule; Humans; Peritonitis

The study presented updates the spectrum of causative organisms in peritonsillar abscesses. Antibiotic treatment and surgery play important roles in this potentially life-threatening disease. A regular screening of the bacterial spectrum present and resistance remains important for optimizing a therapeutic regimen. Swabs of 122 peritonsillar abscesses were taken and investigated for the presence of causative organisms (bacteria and fungi) and potential antibiotic resistances. It was found that group A beta-hemolytic streptococci and Bacteroides spp. were the predominant isolates. It was also found that amoxicillin plus clavulinic acid or, alternatively, a third-generation cephalosporin (e.g., cefotaxime) represented the treatment of first choice to prevent antibiotic resistance.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Infant; Male; Middle Aged; Peritonsillar Abscess

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

Topics: Animals; Bacteria; Bacterial Infections; Cefotaxime; Drug Resistance, Microbial; Humans; Macrophages; Phagocytosis

Switch therapy, the switch from a parenteral to an oral antimicrobial agent, has been used successfully in the treatment of many serious infections. Several studies have found that significant cost savings can be achieved by switch therapy. Moreover, it has the further advantages of shortening hospital stay and reducing nosocomial bacteremia. With the exception of Staphylococcus aureus and penicillin-resistant Streptococcus pneumoniae, cefixime has similar in vitro activity to cefotaxime and ceftriaxone. It has a prolonged half-life, allowing for once-a-day dosing, and has excellent tissue penetration (132%). These characteristics support the use of cefixime for switch therapy when a susceptible pathogen has been identified.

Topics: Administration, Oral; Bacterial Infections; Cefixime; Cefotaxime; Cephalosporins; Humans; Injections; Patient Compliance

During 1991-1995 a Spain collaborative study group surveyed the resistance to cefotaxime both in community as well as in hospital isolates of bacteria. The isolates tested during the study period of 5 years were 813, 875, 3631, 3184, and 3050 strains, respectively. Antimicrobial activity of cefotaxime was assayed by broth or agar microdilution, in accordance with criteria of the National Committee of Clinical Laboratory Standards (NCCLS). Cefotaxime resistance included 2.5% of all isolates: 2.6% Enterobacteriaceae, 1.7% Streptococcus pneumoniae, 0.5% Haemophilus influenzae, 0.0% Haemophilus spp., and 0.0% Moraxella catarrhalis. The overall incidence of resistance to cefotaxime decreased fro member of Enterobacteriaceae from 3.6% in 1991 to 2.5% in 1995. The incidence of resistance varied with the species and was highest in Enterobacter and in Citrobacter freundii.

Topics: Bacterial Infections; Cefotaxime; Cephalosporin Resistance; Cephalosporins; Enterobacteriaceae; Humans; Respiratory Tract Infections; Spain

Through the introduction of a 7-mercapto-1,3-thiazole chain at position 3' of the dihydrothiazine ring, cefodizime, which is structurally similar to cefotaxime, has acquired a number of remarkable immunomodulatory properties while retaining a potent antimicrobial spectrum of activity. Cefodizime penetrates in fact readily through the bacterial cell wall and interacts with its molecular targets in such a way that at high concentrations cell death and lysis are rapidly induced. Its spectrum of action encompasses the Enterobacteria, Neisseriae, Haemophilus, Moraxella catarrhalis, methicillin-susceptible staphylococci and streptococci, with pneumococci included. Cefodizime is devoid of useful potency against Pseudomonas, Acinetobacter and enterococci. Given the wide occurrence of strains synthesizing beta-lactamases in several primary pathogens of community-acquired and nosocomial infections, the complete stability of cefodizime towards the most prevalent of these hydrolytic enzymes (TEM-1, TEM-2, SHV-1, BRO-1 and the staphylococcal penicillinases) seems reassuring. Only a few chromosomally-coded and extended spectrum beta-lactamases produced by gram-negative microorganisms inactivate the new cephalosporin. Since the distribution of pathogens carrying these enzymes depends on the local trends of antibacterial consumption and cannot be easily predicted, a large multicenter study in Italy has recently assessed the antibacterial potency of cefodizime, in comparison with suitable drugs, on 1985 selected nosocomial strains. In this survey cefodizime was more effective in vitro than amoxicillin-clavulanate, gentamicin and piperacillin while being substantially similar in the rates of eradication of gram-negative and gram-positive organisms to other third generation cephalosporins like ceftazidime and ceftriaxone.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adjuvants, Immunologic; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Humans; Multicenter Studies as Topic

Topics: Animals; Bacteria; Bacterial Infections; Cefotaxime; Humans; Infant, Newborn; Intestines; Meningitis, Bacterial; Microbial Sensitivity Tests; Rabbits

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Bacterial Infections; Cefixime; Cefotaxime; Cefuroxime; Clarithromycin; Fluoroquinolones; Humans; Pneumonia

Effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) against severe infections in cyclophosphamide (CY)-induced neutropenic mice were investigated by its single use or by its combination with cephem antibiotics. Treatment with rhG-CSF increased the number of peripheral blood leucocytes and strikingly shortened the duration of the neutropenic state. Most of the regained population in the peripheral blood leucocytes were neutrophils. Functions of neutrophils, such as phagocytic activity, superoxide release, and expression of Mac-1 molecules, were remarkably enhanced by administration of rhG-CSF. When rhG-CSF was administered to CY-induced neutropenic mice before infection, protective effects against various kinds of bacteria were remarkable. On the other hand, such remarkable effects were not observed when rhG-CSF was administered after infections. However, even in the case of post-infectious treatment, a combination therapy of rhG-CSF with cephem antibiotics, particularly with Cefodizime (CDZM), showed a significant improvement in the survival rate and a decrease in the number of viable bacteria in the liver. These results suggest that a combination therapy of rhG-CSF with cephem antibiotics, especially with CDZM, is an efficient regime against severe infections in patients with neutropenia induced by a heavy anti-tumour chemotherapy.

Topics: Animals; Bacterial Infections; Cefotaxime; Cyclophosphamide; Female; Granulocyte Colony-Stimulating Factor; Leukocyte Count; Macrophage-1 Antigen; Mice; Mice, Inbred ICR; Neutropenia; Neutrophils; Phagocytosis; Recombinant Proteins; Respiratory Burst

One hundred and four effusions from 66 children with CSOM were cultured for aerobic and anaerobic bacteria. Fifty percent of all effusions yielded bacterial growth and Gram negative organisms constituted 69.2% of those isolates. H. influenza was the most commonly isolated organism (36.5%) followed by B. catarrhalis and Str. pneumoniae. All B. catarrhalis, Staph. aureus and pseudomonas isolates were resistant to ampicillin while cefotaxime was active against all the isolated Gram positive and Gram negative bacteria. Considering B-lactamase production, all the isolated Staph. aureus were BLPs while in case of Gram negative bacteria, not all the ampicillin resistant strains were BLPs.

Topics: Ampicillin Resistance; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Developing Countries; Egypt; Female; Humans; Infant; Male; Otitis Media with Effusion

Due to changes of humoral immunity, patients with rheumatic heart disease present, even before the operation, a high-risk group with regard to the development of infectious complications. Contamination of intraoperative material was revealed in 61.7% of cases during the operation. Extracorporeal circulation increases the cefotaxime half-life period which is in direct proportional dependence of the period of time between the beginning of the administration of the agent and the beginning of extracorporeal circulation. Immunocorrection by means of myelopid in the early postoperative period accelerates restoration of cellular and humoral immunity, and reduces the frequency of pneumonia occurrence and suppuration of the postoperative wound. Therefore, the prevention of infectious complications after operations on an open heart should be complex and should include broad-spectrum antibiotics and immunocorrective therapy.

Topics: Activins; Adjuvants, Immunologic; Adolescent; Adult; B-Lymphocytes; Bacterial Infections; Cefotaxime; Extracorporeal Circulation; Heart Valve Diseases; Humans; Intraoperative Complications; Middle Aged; Oligopeptides; Peptides; Pneumonia; Postoperative Care; Rheumatic Heart Disease; Risk Factors; Surgical Wound Infection; T-Lymphocytes

We evaluated clinical effects and toxicities of a combination in treatment with cefodizime (CDZM) and minocycline (MINO) for infections complicated with hematological disorders in 67 patients. Fifty-nine patients were evaluable, including 32 with acute leukemia, 15 with malignant lymphoma, and 12 with other hematological disorders. Clinical efficacies were excellent in 17 cases, good in 24 cases, fair in 2 cases, and poor in 16 cases. The efficacy rate was 69.5% (41 cases/59 cases). This treatment was also effective in 8 of 12 cases in which granulocyte counts were less than 500/microliter through the course of administration. No subjective side effects were observed. Abnormal values in laboratory tests were noted in 5 cases. Mild elevations of GOT, GPT, Al-P and bilirubin were observed, but none was serious. Thus, the combination of CDZM and MINO is an effective and safe regimen for the treatment of infections in patients complicated with hematological disorders.

Topics: Adult; Aged; Aged, 80 and over; Alanine Transaminase; Aspartate Aminotransferases; Bacterial Infections; Cefotaxime; Drug Evaluation; Drug Therapy, Combination; Female; Hematologic Diseases; Humans; Immunocompromised Host; Male; Middle Aged; Minocycline

Cefotaxime is the most commonly used antibiotic for initial therapy of spontaneous bacterial peritonitis in cirrhosis. However, since the introduction of cefotaxime no study has been performed to investigate factors influencing prognosis in cirrhotic patients with this type of infection. In this study, predictive factors for infection resolution and patient survival were investigated in 213 consecutive episodes of spontaneous bacterial peritonitis in 185 cirrhotic patients. All patients were initially treated with cefotaxime. One hundred sixty-five episodes (77%) resolved with cefotaxime alone, and two more episodes (1%), initially unresponsive to cefotaxime, were cured after modification of antibiotic therapy. In a multivariate analysis (stepwise logistic regression), only 4 of 51 clinical and laboratory variables obtained at the time of diagnosis of infection were identified as independent predictors of infection resolution: band neutrophils in white blood cell count, community-acquired vs. hospital-acquired peritonitis, blood urea nitrogen level and serum aspartate aminotransferase level. No patient experienced serious adverse effects related to cefotaxime. Eighty-two patients died during hospitalization (38% mortality rate in relation to the 213 episodes of peritonitis). In the multivariate analysis, six variables were independently correlated with survival: blood urea nitrogen level, serum aspartate aminotransferase level, community-acquired vs. hospital-acquired peritonitis, age, Child-Pugh score and ileus. No microbiological data had predictive value for infection resolution or survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Female; Humans; Liver Cirrhosis; Liver Failure; Male; Middle Aged; Peritonitis; Prognosis; Retrospective Studies; Survival Analysis; Treatment Outcome

In order to identify the predictive factors of hospital mortality in cirrhotics with spontaneous bacterial peritonitis (SBP), we studied 64 patients who fulfilled the accepted diagnostic criteria. All cases were treated with cefotaxime up to 2 days after the infection was considered cured (7.7 +/- 2.9 days). Eleven patients (17%) died while in hospital, six of them before SBP was cured. After uni- and multivariate analyses, only seven routine clinical, biological, and bacteriological variables studied were independently associated with hospital mortality. These were: the presence of upper gastrointestinal bleeding at admission (beta = 2.01), the absence of abdominal pain as presenting symptom (beta = -1.29), the polymorphonuclear count (%) in the ascites (beta = 0.48), prothrombin rate (beta = -0.22), and serum Na (beta = -0.64), creatinine (beta = 0.50), and cholesterol (beta = -0.68). When the equation obtained was computed in a randomly selected sample of the patients studied, it correctly predicted the outcome in 92.3% of the cases. We conclude that short-term outcome of SBP patients depends on the existence of recent gastrointestinal bleeding, the severity of SBP, and the degree of liver and renal failure. The prognostic value of this model needs prospective validation in a new series of patients.

Topics: Bacterial Infections; Cefotaxime; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hospital Mortality; Humans; Liver Cirrhosis; Male; Middle Aged; Multivariate Analysis; Peritonitis; Prognosis; Risk Factors; Time Factors

One hundred and seventy one neonates were treated with flomoxef (FMOX) and the clinical efficacy and safety were evaluated. The ages of the patients ranged from 0 to 28 days, and their body weights from 450 to 4300 g. Dose levels were 12.4 to 24.9 mg/kg every 8 or 12 hours for 1 to 10 days. Fifty two patients who responded to the FMOX treatment included 5 neonates with sepsis, 17 with suspected sepsis, 9 with urinary tract infections, 12 with pneumonia, 8 with intrauterine infections, and 1 with omphalitis. The other neonates could not be retrospectively diagnosed as bacterial infections. Of 52 patients, clinical results were excellent in 15, good in 34, fair in 1, and poor in 2. And the FMOX treatment was effective in 13 out of 14 patients in which causative bacteria were identified. The drug was well tolerated, but 6 neonates out of 33 over 5 days old had diarrhea. From these results, empiric treatment with FMOX against neonatal bacterial infection was as clinically useful as that of combination with ampicillin and gentamicin or cefotaxime and ampicillin in our neonatal intensive care unit. But, as this study did not include neonate with meningitis, efficacy to meningitis was not evaluated.

Topics: Ampicillin; Bacterial Infections; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Gentamicins; Humans; Infant, Newborn

The authors compared two groups of pregnant women with early loss of amniotic fluid. In the first group Claforan was administered, 3 x 1 g by the i.m. route, and in the second group Ampicillin, 3 x 1 g by the i.m. route. The data were recorded in a special protocol and were divided into three groups: 1. patient before delivery, 2. patient during puerperium, 3. neonate. From the results two conclusions were drawn: 1. The authors did not detect any reasons why antibiotics should not be administered prophylactically in case of premature loss of amniotic fluid. 2. The main differences between the compared groups were found in neonates where after administration of Claforan there was a substantially lower incidence of positive bacterial cultures than after Ampicillin and there was also a lower incidence of RDS II and adnatal infections.

Topics: Adult; Ampicillin; Bacterial Infections; Cefotaxime; Female; Fetal Diseases; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Pregnancy

One hundred thirty-eight patients with severe infections accompanying hematological diseases were treated with cefodizime (CDZM). CDZM was administered by intravenous injection at daily doses ranging from 2 g to 8 g for about 3 to 18 days. Clinical efficacies of CDZM were excellent in 30 cases, good in 37 cases, fair in 1 case and poor in 53 cases. The efficacy rate was 55.4%. The efficacy rate was 56.4% in patients from whom causative organisms were not identified. The efficacy rate against Gram-negative bacteria (66.7%) was higher than that against Gram-positive bacteria (28.6%). No significant differences in the efficacy rates were found among groups of patients with different initial neutrophil counts (less than 100, 100-499, and over 500/microliters). Skin eruption caused by CDZM was observed in 2 patients (1.5%). Hepatic disorders, renal dysfunction and urinary test abnormality (protein and urobilinogen) were observed in 7 (5.0%), 1 (0.7%) and 1 (0.7%), respectively. Therefore, CDZM was considered to be a clinically useful antibiotic for severe infections complicated with hematological diseases.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Hematologic Diseases; Humans; Infusions, Intravenous; Male; Middle Aged

This is a retrospective study of 35 patients with spontaneous bacterial peritonitis and liver cirrhosis identified between 1981 and 1989. The mean age of all patients was 44 years, with a range of 16 to 68. Criteria for spontaneous bacterial peritonitis included either a positive ascites culture with a polymorphonuclear cell concentration greater than 250 cells per mm3 (18 cases) or a negative ascitic fluid culture with a polymorphonuclear cell count greater than 500 cells per mm3 and no evident intra-abdominal source of infection (17 cases). Twenty-one patients were male and 14 female. The most frequent presenting symptoms were abdominal pain and fever, noted in 20 (57%) and 19 (54%) patients, respectively, while 5 patients (14%) were completely asymptomatic. The overall mortality in this series was 54% (19 of 35 patients). The presence of encephalopathy or renal insufficiency was associated with a high mortality rate (73% and 87%, respectively). Encephalopathy was present in 67% of the non-survivors, but in only 25% of the survivors (p < 0.0025); likewise, renal failure was observed in 68% of the non-survivors, but in only 12.5% of those who survived (p < 0.001). The use of newer-generation cephalosporins and penicillins led to a diminished mortality (42%) as compared with that (64%) observed in patients treated with conventional antibiotic regimens.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Mississippi; Peritonitis; Prognosis; Retrospective Studies

Cefixime is a new oral cephalosporin with in vitro activity similar to that of third-generation cephalosporins. Renal excretion accounts for only 40% of systemic clearance of cefixime, suggesting that biliary excretion of the drug may be significant. This study was designed to determine to what extent nonrenal clearance of cefixime is due to biliary excretion of the parent compound. In an isolated perfused rabbit liver model, biliary excretion of cefixime was very low, with only 0.28 +/- 0.15% of a single 10 mg dose injected in the system being recovered in the bile after three hours perfusion. The liver biotransformation rate for cefixime was found to be 16.2%. These results are in striking contrast with those obtained in human studies. Cefixime levels in duodenal juice aspirates collected over four hours following an intravenous injection of 200 mg cefixime in six healthy volunteers were at least fivefold concomitant serum levels. Studies of bile collected by external biliary drainage during 24 hours following an oral dose of 200 mg cefixime in ten cholecystectomized patients showed that the Cmax was 56.9 +/- 70 mg/l, i.e., 25-fold the serum Cmax (2.3 +/- 0.85 mg/l). The bile AUC/serum AUC ratio was 20.4 +/- 20.3. Mean bile level of cefixime was still as high as 4.3 +/- 3.7 mg/l 20 hours after dosing. The amount of cefixime excreted in the bile over 24 hours was 10.0 +/- 12.3 mg i.e., 5% of the dose administered. Twenty-four hour renal excretion of cefixime was 53.3 +/- 26.2 mg.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adult; Animals; Anti-Infective Agents, Urinary; Bacterial Infections; Bile; Biliary Tract Diseases; Cefixime; Cefotaxime; Cholecystectomy; Duodenum; Humans; In Vitro Techniques; Injections, Intravenous; Liver; Middle Aged; Postoperative Care; Rabbits; Reference Values

In a clinical trial conducted in Japan from 1985-1988, the efficacy of cefodizime was studied in 2,227 adult and 449 pediatric patients. Of these, 1,366 adult and 203 pediatric patients had pathogens isolated and were evaluable. Cefodizime was effective in 78.8% of the adult patients, and adverse reactions occurred in 2.3%. In pediatric patients cefodizime was effective in 91.1% of the cases, and adverse reactions developed in 5.1%. A very high concentration of cefodizime is achieved in blood soon after administration and its penetration into tissues is also high. Moreover, cefodizime exhibits phagocytosis enhancement activity. The above-mentioned excellent efficacy rates, low rates of side effects and enhancement of phagocytic activity make cefodizime an antibiotic of choice in adult and pediatric patients.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Child; Humans; Middle Aged

The influence of cefodizime (CDZ) on spontaneous cell-mediated cytotoxicity (SCMC) and antibody-dependent cell-mediated cytotoxicity (ADCC) was investigated in nine patients with conditions predisposing to infection (T-cell deficiency, humoral immune deficiency, myeloproliferative syndrome, kidney or liver damage, or chronic pulmonary disease). SCMC, using the K562 and LIK cell lines as targets, and ADCC, using the LIK cell line, were measured at baseline and after ten days of therapy with CDZ for lower respiratory tract infections. Six patients were cured; clinical outcome was not evaluable in the other three. SCMC lysis of K562 cells did not change significantly. SCMC and ADCC lysis of LIK (lymphoblastoid) cells both increased significantly. CDZ selectively stimulated a subpopulation of NK cells in this population of immunocompromised patients with lower respiratory tract infections.

Topics: Adult; Aged; Antibody-Dependent Cell Cytotoxicity; Bacterial Infections; Cefotaxime; Cytotoxicity, Immunologic; Female; Humans; Immunologic Factors; Male; Middle Aged

Topics: Ampicillin; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Humans; Peritonitis

Cefotaxime has been used to treat serious bacterial infections in children since 1982. With the predominant use of cephalosporins in pediatrics, reports of adverse effects of certain compounds have increased. A retrospective review is presented of 2,243 cases of children receiving therapy with cefotaxime in order to evaluate the safety profile and efficacy of cefotaxime in the treatment of serious infections in hospitalized children. Overall, 57 (2.5%) children experienced adverse reactions. These included local reactions in 6 (0.3%), rash in 28 (1.2%), diarrhea in 15 (0.97%), vomiting in 10 (0.7%), abdominal pain in 1 (0.1%), headache in 3 (0.4%), and drug fever in 1 (0.1%). No cases of hemolytic anemia, bleeding, or hyperbilirubinemia were found. Efficacy of treatment for different disease categories ranged from 90.5% to 100%. The percentage of children in any treatment group with a particular laboratory abnormality following initiation of cefotaxime therapy ranged from 0% to 2.6%, and rates of superinfection with bacteria or Candida were 0.4% to 1.7%. Cefotaxime has the distinct advantage of high rates of efficacy and low rates of complications and superinfection among children hospitalized for serious infections.

Topics: Adolescent; Arthritis, Infectious; Bacteremia; Bacterial Infections; Cefotaxime; Cellulitis; Child; Child, Preschool; Female; Humans; Infant; Male; Meningitis, Bacterial; Osteomyelitis; Pneumonia; Retrospective Studies; Treatment Outcome

When cephalosporins exert their biological activity by reacting with bacterial enzymes, opening of the beta-lactam ring can lead to expulsion of the 3'-substituent. A series of cephalosporins was prepared in which antibacterial quinolones were linked to the 3'-position through a quaternary nitrogen. Like the 3'-ester-linked dual-action cephalosporins reported earlier, these compounds demonstrated a broad spectrum of antibacterial activity derived from cephalosporin-like and quinolone-like components, suggesting a dual mode of action.

Topics: Animals; Bacterial Infections; Cephalosporins; Chemical Phenomena; Chemistry; Mice; Microbial Sensitivity Tests; Quinolones; Structure-Activity Relationship

Forty-one episodes of ascitic fluid infection were treated with cefotaxime 2 g intravenously every 8 hr, and ascitic fluid and serum were sampled 6, 12, 24, 48, and 96 hr after the first dose of antibiotic. Concentrations of cefotaxime and desacetyl cefotaxime were measured in ascitic fluid and serum by high-performance liquid chromatography. There was essentially 100% penetration of cefotaxime and metabolite from serum into ascitic fluid at all time points. Ascitic fluid was sterilized in 94% of episodes after the first dose of antibiotic. The ascitic fluid concentration of cefotaxime 6 hr after the first dose of antibiotic was greater than 20 times the minimal inhibitory concentration of the drug for 90% of the isolated flora. This rapid ascitic fluid penetration of cefotaxime in high concentration explains the rapid sterilization of ascitic fluid by the drug in the setting of bacterial peritonitis and obviates the need to give a loading dose or intraperitoneal injection.

Topics: Adult; Ascitic Fluid; Bacterial Infections; Cefotaxime; Chromatography, High Pressure Liquid; Female; Humans; Male; Middle Aged; Peritonitis

In intensive care units, treatment is primarily directed at the suspected pathogen. However, the risk of interaction with other concomitantly administered drugs, the possible accumulation when renal and, in particular, hepatic function are impaired, and the possible development of resistance play major roles when selecting a therapeutic regimen. Studies of interactions between the different antimicrobial substances and, in particular, interactions between the antibiotics and other drugs are urgently called for in the future.

Topics: Anti-Infective Agents; Bacterial Infections; Cefotaxime; Colony Count, Microbial; Drug Interactions; Drug Resistance, Microbial; Humans; Intensive Care Units; Patients' Rooms; Time Factors

In acute life-threatening surgical infections requiring immediate institution of antimicrobial therapy before bacteriological results are available, antibiotic treatment must be empiric. For best efficacy a more sophisticated form of empiric therapy is offered, termed calculated antibiotic therapy (CAT). Calculated antibiotic therapy requires consideration of a) typical bacterial spectrum; b) bacterial pathogenicity and synergism; c) antibacterial concentrations at the site of infection; d) toxicity and adverse effects; e) interaction with immune response; and f) results of properly conducted trials. Intraabdominal infections are used as an example here to assess the efficacy of clinically used cephalosporins and penicillins for determination of calculated antibiotic therapy. CAT identifies Escherichia coli and Bacteroides fragilis as the most important pathogens for intraabdominal infections and determines the most effective antibiotics at the tissue breakpoint, which is defined as the minimal concentration maintained for more than 90% of the dosage interval period at the infected tissues. At the tissue breakpoint calculated antibiotic therapy identifies cefotaxime-generation cephalosporins to be fully (100%) active against the most important aerobic pathogen E. coli and metronidazole as fully active against the important obligate anaerobe B. fragilis. Calculated antibiotic therapy becomes relatively important, since impeccably controlled clinical therapeutic trials as a foundation for therapy are rarely published.

Topics: Abdomen; Anti-Bacterial Agents; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefotaxime; Escherichia coli Infections; Humans; Metronidazole; Premedication; Surgical Wound Infection; Time Factors

Bacteriological and clinical studies on cefodizime (CDZM, THR-221), a new cephem developed by Hoechst AG and Roussel Uclaf, were carried out and the results are summarized below: 1. Against Gram-positive bacteria, Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae, antibacterial activities of CDZM were similar to those of cefotaxime (CTX), cefazolin, cefotiam and piperacillin. Against Escherichia coli, Klebsiella pneumoniae and Serratia sp., antibacterial activities of CDZM were similar to that of CTX, and superior to those of other tested antibiotics. Especially against Haemophilus influenzae and Branhamella catarrhalis, it showed an excellent antibacterial activity. 2. Although the clinical efficacy was poor in 1 patient with sepsis caused by Salmonella marcescens and in another with cervical lymphadenitis, in 5 patients with upper respiratory tract infection, 4 patients with bronchitis, 6 patients with bronchopneumonia, 18 patients with pneumonia, 5 patients with urinary tract infection and 1 patient with enteritis, the clinical efficacy was excellent or good and the efficacy rate was 95.1% (39/41) including excellent efficacies in 25 cases. 3. Bacteriologically, all identified causative bacteria were eradicated except for 1 case of Salmonella sp., thus the eradication rate was 97.4% (38/39). Especially S. pneumoniae in 10 cases, H. influenzae in 12 cases and B. catarrhalis in 3 cases were eradicated totally. 4. Adverse reactions were studied in 46 cases, and digestive symptoms were observed in 9 cases (diarrhea 5 cases, loose stools 4 cases). Eruption and vascular pain were observed in 1 case each. As digestive symptoms in 9 cases were mild, the treatment were not suspended. In laboratory test values, elevation of GOT, elevation of GPT, elevation of bilirubin, and eosinophilia were observed in 1 case each. Influences on blood coagulation parameters were studied. No change was observed between the beginning and the end of the treatment. From above results, we have concluded that CDZM is a useful and safe antibiotic in pediatrics, administered at a daily dose of 20 mg/kg divided into 3 or 4 doses and administered intravenously.

Topics: Adolescent; Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Male; Respiratory Tract Infections

Effects of cefodizime (CDZM), a new injectable cephem antibiotic, on the intestinal bacterial flora were studied in tetra-contaminated mice and in pediatric patients. CDZM was intramuscularly administered at a dose of 100 mg/kg once a day for 5 consecutive days to mice contaminated with 4 different species of organisms: Escherichia coli, Enterococcus faecalis, Bacteroides fragilis and Bifidobacterium breve. For 3 species except E. faecalis, bacterial populations in feces were markedly reduced after the start of the treatment. Subjects in the pediatric study were 5 children with bacterial infections (4 boys and 1 girl) at ages from 7 months to 9 years 6 months and with their body weights ranging from 7.6 kg to 51.1 kg. CDZM was intravenously administered at a dose of 9.7 mg/kg to 23.0 mg/kg 4 times a day for 5 to 15 days. Although some variations in the fecal bacterial flora were noticed among these subjects during the treatment, populations of main aerobes and anaerobes such as Enterobacteriaceae, Enterococcus, Bacteroides, Bifidobacterium and Eubacterium decreased markedly in most cases. Glucose non-fermenting Gram-negative rods and fungi tended to increase during or after the administration of CDZM, and they were the most predominant species in some cases. Although these changes tended to return to predosing states after the cessation of the treatment with CDZM, attention must be paid to possible occurrences of diarrhea, superinfection or bleeding tendency when treatment with the drug is continued for long periods of time. Fecal concentrations of CDZM considered to be closely related to the changes of the intestinal bacterial flora showed pretty high values in all cases.

Topics: Animals; Bacteria; Bacterial Infections; beta-Lactamases; Cefotaxime; Child; Child, Preschool; Feces; Female; Humans; Infant; Intestines; Male; Mice

Topics: Bacterial Infections; Cefotaxime; Gram-Negative Bacteria; Humans; Infant, Newborn; Meningitis; Prognosis

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Female; Fosfomycin; Humans; Male; Middle Aged; Moxalactam; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Albuterol; Asthma; Bacterial Infections; Breast Diseases; Carboprost; Cefixime; Cefotaxime; Fatty Acids, Essential; Female; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Pain; Plant Oils; Postpartum Hemorrhage; Pregnancy; Salmeterol Xinafoate

Using a broth microtiter dilution method, minimum inhibitory (MIC) and minimum bactericidal concentrations (MBC) were determined for the aminothiazolyl cephalosporins cefpirome and cefotaxime against 436 blood culture isolates. At concentrations of less than or equal to 16 mg/l, cefpirome inhibited 82.3% of the isolates and cefotaxime 66.5%. At the same concentrations, cefpirome killed 60.0% of the isolates and cefotaxime 46.7%. Whereas the MIC values indicated a far better activity of cefpirome than cefotaxime against oxacillin-resistant Staphylococcus aureus, Enterococci and Pseudomonas aeruginosa, the MBC values showed a poor activity of both drugs against these strains. By comparison, cefpirome was the more active agent, covering a similar spectrum to that of cefotaxime with a slight additional activity against oxacillin-susceptible S. aureus and Staphylococcus epidermidis.

Topics: Bacterial Infections; Bacteriological Techniques; Cefotaxime; Cefpirome; Cephalosporins; Culture Media; Enterobacter; Escherichia coli; Klebsiella; Pseudomonas aeruginosa; Staphylococcus aureus

The dual-action antibacterial R 23-9424 (desacetylcefotaxime linked to the quinolone fleroxacin) is a new antibacterial agent with excellent in vitro activity. It was evaluated for in vivo efficacy in comparison with the cephalosporin cefotaxime and the quinolone component, fleroxacin. Ro 23-9424 demonstrated significant activity against all strains tested in systemic infections, including those strains resistant in vivo to cefotaxime (Staphylococcus aureus 753, Serratia marcescens SM and Pseudomonas aeruginosa 8780) and fleroxacin (Streptococcus pneumoniae 6301 and Streptococcus pyogenes. In prophylactic studies, Ro 23-9424 compared favorably with fleroxacin against Escherichia coli and with cefotaxime against S. pyogenes, but Ro 23-9424 was considerably more active than cefotaxime against E. coli and more active than fleroxacin against S. pyogenes. In a murine pneumonia model, Ro 23-9424 was equivalent in activity to cefotaxime against S. pneumoniae and more active than cefotaxime against Klebsiella pneumoniae. Fleroxacin was inactive against S. pneumoniae and about 20-fold more active than Ro 23-9424 against K. pneumoniae. In a murine meningitis infection caused by S. pneumoniae, Ro 23-9424 was 3 times as active as cefotaxime, while fleroxacin was inactive. When meningitis was induced by K. pneumoniae, Ro 23-9424 was as active as the quinolone, while cefotaxime was inactive. In a neutropenic (immunocompromised) model, Ro 23-9424 was more active than cefotaxime against P. aeruginosa and 5-fold less active than fleroxacin. In the control normal (immunocompetent) mouse infection, Ro 23-9424 was 3-fold more active than cefotaxime, but 10-fold less active than fleroxacin.

Topics: Animals; Anti-Infective Agents; Bacterial Infections; Cefotaxime; Ciprofloxacin; Drug Evaluation, Preclinical; Enterobacteriaceae; Fleroxacin; Fluoroquinolones; Klebsiella pneumoniae; Meningitis; Mice; Neutropenia; Penicillin Resistance; Pneumonia; Pseudomonas aeruginosa; Staphylococcus aureus; Streptococcus pneumoniae; Streptococcus pyogenes; Time Factors

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

We have carried our laboratory and clinical studies on cefodizime (CDZM, THR-221). The results were summarized as follows. CDZM was given by 30-minute drip infusion to 2 children at a single dose of 10 mg/kg and to 2 children at a single dose of 20 mg/kg and to 3 children at a single dose of 40 mg/kg. After the 30-minute drip infusion, mean serum levels of CDZM obtained for the 3 dose levels were 76.16 +/- 5.52 micrograms/ml, 170.49 +/- 16.70 micrograms/ml, 270.01 +/- 50.44 micrograms/ml at the end of injection, respectively, and serum half-lives were 2.03 +/- 0.78 hours, 2.03 +/- 0.38 hours, 2.28 +/- 0.30 hours, respectively. The mean urinary excretion rate of CDZM were 83.3 +/- 22.3%, 73.1 +/- 13.9%, 51.1 +/- 8.5% in the first 8 hours after the 30-minute drip infusion of 10 mg/kg, 20 mg/kg, 40 mg/kg, 40 mg/kg, respectively. Treatment with CDZM was made in 28 cases of pediatric bacterial infections; 5 cases of tonsillitis, 2 cases of bronchitis, 10 cases of pneumonia, 6 cases of enteritis, 3 cases of urinary tract infection and 1 case each of maxillary sinusitis and laryngitis. Results obtained were excellent in 13 cases, good in 7 cases, fair in 2 cases, poor in 6 cases. No significant side effect due to the drug was observed except one case of thrombocytosis and 2 cases each of elevated GOT and elevated GOT and GPT.

Topics: Absorption; Adolescent; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Female; Half-Life; Humans; Infant; Male

Pharmacodynamics of antibiotics in their prophylactic use was studied in 100 operations with artificial circulation, which were performed in patients with rheumatic heart defects. It was established that at the time of operation and after it, the antibiotic excreted via the kidneys insignificantly++, within the whole period of intracardiac stage of the operation, the myocardium remained without the antibacterial protection, and required the local use of an antibiotic.

Topics: Bacterial Infections; Cefotaxime; Extracorporeal Circulation; Humans; Injections, Intravenous; Intraoperative Care; Preoperative Care; Rheumatic Heart Disease; Surgical Wound Infection

Pharmacokinetic parameters of cefotaxime (CTX) and its metabolite desacetylcefotaxime (DCTX) were assessed on the 3rd day of treatment in 10 preterm infants (28-37 weeks gestation) aged 3-8 days and receiving 25 mg/kg CTX twice daily. Blood samples were collected from an umbilical artery catheter at 0, 0.08, 0.25, 0.5, 0.75, 1, 2, 4, 8, 12 h after a short peripheral infusion (5 min) and were assayed by high-performance liquid chromatography. During the 12 h following the CTX infusion, serum concentrations of CTX remained above the mean bactericidal concentration for pathogens commonly isolated during the neonatal period. The mean (+/- SD) elimination half-life, volume of distribution, total body clearance and area under the serum concentration-time curve (AUC0-12 h) for CTX were: 3.68 +/- 1.48 h (range: 1.89-6.82), 431 +/- 149 ml/kg (219-636), 1.57 +/- 0.80 ml/kg/min (0.60-3.27) and 373 +/- 206 micrograms/ml/h (170-867), respectively. The AUC0-12 h for DCTX was 170 +/- 93 micrograms/ml/h (61-374). A significant inverse relationship was found between gestational age and the elimination half-life of CTX, and the AUC of both CTX and DCTX.

Topics: Bacterial Infections; Cefotaxime; Female; Gestational Age; Half-Life; Humans; Infant, Newborn; Infant, Premature; Male

Topics: Aeromonas; Aged; Ampicillin; Bacterial Infections; Cefotaxime; Diarrhea; Feces; Humans; Male; Metronidazole

The in vitro activity of Ro 23-9424, which is desacetyl-cefotaxime linked to fleroxacin, was compared with the activities of cefotaxime, desacetyl-cefotaxime, fleroxacin, ofloxacin, and ciprofloxacin. It inhibited the majority of members of the family Enterobacteriaceae, except for some Serratia marcescens, Citrobacter freundii, and Enterobacter cloacae strains, at less than or equal to 0.25 microgram/ml and had an MIC for 90% of strains tested (MIC90) of 8 micrograms/ml against Pseudomonas aeruginosa. Most group A, B, C, and G streptococci and Streptococcus pneumoniae were inhibited at less than or equal to 0.25 microgram/ml. Ninety percent of the staphylococci were inhibited at less than or equal to 4 micrograms/ml, except for some methicillin-resistant Staphylococcus aureus isolates. The MIC90S of Ro 23-9424 for Enterococcus faecalis and Listeria monocytogenes were greater than or equal to 16 micrograms/ml. Ninety percent of Clostridium perfringens isolates were inhibited by less than or equal to 2 micrograms/ml, whereas Bacteroides fragilis had an MIC90 of 32 micrograms/ml. There was a minimal inoculum size effect. The MICs and MBCs were either identical or within a twofold dilution. The MICs of Ro 23-9424 for Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, Enterobacter cloacae, Citrobacter freundii, Pseudomonas aeruginosa, and Staphylococcus aureus increased 16- to 128-fold after 2 weeks of transfer in the presence of Ro 23-9424, showing that the presence of two agents does not prevent resistance.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bacteria; Bacterial Infections; Cefotaxime; Ciprofloxacin; Drug Resistance, Microbial; Fleroxacin; Fluoroquinolones; Humans; Microbial Sensitivity Tests

In systemic and local infections, the therapeutic efficacy of cefpirome was compared to that of imipenem and cefotaxime. Murine septicemia induced with methicillin-sensitive and methicillin-resistant Staphylococcus aureus strains responded well to cefpirome and imipenem therapy, the ED50 values ranged from 0.8 to 28.40 mg/kg and 0.5 to 15.58 mg/kg, respectively. The carbapenem also displayed high efficacy against Enterococci and was more potent than cefpirome. Cefotaxime, however, exhibited lower activity or proved to be inactive against these strains. With ED50 values of 0.03 to 31.33 mg/kg, cefpirome was the most active of the three antibiotics in protecting mice challenged with Enterobacteriaceae. The corresponding ED50 values of imipenem and cefotaxime ranged from 0.72 to 70.95 mg/kg and 0.06 to 66.30 mg/kg, respectively. Despite distinctly lower in vitro activity against the infecting organism, cefpirome showed efficacy similar to imipenem in the treatment of subcutaneous S. aureus abscesses in mice. It was more effective than imipenem and cefotaxime against experimental Klebsiella pneumonia in mice and the Escherichia coli infected granuloma pouch in rats.

Topics: Abscess; Animals; Bacterial Infections; Cefotaxime; Cefpirome; Cephalosporins; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Granuloma; Imipenem; Male; Mice; Mice, Hairless; Mice, Inbred C3H; Pneumonia; Rats; Rats, Inbred Strains; Sepsis; Staphylococcal Skin Infections; Staphylococcus aureus; Streptococcal Infections

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Retrospective Studies

Topics: Administration, Oral; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Half-Life; Humans; Infusions, Intravenous; Inpatients; Michigan; Retrospective Studies; Treatment Outcome

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Drug Hypersensitivity; Drug Resistance; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Middle Aged; Netilmicin; Treatment Outcome

Topics: Anti-Bacterial Agents; Appendectomy; Bacterial Infections; Cefotaxime; Ceftriaxone; Cesarean Section; Female; Humans; Hysterectomy; Pelvic Inflammatory Disease; Pregnancy; Pregnancy Complications, Infectious; Surgical Wound Infection

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefotaxime; Cefotetan; Controlled Clinical Trials as Topic; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Imidazoles; Male; Middle Aged; Neoplasms; Surgical Wound Infection

One hundred clinical isolates resistant to ceftazidime and/or cefotaxime were examined for susceptibility to cefepime. The most frequently encountered ceftazidime-cefotaxime-resistant strains belonged to the genera Enterobacter, Pseudomonas, and Citrobacter. Among these strains, 92% were resistant to cefoperazone, 91% were resistant to cefotaxime, 84% were resistant to ceftazidime, and 6% were resistant to cefepime. Of the members of the family Enterobacteriaceae, 57% were resistant to ceftriaxone. The six strains resistant to cefepime were all Pseudomonas aeruginosa and were resistant to both cefotaxime and ceftazidime. Cefepime-resistant P. aeruginosa strains had exceptionally high levels of beta-lactamase activity, higher than the levels found in strains resistant to ceftazidime but susceptible to cefepime. The beta-lactamases from the cefepime-resistant strains were type I (Richmond-Sykes), were constitutively produced, and did not have increased affinity or hydrolytic activity for cefepime. Thus, cefepime was active against most gram-negative bacteria which have developed resistance to the broad-spectrum cephalosporins, and resistance to cefepime in P. aeruginosa appears to be associated with higher beta-lactamase levels than in cefepime-susceptible strains.

Topics: Bacterial Infections; Bacterial Proteins; beta-Lactamases; Cefepime; Cefotaxime; Ceftazidime; Cell Membrane Permeability; Cephalosporins; Drug Resistance, Microbial; Enzyme Induction; Gram-Negative Bacteria; Isoelectric Focusing; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections

Topics: Bacterial Infections; Bacteriological Techniques; Cefixime; Cefotaxime; Dose-Response Relationship, Drug; Humans

Clinical studies on cefodizime (CDZM) were performed in patients of obstetrics and gynecology. CDZM was given to patients via drip infusion at a daily dose of 2-4 g, and the results obtained are summarized as follows: 1. A total of 10 cases included 5 cases of intrauterine infections (3 cases of puerperal endometritis, 1 endometritis and 1 puerperal fever), 2 intrapelvic infections (1 pelvic dead space infection and 1 parametritis), and 3 Bartholin's abscess. Clinical efficacies were excellent in 3 cases, good in 6 and poor in 1. The efficacy rate was 90% (9/10). 2. Bacteriological efficacies were as follows: eradicated in 3 cases, replaced in 2, decreased in 1, persisted in 1 and unknown in 3. 3. Neither subjective and objective adverse reactions nor abnormal changes in laboratory test values were observed.

Topics: Adolescent; Adult; Aged; Aztreonam; Bacteria; Bacterial Infections; Cefotaxime; Clindamycin; Drug Evaluation; Female; Genital Diseases, Female; Humans; Infusions, Intravenous; Middle Aged

Cefodizime (CDZM), a new cephem antibiotic, was studied in terms of its pharmacokinetics and clinical efficacy in the field of obstetrics and gynecology, and the results are summarized as follows: Concentrations of CDZM in serum and genital tissues following 1 g drip infusion (30 min.) were determined and good penetration of CDZM into tissues was recognized. The maximum level in uterine arterial serum was 56.25 micrograms/ml and maximum tissue levels ranged 23.56-40.64 micrograms/g which were above its MIC80's for main pathogenic organisms. Peak concentrations of CDZM in pelvic dead space exudates following 1 g intravenous bolus injection or drip infusion ranged 6.25-6.52 micrograms/ml. The clinical efficacy of CDZM in 17 cases of obstetrical and gynecological infections was investigated using a dose of 1-3 g daily. The clinical efficacy rate was 88.2% (15/17 cases). Bacteriologically, the eradication rate was 83.3%. No side effects or abnormal laboratory test values were observed.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Intravenous; Injections, Intravenous; Middle Aged; Tissue Distribution

Pharmacokinetic and clinical studies on a new cephalosporin antibiotic, cefodizime (THR-221, CDZM), were performed and the results obtained are summarized as follows: 1. At about 84 minutes after a bolus injection of 1 g dose of CDZM, the drug was transferred well into tissues of internal genital organs and remained there at therapeutic levels for 285 minutes. The drug was also transferred quickly and sufficiently into exudate from pelvic dead space and its levels were still kept at high levels at 6 hours after administration. 2. CDZM was given to 8 women affected with gynecologic infections. The outcome of CDZM therapies showed that the drug was effective in all 8 of patients (100%) clinically and bacteriologically. 3. Notable adverse effects or abnormal laboratory test results were not observed except for 2 patients with transient and slight elevation of transaminase levels. Based on these results, it may be concluded that CDZM is a highly effective and a very safe antibiotic for the treatment on infectious diseases in gynecologic field.

Topics: Adult; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Genital Diseases, Female; Genitalia, Female; Humans; Injections, Intravenous; Middle Aged; Pelvic Inflammatory Disease; Tissue Distribution

Clinical investigation of cefodizime (CDZM, THR-221), a newly developed cephem antibiotic, was carried out with regard to its distributions to genital organs, and the drug was evaluated clinically against infections in obstetric and gynecological fields. 1. Distributions to genital organs One gram of CDZM was administered to each patient who received simple total hysterectomy by 1 hour intravenous drip infusion and concentrations of CDZM in genital organs such as antecubital vein, uterine artery, ovary, oviduct, endometrium, myometrium, cervix uteri and portio vaginalis were examined. Serum concentrations were elevated to an average of 90.63 micrograms/ml in 15 minutes after administrations of CDZM and decreased gradually at fixed times. CDZM was distributed in concentration ranges of 45.32-10.96 micrograms/g in ovary, 26.58-10.20 micrograms/g in oviduct, 42.20-9.80 micrograms/g in endometrium, 31.28-11.72 micrograms/g in myometrium, 42.20-12.52 micrograms/g in cervix uteri and 45.32-9.40 micrograms/g in portio vaginalis, and these high concentrations lasted more than 3 hours after administrations. 2. Clinical evaluations CDZM was given to 10 patients, including 7 cases with pelvioperitonitis and 1 case each with pyometra, Bartholin's abscess and puerperal fever, at a dose level of 1 or 2 gram 2 times daily by 30-60 minutes intravenous drip infusion. Overall clinical efficacies were excellent in 3 cases and good in 7 and the efficacy rate was very high, at 100%. Bacteriological efficacies were eradicated in 6 cases, and unknown in 2, and the eradication rate was 100%.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Intravenous; Middle Aged; Tissue Distribution

Cefodizime (CDZM, THR-221), a newly developed injectable cephem antibiotic agent, was evaluated for its distribution in intrapelvic genital organ tissues, penetration into exudate of retroperitoneal space and breast milk and therapeutical effects on some infections in obstetrics and gynecology. The results obtained are summarized as follows. 1. When 1 g of CDZM was administered by drip infusion over a 60 minutes period, its serum concentration reached 53.51 micrograms/ml at the completion of drip infusion, then declined rapidly. Peak concentrations of CDZM in intrapelvic genital organ tissues were higher than 20 micrograms/g at different times. CDZM was transferred to the exudate of retroperitoneal space and its concentration reached a peak of 7.01 micrograms/ml at 2.67 hours after initiation of 60 minutes drip infusion at a dose of 1 g, then declined slowly but stood at 4.93 micrograms/ml even at 8 hours. The transfer of CDZM to breast milk was similar to other cephem antibiotic agents and peak levels of CDZM in milk were 0.13-0.36 microgram/ml at 2 or 3 hours after administration of a dose of 1 g. 2. In the clinical study, CDZM was administered by drip infusion over 60 minutes to 6 patients with obstetrical and gynecological infections at a daily dose of 2-6 g. Clinical results were good in 5, poor in 1, and the efficacy rate was 83.3%. No side effects nor abnormal laboratory test results were observed.

Topics: Adult; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Intravenous; Middle Aged; Milk, Human

Clinical studies on cefodizime (THR-221, CDZM), a new injectable cephem antibiotic, were performed and the following results were obtained. Ten patients with obstetrical and gynecological infections such as intrauterine infections, pyometra, adnexitis, parametritis and lymphocystitis. The clinical results were evaluated as excellent in 1 case, good in 4 cases and poor in 5 cases. The efficacy rate was 50.0%. Bacteriologically, 10 organisms were isolated from 8 patients and the eradication rate was 44.4%. No side effects were observed in any of the cases treated with CDZM. In laboratory examinations, transient elevations of serum GOT, GPT and Al-P were noted in 1 case.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Genital Diseases, Female; Humans; Infusions, Intravenous; Middle Aged

We have conducted pharmacokinetic and clinical trials of a new cephem derivative, cefodizime (THR-221, CDZM), and obtained the following results. 1. We administered CDZM to 4 cases with abdominal simple hysterectomy due to myoma uteri at a dose level of 1 g by drip intravenous injection and studied average levels of transfer measured at various locations in the uterine tissues and adnexa at an average of 2 hours after administration. CDZM level was highest in the oviduct, 13.7 micrograms/g (ratio with respect to the uterine arterial blood: 91.3%), followed by the ovary, portio vaginalis, cervix uteri and endometrium, and was lowest in the myometrium, 8.3 micrograms/g (55.3%). CDZM concentrations were higher than 6.04 micrograms/g in any tissues. 2. To study CDZM transfer to pelvic cavity fluid, we administered CDZM to 5 cases with total hysterectomy due to cervical cancer of uteri at a dose level of 2 g using drip intravenous injection. The drug was transferred at high levels to the pelvic cavity fluid. A level of 11.7 micrograms/ml was observed at 3 hours after injection. The drug levels in the pelvic cavity fluid were maintained continuously higher levels than those of venous blood. These concentrations in the uterine tissues and pelvic cavity fluid were higher than the MIC against many strains of Gram-positive and Gram-negative bacteria, hence we considered them to be therapeutically effective concentrations. 3. Eleven cases of gynecological infections receiving in totals of 8 to 48 g of CDZM demonstrated "excellent" results in 3 cases, "good" in 8 cases. Eight strains of organisms were isolated from 10 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Genital Diseases, Female; Genitalia, Female; Humans; Hysterectomy; Infusions, Intravenous; Leiomyoma; Middle Aged; Postoperative Period; Uterine Cervical Neoplasms; Uterine Neoplasms

Two potent third-generation cephalosporins with similar antibacterial spectra but different pharmacokinetics were compared in patients suffering from septicemia due to different organismus. Sixty patients with a variety of underlying diseases were included in the study. They received either 2-4 g ceftriaxone (active ingredient of Rocephin) once a day or 2 g cefotaxime every 8 h for 10-15 days. Our data confirm that a single dose of 2 g ceftriaxone should be sufficient to treat septicemia.

Topics: Adult; Bacterial Infections; Cause of Death; Cefotaxime; Ceftriaxone; Dose-Response Relationship, Drug; Female; Humans; Male; Sepsis

Cefixime (CFIX, Cefspan), a new oral cephem, was used in the treatment of urinary tract infections, and was evaluated for its therapeutic effectiveness and safety at the Department of Urology, Osaka Rosai Hospital. In a total 129 cases, to which daily doses of 200 mg of CFIX were divided into 2 doses and administered clinical efficacies in 35 cases of women with acute uncomplicated cystitis treated for 3.9 days in average and 79 cases with complicated urinary tract infections (UTIs) treated for 5.9 days in average were assessed, according to the Criteria for Evaluation of Clinical Efficacy of Antimicrobial Agents on UTI (3rd ed.) recommended by the Japan UTI Committee with our own minimum modifications. Mid term urine and catheterized urine were examined as urine samples for bacteriological evaluation. Clinical efficacies in 35 cases with acute uncomplicated cystitis were excellent in 24 (69%) and moderate in 11 (31%), with an overall clinical efficacy rate of 100%. Clinical efficacies in 79 patients with complicated UTIs were excellent in 24 (30%), moderate in 26 (33%) and poor in 29 (37%), with an overall clinical efficacy rate of 63%. All of the 35 bacterial strains isolated from urine samples of uncomplicated UTIs patients were totally eradicated by the CFIX treatment, while 85 strains (79%) were eradicated among 107 strains isolated from urine samples of complicated UTIs patients. Subjective adverse reactions were observed in 4 cases (3.1%) out of a total of 128 patients, as general malaise in 1 and lower abdominal symptoms in 3 were recorded. All of them disappeared after the termination of CFIX administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefixime; Cefotaxime; Cystitis; Drug Evaluation; Female; Humans; Male; Middle Aged; Urinary Tract Infections

Cefepime (BMY-28142), a new semisynthetic cephalosporin, was evaluated for in vitro and in vivo antibacterial activities in comparison with ceftazidime, cefuzonam, cefotaxime and cefmenoxime. Cefepime showed a well-balanced, broad spectrum of activity against a number of clinical isolates collected in Japan. The activity of cefepime against Gram-positive bacteria was several times greater than that of ceftazidime, nearly comparable to cefotaxime and cefmenoxime, and slightly weaker than cefuzonam. Against Enterobacteriaceae, cefepime showed superior activity to the reference cephalosporins against Proteus inconstans, Providencia rettgeri, Morganella morganii, Citrobacter freundii and Enterobacter cloacae. The activity of cefepime against Pseudomonas aeruginosa was nearly comparable to that of ceftazidime. Cefotaxime, cefuzonam and cefmenoxime were substantially less active against P. aeruginosa. Cefepime was more stable than cefuzonam, cefotaxime and cefmenoxime to various types of beta-lactamases from Gram-negative bacteria. The high in vitro activity of cefepime was reflected in its in vivo efficacy against experimental infections in normal and immuno-suppressed mice. Cefepime was the most effective among the cephalosporins tested against four Gram-negative bacterial infections.

Topics: Animals; Bacteria; Bacterial Infections; beta-Lactamases; Cefepime; Cefmenoxime; Cefotaxime; Ceftazidime; Ceftizoxime; Cephalosporins; Immunosuppression Therapy; Mice; Microbial Sensitivity Tests

Cefodizime (THR-221, CDZM), a new antibiotic, was studied pharmacokinetically and clinically. The results obtained are summarized as follows: 1. Concentrations of CDZM in internal genital tissues were quite high after an intravenous infusion. 2. Clinical effects of the therapy with CDZM using intravenous infusion twice daily were evaluated in 1 patient with endometritis, 2 patients with pyometra, 1 patient with extragenital abscess and 1 patient with BARTHOLIN'S gland abscess. Clinical responses were good in all 5 patients. No side effects nor abnormal laboratory test values due to the drug were noted.

Topics: Adult; Bacterial Infections; Cefotaxime; Drug Evaluation; Drug Tolerance; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Tissue Distribution

The therapeutic activity of FCE 22891 was compared with that of two new oral cephalosporins, cefuroxime axetil and cefixime against Streptococcus pneumoniae respiratory infection and subcutaneous abscesses induced by mixed aerobes and anaerobes in mice. In experimental pneumonia FCE 22891 was the most active antibiotic. In aerobic abscesses FCE 22891 proved the most active agent in infections induced by methicillin susceptible and resistant Staphylococcus aureus while all three compounds were very active, against Str. pyogenes. In abscesses caused by Gram-negative bacteria, FCE 22891 showed good and constant efficacy. Cefixime was the most active drug against the two susceptible strains of Escherichia coli and Enterobacter cloacae and also against resistant Esch. coli but was inactive against a strain of Ent. cloacae that produced cephalosporinase. Cefuroxime axetil was less active than the other two drugs against Gram-negative bacteria with adequate efficacy only against a susceptible strain of Ent. cloacae. FCE 22891 was more effective than cefixime and cefuroxime axetil in preventing and reducing the size of abscesses induced by Bacteroides fragilis 101. We conclude that FCE 22891, despite its short half life of 6 min in mice, exerts comparable and sometimes better activity than the two oral cephalosporins characterized by longer half lives.

Topics: Abscess; Animals; Anti-Bacterial Agents; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Carbapenems; Cefixime; Cefotaxime; Cefuroxime; Cephalosporins; Female; Half-Life; Lung Diseases; Mice; Microbial Sensitivity Tests; Pneumonia, Pneumococcal

Cefodizime (THR-221, CDZM), a new cephalosporin antibiotic, was evaluated for its safety and efficacy in 27 children with various bacterial infections. The episodes of infections included pneumonia (6 cases), bronchopneumonia (11 cases), lung abscess (1 case), acute pharyngitis (2 cases), cervical lymphadenitis (1 case), infected cephalohematoma (1 case), urinary tract infection (1 case), sepsis (2 cases) and purulent meningitis (2 cases). CDZM was effective in all but one, and its efficacy rate was 96.3%. The main etiologic pathogens were Staphylococcus aureus, Haemophilus influenzae, Haemophilus parainfluenzae, Streptococcus pneumoniae, Streptococcus agalactiae, Escherichia coli, Citrobacter freundii and Branhamella catarrhalis. The elimination rate was 92.3%. As adverse reactions or abnormalities, diarrhea was encountered in 4 cases. A slight elevation of serum transaminases or eosinophils was observed in 4 cases. The serum half-life was approximately 1.8-1.9 hours in children after intravenous bolus injections. Concentrations of CDZM in cerebrospinal fluids were well above MIC values of CDZM against those organisms responsible for the infections. The data suggest that CDZM is a safe and effective antibiotic when used in children with bacterial infections including purulent meningitis.

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male

1. Absorption and elimination Serum and urinary levels of cefodizime (CDZM, THR-221) were determined in 7 children with ages ranging from 3 to 12 years after a intravenous bolus injection of the drug at 20 mg/kg. The average serum level of the drug was 119.27 +/- 13.83 micrograms/ml at 30 minutes, then decreased gradually with a half-life of 2.01 +/- 0.25 hours to 10.56 +/- 2.93 micrograms/ml at 6 hours. The average urinary elimination rate was 77.34 +/- 12.60%. 2. Clinical study CDZM was given to the following 39 patients with ages ranging from 2 months to 15 years and clinical efficacy, bacteriological response and adverse reactions were evaluated. The treated cases were 2 cases of acute purulent tonsillitis, 30 cases of acute pneumonia, 1 case of acute purulent otitis media and 2 cases of acute urinary tract infections. Clinical efficacies were excellent in 29 cases, good in 5 cases and poor in 1 with an efficacy rate of 97.1%. Organisms presumed to be pathogens included 3 strains of Streptococcus pneumoniae, 1 beta-Streptococcus, 1 Staphylococcus epidermidis, 9 Haemophilus influenzae (1 beta-lactamase producing strain and 8 non-producing strains) and 1 Enterococcus faecalis. The last one was decreased and the others were eradicated with an eradication rate of 93.3% for all strains. Adverse reactions occurred in no patients. Abnormal changes in laboratory test values involved only 1 case each of elevated GOT, elevated GOT and GPT, eosinophilia and thrombocytosis. Based on the above-mentioned result and features of this drug, it was confirmed that this drug showed an excellent usefulness in the treatment of infections in childhood. It may be also effective in the management of infections under immunosuppression.

Topics: Adolescent; Age Factors; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male; Respiratory Tract Infections

In this study, cefodizime (CDZM, THR-221) was administered to 34 children with infections and the efficacy was evaluated in 30 patients. The efficacy rate was 90.0% and CDZM was proved to be a highly effective antibiotic for infectious diseases in childhood. We also demonstrated that CDZM had strong antibacterial activities against both Gram-positive and Gram-negative bacteria. No severe toxicity related to intravenous injection of CDZM was observed in our 34 cases.

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Respiratory Tract Infections

Cefodizime (THR-221, CDZM), a new parenteral cephalosporin, was evaluated for its efficacy and safety in 20 children with bacterial infections (Table 1), and the following results were obtained. 1. CDZM was administered in 3 or 4 divided doses at daily dosages ranging from 54.5 to 84.2 mg/kg administered by 30 minutes drip infusion or intravenous injection to 20 patients (7 cases of acute tonsillitis, 6 cases of pneumonia, 2 cases each of bronchitis and suppurative cervical lymphadenitis, and 1 case each of acute pharyngitis, acute enteritis and furunculosis) and the following clinical results were obtained: excellent, 7 cases; good, 11 cases; fair, 2 cases. The overall efficacy rate was 90% (Table 4). 2. MICs of CDZM against 15 strains of isolated organisms are shown in Table 2. MICs against all 7 strains of Haemophilus influenzae were less than 0.025 micrograms/ml. MIC against 1 out of 5 strains of Streptococcus pneumoniae was 0.05 micrograms/ml and those against 2 strains were 0.10 micrograms/ml and against the other 2 were 0.20 micrograms/ml. MICs against 3 strains of Staphylococcus aureus were 1.56, 25 and higher than 100 micrograms/ml, respectively. 3. No clinical adverse reaction was observed in any of the 20 patients. Eosinophilia was observed in 2 cases. A slight elevation of S-GOT was found in 1 patient (case No. 8) and moderate elevation of S-GOT and S-GPT in another (case No. 18) (Table 4). In case No. 18, the S-GOT and S-GPT activity improved after the administration of the drug was stopped.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Pneumonia; Tonsillitis

Cefodizime (CDZM, THR-221), a new cephem antibiotic, was investigated for its clinical efficacy and pharmacokinetics in children. The results obtained are summarized as follows. 1. Antimicrobial activities Antimicrobial activities of CDZM against clinically isolated organisms were determined. MICs of CDZM against 1 strain each of Streptococcus pneumoniae, Escherichia coli and Klebsiella pneumoniae were 0.05 micrograms/ml to 0.10 micrograms/ml. Especially, MIC against all 6 strains of Haemophilus influenzae was less than or equal to 0.024 micrograms/ml. This MIC value was lower than those of other antibiotics such as cefotaxime, cefotiam, cefazolin, piperacillin. 2. Pharmacokinetics CDZM was given to 1 case at a dose of 20 mg/kg by a 60-minute intravenous drip infusion. The peak value of serum concentration of CDZM was 207.80 micrograms/ml at the end of the infusion. The half-life was 2.15 hours. The mean urinary excretion rate was 68.5% in the first 4 hours, 79.2% in 6 hours and 76.5% in 8 hours after the 30-minute drip infusion. 3. Clinical efficacy CDZM was given to a total of 27 patients, 13 with pneumonia, 1 with bronchitis, 2 with acute pharyngitis, 1 with purulent tonsillitis, 5 with urinary tract infection, 1 each with retrograde cholangitis, acute enteritis, pericementitis, phlegmon and inguinal lymphadenitis. Overall clinical efficacies were excellent in 5 cases, good in 17 and the efficacy rate was 81%. Bacteriological effects were investigated in 13 cases and the eradication rate was 85%. No adverse reactions were observed in any case. As abnormal laboratory findings, elevated GOT, GPT, A1-P, LAP and gamma-GTP, were noted in 1 out of the 28 cases examined.

Topics: Adolescent; Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Respiratory Tract Infections

Cefodizime (THR-221, CDZM), a newly developed injectable cephem antibiotic, was injected intravenously to 13 cases of pediatric infections. Patients received the drug at a dose level of approximately 20 mg/kg x 3 times daily. The results obtained are summarized as follows. 1. Clinical efficacy was excellent in 4 patients, good in 6 and poor in 0 for 10 cases (2 phlegmon, 1 periproctal abscess, 5 pneumonia and 2 bronchitis) except 3 Mycoplasma pneumonia. 2. Three strains of pathogens were followed for their changes (Streptococcus pyogenes in 1 phlegmon, Klebsiella pneumoniae in periproctal abscess and Haemophilus influenzae in 1 bronchitis) and they were found to have been eliminated. 3. No adverse reactions occurred. Abnormal changes in laboratory test data found were 2 cases of eosinophilia, 1 cash each of increased GOT and GPT, and thrombocytosis, but none of them was severe.

Topics: Adolescent; Age Factors; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Injections, Intravenous; Male

Clinical studies were performed on cefodizime (THR-221, CDZM), a new cephem antibiotic as described below. CDZM was administered to 13 patients in dose levels ranging from 55 to 96 mg/kg/day t.i.d. for 3-7 days (5.5 days on average). These patients included 8 with pneumonia, 2 with tonsillitis, 1 each with bronchitis, phlegmon and urinary tract infection. The overall efficacy rate was 92.3%, i.e., efficacy was excellent in 8, good in 4 and poor in 1. Bacteriological efficacy was 83.3%, i.e., 5 strains of bacteria (Streptococcus pneumoniae 1, Haemophilus influenzae 3, Haemophilus parainfluenzae 1) were eradicated and 1 was unchanged (Enterobacter cloacae, MIC greater than 100 micrograms/ml). Clinical side effect was not observed during the treatment. Laboratory abnormalities were observed in 2 cases, i.e., a slight elevation of GPT and a mild eosinophilia. The above results suggest that CDZM is a useful antibiotic for treating pediatric bacterial infections.

Topics: Age Factors; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Male

Cefodizime (CDZM, THR-221) was evaluated for its pharmacokinetics, safety and efficacy in 30 pediatric patients with bacterial infections. The following results were obtained. 1. The pharmacokinetics of CDZM in 6 children were investigated with a dose level of 20 mg/kg via intravenous injection. Mean serum half-lives (T 1/2 beta) of the drug were 120.9 minutes (HPLC) and 115.6 minutes (bioassay). In 8 hours after administration of CDZM, urinary excretion rates were 74.7% (HPLC) and 75.0% (bioassay). 2. The clinical efficacies of CDZM were studied in 29 pediatric patients, comprising 22 with respiratory tract infections, 2 with urinary tract infections, 2 with enteritis, 2 with lymphadenitis and 1 with gingivitis. The clinical efficacies were excellent in 13, good in 13 and fair in 3, with an efficacy rate of 89.7%. 3. The eradication rate for pathogens identified in 7 pediatric patients was 60% (6/10). The clinical efficacy rate in cases where pathogens were identified was 100% in terms of excellent+ good evaluations. 4. Only one case of mild diarrhea was observed as a side effect associated with CDZM. Laboratory tests revealed abnormal value of slightly elevated eosinophil in 3 cases. The data suggested that CDZM is a safe and effective injectable antibiotic for the treatment of infections in children.

Topics: Adolescent; Age Factors; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Male; Respiratory Tract Infections

Therapeutic effects of cefodizime (CDZM, THR-221), a new cephalosporin having a methoxyimino group, were examined in various infectious diseases in children. Clinical efficacy rates were 100% (3/3) in pneumonia, 100% (5/5) in acute bronchitis, 75% (3/4) in upper respiratory infections and 100% (1/1) in each of a croup and a mixed infection with Streptococcus pyogenes and staphylococcal impetigo. Hence, the overall efficacy rate was 92.9% (13/14). Adverse effects were observed in 2 cases, i.e. exanthema provably due to drug allergy in 1 case and a slightly elevated GPT in another. Changes in serum concentrations and urinary excretion of CDZM were examined in a child with no infection. T 1/2 values obtained were 124.5 minutes (bioassay) and 143.4 minutes (high performance liquid chromatography (HPLC]. Eight hour recovery rates in urine were 62.9% (bioassay) and 65.4% (HPLC). CDZM was considered to be a safe and useful drug in treating various infectious diseases in children.

Topics: Adolescent; Age Factors; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male

Cefodizime, a new cephem antibiotic, was intravenously injected to mice with systemic or urinary tract infection by Escherichia coli and those with respiratory infection by Streptococcus pneumoniae, and the time courses of the plasma and tissue cefodizime levels were determined and compared with those in healthy mice (control group). In mice with systemic infection, the drug level in the plasma, liver, kidneys and lung changed on the basis of the two-compartment model. In this group, disappearance of the drug from plasma and tissues was obviously delayed and decrease in elimination constant (KE) and increase in the apparent volume of distribution (V2) were noted as compared with the control group. In the group with respiratory infection, T1/2(beta) and AUC for the hepatic drug level and T1/2(beta) for the renal drug level increased but in the other organs there was no great difference from the control group. In the urinary tract infection group, T1/2(beta) and AUC in the kidneys (infected site) and liver that mainly participate in elimination of cefodizime considerably increased differently from the control group. Changes of the distribution volume seemed to correspond with a physiological change of increase in body water content in the peripheral tissues (muscle, etc.) of the systemic infection group and in the liver, kidneys, etc. of the urinary tract infection group. Regarding the protein binding ratio, the urinary tract infection group showed a significant decrease as compared with the control group, but no distinct difference was noted in systemic and respiratory infections.

Topics: Animals; Bacterial Infections; Body Water; Cefotaxime; Injections, Intravenous; Kidney; Liver; Male; Mice; Mice, Inbred ICR; Protein Binding; Respiratory Tract Infections; Time Factors; Urinary Tract Infections

Topics: Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Escherichia coli; Female; Gram-Negative Aerobic Bacteria; Gram-Positive Bacteria; Humans; Male; Pseudomonas aeruginosa; Staphylococcus aureus; Time Factors

The antimicrobial activity of cefotaxime and its intermediate metabolite, desacetylcefotaxime, against 320 Gram-negative bacterial strains was analysed to investigate whether combination of the 2 substances led to increased bactericidal activity. The in vitro study of the minimum inhibitory concentration (MIC) showed the combination to be more effective against Escherichia coli, Klebsiella spp., Enterobacter spp. and Proteus mirabilis, requiring less than or equal to 50% of the concentration of cefotaxime alone to inhibit 90% of strains. For other micro-organisms the MIC90 for the combination was equal to or within 1 dilution of that for cefotaxime alone.

Topics: Bacterial Infections; Cefotaxime; Dose-Response Relationship, Drug; Drug Therapy, Combination; Enterobacter; Escherichia coli; Gram-Negative Bacteria; Humans; Pseudomonas aeruginosa

Topics: Aztreonam; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporins; Imipenem; Thienamycins

Topics: Amoxicillin; Ampicillin; Bacteria; Bacterial Infections; Cefaclor; Cefixime; Cefotaxime; Cephalexin; Humans; Microbial Sensitivity Tests

Topics: Bacterial Infections; Cefotaxime; Enterobacter; Escherichia coli; Gram-Negative Bacteria; Humans; Klebsiella pneumoniae; Proteus mirabilis; Time Factors

Topics: Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Humans; Neutropenia; Tobramycin; Vancomycin

A study was conducted of the effects of cefotaxime, a third generation cephalosporin antibiotic, on the function of the kidney, using several indices of renal function including urinary concentrations of the renal enzyme N-acetyl-beta-D-glucosaminidase (NAG). In 6 patients with respiratory infections and normal renal function (group I), the urinary concentrations of NAG before and after the administration of cefotaxime 2 to 4g daily were 5.7 +/- 0.6 U/L and 5.5 +/- 0.9 U/L, respectively (NS). Similarly, 9 patients with chronic renal failure who were not undergoing haemodialysis showed pre- and post-treatment urinary NAG concentrations of 8.7 +/- 4.0 U/L and 6.6 +/- 1.7 U/L, respectively (NS), while the corresponding values in 12 renally impaired patients undergoing haemodialysis (group III) were 8.1 +/- 3.5 U/L and 8.9 +/- 3.8 U/L, respectively (NS). With regard to other parameters of renal function (serum creatinine, BUN, beta 2M, and creatinine clearance), no statistically significant differences were found between the values obtained before and after therapy with cefotaxime. Therefore, it was concluded that the influence of cefotaxime on renal function is slight, and that this antibiotic can be safely used to treat patients with infections in the presence of renal dysfunction.

Topics: Acetylglucosaminidase; Bacterial Infections; Bronchitis; Cefotaxime; Humans; Kidney; Kidney Failure, Chronic; Pneumonia; Radioimmunoassay; Renal Dialysis

Topics: Adult; Aged; Bacterial Infections; Blood Coagulation; Blood Platelets; Cefotaxime; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Prothrombin Time; Renal Dialysis

Topics: Agranulocytosis; Amikacin; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans

Emergence of bacterial resistance to antimicrobial agents was studied during a period of 30 months of continuous use of parenteral cefotaxime combined with oral non-absorbable polymyxin E and tobramycin (selective decontamination) in a surgical intensive care unit (ICU). No increase in drug-resistance micro-organisms was found. Colonisation of the oropharyngeal cavity or intestine or both by strains resistant to polymyxin E occurred in 8% of patients (invariably Proteus and Morganella species). Tobramycin-resistant strains (Escherichia coli, Acinetobacter and Pseudomonas species) were found in 4% of patients. Intestinal colonisation with cefotaxime-resistant bacilli (e.g. Enterobacter, Pseudomonas and Acinetobacter species) occurred in 10% of patients, but in most patients these strains were eliminated by therapy with the topical antibiotics within one week. The control of emergence of resistance has major implications for the antibiotic policy in the ICU: firstly, the number of different antimicrobials used is sharply reduced since the switching of antibiotics to treat suprainfections is seldom necessary; secondly, it is possible to use a third generation cephalosporin such as cefotaxime for systemic prophylaxis, without risk of induction of resistance.

Topics: Administration, Oral; Bacterial Infections; Cefotaxime; Colistin; Critical Care; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Humans; Infusions, Intravenous; Male; Time Factors; Tobramycin

The synergistic interaction of cefotaxime and desacetylcefotaxime against 187 clinically significant anaerobic organisms was investigated. Fusobacterium nucleatum, Actinomyces odontolyticus, propionibacteria, lactobacilli, peptostreptococci, Streptococcus intermedius and Veillonella were sensitive to cefotaxime. Both Eubacterium lentum and Streptococcus morbillorum were resistant. The susceptibility of the clostridia varied from 0.125 to greater than 256 mg/L; only 20% of species demonstrated synergy between cefotaxime and desacetylcefotaxime. The minimum inhibitory concentration (MIC) of cefotaxime against members of the genus Bacteroides ranged from 0.0625 to greater than 256 mg/L. The MIC50 of cefotaxime to Bacteroides fragilis and B. vulgatus was lowered from 6 and 4 mg/L, respectively, to 2 and 1 mg/L, respectively, when 4 mg/L desacetylcefotaxime was added to the medium. Full or partial synergy was demonstrated by 50.7% of the Bacteroides species tested. While cefotaxime and desacetylcefotaxime act synergistically against many members of the genus Bacteroides, the MIC of at least 10% of strains is not affected by this combination.

Topics: Bacteria, Anaerobic; Bacterial Infections; Bacteroides; Bacteroides Infections; Cefotaxime; Clostridium; Dose-Response Relationship, Drug; Drug Synergism; Eubacterium; Humans; Streptococcus

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Bone and Bones; Cefotaxime; Half-Life; Humans; Injections, Intravenous; Male; Middle Aged

BO-1236, a new cephalosporin having an N-methyl-5,6-dihydroxyisoindolinium moiety on the 3-methylene of the cephem, showed potent activity against gram-negative organisms, including Pseudomonas aeruginosa. The in vitro activity of BO-1236 was superior or comparable to that of ceftazidime, cefotaxime, and cefoperazone in susceptibility tests with clinical isolates. BO-1236 was significantly more active than ceftazidime against P. aeruginosa strains susceptible or resistant to ceftazidime or gentamicin or both. MBCs were usually close to MICs, both of which were influenced by inoculum size to about the same degree as those of the other beta-lactams. BO-1236 was stable to all types of beta-lactamases except type I oxyiminocephalosporin-hydrolyzing enzyme, by which BO-1236 was slightly hydrolyzed. BO-1236 showed protective activity superior to that of ceftazidime and cefotaxime in experimental infections in mice caused by two strains of P. aeruginosa and showed activity comparable to that of ceftazidime and cefotaxime against other gram-negative bacterial infections.

Topics: Animals; Bacterial Infections; beta-Lactamases; Cefoperazone; Cefotaxime; Ceftazidime; Cephalosporins; Chemical Phenomena; Chemistry; Gram-Negative Bacteria; Gram-Positive Bacteria; Isoindoles; Male; Mice; Microbial Sensitivity Tests; Pseudomonas aeruginosa

The cefotiam (CFT) penetration in infected ascitic fluid was investigated in 12 cirrhotic patients. CFT (1 g every 8 h) was given intravenously and measured by HPLC in plasmatic and ascitic samples. The mean ascitic concentrations (+/- SEM), 1 h, 3 h and 8 h after the first injection (J1) were 14.6 +/- 4.6, 11.8 +/- 3 and 8.4 +/- 2.9 micrograms/ml respectively. These values were 38, 62 and 88% of the corresponding mean plasmatic concentrations and higher than the MIC's for the organisms most commonly involved. The mean plasmatic and ascitic concentrations, a few days later (4.5 or 6 days) (Jn) were not significantly different from the corresponding values at J1. A significant decrease of polymorphonuclear cell count was observed between J1 and Jn. These results suggest that CFT diffusion into ascitic fluid is independent of inflammation and CFT is an adequate antibiotic in cirrhotic patients with infected ascitic fluid.

Topics: Adult; Aged; Ascitic Fluid; Bacterial Infections; Cefotaxime; Cefotiam; Diffusion; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Pneumococcal Infections; Staphylococcal Infections; Staphylococcus aureus; Streptococcus pneumoniae; Yersinia enterocolitica; Yersinia Infections

Topics: Amikacin; Anti-Bacterial Agents; Azlocillin; Bacterial Infections; Bone Marrow Transplantation; Cefotaxime; Drug Therapy, Combination; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Penicillin Resistance

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Clindamycin; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Netilmicin; Nitroimidazoles; Ornidazole

The authors administered cefotaxime to 20 children and studied laboratory parameters concerning peripheral blood: hemoglobin count, blood platelet count, red blood cell count, and hematocrit value, and the coagulation system: protein induced by vitamin K deficiency or by the presence of a vitamin K antagonist II (PIVKA II), hepaplastin test (HPT), prothrombin time (PT) and active partial thromboplastin time (APTT). The results obtained are summarized as follows: 1. Peripheral blood No abnormal values were observed. 2. Coagulation system (1) PIVKA II: In all cases, PIVKA II was negative. (2) HPT, PT and APTT: In all cases, no significant changes of these values which would suggest the tendency for prolonged bleeding were observed.

Topics: Adolescent; Bacterial Infections; Bleeding Time; Blood Coagulation; Blood Coagulation Tests; Cefotaxime; Child; Child, Preschool; Female; Humans; Male; Vitamin K

Eighty-one febrile episodes in cancer patients with adequate neutrophil counts (greater than 1000/microliter) were treated with a double beta-lactam combination of ceftizoxime plus ticarcillin. Fifty-four episodes were microbiologically documented and 27 were clinically documented. The overall response rate was 75% (61 of 81). The response rate in 38 episodes where a single organism was identified was 71%. Polymicrobial infections were associated with a high response rate of 87%. Responses occurred in six of eight Gram-positive and 21 of 30 Gram-negative infections. Pneumonia was the most frequent infection and was associated with a response of 61%. Septicaemia and urinary tract infections also occurred commonly and had response rates of 76% and 89% respectively. All but one organism were susceptible to at least one of the antibiotics. No resistant organisms emerged during therapy. Side-effects included rash (1), phlebitis (3), and coagulation abnormalities without bleeding (3). Four patients developed superinfections (three bacterial, one fungal). The double beta-lactam combination of ceftizoxime plus ticarcillin was safe and effective therapy for infections in non-neutropenic cancer patients.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Drug Therapy, Combination; Female; Fever; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Middle Aged; Neoplasms; Penicillins; Pneumonia; Sepsis; Ticarcillin

Gram-negative bacilli that had been selected for resistance to either ciprofloxacin or ceftizoxime as a result of previous exposure to these agents were inoculated into semipermeable subcutaneous chambers in rabbits, modeling a locally neutropenic closed-space infection. Five resistant organisms, one Serratia marcescens (157) and four Pseudomonas aeruginosa (864, 876, 913, and 915) strains, were selected by previous therapy with ciprofloxacin, and six Pseudomonas strains (833, 845, 864, 876, 913, and 915) were selected by previous therapy with ceftizoxime. Animals were treated with either single antibiotics or combinations of antibiotics for four days, and the response was determined by quantitative bacterial count measurements. The selected (induced) resistance was stable for at least four days, both in vivo and in vitro, but was limited to the antibiotic class of the agent used for induction. Four of five isolates for which resistance had been induced by ciprofloxacin returned to preinduction susceptibility by the eight day of subculture. Organisms that were selected for resistance to ciprofloxacin were successfully treated by a combination of azlocillin and amikacin, and were as sensitive to that regimen as were the parent, uninduced strains. Organisms selected for resistance by pretreatment with ceftizoxime were successfully treated by the combination of ciprofloxacin plus azlocillin, and this regimen was also equally active against the selected strains as it was against the parental isolates. Although selection or induction of resistance is a potential problem with all new potent antimicrobial agents, it appears that infections due to these isolates can still be treated successfully through the use of appropriate combination chemotherapy.

Topics: Amikacin; Animals; Azlocillin; Bacterial Infections; Cefotaxime; Ceftizoxime; Ciprofloxacin; Drug Evaluation, Preclinical; Female; Gram-Negative Bacteria; Penicillin Resistance; Rabbits

Topics: Animals; Animals, Domestic; Bacterial Infections; Cefotaxime; Ceftizoxime; Dogs; Drug Therapy, Combination; Gram-Negative Bacteria; Humans; Keratitis; Male; Metronidazole; Middle Aged; Necrosis

Cefmenoxime (CMX) at a dose of 1 g was administered intravenously to each of 10 patients undergoing thoracotomy, and concentrations of CMX in the serum and pleural fluid were measured. Serum concentration of CMX reached its peak of 43.71 micrograms/ml at 1 hour and decreased to 4.15 micrograms/ml at 3 hours after the administration. The concentration of CMX in the pleural fluid reached its peak of 7.61 micrograms/ml at 3 hours and decreased slowly 5.26 micrograms/ml at 7 hours after the administration. A clinical study with 21 patients was performed to evaluate the effect of CMX as a prophylactic antimicrobial agent in thoracotomy. Patients received intravenous administration of 4 g/day of CMX for 7-10 days following operations. Each patient was evaluated daily for fever, sign of allergic reaction, and wound infection and other symptoms. No apparent infection occurred in those clinical patients except 1 patient with a suspected infection, and 1 case of allergic reaction as exanthema was observed during this study. Prophylactic effect of CMX against postoperative infection after thoracotomy was good.

Topics: Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Drug Evaluation; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pleural Effusion; Pneumothorax; Postoperative Complications; Premedication; Thoracic Surgery

The concentrations of tobramycin (TOB) or cefmenoxime (CMX) in serum and burn blister fluid of 51 burn patients (21 for TOB, 30 for CMX) after an i.v. or i.m. injection were determined to find the optimal administration of TOB (2 mg/kg) or CMX (50 mg/kg). Among the various protocols tested, we found from the values of tAUC for TOB that a bolus i.v. injection, or 1-h drip infusion, or i.m. injection are recommended for systemic sepsis, however, the 1-h drip infusion is strongly suggested for treating wound surface infection. It has also been found that with CMX a bolus i.v. injection with a long period of efficacy is recommended for treating systemic sepsis, while a 1-h drip infusion or bolus i.v. injection was the best method for treating wound-surface infection.

Topics: Adult; Aged; Bacterial Infections; Burns; Cefmenoxime; Cefotaxime; Female; Humans; Infusions, Parenteral; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Tobramycin

Topics: Animals; Animals, Newborn; Bacterial Infections; Cefotaxime; Female; Horse Diseases; Horses; Male; Meningitis; Sepsis

Pharmacokinetic and clinical studies on cefotaxime (CTX) in plastic and reconstructive surgery field were carried out. The results obtained are summarized as follows. Two grams of CTX was administered intravenously by single bolus injection to each of 4 patients with burn blisters and mean levels of CTX concentration in blister exudates were investigated. Thirty minutes after administration, the mean level of CTX in the exudates was 3.90 micrograms/ml and it reached a peak of 9.81 micrograms/ml in 2 hours. The clinical efficacy rate for 30 patients with burn infections and postoperative infections was 73.3%, and the efficacy rate for 29 patients in prophylactic use was 72.4%. A side effect (eruption) and abnormal laboratory findings were observed in each one case out of 59. From the above results, CTX may be considered to be useful in plastic and reconstructive surgical treatments.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Burns; Cefotaxime; Child; Drug Resistance, Microbial; Exudates and Transudates; Female; Humans; Kinetics; Male; Middle Aged; Postoperative Complications; Surgery, Plastic

Topics: Bacterial Infections; Cefotaxime; Child; Child, Preschool; Gram-Negative Bacteria; Humans; Infant; Infant, Newborn; Meningitis

Cefodizime was compared with cefotaxime (CTX) in regard to its distribution to an inflammatory site (exudate in croton oil-induced granuloma pouch) of rats and its therapeutic effects on experimental infections in such pouches after intravenous injection. Cefodizime levels in rat serum and pouch exudate were higher than those of CTX, and the former compound disappeared from the serum and pouch exudate far more slowly than the latter. In the tests for therapeutic effects, cefodizime showed almost the same degree of inhibitory activity as CTX against growth in pouch exudate of Escherichia coli Ec-7, Proteus mirabilis Pm-428, and Serratia marcescens Sm-390 for which the minimum inhibitory concentrations (MICs) of cefodizime were equal to or greater than the CTX values, and such activity of cefodizime lasted for a longer period than that of CTX. These results suggest that the above pharmacokinetic features of cefodizime compensate for its MICs against organisms displaying lower values for CTX.

Topics: Animals; Bacterial Infections; Cefotaxime; Croton Oil; Exudates and Transudates; Granuloma; Male; Microbial Sensitivity Tests; Rats

Topics: Bacterial Infections; Cefotaxime; Cholecystectomy; Female; Humans; Male; Premedication; Risk; Time Factors

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Humans; Infant; Infant, Newborn; Meningitis; Meningitis, Haemophilus; Meningitis, Listeria; Meningitis, Meningococcal; Meningitis, Pneumococcal

Topics: Bacterial Infections; Cefotaxime; Child, Preschool; Humans; Infant; Infant, Newborn; Meningitis; Suppuration

The pharmacokinetic and chemotherapeutic properties of the new penem antibiotic HRE 664 (Fig. 1) were evaluated in experimental animals. High and sustained blood and serum levels were achieved following parenteral injection in mice, rats, dogs and monkeys. Half-lives ranged from 27 to 40 minutes in the various species tested. The antibiotic was well distributed in the rodents and penetrated well into tissues and body fluids. At 30 minutes after subcutaneous administration to mice (50 mg/kg), concentrations of between 12.4 and 35.9 micrograms/g were measured in the lungs, liver, heart and kidneys, that is 33 approximately 95% of the corresponding level in murine blood (37.7 micrograms/ml). In experimentally induced infections in mice, HRE 664 displayed good chemotherapeutic activity particularly against septicemias caused by methicillin-sensitive and methicillin-resistant Staphylococcus aureus strains and on abscess formation induced by Bacteroides fragilis. Most of the cephalosporins and other beta-lactam antibiotics exhibited low efficacy against these strains of bacteria.

Topics: Abscess; Animals; Anti-Bacterial Agents; Bacterial Infections; Biological Assay; Cefotaxime; Dogs; Lactams; Macaca; Mice; Rats

Ten patients (two with normal, eight with impaired renal function) on their usual diet were treated with cefodizime (HR 221) for seven days. The dosage was 4 g/day, adapted to renal function as appropriate. Platelet function, plasma coagulation and vitamin K metabolism were investigated before and on day 7 of therapy. Platelet function and plasma coagulation remained unchanged, regardless of the size of the serum antibiotic trough levels, in both normal and impaired renal function. Vitamin K1 metabolism remained unaffected, since no increase in vitamin K1 2,3 epoxide in the circulation was observed during the therapy. Cefodizime (HR 221), a parenteral aminothiazole cephalosporin, does not affect hemostasis.

Topics: Adult; Aged; Bacterial Infections; Bleeding Time; Blood Coagulation; Cefotaxime; Chemical Phenomena; Chemistry; Female; Hemostasis; Humans; Kidney Diseases; Male; Middle Aged; Platelet Aggregation; Platelet Count; Vitamin K

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Meningitis

In 1982, the antibiotic treatment policy for suspected sepsis in neonates admitted to the Southampton special care baby unit was changed from intravenous gentamicin plus penicillin to intravenous cefotaxime with or without penicillin. Analysis of blood culture results during the first 2 years following the change indicates that a higher proportion of blood culture isolates showed sensitivity to cefotaxime compared with gentamicin. Only one baby died with proven bacterial sepsis and this was not thought to be due to treatment failure. Our data suggest that, on our unit, cefotaxime is a suitable alternative to the aminoglycosides for the management of suspected sepsis in the newborn.

Topics: Bacterial Infections; Blood; Cefotaxime; Drug Therapy, Combination; Gentamicins; Humans; Infant, Newborn; Penicillins; Retrospective Studies

The in-vitro activity of ciprofloxacin, a new quinolone derivative, was determined by broth microdilution for 518 clinical isolates. The MICs for 90% of the organisms were 2 mg/l for Pseudomonas aeruginosa, 8 mg/l for P. maltophilia, 4 mg/l for other Pseudomonas spp., 1 mg/l for Acinetobacter anitratus, 0.03-0.5 mg/l for differing species of Enterobacteriaceae, 2 mg/l for Streptococcus faecalis, 0.25 mg/l for coagulase-negative Staphylococcus spp. and 2 mg/l for S. aureus. Furthermore, on a weight basis, the activity of ciprofloxacin was equivalent or superior to that of cefotaxime, ceftazidime, gentamicin, imipenem, latamoxef, piperacillin, oxacillin and vancomycin. In general, ciprofloxacin appears to be highly active against organisms resistant to many broad spectrum antimicrobials, including norfloxacin, gentamicin, cefotaxime, and ceftazidime, with MICs for 90% of organisms in the range of 0.03 to 16 mg/l.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftazidime; Ciprofloxacin; Drug Resistance, Microbial; Enterobacteriaceae; Gentamicins; Humans; Microbial Sensitivity Tests; Norfloxacin; Quinolines

Ceftizoxime (CZX) was given in daily doses of 4 approximately 6 g by intravenous drip infusion to 30 patients with infection accompanying lung cancer to investigate the usefulness of the drug for infectious disease: The rate of effectiveness (marked and moderate) was 73.3% (22/30 patients). Of the 30 patients, 2 had drug fever; 1, arthralgia; and 1, eosinophilia. These side effects improved after the drug was withdrawn. CZX is a very useful antibiotic with high effectiveness and safety in immunocompromised patients with infection accompanying advanced lung cancer.

Topics: Adenoma; Adult; Aged; Bacterial Infections; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Cefotaxime; Ceftizoxime; Female; Fever; Humans; Lung Neoplasms; Male; Middle Aged; Pneumonia; Pyelitis; Respiratory Tract Infections

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Cefotiam; Ceftizoxime; Cephalosporins; Female; Humans; Lung Diseases; Male; Middle Aged; Pneumonia; Suppuration

The wide spectrum of antibacterial activity of cefmenoxime as well as its resistance to beta-lactamase degradation, confers upon this drug a probable efficacy in the treatment of common respiratory infections. The objective of this study was to evaluate the penetration of cefmenoxime into bronchial secretions taken in patients, mostly with chronically superinfected bronchial pathology. Bronchial samples were collected by means of fiber-optic bronchoscopy; simultaneous serum samples were also taken after bolus intravenous injection of 1 g of cefmenoxime, after a single dose in 12 patients (group I); after multiple doses in 12 patients (group II). Concentrations of cefmenoxime were determined by means of microbiological procedure. The results showed: bronchial kinetics of cefmenoxime similar to those of other cephalosporins studied previously; after multiple doses a bronchial steady state with a slow decrease of bronchial levels as a function of time; no difference between levels measured after single or multiple doses; a ratio between bronchial levels (B) and simultaneous serum (S) levels (B/S, %) of about 10% at the 2nd hour, 20% at the 4th hour. Due to the extremely low MICs for most bacteria responsible for respiratory infections, cefmenoxime might be expected as the drug of choice in the treatment of bronchopulmonary infections.

Topics: Bacterial Infections; Bronchi; Bronchial Diseases; Cefmenoxime; Cefotaxime; Diffusion; Drug Administration Schedule; Exudates and Transudates; Humans; Injections, Intravenous; Kinetics; Time Factors

Twenty patients who were performed pulmonary resection for the disease of the lung were administered 2 g of cefmenoxime (CMX) intravenously during the operation. The CMX levels in serum, lung tissue and thoracic muscle were measured by agar-well technique. The CMX levels in lung tissue and thoracic muscle were higher than the MIC80 of CMX for Klebsiella pneumoniae, Haemophilus influenzae and Streptococcus pneumoniae which were commonly as isolated causative organisms from the patients with pulmonary infection. These results indicate that CMX will be useful agent for the prevention and treatment of pulmonary infection.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Humans; Injections, Intravenous; Kinetics; Lung; Lung Diseases; Male; Middle Aged; Pectoralis Muscles; Postoperative Complications

Cefotiam (CTM) in a dose of 2 g was given by intravenous bolus injection to 16 patients with breast cancer operated upon radical mastectomy with suction drainage. The materials of exudate from drain were taken at intervals by sterilized paper disc and determined by the paper disc method with Proteus mirabilis ATCC 21100 as the test organism to CTM concentrations. CTM concentrations in exudate from suction drain of patients increased quickly after intravenous injection, and reached to peak early time on 2 to 3 days after operation. While on 6 days after operation, the CTM concentrations were comparatively lower and reached to peak at 2 approximately 3 hours after injection. The CTM concentrations in exudate exceed the antibacterial levels of CTM and are thought to be sufficient to produce prophylactic effects in the operation.

Topics: Adult; Aged; Bacterial Infections; Breast; Breast Neoplasms; Cefotaxime; Cefotiam; Exudates and Transudates; Female; Humans; Injections, Intravenous; Kinetics; Mastectomy; Middle Aged; Suction; Surgical Wound Infection

Concentrations of cefmenoxime (CMX) in serum and tissue were determined in surgical patients with chronic sinusitis, maxillary cyst or chronic tonsillitis. CMX was intravenously administered in a dose of 1 gram. Thirty minutes after the administration, patients were operated under local anesthesia. Concentrations of CMX in tissues were determined 1 hour after administration, and were 15.8 micrograms/g and 20.3 micrograms/g in mucous membrane of maxillary sinus and maxillary cyst. CMX was not detectable in tonsils of 8 patients out of 11 examined. An examination of MIC against various bacteria isolated from sinus pus and pharyngeal swab indicated that CMX was effective enough to produce a prophylactic effect against otolaryngo-infections.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Diseases; Surgical Wound Infection; Tissue Distribution

Cefotiam (CTM) and cefmenoxime (CMX) were studied for their serum concentrations and transference into bile in patients with PTCD or T-tube. One gram of CTM or either 1 g or 2 g of CMX was administered by an intravenous drip infusion for over 30 minutes. These drugs were also studied for their serum concentrations, bile concentrations, and tissue concentrations in the walls of the gallbladder of patients operated on for cholelithiasis. Intravenous drip infusion (over 30 minutes) was used to administer 1 g of CTM or 1 g or 2 g CMX immediately before surgery. Both CTM and CMX were readily transferred into bile. Their bile concentrations, however, varied greatly among patients, and extremely low levels were detected in some patients. A crossover analysis of concentrations of CMX in bile of patients given doses of 1 g and 2 g revealed a dose-response relationship. The crossover analysis of drug concentrations in bile of patients given CTM and CMX showed that CMX is transferred more readily to bile. The relationship between liver functions and drug transfer to bile was examined by plotting the total bilirubin level against drug concentrations in bile. The plots formed an exponential curve with a correlation coefficient (r) being -0.52 in cases when each subjects received 1 g of CTM and -0.72 in cases when each subjects received 1 g of CMX. A study of 3 patients given CMX at a dose of 1 g suggested that bile levels of CMX may be correlated to ICG. Concentrations of CTM and CMX in tissues of the gallbladder wall were fairly high, with unexpectedly small variance among patients. Even in patients with low bile concentrations of these drugs, drug levels in the tissues of the gallbladder wall were high. Drug levels in the noninflammatory tissues were higher than those in inflammatory lesions. The above findings suggest that CTM should be the antibiotic of choice for patients with ordinary biliary tract infections and after the surgery of the liver and biliary tract system, while CMX should be the antibiotic of choice for patients with severe biliary tract infections, and for compromised hosts after the surgery of the liver and biliary tract system.

Topics: Aged; Bacterial Infections; Bile; Cefmenoxime; Cefotaxime; Cefotiam; Cholelithiasis; Female; Gallbladder; Humans; Male; Middle Aged; Surgical Wound Infection

Seventy-one patients with severe infections associated with hematologic disorders including leukemia, lymphoma and aplastic anemia were treated with ceftizoxime (CZX) in daily doses of 4-6 g for an average of 20.1 days. Infections associated with hematologic disorders consisted of sepsis and pneumonia, and most of the causative organisms appeared to be Gram-negative bacteria. Of the 64 patients who completed the trial, excellent response was observed in 16 and moderate response in 26. The rate of clinical effectiveness was 65.6%. Side effects observed during the treatment included skin rash in only 1 patient, and hepatic disorders in 6 patients. However, the relationship between CZX and these abnormal findings was not established. These results indicate that CZX is a therapeutically effective and safe antibiotic for the treatment of severe infections associated with hematologic disorders.

Topics: Adult; Aged; Anemia, Aplastic; Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Hematologic Diseases; Humans; Leukemia; Lymphoma; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bronchitis; Cefotaxime; Cefotiam; Female; Humans; Male; Middle Aged; Pneumonia

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

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

Ceftizoxime (CZX) were administered and tested for the efficacy and safety in 80 elderly patients who were older than 65 years of age with infections. The sensitivity of bacteria found in these infections to CZX was examined before the administration of the drug. Serum concentrations and the rate of urinary output of the drug were examined in 3 cases. The clinical effect of CZX was as follows: 29 cases (36.3%) of excellent effectiveness and 31 cases (38.8%) showed moderate effectiveness. The patients were divided into 2 groups depending on the presence or the absence of other diseases in their backgrounds. Effectiveness of CZX for patients with and without other diseases were 74.0% and 85.7%, respectively. The effectiveness of CZX in patients with other diseases in their background was lower than the group without other diseases. Other antibiotics were used in 16 cases before the use of CZX. The effectiveness of CZX for these patients was 62.5%. Infecting bacteria were detected in a total of 46 cases (19 cases of respiratory infections and 27 cases of urinary tract infections). Among the respiratory cases, 8 were due to Gram-positive bacteria and 11 were due to Gram-negative bacteria. No Gram-positive organisms were detected from urinary tract infections, which were all due to Gram-negative bacteria. Sensitivities of isolates of these infecting bacteria to CZX were very sensitive 3 isolates, sensitive (++) 8 and slightly sensitive (+) 1 isolate. It was found that CZX was effective against 39 of 46 cases from which causative organisms were identified. The effectiveness ratio was 84.8%. Serum concentration of CZX was determined after a drip injection of 1 g CZX for 1 hour. The half-lives of CZX in plasma in healthy subjects and aged patients were 1.33 hours and 2.15 hours, respectively. The rate of urinary output of CZX during 6 hours after the injection was 76.4% in healthy subjects. Delayed urinary output which was 58.2% during 7 hours after injection was observed in aged patients. Fever in 1 patient and eosinophilia in 3 cases were observed after administration of CZX.

Topics: Age Factors; Aged; Aged, 80 and over; Bacteria; Bacterial Infections; Biliary Tract Diseases; Cefotaxime; Ceftizoxime; Female; Humans; Kinetics; Male; Respiratory Tract Infections; Urinary Tract Infections

Seven neonates and young infants were treated with cefotiam (CTM) in doses ranging from 8-25.6 mg/kg every 6 to 24 hours for 1 to 14 days, and the clinical efficacy and side effects were evaluated. Among 5 infants with bacterial infections including bacteremia, perianal abscess, pneumonia, urinary tract infection and probable sepsis and meningitis, clinical responses were excellent in 1 and good in 4 patients. In the 7 patients, no side effect attributable to CTM was observed. Serum concentrations of CTM were measured in 5 patients administered with 10 to 20 mg/kg of CTM by bolus intravenous injection. Peak serum concentrations of 21.9 to 38.0 micrograms/ml were noted in samples taken at 15 minutes after injection. Serum half-lives of the drug were 2.35 hours in 2 day-old neonate, 0.72 to 0.85 hours in 3 infants of 25 to 37 days, and 8.46 hours in an 18 day-old neonate with renal insufficiency.

Topics: Bacterial Infections; Cefotaxime; Cefotiam; Female; Half-Life; Humans; Infant; Infant, Newborn; Injections, Intravenous; Kinetics; Male; Meningitis; Urinary Tract Infections

Cefotiam (CTM) was given to 25 mature and premature infants, ranging in age from 0 to 24 days, who have various nearly-healed bacterial infections. CTM was administered at the dose of 10 mg/kg by intravenous injections or by 1-hour intravenous drip infusions, or at the dose of 20 mg/kg by intravenous injections. Only a small number of subjects being examined, they were divided by their aged day into 3 groups; 0-3 days old, 4-7 days old and 8-24 days old. We compared the time courses of changes in serum and urine levels of CTM in these groups. The clinical study was done with 8 male and 4 female infants ranging in age from 3 days to 4 months. One had septicemia, 4 had bronchopneumonia, 3 had urinary tract infection, 1 had colitis, 2 had abscess, and 1 had maxillary sinusitis. Changes in serum and urinary levels of CTM Changes in serum levels after 10 mg/kg intravenous injection. Peak serum CTM levels of all 3 groups were achieved at 30 minutes after administration; the levels were between 11.7 and 23.6 micrograms/ml; and differences were not significant. Serum levels then gradually decreased in all the groups to 0.5-7.0 micrograms/ml at 6 hours after administration. Half-lives of serum CTM levels tended to be shorter in older infants; means were 2.7, 2.2 and 1.3 hours for the 0-3 day-old, the 4-7 day-old and the 8-24 day-old respectively. Changes in serum levels of CTM after 10 mg/kg 1-hour intravenous drip infusion. The 0-3 day-old and the 4-7 day-old had peak serum CTM levels, ranging from 16.3 to 35.8 micrograms/ml, at the end of drip infusion. Half-lives of serum CTM levels tended to be shorter in older infants, with 3.2 hours for the 0-3 day-old and 2.0 hours for the 4-7 day-old groups. Changes in serum levels after 20 mg/kg intravenous injection. The 0-3 day-old and the 4-7 day-old had peak serum levels, ranging from 30.6 to 42.1 micrograms/ml, at 30 minutes after administration, then serum levels of CTM in either group showed a gradual decrease to 2.5-11.4 micrograms/ml at 6 hours after injection.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacterial Infections; Bronchopneumonia; Cefotaxime; Cefotiam; Female; Humans; Infant, Newborn; Infant, Premature; Infusions, Intravenous; Kinetics; Male; Urinary Tract Infections

Intravenous drip infusion (d.i.) of cefotiam (CTM) in neonates and infants produced the following pharmacokinetic and clinical results: In a 2 and 3 day-old neonates group, blood concentrations at 1 and 5 hours after intravenous drip infusion of 20 mg/kg of CTM were 33.0 micrograms/ml and 12.3 micrograms/ml, respectively. Thus high blood CTM levels were maintained in these cases. In a 4 day-old neonate, blood concentrations after 1 and 6 hours were 20.5 micrograms/ml and 5.8 micrograms/ml. respectively. In a 8-13 day-old neonates group, blood levels after 1 and 6 hours were 12.2-18.5 micrograms/ml and 0.7-2.4 micrograms/ml, respectively. Compared to the corresponding values in the 2 and 3 day-old neonates, the blood CTM levels in this group were low. Half-lives of CTM in the blood were 1.8-2.7 hours, 2.1 hours, 1.1-1.7 hours and 0.7 hour, in 2-3 day-old neonates, 4 day-old neonate, 8-13 day-old neonates and a 45 day-old infant, respectively. Half-lives tended to become shorter with increasing age. The 6-hour urinary recoveries ranged between 20.3 and 62.3%. Transport of the drug into the spinal fluid was also observed. The CTM was very effective in the treatment of 6 patients suffering from suppurative meningitis, septicemia, bronchopneumonia or UTI with ampicillin-resistant E. coli. The daily dose ranged between 41 and 175 mg/kg. The duration of the treatment was 5 to 18 days, with total doses of 0.72 to 16.25 g. In only one case, a transient eosinophilia was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Cefotaxime; Cefotiam; Cerebrospinal Fluid; Female; Half-Life; Humans; Infant; Infant, Newborn; Infusions, Intravenous; Kinetics; Male; Meningitis; Urinary Tract Infections

Using cefotiam (CTM) against infections in neonates and premature infants, we obtained the following results: With intravenous administration of the drug to 2 cases each of pyoderma, pneumonia, and fetal infection, the drug was effective in all the cases except in 1 premature infant with pneumonia. Dose levels at individual injections were between 18.6 and 27.8 mg/kg, per dose, with an exception in 1 case of pyoderma (36.4-54.5 mg/kg), and 2 to 4 doses per day were given to each patient. For prophylactic purposes, the drug was administered to 1 case of turbid amniotic fluid and 3 cases of massive aspiration syndrome, and no infection was observed in any case. In a total of 11 cases consisting of the above mentioned 10 cases and an additional case which had been excluded from the evaluation because of the detection of P. aeruginosa, neither side effects nor abnormal laboratory values were recognized. In 5 cases of 4 to 31-day old infants, CTM concentrations in blood were measured after one-time intravenous injection of the drug at a dose level of about 20 mg/kg. Blood concentrations of CTM were low in 1 case with levels of 14.4 and 4.5 micrograms/ml at 30 minutes and 2 hours after the intravenous injection, respectively, whereas they were high in another case with readings of 82 and 65 micrograms/ml. In the remaining 3 cases, however, 30-minute and 2-hour values were between 41 to 52, and 13.5 to 22.8 micrograms/ml, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Premature; Male; Pneumonia; Pyoderma

Ninety nine patients with leukemia and/or related disorders were treated with cefmenoxime (CMX). Among them, 77 patients had severe infections, while other 22 patients did not suffer from infection, but it was expected that they would fall into serious conditions if they were infected. Sixty of the 77 patients who had severe infection were used in the evaluation of effectiveness. The remaining 17 patients were not evaluated because they were subjected to combined treatments of CMX and other therapeutic agents such as other antibiotics, gamma-globulin or interferon. Excellent responses were found in 26 (43.3%) patients and good responses in 12 (20.0%) patients. In total, the rate of effectiveness was 63.3%. Nineteen of the 22 patients who were treated prophylactically with CMX were used in the evaluation of effectiveness, while 3 patients were excluded from the evaluation because peripheral neutrophils were counted to be more than 1,000/mm3 before CMX was administrated, although these 3 patients were used in the final evaluation to examine side effects. In the prophylactic treatment, the rate of effectiveness was 89.5%. The side effects were seen in 4 patients (4/82:4.9%). A different symptom was identified in each patient. These symptoms were skin rash, mild nausea, mild diarrhea and slight elevation of serum bilirubin. Prompt improvements of these symptoms occurred as soon as CMX administration was stopped. These results show that CMX is a therapeutically effective and safe antibiotics for the treatment of severe infections or for the prophylaxis of infections in patients associated with leukemia and/or related disorders.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Humans; Leukemia; Leukemia, Myeloid, Acute; Lymphoma; Male; Middle Aged; Sepsis

Cefotiam (CTM) was administered to 37 cases of cesarean section and 29 cases of total abdominal hysterectomy for prophylactic purposes. Group I was given the agent at a total dose of 14 g (postoperatively 4, 4, 2, 2 and 2 g), group II at a total dose of 10 g (postoperatively 2, 2, 2, 2 and 2 g) and group III at a total dose of 10 g (2 g during operation and postoperatively 2, 2, 2 and 2 g). When fever indices between the groups were compared, group III showed the lowest level of fever index regardless the type of operation. When the results of laboratory test (WBC, CRP, ESR) between the groups were compared, no significant differences were observed, but group III tended to show lower values than others. No side effects due to CTM were noted. The above results indicate that the administration of CTM during operation was the most effective for protection against postoperative infections in terms of changes in fever index and laboratory test values.

Topics: Adult; Bacterial Infections; Cefotaxime; Cefotiam; Cesarean Section; Female; Humans; Hysterectomy; Postoperative Complications; Pregnancy; Premedication

Cefazolin (CEZ) and ceftizoxime (CZX) were administered prophylactically to prevent postoperative infections after cesarean section and abdominal simple panhysterectomy, common obstetrical/gynecological procedures. The results were summarized as follows. Total fever indices in cesarean sections for the 2 drug groups were examined and CEZ (n = 8) and CZX (n = 10) indices were found to be 6.0 +/- 3.67 degree hours and 3.6 +/- 1.16 degree hours, respectively. In abdominal simple panhysterectomies, CEZ (n = 11) and CZX (n = 11) indices were 8.15 +/- 5.17 degree hours and 4.26 +/- 2.24 degree hours, respectively. Further, there was a lower daily fever index with CZX than with CEZ in both operation groups. Counts of WBC in both procedure groups were lowest on the 5th postoperative day in the CZX group, so was for the CRP. As for the ESR, the CEZ group was much higher than the CZX group especially in abdominal simple panhysterectomies. Neither subjective/objective side effects nor abnormal laboratory findings were observed in either CEZ or CZX group of patients.

Topics: Adult; Bacterial Infections; Cefazolin; Cefotaxime; Ceftizoxime; Cesarean Section; Female; Humans; Hysterectomy; Middle Aged; Postoperative Complications; Pregnancy; Premedication

Topics: Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Humans; Male; Respiratory Tract Infections; Urinary Tract Infections

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

Infected patients with hematological disorders were treated with the combination of cefmenoxime (CMX) and cefsulodin (CFS). This therapy was done on 74 patients, of whom 38 (51%) had acute myelocytic leukemia, 14 (19%) malignant lymphoma, 7 (9%) acute lymphocytic leukemia, 5 aplastic anemia, 4 adult T cell leukemia, 4 chronic myelocytic leukemia, 1 multiple myeloma and 1 histiocytic medullary reticulosis. Complicated infections included 5 cases of septicemia, 41 cases of suspected septicemia, 19 cases of respiratory tract infection, 2 with anal abscess, 1 with urinary tract infection and others. The obtained results were as follows: Clinical effectiveness of the combination therapy was excellent in 17 cases (23.0%), good in 24 (32.4%) and poor in 33 (44.6%). Total clinical efficacy rate was 55.4%. Clinical efficacy rate was 40% against septicemias, 51.2% against suspected septicemias and 57.9% against respiratory tract infections. Causative pathogens were isolated in only 21 cases (28.4%): Gram-positive bacteria in 9 cases, Gram-negative bacteria in 11 and fungus in 1. About half of the Gram-negative bacteria belonged to Pseudomonas sp. The efficacy rate of this combination therapy against Gram-negative bacterial infections was 72.7% but the rate against Gram-positive bacterial infections were only 33.3%. Only in 1 case, this combination therapy was discontinued because of drug eruption. Abnormal laboratory findings were observed in 5 cases: Elevation of BUN in 3, GOT and GPT in 1 and prolongation of activated partial thromboplastin time in 1. In conclusion, this combination therapy of CMX and CFS is useful and safe against infections complicated by hematological disorders.

Topics: Adolescent; Adult; Aged; Anemia, Aplastic; Bacterial Infections; Cefmenoxime; Cefotaxime; Cefsulodin; Drug Therapy, Combination; Female; Hematologic Diseases; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Lymphoma; Male; Middle Aged; T-Lymphocytes

Information on 62 bacteriologically confirmed cases of bacterial meningitis treated with cefotaxime in this country was obtained retrospectively from infectious disease consultants. This series of cases differed markedly from the world cumulative case data thus far presented. One of the two most common organisms treated was the pneumococcus (allergy to penicillin or misdiagnosis of the Gram stain results were the major reasons given). The other organism was Klebsiella. Unanticipated bacteriologic successes were noted in two cases of staphylococcal meningitis secondary to parameningeal foci. The bacteriologic cure rate and survival rate were about 85 percent. Failure of monotherapy was seen in one case of Pseudomonas meningitis, as well as in three of five cases of Enterobacter meningitis. In addition, two cases of Escherichia coli meningitis in which moxalactam therapy inexplicably failed were cured with cefotaxime. Close analysis of killing kinetics appeared to explain the Enterobacter and E. coli failures. Thus, overall not all gram-negative species and not all isolates of any particular species that cause meningitis can be successfully treated by cephalosporins. Data obtained during the investigative trials do not appear to be entirely predicative of what occurred during the free clinical use of an antibiotic. Post-investigatory follow-up and surveillance of all newly introduced therapeutic agents are needed.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Escherichia coli; Escherichia coli Infections; Humans; Infant, Newborn; Klebsiella Infections; Male; Meningitis; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Middle Aged; Moxalactam

Cefotiam (CTM) is a new cephalosporin with a broad spectrum of activity against both Gram-positive and Gram-negative microorganisms. Cephalosporins are widely used for prophylaxis of infections in patients undergoing thoracotomy. Augmentation by serrapeptase on tissue permeation of CTM was examined in 35 thoracotomy patients with lung cancer. The subjects were divided into two groups according to the method of the administration of CTM. Group I consisted of 17 subjects, each of whom received a single dose of 2 g of CTM alone by an instillation for 30 minutes. Group II consisted of 18 subjects, each of whom received a combination of CTM and serrapeptase; serrapeptase was given 2 tablets (10 mg) each time for three times/day until the day before surgery, and then CTM was administered by the same procedure. The following results were obtained: Individual difference was observed for the permeation of CTM into tissues. Pathologic differences also affected the permeation. Nevertheless, the CTM levels in pulmonary tissues reached about a half of those in the blood in both the single dose group and the combination group, hence sufficient concentrations exceeding MIC80 for main microorganisms that caused infections in the lung were obtained. The concentrations of CTM in inflammatory tissues have showed lower levels than those of normal tissues in both CTM single dose and the combination groups. Decrease of blood flow volume may have contributed to the reduction in levels of CTM in the inflammatory tissues. The ratio of the concentration of the drug in pulmonary tissues to that in the blood was 29.1 +/- 2.5% in the single dose group, and 44.2 +/- 6.0% in the combination group, the latter showing quite a significant increase (P less than 0.05). Combined administrations of CTM and serrapeptase deserves more trials in the case when surgical treatments of the lung are performed. An antiinflammatory effect of serrapeptase in the respiratory system is expected, and in addition, the combined use of CTM and serrapeptase should stimulate permeation of the antibiotic into tissues.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Therapy, Combination; Female; Humans; Lung; Male; Middle Aged; Peptide Hydrolases; Stimulation, Chemical; Surgical Wound Infection

Peritonitis remains the main complication of CAPD. This study demonstrates that most cases can be successfully treated with cefotiam. In 17 patients under CAPD, 33 cases of bacterial peritonitis were observed, with clinical manifestations in 28. The mean cell count in peritoneal dialysis fluid was 2 820/mm3, with 2 200/mm3 polymorphonuclear leukocytes. Causative pathogens were Staphylococcus in 18 cases, Streptococcus in 4, Stomatococcus mucilaginous in 1, Corynebacterium J.K. in 1, Enterobacter in 3, Acinetobacter in 3 and Pseudomonas in 2. Two cultures were negative. First choice treatment was a daily intraperitoneal injection of 1 g cefotiam. 68.80% of patients recovered within 6 days. Failures were due to a methicillin-resistant Staphylococcus epidermidis in 3 cases, a relapsing Stomatococcus mucilaginous infection in 1, a Streptococcus faecalis in 1, an Acinetobacter in 3 and a Pseudomonas in 2. Mean cefotiam concentrations 24 hours after the intraperitoneal injection were 9.4 +/- 7.0 micrograms/ml (range 1.3-26.4 micrograms/ml) in serum and 3.4 +/- 3.3 micrograms/ml (range 0.4-12.2 micrograms/ml) in dialysate. These concentrations are greater than most of cefotiam's MICs for susceptible bacteria, a finding that confirms the value of treatment with a single daily intraperitoneal injection of cefotiam.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Resistance, Microbial; Female; Humans; Injections, Intraperitoneal; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recurrence

BMY-28142, 7-[(Z)-2-(2-aminothiazol-4-yl)-2-methoxyiminoacetamido]-3- (1-methylpyrrolidinio)methyl-3-cephem-4-carboxylate, exhibited a well-balanced, extended-spectrum of antibacterial activity both in vitro and in vivo. Against Staphylococci and Streptococci, BMY-28142 was about four to ten times more active than ceftazidime and comparable to cefotaxime. Most Enterobacteriaceae were more susceptible to BMY-28142 than to ceftazidime, though strains of Pseudomonas aeruginosa were slightly more sensitive to ceftazidime. BMY-28142 showed potent activity against Gram-negative bacteria resistant to ceftazidime and/or cefotaxime. Bactericidal activity of BMY-28142 against 10 strains of P. aeruginosa was superior to that of ceftazidime. In bacterial infection models in mice, BMY-28142 was more effective than ceftazidime against three Gram-positive and three Gram-negative pathogens. The anti-pseudomonal in vivo activity of BMY-28142 was nearly comparable to that of ceftazidime. The blood levels and urinary excretion rates of BMY-28142 in mice were similar to those of ceftazidime.

Topics: Animals; Bacterial Infections; Cefepime; Cefotaxime; Ceftazidime; Cephalosporins; Chemical Phenomena; Chemistry; Male; Mice; Microbial Sensitivity Tests; Penicillin Resistance

The effect of cefotiam (CTM) on neonates and premature infants was examined in basic and clinical studies. Minimum inhibitory concentrations of CTM against 190 clinically isolated strains kept by this department were investigated. This drug was found to have a strong antibacterial effect against Escherichia coli, Klebsiella spp., Proteus mirabilis and Streptococcus agalactiae, Staphylococcus aureus and Staphylococcus epidermidis, although some strains were resistant. The CTM was given to 0-3, 4-7, and greater than or equal to 8 day-old premature infants and neonates by intravenous injection at the dose of 20 mg/kg, and we studied changes in serum CTM levels over time. Mean serum CTM levels were 62.3 micrograms/ml at 15 minutes and 16.4 micrograms/ml at 6 hours after the injection, with the half-life of 3.6 hours, for the 0-3 day-old premature infants. They were 38.5 micrograms/ml at 15 minutes and 10.1 micrograms/ml at 6 hours, with the half-life of 2.9 hours, for the 0-3 day-old neonates. Those levels were 22.5 micrograms/ml at 15 minutes and 2.9 micrograms/ml at 6 hours, with the half-life of 1.9 hours, for the 4-7 day-old neonates, and 51.8 micrograms/ml at 15 minutes and 1.0 micrograms/ml at 6 hours, with the half-life of 1.1 hours, for the greater than or equal to 8 day-old neonates. The CTM was given to 0-3 and greater than or equal to 8 day-old premature infants and neonates by 1-hour intravenous drip infusion at the dose of 20 mg/kg, and changes in serum CTM levels after the infusion were followed. The 0-3 day-old premature infant (there was only one subject) had a peak serum CTM level of 21.0 micrograms/ml 1 hour after the start of the infusion (that is, at the time of its completion), with the level decreased to 8.6 micrograms/ml at 7 hours and the half-life was 5.4 hours. The mean peak serum CTM level in 0-3 day-old neonates were 36.7 micrograms/ml at 1 hour, which decreased to a mean of 7.0 micrograms/ml at 7 hours; the half-life was 2.3 hours.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacterial Infections; Cefotaxime; Cefotiam; Drug Resistance, Microbial; Escherichia coli; Female; Half-Life; Humans; Infant; Infant, Newborn; Infant, Premature; Infusions, Intravenous; Injections, Intravenous; Male; Streptococcus agalactiae

Excretion of an antibiotic bile may result in high intraintestinal concentrations and thus alteration in the fecal flora. We investigated the effect of ceftriaxone (45% biliary excretion) and cefotaxime (less than 5% biliary excretion) on the aerobic fecal flora. Ceftriaxone eradicated susceptible enteric organisms and resulted in overgrowth of Candida spp. and resistant enterococci. In some patients multiresistant gram negative bacteria appeared during of after therapy. Cefotaxime had a moderate effect on fecal microecology and did not promote the emergence of resistant organisms.

Topics: Bacteria; Bacterial Infections; Bile; Cefotaxime; Ceftriaxone; Child; Drug Resistance, Microbial; Feces; Humans

Topics: Bacterial Infections; Cefotaxime; Humans

Mortality due to serious infections is significantly higher among elderly patients than among younger patients. This differential is particularly striking in some subsets of patients; for example, the mortality rate among older patients with afebrile bacteremia is 65 percent, compared with 25 to 35 percent in younger patients. Although serious underlying disease is an important reason for older patients' difficulties with infection, other problems of these patients include a tendency to deny the presence of disease and some obstacles to interaction with the health care system. Older patients with infection are less likely to present with typical symptoms, which makes early recognition difficult for physicians. For example, typical findings of sepsis (mental obtundation, tachycardia, and fever) may be absent in an elderly patient; the only clue may be the patient's failure to eat. Once sepsis is recognized, its source must be identified. Urinary tract infection is the most common cause of sepsis in the elderly and responds best to antibiotic therapy. Pneumonia is the next most common cause and leads to the highest mortality in this age group; rapid (sometimes invasive) methods must be utilized to identify the etiologic agent. In this life-threatening infection, initial antibiotic therapy should include an aminoglycoside, such as amikacin, to ensure the broadest coverage against the common pathogens. Supportive measures should be instituted for patients with sepsis, including careful monitoring of fluid intake and output and special attention to adequate oxygenation. Fluid volume replacement must be carried out in patients with septic shock, and hemodynamic monitoring with a Swan-Ganz catheter should be performed frequently. Careful consideration should be given to the use of corticosteroids and inotropic agents. After appropriate cultures have been obtained, antibiotics should be started; the time from initial presentation to the administration of the first dose of antibiotic should not exceed one hour. Important considerations in antibiotic selection include the patient's history and environment (community, nursing home, or hospital), anatomic location of the infection, and the pathogen. In our institution, initial empiric antibiotic therapy consists of a combination of amikacin and cefotaxime. When older patients are treated, adjustments in dosing should be based on estimates of kidney function.

Topics: Aged; Amikacin; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cross Infection; Drug Therapy, Combination; Female; Humans; Male; Pneumonia; Risk; Shock, Septic; Urinary Tract Infections

The most frequently encountered infectious disease in the field of internal medicine is respiratory tract infections. One of the most important requirements for an antibiotic in the treatment of infections is that it must be efficiently transferred to the infected site to attain a high concentration there. In the case of respiratory tract infections, it is desirable for the drug concentration in the sputum to be higher than the MIC for the causative bacterium. Cefotaxime (CTX) expresses potent antibacterial activity against Haemophilus influenzae, Klebsiella pneumoniae and Streptococcus pneumoniae, which are the major causative bacteria of respiratory tract infections. CTX also exerts antibacterial effects against a wide range of other bacteria. We administered CTX to patients with respiratory tract infections, then measured and compared the drug concentrations in the serum and sputum. The results are described below. When 2 g of CTX was drip-infused, the drug concentration in the serum was 113.0 micrograms/ml at 5 minutes after the completion of infusion, 64.9 micrograms/ml at 30 minutes, 38.7 micrograms/ml at 1 hour, 19.0 micrograms/ml at 2 hours, 8.9 micrograms/ml at 4 hours and 3.8 micrograms/ml at 6 hours. The drug concentration in the sputum was 1.29 micrograms/ml at 5 minutes after completion of infusion, 1.54 micrograms/ml at 5 to 30 minutes, 1.36 micrograms/ml at 30 minutes to 1 hour, 1.47 micrograms/ml at 1 to 2 hours, 1.12 micrograms/ml at 2 to 4 hours and 1.35 micrograms/ml at 4 to 6 hours. The drug concentration in the serum was the highest at 5 minutes after completion of the drip-infusion, and then it gradually decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Sputum

Cefotaxime (CTX) was intravenously administered in an amount of 2.0 g to each of 34 adult patients before the surgery mainly of the hip joint. Samples of the blood from the bone marrow around the trochanter were taken at the time of the operation. At the same time blood samples were taken from peripheral veins. The sample was centrifuged and the supernatant was analyzed for CTX and desacetyl-CTX. The concentration of CTX in the marrow blood was 150.9 micrograms/ml and that in the blood was 182.5 micrograms/ml in the earliest samples taken at 20 minutes after injection. In the 44 pairs of samples, the concentration of CTX in the marrow blood was lower than that in the peripheral blood in all the cases except 4. The concentration of desacetyl-CTX (Des-CTX), however, in the marrow blood was higher than in the peripheral blood in 33 of the 44 pairs of specimens. Since the degradation of the drug progresses with time, the ratio of Des-CTX to CTX increased with time. This trend was particularly marked in the bone marrow blood and can be expressed as Y = 113.0 + 0.32 t, when Y is the ratio percentage (Des-CTX/CTX) and t is time after the injection of the drug in minute. Thus, CTX transferred into the bone marrow tends to remain there and transformed into the desacetyl form.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bone Marrow; Cefotaxime; Female; Hip Joint; Humans; Male; Middle Aged; Surgical Wound Infection

Cefotaxime (CTX) was administered in a dose of 2 g to 20 adult patients prior to orthopaedic surgery. Samples of the bone marrow blood and the forearm venous blood were collected at 30, 60, 90 and 120 minutes after the CTX administration, and the concentration of the drug in each sample was determined. The results are described below. The mean concentration of CTX transferred into the bone marrow blood was 59.7, 28.9, 14.7 and 7.2 micrograms/ml at 30, 60, 90 and 120 minutes after the CTX administration, respectively. The mean concentration of CTX in the venous blood was 84.0, 39.1, 19.0 and 13.8 micrograms/ml at 30, 60, 90 and 120 minutes after the CTX administration, respectively. The mean ratio of the CTX concentration in the bone marrow blood to that in the venous blood was 73.9%, 71.0%, 75.1% and 51.6% at 30, 60, 90, 120 minutes after the CTX administration. From the above results, CTX is considered to be a useful antibiotic if it is administered prior to orthopaedic surgery to prevent infections.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bone Marrow; Cefotaxime; Female; Humans; Male; Middle Aged; Orthopedics; Surgical Wound Infection

A new beta-lactamase-stable oral cephem antibiotic, cefixime (CFIX), was evaluated for safety, efficacy and pharmacokinetics in children. CFIX was effective in 19 of 20 cases (95%) with bacterial infections. The drug was especially effective against the cases of pneumonia due to beta-lactamase-producing H. influenzae or B. catarrhalis. Pharmacokinetic parameters of CFIX (3 mg/kg) with premeal administration were as follows: Kel 0.328 +/- 0.066 hr-1, T 1/2 2.14 +/- 0.36 hrs, AUC 10.9 +/- 8.7 micrograms X hr/ml, and Vd/F 1.64 +/- 1.42 L/kg. In most of the cases tested, the urinary excretion rate in 12 hours was 5 to 17%. A dose of 3 mg/kg twice daily seems to be adequate for a regular treatment.

Topics: Bacterial Infections; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Haemophilus Infections; Humans; Infant; Kinetics; Male; Pneumonia; Pneumonia, Mycoplasma; Respiratory Tract Infections; Urinary Tract Infections

A newly developed cephalosporin, cefixime (CFIX), was evaluated clinically in 35 pediatric patients. A pharmacokinetic study was also performed with 11 patients. CFIX was administered as granules. The pharmacokinetic study was conducted in 11 patients, each of 6 patients was given CFIX at a dose of 3 mg/kg and each of the remaining patients was given CFIX at 6 mg/kg. Serum concentrations of CFIX were measured at 2, 4, 6, 8 and 12 hours after dosing. Urinary concentrations of CFIX were measured for periods of 0-6 and 6-12 hours after dosing. CFIX was assayed by the disk method using E. coli ATCC 39188 as the test organism. The clinical evaluation was conducted in 35 children including 5 patients of acute tonsillitis, 10 of acute lacunar tonsillitis, 1 of purulent lymphadenitis, 1 of scarlet fever, 8 of acute bronchitis, 5 of pneumonia, 3 of urinary tract infections and 1 of paratyphoid B. One additional patient was included only in the evaluation of safety since he was suffering from Mycoplasma pneumonia. the patients were from 4 months to 8 years 2 months old and 11 of them were inpatients. Daily doses were from 6.0 to 13.5 mg/kg. After CFIX administration in doses of 3 mg/kg and 6 mg/kg, peak serum concentrations were 1.75 and 3.36 micrograms/ml, half-lives were 2.65 and 2.86 hours and urinary excretions rates up to 12 hours after dosing were 16.1 and 12.4%, respectively. Serum concentrations were dose dependent and the half-life was fairly long compared with other known oral cephalosporins. Clinical efficacies of CFIX in 34 patients were "excellent" in 25 children, "good" in 8 and "poor" in 1 with effectiveness rate of 97.1%. Twenty-two strains of causative organisms, including 6 strains of S. aureus, 3 of S. pyogenes, 2 of S. pneumoniae, 3 of E. coli, 5 of H. influenzae, 2 of H. parainfluenzae and 1 of S. paratyphi B, were isolated. After treatment all strains except 2 strains of S. aureus (one was unknown and the other was decreased), 1 strain of S. pneumoniae (unknown) and 1 strain of H. influenzae (unknown) were successfully eradicated but S. paratyphi B was proved again in feces 9 days after treatment. No adverse reaction was observed. Among 18 children who went through laboratory test, however, an elevation of eosinophile and elevations of GOT and GPT were observed in 2 children and 1 child, respectively.

Topics: Administration, Oral; Bacterial Infections; Capsules; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Kinetics; Male; Respiratory Tract Infections; Urinary Tract Infections

Fundamental and clinical studies of cefixime (CFIX) granules, a new oral cephalosporin, were carried out with the following results: The MICs of CFIX against 234 clinical isolates were determined. Antibacterial activities of the drug against S. aureus, S. epidermidis and E. faecalis were weaker than those of conventional oral cephalosporins but antibacterial activities against Gram-negative bacteria were almost the same as those of cephem antibiotics of the Fujii's group 5. Peak serum concentrations of CFIX after oral doses of 3 and 6 mg/kg were, respectively, 1.51-4.86 micrograms/ml at 2-6 hours and 3.22-7.76 micrograms/ml at 4-8 hours. Serum concentrations of CFIX were dose-dependent in a patient given 3 and 6 mg/kg in a cross-over study. CFIX granules were administered mainly to children suffering from respiratory tract infection, otitis media and urinary tract infection at a dose of 3 mg/kg b.i.d. or t.i.d. for 3-27 days. The clinical responses to CFIX were excellent to good in 44 of the 50 children with infections, with an effectiveness rate of 88%. Thirty-five strains of the 40 clinical isolates were eradicated by the treatment with CFIX. The bacteriological eradication rate was 87.5%. Side effects observed were diarrhea and soft stool in 2 patients each, and elevated GOT X GPT and eosinophilia in 1 patient each. These symptoms and laboratory abnormalities disappeared on the day after the completion of therapy with CFIX. From the above results it has been concluded that CFIX is a useful and safe antibiotic for treating various bacterial infections in children.

Topics: Adolescent; Bacteria; Bacterial Infections; Capsules; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Kinetics; Male; Respiratory Tract Infections; Species Specificity; Urinary Tract Infections

Fundamental and clinical studies were carried out on cefixime (CFIX) 5% granules, and the results are summarized below. Antimicrobial activity Antimicrobial activities of CFIX, cefaclor, cefroxadine, cephalexin and amoxicillin (AMPC) were studied against clinical isolates. CFIX showed greater activities than all the other antibiotics against E. coli, K. pneumoniae, H. influenzae, P. mirabilis, E. cloacae and S. marcescens, but it was slightly less active than AMPC against S. pyogenes. Absorption and excretion Serum concentrations and urinary excretions of CFIX were determined following single or repeated oral administration. In 8 patients given single dose of CFIX 1.5 or 3.0 mg/kg, mean serum concentrations were 1.27 and 1.09 micrograms/ml at 2 hours, 1.27 and 1.35 micrograms/ml at 4 hours, 0.85 and 1.10 micrograms/ml at 6 hours, 0.17 and 0.24 micrograms/ml 12 hours after administration, respectively. Mean serum half-lives were 2.54 hours for the dose of 1.5 mg/kg and 2.60 hours for 3.0 mg/kg. Urinary recovery rates in the 12-hours urine varied 6.7 to 33.6%, with an average of 13.5%. In 3 patients given a repeated dose of CFIX 3.0 or 5.6 mg/kg b.i.d., the serum concentrations were 0.23-1.01 micrograms/ml at 0 hour, 1.91-2.80 micrograms/ml at 2-4 hours and 1.13-2.07 micrograms/ml at 6-8 hours after administration. Clinical study The CFIX was given orally by mainly b.i.d. at a daily dose of 4.4-11.6 mg/kg for 4-15 days to a total of 33 patients consisting of 3 patients with pneumonia, 3 with bronchitis, 9 with tonsillitis, 15 with UTI, one each with scarlet fever, lymphadenitis and colitis. Clinical responses were excellent in 24 patients, good in 8 and fair in 1, with an effectiveness rate of 97.0%. All of the 21 bacterial isolates examined were eradicated after CFIX treatments including 3 beta-lactamase producing strains. No side effects of abnormal laboratory findings were observed in these patients.

Topics: Administration, Oral; Bacteria; Bacterial Infections; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Intestinal Absorption; Kinetics; Male; Respiratory Tract Infections; Species Specificity; Urinary Tract Infections

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

Bacteriological, pharmacokinetic, and clinical studies of cefixime (CFIX), a newly developed oral cephalosporin, was conducted in our pediatric department as outlined below. Bacteriology The prevalent MICs of CFIX by microbiological species, compared with those of the reference drugs, were detailed below. Against 16 strains of S. aureus, the MICs averaged 6.25 micrograms/ml, and were found to be nearly the same as the MICs of amoxicillin (AMPC) but higher than those of cephalexin (CEX) and cefaclor (CCL). For 4 strains of S. pyogenes, the MICs averaged 0.05 microgram/ml, and were higher than the MICs of AMPC but lower than those of CEX and CCL. Mean MICs of CFIX against other clinical isolates were lower than those of CEX, CCL, or AMPC; E. coli (20 strains), 3.13 micrograms/ml; K. pneumoniae (9), 0.10 microgram/ml; P. mirabilis (16), 0.025 microgram/ml; P. vulgaris (5), 0.10 microgram/ml; H. influenzae (11), 0.05 microgram/ml; and S. typhimurium (4), 0.10 microgram/ml. The MICs of CFIX against 10 strains of P. aeruginosa were distributed at and above 25 micrograms/ml, a range much lower than greater than or equal to 100 micrograms/ml for CEX, CCL, or AMPC. Pharmacokinetics The serum concentrations and urinary recovery were studied in 3 children ranging from age 7 to 13. They were given CFIX on empty stomach in 2 different single doses of 3 and 6 mg/kg in a cross-over design. Average serum CFIX concentrations were dose-dependent, as evidenced by the respective peak concentrations of 1.70 microgram/ml for a 3 mg/kg dosage and 2.72 micrograms/ml for 6 mg/kg, which were attained 4 hours after the administration of the drug. The average half-lives of CFIX in the serum were 3.09 hours and 3.11 hours, respectively, and the 12-hour serum concentrations were 0.32 microgram/ml and 0.77 microgram/ml, respectively, for the 2 different dose levels. The average 12-hour urinary recovery was 25.2% and 22.3%, respectively. Clinical study Clinical effectiveness, bacteriological effectiveness, and side effects were studied in 27 children with infection including 4 patients with acute pharyngitis, 13 with acute purulent tonsillitis, 5 with acute pneumonia, 3 with urinary tract infection, and 1 each with acute rhinitis and acute bronchitis. One child with acute pneumonia (Mycoplasma pneumonia) was excluded from the study. The therapeutic effectiveness was "excellent" in 21, "good" in 3, "fair" in 1, and "poor" in 1, with an effectiveness rate of 92.3%.(ABSTRACT TRUNCATED AT 4

Topics: Bacteria; Bacterial Infections; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Intestinal Absorption; Kinetics; Male; Respiratory Tract Infections; Species Specificity; Urinary Tract Infections

The absorption and excretion and clinical effectiveness of cefixime (CFIX) granules, a new oral cephalosporin, were studied with pediatric patients with tonsillitis and urinary tract infection (UTI). Peak serum concentrations in 3 children given orally a single dose of 3 mg/kg on fasting were 0.545 micrograms/ml at 2 hours in 1 patient, and 1.56 and 1.26 micrograms/ml at 4 hours in the other 2. The half-lives in the 3 patients were 3.21-3.42 hours, with an average of 3.29 hours. The urinary concentration during the first 6 hours was 36.5 micrograms/ml in 1 patient showing the low serum level, and the first 6-hour urinary recovery rate was 7.3%. In the other 2 patients, urinary concentrations and recovery rates up to 6 hours were 87 and 62 micrograms/ml, and 17.0 and 15.1%, respectively. The second 6-hour urinary concentrations and recovery rates were 35.5 and 20.8 micrograms/ml, and 12.7 and 8.8%, respectively. The urinary recovery rates up to 12 hours were 29.7 and 23.9%, respectively. CFIX was given orally to 19 children with 20 diseases in daily doses of 6.4-12.9 mg/kg in 2 or 3 divided portions for 3 to 12 days. Clinical evaluations were made on 18 diseases. Clinical effects of CFIX were excellent in 4, good in 7 and poor in 1 of the 12 patients with tonsillitis, and excellent in 5 and good in 1 of the 6 patients with UTI. The overall clinical effectiveness rate was 94.4%. No side effects were observed in any of the 19 patients. Hematological tests, showed slight elevation of blood platelet counts in 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Bacterial Infections; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Half-Life; Humans; Infant; Kinetics; Male; 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

A clinical study of cefixime (CFIX), a new oral cephalosporin, was carried out to evaluate its therapeutic effectiveness on bacterial infections in children. CFIX was orally administered to 13 patients including 6 with upper respiratory tract infection (RTI), 3 with pneumonia, and 1 each with bronchitis, otitis media, skin abscess, and urinary tract infection (UTI). The daily dosage per kg bodyweight ranged from 5.1 to 17.4 mg (average: 8.7 mg), and was given in 2 or 3 divided doses per day for 3 to 10 days (average: 5.8 days). The clinical response was excellent in 4 (30.8%), good in 7 (53.8%) and poor in 2 (15.4%), with an overall efficacy rate of 84.6%. Bacteriological efficacy was good, and 6 of the 8 identified causative organisms were eradicated. Side effects were observed in 3 children, i.e., loose stool in 1 and transient elevations of GOT and GPT in 2. The above results suggest that CFIX is a useful new oral cephalosporin for the treatment of bacterial infections in children.

Topics: Bacteria; Bacterial Infections; Cefixime; Cefotaxime; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Diarrhea; Female; Humans; Infant; Male; Otitis Media; Respiratory Tract Infections; Skin Diseases; Urinary Tract Infections

We have evaluated cefixime (CFIX) fine granules for pharmacokinetics and therapeutic effectiveness in children with infections. The results were summarized as follows. Pharmacokinetic parameters after the oral administration of single doses of 1.5 mg and 6.0 mg per kg body weight in a cross-over design in 1 child were as follows: The peak serum CFIX concentrations were 0.65 microgram/ml at 2 to 3 hours and 3.33 micrograms/ml at 4 hours for the low and the high doses, respectively; the respective biological half-lives were 2.4 hours and 2.5 hours, and urinary recovery was 10.3% at 8 hours and 5.2% at 12 hours, respectively. A clinical study was performed on 19 children with infections, including 7 with bronchitis; 3 each with tonsillitis, UTI, and cervical lymphadenitis; and 1 each with pharyngitis, retroauricular lymphadenitis, and enteritis. Doses ranging from 1.8 to 7.8 mg/kg body weight were given b.i.d. or t.i.d. The period of treatment ranged from 3 to 13 days. The therapeutic response was considered "excellent" in 15 and "good" in 4, with an effectiveness rate of 100%. No side effects were observed. The only abnormal laboratory findings was a slight elevation of GOT and GTP recorded in 1 child. It was concluded that CFIX was a promising drug for the treatment of bacterial infections in children.

Topics: Administration, Oral; Bacterial Infections; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Half-Life; Humans; Infant; Intestinal Absorption; Kidney; Kinetics; Male; Respiratory Tract Infections; 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

Concentrations of cefotaxime (CTX) in bone marrow blood and venous blood were examined with the passage of time in 21 cases which received operations of bone and joint. Concentrations of CTX in bone marrow blood at 30 minutes of a single intravenous administration 2 g each of CTX were found to be 85.2 +/- 24.5 micrograms/ml. Concentration ratio of CTX in bone marrow blood to that in venous blood was reached the peak at 120 minutes after administration. Concentrations of CTX observed were higher than the MIC of CTX against major pathogens responsible for the postoperative infections in orthopaedic field. The CTX, therefore, is expected to have an effective antibiotic in prophylaxis.

Topics: Adolescent; Adult; Bacterial Infections; Bone and Bones; Bone Marrow; Cefotaxime; Child; Female; Humans; Injections, Intravenous; Joints; Male; Middle Aged; Postoperative Complications; Veins

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Cefuroxime; Drug Administration Schedule; Humans; Infant; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal

Topics: Adolescent; Adult; Aged; Amphotericin B; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Infant; Middle Aged; Thoracic Injuries; Tobramycin

Bacterial meningitis in 20 children was treated with cefotaxime. 17 children received this antibiotic throughout the disease as monotherapy, three were changed to Penicillin G (2) or ampicillin (1), after sensitivity of the pathogen was known, although cefotaxime had been effective. All bacterial isolates were highly susceptible to cefotaxime. All CSF cultures were sterile at second tap, performed 24 to 48 hrs after therapy was started. Cefotaxime and desacetyl-cefotaxime concentrations in CSF, measured by HPLC in 9 patients were in the range of 4 to 34 (average 17.6) mg/l and 2.1 to 82 (average: 15.1) mg/l, representing a CSF-serum ratio of 8 to 74% (average 45.6%) for cefotaxime and 25 to 151% (average: 73.7%) for desacetyl-cefotaxime. Clinical outcome was favourable in 17 patients. There were one death and late neurological deficits in three. Cefotaxime monotherapy is recommended instead of standard therapy with chloramphenicol and/or ampicillin because of superior antibacterial activity, lower toxicity and lesser side-effects for primary meningitis in children caused by N. meningitides, S. pneumoniae, or H. influenzae type b.

Topics: Bacterial Infections; Blood-Brain Barrier; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Male; Meningitis; Pilot Projects

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

Topics: Bacterial Infections; Cefotaxime; Diabetic Angiopathies; Gangrene; Humans; Injections, Intra-Arterial; Osteomyelitis; Sepsis

Kingella species are rarely reported as a cause of endocarditis. We report two cases of K. denitrificans endocarditis occurring in patients with prosthetic valves. K. denitrificans has not been previously reported to cause prosthetic valve endocarditis. Both patients may have developed bacteremia from altered upper respiratory or oral mucosa with subsequent prosthetic valve infection. Treatment with penicillin G and streptomycin was successful in the first patient, whereas ampicillin alone resulted in clinical cure in the second case. Neither patient required further surgery. In vitro antibiotic susceptibility testing indicated that both organisms were highly sensitive to cefotaxime and ampicillin.

Topics: Adult; Aged; Ampicillin; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Dental Prophylaxis; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Neisseriaceae; Penicillin G; Streptomycin

The therapeutic effect of ceftizoxime suppositories (CZX-S) was studied in 8 physically handicapped patients, comprising 6 with pharyngitis, 1 with pneumonia, and 1 with urinary tract infection. The clinical effect was "excellent" in 7 and "good" in 1. Neither adverse reactions nor abnormal laboratory test findings attributable to CZX-S were detected. CZX-S proved to be useful in physically handicapped children, especially in those not suited to treatment with oral or intravenous preparations.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Disabled Persons; Drug Evaluation; Drug Resistance, Microbial; Enterobacter; Female; Humans; Male; Pharyngitis; Pneumonia; Suppositories; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Female; Gram-Negative Bacteria; Humans; Kinetics; Male; Middle Aged

Topics: Adult; Bacterial Infections; Cefotaxime; Female; Genital Diseases, Female; Humans; Middle Aged; Pregnancy; Pregnancy Complications, Infectious

In a 710-bed teaching hospital, the infectious disease section and pharmacy service initiated a joint programme to control and monitor the use of third-generation cephalosporins (TGC): cefotaxime, moxalactam and cefoperazone. The policy requires that an infectious disease physician approve the use of a TGC prior to its administration. This retrospective study sought to assess the pattern of utilization of these agents. From January to December 1983, 109 patient courses of cefotaxime (CT), moxalactam (MX), and cefoperazone (CP) were tabulated. Records from 92 patient courses were available for review (84.4%). The preliminary data show that 46.7% of TGC were used empirically to treat suspected infections without culture and sensitivity data, while 50.0% were used to treat various infections (central nervous system, pulmonary, wound, abdominal, biliary, urinary and blood) after culture and sensitivities were known. Only 3.3% of the TGC were used for surgical prophylaxis. In the empirical treatment group, the leading indications for use of TGC were central nervous system (CT = 40.0%, MX = 48.0%) and biliary (CP = 23.1%) infections. In the treatment group with culture and sensitivity data, the primary uses of TGC were for the treatment of Gram-negative pulmonary (MX = 28.0%, CP = 19.2%) and wound (CP = 15.4%) infections. This study shows that physician and pharmacy control does not eliminate empirical treatment with TGC; but it does narrow their use to situations in which their properties are best exploited.

Topics: Bacterial Infections; Cefoperazone; Cefotaxime; Hospitals, Teaching; Humans; Medical Records; Moxalactam; Pharmacy Service, Hospital; Premedication; Retrospective Studies

Following a brief review of the main bacteriological and pharmacokinetic properties of ceftriaxone, the authors present a therapeutic evaluation of this new cephalosporin antibiotic. The effects of ceftriaxone in severe infections, such as septicaemia, bacterial meningitis, urinary tract infections, typhoid, bone infections and sexually transmitted diseases, are described on the basis of recent publications. Mention is also made of the adverse reactions to, and benign side-effects of the drug. Finally, the advantages of ceftriaxone in the treatment of some infections are envisaged: the single daily dose and short therapeutic courses may modify therapeutic habits and exert a beneficial effect on costs in some cases.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Humans; Meningitis; Respiratory Tract Infections; Sepsis; Sexually Transmitted Diseases; Typhoid Fever; Urinary Tract Infections

Against 17 Gram-negative bacteria, excluding Proteus species, the difference between cefminox and cefotaxime was significant in terms of MIC distribution, in favour of cefotaxime, but was not significant in terms of ED50 distribution. Against 22 Proteus species, the difference between cefminox and cefotaxime was not significant in terms of MIC distribution, but was significant for ED50 distribution, in favour of cefminox. The difference between cefminox and cefoperazone was not significant for either MIC or ED50 distribution against 17 Gram-negative bacteria, but was significant against 22 Proteus species, in favour of cefminox. The distribution of rank of the ED50/MIC ratios for cefminox was significantly lower than those for cefotaxime and cefoperazone, indicating that cefminox showed lower ED50 values than expected from the MIC values.

Topics: Animals; Bacterial Infections; Cefoperazone; Cefotaxime; Cephamycins; Female; Gram-Negative Bacteria; Humans; Mice; Mice, Inbred Strains; Microbial Sensitivity Tests; Proteus; Proteus Infections

The susceptibility of a total of 2014 Gram-negative clinical isolates (except Pseudomonas aeruginosa) to a number of antibiotics, including temocillin, was investigated in 2 geographically distinct areas. Overall, more strains were sensitive to temocillin than to mezlocillin, piperacillin, amoxycillin plus clavulanic acid, cefotaxime, cephazolin, latamoxef (moxalactam), cefoxitin, or netilmicin. Susceptibility to temocillin of multiple-resistant strains was studied.

Topics: Bacterial Infections; Cefotaxime; Humans; In Vitro Techniques; Mezlocillin; Microbial Sensitivity Tests; Moxalactam; Penicillin Resistance; Penicillins; Piperacillin

The concentration of cefotiam (CTM) in the serum and the bloodless lung with time is discussed. Five patients who were undergone pneumonectomy or lobectomy, were given 1 g of CTM intravenously during the operation. Blood samples and lung samples were collected 15, 30, 60, 90, 120, and 300 minutes after the administration. The CTM levels in the blood and the lung samples were measured by the agar well bioassay. The CTM levels in the lung samples were modified as the CTM levels in the bloodless lung by calculating the contained blood volume, as lung samples were proven to have a mean value of 34.2% of blood in weight. The serum CTM level was 73.3 micrograms/ml at 15 minutes after injection and then decreased gradually. The CTM level in bloodless lung was elevated during the first 60 minutes, became equal to that of the blood during next 30 minutes and then exceeded the serum levels thereafter. These results indicate that the distribution of CTM to the bloodless lung was excellent and a satisfactory preventative effect against postsurgical infection could be expected.

Topics: Aged; Bacterial Infections; Cefotaxime; Cefotiam; Humans; Injections, Intravenous; Intraoperative Period; Lung; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Surgical Wound Infection

Comparative study of prophylaxis with cefotiam (CTM) was carried out in 47 patients undergoing surgery for gastric cancer. The patients were randomized in 2 treatment groups. The first group A received a single intravenous drip dose of 0.5 g CTM, given 4 times daily for 5 days after surgery. The second group B received a single intravenous drip dose of 1 g CTM, given twice daily for 5 days. Postoperative infections occurred in 8.7% (2/23) of the patients receiving CTM in group A, and in group B 8.3% (2/24). The number of infections was similar in both groups of patients. Prophylactic efficacy of CTM has also been evaluated in fever index of A and B groups. Fever index was 16.36 +/- 4.00 degree hours in A group, and in B group 7.91 +/- 2.30 degree hours, respectively. The difference between the 2 groups are statistically significant tendency. A single dose of 1 g CTM, given twice daily for 5 days, provide effective prophylaxis against infections in patients undergoing surgery for gastric cancer. CTM can be recommended for surgical prophylaxis.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Humans; Infusions, Parenteral; Middle Aged; Stomach Neoplasms; Surgical Wound Infection

Basic and clinical studies in 37 patients with biliary tract disease on comparison between cefmenoxime (CMX) and cefotiam (CTM) were studied and the following results were obtained. In vitro antibacterial activities of CMX and CTM against 25 strains (15 organisms) isolated from bile of patients with biliary tract disease were stronger than that of cefazolin (CEZ). In cholecystectomized patients, CMX (2 g) or CTM (2 g) was injected intravenously, followed by determination of concentration in bile and gallbladder tissue about 2 hours after administration. In CMX administration, the mean concentration in gallbladder bile was 812.1 micrograms/ml, and the mean concentration in duct bile was 1,050.6 micrograms/ml, and the mean concentration in gallbladder tissue was 100.7 micrograms/g. In CTM administration, the mean values were, 1,092.5 micrograms/ml, 1,287.8 micrograms/ml, 28.5 micrograms/g, respectively. The concentration of CMX and CTM were almost similarly. The bile concentration of CMX (i.v.) was compared with CTM (i.v.) by cross-over method in cases of T-tube drainage. The peak bile concentrations of CMX and CTM were as high as 172.4 micrograms/ml and 182.2 micrograms/ml, respectively, 1 approximately 2 hours after 2 g intravenous administrations. Furthermore, the concentration of them were highly gained, 16.1 micrograms/ml of CMX and 33.8 micrograms/ml of CTM, even at 5 approximately 6 hours. In choledochostomized patients, CMX (4 g/day) was injected intravenously, followed by determination of concentration in intraperitoneal exudate. The mean concentration of CMX was 15.3 micrograms/ml on the first day after the operation, and 6.0 micrograms/ml even on the third day after the operation. Those results suggest that the high antibacterial activity of CMX against organism in bile and, the high penetration of CMX to bile, gallbladder tissue and intraperitoneal exudate will promise its important role in treatment of biliary tract infections.

Topics: Adult; Aged; Bacterial Infections; Bile; Biliary Tract Diseases; Cefmenoxime; Cefotaxime; Cefotiam; Cholecystectomy; Common Bile Duct; Female; Gallbladder; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Surgical Wound Infection

Ten patients who were performed pulmonary resection for the disease of the lung, were administered 2 g of cefmenoxime (CMX) by intravenous injection before their operation. The concentrations of CMX in serum and lung tissue were determined. The CMX concentrations in lung tissue were observed to be higher than the MIC of CMX for Klebsiella pneumoniae, Haemophilus influenzae and Serratia. These results suggested that CMX will be useful agent for the prevention and treatment of pulmonary infection.

Topics: Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Humans; Injections, Intravenous; Lung; Lung Diseases; Lung Neoplasms; Male; Middle Aged; Surgical Wound Infection

The efficacy of cefmenoxime (CMX), which is a third generation, beta-lactamase-resistant cephem with a broad antibacterial spectrum, was examined in 43 patients with chronic complicated urinary tract infections. The usual dosage regimen was given 2 approximately 4 g/day of CMX by intravenous drip infusion over 1 hour. The duration of treatment was 5 days. Fifteen patients were cured and 21 improved, and the effective rate was 83.7%. Bacterial eradication rate in these cases was 88.2%, especially eradication of the original pathogens such as Serratia marcescens, Proteus species and Klebsiella species, occurred in high frequency. Laboratory abnormalities were slight elevation of serum GOT and GPT in 2 cases. From these findings, CMX was considered to be very effective in complicated urinary tract infections.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Cystitis; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Pyelonephritis; Urinary Tract Infections

Modern cephalosporins are of considerable importance for the therapy of severe infections by multiresistant organisms. According to in-vitro-findings on ampicillin-resistant E. coli as well as Klebsiella spp., Proteus spp., and serratia spp., altogether 159 strains, instead of cefotaxime nearly always also cefotiam can be used. The two remedies are clearly superior to cephalothin. cefotiam is ineffective to Pseudomonas aeruginosa. But in this case also cefotaxime is clearly inferior to azlocillin. In 6 of 7 casuistic instances the clinical effectiveness of cefotiam could be confirmed with good tolerability. The contemporary establishment of staph. aureus in mixed infections of serratiastaphylococci proved as as particular advantage. A primary therapeutic failure referred to a necrotizing pancreatitis, when no causative organism was proved, in which case also cefotaxime remained without any effect. Despite the improved individual medical possibilities the control of the infectious hospitalism by critical administration of antibiotics and improved hospital hygiene, particularly strict non-infection, must remain the pre-eminent task.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Cefotiam; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Surgical Wound Infection; Urinary Tract Infections

Monotherapy of osteomyelitis with the newer broad-spectrum beta-lactam antibiotics has become attractive because of the efficacy, safety, and cost of these antibiotics when compared with conventional combination therapy. Imipenem/cilastatin is a recent and promising addition to this antibiotic family. Experience with imipenem/cilastatin and that reported for cefotaxime, ceftazidime, and ceftizoxime in the treatment of biopsy-proved osteomyelitis was compared, using data from published reports from five centers. Two hundred forty-three patients were evaluable: 34 were treated with imipenem/cilastatin, 84 with cefotaxime, 122 with ceftazidime, and 33 with ceftizoxime. Staphylococcus aureus was isolated by 80 bone cultures and was the most common single species encountered. There were 75 isolates of Pseudomonas aeruginosa, 113 mixed Enterobacteriaceae species, 115 mixed gram-positive and -negative isolates of miscellaneous species, and 30 anerobic isolates. Polymicrobial infection was present in 101 cases (41.6 percent). Failure rates were similarly low in all groups (10 to 30 percent). However, resistance developed during therapy in all groups with P. aeruginosa. Side effects were predictably few, but reversible neutropenia, pseudomembranous colitis due to Clostridium difficile, and nausea required therapy to be discontinued in seven patients. Imipenem/cilastatin should prove to be a very effective and relatively safe single agent for treatment of osteomyelitis.

Topics: Adult; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Cilastatin; Cyclopropanes; Drug Combinations; Drug Resistance, Microbial; Humans; Imipenem; Osteomyelitis; Thienamycins

Cefmenoxime, a new third-generation cephalosporin, was used as a single drug in the therapy for female genital tract infections. Therapeutic response was considered satisfactory in 21 of 22 cases of pelvic inflammatory disease, six of nine tuboovarian abscesses, two of three severe wound infections, and all five cases of endometritis. Overall, 34 of 39 patients responded. The peak serum antibiotic levels in this study ranged from 15.8 to 64 (average 48.7) micrograms/mL, and the trough level ranged from 0.9 to 4 (average 3.1) micrograms/mL. Cefmenoxime was tested in vitro against 424 isolates of anaerobes including 208 strains of bacteroides of which 80 were Bacteroides fragilis. Cefmenoxime inhibited the growth of 90% or greater of the organisms (minimal inhibitory concentration 90) at less than or equal to 64 micrograms/mL. The minimal inhibitory concentration for 75% of B fragilis was 32 micrograms/mL. This study suggests that cefmenoxime as a single-drug therapy is effective in the treatment of female genital tract infections caused by aerobic (including the gonococcus) and anaerobic bacteria.

Topics: Abscess; Bacterial Infections; Cefmenoxime; Cefotaxime; Endometritis; Fallopian Tubes; Female; Genital Diseases, Female; Humans; Microbial Sensitivity Tests; Ovarian Diseases; Pelvic Inflammatory Disease; Pregnancy; Puerperal Infection; Surgical Wound Infection

There are few clinical reports about the concentration of ceftizoxime (CZX) in lung tissues. At present, clinically, we report the concentration of the drug in serum and lung tissues on 26 cases of chest disease and an effect of the drug on prophylaxis of postoperative pulmonary infections. Our results are the following; The peak concentration of CZX in serum is 54.7 micrograms/ml at 1 hour after starting drip infusion of CZX 1 g. The serum half-life of CZX (beta phase) is 2.07 hours. The concentration of CZX in lung tissues is from 43.6 to 78.7% of serum level. CZX is useful to prophylaxis of postoperative infections after thoracotomy, especially in case of administration of CZX 1 g just before operation. Eruption was found in 1 of 26 cases. However, no side effects of the drug are noticed in other 25 cases.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Drug Evaluation; Female; Half-Life; Humans; Infusions, Parenteral; Kinetics; Lung; Lung Neoplasms; Male; Middle Aged; Postoperative Complications; Premedication

With the cooperation of 13 medical institutions in the Tokyo area, the methods to determine the prophylactic effect on postoperative infections in gynecological surgery were evaluated. Two hundred and ninety-nine patients were enrolled for the study of postoperative infections, febrile morbidity and fever index following abdominal (275) and vaginal (24) hysterectomies. Prophylactic cefotiam (CTM) of 1 gram was intravenously administered twice a day postoperatively for 3 to 5 days. The rates of postoperative infections were 5.1% (14/275) in abdominal hysterectomy and 4.2% (1/24) in vaginal hysterectomy. The febrile morbidity (57.1% = 8/14) and fever index (52.3 +/- 41.1 degree hours) in the infection group were approximately about 4 times higher than those (12.3% = 32/261, and 15.6 +/- 13.7 degree hours, respectively) in the non-infection group. No significant differences were observed in age, body weight, height of patients, period of operation and blood loss between these 2 groups. These data suggested that febrile morbidity and fever index were able to indicate the prophylactic effect of antibiotics on patients undergoing abdominal and vaginal hysterectomies.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Fever; Genital Diseases, Female; Humans; Hysterectomy; Middle Aged; Postoperative Complications

Cefmenoxime, an investigational semisynthetic cephalosporin, was evaluated in 18 pediatric patients with a variety of infections. There were seven patients with urinary tract infections, two with wound infections, two with osteomyelitis, two with abscess infections, one with cervical adenitis, one with hidradenitis, one with pneumonia and sepsis, one with periorbital cellulitis, and one with ventriculitis. A total of 16 (88%) patients had a satisfactory clinical response demonstrated by improvement in clinical signs and symptoms. A total of 12 (67%) patients demonstrated eradication of their infecting organisms. Of the pathogens isolated in these patients, 16 isolates were susceptible to cefmenoxime. One patient developed a generalized urticarial rash that resolved within 24 h after cessation of cefmenoxime therapy. Mean peak level in serum after intravenous infusion was 55 micrograms/ml.

Topics: Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Kinetics; Male; Microbial Sensitivity Tests

Cefmenoxime (CMX) was administered to protect against postoperative infections in 52 cases of cesarean section and 50 cases of total abdominal hysterectomy. These two represent common operations in the gynecological field. Group I was given the agent at a total dose of 14 g (postoperatively 4, 4, 2, 2 and 2 g), group II at a total dose of 10 g (postoperatively 2, 2, 2, 2 and 2 g) and group III at a total dose of 10 g (2 g during operation and postoperatively 2, 2, 2 and 2 g). 1. When comparing the fever index between the groups, group III showed the lowest level regardless of the type of operation. 2. When comparing clinical test values between the groups, low values of white blood cell count (P less than 0.05, P less than 0.01) and erythrocyte sedimentation rate (P less than 0.05) were observed in group III with cesarean section, and significant decreases in white blood cell count (P less than 0.05) and CRP (P less than 0.01, P less than 0.001) were observed in group III with total abdominal hysterectomy. The above results indicate that the administration of CMX during operation was the most effective method of administration for protection against postoperative infections in terms of changes in fever index and clinical test values.

Topics: Adult; Bacterial Infections; Cefmenoxime; Cefotaxime; Cesarean Section; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Hysterectomy; Infusions, Parenteral; Middle Aged; Postoperative Complications; Pregnancy; Premedication

Ceftizoxime suppository (CZX-S) was evaluated for its safety, clinical efficacy and pharmacokinetics in pediatric patients. The Cmax, 4.8 to 9.5 micrograms/ml, was obtained 15 to 30 minutes after administration of CZX-S, and the serum half-life was 0.93 hour. Cross-over comparison with intramuscular CZX in a child showed approximately one-third bioavailability of the suppository against intramuscular injection. CZX-S was effective in all the 26 bacterial infections including acute pharyngitis, pneumonia, soft tissue infection, and urinary tract infections. The causative organisms were eradicated in 95%. Mild diarrhea (17%) was the only side effect observed in the study. The data suggest that CZX-S is an excellent alternative to oral and injectable antibiotics for the treatment of mild to moderate bacterial infections due to the susceptible organisms.

Topics: Bacteria; Bacterial Infections; Biological Availability; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Male; Suppositories

Fundamental and clinical studies were carried out on ceftizoxime suppository (CZX-S), and the following results were obtained in pediatrics. In 4 patients of the CZX-S 125 mg-administered group (9.4-9.9 mg/kg), the serum concentration of CZX reached a peak of 5.55 micrograms/ml on the average, 30 minutes after dosing, i.e. at the time of initial blood collection, and decreased gradually to 0.20 microgram/ml 6 hours after dosing. The half-life was 1.09 hours. In 5 patients of the CZX-S 250 mg-administered group (8.4-18.1 mg/kg), the serum concentration of CZX peaked at 7.07 micrograms/ml on the average and then gradually declined to 0.16 microgram/ml 6 hours after dosing. The half-life was 1.00 hour. The urinary recovery rate varied as widely as 6.5-38.0% in all the patients of both groups. CZX-S was given to total 19 patients; 8 patients with urinary tract infection (UTI), 3 with pharyngitis or tonsillitis, 4 with bronchitis, 2 with pneumonia, 1 with otitis media and 1 with staphylococcal scalding skin syndrome. The overall effect of CZX-S in 15 patients was "effective" or better response, with an effectiveness rate of 83.3%, except one who discontinued the drug because of side effects. CZX-S was given to most of the patients weighing 15 kg or higher in a dose of 250 mg 3-4 times a day and frequently to patients weighing less than 15 kg in a dose of 125 mg 3-4 times a day. As to side effects, slight diarrhea was encountered in 1 patient. Laboratory examinations disclosed an increase in GOT in 1 patient, which returned to normal after continual insertion of the suppository.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Male; Suppositories

Ceftizoxime suppository (CZX-S) was given to 19 children with infections, including upper and lower respiratory tract infections, urinary tract infections and otitis media at dose level of 18-83 mg/kg/day divided into 2-3 times. Clinical response was excellent in 12 patients, good in 6 patients and poor in 1 patient. Bacteriological response was eradicated in 11 strains, decreased in 3 strains and unchanged in 4 strains. No severe side effects were observed with this drug. These results obtained suggest that CZX-S should be a useful antibiotic in treatment of infections in pediatric field.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Suppositories

Clinical evaluation of ceftizoxime suppository (CZX-S), a new antibiotic rectal suppository, was performed in 5 cases with bacterial infections in pediatric field (2 with acute bronchitis, 1 with acute tonsillitis, UTI and pertussis, respectively) and the following results were obtained; Blood levels of CZX at 10-20 minutes after administration of CZX-S at a dose of 10.0-26.3 mg/kg in 5 cases were 3.26-23.3 micrograms/ml and the urinary excretion rates within 6 hours were 15.2, 60.1, 60.2% in 3 of 5 cases measured respectively. Clinical effects were excellent in 3 and good in 2 cases. Slight elevation of GOT and GPT was observed in 1 case. No other side effects were observed. The patients' tolerability against rectal suppository was good. From the above results, we concluded that CZX-S is useful for treating the pediatric patients with various infections.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Male; Suppositories

A fundamental and clinical study of ceftizoxime (CZX) suppositories was performed in pre-school and school-age children. The average time courses of CZX serum and urinary concentrations after administration of CZX suppository 250 mg (i.e. per kg body weight doses of 8.3-10.9 mg) to 4 school-age children were as follows. Serum concentrations: 6.1 micrograms/ml at 15 minutes, 6.3 micrograms/ml at 30 minutes, 3.8 micrograms/ml at 1 hour, 1.7 microgram/ml at 2 hours, 0.5 microgram/ml at 4 hours and 0.2 microgram/ml at 6 hours with a biological half-life of 1.43 hours. Urinary concentrations: 885 micrograms/ml for 0-2 hours, 209 micrograms/ml for 2-4 hours and 112 micrograms/ml for 4-6 hours with an average 6-hour urinary recovery rate of 25.6%. The clinical and biological effectiveness and adverse reactions were studied in 11 infants and school-age children afflicted with various infections (acute purulent tonsillitis, 1; acute bronchitis, 3; acute pneumonia, 4; and UTI, 3). The clinical responsiveness was "excellent" in 8, "good" in 2, and "failure" was recorded in 1, with an overall efficacy of 90.9% inclusive of "excellent" and "good". The microbiological effectiveness of CZX suppositories on presumed pathogenic organisms comprising 4 strains of H. influenzae, 1 strain of H. parainfluenzae, and 3 strains of E. coli was satisfactory, as evidenced by the substantially high eradication rate of 87.5%. The only organism that survived CZX suppository treatment was 1 strain of H. influenzae which however was greatly decreased. The only side effect was diarrhea in 1 patient, which however did not necessitate withdrawal of the drug. The only laboratory test abnormality was GOT and GPT elevation in 1 patient which was normalized within 8 days. In conclusion, CZX suppositories were found to be efficacious and safe for treatment of bacterial infections in children.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Male; Respiratory Tract Infections; Suppositories; Urinary Tract Infections

Pharmacokinetic and clinical studies of ceftizoxime suppository (CZX-S) were performed in 10 children with the following results. CZX-S attained a peak serum concentration of 6.85 micrograms/ml 30 minutes after dosing with the drug 5.6 mg/kg (one suppository of CZX-S contains 250 mg of CZX in potency). The mean 6-hour urinary excretion rate in 4 children was 18.9%. The subjects consisted of 8 patients comprising 1 with pharyngitis, 3 with tonsillitis, 1 with gingivitis and 3 with urinary tract infection. The overall effect of CZX-S was "excellent" in 5 patients and "good" in 3, with an effectiveness rate of 100%. No side effects ascribable to CZX-S were encountered in any of the patients. A few patients complained of discomfort after the first or second insertion of the drug. However, the discharge of the suppository was as infrequent as 1.5% of the total 133 insertions. CZX-S is therefore well tolerated for clinical use in children. It is concluded that the unique suppository formulation of CZX-S is useful in the treatment of infections in children with heavy psychophysiologic disorders and in children who cannot take oral drugs because of severe vomiting.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Kinetics; Male; Suppositories

A bacteriological and clinical study of ceftizoxime suppositories (CZX-S) let to the following results. The CZX serum concentration 10 minutes after insertion of one 250 mg suppository (i.e. 5.7-15.2 mg CZX per kg body weight) ranged from 1.64 to 6.53 micrograms/ml (average: 4.41 micrograms/ml). In one child the concentration 7 minutes after insertion was 4.13 micrograms/ml. Therapeutic responsiveness was recorded as "effective" in 8 (88.9%) of the 9 children who were broken down into 6 with tonsillitis, 1 with pharyngitis, and 2 with UTI. Bacteriological studies conducted in 5 children have confirmed eradication in 4 children, one of whom showing appearance of another strain. The rate of discharge of the suppository within 10 minutes after insertion was 20.4%. Reddening and erosion of the anus were observed in 1 child.

Topics: Adolescent; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Male; Suppositories

A clinical trial of ceftizoxime suppositories (CZX-S) was performed to evaluate the therapeutic effectiveness in children with bacterial infection. The subjects were 10 children comprising 4 with pneumonia, 3 with lacunar tonsillitis, 2 with pharyngitis, and 1 with UTI. They were given 1 suppository containing either 125 mg or 250 mg of CZX 2 to 4 times a day. The daily per kg body weight dose ranged from 17.1 to 60.0 mg. The result was "markedly effective" in 3, "effective" in 6, and "failure" was recorded in 1. Bacteriologically, successful eradication of causative organisms was confirmed in all the 4 children who underwent the test. No clinical side effects were observed. The only laboratory test abnormality recorded in a single patient was eosinophilia, which was not definitely ascribable to CZX-S. In conclusion, CZX-S have proved to be a clinically safe and effective antibiotic preparation in infantile infection, even in children whose treatment with conventional antibiotics is associated with difficulties.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Male; Suppositories

Ceftizoxime suppositories (CZX-S) were given to 5 children comprising 3 with acute bronchitis, 1 with acute bronchitis complicated by enteritis, and 1 with acute urinary tract infection, in doses of 12.5 12.5-17.4 mg/kg with 1 suppository containing 125 mg or 250 mg (potency) given 3 times a day. The clinical response was "markedly effective" in 2 and "effective" in 3. Microbiologically CZX-S caused a eradication of 1 strain each of S. aureus and E. coli and caused a decrease of organisms in 1 strain of S. aureus. There were no adverse reactions or abnormal laboratory test findings attributable to CZX-S. In conclusion, CZX-S proved to be a clinically useful antibiotic preparation for the treatment of infection in children not suited to treatment with oral or intravenous preparations.

Topics: Bacteria; Bacterial Infections; Bronchitis; Cefotaxime; Ceftizoxime; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Suppositories; Urinary Tract Infections

The peak levels of serum ceftizoxime (CZX) after a single rectal administration of CZX-S at doses of 125 and 250 mg in 157 pediatric patients were occurred at 21 approximately 25 minutes in pediatric patients aged less than 1 year and over than 7 years, at 16-20 minutes in 1-3 years patients, at more than 26 minutes in 4-6 years patients. They were 9.45, 9.58, 11.71, 12.43 mcg/ml, respectively. The mean highest levels of serum CZX were 8.56, 10.66, 12.50 mcg/ml after the administration of CZX-S as less than 10.0, 10.1-15.0, 15.1-20.0 mg/kg dose respectively, all of which were occurred at 21-25 25 minutes. A close dose response was observed. The pain of insertion was not observed in any cases. The discharge of melted suppository or defecation after administration was observed in 15.2% of total 184 cases, which was noticed more frequently in the lower aged children. There was no influence by dose. Clinical effects of CZX-S were studied in 72 pediatric patients with various infections. CZX-S was administered rectally at the mean daily dose of 41.0 mg/kg divided into 3 or 4 times for 6 days. Clinical responses were excellent in 46 cases, good in 24 cases, fair in 2 cases. The efficacy rate was 97.2%. Regarding side effects, the pain of insertion was noted in 2 cases (2.8%), diarrhea in 6 cases (8.3%), the elevation of eosinophil in 1 case (1.7%). Bacteriologically, 23 strains (92.0%) out of 25 strains isolated from the patients were eradicated.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Male; Suppositories

The clinical study of CZX-S in the field of pediatrics was performed and the following results were obtained. The overall effect of CZX-S was "markedly improved" in 2 and "moderately improved" in 4 of the 6 patients with bacterial infection. Bacteriological findings show that causative organisms were eradicated in all the 5 patients observed. The breakdown of the organisms was S. aureus, S. pyogenes, S. pneumoniae, H. influenzae and E. coli. The serum concentration of CZX was 3.3 approximately 15.4 micrograms/ml (mean +/- S.E. 8.9 +/- 2.0 micrograms/ml) at 15-37 minutes after initial rectal administration with CZX-S 125 (dose: 7.7-11.9 mg/kg). While, in the CZX-S 250 administratered group, the serum concentration was 3.1 micrograms/ml and 10.5 micrograms/ml at 20 minutes after initial rectal administration (dose: 5.6 mg/kg and 14.7 mg/kg). The urinary recovery rate up to 6 hours after initial rectal administration was 68.6% in 1 patient given CZX-S 125 and 28.3-52.5% (mean +/- S.E. 38.7 +/- 7.2%) in 3 patients given CZX-S 250. Side effects and abnormalities in laboratory test values were not observed in any cases.

Topics: Adolescent; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Male; Suppositories

BMY 28142, a new broad-spectrum semisynthetic cephalosporin, was evaluated in vitro and in vivo in comparison with ceftazidime, cefotaxime, moxalactam, and cefoperazone. The activity of BMY 28142 compared favorably with the activities of the other compounds against both Pseudomonas aeruginosa and Staphylococcus aureus and was somewhat greater against members of the family Enterobacteriaceae. The influence of inoculum size on MICs of BMY 28142 was small for most of the isolates tested, except Enterobacter species. With Enterobacter strains, a marked inoculum effect was found with all of the compounds, and the effect was more pronounced in broth than agar. Still, MICs of BMY 28142 in broth did not exceed 16 micrograms/ml. Of 37 Enterobacteriaceae strains resistant to one or more of the comparison beta-lactams, none were resistant, at a low inoculum size (10(4) CFU), to BMY 28142, compared with 3 for moxalactam, 18 for ceftazidime, 23 for cefotaxime, and 34 for cefoperazone; at an inoculum size of 10(6) CFU, the number of resistant strains was 12, 17, 25, 34, and 37, respectively. Binding to human serum proteins approximated 19%. Recovery of 73% of the drug in mouse urine indicated good bioavailability. The in vitro profile was sustained in vivo by the results obtained with experimental infections in mice. BMY 28142 was as effective as ceftazidime against systemic infection with P. aeruginosa and as effective as cefotaxime against systemic infection with S. aureus. Overall, infections with 18 of 20 strains representing nine genera were responsive to BMY 28142 at doses equivalent to or lower than those of the most effective of the comparison compounds.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Biological Availability; Blood Proteins; Cefepime; Cefoperazone; Cefotaxime; Ceftazidime; Cephalosporins; Drug Resistance, Microbial; Humans; Male; Mice; Microbial Sensitivity Tests; Moxalactam; Protein Binding

Experience with the use of first-generation cephalosporins in bacterial meningitis has been disappointing; low concentrations were obtained in the cerebrospinal fluid, and therapeutic failures were encountered. Of the second-generation cephalosporins cefamandole, cefuroxime, and cefoxitin, only cefuroxime has proved efficacy in meningitis caused by meningococci, pneumococci, or Hemophilus influenzae. The third-generation cephalosporins offer new advantages in the treatment of meningitis because they are active at the cerebrospinal fluid concentrations obtainable. Cefotaxime has produced high cure rates in patients with meningitis caused by meningococci, pneumococci, or H. influenzae. Several controlled comparative studies indicate that ceftriaxone is as effective as conventional treatment in therapy for neonatal or childhood meningitis caused by Streptococcus agalactiae, Escherichia coli, or H. influenzae. Moxalactam has been found in uncontrolled studies to be effective when the cause was enteric gram-negative bacilli. Ceftazidime is a new cephalosporin with a high degree of beta-lactamase stability and a broad antibacterial spectrum, which includes Pseudomonas aeruginosa that enters the cerebrospinal fluid. Data from 29 patients who received ceftazidime as monotherapy for bacterial meningitis showed an overall cure or improvement rate of 75.9 percent. Therapy failed in three patients with meningitis caused by gram-positive organisms (Staphylococcus aureus, S. epidermidis, S. agalactiae), and in three with gram-negative organisms. Of 14 patients with Pseudomonas meningitis, 11 showed a cure, as did six of six patients with meningitis caused by Enterobacter, Serratia, or Acinetobacter. More, preferably controlled, studies of the efficacy of ceftazidime in the treatment of meningitis should be undertaken.

Topics: Adult; Animals; Bacterial Infections; Cefoperazone; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Disease Models, Animal; Humans; Meningitis

The fundamental and clinical studies of ceftizoxime suppository (CZX-S) in the field of pediatrics were made, with the following results. The serum concentration of CZX in the CZX-S 250 mg-administered group peaked 6.00-22.5 micrograms/ml during the period of 15 minutes to 1-hour after dosing, and gradually declined thereafter. The half-life was 1.37-3.81 hours. In the CZX-S 125 mg-administered group, the serum concentration peaked 2.25-21.0 micrograms/ml at 15-30 minutes after dosing and decreased with time. The half-life was 0.95--1.84 hours. The 6-hour urinary recovery rate of CZX in the CZX-S 250 mg group was 22.0-47.5%. The 6-hour urinary recovery rate in the CZX-S 125 mg group was 17.2-25.3%. CZX-S was given 12-73 mg/kg/day (divided into 1-3 times) to 7 children with respiratory tract infection etc. who were considered to respond well to the drug. The clinical effectiveness rate was 100% inclusive of "excellent" and "good". The side effect of pain on insertion was encountered in 1 child.

Topics: Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Klebsiella pneumoniae; Male; Suppositories

A clinical trial of ceftizoxime suppositories (CZX-S) was conducted in children whose chemotherapy was considered to be best performed in this dosage form at the physician's discretion. The subjects were 5 children with infection, consisting of 2 with pneumonia, 1 with tonsillitis, and 2 with UTI. The results were as follows. The clinical response to CZX-S was "markedly effective" in 3 and "effective" in 2, with the 100% effectiveness rate. Neither adverse drug reactions nor abnormal laboratory tests were detected. No unwanted expulsion of the suppository occurred. The serum concentration of CZX 30 minutes after the first insertion ranged from 8.38 to 11.4 micrograms/ml, and the urinary concentration of CZX in the 6-hour urine collections, from 23.6 to 290 micrograms/ml.

Topics: Bacterial Infections; Cefotaxime; Ceftizoxime; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Infant; Kinetics; Male; Suppositories

Ceftizoxime suppository (CZX-S) was given to 6 patients, with the following results. The peak serum concentration of CZX was 1.8-7.5 micrograms/ml at 30 minutes after dosing of CZX-S with 9.6-16.7 mg/kg. The antibacterial activity of CZX revealed that the drug can be expected to be effective sufficiently. The overall effect of CZX-S was "markedly improved" in 1 and "moderately improved" in 3 of the 4 patients with pneumonia and "markedly improved" in 1 and "slightly improved" in 1 of the 2 with UTI. CZX-S caused a slight increase in frequency of defecation in 2 of the 6 patients. There were no abnormal findings of symptoms or laboratory test values which were ascribable to side effects.

Topics: Bacterial Infections; Cefotaxime; Ceftizoxime; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Infant; Kinetics; Male; Suppositories

The large apparent volume of distribution of cefotiam (reported by Fourtillan et al. [4]), prompted an investigation of cefotiam diffusion into ascitic fluid. Eight patients with non-infected ascites were each given a single intravenous bolus of 2 gr cefotiam. Samples of blood and ascitic fluid were collected 0.5, 1, 2, 3, 4, 6 and 8 hours after the injection. Plasma and ascitic fluid concentrations of unchanged cefotiam were determined using HPLC. Peak concentration in ascitic fluid averaged 18 micrograms/ml and was reached at two hours. Concentrations were still high (approximately 13 micrograms/ml) at 8 hours, leading to further assays 12 and 24 hours after the injection in three subjects. Cefotiam concentrations achieved in ascitic fluid seem adequate for the treatment of infected ascites, given the antibiotic's MICs for the organisms most commonly involved.

Topics: Ascitic Fluid; Bacterial Infections; Cefotaxime; Cefotiam; Chromatography, High Pressure Liquid; Diffusion; Humans; Kinetics

20, 30 and 90 minutes after a single intravenous injection of 2 g of cefotiam prostatic tissue and serum samples were taken from 12 patients who underwent transabdominal prostatectomy for prostatic adenoma. Cefotiam was assayed by HPLC. Mean serum and prostatic concentrations were respectively 157 +/- 39 mg/ml and 42 +/- 23 mg/g at 20 mn, 77 +/- 52 mg/ml and 54 +/- 2 mg/g at 30 mn, 36 +/- 21 mg/ml and 16 +/- 18 mg/g at 90 mn. Elimination half-life of cefotiam was 1 h 39 mn for serum and 1 h 10 mn for prostatic tissue. These findings confirm the satisfactory diffusion of cefotiam within prostatic tissue, although saturation occurs after 30 mn. Treatment of prostatitis by cefotiam can be expected to give excellent results.

Topics: Adenoma; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Chromatography, High Pressure Liquid; Half-Life; Humans; Kinetics; Male; Prostate; Prostatectomy; Prostatic Neoplasms; Prostatitis

Topics: Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Humans; Nafcillin; Tobramycin

Seventy-eight infectious episodes in 75 cancer patients with adequate granulocyte counts were treated with cefotaxime. Sixty-six episodes were evaluable. The overall cure rate was 77% (51/66). The response rate in 46 episodes where an organism was identified was 72% (33/46). Gram-positive and Gram-negative infections responded equally with rates of 81% and 80% respectively. Pneumonia, septicaemia and urinary tract infections occurred most frequently and had response rates of 62% (18/29), 90% (9/10) and 91% (10/11) respectively. Polymicrobial infections were associated with a poor response--40% (4/10). No serious adverse effects occurred. Cefotaxime as a single agent was effective therapy for most Gram-positive and Gram-negative infections in cancer patients with adequate granulocyte counts. Polymicrobial infections and Gram-negative pneumonias might require additional agents.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Female; Granulocytes; Humans; Leukocyte Count; Male; Middle Aged; Neoplasms

Ceftriaxone administered as a single daily dose of 50 mg/kg was evaluated in the treatment of 35 children with a variety of nonmeningitic bacterial infections. In two of the patients, the drug was discontinued before the response to the drug could be evaluated. All of the remaining patients had a satisfactory response. In 22 of the patients, plasma was available for the determination of ceftriaxone levels 1 h after a dose and immediately before the next dose. All but one of these patients had trough ceftriaxone levels which exceeded the MIC of the infecting organism, although marginally so for Staphylococcus aureus. Ceftriaxone appears to be safe and effective in the treatment of a variety of bacterial pathogens in children when administered at a single daily dose of 50 mg/kg. This drug may be especially useful in those patients in whom outpatient antibiotic therapy is contemplated or in whom maintenance of intravenous access is difficult.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Humans; Infant; Infant, Newborn; Kinetics; Microbial Sensitivity Tests

Ceftriaxone (Ro 13-9904, CTRX) was administered to 3 cases with gynecological infections and following results were obtained. CTRX was administered by intravenous drip infusion or intravenous injection with 2 g per day for 4 to 6 days. The clinical efficacy was good in all cases (2 cases with pyometra, 1 case with adnexitis and endometritis). No side effect could be determined in all cases.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Endometritis; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Middle Aged; Pelvic Inflammatory Disease; Suppuration; Uterine Diseases

Cefotaxime (CTX) was administered to 117 pediatric patients. Although 26 of these patients were excluded from the clinical evaluation of the study because other antimicrobial agents were given concomitantly with CTX or because no infectious diseases were proved, these cases were evaluated for adverse effects of the drug. The remaining 91 cases were evaluated for clinical effect; pneumonia in 56 cases, septicemia in 5, suspected septicemia in 5, meningitis (aseptic cases included) in 3, urinary tract infection in 5 and other diseases in 17. No pathogenic organisms were identified in any of the pneumonia cases, even either by bacterial culture or other laboratory test methods. Pathogens of septicemia were E. coli in 3 cases, K. pneumoniae in 1 and E. agglomerans in 1. Those of urinary tract infections were E. coli in 3 cases, a mixed infection of S. aureus and an unidentified species of Gram-negative rods in 1, and unknown in 1. Clinical effectiveness rates of CTX were 78.6% in pneumonia and 100% in septicemia, suspected septicemia and urinary tract infections. One patient with purulent meningitis caused by H. influenzae was also treated with CTX successfully. Adverse reactions and abnormal laboratory findings were observed in 12 cases (12/117 = 10.3%); rash in 2 cases, vomiting in 1, abdominal pain in 1, diarrhea in 5, granulocytopenia and thrombocytopenia in 1, eosinophilia in 3 and elevation of liver enzymes (GOT and LDH) in 1.

Topics: Bacterial Infections; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Pneumonia; Sepsis; Urinary Tract Infections

Clinical studies were made on ceftriaxone (CTRX, Ro 13-9904), a new long-acting cephalosporin antibiotic, with the following results. Following a single intravenous injection of 1 g, the transfer of CTRX to the internal genital organs was found to be good. The transfer of CTRX to exudate of the dead space of pelvis was also good. Elbow vein and uterine artery blood serum levels revealed marked increase immediately after administration, then followed by gradual reduction at very slow rate. CTRX was given to 3 patients of female genital infections. Efficacy was excellent in 1 case and good in 2 cases. As to side effect, 2 cases of diarrhea and 1 case of leukopenia were observed.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Injections, Intravenous; Pelvic Inflammatory Disease; Pregnancy; Puerperal Infection; Suppuration; Uterine Diseases

Ceftriaxone (Ro 13-9904, CTRX), a newly developed parenteral cephalosporin antibiotic was clinically evaluated in gynecoobstetric infections and the following results were obtained. CTRX was administered by intravenous drip infusion twice a day in a daily dose of 2 to 4 g to 10 cases with gynecoobstetric infections, consisting of 8 with intrauterine infections, 1 with adnexitis and 1 with infection of external genitalia. The global clinical efficacy was excellent in 2 and good in 6 out of 8 cases with intrauterine infections, and in 2 others, the efficacy rate being 100%. Bacteriologically, the eradication of bacteria was observed in 5, unchange in 2 and alternation of bacteria in 2 among 9 cases where the causative strains were detected. Neither adverse reaction nor laboratory test abnormality was observed. The above-mentioned results suggest that CTRX is a highly safe antibiotic expected to be excellent in the clinical efficacy and bacteriological effects.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Endometritis; Female; Humans; Infusions, Parenteral; Middle Aged; Pelvic Inflammatory Disease; Pregnancy; Puerperal Infection; Uterine Diseases

Ceftriaxone (Ro 13-9904, CTRX) was administered to 13 cases with gyneco-obstetric infections and the following results were obtained. The responses were excellent in 4 cases (30.8%) and good in 7 (53.8%) out of the 13 cases, the efficacy rate (good or above) being 84.6% (11/13). Two cases showing a poor response were considered inappropriate for a study on the efficacy of an antibiotic, as they had received anticancer drugs concomitantly for treatment of their underlying disease of peritonitis carcinomatosa due to ovarian cancer. From a bacteriological viewpoint, CTRX was effective against E. coli, S. aureus, S. faecalis, Pseudomonas, Staphylococcus, K. pneumoniae, S. epidermidis, etc. No specific side effects were observed.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Suppuration; Surgical Wound Infection; Uterine Diseases

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

Cefotaxime sodium was assigned to the open formulary for 12 months and then was placed on formulary restriction to evaluate the restriction's effect on rate of use by services and appropriateness of use. Over 18 months, 187 cases (72 before and 115 after restriction) were reviewed. The majority of use (prerestriction and postrestriction) was in the medicine, pediatrics, and surgery services. The postrestriction usage rate for the three services increased significantly. Cefotaxime was used appropriately in 85% of cases during both periods and was not used prophylactically. Appropriateness of use was independent of formulary restriction. During both periods, approximately 76% of patients received cefotaxime for pneumonia, sepsis, meningitis, or immunosuppression. Of 205 infections, gram-negative bacilli accounted for over half of the pathogens isolated. Thus, formulary restriction was ineffective in reducing the rate of cefotaxime usage and had no effect on the appropriateness of usage.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoperazone; Cefotaxime; Child; Child, Preschool; Drug Utilization; Female; Formularies, Hospital as Topic; Humans; Infant; Male; Medicine; Middle Aged; Moxalactam; Retrospective Studies; Specialization; Specialties, Surgical

Topics: Bacterial Infections; Cefoperazone; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male

Topics: Adult; Bacterial Infections; Belgium; Cefotaxime; Ceftriaxone; Child; Humans; Infant; Legislation, Drug

Cefpimizole was compared with cefoperazone and cefotaxime against 6,599 clinical bacterial isolates from five medical centers. Cefoperazone and cefotaxime were both more active and provided a greater spectrum of antimicrobial coverage than cefpimizole. Some of the cefpimizole minimum concentrations inhibiting 50% of tested strains were as follows: Citrobacter freundii and Enterobacter cloacae, 16 micrograms/ml; Escherichia coli and Klebsiella pneumoniae, 2.0 micrograms/ml; Proteus mirabilis, 1.0 microgram/ml; Pseudomonas aeruginosa, 16 micrograms/ml; Staphylococcus spp., 32 micrograms/ml; and the enterococci, greater than 32 micrograms/ml.

Topics: Bacteria; Bacterial Infections; Cefoperazone; Cefotaxime; Cephalosporins; Humans; Microbial Sensitivity Tests

A group of 104 neonates with clinical signs of infection sufficient to justify treatment with penicillin plus gentamicin received instead monotherapy with ceftriaxone (50 mg/kg once daily). Bacteriological cultures from 20 babies before treatment yielded significant isolates (9 had bacteraemia). Following treatment, infecting bacteria were eradicated from 15/20 babies. Ten of the 104 babies died; all were examined post mortem. Only one death was attributed to bacterial infection. The remaining babies responded well to treatment. No adverse alteration in biochemical or haematological values was associated with ceftriaxone therapy. The incidence of diarrhoea, blood in the stools, necrotising enterocolitis or anti-coagulation problems was the same as in the babies not receiving ceftriaxone. Pharmacokinetic values were determined on 40 babies. Elimination half life (T1/2 beta) and minimum serum concentration (Cmin.) decreased and clearance increased with increasing postnatal age. Postnatal age was the single most significant factor affecting pharmacokinetics. Ceftriaxone is a safe and effective alternative to conventional therapy for infected neonates. Prolonged therapy is associated with superficial colonisation with inherently resistant bacteria.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Male; Respiratory Tract Infections; Sepsis

The efficacy and safety of ceftriaxone (Ro 13-9904, CTRX) a new broad-spectrum semisynthetic cephalosporin with an outstanding long serum half-life, was evaluated in 22 patients with chronic complicated urinary tract infections. Although the overall clinical efficacy evaluated on day 5 and 10 were similar, the rate of excellent effectiveness was higher on day 10 than on day 5. Eighteen bacterial strains were cultured from freshly voided urine. Eighty percent of the bacteria were eradicated on day 5 and 86.2% were eradicated on day 10. Bacterial replacement had occurred in 3 cases on day 5 and in 6 cases on day 10.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Urinary Tract Infections

The penetration of cefotaxime (CTX) into the cerebrospinal fluid (CSF) was monitored to evaluate the prophylactic efficacy of the drug against post-craniotomy infections. Doses ranged from 1 to 2 g were administered to patients with subarachnoid hemorrhage due to the rupture of cerebral aneurysm, traumatic cerebral contusion, or subdural edema accompanied by intracerebral hemorrhage, by intravenous drip infusion over a period of 30 or 60 minutes. CTX readily entered the CSF with concentrations exceeding MICs against the major pathogens occurring after craniotomy. CTX proved to be effective in the prevention of post-craniotomy infections in noninflammatory situations, especially after surgery in the case of cerebral traumas or subarachnoid hemorrhage.

Topics: Adult; Aged; Bacterial Infections; Brain Injuries; Cefotaxime; Craniotomy; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Postoperative Complications; Subarachnoid Hemorrhage

Urinary tract infections (UTI) due to gram-positive bacteria are fairly uncommon. In order to investigate the efficacy of treatment for UTI secondary to gram-positive rods, we performed a non-comparative study on the effect of cefotaxime in 64 patients with gram-positive UTI. Patients with a history of hypersensitivity to cephalosporins and penicillin as well as patients who had received antibiotic treatment within 48 hours after the administration of cefotaxime, patients with hepatic disease and patients with fatal progressive disease were excluded from the study. UTI was confirmed by positive cultures with a colony count of greater than or equal to 100,000 cfu/ml of gram-positive organisms before treatment with cefotaxime. When sepsis or bacteriuria occurred after two days of hospitalization, the UTI was considered nosocomial. The most common microorganism isolated was Staphylococcus aureus, followed by Streptococcus faecalis. 30% of the patients showed polymicrobic bacteriuria, especially in association with gram-negative bacteria (70%). A high frequency of predisposing factors was present in the urinary tract, mainly obstruction, indwelling catheters, surgery and chronic debilitating diseases. Seven patients developed bacteremia. All patients were treated with cefotaxime i.m. or i.v. at a daily dosage ranging between 4 and 12 g. Urine cultures were repeated five days after the beginning of treatment and again two to three weeks after the end.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Female; Gram-Positive Bacteria; Humans; Male; Middle Aged; Urinary Tract Infections

We studied the activity of cefotaxime both microbiologically and clinically. 138 blood cultures positive for gram-positive cocci were evaluated (90 strains of Staphylococcus aureus, 25 of Streptococcus faecalis, 13 of Streptococcus alpha and ten of Streptococcus mutans). Cefotaxime showed good activity against all strains with the exception of S. mutans, of which only 30% were sensitive. Ten cases of gram-positive infections were studied clinically: six sepsis cases and one endocarditis case due to S. aureus, two sepsis cases caused by Streptococcus alpha and one Enterococcus endocarditis case. Therapy was successful in nine; the S. aureus endocarditis failed. The local and general tolerance of cefotaxime was good.

Topics: Adult; Bacterial Infections; Cefotaxime; Female; Gram-Positive Bacteria; Humans; Male; Middle Aged

66 patients with predominantly community-acquired pneumonia were treated with cefotaxime. The group consisted of 45 males and 21 females, aged 56 to 90 years, 43 of the patients belonging to the age groups 65-80 years. Streptococcus pneumoniae was isolated in 21 of the 34 patients with gram-positive pneumonia, Staphylococcus aureus in six, Staphylococcus epidermidis in five and Streptococcus faecalis in two. Klebsiella pneumoniae was the predominant pathogen in gram-negative pneumonia (eight patients), followed by Enterobacter (n = 6), Pseudomonas aeruginosa (n = 5), Haemophilus influenzae (n = 4), Escherichia coli (n = 3), Serratia marcescens and Citrobacter (two cases each). The in vitro activity of cefotaxime against the isolates was compared to the activity of other beta-lactam antibiotics. Characteristically, the classical signs and symptoms of pneumonia were absent or discrete in some of the elderly patients. There was a delayed clearance of pulmonary infiltrates. 55 of 66 patients responded to cefotaxime within four weeks of treatment; the symptoms were aggravated or remained unchanged in seven patients. Patients with a delayed clinical response displayed decreased peripheral lymphocyte counts and T cell functions in PHA stimulation tests, as well as low immunoglobulin levels. A combination of cefotaxime and gamma-venin cleared the symptoms in some of these patients.

Topics: Aged; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Immunologic Deficiency Syndromes; Leukocyte Count; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia

Cefotaxime is an effective antibiotic in lower respiratory tract infection caused by streptococci and staphylococci. There is a limited tendency to superinfections with Pseudomonas aeruginosa (1.5%) and there is a low incidence of side-effects. It is questionable whether there is really an urgent need for cefotaxime in gram-positive lower respiratory tract infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Gram-Positive Bacteria; Humans; Middle Aged; Respiratory Tract Infections

The in vitro activity of cefotaxime and other third-generation cephalosporins against gram-positive pathogens is generally considered to be less than that of earlier cephalosporins, such as cefazolin. A review of pooled pre-release data collected by numerous investigators and supplied by Hoechst-Roussel made it possible to evaluate the clinical and bacteriologic efficacy of cefotaxime in more than 900 infections caused by gram-positive organisms. The most commonly isolated pre-treatment organisms were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, and other streptococcal species. The overall clinical efficacy rate was 95% and the bacteriologic eradication rate was 94.5%. Side-effects were limited to rash in two, diarrhea in one and fever in one. Pain at the administration site was reported by four patients. Comparative studies with cefazolin against S. aureus showed no statistically significant differences in efficacy. The highest failure rates were seen in enterococcal urinary tract infections, as predicted by in vitro sensitivity tests. Cefotaxime appears to be a safe, effective antibiotic for the therapy of infections caused by gram-positive pathogens.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Child; Female; Gram-Positive Bacteria; Humans; Male; Middle Aged

In order to evaluate the efficacy of cefotaxime in gram-positive surgical infections, three clinical studies were re-evaluated. Antibiotic susceptibility tests were carried out on clinical isolates from our hospital during the period of clinical use of cefotaxime. The tissue fluid concentrations measured were compared to minimal inhibitory concentrations of gram-positive pathogens. Following 2 g cefotaxime i.v., tissue fluid concentrations were higher than 8 mg/l for more than 6 h and higher than 4 mg/l for more than 8 h. More than 90% of gram-positive pathogens excluding enterococci were inhibited at 4 mg/l. A comparison was made on the clinical efficacy of cefotaxime on infections caused by gram-positive organisms (group I) versus infections due to gram-negative bacteria (group II). 89 patients entered this study. In 40 patients only gram-positive bacteria were isolated initially (group I) and in 49 mainly gram-negative bacteria (group II). The mean age was 43 years (range 8-80 years) in group I and 61 years (range 19-92 years) in group II. Most patients received 2 g cefotaxime every 12 h. 40 skin and soft tissue infections (group I = 25, group II = 15), 25 pulmonary infections (group I = 7, group II = 18), 17 biliary infections (group I = 4, group II = 13) and nine bone and joint infections (group I = 4, group II = 5) were treated. The mean duration of therapy was nine (group I) and 11.2 (group II) days. Surprisingly, the cure rate was better in group I (70%) than in group II (59%).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Child; Female; Gram-Positive Bacteria; Humans; Male; Middle Aged; Postoperative Complications

Data compiled from computer-generated summaries of patient records submitted to Hoechst-Roussel Pharmaceuticals were reviewed regarding the efficacy and toxicity of cefotaxime in the therapy of skin and skin structure infections associated with gram-positive pathogens. In addition, published open and comparative trials employing cefotaxime in gram-positive and gram-negative skin infections were evaluated with respect to the pathogens isolated and the nature, severity and bacteriological and clinical outcome of the treated infections. Within the limitations of the data reviewed, cefotaxime appeared to be a safe and effective therapy in greater than 90% of infections including cellulitis, abscesses and necrotizing ulcers of the skin and subcutaneous tissues when associated with the isolation of susceptible gram-negative bacilli, methicillin-susceptible Staphylococcus aureus, or aerobic or anaerobic gram-positive pathogens susceptible to aqueous penicillin G. The data would indicate that cefotaxime is a suitable therapy for patients with presumed polymicrobial, non-crepitant infections of the skin or skin structures pending microbiological studies. However, cefotaxime cannot be recommended for similar infections due to organisms such as methicillin-resistant S. aureus or Pseudomonas aeruginosa that are commonly resistant to cefotaxime in vitro. Data regarding skin and skin structure infections associated with Clostridium spp. and enterococcal group D streptococci are either lacking or inconclusive with respect to the utility of cefotaxime.

Topics: Bacterial Infections; Cefotaxime; Gram-Positive Bacteria; Humans; Skin Diseases, Infectious

Cefotaxime treatment was evaluated in 41 patients with serious bone and joint infections. Septic arthritis and bursitis (8), acute and chronic osteomyelitis (33) were treated with 3 to 12 g of cefotaxime per day for three to 52 days. The diagnosis of osteomyelitis or septic arthritis was made on the basis of clinical and roentgenographic evidence of infection. The diagnosis of a joint infection was confirmed by a positive culture of a joint aspirate sample. The diagnosis of a bone infection was confirmed by either a positive culture of a bone biopsy or of blood in combination with a positive bone scan or roentgenogram. Staphylococcus aureus was the most frequently isolated pathogen. Overall, 36 of 41 patients, who met all criteria for evaluation, had satisfactory responses to cefotaxime. The drug was well tolerated by all patients. However, six patients had a direct Coomb's test, two patients were noted to be neutropenic and two patients developed a macular rash. It is concluded that cefotaxime is a useful and safe antibiotic for the treatment of osteomyelitis and septic arthritis.

Topics: Adolescent; Adult; Aged; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Female; Gram-Positive Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neutropenia; Osteomyelitis

Primary meningitis in children is caused by two gram-negative bacterial species, Neisseria meningitidis and Haemophilus influenzae, and one gram-positive bacterial species Streptococcus pneumoniae. Despite optimal penicillin susceptibility, with few exceptions, therapeutic results in pneumococcal meningitis are by far worse than with the other two pathogens. Therefore, and because of the detection of penicillin-resistant rods, the study of alternatives in therapy is justified and was started with cefotaxime. Including six of our own patients, there are reports on 87 patients in the literature suffering from S. pneumoniae meningitis who were treated with cefotaxime monotherapy. Results of these studies will be analyzed. As none of these patients belonged to a prospective controlled study group, final evaluation in comparison with penicillin therapy remains open. There are also several reports on successful treatment of group B streptococcus meningitis with cefotaxime, although there is no need to abandon penicillin therapy. Staphylococcus aureus and Staphylococcus epidermidis meningitis, usually secondary in shunted hydrocephalus, brain tumors, brain injury or other causes, should not be treated with cefotaxime because of its limited activity on these bacteria. Listeria monocytogenes and Streptococcus faecalis are primarily cefotaxime-resistant, and neonatal meningitis of unknown origin, therefore, should not be treated with cefotaxime alone as long as these pathogens cannot be excluded.

Topics: Bacterial Infections; Cefotaxime; Gram-Positive Bacteria; Humans; Infant; Meningitis

Information on 62 bacteriologically confirmed cases of bacterial meningitis treated with cefotaxime in this country was obtained retrospectively from infectious disease consultants. This series of cases differed markedly from the world cumulative case data so far presented. One of the two most common organisms treated was the pneumococcus (allergy to penicillin or misdiagnosis of the Gram stain were the major reasons given). Unanticipated bacteriologic successes were noted in two cases of staphylococcal meningitis secondary to parameningeal foci. The bacteriologic cure rate and survival rate were about 85%. Failure of monotherapy was seen in one case of pseudomonas meningitis, as well as in three of five cases of enterobacter meningitis. In addition, two cases of Escherichia coli meningitis which had inexplicably failed on moxalactam were cured with cefotaxime. Thus, overall not all gram-negative species and not all isolates of any particular species which cause meningitis can be successfully treated by cephalosporins. Data obtained during the investigative trials do not appear to be entirely predicative of what occurred during the free clinical use of an antibiotic. There is a need for the post-investigatory follow-up and surveillance of all newly introduced therapeutic agents.

Topics: Bacterial Infections; Cefotaxime; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Meningitis; Microbial Sensitivity Tests

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Humans

Cefotaxime (CTX) was the first third-generation cephalosporin to be launched. According to my classification of cephalosporins for practitioners, in contrast to old beta-lactamase-labile cephalosporins (Group I-III), CTX is beta-lactamase-stable and belongs to Group V with anti-pseudomonas activity. A critical review of about 90 patients with Staphylococcus aureus infections, found among analyzable subjects treated with CTX for gram-positive infections, demonstrates that CTX can be expected to be bacteriologically and clinically effective against this pathogen. Moreover, CTX had excellent efficacy against gram-positive organisms compared with other so-called third-generation cephalosporins. CTX is comparable to or more effective than conventional antibiotics in the treatment of respiratory tract infections, soft tissue infections, and neonatal and pediatric infections caused by gram-positive organisms, S. aureus included, if used after taking the susceptibility of the pathogen into account.

Topics: Bacterial Infections; Cefotaxime; Gram-Positive Bacteria; Humans; Staphylococcal Infections

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Humans; Infant, Newborn

Cefotaxime (CTX) was administered to 130 children with various bacterial infections of 41 to 400 mg/kg/day for 2 to 21 days. The clinical effect of CTX was very satisfactory in respiratory tract infection, urinary tract infection and meningitis. The overall clinical effect was excellent in 59, good in 39, fair in 17 and failure in 8 with effective rate of 79.7%. During this therapy, side effects were seen in 3 cases, diarrhea in 1 and rash in 2. Abnormal laboratory findings were seen in 5 cases, elevation of GOT in 1, GOT, GPT and A1-P in 1, GOT, GPT and T. Bil. in 1, elevation of BUN, increase of number of basophils and albuminuria in 1 and observation of albuminuria in 1. The above results demonstrate that CTX is a clinically useful antibiotic for the therapy of pediatric infections.

Topics: Adolescent; Age Factors; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Female; Hematologic Diseases; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Male; Neoplasms

A 6-week-old infant admitted to the University Hospital of the West Indies with hydrocephalus later developed ventriculitis. A heavy growth of Flavobacterium odoratum susceptible to gentamicin and cefotaxime was recovered from the ventricular fluid. Since intraventricular therapy was envisaged, a Pudenz reservoir was installed and ventricular fluid aspirated every 24 h to monitor treatment. Initial therapy consisted of intravenous cefotaxime, 50 mg/kg q.i.d. for 4 days. No significant reduction in the number of organisms in the ventricular fluid was achieved with this regimen. Intravenous therapy was therefore discontinued. On day 5 intraventricular therapy began with 5 mg cefotaxime 24 h for 6 days, followed by 1 mg/24 h for 4 days. Daily monitoring of intraventricular fluid indicated a high degree of antibacterial activity with rapid elimination of bacteria. Ventricular fluid remained sterile 10 days after therapy stopped. The Pudenz reservoir was removed, a ventriculoperitoneal shunt installed, and the patient discharged from hospital 4 days later without noticeable sequelae.

Topics: Bacterial Infections; Cefotaxime; Cerebral Ventricles; Cerebrospinal Fluid; Encephalitis; Flavobacterium; Humans; Infant; Injections, Intraventricular; Male

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Ethiopia; Female; Humans; Infant; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged

Twenty infectious episodes were caused mainly by Gram-negative rods in 16 patients with a disorder of the hemopoietic tissue. The ages of the patients ranged between 20 and 76 years. Cefotaxime (CTX) was used alone in 9 infectious episodes (group I) and in combination with other antibiotics in the remaining 11 infectious episodes (group II). The following results were obtained. A good response to CTX was noted. The clinical and bacteriological success rates were 100% and 83% in group I, and 82% and 100% in group II, respectively. Bleeding was not clinically found during and after treatment of any infectious episodes with CTX. No change in PT and aPTT was noted during CTX treatment, either. CTX was thus evaluated to be an effective and safe cephem antibiotic in the treatment of infectious episodes secondary to a disorder of the hemopoietic tissue, which is usually accompanied by a marked hemorrhagic tendency.

Topics: Adult; Aged; Bacterial Infections; Blood Coagulation; Cefotaxime; Drug Evaluation; Female; Humans; Infusions, Parenteral; Leukemia; Lymphoma; Male; Middle Aged; Multiple Myeloma; Partial Thromboplastin Time; Prothrombin Time

Clinical investigation of combination use of cefotiam (CTM), aminoglycoside, or (and) penicillin against complicated infections with hematopoietic disorders was performed, and the results were as follows. Fifty-one patients were administered CTM in combination with aminoglycoside or (and) penicillin. The clinical response was excellent 19.6%, good 27.4%, fair 21.6%, and poor 31.4% showing efficacy rate of 47.1%. The combined therapy of CTM and aminoglycoside was clinical effective in 70% of 10 patients with complicated sepsis. Therefore, combination use of CTM and aminoglycoside is considered to be the first choice for the treatment of complicated sepsis with hematopoietic disorders. The clinical effectiveness of CTM was not influenced by the number of mature neutrophil at the first phase of CTM treatment, but was influenced at the end phase of CTM treatment. Gram-negative bacilli were dominantly isolated from the patients. Pseudomonas sp. was isolated from 70% of the patients with sepsis. No remarkable side effects were observed in this investigation.

Topics: Adolescent; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Drug Therapy, Combination; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged; Penicillins; Pneumonia; Sepsis

Ceftizoxime (CZX), a parenteral cephalosporin derivative belonging to the so-called third generation cephalosporin is reported to have a broad antibacterial activity, particularly against Gram-negative aerobic bacilli and some anaerobes, such as Bacteroides fragilis and a good stability to beta-lactamases. Clinical study was performed on a total of 20 cases, 9 females (1 case had urinary tract infection 3 times) and 11 males, aged from 27 to 82 years. All patients had the underlying diseases. They were bronchial asthma in 3 cases, influenza in 1, chronic pulmonary emphysema in 1, pulmonary fibrosis in 1, chronic bronchitis with strongyloidiasis in 1, lung cancer in 3, esophagus cancer in 2, stomach cancer in 1, hepatoma with urolithiasis in 1, liver cirrhosis with diabetes mellitus in 1, alcoholism with strongyloidiasis in 1, cholelithiasis in 1 and congestive heart failure in 1, respectively. Clinical diagnoses for infections were 2-acute bronchitis, 2-exacerbation of chronic bronchitis, 2-broncho-pneumonia, 2-pneumonia including one suspected case, 1-obstructive pneumonia, 2-secondary pulmonary infection, 1-pulmonary infection, 3-urinary tract infection (UTI), 1-UTI with sepsis, 1-sepsis, 1-sepsis with purulent meningitis, 1-biliary tract infection and 1-infected bronchoesophageal fistula. CZX was given by intravenous drip infusion, at a dose of 1 to 2 g, twice daily for 3 to 15 days. Because of severity in infections and underlying diseases, some cases were treated either steroid, gamma-globulin preparations or other antibiotics in combination with CZX. Twelve out of 15 cases assessed clinically responded satisfactorily to the treatment and efficacy rate was 80.0%.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Drug Evaluation; Female; Gram-Negative Bacteria; Humans; Liver Diseases; Lung Diseases; Male; Middle Aged

The clinical efficacy and safety of ceftriaxone when administered twice daily was evaluated in the treatment of serious infections, including 9 episodes of bacteremia, 4 of pneumonia, 7 of intra-abdominal or soft tissue infections, 11 of urinary tract infections, 3 of osteomyelitis, and 5 of meningitis. Causative pathogens were Strep. pneumoniae, other hemolytic streptococci, E. coli, P. mirabilis, K. pneumoniae, and species of Enterobacter, Serratia, and Pseudomonas. The overall clinical cure rate was 87 percent and the bacteriologic cure rate was 77 percent. Cures were achieved in infections due to organisms resistant to ampicillin, cefazolin, cefamandole, carbenicillin, and gentamicin. Peak plasma levels were far in excess of the minimal inhibitory concentrations of Enterobacteriaceae. Adverse effects were infrequent, and in only one instance was it necessary to discontinue treatment. Resistance to ceftriaxone developed during therapy with several Enterobacter and Pseudomonas species isolates. Ceftriaxone appears to be a useful agent for treatment of serious gram-negative infections in seriously ill patients.

Topics: Abdomen; Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Drug Resistance, Microbial; Female; Gram-Negative Bacteria; Humans; Kinetics; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Renal Dialysis; Urinary Tract

Topics: Animals; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Humans

Thirty pediatric and young adult patients with bacterial meningitis were treated with ceftriaxone or "standard therapy" in a comparative trial; 41 other patients with severe bacterial infections were treated with ceftriaxone in an open protocol. Meningitis and brain abscesses were treated successfully with 50 mg/kg of ceftriaxone every 12 hours. In children, other infections were treated with 25 to 37.5 mg/kg of ceftriaxone every 12 hours. Young adults with pneumonia received 1 g of the antibiotic every 12 hours, whereas those with soft tissue infections were treated every 24 hours. All patients responded to therapy, and in all but one was the infectious process sterilized. No significant toxicity was observed. Ceftriaxone appears to be an excellent single agent for the treatment of most severe bacterial infections in pediatric and young adult patients and need not be administered more frequently than once every 12 hours.

Topics: Adolescent; Adult; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Meningitis; Microbial Sensitivity Tests

The pharmacokinetic behavior of ceftriaxone was studied in 60 patients with severe community- or hospital-acquired infections. Serum concentrations one to three hours after a 30-minute intravenous infusion appeared to be dose related. The mean two-hour levels were 110, 138, and 146 mg/liter, and trough values averaged 54.9, 28.5, and 16.1 mg/liter after doses of 1.0, 2.0, and 3.0 g, respectively. At 24 hours, values were at least 10 mg/liter in all but seven patients. The serum half-life of ceftriaxone in all patients and for all dosage regimens varied from 3.5 to 59.4 hours. In patients with normal renal function (serum creatinine 1.30 mg/dl or less) the mean half-life was 8.2 hours. In patients with moderate (creatinine 1.34 to 1.83 mg/dl) and severe (creatinine 2.40 mg/dl or greater) renal insufficiency, the mean serum half-lives were 12.8 and 12.4 hours, respectively. In six patients who had severe renal failure and concomitant hepatic dysfunction, half-lives ranged from 23.7 to 59.4 hours. Single daily doses of 2.0 g of ceftriaxone produced adequate serum concentrations. Dose reductions are recommended in patients with both renal and hepatic dysfunction.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Half-Life; Humans; Kidney Diseases; Kinetics; Liver Diseases; Middle Aged

Cefotaxime concentrations in the cerebrospinal fluid and serum were determined in patients with purulent meningitis by means of a simple, rapid and reproducible method in agar medium. The CSF concentrations of cefotaxime fluctuated around 4 mg/l. The pharmacokinetics of the antibiotic in relation to the integrity of the blood-brain barrier was studied by means of an assay of the albumin and IgG present in the cerebrospinal fluid and in the serum.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Child; Humans; Meningitis; Middle Aged

Seventy-five children with bacterial meningitis were included in a multicentre trial for evaluation of cerebrospinal fluid (CSF) pharmacokinetics and clinical efficacy of cefotaxime. Mean age of patients was 4 years. Causative pathogens were Haemophilus influenzae in 28 patients (37%), Neisseria meningitidis in 27 patients (36%), Streptococcus pneumoniae in 10 patients (13%), group B streptococcus in 2 patients (2%) and unknown in 8 patients. All isolated pathogens were susceptible to cefotaxime. Seven ampicillin-resistant H. influenzae (9.4%) were found. Cefotaxime was 50 mg/kg intravenously, 4 times daily. The duration of treatment ranged from 5 to 22 days (mean: 13.8). Blood and CSF concentrations of cefotaxime were performed in 50 patients 3 h after infusion at day one and seven cefotaxime levels were determinated both by microbiological assay procedure and high pressure liquid chromatography. On day 1, CSF levels ranged from 0.39 to 2.0 mg/l by microbiological assay procedure (median 3.6) and from 0.0 to 17.4 mg/l (median 2.2) for cefotaxime and from 0.0 to 11.5 mg/l (median 2.2) for desacetyl-cefotaxime by HPLC. We observed a decrease in CSF levels of cefotaxime on day 7. They ranged from 0.3 to 7.0 mg/l (median 1.1) by microbiological assay and from 0.0 to 3.3 mg/l (median 0.8) for cefotaxime and from 0.0 to 6.0 mg/l (median 1.0) for desacetyl-cefotaxime by HPLC. On day 1 and day 7, CSF levels determined by microbiological assay and HPLC were correlated as follows: day 1:r = 0.59 (P less than 0.001). All children (100%) were cured and efficacy of cefotaxime was excellent in 72 cases (96%).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kinetics; Male; Meningitis

Ampicillin-cefotaxime was tested as initial therapy of presumptive bacterial meningitis in 55 children greater than or equal to 2 months of age at our hospital. During the first year of this ongoing trial, 11 patients, 10 whose CSF yielded ampicillin-resistant Haemophilus influenzae type b (MIC greater than 16 mg/l, beta-lactamase +) and one, indole-negative proteus (MIC 4 mg/l), were begun on ampicillin-cefotaxime and then continued on cefotaxime alone. All did well clinically except one who convulsed briefly but recovered without sequelae. The cefotaxime MICs/MBCs of the beta-lactamase-positive H. influenzae isolates (less than or equal to 0.007 to 0.03/less than or equal to 0.007 to 0.12) and the proteus isolate (0.03/0.12) were significantly lower than chloramphenicol MICs/MBCs (0.25 to 1.0/0.5 to 1.0 and 8/greater than 16). We followed 44 other children with meningitis due to ampicillin-sensitive organisms who were treated with ampicillin or penicillin after 1 or 2 days of ampicillin-cefotaxime. Aetiological agents included ampicillin-sensitive H. influenzae (25), pneumococci (9), meningococci (8), Strept. MG (1) and Listeria monocytogenes (1). 40/44 recovered uneventfully. There were 4 neurological complications: the streptococcal meningitis sustained a brain abscess and the three others were motor incoordination (sensitive haemophilus), hearing loss and subdural effusion (2 pneumococci). There were no deaths. 18/48 children managed initially with ampicillin-chloramphenicol during the same 12-month period one year earlier had significant neurological complications and/or sequelae and there was one death; aetiological agents included sensitive H. influenzae (30), pneumococci (9), ampicillin-resistant haemophilus (5), meningococci (3) and pneumococci plus strept. MG (1). The two groups were comparable except for the number of resistant haemophilus and meningococcal strains and underlying disease more frequent in the ampicillin-cefotaxime group. A significant reduction of neurological morbidity (5/55 or 9.1% vs. 18/48 or 37.5%:P less than 0.001) was therefore associated with the ampicillin-cefotaxime schedule in the initial treatment of proven bacterial meningitis. A prolonged hospitalization (greater than 15 days) was less frequent (P less than 0.01) in the ampicillin-cefotaxime group (3/55 or 5.5% vs. 13/48 or 27.1%). The results of the trial to date are considered to be very promising.

Topics: Adolescent; Ampicillin; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Chloramphenicol; Drug Combinations; Female; Humans; Infant; Male; Meningitis; Microbial Sensitivity Tests

Dangerous in all circumstances, purulent meningitis is even more life-threatening in tropical areas. This results from underlying malnutrition, haemoglobinopathy and enzymopathy, but also from delays in treatment. We have treated 28 patients, 16 boys and 12 girls, aged from 16 days to 7 years suffering from purulent meningitis, with cefotaxime. Almost half of the patients were suffering from malnutrition and low body weight, or from haemoglobinopathy. Cefotaxime, administered 2 or 3 times daily intramuscularly, was given at 90 to 200/mg/kg with a mean of 150/mg/kg/day. Overall, results showed a 79% cure rate including 71% complete recovery, the highest ever seen in the department.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Cerebrospinal Fluid; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Meningitis

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

In a control group of 59 multiple trauma patients requiring prolonged intensive care, a conventional restrictive antibiotic policy was followed. Forty-eight patients (81%) developed 94 infections. Fifty-one patients received systemic antibiotic therapy with one or more drugs. The total quantity of systemic antibiotics used was very high (18.3 +/- 22.1 antibiotic days per patient). This policy resulted in a very high incidence of superinfections (24%) with multiply-resistant Gram-negative bacteria, mostly emerging from the digestive tract (secondary endogenous infections). Five patients died from infection. A novel technique of infection prevention, based on the maintenance of the colonization resistance and on selective decontamination of the digestive tract in combination with systematic antibiotic prophylaxis with cefotaxime, proved to be very effective. Out of 63 multiple trauma patients, intubated and ventilated for 5 days or more in the ICU, 10 (16%) developed 11 infections. Most infections occurring under this regimen were primary endogenous infections which were treated by continuation of cefotaxime. Only two patients (3%) developed a superinfection with cefotaxime-resistant Gram-negative bacteria. No patient died. This approach to infection prevention in the ICU, shows that prophylactic administration of antibiotics significantly reduced the infection rate of critically ill patients without the development of superinfection.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Intestines; Male; Middle Aged; Wounds and Injuries

Fifty women who had Caesarian section in the presence of chorioamniotitis due to mixed aerobic and anaerobic bacteria were treated with cefotaxime 4 g daily. There was complete recovery in 96% of cases.

Topics: Adolescent; Adult; Bacteria; Bacterial Infections; Cefotaxime; Cesarean Section; Chorioamnionitis; Female; Humans; Pregnancy; Pregnancy Complications, Infectious

We treated 12 adult patients who had gram-negative bacillary meningitis with cefotaxime administered intravenously at a dose of 2 g every 4 hours. The etiological organisms included Haemophilus influenzae (3 cases), Serratia marcescens (3 cases), Klebsiella pneumoniae (3 cases), Escherichia coli (2 cases), and Enterobacter (1 case). The infection followed a neurosurgical procedure in 6 cases. The mean inhibitory and bactericidal concentrations of cefotaxime for the isolates ranged from 0.125 to 0.25 microgram/ml. The cerebrospinal fluid (CSF) concentrations of cefotaxime ranged from 5.0 to 15.2 micrograms/ml, and the CSF bactericidal titers were 1:64 to 1:128. The CSF in all patients was sterilized within 96 hours. All 12 patients recovered, and there were no relapses.

Topics: Adult; Bacterial Infections; Cefotaxime; Enterobacteriaceae Infections; Escherichia coli Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae; Meningitis; Meningitis, Haemophilus; Middle Aged; Serratia marcescens

Topics: Bacterial Infections; Cefotaxime; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Male; Thailand

Patients with chronic complicated urinary tract polymicrobial infections due to Pseudomonas aeruginosa and other bacteria were treated with cefsulodin using cefotiam or cefmenoxime as a concomitant drug. Each drug was given to the patients in daily dose of 1 or 2 g by drip infusion twice a day for 5 to 16 days. The results were as follows: Overall clinical efficacy was excellent in 7 cases (44%), moderate in 6 cases (38%) and poor in 3 cases (19%), the effectiveness rate being 81.3%. Bacteriologically, 38 strains (88.4%) were eradicated, 1 strain decreased and 4 strains unchanged out of the 43 clinical isolates from the patients. No side effects and no abnormalities of laboratory findings were observed.

Topics: Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Cefotiam; Cefsulodin; Cephalosporins; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Pseudomonas Infections; Urinary Tract Infections

Clinical studies on a new cephalosporin antibiotic, cefotaxime (CTX) were carried out in 79 patients with various types of infections in internal medicine. The efficacy rates were 65.8% in 39 cases of respiratory tract infections, 94.1% in 17 cases of biliary tract infections, 75.0% in 12 cases of urinary tract infections, 80.0% in 11 cases of other infections, and 75.3% in all cases. After CTX therapy, body temperature was improved in 76.7% of all 79 patients, particularly being excellent in all cases of biliary tract infections. Furthermore, symptoms such as cough, dyspnea, chest pain, moist rale and anorexia were improved to a great degree after CTX therapy. Adverse reactions and abnormal laboratory findings consisted of mild liver injury in 1 out of 79 cases. CTX was assessed to be an effective antibiotic for various types of infections in internal medicine.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged

Cefotaxime (CTX) was microbiologically and clinically studied in surgery. CTX shows excellent antibacterial activity in vitro against Gram-negative bacilli including E. coli. Klebsiella spp., and Proteus spp. in comparison with cefmetazole (CMZ) and cefazolin (CEZ). Antibacterial activity of CTX is found to be superior to that of CEZ and equal to that of CMZ against Gram-positive bacteria (S. aureus and S. epidermidis). The antibacterial activity of CTX against anaerobic bacteria exceeds that of CEZ and almost equal to that of CMZ. It also showed minimum inhibitory concentration values which, clinically speaking, offer great expectation. CTX is also superior to CMZ and CEZ in its antibacterial activity against P. aeruginosa. Clinical studies were carried out in the group A for which CTX was administered a drug of first choice for postoperative infections in surgery, and in the group B for which CTX was administered as a drug of second choice since the antibiotic of first choice had been ineffective for these cases. As a result, high effective rates were obtained in both groups (80.3% for the group A, and 77.1% for the group B). With reference to the group B, an effectiveness rate of 100% was obtained for the cases in which CEZ had been ineffective and 55.6% was obtained for 10 cases in which mainly combination of CMZ had been ineffective. Side effects appeared in 3 cases (1 case each of tinnitus and malaise, vomiting and nausea, and fever) with an incidence rate of 1.46%. Abnormal clinical laboratory findings appeared in 4 cases (1 case each of leukopenia and increase in GOT and GPT; eosinophilia; increases in platelet and monocyte; and increases in GOT, GPT and A1-P) with an incidence rate of 1.95%.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Child; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Postoperative Complications

Twenty-seven septicemia, 2 urinary tract infections and 2 meningitis were treated with Cefotaxime. The pathogenic organisms were most often entero-bacteria (16 E. coli, 2 Klebsiella, 2 Enterobacter cloacae, 1 Proteus, 1 Acinetobacter); sometimes they were Streptococcus (5 Streptococcus D, 3 Streptococcus B, 1 Streptococcus Salivarius). Cefotaxime was given alone to 16 patients, in association to an aminoglycoside in 15 cases. It was administered by infusion over 30 minutes every 8 hours in a daily dose of 150 mg/kg (during 10 days in case of septicemia and during 18 days if it was a meningitis). A clinical and bacteriological success was obtained in 86% of the 22 cases caused by Enterobacteria, in one of the 5 septicemia due to Streptococcus D and in the 3 infections caused by Streptococcus B. It may be concluded from these results that cefotaxime may be used in neonate infection due to a Gram-. But when a Listeria or a Streptococcus D is discovered the ampicillin classically prescribed must be maintained.

Topics: Bacterial Infections; Cefotaxime; Humans; Infant, Newborn; Sepsis

Cefmenoxime administered intravenously was used to treat a variety of gynecologic and obstetric infections in 40 patients. Many were mixed infections. The mean age of the patients was 39.7 +/- 2.39 years. The dosage of cefmenoxime was 2 g per day (n = 30) or 1 g per day (n = 10). Cefmenoxime levels were assayed microbiologically in serum, milk, amniotic fluid, and placental tissues. The overall bacteriologic cure rate was 86 percent. Clinically, 100 percent of the patients were treated successfully. Side effects were generally mild, and in no case was treatment discontinued. Twelve hours after the last bolus injection, levels of cefmenoxime were 1.1 microgram/ml in serum and 1.75 microgram/ml in milk. Thirty minutes after a 1 g bolus injection in patients undergoing cesarean section, mean maternal serum concentrations were 33 micrograms/ml. Concentrations were 7.4 micrograms/ml in umbilical cord blood and 2.3 micrograms/ml in amniotic fluid.

Topics: Adult; Aged; Amniotic Fluid; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Humans; Middle Aged; Milk, Human; Pregnancy; Umbilical Cord

Cefmenoxime, a new parenteral beta-lactamase-resistant cephalosporin, was evaluated for safety and efficacy in 15 patients (10 male and five female) with acute (1 patient) and chronic (14 patients) osteomyelitis. Diagnosis was made by culture of the surgical biopsy specimen. Osteomyelitis was treated with 8 to 12 g of cefmenoxime per day (mean 9.1 g) for 42 to 66 days (mean 47.3). Staphylococcus aureus was the most frequently isolated organism. Minimum inhibitory concentrations (MICs) of cefmenoxime were determined and all pathogens were inhibited by 12.5 micrograms/ml or less, except for Enterobacter cloacae and Acinetobacter species, both of which had an MIC of 25.0 micrograms/ml. All patients had at least one surgical debridement. Of the 15 patients, 10 (67 percent) had the osteomyelitis "arrested." These patients have been followed up five to 14 months after completion of cefmenoxime therapy. Toxicity studies indicated mild elevations in serum glutamic oxalacetic transaminase and serum glutamic pyruvic transaminase in two patients. Cefmenoxime appears to be a safe and effective antibiotic in the treatment of osteomyelitis.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Drug Administration Schedule; Drug Evaluation; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Osteomyelitis

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

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

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Respiratory Tract Infections; Urinary Tract Infections

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Female; Humans; Infant; Male; Middle Aged

The study included 88 patients with sterile urine prior to transurethral prostatectomy. Forty-five received a preoperative dose of 2 g of cefotaxime (Claforan) and the remaining 43 were given 10 ml of 0.9% NaCl. The two groups did not differ in frequency of postoperative urinary infection (greater than 10(5) colonies per ml urine); 6 patients (13.3%) in the cefotaxime group had postoperative infections during hospital stay as compared to 8 patients (18.6%) in the control group (0.5 greater than p greater than 0.3). Those in the cefotaxime group who had infections were tested for resistance. They were all fully sensitive to cefotaxime except one, who was infected with enterococci. There was no growth of bacteria from either venous blood or bladder irrigating fluid taken during the operations. Nor were any serious complications observed in any of the patients. In view of the relatively low risk of infection and the few side effects of the infections that did occur, prophylactic treatment with an antibiotic is not indicated for transurethral prostatectomy in patients with sterile urine.

Topics: Aged; Bacterial Infections; Bacteriuria; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prostatectomy; Random Allocation; Urinary Tract Infections

A single one-gram pre-operative dose of ceftriaxone was compared with seven one-gram doses of cefazolin administered peri-operatively with the aim of preventing infections associated with coronary artery bypass graft surgery. Ninety-four evaluable cases were analyzed; 49 patients received ceftriaxone and 45 received cefazolin. There was no significant difference in the number of infectious complications between the two groups. Ceftriaxone had a terminal half-life of approximately 15.7 hours. There was no toxicity associated with either antibiotic. Because of the reduced number of doses, single-dose prophylaxis may result in considerable savings. Single-dose prophylaxis with ceftriaxone was found to be an effective modality for prevention of infection in open heart surgery.

Topics: Bacterial Infections; Cefazolin; Cefotaxime; Ceftriaxone; Coronary Artery Bypass; Costs and Cost Analysis; Double-Blind Method; Humans; Kinetics; Premedication; Surgical Wound Infection

The pharmacokinetics of ceftriaxone (Ro 13-9904, CTRX) was studied in 14 children receiving a dose of 10, 20 mg/kg or 1 g as a intravenous bolus. The mean half-lives of CTRX were 4.5, 6.3 +/- 0.5 and 5.2 +/- 0.7 hours, respectively, while the urinary recovery rates up to 12 hours were 51.7, 48.6 and 48.9%. Forty-one patients, aged 2 months to 10 years, were treated with an intravenous dosage of 10 to 58 mg/kg CTRX every 12 hours for 2 to 29 days. The diseases consisted of upper respiratory tract infections (4), bronchitis (7), pneumonia (18), pyothorax (2), urinary tract infections (4), pertussis (4), meningitis (1) and endocarditis (1). Clinical cures were achieved in 38 cases, overall clinical response rate being 92.7%. No serious side effects were observed, although mild diarrhea was seen in 2 cases.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Female; Half-Life; Humans; Infant; Injections, Intravenous; Male; Pleural Effusion

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX) was performed and the following results were obtained. As to bacteriological efficacy, bacteria were reduced in the case with S. panama bacteremia, while they were eradicated within 2 to 5 days after CTRX administration in 2 cases with acute urinary tract infections and 1 with recurrent urinary tract infection, both caused with E. coli, and in 1 with acute urinary tract infection with P. mirabilis. The clinical efficacy was excellent in 2 cases and good in 3, the efficacy rate being 100%. No side effects were observed to require the withdrawal of CTRX.

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

Ceftriaxone CTRX was evaluated about its antibacterial activity against clinical isolates at our department and tried clinically in 10 children of 6 months to 10 years and 6 months of age. The antibacterial activity was equal to cefotaxime or higher while the clinical results were almost satisfactory. Three out of 4 strains were eradicated (75%). As to the adverse reaction, eosinophilia was observed only in 1 case.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Respiratory Tract Infections; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX) was performed in the field of pediatrics and the following results were obtained. The antibacterial activity of CTRX was determined against clinically isolated strains at our department. CTRX was definitely superior to CEZ and CMZ and almost equal or slightly superior to CTX in activity against Gram-negative bacteria, while the MIC of CTRX against Gram-positive bacteria was higher than that of CEZ and CMZ and about equal to that of CTX. The blood concentration of CTRX after one shot intravenous injection with 10 mg/kg was 67.98 micrograms/ml at 15 minutes, 51.96 micrograms/ml at 30 minutes, 37.51 micrograms/ml at 1 hour, 28.91 micrograms/ml at 2 hours, 20.71 micrograms/ml at 4 hours, 13.97 micrograms/ml at 6 hours and 6.45 micrograms/ml at 12 hours, while the half-life time was 3.74 hours. The blood concentration of CTRX after one shot intravenous injection with 20 mg/kg was 179.55 micrograms/ml at 15 minutes, 120.01 micrograms/ml at 30 minutes, 100.01 micrograms/ml at 1 hour, 53.75 micrograms/ml at 2 hours, 33.13 micrograms/ml at 4 hours, 26.41 micrograms/ml at 6 hours and 21.49 micrograms/ml at 12 hours, while the half-life time was 4.15 hours. The blood concentration of CTRX after intravenous drip infusion for 1 hour with 10 mg/kg was 19.54 micrograms/ml at 15 minutes, 27.19 micrograms/ml at 30 minutes, 36.57 micrograms/ml at 1 hour, 23.83 micrograms/ml at 2 hours, 19.69 micrograms/ml at 3 hours, 14.46 micrograms/ml at 5 hours, 11.02 micrograms/ml at 7 hours and 7.27 micrograms/ml at 13 hours, while the half-life time was 6.59 hours. The blood concentration of CTRX after intravenous drip infusion for 1 hour with 20 mg/kg was 61.72 micrograms/ml at 30 minutes, 108.1 micrograms/ml at 1 hour, 54.95 micrograms/ml at 2 hours, 35.68 micrograms/ml at 3 hours, 28.13 micrograms/ml at 5 hours, 20.51 micrograms/ml at 7 hours and 11.43 micrograms/ml at 13 hours, while the half-life time was 4.23 hours. There was noticed a tendency of the blood level being elevated by consecutive administration. The urinary recovery rate of CTRX ranged from 36.5 to 71.6%. The excretion rate of CTRX into the cerebrospinal fluid ranged from 5.2 to 11.6%. The excretion rate of CTRX into the pleural fluid was 31.0%. The clinical efficacy rate was 87.5% (excellent or good) in 8 children with infections treated with CTRX. The eradication of bacteria was observed in all of 5 cases bacteriologically evaluation.(ABSTRACT

Topics: Adolescent; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Half-Life; Humans; Infant; Male

Ceftriaxone (Ro 13-9904, CTRX) was evaluated for its safety and efficacy in 33 children with various bacterial infections including 10 cases of bacterial meningitis. CTRX was effective in all but 1 case who had acute mucositis due to a resistant strain of Enterobacter cloacae. The serum half-life (T1/2 beta) was 4.5 +/- 1.6 hours after an intravenous bolus injection in children. Cerebrospinal fluid levels of CTRX in the acute phase of bacterial meningitis were 7.69 +/- 4.75 mcg/ml. The only side effect was mild to moderate diarrhea observed in 10 of the 33 cases, but in no case was it necessary to discontinue the drug.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Half-Life; Humans; Infant; Infant, Newborn; Kinetics; Male

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX) was performed. CTRX was compared with CEZ, CMZ, CTX and LMOX in the antibacterial activity against the clinical isolates such as S. aureus, E. coli, P. mirabilis, K. pneumoniae and S. marcescens. Against S. aureus, the MIC of CTRX ranged from 0.2 to greater than 100 micrograms/ml with a peak of 3.13 micrograms/ml, showing that CTRX was almost equal to CTX in activity, slightly superior to LMOX and much inferior to CMZ and CEZ, although some strains were not susceptible to CEZ. Against the intestinal strains of E. coli, K. pneumoniae and P. mirabilis, the MIC distribution of CTRX was similar to that of CTX and LMOX while CTRX showed the MIC as high as 3.13 micrograms/ml or above against 44% of all strains including the beta-lactamase producing strains of E. coli and K. pneumoniae, indicating a slight tendency of their becoming resistant. The MIC peaks against E. coli, K. pneumoniae and P. mirabilis were less than or equal to 0.1, 0.39 and less than or equal to 0.1 microgram/ml, respectively. As to S. marcescens which is drawing attention as a causative agent for infections inside of hospitals or those among young infants, CTRX inhibited 84% of the strains at 3.13 micrograms/ml, showing a definite superiority to CEZ and CMZ and a slight superiority to CTX and LMOX. The serum concentration after a single intravenous injection with 40 mg/kg reached a mean peak of 168.8 micrograms/ml at the first blood sampling (at 30 minutes) and gradually decreased to 137.5 micrograms/ml at 1 hour, 30.9 micrograms/ml at 6 hours, 12.6 micrograms/ml at 12 hours and 3.8 micrograms/ml at 24 hours, while the half-life time was 6.0 hours. The comparison of the serum level by 1 hour intravenous drip infusion between the dosage groups of 20 mg/kg and 40 mg/kg revealed that the former group reached a peak of 85.4 micrograms/ml at the termination of drip while the latter's peak was 176.6 micrograms/ml observed during the drip (30 minutes after the initiation of drip). The respective levels of the 2 groups were 15.4 and 32.1 micrograms/ml at 6 hours, 5.1 and 15.0 micrograms/ml at 12 hours, and 1.6 and 4.1 micrograms/ml at 24 hours, indicating a distinct dose-response 2 hours after the initiation of drip administration. The half-life times were 4.9 and 6.2 hours, respectively, which are the longest among the cephalosporins presently being developed.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male

Fundamental and clinical evaluation on ceftriaxone (CTRX, Ro 13-9904) was performed in the pediatric field and the following results were obtained. The MIC of CTRX against the recently isolated 10 strains of B. pertussis was less than or equal to 0.05 microgram/ml at inoculum size of 10(6) CFU/ml. The blood level of CTRX after intravenous drip infusion with 10 to 20 mg/kg for 30 minutes to 1 hour reached a peak ranging from 45.3 to 137 micrograms/ml at the end of infusion. The effective blood level was maintained up to 12 hours to be 3.52 to 26.7 micrograms/ml at that time. The half-life time was over 6 hours in most cases, but the multiple intravenous dosage did not cause any elevation of the blood level. The urine excretion rate till 12 to 24 hours after intravenous drip infusion ranged from 58.2 to 84.2%. The excretion of CTRX into the cerebrospinal fluid was favorable in the acute period when administered by intravenous drip infusion in the child with S. pneumoniae purulent meningitis, which was considered to be satisfactory for treatment against the bacteria susceptible to CTRX. The active CTRX was transferred into the feces by the multiple dosage. CTRX was administered by intravenous drip infusion in 26 cases with acute pediatric infections. The clinical efficacy was observed in all the cases with upper/lower respiratory tract infections including bronchopneumonia and pertussis, and the cases with acute urinary tract infections caused by ABPC-resistant E. coli, administered by intravenous drip infusion twice daily with about 40-50 mg/kg/day. The bactericidal efficacy was seen against all bacteria except Salmonella. CTRX by intravenous drip infusion was effective against S. pneumoniae purulent meningitis; the clinical symptom was rapidly improved while the culture of causative strains from the cerebrospinal fluid turned negative. Although CTRX was clinically effective against Salmonella enteritis and typhoid, bacteriological and symptomatological relapses were observed in some cases. An increase in dose of CTRX is considered to be needed for these diseases. No adverse reaction was found clinically but soft stool in 1 case while eosinophilia and thrombocytosis were observed each in 1 out of 30 cases in laboratory test. The efficacy was good or higher in all the 26 cases (100%) administered by intravenous drip infusion. The above-mentioned results indicate that CTRX is useful in the pediatric field.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

Fundamental and clinical evaluation of ceftriaxone (Ro 13-9904, CTRX) was performed in the pediatric field. Antibacterial activity The MIC80 of CTRX against clinical isolates such as S. aureus (23 strains), S. pyogenes (23 strains), E. coli (20 strains), K. pneumoniae (23 strains), H. influenzae (15 strains) and P. aeruginosa (23 strains) were 6.25 micrograms/ml, 0.024 microgram/ml, 0.20 microgram/ml, 0.05 microgram/ml, less than or equal to 0.006 microgram/ml and 12.5 micrograms/ml, respectively. The antibacterial activity of CTRX was therefore poor against S. aureus and P. aeruginosa, but quite excellent against S. pyogenes, E. coli, K. pneumoniae and H. influenzae. Compared with cefotaxime (CTX), cefoperazone (CPZ), cefmetazole (CMZ), cefazolin (CEZ) and ceftazidime (CAZ), CTRX was the highest in the antibacterial activity against H. influenzae, next to CTX against S. pyogenes, E. coli and K. pneumoniae, similar to CTX, CPZ and CAZ against S. aureus and similar to CTX against P. aeruginosa. Absorption, Excretion The mean serum levels of CTRX after an intravenous one shot injection with about 20 mg/kg in 3 children aged 10 to 14 years were 160.0 +/- 23.3 micrograms/ml after 1/4 hour, 134.3 +/- 27.5 micrograms/ml after 1/2 hour, 115.0 +/- 33.2 micrograms/ml after 1 hour, 95.3 +/- 28.4 micrograms/ml after 2 hours, 75.3 +/- 14.5 micrograms/ml after 4 hours, 30.3 +/- 13.5 micrograms/ml after 12 hours and 8.2 +/- 3.1 micrograms/ml after 24 hours, while the half-life time was 5.92 +/- 0.43 hours on the average. The mean urinary levels were 1,060 +/- 461 micrograms/ml from 0 to 2 hours, 309 +/- 122 micrograms/ml from 2 to 4 hours, 375 +/- 83 micrograms/ml from 4 to 6 hours, 237 +/- 77 micrograms/ml from 6 to 12 hours and 122 +/- 23 micrograms/ml from 12 to 24 hours, the mean urinary recovery rate up to 24 hours being 38.9 +/- 13.6%. The concentration in the cerebrospinal fluid The mean levels of CTRX in the cerebrospinal fluid of the patients with purulent meningitis were 4.30 +/- 4.22 micrograms/ml 1 hour after an intravenous one shot injection with 42 to 51 mg/kg, 4.64 +/- 3.53 micrograms/ml after 3 1/2 hours to 6 hours, 3.79 +/- 2.15 micrograms/ml after 7 1/2 hours to 12 hours and 1.79 +/- 0.23 microgram/ml after 19 hours.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adolescent; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Half-Life; Humans; Infant; Male

Ceftriaxone (Ro 13-9904, CTRX), a new parenteral cephalosporin, was used for pediatric infections and the following results were obtained. CTRX was administered twice daily by intravenous injection with about 20 mg/kg in 6 cases consisting of 2 cases with purulent lymphadenitis of the neck, 2 with urinary tract infection, 1 with sepsis and pyelonephritis and 1 with sepsis and purulent lymphadenitis of the neck. The result was excellent in 4 and good in 2. One case with H. influenzae meningitis, receiving 50 mg/kg CTRX by intravenous injection twice daily, showed an excellent response without having any sequela. Among those mentioned above, diarrhea in 2 cases and elevated GOT and GPT in 2 were observed, all of which were transitory and not serious. The blood level of CTRX at 1/2, 1, 2, 4, 6 and 8 hours after intravenous injection with 20 mg/kg to a girl of 8 years and 8 months of age with urinary tract infection was 114, 86, 70, 42, 29 and 21.8 micrograms/ml, respectively. The half-life time was 3.5 hours while the urinary recovery rate up to 6 hours was 58.0%. The concentration in the cerebrospinal fluid of 1 case with H. influenzae meningitis ranged from 2.1 to 8.2 micrograms/ml at 3 hours after administration and from 1.15 to 2.65 micrograms/ml after about 12 hours (prior to the next administration). The above-mentioned results suggest that CTRX is a new antibiotic useful for pediatric infections caused with susceptible bacteria and is effective by intravenous injection with 10 mg/kg twice daily for moderate infections and with 20 mg/kg twice daily for severe ones, except for meningitis. As for purulent meningitis, the administration dosage and frequency will have to be further examined based on the intravenous injection with 50 mg/kg twice daily.

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

The authors have carried out the laboratory and clinical studies of ceftriaxone (Ro 13-9904, CTRX) and obtained the following results. The antibacterial activities of CTRX against the clinical isolates of S. aureus, E. coli, K. pneumoniae, E. cloacae, E. aerogenes, S. marcescens, Citrobacter sp. and P. aeruginosa were measured by the agar dilution method with inoculum size of 10(6) cells/ml. The susceptibility distribution of S. aureus to CTRX ranged from 0.2 to 12.5 micrograms/ml, and the peak of distribution was 3.13 micrograms/ml. The peak of susceptibility distribution of E. coli and K. pneumoniae were 0.1 microgram/ml or lower, and the distribution of E. aerogenes and E. cloacae ranged from 0.1 to 100 micrograms/ml, Citrobacter sp. and S. marcescens, from 0.1 to 12.5 micrograms/ml and that of P. aeruginosa, from 0.39 to 100 micrograms/ml or more. For pharmacokinetic study, CTRX was given in a single dose of 10 mg/kg in 1 child and 20 mg/kg in 2 children by drip infusion for 1 hour. After drip infusion of CTRX in a single dose of 10 mg/kg, the peak serum level was 61.4 micrograms/ml on completion of the infusion, and 8.43 micrograms/ml at 12 hours. Half-life time was 4.6 hours. With drip infusion of CTRX in a single dose of 20 mg/kg, the peak serum level was 105.5 micrograms/ml on completion of the infusion, and 19.1 micrograms/ml at 12 hours. Half-life time was 8.7 hours. CTRX was effective all cases out of 8 cases with bacterial infection. No side effect was observed except for elevation of serum GOT in 2 cases and eosinophilia in 1 case.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX), a newly-developed injectable cephem antibiotic was performed as follows. The serum and urine concentrations of CTRX as well as the urinary recovery rate were determined in 7 children at 3 different dose levels; 3 cases administered with 10 mg/kg, 3 with 20 mg/kg and 1 with 48 mg/kg by one shot intravenous injection. The concentration in the cerebrospinal fluid was determined in 1 case of purulent meningitis associated with bacteremia, administered by one shot intravenous injection with 47.6 mg/kg. CTRX was also examined in its clinical and bacteriological efficacies by one shot intravenous injection for 8 days on average in a mean daily dose of 46.5 mg/kg, divided into twice a day in 31 cases, 3 times in 1 case, and 4 times changed from twice in 1 case; in a total of 33 children consisting of 3 with tonsillitis, 1 with chronic bronchitis, 20 with pneumonia, 2 with purulent meningitis associated with bacteremia, 3 with urinary tract infections, 1 with osteomyelitis associated with phlegmon, 3 with purulent lymphadenitis. The adverse reactions and laboratory test values were examined in a total of 40 cases, i.e., the above-mentioned 33 cases plus the 7 drop-out cases in which the clinical efficacy could not be evaluated. The results were as follows. The serum levels of CTRX in 7 cases consisting of 3 administered with 10 mg/kg, 3 with 20 mg/kg and 1 with 48 mg/kg reached their peaks 5 minutes after one shot intravenous injection and the mean values of them were 93.6 mcg/ml, 143.0 mcg/ml and 558.0 mcg/ml, respectively, indicating the existence of a dose-response among these groups, while the half-life times were 4.41, 5.86 and 4.09 hours. Among the 7 cases examined in the urinary levels as well as the serum levels, the 3 cases administered with 10 mg/kg reached the mean peak of 334.0 mcg/ml 2 to 4 hours after administration, while another 3 cases administered with 20 mg/kg showed peaks of 793.0, 522.0 and 536.0 mcg/ml, respectively, 2 to 4 hours, 4 to 6 hours and 6 to 12 hours after injection; this dispersion being partly because of that the urine specimen was unable to be collected regularly every hour in this dose group. In the case administered with 48 mg/kg, urinary level reached the highest value of 6,100.0 mcg/ml from 0 to 2 hours.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Female; Half-Life; Humans; Male

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

Ceftriaxone (CTRX), a new cephalosporin antibiotic, was evaluated in the field of obstetrics and gynecology and the following results were obtained. The concentration of CTRX after an intravenous injection with 1 g was determined in the uterine artery, cubital vein and in the intrapelvic genital tissues such as the oviduct, ovary, endometrium, myometrium, cervix uteri and portio vaginalis. The peak level was 160 micrograms/ml at 26 minutes after injection both in the uterine arterial serum and cubital venous serum, 48 and 38 micrograms/g at 1 hour and 18 minutes in the tissues of oviduct and ovary, respectively, 54 and 50 micrograms/g at 48 minutes in the myometrium and cervix uteri, respectively, while 46 micrograms/g at 39 minutes in the portio vaginalis. The mean level 18 to 24 hours after administration was 19 micrograms/ml in the uterine arterial serum and cubital venous serum and 6.3 micrograms/g in the intrapelvic genital tissues. A case of intrapelvic infection clinically showed an excellent response without any side effects by intravenous drip infusion with 2 g divided as twice a day for 7 days. The above results show that CTRX is useful in the field of obstetrics. and gynecology.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Female; Genitalia, Female; Humans; Hysterectomy; Infusions, Parenteral; Injections, Intravenous; Middle Aged; Pelvic Inflammatory Disease; Postoperative Complications

Ceftriaxone (Ro 13-9904, CTRX), a new cephem antibiotic, was studied in the field of obstetrics and gynecology, and the following results were obtained. The absorption and tissue penetration of CTRX into intrapelvic genital organs were good. The peak serum level in the uterine artery after a single intravenous injection and that after an intravenous drip infusion for 30 approximately 60 minutes, both with 1 g, were 162.5 micrograms/ml and 84.4-93.8 micrograms/ml, respectively. High concentrations were obtained also in genital organ tissues; the maximum concentration was 93.8 micrograms/g by intravenous injection and 56.3-59.4 micrograms/g by intravenous drip infusion. Changes in the tissue concentration were similar to those in the serum, the level over MIC80 against main pathogenic organisms being maintained for a long time. The penetration of CTRX into intrapelvic dead space exudate was good. The level reached a peak of 18.8 micrograms/ml 2 hours after an intravenous injection with 1 g and 13.3 micrograms/ml after 12 hours, while the level over MIC80 against main pathogenic organisms was maintained for a long time. CTRX was effective in 15 out of 16 cases (93.8%) with gyneco-obstetric infections such as intrauterine, intrapelvic, adnexal infections, and postoperative would infections, administered with 1 g twice a day. No side effects were observed.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Parenteral; Injections, Intravenous; Kinetics; Middle Aged; Pregnancy; Puerperal Infection; Tissue Distribution

Ceftriaxone (Ro 13-9904, CTRX), a newly developed third-generation cephem antibiotic, reportedly has an antibacterial spectrum of wide-range and shows a much greater activity than cefazolin especially against Gram-negative bacteria and satisfactory effectiveness against anaerobes. In the gyneco-obstetric infections, the relation between the level in the intrapelvic organs and MIC is an important subject in many respects. The levels in the blood and each tissue determined in 54 cases, as presented in Fig. 2, show that a high concentration can be maintained for a long time. In particular the half-life time in the uterine artery and cubital vein was 8.2 hours and 7.8 hours, respectively, which was longer than that of any other existing antibiotics. This fact suggests that CTRX exhibits sufficient efficacy when administered intravenously even in a small dosage of 1 g in the present study. The clinical efficacy was good or above in all the 7 cases treated. There was neither clinical adverse reaction nor laboratory test abnormality found during and after the administration in any of the 54 cases in the fundamental study and 7 cases in the clinical study. It is suggested from the above-mentioned results that CTRX is an unprecedentedly useful antibiotic with an antibacterial spectrum of wide-range.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Parenteral; Middle Aged; Pregnancy; Puerperal Infection

Fundamental and clinical studies on ceftriaxone (CTRX, Ro 13-9904) were performed in the field of obstetrics and gynecology and the following results were obtained. The serum concentration was maintained at a high level to remain 22 micrograms/ml about 24 hours after intravenous injection with 1 g CTRX. The level in each tissue except myometrium reached a peak of 50 micrograms/g or higher at 54 minutes after intravenous injection with 1 g CTRX. The peak level in the dead space exudate, obtained 4 to 6 hours after intravenous injection was 77 micrograms/ml with 1 g, and 125 micrograms/ml and 115 micrograms/ml with 2 g. The clinical efficacy was observed in all the cases (excellent in 1 and good in 3) consisting of 1 with Bartholin's abscess, 2 with adnexitis and 1 with pelvioperitonitis. Neither adverse reaction nor posttreatment laboratory test abnormality was observed in any case.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Cervix Uteri; Drug Evaluation; Endometrium; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Injections, Intravenous; Middle Aged; Pelvis; Uterus

In vitro activity of ceftriaxone (CTRX) was examined by agar plates dilution method against 398 strains isolated from the infections in the field of obstetrics and gynecology. MIC90 of CTRX against Staphylococcus (107 strains), E. coli (54 strains), K. pneumoniae (27 strains), Peptococcus and Peptostreptococcus (106 strains) and Bacteroides (104 strains) was more than 100 micrograms/ml, less than 0.20 micrograms/ml, less than 0.20 micrograms/ml, 6.25 micrograms/ml and 50 micrograms/ml, respectively. The concentrations of CTRX 16.9 hours after 1 hour intravenous drip infusion with 1 g were 46.2 micrograms/ml in the uterine artery, 48.0 micrograms/ml in the cubital vein, 11.0 micrograms/g in the endometrium, myometrium and cervix uteri, and 14.0 micrograms/g in the portio vaginalis. These concentrations of CTRX in the serum and uterine tissues were higher than the level required to inhibit 90% of the strains of E. coli, K. pneumoniae, and Peptococcus and Peptostreptococcus, isolated from the infections in the field of obstetrics and gynecology. Clinical efficacy of CTRX was evaluated in 7 cases consisting of 2 with puerperal fever and one each with puerperal intrauterine infection, intrauterine infection, pyometra, adnexitis and Bartholin's abscess. Clinical and bacteriological efficacies were seen in 6 and 4 cases, respectively. Neither noteworthy adverse reactions nor laboratory abnormalities were observed throughout this study.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Drug Resistance, Microbial; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged; Pregnancy

Fundamental and clinical studies on ceftriaxone (CTRX, Ro 13-9904), a new cephalosporin antibiotic, were carried out with the following results. Concentration of CTRX was examined in serum, internal genital organs and retroperitoneal fluid after single intravenous administration of 1.0 g dose. The venous serum level of CTRX was 156 micrograms/ml at 5 minutes after the administration. The favorable transfer of CTRX to internal genital organs and retroperitoneal fluid was demonstrated. In clinical trial, CTRX was given to 10 cases with obstetrical and gynecological infections such as endometritis, adnexitis, pelvic peritonitis and parametritis. The efficacy was evaluated as excellent in 1 case, good in 8 cases and poor in 1 case. No side effects were observed in any of the cases treated with CTRX.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Half-Life; Humans; Injections, Intravenous; Middle Aged; Pelvis; Pregnancy

Fundamental and clinical studies on ceftriaxone (Ro 13-9904, CTRX), a new cephem antibiotic, were carried out with the following results. Following each 1.0 g of drip infusion, transfer of CTRX to female genital organs was found to be excellent. Transfer of CTRX to exudate of the pelvic dead space was also excellent. And high concentration of CTRX was kept for long time after administration. CTRX was given to 7 cases. It was effective for 5 cases and ineffective for 2 cases. The above results demonstrated that CTRX is a safe and effective drug.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged; Pelvis; Pregnancy

It is reported that ceftriaxone (Ro 13-9904, CTRX) has a half-life time of 7 to 8 hours. In the present study, the serum level 18 hours after intravenous injection with 1 g CTRX was as high as 9.3 micrograms/ml while obviously a higher tissue concentration was maintained compared with other drugs. These facts suggest that CTRX is effective against infections and that the dosage and frequency of administration could be reduced. The global evaluation revealed that CTRX was clinically effective in all the 4 cases with infections. As the adverse reaction, light leukopenia was observed only in 1 case out of the present 4 cases and 20 others administered with CTRX.

Topics: Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Half-Life; Humans; Middle Aged; Pelvis

Ceftriaxone (Ro 13-9904, CTRX), a new cephalosporin antibiotic, was basically and clinically studied in the field of obstetrics and gynecology. The following results were obtained. The pelvic dead space exudate and serum levels of CTRX were measured in patients with radical hysterectomy with pelvic lymphadenectomy for uterine cervical cancer after the intravenous injection of 1 g. Immediately after the injection, the serum level increased to 146 micrograms/ml on average and thereafter declined rapidly. The pelvic dead space exudate level attained the peak of 88 micrograms/ml after 4 hours and thereafter declined gradually but was 74 micrograms/ml even at 8 hours after the injection. A total of 13 cases comprising 2 with intrauterine infection, 5 with pelveoperitonitis, 4 with adnexitis and 2 with external genital organ infection were intravenously treated with CTRX at a dose of 1 g twice daily for 3-7 days. The clinical results were good in 12 cases and unknown in 1 case. Eruption was noted in 1 case.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Humans; Middle Aged; Pelvis; Uterine Cervical Neoplasms

Ceftriaxone (Ro13-9904, CTRX), a newly developed cephalosporin antibiotic, was fundamentally evaluated through determination of the levels in the female genital organ tissues and in the pelvic dead space exudate. CTRX was also studied on its clinical efficacy in 13 cases with gyneco-obstetric infections. The transmission of CTRX into the female genital organ tissues was favorable: the peak level in each tissue was as high as 38 to 63 micrograms/g 18 to 37 minutes after administration. The level in each tissue even after about 18 hours remained around 10 micrograms/g, suggesting its better transmission into the tissues than other drugs. The transmission into the pelvic dead space exudate was also good: the level reached a peak of 100 to 120 micrograms/ml 1 to 3 hours after administration and still ranged from 74 to 76 micrograms/ml even after about 12 hours. The clinical efficacy was excellent in 5, good in 5 and poor in 3 out of 13 cases with gyneco-obstetric infections and the efficacy rate was 76.9%. Neither adverse reaction nor laboratory test abnormality was observed in any case. The above-mentioned results suggest that CTRX is a useful antibiotic for gyneco-obstetric infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged; Pelvis; Pregnancy

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX), a new cephalosporin antibiotic, was performed in the field of obstetrics and gynecology and the following results were obtained. The concentration of CTRX after intravenous injection was determined in the arterial and venous blood, and in the internal genital organs and a favorable tissue transfer was observed. The clinical efficacy rate was not very high (40%); good in 2 out of 5 cases with gyneco-obstetric infections, but it is notable that efficacy was recognized in the case which B. fragilis was detected. Neither adverse reaction nor laboratory test abnormality was seen to be attributable to CTRX in any case.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Parenteral; Middle Aged

The study was done to evaluate the usefulness of ceftriaxone (Ro 13-9904, CTRX) injection for the treatment of infections in the field of obstetrics and gynecology. Fundamental and clinical studies were made and following results were obtained. When 1 g of CTRX is administered by intravenous single shot, the concentrations in various tissues of female genital organs were as follows: 40 micrograms/g in oviduct, 30 micrograms/g in ovary, 23 micrograms/g and 32 micrograms/g in corpus uteri and cervix uteri, respectively, at 2 hours 20 minutes after single shot. As for the transfer to the exudate in the pelvic dead space, the peak concentrations were 66-69 micrograms/ml after 4-5 hours. In the clinical studies, CTRX was given to 20 cases with female genital organ infections and others. As for the clinical effects, responses were excellent in 2 cases, good in 18 cases among 20 cases in total. The efficacy rate was 100%. As for the clinical effects on causative bacteria, the efficacy rates were 100% for single infections due to Gram-positive bacteria (6/6), due to Gram-negative bacteria (1/1), for mixed infection (3/3). Side effect was observed in 1 case with diarrhea. CTRX showed a satisfactory clinical efficacy and a potent bacteriological effect in treatment of the infections in the field of obstetrics and gynecology, and it has been concluded that CTRX will be a useful addition to the antibiotics for the therapy of these infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Parenteral; Middle Aged; Pelvis; Pregnancy

Ceftizoxime (CZX) was given by intravenous injection in daily doses of 2-8 g to 103 patients with severe infections complicating hematopoietic disorders. The clinical effect was evaluated in 95 of the 103 patients. The causative organisms were identified in 22 patients but were unknown in the remaining 73. Infected sites were the respiratory tract, urinary tract, soft tissue, and blood. The overall effectiveness rate (inclusive of marked and moderate) was 61.1% (58/95). The effectiveness rate was 63.6% (14/22) in patients in whom the causative organisms were identified and 60.3% (44/73) in patients in whom the causative organisms could not be identified and 60.0% (18/30) in 30 patients with less than 100 neutrophils per mm3 before treatment. No side effects were noted except drug fever in 1 patient. Abnormal hepatic function was seen in 6 patients but was not attributed to the drug in any case. The results indicate that CZX is a safe and useful antibiotic for the treatment of severe infectious complications in hematopoietic disorders.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Female; Hematologic Diseases; Humans; Male; Middle Aged

Clinical evaluation of cefmenoxime (CMX, Bestcall) was examined in the infection associated with hematological disorders, respiratory tract and other disorders. Clinical effectiveness for severe infection of hematological disorders was 47.4% in good and 84.2% in fair response, however, in the respiratory tract infections, 89.7% in good response was obtained. Opportunistic infection due to Gram-negative bacilli are often experienced in patients with hematological disorders. It was discussed that CMX would be a good therapeutic agent against infectious diseases associated with hematological disorders because it's antibacterial spectrum would be parallel to pathogens of such disorders.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Hematologic Diseases; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged; Respiratory Tract Infections; Urinary Tract Infections

Topics: Bacterial Infections; Cefotaxime; Female; Humans; Infant; Infant, Newborn; Male

Topics: Bacterial Infections; Cefotaxime; Endophthalmitis; Eye Diseases; Humans; Injections, Intravenous; Kinetics; Vitrectomy; Vitreous Body

Three cases of meningitis with E. coli and H. influenzae are reported. They illustrate the recrudescence and relapse in bacterial meningitis. After the failure of initial antibiotic therapy, the treatment by Cefotaxime allowed a good outcome in all the cases. On account of the bacteriological, pharmacological and clinical data the authors advise using Cefotaxime in first purpose in meningitis with common gram negative bacilli.

Topics: Bacterial Infections; Cefotaxime; Escherichia coli Infections; Female; Gram-Negative Bacteria; Humans; Infant; Infant, Newborn; Kinetics; Male; Meningitis; Meningitis, Haemophilus; Recurrence

Five newer beta-lactam antibiotics and two aminoglycosides were tested on 400 freshly isolated clinically significant organisms from specimens at a district general hospital. All the antibiotics had very broad-spectrum activities but none could cover against all probable pathogens. Latamoxef was the best of all against Bacteroides spp. Aminoglycosides, followed by cefotaxime and ceftizoxime, were best against staphylococci. Tobramycin, followed by ceftazidine and netilmicin, had the best activity against Pseudomonas aeruginosa. Of all 7 antibiotics tested only piperacillin demonstrated activity against Streptococcus faecalis. Cefotaxime and ceftizoxime were the best against Escherichia coli, Klebsiella spp. and most of streptococci. The study demonstrated that safer alternatives to aminoglycosides are now available.

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftazidime; Humans; Microbial Sensitivity Tests; Moxalactam; Netilmicin; Piperacillin; Tobramycin

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftazidime; Ceftizoxime; Cephalosporins; Drug Resistance, Microbial; Humans

Cefotaxime, a third generation cephalosporin antibiotic, was evaluated in 26 infants and children for the treatment of documented or suspected bacterial infections, including pneumonia (10 cases), soft tissue skin infection (13 cases), and urinary tract infection (3 cases). An average daily dose of 60 mg/kg in 3 to 4 divided doses was administered parenterally for an average of 7 days. In 14 of the cases, primary pathogens, including Haemophilus influenzae b (resistant to ampicillin), Staphylococcus aureus, Staphylococcus pyogenes, Streptococcus pneumoniae and Escherichia coli, were eradicated. Clinical recovery occurred in each case. Blood levels at different time intervals and biological half-life were similar to those reported for adults. Mild and transient side effects observed were elevation of SGOT in two cases, alkaline phosphatase in one, and eosinophilia in one case.

Topics: Alkaline Phosphatase; Aspartate Aminotransferases; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Eosinophilia; Female; Humans; Infant; Kinetics; Male; Pneumonia; Urinary Tract Infections

The use of cefotaxime was monitored to evaluate the appropriateness and cost of its use. This was done by chart review and physician questionnaire. Of 57 patients reviewed, 19 were treated empirically for specific established infections; 19 for sepsis without an identified source; 3 for infections with a known pathogen; and 16 for surgical prophylaxis. In the majority of patients treated empirically for specific infection or sepsis, the use of cefotaxime was judged appropriate by infectious disease consultants, while for surgical prophylaxis, it usually was judged inappropriate. The average charge for cefotaxime was +396 per course vs. +318 for antibiotics commonly used before cefotaxime became available. When used alone, cefotaxime was less expensive to the patient than a combination of antibiotics in 22 of 29 cases. We concluded that cefotaxime was used appropriately for empiric therapy without increasing costs greatly.

Topics: Bacterial Infections; Cefotaxime; Drug Utilization; Fees, Pharmaceutical; Hospitals, Community; Humans; Surgical Wound Infection

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Chemical Phenomena; Chemistry; Humans

The in vitro susceptibilities of 393 recent clinical isolates to WIN 49375, a new quinolone derivative, were determined and concurrently tested with cefotaxime, tobramycin, and piperacillin. In general, members of the family Enterobacteriaceae were not as susceptible to tobramycin and piperacillin as they were to WIN 49375. Methicillin-resistant and -susceptible Staphylococcus aureus were equally susceptible to WIN 49375.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Ciprofloxacin; Enterobacteriaceae; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Piperacillin; Pseudomonas; Quinolines; Staphylococcus; Tobramycin

One hundred patients with severe infections associated with hematologic disorders, including leukemia and lymphoma, were treated with ceftizoxime (CZX) in daily doses of 4 approximately 9 g for an average of 8.9 days. In the 84 patients who completed the trial, response was excellent in 27 (32.1%) and moderate in 25 (29.8%). The rate of effectiveness was 61.9%. The only side effect seen during the treatment was skin rash in 3 patients. Hepatic disorders were observed in 5 patients. The relation between CZX and these abnormal findings was not established. These results indicate that CZX is a therapeutically effective and safe antibiotic for the treatment of severe infections in patients with underlying hematologic disorders.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Drug Evaluation; Female; Hematologic Diseases; Humans; Male; Middle Aged

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

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

Ceftriaxone (Ro 13-9904, Rocephin) was given to 67 patients suffering from 74 various infections. Patients had infections of the urinary tract (36), soft tissue phlegmon (12), infections of the respiratory tract (13), osteomyelitis (7), abscesses (5) and meningitis (1). Infecting organisms were E. coli (26), Proteus spp. (20), P. aeruginosa (7), H. influenzae (6), Enterobacter spp. (6), K. pneumoniae (3), C. freundii (2), S. marcescens (1), S. aureus (4), S. pneumoniae (2), Peptostreptococcus spp. (4) and Clostridium spp. (1). The organisms were often multiresistant. Dosage ranged from 1-2 g once or twice daily i.m. or i.v. The clinical response was excellent in 56 infections (75.6%) while 13 (17.6%) infections were improved and in 5 (6.8%) treatment failed. The pathogen was eradicated in 63 (85.1%), and relapsed in 3 (4.0%) while bacteria persisted in 11 (14.9%). No appreciable side effects or toxicity were observed. Sputum, bile, cerebrospinal fluid and prostatic fluid kinetics revealed ceftriaxone concentrations several times above the minimal bactericidal concentrations required to kill the enterobacteriaceae, but mostly inadequate to inhibit P. aeruginosa strains. Ceftriaxone was a safe and effective drug for the treatment of various infections. However, with the exception of urinary tract infections it should be given with caution in P. aeruginosa infections.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Biological Availability; Cefotaxime; Ceftriaxone; Female; Humans; Kinetics; Lidocaine; Male; Middle Aged

The clinical efficacy and safety of ceftriaxone, a long half-life cephalosporin were evaluated in 48 children with a variety of serious bacterial infections. Clinical cure was achieved in 92% (44 of 48) of patients. Peak serum bactericidal titres for Haemophilus influenzae type b, Streptococcus pneumoniae, Str. pyogenes and Escherichia coli were greater than or equal to 1:1024. Mean peak and trough ceftriaxone levels were 173 and 42 mg/l, respectively. Mild and transient diarrhoea was observed in 10% of patients. Laboratory side effects encountered were eosinophilia, thrombocytosis and neutropenia in another 8%. Ceftriaxone is a useful antibiotic for common childhood infections. Its prolonged half-life allows twice daily administration which reduces problems related to intravenous therapy as well as the cost and personnel time.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Female; Half-Life; Humans; Infant; Infusions, Parenteral; Male

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Female; Humans; Male; Middle Aged

Experimental and clinical studies on cefotiam (CTM), a new synthetic cephalosporin, were performed in digestive diseases. Among the 7 cases of 'cholelithiasis and cholangitis', 6 cases (86%) showed better response than "effective". Among the 9 cases of infections except 'cholelithiasis and cholangitis' which had no connection with cancers, 6 cases (67%) showed better response than "effective". Among the 15 cases of 'infections following advanced cancers', 7 cases (47%) showed better response than "effective". This inferior result was due to the relation to factors coming from cancers. CTM was effective in not only infections of the aged but that which resisted antibiotics of penicillins and the other cephems. Sensitivity of E. coli, Klebsiella and S. aureus was made a comparative study of by MIC and disc test. It was found as a result that CTM had the equal or superior antimicrobial activity to other antibiotics of cephems, penicillins and aminoglycosides.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Cefotiam; Digestive System Diseases; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged

Cefmenoxime, a new semisynthetic third-generation cephalosporin, was evaluated in 105 patients (45 men and 60 women) with the following infections: skin or skin structure (33), pulmonary (22), urinary tract (30), and septicemia (20). Forty-two infections were hospital-acquired, 85 patients had underlying diseases, 29 patients required concomitant surgery, and 32 patients had positive results of blood culture. Cefmenoxime dosages ranged from 4 to 12 g per day intravenously for one and a half to 51 days. Cultures revealed 183 organisms in the 105 patients. Minimal inhibitory concentrations were obtained for cefmenoxime, cefoperazone, cefotaxime, cefamandole, cefoxitin, and moxalactam. Cefmenoxime and cefotaxime exhibited nearly equivalent activities against all organisms tested and were the most active agents tested against all aerobic and facultative organisms except Staphylococcus aureus. Mean serum peak and trough levels obtained after 2 g every six hours were 84.1 micrograms/ml (peak), 8.3 micrograms/ml (trough); and after 2 g every four hours, 106 micrograms/ml (peak) and 10.9 micrograms/ml (trough). Of 105 infections, 86 were clinically cured, three were not cured, and 16 were not evaluable. Safety studies revealed 24 transient reactions in 23 patients including eosinophilia, diarrhea, leukopenia, rash, elevated liver enzyme levels, Antabuse effect, and phlebitis. On the basis of these clinical and in vitro results, cefmenoxime is a safe drug for the treatment of infections caused by gram-negative and gram-positive aerobic organisms.

Topics: Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Humans; Kinetics; Lung Diseases; Male; Middle Aged; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

The in vitro activity of Cefotiam (Spizef) was tested using the agar diffusion test method according to DIN 58940 and compared with the antibacterial activity of 12 other routinely tested antibacterial chemotherapeutics. A total of 3000 strains from patients' specimens from the University Hospital of the Free University of Berlin and the Municipal Wenckebach Hospital, West Berlin, was tested. Cefotiam proved effective against strains of Staphylococcus aureus in 99,4%, Escherichia coli in 99,7%, Klebsiella species in 97,8%, Enterobacter species in 90,3%, Proteus mirabilis in 98,7%, indolpositive Proteus species in 91,7%, Citrobacter in 92,6%, and beta-hemolytic Streptococci in 99,3% of all strains tested. There were only few sensitive strains of Enterococci and of Pseudomonas aeruginosa.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Berlin; Cefotaxime; Cefotiam; Drug Resistance, Microbial; Enterobacteriaceae; Germany, West; Hospitals; Humans; Immunodiffusion; Species Specificity

Topics: Adolescent; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Meningitis

We evaluated the efficacy and safety of ceftriaxone in 50 adults with serious infections, usually giving 1 g every 12 h. Of the 35 patients who could be evaluated for clinical efficacy, 15 had failed on previous therapy, 15 had nosocomial infections, and all but 1 had underlying diseases. One patient had three sites of infection. Favorable responses were seen in 34 of 37 infections, including 11 of 13 respiratory tract infections, all 7 urinary tract infections, all 12 skin and soft tissue infections, 1 of 2 bone and joint infections, a catheter-related septicemia, a liver abscess, and an otitis media and externa. Favorable bacteriological responses were seen for 48 of 58 organisms. This included 6 of 7 Staphylococcus aureus strains, 14 of 16 other aerobic gram-positive cocci, 18 of 20 Enterobacteriaceae, 6 of 9 Pseudomonas aeruginosa, and 1 of 2 anaerobes. Peak plasma ceftriaxone levels on day 1 were 152 micrograms/ml by bioassay and 78 micrograms/ml by high-pressure liquid chromatography. Four of the 31 initial isolates of aerobic gram-negative rods developed resistance to ceftriaxone on disk diffusion testing. Diarrhea occurred in 3 of 50 patients. All three had received a higher than usual dose. Drug administration was stopped twice, once for a thrombocytopenia and once for a thrombocytopenia with leukopenia. Neither problem could be attributed exclusively to ceftriaxone. Other adverse reactions were eosinophilia, abdominal pain, inguinal candidiasis, and nonsuppurative phlebitis. Even among debilitated adults, ceftriaxone was safe and effective in a twice daily regimen.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Skin Diseases, Infectious; Urinary Tract Infections

Ceftriaxone pharmacokinetics were determined in 40 newborn infants who were 1 to 45 days of age. Mean peak plasma concentrations of 136 to 173 micrograms/ml were observed at the completion of a 15-min intravenous infusion of 50 mg of ceftriaxone per kg. Mean half-life values were 5.2 to 8.4 h, and mean plasma clearances were 0.7 to 1.8 ml/min. Rectal swab cultures from 14 of 16 infants had either reduced numbers of aerobic and anaerobic bacteria or no growth during therapy. A once-daily dosage schedule is suggested for ceftriaxone therapy in newborn infants.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases

31 patients received an intravenous 15-min injection of 2 g ceftriaxone at various times before abdominal or vaginal hysterectomy. Ceftriaxone concentrations in salpinges were significantly higher than in myometrium and endometrium. Tissue concentrations of 20 micrograms/g could be maintained for at least 5 h. Due to its high tissue concentrations maintained for the whole operative procedure, ceftriaxone does seem to be one of the antibiotics of choice for single-dose prophylaxis of postoperative infections in gynecology.

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Genitalia, Female; Humans; Hysterectomy; Middle Aged; Postoperative Complications

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

Topics: Adult; Aged; Bacterial Infections; Bronchi; Cefotaxime; Drug Evaluation; Female; Humans; Kinetics; Lung; Lung Diseases; Male; Middle Aged; Respiratory Tract Infections

All subjects were patients with malignant tumors on the gastroenterological system and in whose cases there were marked ascites (Table 1). In the study, each patient was subjected to the intravenous drip infusion of CTM 1 g for a period of 1 hour. Samples of peripheral venous blood and ascites were taken 4 times, at 1 hour after completion of infusion, and at 2, 3 and 4 hours. The test samples were kept at -80 degrees C until the CTM contents were determined (Fig. 1). Determination results 1. Blood concentrations of CTM decreased with the passage of time (Fig. 2). 2. There was hardly any difference in the concentration of CTM in ascites between the 1 hour and 4 hour samples. Furthermore, the concentration was maintained which exceeded the MIC against intestinal flora, including Escherichia coli, without Pseudomonas and Bacteroides (Fig. 3, Table 2). 3. The higher serum creatinine levels were the greater the concentration of CTM in blood (Fig. 5). 4. The maximum blood and ascites concentration of CTM indicated a correlation coefficient of 0.809, P less than 0.01 (Fig. 6). These results led to the following conclusions: 1. If 1 hour intravenous drip infusion of CTM 1 g/100 ml is to be carried out against postoperative peritoneal infection, such administration at interval less than 5-hours would not be reasonable. 2. The peritoneal invasion of malignant tumor is not a factor in the inhibition of CTM transition from blood to ascites.

Topics: Adult; Aged; Ascitic Fluid; Bacterial Infections; Body Fluids; Cefotaxime; Cefotiam; Female; Gastrointestinal Neoplasms; Humans; Infusions, Parenteral; Male; Middle Aged; Postoperative Period

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Humans; Infant

Pharmacological studies of ceftriaxone, a new semisynthetic cephalosporin, were conducted in 35 cancer patients. This antibiotic was administered in a variety of doses and schedules with no observed toxicity. Intramuscular administration of 500 mg of ceftriaxone to seven patients produced mean peak serum concentrations of 32.9 mug/ml 2.0 h after administration. The terminal serum half-life was 10.9 h. Intravenous infusion of 500 mg of ceftriaxone over 5 min to the same group of seven patients produced a mean peak concentration of the drug in serum of 83 mug/ml at the end of administration which decreased to 16.8 mug/ml at 8 h. A dose of 1 g of ceftriaxone given in identical fashion to the same group of seven patients produced mean peak concentrations in serum of 130 mug/ml at the end of administration and 17.3 mug/ml at 12 h. The mean percentages of drug recovered in urine 12 h after single intravenous doses of 500 mg and 1 g were 30 and 20%, respectively. A 1-g dose of ceftriaxone was administered every 8 h to 10 patients, and a 2-g dose was administered every 12 hours to 9 patients. Drug concentrations in serum were measured for each patient after drug administration on day 1, day 3 or 4, and day 7 or 8. The 1-g dose produced an observed mean peak concentration of 154 mug/ml and a mean terminal-phase half-life of 5.6 h on day 3 or 4. The 2-g dose produced a mean peak concentration in serum of 262 mug/ml and a terminal-phase serum half-life of 6.3 h on day 3 or 4. Continuous infusion studies were performed in nine neutropenic patients for up to 8 days by using a loading dose of 1 g over 30 min, followed by 2 g every 8 h. Mean concentrations in serum were maintained at about 135 mug/ml during the infusion period.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Half-Life; Humans; Kinetics; Male; Neoplasms

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bronchitis; Bronchopneumonia; Cefotaxime; Female; Humans; Lung Diseases; Lung Neoplasms; Male; Middle Aged; Pulmonary Emphysema

Topics: Adolescent; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Humans; Infant; Infant, Newborn

Topics: Bacterial Infections; Cefoperazone; Cefotaxime; Ceftriaxone; Cephalosporins; Cephamycins; Child; Humans; Microbial Sensitivity Tests; Moxalactam

Ceftriaxone (Rocephin 13-9904) was tested against 409 isolates of gram-negative bacilli. No difference was found in the susceptibility of the 262 gentamicin-sensitive or 147 gentamicin-resistant isolates to ceftriaxone. Comparison with other third-generation cephalosporins showed that ceftriaxone was as active as or more active than lamoxactam, cefoperazone, cefotaxime and ceftazidime against Escherichia coli, Proteus mirabilis, Proteus sp., Klebsiella. Ceftriaxone was not as active as ceftazidime against Pseudomonas aeruginosa, but was more active than lamoxactam, cefoperazone and cefotaxime.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Gentamicins; Humans; Microbial Sensitivity Tests

Topics: Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Endometritis; Female; Horse Diseases; Horses

The use of cephotaxim in the treatment of obstetric and gynecological patients with various infectious complications, as well as in the treatment of newborn infants in the Department of Intensive Therapy showed it to be highly effective in 100 per cent of the cases. The adverse reactions of cephotaxim were observed in 1 out of 43 patients. It should be noted that cephotaxim did not inhibit the host anaerobic indigenous flora. No cases of dysbacteriosis were recorded. Comparative analysis of the data on determination of the MIC of cephotaxim and cephuroxim with respect to various species of opportunistic microorganisms demonstrated that cephuroxim was more active against Staph. aureus, while cephotaxim against Klebsiella. Cephotaxim displayed activity against part of the strains of Ps. aeruginosa and streptococci of group D, which was not common to cephalosporins of the previous generations.

Topics: Bacterial Infections; Cefotaxime; Cefuroxime; Cephalosporins; Endometritis; Enterococcus faecalis; Escherichia coli; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Klebsiella; Pregnancy; Pseudomonas aeruginosa; Puerperal Infection; Pyelonephritis; Staphylococcus aureus

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Humans; Male; Middle Aged

Ceftriaxone, a broad spectrum cephalosporin with a markedly extended half-life, was administered to 68 patients with 71 infections in an open trial. Sixty-three infections (89%) had a satisfactory clinical response with eradication of bacteria present at the initiation of therapy in 62 infections (87%). The eight treatment failures correlated well with the development of resistance to ceftriaxone during therapy in Enterobacter and Pseudomonas species (two cases) and with superinfection with Bacteroides fragilis (three cases). Treatment was discontinued in eight patients because of unwanted effects. Serious side effects included leukopenia, rash, fever, and enterocolitis.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Creatinine; Female; Humans; Male; Middle Aged; Osteitis; Respiratory Tract Infections; Skin Diseases, Infectious

Cefotiam (SCE 963), a new, broad-spectrum, third generation cephalosporin was used in the treatment of 136 patients suffering from respiratory tract infections, urinary tract infections, septicemia, meningitis, biliary tract infections and osteoarthritis infections. Cefotiam was administered in monotherapy to 98 patients at the mean posology of two grams per day (extreme doses: 1 to 6 g). The following clinical effectiveness was noted: 83 successes and 18 failures on 101 available clinical reports. The general, biological tolerance and renal tolerance was good in all patients.

Topics: Adolescent; Adult; Age Factors; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Respiratory Tract Infections; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

Thirty-four patients admitted for a suspicion of septicaemia were treated with ceftriaxone, a third generation cephalosporin. Ceftriaxone was administered IV at a dose of 2 grams daily, either as a single injection of 2 g or as two injections of 1 g each. 43 organisms were isolated from the blood of the 34 patients: 20 E.coli; 5 Klebsiella; 2 Salmonella; 2 indole positives Proteus; 1 indole negative Proteus; 1 Enterobacter; 2 Acinetobacter; 3 Staphylococcus aureus; 2 Streptococcus; 1 Enterococcus; 1 Meningococcus and 3 anaerobes. The MIC of the enterobacteria for ceftriaxone ranged from less than or equal to 0.097 microgram/ml to 1.56 microgram/ml. Only two staphylococci, one Acinetobacter and the enterococcus were resistant to the drug. Serum assays of ceftriaxone were performed on the second day of treatment for 15 patients. Within the group treated with a single dosis of 2 g per day, the blood levels were: maximal level (10 min, after the injection): 175 to 460 micrograms/ml (average: 315), minimal level (before injection) 12 to 100 micrograms/ml (average 53). Among the patients treated with two doses of 1 g per day, we obtained: maximal levels 121 to 260 micrograms/ml (average 178), minimal levels 31 to 70 micrograms/ml (average 52). A clinically favorable evolution was obtained for 29 patients (85%). In the cases of 4 patients, the antibiotherapy had to be adapted in view of the susceptibility of the organisms isolated. Ceftriaxone was very well tolerated. The only observed secondary effect was a drug fever occurring in 3 patients who remained febrile in spite of a general improvement.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Humans; Microbial Sensitivity Tests; Time Factors

The penetration of cefotaxime, a new semi-synthetic cephalosporin, into human aqueous humour was investigated. Doses of 1 g (17 patients) and 2 g (19 patients) were administered intravenously at time intervals varying from 45 min to 4 h prior to routine cataract surgery. After the 2 g dosage the average concentration of cefotaxime in the aqueous humour was higher (P less than 0.05) and lasted longer than after the 1 g dosage. The highest average concentration in the aqueous humour after the 1 g dosage was 1.85 microgram/ml, 3.95 micrograms/ml after the 2 g dosage. Therapeutic levels were consistently found in both groups for the organisms most commonly responsible for bacterial endophthalmitis, except for Pseudomonas aeruginosa and Staphylococcus epidermidis.

Topics: Aqueous Humor; Bacterial Infections; Cataract Extraction; Cefotaxime; Cephalosporins; Endophthalmitis; Humans; Injections, Intravenous; Kinetics

The flora in the throat and the stools of 10 patients receiving chemotherapy for malignant diseases in a laminar air-flow room was studied during the prophylactic administration of ceftazidime. Ten percent of aerobic gram-negative bacilli, 41% of aerobic gram-positive organisms, 59% of anaerobes, and 70% of fungi persisted in stool specimens during ceftazidime administration. This drug had a less pronounced effect on the throat flora; 66% of organisms persisted during antibiotic administration. The throat and fecal flora of another eight patients were studied during the prophylactic administration of ceftriaxone. This antibiotic had a profound effect on the fecal flora; none of the gram-negative bacilli, only 24% of aerobic gram-positive organisms, and only 10% of anaerobes persisted during ceftriaxone administration. Like ceftazidime, ceftriaxone had a less marked effect on the throat flora; 59% of organisms persisted during antibiotic administration. The results show that new, expanded-spectrum cephalosporins can have a major suppressive effect on patients' endogenous microbial flora.

Topics: Adult; Aged; Bacterial Infections; Bacteroides; Candidiasis; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Enterobacteriaceae; Feces; Female; Humans; Male; Middle Aged; Neoplasms; Pharynx; Staphylococcus; Streptococcus

Effective and safe antibiotic control combined with surgical measures is the mainstay of the management of serious sepsis in burn wounds. To determine the effects of the third-generation cephalosporins on the clinical and bacteriological course of burn sepsis, 30 adult patients with a comparable degree of burn sepsis were treated with cefatriaxon (Ro 13-9904 (Rocephin); Roche). No significant side-effects were observed, and clinical observation showed a marked to moderate improvement in wound sepsis in 26 cases. Of 61 wound cultures obtained after completion of the course of cefatriaxon, only 19 yielded a positive growth. The beneficial role of the third-generation cephalosporins indicated by this prospective trial could be very important in the management of extensive burn wound sepsis.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Burns; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged

Ceftriaxone is an investigational cephalosporin with a half-life of five to eight hours. In an uncontrolled study, we evaluated its efficacy and safety in 30 pediatric and 12 young adult patients with serious bacterial infections. This agent was administered to children at a dosage of 50 to 75 mg/kg/day intravenously in two divided doses. Those with CNS infections received 100 mg/kg/day. In adults, the dosage was 1 g either once or twice daily. The diseases we treated included pneumonia (17), sepsis (eight), ventriculoperitoneal shunt infections (three), osteomyelitis (three), brain abscess (two), peritonitis (two), and miscellaneous (seven). Clinical cures were achieved in all cases, although one child with cystic fibrosis and Pseudomonas pneumonia had persistent colonization in his sputum. No serious side effects were observed. Although not the agent of choice for many of these pathogens, ceftriaxone appears to represent an important alternative to therapy.

Topics: Bacteria; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Osteomyelitis; Pneumonia

Twenty-six children, aged 2 months to 15 years, were treated with intravenous ceftriaxone sodium, 37.5 mg/kg every 12 hours, for an average of seven days. Clinical and microbiologic cures occurred in 19 of 21 patients, from whom bacterial pathogens were cultured. Ceftriaxone was not effective in treating an 18-month-old infant with periorbital cellulitis caused by relatively resistant Staphylococcus aureus. A relapse occurred in a 2-month-old infant with meningitis caused by ceftriaxone-sensitive Salmonella. Eleven patients had transient diarrhea, superficial candidiasis developed in ten patients, and one patient experienced skin flushing during administration of the antibiotic. Transient asymptomatic laboratory abnormalities were detected in 15 patients; nine patients had elevated serum concentrations of transaminases or bilirubin, 11 had thrombocytosis, three experienced eosinophilia, and one had thrombocytopenia. Transient suppression of normal flora of the intestine occurred in 21 patients. Side effects were not serious enough to warrant discontinuing ceftriaxone therapy in any patient.

Topics: Adolescent; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Ceftriaxone; Cellulitis; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Male; Mastoiditis; Meningitis; Recurrence

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Escherichia coli Infections; Gonorrhea; Humans; Pseudomonas Infections

Forty-three children (ten neonates, 15 infants and 18 older children) were treated with single daily doses of ceftriaxone (50 to 100 mg/kg) intravenously or intramuscularly for serious bacterial infections. The infections included meningitis (31 patients), brain abscesses (four patients), septicaemia (three patients), pleuro-pneumonia (two patients), septic arthritis and soft tissue phlegmona (three patients). No other antibacterial agents were used except in four patients with brain abscesses, in whom ceftriaxone was combined with ornidazole. The overall bacteriological cure rate was 98%, and sterilisation of the cerebrospinal fluid occurred in 27 of 28 patients (96%) with proven bacterial meningitis. Two patients died, three survived with severe neurological sequelae; one neonate required partial gut resection. A complete clinical cure was achieved in the remaining 37 patients. Only one treatment failure was directly related to the drug therapy. The only side effect noted were sterilisation of the gut with overgrowth of Candida albicans in 35% of neonates and infants, an prolonged fever in 13% of all patients. Ceftriaxone given in a 24-hourly regimen is convenient and highly effective in serious bacterial infections in children and is without significant toxicity.

Topics: Adolescent; Arthritis, Infectious; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Cellulitis; Child; Child, Preschool; Drug Evaluation; Humans; Infant; Infant, Newborn; Meningitis; Pleuropneumonia; Sepsis

On the occasion of clinically indicated lumbar of cisternal punctures in 19 newborn and premature babies treated with Cefotaxime 33 CSF-levels of Cefotaxime (CTX) and it's metabolite Desacetyl-Cefotaxime (D-CTX) were measured by means of HPLC. 6 of the 19 infants suffered from meningitis. The highest CTX-levels were found 2 to 4 hours after the last infusion of CTX (50 or 100 mg/kg within 20 min, each 12 hours). Patients with meningitis showed CTX-levels between 20 mg/l and less than 0.5 mg/l (limit of detection), those without meningitis between 11 mg/l and less than 0.5 mg/l. Because of the widely scattered CTX-levels any dependence from CTX-dosage or from degree of meningeal inflammation is not to be shown. With two exceptions D-CTX-levels ranged from 2 to 20 mg/l. Up to 9 1/2 hours after the last CTX-dose no clear decrease of the D-CTX-concentration in CSF may be seen. On the other hand, D-CTX-levels are also widely scattered. Nevertheless D-CTX apparently stays significantly longer in the CSF than CTX does. An influence of meningeal inflammation on the D-CTX-levels can not be observed. In E. coli- and in Klebsiella-spp. The geometrical means of MIC are found to range below 0.5 mg/l for CTX and below 2 mg/l for D-CTX. Therefore CTX might be recommended for treatment of meningitis caused by these germs. This recommendation may be supported by some reports about good clinical results, from our unit and from the literature as well.

Topics: Bacterial Infections; Cefotaxime; Chromatography, High Pressure Liquid; Humans; Infant, Newborn; Infant, Premature, Diseases; Meningitis

Bacterial infections are frequent events in premature and newborn infants. The reason is a defective specific and nonspecific defence of bacterial organisms. Some immunoglobulins like IgM and IgA including secretory IgA are absent. Premature infants also show a decreased level of IgG. Cellular immunity is anatomically intact but functionally defective. A number of complement factors are lacking, the activation of the alternative pathway is impaired. Newborn infants with perinatal problems like asphyxia or difficult delivery, show defects of leucocyte function like decreased deformability, defective chemotaxis and defective killing of ingested bacteria. Certain diseases, like hypoxia and malformations of immature organ functions in this age group (decreased acid production in the stomach), facilitate bacterial colonization of surface epithelia and the invasion of tissues. Consequences of these pathogenetic mechanisms are an unimpaired propagation of bacterial organisms into the blood and meninges without localization of the infecting organisms at the entry site. Bacterial meningitis is not considered a separate disease entity but a complication of bacteremia and sepsis. Clinical symptoms are nonspecific at the onset of the infection. Fever is frequently absent; decreased appetite, vomiting, a bloated abdomen, diarrhea, tachycardia, tachypnea are early signs of a bacterial infection, a grey mottled appearance, cyanosis, jaundice, petechiae, apneic spells, seizure activity and a metabolic acidosis are symptoms of advanced infection. Successful treatment at this stage is often not possible. Every sign of a decreased well being of a newborn of premature infant warrants laboratory and bacteriologic work up for septicemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Clindamycin; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Meningitis; Metronidazole; Penicillin G; Pseudomonas Infections; Streptococcal Infections

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

To evaluate the antibacterial potency of cefotiam (CTM) clinical and laboratory studies were carried out and the results were as follows. Clinical evaluation and adverse reaction CTM was given to total of 23 patients, 10 with bronchopneumonia, 10 with bronchitis and one each with cystitis, enteritis and suspected sepsis. Overall efficacy rate was 78.3% (18/23) (excellent 9, good 9, fair 3, poor 2). Only 1 case showed a side effect of slightly elevated GOT and GPT. Antibacterial activities MIC of CTM against isolates from sputum was investigated on those patients mentioned above and was compared with MIC of CEZ and CMZ. CTM showed superior antibacterial activity against almost all strains. Especially on Haemophilus and Klebsiella antibacterial activity of CTM was impressive. Organisms in sputum Four out of 8 causative bacteria disappeared and 1 out of 8 decreased after administration of CTM. Thus CTM is considered to be the useful drug for the treatment of respiratory infection.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Sputum

Twenty patients suffering from severe infections (9 with respiratory tract infection, 9 with urinary tract infection, 2 with pharyngitis, 1 with enteritis and 4 with fever of unknown origin (FUO] were treated by intravenous infusing CTX 2 g over 30 to 40 minutes 2 or 3 times daily for 4 to 10 days. Other antibiotics were concomitantly used in 9 cases. Response to CTX was proved good in 15 cases (75%), fair in 3 cases and poor in 2 cases. No adverse reactions were observed.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infusions, Parenteral; Leukemia; Lymphoma; Male; Middle Aged; Respiratory Tract Infections; Urinary Tract Infections

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Humans; Kinetics

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Female; Humans; Injections, Intravenous; Male; Middle Aged

Thirty-four patients aged 1 month to 19 years were treated with ceftriaxone for suspected bacterial infections. Bacterial pathogens were isolated from 25 children. The overall bacterial cure rate was 88%, with an overall clinical response rate of 96%. No side effects requiring cessation of therapy were observed. Ceftriaxone proved to be safe and effective in the treatment of serious infections in children.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Microbial Sensitivity Tests

The effect of cefotaxime in treatment of lower respiratory tract infections was evaluated in 23 patients. Because of its high efficacy, low potential for adverse reactions, and convenient dosage, cefotaxime was found to be an effective antibacterial choice in the treatment of this troublesome condition.

Topics: Aged; Bacteria; Bacterial Infections; Blood Chemical Analysis; Cefotaxime; Drug Evaluation; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections; Urine

Topics: Bacterial Infections; Cefotaxime; Cross Infection; Female; Humans; Male; Resuscitation

Cefotiam (CTM) was intravenously or intramuscularly given to 14 patients with infections in the field of otorhinolaryngology including 5 cases with chronic suppurative otitis media. Daily doses of CTM were 1 to 3 g and its administration period was 3 to 10 days. Clinical responses were excellent in 1 patient, good in 8, fair in 2 and poor in 3, the rate of satisfactory clinical responses (excellent and good) being 64.3% (9/14). Staphylococci were most frequently isolated from the clinical materials. As for side effects, elevation of GOT and GPT was observed in 1 patient.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Diseases

Cefotiam (CTM) was intravenously given to 12 patients with infectious diseases in the field of otorhinolaryngology including 10 cases with chronic suppurative otitis media. Daily doses of CTM were 1 to 4 g. Clinical responses were excellent in 3 patients, good in 5, fair in 1 and poor in 3. The rate of overall clinical effectiveness was 67%. Staphylococcus species were most frequently isolated from the patients and all of them were eradicated by the CTM treatment. No side effects and no abnormal laboratory findings relating to the drug administration were observed.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Child; Drug Evaluation; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged; Otorhinolaryngologic Diseases

CTM was administered at dose levels of 1 to 3 g a day to 77 cases of otorhinolaryngological infections, and the following results were obtained: The effect of the drug was determined in 75 cases. The responders were 3 out of 5 (60.0%) in acute suppurative otitis media, 4 out of 11 (36.4%) in chronic suppurative otitis media, 39 out of 43 (90.7%) in tonsillitis and peritonsillar abscess and 12 out of 16 (75.0%) in other diseases, a total of 58 out of 75 cases (77.3%). The bacteriological effect of CTM was evaluated in 53 cases, and bacterial eradication was demonstrated in 41 cases (77.4%). Also, its antibacterial potency was 2 to 4 times superior in comparison to that of CEZ against isolated bacteria in which MICs were measurable. Side effects which were neither severe nor specific were recognized in 3 out of 77 cases (3.9%). In the cases with abnormal laboratory values, none was determinable to be attributed to CTM.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Child; Drug Evaluation; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged; Otorhinolaryngologic Diseases

Clinical investigation with cefotiam (CTM) was performed, the following results were obtained. CTM was administered to 18 cases of infectious diseases in the otorhinolaryngologic field. Clinical results were excellent in 7 cases, good in 5 cases, fair in 4 cases and poor in 2 cases. Clinical efficacy was 66.7%. No side reactions were noted in any cases.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Otorhinolaryngologic Diseases

Cefotiam (CTM) was intravenously given to 20 patients with infections in the field of otorhinolaryngology. Daily doses of CTM were 2 to 4 g divided into 2. Clinical responses were excellent in 11 patients, good in 8 and fair in 1, the rate of satisfactory clinical responses being 95% (19/20). Ninety-one % (10/11) of Gram-positive cocci isolated from the patients were eradicated by the CTM treatment, while 60% (6/10) of Gram-negative bacilli were persisted. As for the side effects, eruption and elevation of GOT and GPT were observed in 1 patient.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged; Otorhinolaryngologic Diseases

Clinical studies of cefotiam (CTM), a new cephalosporin derivative, in otorhinolaryngological field were performed, and the results were summarized as follows. CTM was intravenously injected to 31 cases of otorhinolaryngological infections in daily dose of 1--4 g. Clinical efficacy was 33.3% in acute otitis media and chronic otitis media (acute exacerbation) (6 cases), 90% in acute tonsillitis (including peritonsillitis, peritonsillar abscess) (20 cases), 50% in acute pharyngitis (2 cases), 100% in acute sinusitis (2 cases) and 100% in epiglottis abscess (1 case), respectively. Bacteriological efficacy was 80% for beta-Streptococcus, 100% for K. pneumoniae, 50% for P. aeruginosa, and 85.7% for Peptococcus and Peptostreptococcus, respectively. No difference was observed in various daily doses for clinical efficacy. As for side effects and laboratory findings, eruption in 1 case, elevation of GOT in 1 case and elevation of GOT, GPT in 2 cases were observed. But, all of the cases were normalized after stoppage of administration or postadministration.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged; Otorhinolaryngologic Diseases

The clinical effectiveness and safety of cefotiam (CTM) in infectious diseases in the field of otorhinolaryngology was evaluated from 30 patients (otitis media 18, pharyngeal infection 4, chronic paranasal sinusitis 1, esophagitis 1, acute bronchitis 1, others 4). Side effect (fever, nausea) was found in a 14 years old male patient. Skin test revealed positive in 1 patient. These cases were excepted from evaluating clinical effectiveness of CTM. In 28 patients, the overall ratio of clinical effectiveness was 60.7%. In patients of otitis media, the clinical effectiveness ratio was 41.2%, whereas the ratio was 75.0--100% in patients of other diseases. In particular, the clinical effect was fair or poor in patients to whom the drug was given only once a day. These results suggest that this chemotherapeutic drug should be administered at least twice a day, particularly to the patients of otitis media. The bacteriological response to CTM was evaluated from 53 strains, isolated from 28 patients before treatment. Eradication rate of bacteria was 60.4%. No abnormal laboratory findings, relating to the drug, were observed after treatment.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Humans; Infusions, Parenteral; Injections; Male; Middle Aged; Otorhinolaryngologic Diseases

Basic and clinical studies on cefotiam (CTM) for the infectious diseases in otorhinolaryngological field were performed and the following results were obtained. The peak value in the serum level of CTM was 18.05 micrograms/ml by 0.5 g administration and 35.2 micrograms/ml by 1 g at 30 minutes after a single intravenous injection. CTM was rapidly excreted from the blood after injection and was detected a little amount in serum at 6 hours after the administration. Tissue concentrations of the drug into palatine tonsil and the mucous membrane of the nasal cavity or maxillary sinus were seen in relatively rapid and good manner. Chemotherapeutic results excepting Pseudomonas aeruginosa infections (3 cases) were excellent in 2 cases, good in 7 cases and poor in 3 cases of 12 patients with the infectious diseases in otorhinolaryngological field. No adverse effects and abnormal values in the laboratory findings were revealed in every patients.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Cefotiam; Child; Drug Evaluation; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Diseases; Palatine Tonsil; Paranasal Sinuses; Tissue Distribution

Seventy-five patients with severe infection accompanying hematologic disorder, including leukemia and malignant lymphoma, were treated with cefotaxime (CTX). CTX was administered by intravenous drip infusion at a daily dose ranging from 4 to 16 g for terms of 3 to 21 days. The total doses were ranged from 12 to 226 g. The results obtained were as follows: Clinical effects: Excellent in 20 cases, good in 21 cases, fair in 7 cases and poor in 27 cases. The efficacy rate was 54.7% (41/75). Clinical effectiveness on isolated organisms (27 cases): In single infection (21 cases), the efficacy rates were 80% for Gram-positive cocci, including S. aureus and 63.6% for Gram-negative bacilli other than P. aeruginosa. In mixed infection (6 cases), the rate was 50.0%. There were no significant differences in the efficacy rates for those patients who were grouped by the initial number of neutrophil (less than 100, 101--500 and over 501/mm3). There were no significant difference in the efficacy rates for those patients who were grouped by the initial number of lymphocyte (less than 500 and over 501/mm3). Side effects and abnormal laboratory findings: One case of skin rash and 2 cases of elevated GOT and GPT were observed. CTX was therefore considered as a clinically useful antibiotic for the severe infections even in neutropenic state in patients suffering from malignant hematological diseases.

Topics: Adolescent; Adult; Aged; Anemia, Aplastic; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infusions, Parenteral; Leukemia; Lymphoma; Male; Middle Aged; Multiple Myeloma

Fifty-eight patients were treated with cefotaxime (CTX, Claforan) intravenously. Almost all patients (54 patients) had underlying diseases that were 16 cases of diabetes mellitus, 10 cases of respiratory diseases, 8 cases of cerebral vascular disturbance, 6 cases of renal diseases and blood diseases, 5 cases of carcinoma and hypertension, 4 cases of cholelithiasis, 3 cases of heart diseases and 7 cases of other diseases. The clinical efficacy of CTX in 34 cases of RTI, 11 cases of UTI, 8 cases of BTI and 5 cases of other infection was excellent in 11 cases, good in 27 cases, fair in 12 cases, poor in 4 cases and unclear in 4 cases. The over all clinical effectiveness was 70.4%. No adverse reaction was observed except for 2 cases (general fatigue in 1 case and eruption and itching in another). These results obtained should support the usefulness of CTX.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged

Various antibiotics are widely used for the purpose of protection against postoperative infections. Neurosurgeon must select the effective antibiotics to bacterium, that which penetrated enough to the intracranial organ through the blood-brain barrier. Eighteen cases with ventriculo-peritoneal shunt received intravenous drip infusion of cefotiam (CTM) and the concentration of CTM in blood and cerebrospinal fluid (CSF) was measured. The conclusion drawn from this study on penetration of CTM is summarized as follows: The concentration of CTM in CSF and its ratio to that of serum (CSF/serum %) showed the values of 0.543 microgram/ml (3.66%) in the group of 1 g CTM injection and 0.900 microgram/ml (4.02%) in the group of 2 g CTM injection, 2 hours after an intravenous administration. The concentration of CTM in CSF were gradually decreased in comparison with antibiotic levels in the blood. The most cases of 1 g or 2 g intravenous administration were able to get the sufficient concentration in the CSF, which exceeds MIC (minimal inhibitory concentration) against Gram-positive cocci and Gram-negative bacilli. As a result of penetration of CTM into cerebrospinal fluid, we recommend the intermittent intravenous injection of 2 g CTM for prophylaxis of postoperative infections.

Topics: Adult; Aged; Bacterial Infections; Brain; Brain Neoplasms; Cefotaxime; Cefotiam; Cerebrovascular Disorders; Child; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Postoperative Complications; Premedication

Twelve infants having undergone extrahepatic cholangiojejunostomy (SURUGA'S procedure II) after portal hepaticojejunostomy as a radical operation for congenital biliary atresia received prophylactic cefotiam (CTM) against biliary tract infection, 50 mg/kg by intravenous drip in 1 hour, followed by serial determinations of bile and serum CTM levels. The patients were evaluated as to degree of CTM excretion into the bile, by classification into 4 groups according to success or failure in establishing the anastomosis, bile outflow and persistence of jaundice. Patients with an established anastomosis, satisfactory bile flow and no longer jaundice showed high biliary antibiotic concentrations whereas lower biliary antibiotic levels were seen in those with failure in anastomosis, poor bile flow and persistent jaundice. In both cases, nevertheless, the antibiotic concentration in bile sufficiently exceeded the MIC80 values of CTM against principal bacterial pathogens causative of biliary tract infections, thus demonstrating clinical significance of the use of CTM for this purpose. The antibiotic excretion into the bile improved with normalization of liver function in an infant displaying satisfactory bile outflow from an early postoperative stage. The bile and serum CTM assay data obtained by the agar well method showed a high degree of correlation with those by high performance liquid chromatography.

Topics: Bacterial Infections; Bile; Bile Ducts; Biliary Tract Diseases; Cefotaxime; Cefotiam; Female; Humans; Infant, Newborn; Infusions, Parenteral; Male; Postoperative Complications; Premedication

The in vivo antibacterial activity and the penetration into inflammatory tissues of cefoperazone (CPZ) were compared with those of cefotiam (CTM) in local infection systems using mouse subcutaneous abscess and rat granuloma pouch. The serum levels of CPZ in subcutaneous abscess in mice caused by Staphylococcus aureus F-230 (penicillinase producing strain) were lower than that of CTM, but there was no significance between the therapeutic effects of both drugs. The same results were obtained using Staphylococcus aureus F-196 (penicillinase non-producing strain). When infected with Enterobacter cloacae H-27 (cephalosporinase producing strain) in rat granuloma pouch, the exudate levels of CTM were lower than those of CPZ. Judging from these results, it was suggested that CPZ was a useful antibiotic for the treatment of bacterial-inflammatory tissues.

Topics: Abscess; Animals; Bacterial Infections; Cefoperazone; Cefotaxime; Cefotiam; Drug Evaluation, Preclinical; Male; Mice; Rats

The physicochemical properties of the blood-to-brain barrier, the cerebrospinal fluid (CSF) to brain barrier, and the blood-CSF barrier, including their specific transport mechanisms, are responsible for drug concentration time courses in the CSF, which increase slower and remain lower than in the serum. From the kinetic point of view the central nervous system (CNS) can be understood as a deep compartment in the organism. During the initial inflammatory phase of a bacterial meningitis, the penetration of antibiotics can be increased. Consequently, sufficient CSF concentrations should be achieved as soon as possible. To investigate the influence of the dosage regimen on the kinetic profile of antibiotics in the CSF, chloramphenicol and cefotaxim were measured using high pressure liquid chromatography (HPLC)-techniques. Five children had a bacterial meningitis and five an external ventricular drainage due to various diseases. Neither continuous infusion over a 12-24-hour-period nor four bolus-injections per day led to sufficient antimicrobial concentrations within the first hours after starting therapy. Using a loading dose of 40-50% of the daily dose administered over a 2-4-hour infusion period and followed by bolus injections, sufficient concentrations of chloramphenicol and cefotaxim could be achieved within a few hours. Besides an adequate choice of antibiotics, the special pharmacokinetic properties of the cerebrospinal membranes should not be neglected in the concept of the antibiotic therapy of meningitis.

Topics: Bacterial Infections; Cefotaxime; Child, Preschool; Chloramphenicol; Chromatography, High Pressure Liquid; Drug Administration Schedule; Female; Humans; Infant; Infant, Newborn; Kinetics; Male; Meningitis; Time Factors

The in vitro activity of ceftriaxone was compared with those of other recently introduced beta-lactam antimicrobial agents (cefoperazone, cefotaxime, and moxalactam) and with those of cefoxitin, clindamycin, and metronidazole against 227 strains of anaerobic bacteria. The data obtained in this investigation suggest that ceftriaxone, like a majority of the new beta-lactam antimicrobial agents, may be of limited value in the treatment of serious infections involving anaerobic bacteria.

Topics: Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests

In three groups of patients levels of cefotaxime in serumand cerebrospinal fluid were determined. Therapeutic value and efficacy are discussed in meningitis patients. Nine concentrations of cefotaxime in lumbar and ventricular CSF out of 19 in a group of seven neurosurgical patients with mild to moderate impairment of the blood-CSF-barrier were higher than 0.5 micrograms/ml. In seven determinations in a second group of six patients with no or very little dysfunction of the blood-cerebrospinal-fluid barrier only twice cefotaxime was not detectable in lumbar CSF. Concentrations of cefotaxime in 25 determinations of lumbar or ventricular CSF in six patients with bacterial meningitis ranged from 1.1 micrograms/ml to 19.2 micrograms/ml. Treatment with cefotaxime alone was successful in a patient with E. coli meningitis and ventriculitis after infection of a ventriculo-atrial shunt and in another patient with pneumococcal meningitis and penicillin allergy. The other four patients with bacterial meningitis were treated successfully by antibiotics including cefotaxime.

Topics: Bacterial Infections; Blood-Brain Barrier; Cefotaxime; Cerebral Ventricles; Cerebrospinal Fluid Shunts; Encephalitis; Heart Atria; Humans; Meningitis

Topics: Adolescent; Adult; Aged; Bacterial Infections; Blister; Body Fluids; Cefotaxime; Female; Humans; Kinetics; Male; Microbial Sensitivity Tests; Middle Aged

Topics: Aerobiosis; Anaerobiosis; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephamycins; Humans; Imipenem; Lactams; Methicillin; Microbial Sensitivity Tests; Moxalactam; Penicillin Resistance

We studied the pharmacokinetics and efficacy of cefotaxime in 32 neonates with severe gram-negative infections. Many of these patients had been treated unsuccessfully with combinations of antibiotics. Eighty-one percent of these patients were cured, 6% improved, and 13% had treatment failures; there were three deaths. Eighteen patients received cefotaxime alone; 16 were cured and two improved. These data indicate an efficacy of cefotaxime sufficient to warrant more rigorous future trials. The elimination half-life of cefotaxime ranged from 2.0 +/- 0.4 hours in term neonates more than one week of age to 5.7 +/- 0.8 hours in preterm neonates less than one week of age. A volume of distribution of approximately 0.63 L was similar for all infants irrespective of age and maturity. These kinetic data can be used in design of future therapeutic regimens in more rigidly controlled trials assessing indications for cefotaxime therapy in neonates. We recommend dosing as follows, using a dose of 25 mg/kg: every 12 hours for preterm infants less than one week of age, every 8 hours for preterm infants one to four and term infants less than one week of age, and every 6 hours for term infants more than one week of age.

Topics: Bacterial Infections; Cefotaxime; Enterobacteriaceae Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Models, Biological; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections

Topics: Azlocillin; Bacterial Infections; Cefoperazone; Cefotaxime; Cephalosporins; Cephamycins; Humans; Mezlocillin; Moxalactam; Penicillins; Piperacillin

Ceftizoxime (FK 749, CZX) was evaluated in 24 children with a suspicion of bacterial infection. Of the 17 confirmed bacterial infections, 16 were shown to be effective (effective rate, 94.1%). The diagnosis included acute pharyngitis (2), pneumonia (6), staphylococcal empyema (1), cervical purulent lymphadenitis (2), acute enterocolitis (2), acute pyelonephritis (1), SSSS (1) and suspected septicemia (2). The etiological pathogens recovered were Streptococcus anginosus (1), Streptococcus pneumoniae (1), Staphylococcus aureus (2), Haemophilus influenzae (3), enteropathogenic Escherichia coli (1) etc. A case of suspected Pseudomonas aeruginosa septicemia was not effectively treated with CZX. The serum half-life of CZX was 1.36 hours after intravenous bolus infection. A cerebrospinal fluid level of CZX was 6.2 mcg/ml 1 hour after intravenous bolus injection of 1 g (23.8 mg/kg) in a child with inflamed meninges. No severe adverse reaction was encountered with the CZX therapy. The data suggest that CZX is an excellent candidate for the first choice parenteral antibiotic in the pediatric infections.

Topics: Age Factors; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male

Clinical studies on ceftizoxime, a new cephalosporin, were carried out in our department. The following results were obtained. 1. Antibacterial activity. Antibacterial activity of ceftizoxime against 7 strains of E. coli, 6 strains of Klebsiella, 6 strains of H. influenzae, 7 strains of E. cloacae and 10 strains of S. aureus, recently isolated from patients, was compared with that of cefotiam, cefmetazole and cefazolin. Ceftizoxime was more active than the other antibiotics against E. coli, Klebsiella, H. influenzae and E. cloacae, but less active against S. aureus. 2. Urinary excretion. Urinary excretion was measured in 2 cases with normal renal function after dosing with 750 mg (35 mg/kg) and 350 mg (17 mg/kg) of ceftizoxime by intravenous injections. Urinary recovery rates within 6 hours were 97% and 82% respectively. 3. Clinical study. Eighteen children with the following bacterial infections were treated with ceftizoxime; respiratory tract infection (13), acute otitis media (1), acute intervertebral chondritis and tonsillitis (1), chronic cystitis (1), subcutaneous abscess (1) and chronic bacteremia (1). The dosage was 69--147 mg/kg q.i.d. by intravenous injection. The duration of administration was from 3 to 32 days. The clinical results were excellent in 4 cases, good in 13 cases and fair in 1 case of chronic bacteremia. The overall effectiveness rate was 94%. Slight elevation of GPT in 1 case and leukopenia (neutropenia) in 1 case were observed, but returned to the normal range immediately after discontinuation of dosing. It is considered that ceftizoxime is one of the useful first choice antibiotics used for children with bacterial infections.

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male

Pharmacokinetics and clinical effects of ceftizoxime (CZX), a new cephalosporin antibiotic, were investigated and following results were obtained. 1) Ceftizoxime was given by intravenous injection or drip infusion for 1 hour at a single dose of 30 mg/kg. After intravenous injection, the mean peak serum level of 3 children was 95.9 mcg/ml at 15 minutes and half-life time was 1.18 hours. After 1 hour drip infusion, the mean peak serum level of 3 children was 79.5 mcg/ml at the end of infusion and half-life time was 1.20 hours. The urinary level was high and the mean urinary recovery rate was 69.6% and 63.4% up to 6 hours after intravenous injection and 1 hour drip infusion, respectively. 2) CZX was administered in dose of 39--76 mg/kg to 7 pediatric patients (4 cases of purulent meningitis, 2 of septicemia with purulent meningitis, and 1 of aseptic meningitis) by a single intravenous injection. In patients with purulent meningitis, passage into the cerebrospinal fluid was relatively as good as 30% of serum level at the same time in the presence of remarkable signs of inflammation, but poor in cases of mild inflammation or aseptic meningitis. 3) Cerebral puncture fluid level in 1 patient with cerebral abscess was as good as 65.5% of serum level at the same time. 4) CZX was given to 28 cases of respiratory tract infection, 1 of tonsillitis with otitis media, 6 of scarlet fever, 1 each of maxillary sinusitis and bacterial endocarditis, 6 of purulent meningitis, 2 of septicemia, 5 of septicemia suspected, 2 of septicemia with purulent meningitis, 1 each of osteomyelitis, typhoid fever, peritonitis and biliary tract infection, 16 of urinary tract infection, 14 of skin and soft tissue infection, and 1 of external otitis, totaling 87 cases. The mean daily dose of 101.6 mg/kg was administered for an average of 10 days mainly by intravenous injection 4 times daily. Clinical results obtained were excellent in 34 cases, and good in 46. Bacteriological effectiveness rate was 100%. As for side effects, fever, fever with rash, fever with cough and diarrhea appeared in 1 each case out of 182 cases including 95 drop out cases. As for laboratory findings, eosinophilia, thrombocytopenia, elevation of GOT, that of GOT with GPT, and that of GOT with LDH appeared in 10, 2, 2, 3 and 1 cases, respectively.

Topics: Age Factors; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Kinetics; Male

Topics: Adolescent; Age Factors; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Infant, Newborn; Male

Laboratory and clinical studies were performed as follows on ceftizoxime (CZX), a new cephalosporin antibiotic. 1. Susceptibility of clinically isolated bacteria to CZX and cefotiam (CTM) or sulbenicillin (SBPC). Antibacterial activities of CZX and CTM were compared against S. aureus, E. coli, K. pneumoniae, E. cloacae, H. influenzae and E. aerogenes; CZX was compared with SBPC against Ps. aeruginosa. CZX and CTM were nearly equal in activity against S. aureus, but CZX was found to be more active than CTM by 1--10 tubes against E. coli, K. pneumoniae, E. cloacae, H. influenzae and E. aerogenes. Against Ps. aeruginosa, CZX and SBPC were nearly equal in activity. 2. Serum concentration and urinary recovery. Serum concentrations of CZX were measured in 6 patients given CZX for prophylactic purpose during cardiac catheterization. In 2 patients given 20 mg/kg of CZX intravenously, the average serum concentration was 38.9 micrograms/ml at 30 minutes after intravenous bolus injection. In 3 patients given 10 mg/kg of CZX by intravenous drip infusion, the peak average serum concentration was 28.1 micrograms/ml at the end of infusion. Urinary recovery in 2 patients tested was 81.1% and 92.5% until 6--7 hours after intravenous bolus injection. 3. Clinical efficacy. CZX was given intravenously to 24 patients in doses of 30--111 mg/kg (57.1 mg/kg on an average) t.i.d. or q.i.d. for 3--16 days (5.5 days on an average): 1 with lacunar tonsillitis, 4 with acute bronchitis, 12 with pneumonia, 2 with enterocolitis, 2 with soft tissue infection, 2 with lymphadenitis and 1 with UTI. The overall efficacy rate was 95.8%, i.e., efficacy was excellent in 10 (41.7%), good in 13 (54.2%), and poor in 1 (4.2%). Bacteriological efficacy was excellent, i.e. 21 of the 23 strains disappeared. One patient had mild and transient diarrhea, but no other laboratory abnormalities were observed during treatment. The above results suggest that CZX is 1 of the most useful antibiotics for treating pediatric infections, especially due to Gram negative bacteria.

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Infant, Newborn; Male

Pharmacokinetics of ceftizoxime (CZX), a new cephalosporin antibiotic, was investigated in 9 children with normal renal and hepatic function. In addition, the clinical effect of CZX was evaluated in 26 pediatric patients with various infections. In 4 of the 9 children with normal renal and hepatic function, intravenous bolus injection of CZX in a dose of 20 mg/kg yielded a mean peak serum level of 36.5 micrograms/ml at 1/2 hour after infusion, and mean serum levels of 12.5 micrograms/ml at 2 hours and 6.0 micrograms/ml at 4 hours after infusion. The biological half-lives of CZX were estimated to be 1.25--2.55 hours. In another child, serum levels of CZX at 1/2, 2 and 4 hours after intravenous bolus injection in a dose of 10 mg/kg were 19.60, 5.96 and 2.06 micrograms/ml, respectively. The clear difference in dose response between 20 mg/kg and 10 mg/kg reflected the doubled dose levels. In the remaining 4 children, drip infusion of CZX in a dose of 20 mg/kg (1 child 17 mg/kg) over 0.5--1.5 hours yielded peak serum levels at the end of infusion. The biological half-lives of CZX were estimated to be 0.95--1.50 hours. About 80% of CZX was excreted in the urine within 6 hours after infusion in the 4 children tested. Twenty-six pediatric patients with various infections were treated with CZX intravenous doses of 20 mg/kg to 118 mg/kg b.i.d.--q.i.d. for 3--14 days. Of the 12 patients with acute bronchitis and pneumonia, 5 showed excellent response, 6 good and 1 fair response. Of the 5 patients with urinary tract infection, 4 showed excellent response and 1 good response. One patient each with colitis, tonsillitis and facial cellulitis, pharyngitis showed excellent response and 1 patient each with purulent thyroiditis and gluteal abscess showed good response. The single patients with sepsis showed excellent response. One patient each with pyothorax, purulent arthritis and cerebral abscess showed poor response. Overall effectiveness rate was 84.6%. although 22 of all 26 patients treated had serious underlying diseases such as APL, AML. A mild increase in GOT and GPT was observed in 1 patient during treatment with CZX, and the values returned to normal after discontinuation of the drug. These results suggest that ceftizoxime is 1 of the most important antibiotics for treating a wide range of infections in children as well as in adults.

Topics: Adolescent; Age Factors; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Kinetics; Male

Experimental and clinical trials were carried out with ceftizoxime in pediatric infections. Results were as follows. 1. The antibacterial activity of ceftizoxime against clinically isolated organisms was determined. Ceftizoxime was more active than cefazolin, cefotiam and cefmetazole against K. pneumoniae, E. coli and H. influenzae. 2. The serum concentrations of ceftizoxime following intravenous injection of 10 mg/kg were 16.2, 10.1, 6.2, 1.8 micrograms/ml at 30, 60, 120, 240 minutes after injection, respectively. Ceftizoxime was excreted with the rate of 97.2% in the 6-hour urine after injection. 3. Twenty-one patients comprising 5 with urinary tract infection, 16 with respiratory tract infection were received ceftizoxime at the doses ranging from 32 to 109 mg/kg divided 3 or 4 times a day. The results were excellent in 8 and good in 13 patients. The rate of satisfactory clinical response was 100%. 4. Slight and transient elevation of GPT was observed in 1 patient. Other side effects were not observed in any of these 21 patients.

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male

Topics: Animals; Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Humans; Injections; Kidney; Lethal Dose 50; Male; Mice; Rats; Reproduction

We conducted a therapeutic trial with cefmenoxime in the field of otorhinolaryngology on a total of 14 subjects including 7 cases of otitis media, 5 cases of peritonsillar abscess, 1 case of chronic sinusitis and 1 case of congenital aural fistula. 1. The effective rate for peritonsillar abscess was extremely high being judged 'markedly effective' in 3 cases and 'effective' in 2 cases. 2. The effective rate for otitis media was also remarkably high; it was judged effective in 85.7% of the cases. It is thought that this is probably due to the fact that therapy and supervision were carried out on inhospital patients. 3. The 1 case of chronic sinusitis and the 1 case of congenital aural fistula were each judged 'effective' and 'markedly effective'. The only side effect observed was a slight case of skin eruption in 1 of the patients.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Diseases

Fundamental and clinical studies in the pediatric field on ceftizoxime were carried out, and the following results were obtained. 1. In 4 children age from 3 years to 5 years, the serum concentrations and urinary excretion of ceftizoxime in a dose of 20 mg/kg by intravenous drip infusion over 60 minutes were measured. The peak serum levels were 22.0--84.0 microgram/ml (mean 45.0 microgram/ml) at the end of infusion. The mean serum levels after the end of infusion were 16.9 microgram/ml at 30 minutes, 12.1 microgram/ml at 1 hour, 6.2 microgram/ml at 2 hours, 1.6 microgram/ml at 4 hours and 0.6 microgram/ml at 6 hours, with mean serum half-life (T 1/2) of 1.03 hours, mean urinary recovery rate was 64.9% up to 6 hours. 2. Concentrations of the drug in the cerebrospinal fluid in 1 patient with purulent meningitis at 30 minutes after an intravenous drip infusion of about 33.3 mg/kg were 0.2 to 1.5 microgram/ml, which were 8 to 60 times higher than the MICs of the causative organisms. 3. Ceftizoxime was administered to 38 children with pneumonia, bronchitis, Salmonella enteritis, purulent meningitis, etc. in the daily dose of 44--200 mg/kg for 3--19 days. Clinical response was excellent in 24, good in 12, poor in 1 and unknown in 1. The drug was proved to be very effective in 1 case of purulent meningitis due to H. influenzae. As for side effect, eruption was observed in only 1 case.

Topics: Adolescent; Age Factors; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Male

Fundamental and clinical studies of ceftizoxime, a new cephalosporin antibiotic, in children led to the following results. 1. Ceftizoxime compared favorably with cefazolin (CEZ) and cefmetazole (CMZ) for in vitro activity against clinically isolated strains of Staphylococcus aureus (31 strains), Escherichia coli (29), Klebsiella pneumoniae (30) and Pseudomonas aeruginosa (16). While somewhat less active against S. aureus than CEZ and CMZ, ceftizoxime was far more active than these 2 cephalosporin antibiotics against the test strains of E. coli and K. pneumoniae, which included strains resistant to the 2 drugs. Ceftizoxime was not particularly active against Ps. aeruginosa, but this seeming disadvantage was offset by the absolute ineffectiveness of the 2 reference drugs on this obstinate organism. 2. The time course of mean serum ceftizoxime levels in 3 pediatric patients of 5--10 years old given a single intravenous dose of 20 mg/kg was as follows: 45.4 micrograms/ml at 15 minutes, 40.4 micrograms/ml at 30 minutes, 22.1 micrograms/ml at 1 hour, 10.4 micrograms/ml at 2 hours, 2.9 micrograms/ml at 4 hours and 0.9 microgram/ml at 6 hours. The mean serum half life was 1.12 hours. The mean urinary levels of ceftizoxime at serial 2-hour collection intervals were as follows: 2,477 micrograms/ml for 1--2 hours, 1,235 micrograms/ml for 2--4 hours and 462 micrograms/ml for 4--6 hours. The mean urinary recovery up to 6 hours was 61.0%. 3. The clinical response of 28 children with infection to ceftizoxime treatment was 'excellent' in 22 children, 'good' in 4, and 'poor' in 2. These children comprised 11 with acute pneumonia, 3 with acute bronchitis, 4 with acute pyelonephritis, 2 each with acute purulent arthritis and acute enterocolitis, and 1 each with acute purulent tonsillitis, acute purulent lymphadenitis, furunculosis, subcutaneous abscess, subdural abscess and sepsis. The overall rate of effectiveness was 92.9%. Successfully eradicated strains in the bacteriological sense consisted of 4 strains each of H. influenzae and E. coli, 1 strain each of P. morganii, S. pneumoniae and S. pyogenes, 1 of the 2 strains of S. enteritidis, and 1 of the 3 strains of S. aureus. The overall rate of bacteriological effectiveness was 81.3%. No clinical side effects were observed. Changes in laboratory test findings included slightly and transiently elevated GOT and GPT in 1 child and GOT alone in another child.

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

The authors have carried out the laboratory and clinical studies of ceftizoxime (CZX), and obtained the following results. 1. The antibacterial activities of CZX were measured by plate dilution method against clinical isolates of S. aureus, E. coli, K. pneumoniae and P. aeruginosa. CZX inhibited the growth of S. aureus at concentrations less than 12.5 micrograms/ml, and the peak of sensitivity distribution was obtained at 3.13 micrograms/ml with an inoculum size of 10(6) cells/ml. And the peak sensitivity distribution of E. coli and K. pneumoniae were obtained at less than 0.1 microgram/ml and that of P. aeruginosa was obtained at 6.25 micrograms/ml. 2. Phagocytosis was determined by Quie's method. Phagocytosis of E. coli and K. pneumoniae by human polymorphonuclear neutrophil was more enhanced in the presence of 1 MIC and 1/2 MIC of CZX than of CEZ at 4 and 6 hours after incubation. 3. As for pharmacokinetic study, CZX was given by intravenous injection and drip infusion for 1 hour at a single dose of 10 mg/kg and 30 mg/kg. After intravenous injection of 10 mg/kg and 30 mg/kg of CZX, the mean peak serum levels were 19.1 +/- 3.4 micrograms/ml and 69.1 micrograms/ml at 30 minutes, and half-life times were 1.20 hours and 1.35 hours, respectively. After 1 hour drip infusion of 10 mg/kg and 30 mg/kg of CZX, the mean peak serum levels were 28.8 +/- 3.6 micrograms/ml and 60.9 +/- 5.9 micrograms/ml at the end of infusion, and half-life times were 1.40 hours and 1.77 hours, respectively. The mean urinary excretion rates were between 75.3% and 101% up to 6 hours after intravenous injection and drip infusion. 4. CZX was given to 4 cases with tonsillitis, 3 with pneumonia, 1 with enteritis, 4 with U.T.I., totaling 21 cases. A daily dose of CZX between 350 mg and 2,000 mg was given for 3 to 5 days. Clinical results obtained were good in all cases. No side effects and abnormal laboratory findings were observed.

Topics: Adolescent; Adult; Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Female; Humans; Infant; Leukocytes; Male; Phagocytosis

Ceftizoxime (CZX) was given intravenously to 28 children with the following acute bacterial infections; 15 cases of bronchopneumonia, 4 cases of urinary tract infection, 3 cases of purulent meningitis, 2 cases of acute tonsillitis, each 1 case of purulent cervical lymphadenitis and acute tonsillitis, orbital cellulitis, abscess of eyelid, and peritonitis. Out of 28 patients, good clinical responses were obtained in 26 patients, and bacteriological effectiveness was seen in all 14 cases. Side effects with CZX were observed in 2 cases; 1 case was drug fever, and the other case was eosinophilia. From the above clinical results, CZX is useful antibiotic for treating the pediatric patients with various kinds of bacterial infections.

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Male

Ceftizoxime, a new cephalosporin preparation, was evaluated for its antibacterial activity, absorption, excretion and clinical effectiveness, and the following results were obtained. The minimum inhibitory concentrations (MICs) of ceftizoxime against 211 clinical isolates were determined in comparison with those of cefazolin, cefmetazole, cefotiam and 6059 S. Against S. pyogenes (50 strains), ceftizoxime was 1 tube inferior to cefazolin inoculum size of 10(8) cells/ml, but was 2--3 tubes superior to cefmetazole and 6059-S. Against E. coli (50 strains), ceftizoxime and 6059-S were significantly more active than the other drugs. The susceptibility pattern of Klebsiella sp. (50 strains) to ceftizoxime was similar to that to cefotiam and 6059-S. Against Proteus sp. (50 strains), cefotiam and 6059-S were more active than the other drugs. Ceftizoxime was intermediate in activity, and cefazolin was the least active. Against H. influenzae (11 strains), ceftizoxime was the most active, with concentrations of 0.1 mcg/ml required to inhibit 100% of strains with an inoculum size of 10(8) cells/ml and 10(6) cells/ml. A dose of ceftizoxime 10 mg/kg or 20 mg/kg was administered to 15 patients aged from 5 years to 12 years, and serum levels and urinary excretion of the drug were measured. Intravenous bolus injection of the drug in dose of 10 mg/kg and 20 mg/kg yielded mean serum levels of 26.6 mcg/ml and 55.7 mcg/ml at 30 minutes, respectively. The serum levels of the drug, thereafter, declined gradually but still remained 1.3 mcg/ml and 2.7 mcg/ml at 6 hours. The serum half-lives (T 1/2) were estimated to be 1.17 hours in dose of 10 mg/kg and 1.31 hours in dose of 20 mg/kg. When a dose of 20 mg/kg was infused over a period of 30 minutes, the serum levels attained the peak of 72.4 mcg/ml to 82.4 mcg/ml (mean 79.4 mcg/ml) at the end of infusion. The levels, thereafter, tapered to mean levels of 45.3 mcg/ml at 30 minutes, 24.7 mcg/ml at 1 1/2 hours, and 3.6 mcg/ml at 5 1/2 hours, with a T 1/2 of 1.22 hours. Meanwhile, when the same dose was infused over 1 hour, the serum levels attained the peak of 59.4 mcg/ml to 68.5 mcg/ml (mean 64.2 mcg/ml). The mean serum levels after the end of infusion were 41.3 mcg/ml at 30 minutes, 21.6 mcg/ml at 1 hour and 1.9 mcg/ml at 5 hours, with a T 1/2 of 0.97 hours. Urinary recovery of the drug was 69.2% to 79.9% after intravenous injection and 62.3% to 79.9% after drip infusion, most of the given drug was excreted in the first 2 hours afte

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Infant, Newborn; Infusions, Parenteral; Male

Ceftizoxime was tried in children with various infections and the following results were obtained. 1) Serum levels and urinary recovery of ceftizoxime were studied in 6 patients aged from 6 to 10 years. After intravenous bolus injection of 20 mg/kg, the mean serum concentrations were 113.9 micrograms/ml, 47.6 micrograms/ml, 31.8 micrograms/ml, 18.5 micrograms/ml, 6.3 micrograms/ml and 2.1 micrograms/ml at 5 minutes, 30 minutes, 1 hour, 2 hours, 4 hours and 6 hours, respectively. The average urinary recovery rates of ceftizoxime were 55.1%, 90.9% and 98.3% at 2 hours, 4 hours and 6 hours after the administration, respectively. 2) The therapeutic efficacy was excellent in 11, good in 9 and poor in 2 patients, the efficacy rate being 91%. 3) As for the side effects, elevation of S-GOT and S-GPT, and drug fever were observed in 1 case, but disappeared soon after discontinuation of the therapy.

Topics: Age Factors; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male

33 patients with serious gram-negative bacillary infections were treated with cefotaxime. In patients with normal renal function the dose varied between 1.5 to 4 g/day. 17 patients had urinary tract infections, 5 respiratory tract infections, 1 combined urinary tract infection and respiratory tract infection, and 10 miscellaneous infections. 16 patients had septicemia. 25 infections were due to pathogens resistant in vitro to ampicillin, cephalothin, gentamicin and/or tobramycin. 15 infections had failed to respond to ampicillin, cefazolin, gentamicin or tobramycin therapy. 32/33 patients responded favourably to cefotaxime (cure or improvement) but 4 patients developed superinfection with cefotaxime-resistant bacteria. No evidence of nephrotoxicity was observed except for a transient moderate rise in creatinine in one patient.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Urinary Tract Infections

Thirty-five patients underwent 38 treatment courses with cefotaxime. Documented infections included 11 bacteremias, 7 cases of nosocomial pneumonia, 6 surgical wound infections, 3 bone infections, 1 biliary infection, and 1 urinary tract infection. Granulocytopenic patients with fever received 15 courses of empiric cefotaxime therapy alone; in 8 courses, no definite site of infection or pathogen was isolated. Broad-spectrum antibiotics had been administered to 23 patients before cefotaxime. Thirty-seven bacterial pathogens were isolated from 25 patients. Three such pathogens were resistant to cefotaxime and required alternative therapies. Pathogenic isolates included 13 Serratia marcescens, 12 Pseudomonas aeruginosa, 4 Escherichia coli, 2 Klebsiella pneumoniae, 2 Providencia stuartii, 1 Enterobacter cloacae, 1 Haemophilus influenzae, 1 Enterococcus, and 1 Staphylococcus aureus. Of the treatment courses, 25 of 38 resulted in a favorable response to cefotaxime, including 9 of 15 in granulocytopenic patients. Superinfection was seen in one patient. The emergence of resistance was documented in another patient. Of 15 patients with multiply resistant pathogens, 12 improved with cefotaxime. Of 12 patients with Pseudomonas aeruginosa, 6 favorably responded. Possible complications of cefotaxime were observed in 14 of 42 treatment courses. Cefotaxime is most useful in treatment of infections due to multiply resistant, gram-negative pathogens other than Pseudomonas aeruginosa.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Cross Infection; Female; Humans; Male; Middle Aged; Sepsis

Topics: Bacterial Infections; Cefotaxime; Hospitalization; Humans

Experimental and clinical studies on ceftizoxime (CZX), a new cephalosporin derivative, were carried out and the following results were obtained. 1. The minimal inhibitory concentrations of CZX, cefazolin (CEZ), cephalothin (CET), cefotiam (CTM) and cefmetazole (CMZ) against Gram-positive cocci (31 strains) and Gram-negative rods (169 strains) isolated from the patients with oral infections were determined. CZX, though somewhat less active against Gram-positive cocci than the other cephalosporins, was the most active of the antibiotics tested against Gram-negative rods. 2. The mean serum levels in 19 patients who received 1 g of CZX by intravenous drip infusion for 1 hour were as follows. 19.6 micrograms/ml 30 minutes after the start of intravenous drip infusion, 52.2 micrograms/ml after 1 hour, 25.0 micrograms/ml after 1.5 hours, 20.3 micrograms/ml after 2 hours, 7.9 micrograms/ml after 4 hours, 3.5 micrograms/ml after 6 hours. The mean peak tissue levels of CZX after 1 g dose by intravenous drip infusion for 1 hour were 14.3 micrograms/g (n = 5) in gingiva and 8.5 micrograms/g (n = 2) in bone marrow at the end of intravenous drip infusion. 3. CZX was administered to 17 patients with various infections in the oral surgical field at daily dose of 1 approximately 2 g for 3 approximately 6 days. The therapeutic effect was as follows: 'excellent' in 6 cases, 'good' in 9, 'fair' in 1 and 'poor' in 1. The final rate of effectiveness was 88.2%. No adverse reaction was observed except for 2 cases of slight elevation of S-GPT.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Mouth Diseases; Tissue Distribution

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Female; Humans; Male; Middle Aged; Sepsis

Clinically isolated 741 strains of 10 bacterial genus (except for Pseudomonas aeruginosa) which are frequent causal pathogens of infection in the otorhinolaryngological field were examined for their sensitivity to second-generation cephem agents, CTM, CXM and CMZ using the first-generation agent, CEZ, as a control. 1) The antibacterial activity of CTM, CXM, and CMZ was expanded to H. influenzae and Proteus spp. (indole positive) as compared with the first-generation agent, CEZ. CTM and CXM and strong antibacterial activity against H. influenzae. CMZ was slightly inferior to them in this activity. In contrast, against Proteus spp. (indole positive) CMZ was most effective and CTM was more effective than CXM. 2) The proportion of strains of S. aureus resistant to CEPs was 6.5% in CEZ, 4.8% in CTM, 8.1% in CXM, and as low as 1.6% in CMZ.

Topics: Bacteria; Bacterial Infections; Cefazolin; Cefmetazole; Cefotaxime; Cefotiam; Cefuroxime; Cephalosporins; Cephamycins; Drug Resistance, Microbial; Humans; Otorhinolaryngologic Diseases

The preoperative administration of cefotiam (CTM) 1 g by intravenous drip infusion for 30 minutes was performed. And the concentration of CTM in peripheral blood, bone marrow fluid and bone tissue was investigated. CTM was smoothly transmigrated from blood to bone tissue, and kept on the concentration in bone tissue over MIC values for several hours. These preliminary results encourage us to think that CTM may be as useful in prophylaxis against postoperative infections.

Topics: Adult; Aged; Bacterial Infections; Bone and Bones; Bone Marrow; Cefotaxime; Cefotiam; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Postoperative Complications; Premedication

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bone Marrow; Cefotaxime; Cefotiam; Female; Humans; Injections, Intravenous; Male; Middle Aged; Postoperative Complications; Premedication

Ceftriaxone is a new semisynthetic cephalosporin with broad-spectrum in vitro activity and an unusually long serum half-life. The clinical efficacy of ceftriaxone was evaluated in 35 infections in 34 patients; 12 of these patients had skin and soft tissue infections, 10 had infections of the urinary tract, 8 had pneumonia, 2 had biliary tract infections, 1 had sinusitis, 1 had diverticulitis, and 1 had a retroperitoneal abscess. Of the 35 infections, 9 were bacteremic. The bacteria isolated included Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus faecalis, other streptococcal species, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Serratia marcescens, Enterobacter cloacae, Haemophilus influenzae, Pseudomonas aeruginosa, Bacteroides fragilis, other Bacteroides species, and anaerobic cocci. Improvement or cure occurred in 32 episodes, for a response rate of 91%. There were three treatment failures in patients with soft tissue infections. No serious drug toxicities were observed. At a dosage regimen of 1 g every 12 h the peak and trough serum antibiotic concentrations were well above the minimal inhibitory concentrations of most pathogens. Our findings suggest that ceftriaxone is a safe and effective antibiotic for therapy of serious bacterial infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Sepsis

We evaluated the efficacy, safety, and tolerance of cefotaxime in 35 adults (25 with pleuropulmonary infections, 7 with genitourinary tract infections, and 3 with soft tissue infections). Of these 35 patients, 18 (51.4%) were seriously or critically ill. In vitro susceptibility testing revealed that 90.4% of the pathogens isolated were susceptible to cefotaxime (minimal inhibitory concentration, less than 8 micrograms/ml), 4.8% were intermediately susceptible (minimal inhibitory concentration, 8 to 32 micrograms/ml), and 4.8% were resistant (minimal inhibitory concentration, greater than 32 micrograms/ml). A total of 34 of the 35 patients (97%) were clinically and bacteriologically cured of their infections. Adverse reactions occurred in two patients, but these reactions did not require interruption of therapy.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Child; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged

A multi-centre study was carried out in 327 patients with a wide variety of moderate to severe infections. Patients were treated with cefotaxime at the recommended dosages and, in most cases, as the sole antibiotic. The bacteriological eradication rate was 83% while 92% of clinically assessable cases were successful; 3% of cases relapsed and 5% failed to respond. There was a low incidence of side-effects.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged

55 intensive care patients with an internal underlying disease were treated with cefotaxime, and 12 patients with bronchopulmonary infections were treated with the combination cefotaxime/ticarcillin. The following aspects were evaluated: clinical success, antimicrobial activity of bacteria in evidence before and after therapy, persistence of pathogens, and resistance. Renal function was monitored continuously in 21 patients over a period of 20 days in order to demonstrate nephrotoxic side-effects of cefotaxime when administered simultaneously with furosemide (in doses of mre than 1 g/day). In view of the clinical results and of the fact that the cefotaxime/ticarcillin combination is well tolerated by the kidneys, the possibility of efficient chemotherapy without aminoglycosides is being discussed for treatment of bronchopulmonary infections in patients under intensive care.

Topics: Aged; Bacterial Infections; Cefotaxime; Critical Care; Drug Combinations; Female; Furosemide; Humans; Kidney; Lung Diseases; Male; Penicillins; Ticarcillin

Topics: Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged

Cefotiam, a new broad-spectrum cephalosporin was used for the treatment of 30 cases of urinary-tract infections (UTI). Patients, 20 females, 10 males were between 23 and 76 years old. UTI were 17 cystitis, 9 pyelonephritis and 4 prostatitis. Bacteria isolated from urine were : 24 E. Coli, 3 Proteus mirabilis, 1 Providencia, 3 Klebsiella, 3 Enterobacter, 2 Serratia, 1 Staphylococcus coagulase--, DNAse--. MIC's of cefotiam ranged from 0.003 to 32 micrograms/ml (median MIC : 0.06 microgram/ml). Cefotiam was given intramuscularly in monotherapy, at the daily dosage of 1 and 2 g in two injections during 7 to 28 days. Followup of patients were at least 4 weeks after the end of treatment. Therapeutic results were : 15 cures and 2 failures by relapse in 17 cystitis, 6 cures and 3 failures by relapse in 9 pyelonephritis, 4 cures in 4 prostatitis. General tolerance was excellent in all cases. Intramusculary injections were well tolerated with a 2 p. cent lidocain solution. Biological tolerance and particularly renal tolerance was good in all patients.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Female; Humans; Kidney; Male; Middle Aged; Urinary Tract Infections

Kinetic and clinical evaluation of cefotiam, a new cephalosporin, is reported. It was found that the drug is rapidly distributed to the tissues. Equilibrium between tissues and plasma is reached in about an hour. Some 90-91% of the dose administered is excreted in the urine, and accumulation does not occur. A clinical cure was obtained in 27 of a series of 35 patients (77.1%). Improvement was observed in 7 cases (20%). The antibiotic proved ineffective in the remaining cases (2.8%). Tolerance was excellent and there were no side-effects worthy of note.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Tolerance; Female; Humans; Kinetics; Male; Middle Aged; Sarcina; Tissue Distribution

Ceftriaxone is a wide-spectrum-third generation cephalosporin characterized by outstandingly high efficacy as well as pharmokinetic properties making it suitable for administration in a single daily injection. Ceftriaxone has been found to be useful for treatment of the very severe infectious pathology in countries where hygiene and medical superstructures are still rudimentary. Eighteen of 20 patients with purulent meningitis (13 to Neisseria meningitidis A, 3 to Streptoc. pneumoniae, 1 to Listeria and 3 aseptic) recovered (there being 2 deaths at the 36th hour) after a mean 6 days of hospitalization. Despite the very delicate patient condition, recovery was seen in all 11 cases of very grave bronchopneumopathy, generally due to Streptoc, pneumonia. A dose of 2 g/day in 1 or 2 IV injections is sufficient in the adult, 0.50 g in a single dose being injected to infants weighing less than 10 kg, Meningitis required 4 to 7 days treatment (9 days in a case of Listeria) while the treatment period was longer for respiratory infections. Seven patients had been refractory to treatment with beta-lactamines and/or aminosides, and no adverse drug reactions were noted.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bronchopneumonia; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Injections; Male; Meningitis; Meningitis, Meningococcal; Meningitis, Pneumococcal; Middle Aged; Niger

Two series of patients suffering purulent meningitis were treated: one (137 patients) with amoxycillin (200 mg/kg/day) by 4 intramuscular injections each day, the other with ceftriaxone (163 patients)/42 mg/Kg/day IM by intramuscular injections each day in the first 23 patients and then only one injection by day in the 140 other patients. Bacteriologically the superiority of CFTRX appears the whole studied strains: MIC of CFTRX are four times lower than those of AMOX for pneumococci, ten times lower for H. influenzae, hundred time lower for meningococci. Amongst the add strains the percentage of resistance to AMOX reaches 64 and only 7 to CFTRX. Pharmacologically, after a same dose of 50mg/kg the peak concentrations in CSF has the same level: CFTRX: 6.8 micrograms/ml, AMOX: 6 micrograms/ml. CSF levels remain efficient for 2 hours with AMOX and for 24 hours with CFTRX. The therapeutic index (mean antibiotic concentration in CSF/mean MIC of the strains) is higher with CFTRX than with AMOX (X 4 for pneumococci, X 15 for H. influenzae, X 100 for meningococci). Clinical results are better with CFTRX than with AMOX in each of the aetiological groups except meningococcal meningitis but the only significative difference concerns pneumococcal meningitis. Clinical tolerance of the two treatments was good. However 2 neonates treated with CFTRX has a severe eczematous erythrodermia and 8 other patients treated with CFTRX had diarrhoea due to elimination of the sensitive flora.

Topics: Amoxicillin; Bacterial Infections; Cefotaxime; Ceftriaxone; Haemophilus influenzae; Humans; Meningitis; Neisseria meningitidis; Streptococcus pneumoniae

The in vitro activity of ceftriaxone against 437 clinical isolates of gram-negative bacilli was determined. Ceftriaxone was found to have high in vitro activity against Enterobacteriaceae, with the exception of Enterobacter cloacae. Ceftriaxone was only minimally active against Pseudomonas aeruginosa and Acinetobacter calcoaceticus. We evaluated the clinical efficacy and toxicity of ceftriaxone in 55 adult patients. Bacterial infection was confirmed by the isolation of etiological bacteria in 30 patients. Infectious disorders treated included 10 pneumonias, 13 urinary tract infections, and 7 soft tissue or bone infections. Pathogens identified were 25 isolates of gram-negative bacilli, 5 isolates of Staphylococcus aureus, 5 isolates of pneumococci, and 4 isolates of other streptococci. The overall efficacy of ceftriaxone was excellent. The clinical cure rate was 93%, and the bacteriological cure rate was 93%. A total of 30 adverse reactions were noted in 22 of 55 patients receiving ceftriaxone, but only one necessitated discontinuation of treatment. Adverse effects frequently noted were elevated hepatic enzymes (16%), thrombocytosis (16%), and eosinophilia (8%). Ceftriaxone is an effective and well-tolerated antimicrobial agent that appears promising for the treatment of serious gram-negative bacillary infections.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Urinary Tract Infections

Eighteen patients with 21 serious infections were treated with ceftriaxone, 1 g intravenously every 12 h, for a mean duration of 8 days. Eighteen gram-negative and two gram-positive organisms were isolated. Sites of infection included blood (three patients), urinary tract (six patients), respiratory tract (seven patients), biliary tract (three patients), ascitic fluid (one patient), and skin (one patient). Serum, bile, and ascitic fluid concentrations of ceftriaxone were in excess of the minimal bactericidal concentration required for the infecting organism in all cases. A bacteriological response was demonstrated in 94% of the infections. A clinical response occurred in four infections from which no pathogens were recovered. In one patient, ceftriaxone failed to eradicate a peritoneal infection due to Bacteroides fragilis. In two patients, superinfection with enterococci developed both during and after therapy. Systemic tolerance to ceftriaxone was excellent.

Topics: Aged; Bacterial Infections; Biliary Tract Diseases; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Humans; Male; Middle Aged; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

Ceftriaxone (Ro 13-9904), a newly developed cephalosporin with a long half-life, was evaluated for efficacy and safety in 19 patients with serious infections. Underlying illnesses were present in 16 patients. Ceftriaxone was given intravenously every 12 h. Infections treated included gram-negative bacillary pneumonias (two cases), staphylococcal and streptococcal soft tissue-skeletal infections (six cases), spontaneous peritonitis (two cases), and complicated urinary tract infections (nine cases). Bacteremia was present in three patients. Microbiological and clinical cures were achieved in all but one case, although three patients with urinary infection had recurrences 6 weeks posttherapy. The only failure occurred in a patient with pneumonia who had a Pseudomonas aeruginosa isolated from sputum with an initial minimal inhibitory concentration of 4 micrograms/ml, but after 9 days of therapy, a repeat isolate had a minimal inhibitory concentration of 32 micrograms/ml. The minimal inhibitory concentrations for the other isolates ranged from less than or equal to 0.6 to 8.0 micrograms/ml. The mean peak plasma level of ceftriaxone was 99.9 micrograms/ml. The only side effects noted were drug fever in one patient, phlebitis in two patients, and thrombocytosis in four patients.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged

Cefotiam (CTM) was administered to 52 patients with infectious disease associated with respiratory system, hematological malignancy, urinary system and other system. Good clinical responses were obtained in 38 out of 52 cases (73.1%). Neither objective and subjective side effects nor extreme abnormalities of laboratory tests were observed in these patients. It can be, therefore, concluded that CTM is 1 of the most useful drugs for infectious diseases in respiratory system, hematological malignancy, urinary system and other system.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Hematologic Diseases; Humans; Male; Middle Aged; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Laboratory and clinical comparative investigations with cefotiam (CTM) and cefazolin (CEZ) were performed to confirm efficacy and safety in surgical, biliary tract infections. The following results were obtained. 1) The MICs of CTM against organisms, 20 strains, which were isolated from bile of patients with cholecystitis, were studied, especially those of CTM against E. coli and Klebsiella were 0.2 - greater than or equal to 100 micrograms/ml and 0.1--12.5 micrograms/ml, respectively, considerably lower than those of CEZ. And moreover against CEZ-resistant Proteus morganii and Serratia marcescens, CTM showed potent activities, that is, MIC values, 12.5--50 micrograms/ml and 0.78 microgram/ml, respectively. 2) In cholecystectomized patients, 2 grams of CTM was injected intravenously, followed by determination of bile concentration in gallbladder, common bile duct and concentration of gallbladder and liver tissue about 2 hours after administration. The mean bile concentrations of CTM in gallbladder and common bile duct were 1,213.2 micrograms/ml and 1,287.8 micrograms/ml, respectively. The peak concentration of CTM was 2,919.0 micrograms/ml. The mean concentrations of CTM in gallbladder and liver tissue were 28.5 micrograms/g and 45.7 micrograms/g, respectively. On the other hand, the mean bile concentrations of CEZ in gallbladder and common bile duct were 138.7 micrograms/ml and 128.8 micrograms/ml, respectively. 3) Bile concentrations of CTM was compared with those of CEZ by crossover method. The concentration of CTM was 37.7 micrograms/ml even at 5 or 6 hours after 2 grams intravenously administration. CTM showed extremely higher concentration than CEZ in bile. 4) The clinical effect was studied in 6 cases of surgical, biliary tract infections. The results were excellent in 2 cases, good in 3 cases and poor in 1 case, and the clinical efficacy was 83%. 5) CTM was administered to 6 patients who showed negative to intracutaneous reaction test. Nausea, itching, and eruption were observed in each 1 case after intravenously administration of CTM 2 g, however these adverse reactions disappeared within several hours. Throughout the course of treatment, any unusual laboratory findings related to CTM were not observed.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Bile; Biliary Tract Diseases; Cefotaxime; Cefotiam; Cholecystectomy; Drug Evaluation; Drug Resistance, Microbial; Female; Gallbladder; Humans; Liver; Male; Middle Aged

As useful antibiotics for biliary tract infections, smooth transmigration to lesion and potent antibacterial activities will be demanded. Usually the antibiotics having potent antibacterial activities against E. coli and Klebsiella, which are considered to be main causative organisms of biliary tract infections, will be used for treatment. The concentrations of cefotiam (CTM) in bile and gallbladder wall tissue were investigated, and CTM showed very high concentrations in these tissues for several hours. And very good correlation between concentration of CTM in bile and laboratory findings, especially ICG R15 value, was obtained. CTM showed also very potent antibacterial activities against E. coli and Klebsiella. These results suggest that CTM will be useful agent for the treatment of biliary tract infections.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Bile; Biliary Tract Diseases; Cefotaxime; Cefotiam; Drug Resistance, Microbial; Female; Gallbladder; Humans; Male; Middle Aged

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: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Hematologic Diseases; Humans; Male; Middle Aged

Clinical bacteriological studies on cefotiam and cefsulodin in the field of otorhinolaryngology were carried out and the following results were obtained. 1) Aerobic and anaerobic Gram-positive bacteria were dominantly isolated from the clinical materials sent to the center from the clinical institutes. 2) It was considered that Streptococcus pneumoniae, Haemophilus influenzae and beta-Streptococcus played an important role in the primary infections in the field of otorhinolaryngology. Staphylococcus aureus was also frequently isolated from the primary infections. Peptostreptococcus spp. was dominantly isolated from peritonsillar abscess. Gram-negative bacilli (GNB) were mainly isolated from the chronic secondary infections. Among GNB, Pseudomonas aeruginosa and Proteus spp. were more frequently isolated. Staphylococcus aureus was also constantly detected in the secondary infections together with GNB. Anaerobic bacteria were isolated from 20.1% of the patients with chronic otitis media and 27.1% of sinusitis. 3) Cefotiam showed potent antibacterial activities against most isolates of Gram-positive and Gram-negative bacteria. 4) Cefsulodin showed potent antibacterial activities against clinically isolated Pseudomonas aeruginosa. Staphylococcus aureus and beta-Streptococcus were also susceptible to cefsulodin.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Cefotiam; Cefsulodin; Cephalosporins; Drug Evaluation, Preclinical; Drug Resistance, Microbial; Humans; Middle Aged; Otorhinolaryngologic Diseases

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Cephamycins; Enterobacteriaceae Infections; Humans; Moxalactam

Cefotiam (CTM) is a new synthetic cephem antibiotic developed in Japan. The results of the fundamental and clinical studies are as follows. 1. CTM showed antibacterial activity, in terms of MIC, as strong as those of cephalothin (CET) and cefazolin (CEZ) for Gram-positive cocci, and several times superior to for Gram-negative bacilli. 2. CTM serum levels approximately reached the peaks on completion of 60 minutes intravenous drip infusion of 1 g of this preparation dissolved in 5% glucose solution of 250 ml; the mean value was 65.00 micrograms/ml. Then the levels dropped rather quickly up to 180 minutes after the start of drip infusion. After that, the levels dropped gradually up to 360 minutes. 3. As for the passage of CTM in the oral tissues, satisfactory passage was observed in both maxillomandibular marrow and gingiva, which adequately exceeded MICs of the clinically isolated strains of oral infections. 4. This preparation was administered 1 g of 2 g daily by intravenous drip infusion in 18 cases of moderate or more serious infections in the field of oral surgery; the clinical efficacy rate obtained was 94.4%. 5. No manifestations of side effect were observed clinically. As for laboratory findings, 1 case of large increases in GOT and GTP (a hepatitis B antigen positive patient) and 2 cases of slight increase in GTP were observed. On the basis of these results of the fundamental and clinical studies, it was concluded that CTM is an excellent antibiotic for the treatment of oral infections.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Cellulitis; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mouth Diseases; Osteomyelitis; Surgical Wound Infection

Fundamental and clinical investigations of cefotaxime were carried out in neonates. The following results were obtained. 1. Seven neonates with serious infections caused by identifiable pathogens, including Group B streptococcal meningitis and Group A streptococcal sepsis, were treated by intravenous bolus injection of 20-200 mg/kg of cefotaxime 2 or 3 times daily (60-400 mg/kg/day). The clinical efficacy of cefotaxime was assessed to be good in 6 patients and fair in 1 patient. Bacteriological efficacy was evaluable in 4 patients, all of whom displayed complete eradication of pathogens. 2. Among 22 neonates administered cefotaxime, adverse reactions appeared in 3 patients. Adverse reactions consisted of a transient skin rash in 1 patient and elevation of GOT in 2 patients. 3. Serum concentrations of cefotaxime and desacetyl cefotaxime were investigated in 8 mature infants and 5 immature infants on days 0-7 postpartum. A single intravenous injection of 20 mg/kg produced peak serum concentrations of 31.8-49.7 mcg/ml, associated with a half-life of 1.38-4.47 hours, in mature infants and peak serum concentrations of 35.5-55.0 mcg/ml, associated with a half-life of 3.22-6.43 hours, in immature infants. On days 0-2 postpartum the half-life was longer than on subsequent days. This tendency was particularly remarkable in immature infants. Serum concentrations of desacetyl cefotaxime displayed high individual variations; no consistent trends were noted. 4. Cefotaxime and desacetyl cefotaxime serum concentrations were studied in 3 neonates undergoing exchanged transfusion (exchanged volume 177-180 ml/kg) on 1-4 days postpartum. Serum concentrations of cefotaxime after exchanged transfusion were equivalent to 32.6-63.9% of the pretransfusion level, while those of desacetyl cefotaxime were 75.2-106% of the pretransfusion level. 5. Minimal inhibitory concentration (MICs) and minimal bactericidal concentration (MBCs) of cefotaxime were determined against clinical isolates. MICs for inoculum sizes of 10(8)/ml and 10(6)/ml were respectively 3.13-25 mcg/ml and 3.13-25 mcg/ml against S. aureus, 0.024 mcg/ml and 0.012 mcg/ml against Group A Streptococcus, 0.05 mcg/ml and 0.05 mcg/ml against Group B Streptococcus and 0.39 mcg/ml and 0.1 mcg/ml against E. coli. MBCs for an inoculum size of 10(6)/ml were 3.13-100 mcg/ml or over against S. aureus, 0.012 mcg/ml against Group A Streptococcus, 0.39 mcg/ml against Group B Streptococcus and 1.56 mcg/ml against E. coli.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Feces; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Pharynx

Cefotaxime (CTX) was used in the treatment and prophylaxis of infections in neonates and immature infants. The following results were obtained. 1. Mean serum concentrations (bioassay) 30 minutes after a single intravenous injection of about 20 mg/kg of CTX were 44.5 mcg/ml in neonates and 47.2 mcg/ml in immature infants aged 0-3 days, 45.8 mcg/ml in neonates and 56.4 mcg/ml in an immature infant aged 4-7 days and 40.6 mcg/ml in neonates and 38.1 mcg/ml in immature infants aged 8 or more days. Six hour values were respectively 10.9 mcg/ml, 17.0 mcg/ml, 4.6 mcg/ml, 13.4 mcg/ml, 3.8 mcg/ml and 2.7 mcg/ml. 2. Mean serum concentration half-lives were 3.0 hours in neonates and 3.2 hours in immature infants aged 0-3 days, 1.8 hours in neonates and 3.2 hours in an immature infant aged 4-7 days, and 1.5 hours in neonates and 1.6 hours in immature infants aged 8 or more days. 3. Urinary recovery rates were 0.8-78.0% for 0-6 hours after treatment. 4. Adequate clinical efficacy can be expected by the intravenous injection of CTX in doses of 20 mg/kg 2 times daily, every 12 hours, in neonates and immature infants aged 0-3 days, 20 mg/kg 3 times daily, every 8 hours, in neonates and immature infants aged 4-7 days, and 20 mg/kg 3 to 4 times daily, every 6-8 hours, in neonates and immature infants aged 8 or more days. 5. The clinical efficacy of CTX was good in all 4 cases of sepsis (including suspected case), excellent in 1 case of urinary tract infection, and good in all 4 cases of fever of unknown origin for a cure rate of 100%. 6. Adverse reactions were not noted in any cases.

Topics: Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Injections, Intravenous; Male; Premedication

It has been proven that, when cephem group antibiotics are administered intravenously to neonates, the peak serum level of the drug is higher, and the half-life is longer, compared with the values attained in suckling infants. The same pattern is seen even with cefmetazole. This is, the Post- and Perinatal Period Research Group recently reported that, when 20 mg/kg of cefmetazole was administered intravenously, the mean serum half-life of the drug was 4.18 hours in infants up to 3 days after birth, while by about the age of 2 weeks there was no longer a difference with suckling infants. In the present study, cefotaxime was administered at a dosage level of 20 mg/kg by intravenous drip infusion over a 30-minute period. The administered subjects were a 16-day-old neonate and a 45-day-old suckling infant, and the serum level of cefotaxime was monitored. The peak concentration was found to be higher in the younger subject, and the half-life in the serum was longer, i.e., 2.52 hours compared with 1.5 hours in the suckling infant. In addition, 4 cases of newborn infection were treated with cefotaxime at 120--504 mg/day (approximately 35--300 mg/kg/day), given intravenously for a period of 6 to 21 days. Clear clinical efficacy and bacteriological efficacy were achieved in relation to 1 case of staphylococcal pneumonia, 1 case of septicemia compounded by purulent meningitis caused by Enterobacter aerogenes and 1 case of fever of undetermined origin. The following summarizes the results of the present study. 1) There was no adverse effect exerted on the hepatic or renal functions. 2) Cefotaxime was efficacious in the treatment of neonates suffering from infections caused by staphylococci and a Gram-negative rod.

Topics: Bacterial Infections; Cefotaxime; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Injections, Intravenous; Male

Topics: Age Factors; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Infusions, Parenteral; Injections, Intravenous; Male

Topics: Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Male

Topics: Bacteria; Bacterial Infections; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male

Topics: Age Factors; Bacterial Infections; Biological Assay; Cefotaxime; Child; Chromatography, High Pressure Liquid; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Kinetics

One full-term newborn infant and 2 premature ones were treated with cefotaxime for the treatment of suspected sepsis and umbilical suppurative inflammation. Pathogenic organisms could not be identified in all cases. A good result was obtained with the case of suspected sepsis. But the other 2 cases were not evaluable because underlying diseases such as massive pulmonary atelectasis or respiratory distress syndrome masked the effects of this agent. Serum levels of cefotaxime in 3 of the 4 cases were determined with bioassay. Time courses of the serum levels in 2 of them resulted in peculiar biphasic disappearance curves. This fact implies the possibility that desacetylation of cefroxime proceeds also in newborns as in adults and that desacetyl metabolite accumulates in the body owing to the premature function of the neonatal kidney.

Topics: Bacterial Infections; Cefotaxime; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Time Factors

The in vitro activity of cefodizime (HR-221), a new cephalosporin antibiotic, was compared with the activities of selected antimicrobial agents against a broad spectrum of aerobic bacteria. Cefodizime concentrations of 2 micrograms/ml inhibited about 90% of Enterobacteriaceae studied. Serratia marcescens required 8 micrograms/ml to inhibit 90% of strains. Among gram-positive cocci, 50% of strains were inhibited by 2 micrograms/ml of cefodizime (including methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis, and penicillin-resistant Streptococcus pneumoniae). Pseudomonas aeruginosa was less susceptible to cefodizime. Cefotaxime, an antibiotic closely related to cefodizime structurally, was about fourfold more active.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Drug Resistance, Microbial; Enterobacteriaceae; Humans; Microbial Sensitivity Tests

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Critical Care; Cross Infection; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Cross Infection; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Pneumonia; Pyelonephritis; Sepsis; Urinary Tract Infections

Topics: Adult; Aged; Agranulocytosis; Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Humans; Leukocyte Count; Male; Microbial Sensitivity Tests; Middle Aged; Neoplasms; Neutropenia; Neutrophils

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Humans; Leukocyte Count; Male; Microbial Sensitivity Tests; Middle Aged; Neoplasms; Neutrophils; Pneumonia; Sepsis

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

Topics: Bacterial Infections; Carbenicillin; Cefamandole; Cefazolin; Cefotaxime; Ceftizoxime; Cephalothin; Humans; Penicillin Resistance; Tobramycin

Topics: Adolescent; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Humans; Injections, Intramuscular; Injections, Intravenous; Microbial Sensitivity Tests

Topics: Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Cefazolin; Cefotaxime; Ceftizoxime; Cephalosporins; Humans; Respiratory Tract Infections; Skin Diseases, Infectious; Tobramycin; Urinary Tract Infections

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Drug Interactions; Drug Resistance, Microbial; Gentamicins; Humans; Microbial Sensitivity Tests

Topics: Animals; Bacterial Infections; Bacteroides Infections; Cefotaxime; Ceftizoxime; Disease Models, Animal; Male; Mice; Neutropenia; Sepsis; Wound Infection

Topics: Adult; Aged; Agranulocytosis; Antineoplastic Agents; Bacterial Infections; Cefotaxime; Cefotiam; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged

Topics: Age Factors; Animals; Bacteria; Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Male; Meningitis; Rabbits; Staphylococcal Infections

Topics: Adolescent; Age Factors; Bacteria; Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male

Laboratory and clinical studies were performed on cefmenoxime (CMX), a new cephalosporin antibiotic, and the following results were obtained. 1. Susceptibility of clinically isolated bacteria to CMX and cefotiam (CTM) or cefazolin (CEZ) Antimicrobial activity of CMX was compared with that of CTM and CEZ against S. aureus, S. epidermidis, S. pneumoniae, H. influenzae and E. coli. CEZ and CTM were more active than CMX against S. aureus, S. epidermidis and S. pneumoniae. But CMX was found to be more active by 1-10 tubes than CEZ and CTM against H. influenzae and E. coli. 2. Clinical efficacy. CMX was intravenously administered to 19 patients; 3 with lacunar tonsillitis, 2 with acute bronchitis, 8 with bronchopneumonia, 3 with UTI, 1 with septicemia, 1 with acute panperitonitis, 1 with S.S.S.S. at daily doses of 30-115 mg/kg (64.6 mg/kg on an average) t.i.d. or q.i.d. for 3-17 days (6.1 days on an average). The overall efficacy rate was 94.7%, i.e., efficacy was excellent in 10 cases (52.6%), good in 8 cases (42.1%), and poor in 1 case (5.3%). Bacteriological efficacy was good, i.e. 16 of the 19 strains disappeared. Transient eosinophilia was observed in 1 patient, but no other laboratory abnormality was observed during treatment. The above results suggest that CMX is 1 of the useful antibiotics in treatment of pediatric infections, especially due to Gram negative bacteria.

Topics: Adolescent; Age Factors; Bacteria; Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male

The therapeutic effects of cefmenoxime (CMX), a new synthetic cephalosporin antibiotic, were examined in the treatment of various pediatric infections. Patients treated were infants and children ranging from one-month-old to 13-year-old suffering from pharyngitis in 2 cases, bronchopneumonia in 3 cases, cervical lymphadenitis in 2 cases, urinary tract infections in 7 cases, tympanitis in 2 cases, suppurative meningitis, sepsis, subcutaneous apostem, acute enteritis, chest wall apostem, phlegmon, staphylococcal scalded skin syndrome in 1 case each, a total of 23 cases. As regards method of administration, CMX from a vial was dissolved in physiological saline or distilled water for injection, and the solution was administered by 3 to 5 minutes one short intravenous injection (14 cases), or CMX was diluted with large volume parenteral product and administered by 30 to 60 minutes drip infusion (9 cases). The dosage of the drug was 30 to 200 mg/kg/day; 103 mg/kg/day and under in 21 cases, 150 mg/kg/day and 200 mg/kg/day in 1 case each. The administration was continued for 3 to 27 days. As regards clinical efficacy, "good" or "excellent" results were obtained in all the cases except 2 cases, one was alpha-Streptococcus acute tympanitis supervening neuroblastoma, and the other was Pseudomonas urinary tract infection. The efficacy rate was 91.3% with excellent in 11 cases, good in 10 cases. As regards bacteriological effects, of 13 strains of Gram-positive bacteria, 10 strains were eliminated and 3 strains were not changed, while of 10 strains of Gram-negative bacteria, 8 strains were eliminated and 2 strains were reduced; thus CMX showed better results against Gram-negative bacteria rather than against Gram-positive ones. The antimicrobial activity of CMX against Gram-positive bacteria was inferior to those of CTM and CEZ, but CMX showed the highest antimicrobial activity against Gram-negative bacteria. No clinical side effects nor abnormal laboratory findings obviously attributable to CMX were observed.

Topics: Adolescent; Age Factors; Bacteria; Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Male

Cefmenoxime (CMX) was intravenously administered to 20 children with the following bacterial infection; pneumonia in 14 cases, purulent meningitis in 2 cases, pyothorax in 2 cases, urinary tract infection in 1 case and brain abscess in 1 case. The daily dosage administered in meningitis, pyothorax and brain abscess ranged from 145-311 mg/kg/day, from 43-88 mg/kg/day in other bacterial infections. The therapeutic efficacy was excellent in 15, good in 3, poor in 2 patients, efficacy rate being 90%. Causative organisms were H. influenzae in 4 cases, S. aureus in 2 cases, Streptococcus sanguis in 1 case, E. coli in 1 case and unknown in 12 cases. All were eliminated with the exception of 2 strains of S. aureus after the administration of CMX. As for side effect, transient eosinophilia was only observed in 1 case.

Topics: Age Factors; Bacteria; Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Injections, Intravenous; Male

It was known that antibacterial spectrum and activity of CTM were superior to those of other cephalosporins. Basic and clinical studies in the field of obstetrics and gynecology on CTM were carried out. The results were summarized as follows. 1. Bacteriologically, the MIC of CTM against E. coli was less than 0.39 mcg/ml with an inoculum size of 10(6) CFU/ml. The 50% of Bacteroides sp. were inhibited by CTM at a concentration of 25 mcg/ml or less. 2. CTM was more stable against beta-lactamase extracted from B. fragilis than CEZ or cefpiramide. 3. After administration by the drip infusion of 1 g or 2 g to 5 cases, distribution of CTM to intrapelvic organs was measured. The results were relatively favourable. The concentration in the tissues was sufficient to inhibit clinical isolates such as E. coli and K. pneumoniae in the field of obstetrics and gynecology. 4. CTM was administered to 6 cases of various infections, and clinical response was excellent in 2 cases and good in 4 cases. No side effect nor adverse reaction of CTM was observed. Consequently CTM was considered to be one of useful antibiotics.

Topics: Adult; Bacterial Infections; Bacteroides fragilis; beta-Lactamases; Cefotaxime; Cefotiam; Drug Evaluation; Drug Resistance, Microbial; Drug Stability; Escherichia coli; Female; Genital Diseases, Female; Humans; Middle Aged; Pregnancy

Cefmenoxime (CMX) was evaluated in 25 children with a suspicion of bacterial infection. Of the 20 confirmed bacterial infections, 19 were cured by CMX therapy (effective rate, 95%). The diagnoses included acute pharyngotonsillitis (4), acute bronchitis (1), pneumonia (7), streptococcal dacryocystitis (1), infections accompanied with acute leukemia (4), and acute urinary tract infections (3). The etiologic pathogens were beta-hemolytic Streptococcus group A (1), and F (1), Staphylococcus aureus (4), Haemophilus influenzae (4), Escherichia coli (4), Klebsiella pneumoniae (2), etc. CMX was very effective for 2 children with respiratory infections due to ampicillin resistant H. influenzae type b. The half life of serum concentration of CMX was 0.76 +/- 0.17 hour after an intravenous bolus injection. A cerebrospinal fluid level of CMX was 5.2 mcg/ml 1 hour after intravenous injection of 1 g (23.8 mg/kg) in a child with inflamed meninges. However this level was not as high as those of cefotaxime, latamoxef, or ceftizoxime measured in the same case. No severe adverse reaction was encountered with CMX therapy. The data suggest that CMX is a safe and effective parenteral antibiotic when used in children with susceptible bacterial infections.

Topics: Adolescent; Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Female; Half-Life; Humans; Infant; Leukemia, Lymphoid; Male; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

The in-vitro antibacterial activity of ceftazidime was assessed against recent clinical isolates of common bacteria and also against reference strains that produced known beta-lactamases. The compound was active, though less so than cephaloridine against staphylococci and streptococci with MICs mostly 0.12-2 mg/l for streptococci and 8 mg/l for staphylococci, but enterococci (MICs > or =64 mg/l) and methicillin-resistant staphylococci (MICs 16-32 mg/l) were resistant. Penicillin-resistant pneumococci (MICs 2-4 mg/l) were much less sensitive than other pneumococci (MICs 0.12-0.25 mg/l). Ceftazidime was also active, but slightly less so than cefotaxime or moxalactam, against enterobacteria (MICs mostly 0.12-0.25 mg/l). Its activity was also inferior to that of cefotaxime against Neisseria gonorrhoeae (MICs mostly 0.03-0.06 mg/l) and Haemophilus influenzae (MICs mostly 0.06-0.25 mg/l). However it was about eightfold more active than cefotaxime or moxalactam against Pseudomonas aeruginosa (MICs mostly 1-4 mg/l), and it was also more active than these compounds against other pseudomonads. Ceftazidime was less active than cefoxitin against Bacteroides spp. (MICs mostly 16-64 mg/l for Bact. fragilis and 2-8 mg/l for other bacteroides) and less active than ampicillin or cefoxitin against other anaerobes. The compound was highly resistant to hydrolysis by most beta-lactamases including OXA-1 and the enzymes from Klebsiella 1082E and Proteus vulgaris PC37 which hydrolyse cefuroxime and cefotaxime. However, it was hydrolysed slowly by the enzyme from a highly ampicillin-resistant isolate of Bact. fragilis.

Topics: Anti-Bacterial Agents; Bacteria; Bacteria, Anaerobic; Bacterial Infections; beta-Lactamases; beta-Lactams; Cefotaxime; Ceftazidime; Drug Resistance, Bacterial; Gram-Negative Aerobic Bacteria; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Moxalactam; Staphylococcus

Ceftazidime showed moderate activity against Staphylococcus aureus and a high activity against Haemophilus influenzae and the streptococci except against the enterococci. Ceftazidime inhibited 90% of the 830 Enterobacteriaceae tested at a concentration of 0.5 mg/l and 99% at 8 mg/l, an activity very similar to that of cefotaxime. Against Pseudomonas spp. ceftazidime proved to be the most active beta-lactam antibiotic studied. It inhibited 67% of the 141 Ps. aeruginosa strains at 2 mg/l, 84% at 4 mg/l, 98% at 8 mg/l and 100% at 16 mg/l. The inhibitory and the bactericidal concentrations were very close and there was only a minor effect of the inoculum. Ceftazidime retained its high activity against microorganisms with acquired as well as with natural resistance to other beta-lactam antibiotics.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Carbenicillin; Cefotaxime; Ceftazidime; Cefuroxime; Cephalosporins; Cephalothin; Gram-Negative Bacteria; Humans; Microbial Sensitivity Tests; Pseudomonas aeruginosa

Cefotaxime was administered as sole treatment (49 cases) or after failure of another previous antibiotic (17 cases) to 66 patients suffering from infectious diseases. The 78 infections thus treated included urinary tract infections (35), septicaemia or endocarditis (25), respiratory tract infections (7), osteitis (5), meningitis (4), biliary infection (1), and skin infection (1). The pathogens identified were more often enterobacteria: Serratia: 23, E. coli: 15, Klebsiella: 7, Proteus: 7, Enterobacter: 1, Providentia: 1, Pseudomonas: 5, Staphylococcus: 7, Pneumococcus: 4, Streptococcus: 2, Branhamella: 1. Cefotaxime was given either intravenously (2/3 of cases) or intramuscularly, at an average daily dose of 3.75 g (mean: 1.5-8 g). It was administered alone to 49 patients suffering from septicaemia and urinary tract infections caused by E. coli, Klebsiella and especially Serratia, and it was combined in 17 cases, particularly in meningitis and bone infections. The overall results of cefotaxime given in serious diseases were especially favourable in debilitated patients (88% therapeutic success). The local tolerance was good and side effects were not observed in any patient. Cefotaxime seems to be an active antibiotic, indicated in many severe septicemic or not septicemic infections, more particularly in diseases with multiresistant Gram negative pathogens.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Female; Humans; Male; Middle Aged; Sepsis; Urinary Tract Infections

Seventeen septicaemia, 18 urinary tract infections, 13 acute bacterial pulmonary infections and 7 infections at various other site were treated with cefotaxime, and, in 48 cases, with cefotaxime alone. The pathogenic organisms were mainly enterobacteria: 19 E. coli, 10 Klebsiella, 8 Proteus, 2 Serratia, 1 Enterobacter, almost all of them having a MIC less than or equal to 1 mcg/ml. The route of administration used was the i.m. route in 33 cases and the i.v. route in 18 cases, both routes having been used in 4 patients. The mean dosage was 45 mg/kg/day. A cure was obtained in 49 cases were clinical and bacteriological results were interpretable (85,7% of cases). The cure rate was 80% in septicaemia, 88,2% in urinary infections and 91,6% in pulmonary infections. In 19 infections due to beta-lactamase producing strains of Gram-negative bacteria, the percentage of cure was 68,4%. The systemic and local tolerance was excellent. Cefotaxime is a very well tolerated and very effective antibiotic, even in prolonged treatment and even in monotherapy, at a mean dosage of 50 mg/kg/day.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Female; Humans; Male; Middle Aged; Pneumonia; Sepsis; Urinary Tract Infections

Cefotaxime was administered to 20 patients suffering from severe bacterial infections. Four were newborn babies, seven were infants, and nine were children. The infections treated included 9 bronchopulmonary infections and 6 urinary tract infections. In 9 patients, the infecting organism was identified: E. coli (3), Klebsiella (2), Staphylococcus aureus (3), and Proteus (1). Except in one case, cefotaxime was administered alone at doses of 50 to 100 mg/kg every 12 hours. The route of administration was intramuscular. 4 patients had already received unsuccessful antimicrobial therapy. All patients were clinically cured. In those with pneumonia, the clinical and radiological response was very prompt; in urinary tract infections, the temperature returned to normal in less than 48 hours. The local and general tolerance was always good. It may be concluded from these results that cefotaxime, a new parenteral cephalosporin, is especially useful and should prove particularly effective in severe infectious conditions found in pediatric practice.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Lymphadenitis; Male; Osteoarthritis; Pneumonia; Skin Diseases, Infectious; Urinary Tract Infections

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: Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Female; Humans; Infant; Male; Middle Aged; Sepsis

The in vitro activity of cefmenoxime (SCE-1365 or A-50912), a new semisynthetic cephalosporin antibiotic, was compared with those of cefazolin, cefoxitin, and cefamandole against a broad spectrum of 486 organisms and with that of cefotaxime against 114 organisms. Cefmenoxime and cefotaxime exhibited nearly equivalent activities against those organisms tested and were the most active of these cephalosporins against all aerobic and facultative organisms except Staphylococcus aureus. The minimum inhibitory concentration (MIC) of cefmenoxime required to inhibit at least 90% of strains tested (MIC(90)) ranged from 0.06 to 8 mug/ml for the Enterobacteriaceae. The MIC(90)s for gram-positive cocci were 0.015 and 128 mug/ml with good activity against the gram-positive organisms. In addition, cefmenoxime activity was bactericidal and only slightly affected by differences in inoculum size. The combination of cefmenoxime and gentamicin was synergistic against 80% of the Enterobacteriaceae and 100% of P. aeruginosa strains tested. Development of resistance to cefmenoxime was slow or absent for organisms with low initial MICs but more rapid for those with higher initial MICs. Cefmenoxime exhibited good protective activity in mice infected with Escherichia coli, Enterobacter cloacae, Proteus mirabilis, Proteus vulgaris, or S. aureus but was less effective against P. aeruginosa.

Topics: Animals; Bacteria; Bacterial Infections; Cefamandole; Cefazolin; Cefmenoxime; Cefotaxime; Cefoxitin; Cephalosporins; Drug Synergism; Female; Mice

Topics: Abscess; Adult; Aged; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Cephalosporins; Cholangitis; Female; Humans; Male; Middle Aged; Otitis Media; Pelvic Inflammatory Disease; Pharyngitis; Urinary Tract Infections

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Humans

Cefotaxime is a cephalosporin active against most gram-positive and gram-negative organisms, including streptococci, Staphylococcus aureus, Enterobacteriaceae, Proteus, and many Pseudomonas and Bacteroides fragilis--all but the latter two are inhibited at concentrations below 0.5 micrograms/ml. We evaluated cefotaxime as the sole therapy for 32 infections in 31 patients. Infection sites included 18 bacteremias; pulmonary, urinary tract, deep tissue infections; and meningitis. Clinical cures were achieved in 88 percent and bacteriologic cures in 86 percent of the patients--including those with infections due to organisms resistant to cephalosporins, chloramphenicol, carbenicillin and aminoglycosides; and in two patients with meningitis due to multiresistant Klebsiella pneumoniae. Serum and cerebrospinal levels were readily maintained above the inhibitory levels of susceptible organisms. Adverse reactions were minimal. Cefotaxime was a safe, effective antibiotic in the treatment of infections due to susceptible organisms, including those resistant to other agents.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged

Ceftizoxime, a new cephalosporin, was active against Pseudomonas cepacia, Flavobacterium meningosepticum, Alcaligenes faecalis, and Acinetobacter calcoaceticus and was more potent against Pseudomonas aeruginosa and Pseudomonas putida than was carbenicillin.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Glucose; Humans; Microbial Sensitivity Tests; Species Specificity

The antibacterial activity of N-formimidoyl thienamycin was compared with those of cefotaxime, cefoperazone, and piperacillin against 536 clinical aerobic isolates.

Topics: Aerobiosis; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefoperazone; Cefotaxime; Cephalosporins; Humans; Imipenem; Lactams; Penicillins; Piperacillin; Species Specificity

Ceftriaxone (Ro 13-9904) was compared with other newer beta-lactam antibiotics for activity in experimental infections of mice with Enterobacteriaceae, Haemophilus influenzae, Pseudomonas aeruginosa, and gram-positive bacteria. Overall, ceftriaxone was equal or superior to cefotaxime and cefoperazone against systemic infections. All three drugs were highly potent against most organisms but were considerably less active against P. aeruginosa. However, ceftriaxone tended to be more active than the other two agents against 8 of the 10 P. aeruginosa strains tested. Ceftriaxone, cefmenoxime (SCE 1365), and moxalactam were all highly active against systemic infections with 16 strains of Enterobacteriaceae, whereas ceftriaxone was more active against infections with two strains of streptococci. When the drugs were administered at various time intervals before infection, ceftriaxone was superior to cefotaxime, cefmenoxime, and moxalactam. This suggested that ceftriaxone might be eliminated from mice more slowly than the other drugs. In the case of cefotaxime, this was directly confirmed by microbiological assays of plasma samples. In a murine meningitis model induced by Klebsiella pneumoniae or Streptococcus pneumoniae, ceftriaxone was more active than ampicillin or cefotaxime. Ceftriaxone was more active than ampicillin, cefotaxime, piperacillin, cefamandole, or carbenicillin in a pneumococcal, pneumonia model in mice. These studies indicate that ceftriaxone is a potent, broad-spectrum cephalosporin with unusual pharmacokinetic properties.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Meningitis; Mice; Microbial Sensitivity Tests

In vivo transfer and therapeutic efficacy of a new cephalosporin derivative, cefotaxime, which is stable against beta-lactamase hydrolysis, have studied in gynecology field. The following results have been obtained. (1) The level of cefotaxime transferred to uterus artery and to uterus was higher than its MIC against majority of Gram-negative bacilli, such as E. coli. (2) Transfer of this drug to umbilical blood was also satisfactory. (3) This drug as demonstrated its efficacy in treating 8 infection cases refractory to CET, CEZ and ABPC, out of which 3 had 'excellent' and 5 had 'good' results. (4) No side effect was evidenced in any of our patients. In conclusion, this drug has satisfactory tissue transfer as well as sufficient safety and excellent efficacy in treatment of gynecological infection cases.

Topics: Adult; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Fetal Blood; Genital Diseases, Female; Humans; Middle Aged; Pregnancy; Uterus

Ten cases of gynecological infection were treated successfully by a new cephalosporin derivative, cefotaxime (HR 756, CTX), which proved excellent in 4 cases and good in 6 cases. No adverse reaction was found to be induced by administration of this drug. Post-administration results were all normal for both renal and hepatic function tests. It is extremely difficult to accurately assess bacteriological efficacy of a drug in treatment of female genital infections. Nevertheless, we determined its MICs for a few number of strains we could isolate from clinical cases. Its MIC against 4 strains of B. fragilis inoculated at 10(8) cells/ml was 25 approximately 50 mcg/ml and was 1.56 approximately 3.13 mcg/ml at 10(6) cells/ml inoculation. Its MIC against 2 strains of Ps. cepacia was 12.5 mcg/ml at 10(8) cells/ml inoculation and 6.25 mcg/ml at 10(6) cells/ml inoculation. These MICs suggest that this drug is a very promising antimicrobial agent for treatment of gynecological infections, as been already indicated by clinical results of this drug.

Topics: Adult; Bacteria; Bacterial Infections; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Female; Genital Diseases, Female; Humans; Middle Aged

The following results have been obtained in our basic and clinical studies to examine a new cephalosporin derivative, cefotaxime (CTX). For basic study purpose, we injected 1 g of CTX to 6 patients who had received simple total hysterectomy and measured its level in elbow vein, uterine artery, corpus uteri, cervix uteri, endometrium, oviduct and ovary. Any definitive conclusion should not be drawn from these results, since they have too big variation. However, slightly higher levels were achieved cervix uteri and oviduct than in other organs in a same patient. For clinical evaluation, we tried this drug to 12 cases of female genital infections and 91.7% response rate was obtained. Our studied population includes 8 cases of adnexitis, 2 with pelvioperitonitis, 1 with panperitonitis, and 1 patient with BARTHOLIN abscess. Organisms were detected only in 3 cases, including S. aureus in one patient, Micrococcus sp. in one, and mixture of Klebsiella sp. and B. fragilis in 1. Puncture of DOUGLAS pouch was performed in 3 cases after the completion of therapy and all had negative results. No side effect was observed, and no significant difference was noted between pre- and post-therapy examinations of peripheral blood, hepatic function and renal function.

Topics: Adult; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged

Therapeutic efficacy and safety of a new cephalosporin for injection, cefotaxime (CTX) have been examined in gynecological infection cases. CTX has demonstrated in this study excellent therapeutic efficacy in infections with aerobes only, anaerobes only and with mixture of aerobes and anaerobes. No side effect has been observed in our patients who had been administered total dose of 8 approximately 28 g during the period of 4 approximately 7 days.

Topics: Adult; Bacteria; Bacterial Infections; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Female; Genital Diseases, Female; Humans; Infusions, Parenteral; Middle Aged; Pregnancy; Puerperal Infection

Fundamental and clinical studies of cefotaxime (CTX), a new semisynthetic cephalosporin antibiotic were carried out in the field of obstetrics and gynecology. The following results were obtained. 1. CTX was almost equally active to SCE-1365 and less active than cefotiam (CTM) and cefazolin (CEZ) against S. aureus, much more active than these 3 antibiotics against E. coli, more active than the 3 antibiotics against Enterobacter, equally active to SCE-1365 and a little weaker than CEZ against anaerobic Gram positive cocci, and superior to SCE-1365 and CEZ against Bacteroides. 2. CTX was more stable to B. fragilis-producing beta-lactamase than CET, CEZ and cefoperazone (CPZ). 3. The concentrations of CTX transferred to the female genital organs after CTX 1 g d. i. were sufficiently effective against facultative or strict anaerobic bacteria mainly isolated from obstetrical and gynecological infections. 4. CTX was administered to 10 patients with genital infections. CTX was excellent in 1 case, good in 8 cases and poor in 1 case. The response rate of CTX was 90%. Bacteria, isolated in 5 cases before CTX treatment, were eradicated in 4 cases. The bacteriological effectiveness of CTX was thus 80%. 5. No side effect attributable to CTX was observed.

Topics: Adult; Bacteria; Bacterial Infections; Bacteroides fragilis; beta-Lactamases; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Drug Stability; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged; Pregnancy

Fundamental and clinical studies were made on cefotaxime (CTX), a new cephalosporin antibiotic. The following results were obtained: 1. Antibacterial activity: At a concentration of 3.13 mcg/ml, CTX inhibited the growth of 90.2% of 92 strains of Gram-negative rods and 80.0% of 15 strains of Gram-positive cocci. 2. Concentrations of CTX in body fluids and genital organs after 2 g i.v.: (1) CTX level in pus reached the peak (5.6mcg/ml) at 2 hours after administration. (2) Mean CTX levels in the pelvic space exudate reached the peak (28.0 mcg/ml) at 2 hours after administration. (3) CTX levels in the uterine appendages and uterus reached the peak (8.9 and 4.5 mcg/g, respectively) at 100 to 280 minutes after administration. 3.. CTX was excellent in 7 of 13 cases and good in the remaining 6 cases. The response rate to CTX was 100%. 4. The bacteriological effect: The bacteriological effect of CTX was also 100%. Bacteria were eradicated in 7 of the 10 cases where organisms were demonstrated before CTX treatment. Partial reduction bacteria was observed in the remaining 3 cases. 5. No side effect attributable to CTX was observed.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Body Fluids; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged

We have conducted basic and clinical examination of a new cephalosporin derivative, cefotaxime (CTX). The average level of transfer measured at various locations in uterus tissue and adnexa 15 to 105 minutes (53.4 minutes in average) after intravenous administration of this drug ranged from 1.5 mcg/g (myometrium) to 3.3 mcg/g (portio vaginalis). It was distributed in cervix uteri and portio vaginalis at highest concentration, followed by oviduct, tunica serosa and ovary, and to myometrium at lowest concentration. The same pattern of distribution was observed in transfer ratio of various location in uterus tissue to uterus arterial blood. The drug was transferred at very high level in pelvic cavity fluid after total hysterectomy throughout 3 postoperative hours. Five cases of gynecological infections receiving in total 10 to 42 g of CTX demonstrated 'excellent' results in 2 cases, and 'good' in 3 cases. Out of these, 3 cases did not respond to other antibiotic. Neither side effect nor clinical test abnormality was observed, except for one case, in which mild increase of GOT and GPT occurred. Based on the results of basic and clinical studies as described above, this drug is considered to have excellent efficacy and safety.

Topics: Adult; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Genital Diseases, Female; Genitalia, Female; Humans; Hysterectomy; Middle Aged; Pelvis; Pregnancy; Tissue Distribution; Uterus

A clinical study on cefotiam (CTM) was performed in the field of pediatric infection, and the following results were obtained: The number of cases studied were six including 2 cases of U.T.I., 1 case of vaginitis and vulvitis, 1 cervical lymphadenitis, 1 absence of thigh and coxitis. Clinical responses to CTM were excellent in 3 cases, good in 1 cases but there was 1 exception who dropped out because of concurrent use of other antibiotics. As for bacteriological responses, CTM eliminated the pathogens E. coli and P. mirabilis from U.T.I., Staph. epidermidis and P. morganii, from vaginitis and vulvitis, H influenzae and Str. pneumoniae from cervical lymphadenitis and Staph. aureus from abscess of thigh. No side effect was observed except 1 case who showed an elevation of GOT, GPT and LDH. It is uncertain, however, wether this abnormality was resulted from the use of CTM or not, because the other antibiotics were used also.

Topics: Age Factors; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Female; Humans; Injections, Intravenous; Male

The therapeutic effects of cefotiam (CTM) in the pediatric field were studied, and the following results were obtained: 1. Absorption and excretion: After 30 minutes intravenous drip infusion of 250 mg (14.7 mg/kg) of CTM to a 5-year old child weighing 17 kg, the serum levels and urinary excretion were measured. The serum levels were 47.8 mcg/ml at 30 minutes after administration, 23.9 mcg/ml after 1 hour, 12.5 mcg/ml after 1 hour and 30 minutes, 5.2 mcg/ml after 2 hours and 30 minutes, 0.3 mcg/ml after 6 hours and 30 minutes. Excretion rate in the urine was 48.8% at 6 hours after administration. 2.. CTM was administered at a daily dose of 35 to 91 mg/kg b.i.d. to q.i.d. by intravenous or intravenous drip injection for 2 to 6.5 days to six patients i.e. two with bronchopneumonia, one with acute bronchitis, one with acute enteritis, one with impetigo and atopic dermatitis one with acute tonsillitis and acute cervical lymphadenitis. The responses were excellent in 2 cases and good in 4 cases. The response rate was 100%. No side effect was observed.

Topics: Age Factors; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Male

The studies on cefotiam (CTM) administered by intravenous drip infusion in pediatric field made the following results: 1. The serum levels after administration of cefotiam 25 mg/kg, 63 mg/kg by intravenous was maintained high until 2 hours after and kept to be able to measure after 5 hours, and the half life was 0.9-1.7 hours. 2. The drug transferred actively about 1/5 of serum level into the intrathoracic pus. The excretion rate in urine was about 80% of the drug administered. 3. The clinical effective rate after the administration of CTM 50-70 mg/kg for 4 to 29 days was 95% in 21 patients with different five diseases. 4. No side effect and abnormality in laboratory findings were observed.

Topics: Age Factors; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Injections, Intravenous; Male

Cefotiam is a new semisynthetic cephalosporin antibiotic. The treatment with this drug was carried out in 12 cases of pediatric infection. The clinical response was observed in 92% of the cases. Cefotiam was found to be active against a variety of Gram-positive and Gram-negative bacteria. Neither marked side effects nor laboratory abnormalities were found with this treatment.

Topics: Adolescent; Age Factors; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Infant, Newborn; Infusions, Parenteral; Injections, Intravenous; Male

We have administered cefotiam intravenously to 23 pediatric patients. The daily dose was 13-210 mg/kg. The clinical responses were excellent and good in 20 cases. Excluding 1 case with infectious mononucleosis, the efficacy rate of 90.9% (20/22 cases) was achieved As for side effect, diarrhea and eosinophilia were observed one each in 2 cases. In 2 cases, half lives were 24 and 53 minutes, urinary recovery rates were 88.3 and 91% over 6 hours.

Topics: Age Factors; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Infant, Newborn; Injections, Intravenous; Kinetics; Male

Cefotiam (CTM) were clinically applied to 6 cases and the following results were obtained: 1. The patients were aged 1 year in 5 cases and 7 years in 1 case. They comprised three cases of acute tonsillitis and 1 case each of phlegmon, bronchopneumonia and cervical abscess. CTM was administered in a daily dose of 50-115 mg/kg t.i.d. by an 1-hour intravenous drip infusion for 4 to 8 days. 2. The causative bacteria were S. aureus in 3 cases and H. parainfluenzae, K. pneumoniae and unknown pathogen in each 1 case. The organisms were eradicated in all cases except for only 1 case of S. aureus. 3. Overall responses were good in 4 cases and fair in 2 cases. 4. As for the abnormal laboratory findings, slight increase of GOT and GPT was observed in 1 case. Any other side effects were not observed.

Topics: Age Factors; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Drug Evaluation; Female; Humans; Infant; Male

A new synthetic cephalosporin, cefotiam (CTM) was studied from the basic and clinical aspects, and the following results were obtained: 1. Bacteriological study: The bacterial activities of CTM against the clinical isolates of S. aureus, S. pyogenes, E. coli, Klebsiella sp. and Proteus sp. were compared with those of CEZ, CER, ABPC and GM. (1) As for S. aureus and S. pyogenes, the antibacterial actions of the conventional cephalosporins were slightly more potent than those of CTM. (2) However, CTM had the antibacterial actions which were most potent Proteus sp. among the above 4 antibiotics and more potent against E. coli and Klebsiella sp. than the above 2 conventional cephalosporins. 2. Pharmacokinetic study: The peak serum levels of CTM were comparatively low with 19.30 +/- 1.66 mcg/ml 30 minutes after a bolus injection of 20 mg/kg and 25.85 +/- 4.32 mcg/ml just after a drip infusion of 20 mg/kg. The half-life of the serum levels was 0.98 hrs. and 0.87 hrs., respectively. The 4 hours urinary excretions in six patients ranged from 38.6 to 64.9%, showing a slightly wide variance. 3. Clinical study: The clinical response was good in 23 out of total 25 cases, i.e. 14 cases with respiratory tract infection, 7 with urinary tract infection and 4 with skin and soft tissue infection. The response rate was 92%. Also, neither side effects nor abnormal laboratory findings was observed.

Topics: Adolescent; Age Factors; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Male

Cefotiam, one of the new cephem antibiotics, was used in 14 cases with pediatric infections: (10 cases with respiratory tract infections, 2 with urinary tract infections, each 1 with purulent meningitis + sepsis and acute appendicitis). The patients were aged between 15 days and 9 years old. The drug was, a rule, given at a daily dose of 50 mg/kg to 100 mg/kg q.i.d. by bolus intravenous injection. The duration of treatment was between 3 and 38 days. The treatment produced the following clinical responses: Out of the 10 cases, good response in 7 with respiratory tract infections, fair in 1 and poor in the remaining 2. The responses in urinary tract infections were excellent in 1 and good in the other case. An apparently clear response was obtained in 1 case with purulent meningitis + sepsis due to K. pneumoniae. Also, an excellent response was seen in 1 case with acute appendicitis. The response rate including fair response was 85.7%. The suspected pathogens isolated from 5 cases (S. aureus: 1. strain, H. influenzae: 1, K. pneumoniae 2, E. coli: 1) were eliminated after CTM administration. Good clinical responses were also obtained in these cases. No side effect was observed. Mild elevation of GOT and GPT was noted during the treatment in 1 case. It is unclear, however, if CTM was associated with this side effect or not. P. aeruginosa, Serratia appeared after superinfection in 1 case.

Topics: Age Factors; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Infant, Newborn; Male

Cefotiam (CTM) was evaluated for its safety and efficacy in children. Twenty-six patients were treated with 40 to 200 mg/kg per day of CTM by intravenous administrations. The diagnosis of the patients were acute pharyngitis (2), acute bronchitis (1), pneumonia (4), empyema (2), urinary tract infection (2), typhoid fever (1), acute enterocolitis (2), partially-treated purulent meningitis (1), and suspected septicemia in neuroblastoma (1); and the remaining ten patients were considered to have nonbacterial infections. The pathogens recovered were Streptococcus pyogenes (1), Streptococcus pneumoniae (1), Staphylococcus aureus (4), Haemophilus influenzae (4), Escherichia coli (1), enteropathogenic Escherichia coli (1), Salmonella typhi (1), and Campylobacter jejuni (1). All but two patients of bacterial infections were cured after the CTM therapy, and the rate of efficacy was 87.5%. Diarrhea (3), urticaria (1), transient elevation of GOT and GPT (1), and transient eosinophilia (3) were found to be associated with the CTM therapy. However, no severe adverse reactions were encountered. Half life of the serum CTM level was 0.93 +/- 0.13 hours, and excretion into the urine was rapid. CSF concentration obtained 1 hour after an intravenous injection of 21 mg/kg of CTM in a case with inflamed meninges was 1.5 mcg/ml, and the CSF/serum ratio was 9.0%. From these data, CTM appears to be a safe and effective antibiotic when used in children with susceptible bacterial infections.

Topics: Age Factors; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Infant, Newborn; Injections, Intravenous; Male

The fundamental and clinical studies on cefotiam (CTM) were performed in the field of pediatrics, and the following results were obtained: 1. The peak MIC's of CTM against Gram negative rods such as E. coli, Klebsiella, Salmonella, Proteus were 1.56 mcg/ml. The MIC distribution against S. aureus was almost equal to the conventional cephalosporin antibiotics. The MICs against P. pseudomonas and Serratia were over 400 mcg/ml. 2. The mean serum levels of CTM after bolus intravenous injection of 25 mg/kg were 59.9 mcg/ml after 15 min., 30.0 mcg/ml after 30 min., 15.6 mcg/ml after 1 hour. 3. Administration of CTM to 6 pediatric patients produced the clinical responses which were good in all 6 cases and the bacterial effects of eradication in 3 cases and superinfection in the 2 cases in the 5 cases from whom the organism were isolated. No side effect was observed. From the above results, it is considered that a bolus injection of CTM 25 mg/kg t.i.d. to q.i.d. is a safe and useful treatment for pediatric cases.

Topics: Age Factors; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

Studies on the antibacterial activity, absorption and excretion and also clinical investigation in the field of pediatrics have been carried out with cefotiam (SCE-963, CTM), a new cephalosporin antibiotic. 1) The MICs of CTM against the following clinical isolates were measured and compared with those of CEZ: S. aureus (81 strains), E. coli (27) and K. pneumoniae (27), with CTM being inferior by 1 tube in S. aureus, being superior by 2 to 3 tubes in E. coli and by about 2 - 3 tubes in K. pneumoniae. 2) Absorption and excretion. After intravenous one shot injection at dose levels of 10 mg/kg and 20 mg/kg, the peak in the serum concentration was shown in the 15-minute value with 18.1 and 36.6 mcg/ml for 10 mg/kg and 20 mg/kg, respectively. The half-life in ;the serum was 1.14 and 0.61 hours, respectively. In the case of 1-hour intravenous drip infusion at a dose level of 10 mg/kg, it was 14.3 mcg/ml, with 0.98-hour half-life in the serum. The recovery rates from the urine within 0 to 6 hours were 50.6% and 66.2% in the case of intravenous one shot injection at dose levels of 10 mg/kg and 20 mg/kg, respectively, with 71.1% in the case of the 1-hour intravenous drip infusion. 3) Two to 3 hours after intravenous one shot injection of CTM in H. influenzae-meningitis every 4 hours at a dose level of 62.5 mg/kg at one time, the cerebrospinal fluid concentration of CTM was only 2.12 to 10.0 mcg/ml, and this fact suggests that CTM is a useful cephalosporin for treating purulent meningitis. 4) CTM was administered in 19 clinical cases, with the results being: excellent in 4 out of 4 cases of bronchitis; excellent in 5 and good in 1 out of 6 cases of pneumonia; excellent in 3 cases of pyelitis; good in purulent parotitis, purulent meningitis and bacterial pericarditis; and excellent in peritonsillar abscess, purulent osteomyelitis and staphylococcal scalded skin syndrome (S.S.S.S.). No side effects have been observed in all cases. As for abnormal laboratory findings, 3 cases of eosinophilia were seen.

Topics: Age Factors; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Male

The basic and clinical studies of cefotiam (CTM) in pediatric infections were carried out, and the following results were obtained: 1. The antibacterial activity of CTM against S. aureus was equal or slightly less than that of cefazolin (CEZ). Those of CTM against E. coli and K. pneumoniae were eight times more active than those of CEZ. 2. CTM 20 mg/kg was administered wither by 30 minutes or 1 hour intravenous drip infusion. The peak serum levels were obtained at the end of each drip infusion, with the mean peak levels being 44.8 and 41.4 mcg/ml respectively. The serum levels at 1.5 and 2 hours after drip infusion were 2.8 and 2.2 mcg/ml respectively, and at 3.5 and 4 hours after drip and 4 hours after drip infusion were 0.3 and 0.7 mcg/ml respectively. The half lives were 0.62 and 1.15 hours, respectively. The mean urinary excretion over 6 hours were 52.8% in ;the 30 minutes drip infusion group and 42.6% in the 1 hour drip infusion group. 3. Clinical efficacy was evaluated in sixteen cases suffering from tonsillitis (4 cases), pneumonia (4), bronchitis (2), cervical lymphadenitis (2), purulent meningitis (2), suppurative arthritis (1) and suspected sepsis (1). Good and excellent responses were obtained in 15 of 16 cases (93.8%). Bacteriological response in the form of eradication was noted in 4 of 6 cases. Side effect observed was rash in 1 case, and laboratory abnormalities were elevation of BUN in 1 case and elevation of GPT in 2 cases.

Topics: Adolescent; Age Factors; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Infant; Klebsiella pneumoniae; Male; Staphylococcus aureus

Clinical trial of cefotiam was made in children and the following results were obtained. 1. Pharmacodynamic studies of the drug in CSF of experimental staphylococcal meningitis in rabbits showed a CSF/serum ratio of T 1/2 of 3.52, which was relatively high, but a percentage of CSF/serum ratio of AUC of only 3.42% up to 3 hours, suggesting a low efficiency of passage of the drug into CSF. 2. Blood concentrations of the drug were determined in children after an intravenous bolus injection of 20 mg/kg and were 46 mcg/ml (15 min.) and 26 mcg/ml (30 min.), T 1/2 being 40.8 min., Urinary recovery rate was 91.3% up to 4 hours in one patient and 61.9% up to 6 hours in another, respectively. 3. Thirteen patients with the following 14 episodes of infections were treated with cefotiam; urinary tract infection (5 cases), pneumonia (5), empyema (1), tonsillitis (1) and suspected sepsis (2). An overall efficacy rate was 100%, i. e., excellent in 12, good in 2 and no failure. No adverse reactions were clinically discernible and only laboratory abnormalities were transient or slight elevations of transaminase levels in 2 patients. 4. Based on the above results, it was concluded that cefotiam is a potent new antibiotic in the treatment of bacterial infections. Spectrum and antibacterial activity of the drug suggest that the drug particularly indicated for pneumonia.

Topics: Age Factors; Animals; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male; Rabbits

Cefotaxime, a new parenteral beta-lactamase-resistant cephalosporin, was tested against 78 cephalothin-resistant clinical isolates of Enterobacteriaceae and Pseudomonas species. The anti-bacterial activity of the drug was compared with activities of cefazolin and cefuroxime and was found considerably more active. Most of the cephalothin-resistant strains were resistant to cephazin, too. The antipseudomonal activity of cefotaxime was found limited. The drug was found effective against 23 infections in hospitalized patients with only one clinical failure and two colonizations with cefotaxime-resistant bacteria. Cephalosporinases hydrolyzing cefotaxime were detected in two cefotaxime-resistant strains. Also, beta-lactamases hydrolyzing cefoxitin and cefuroxime were produced by the cefotaxime-resistant isolates studied.

Topics: Aged; Bacteria; Bacterial Infections; beta-Lactamases; Cefazolin; Cefotaxime; Cefuroxime; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged

Clinical evaluation of cefotiam (panspolin), a new cephem antibiotics, was performed in the infectious disease associated with hematological disorders and in the respiratory system. In hematological dis orders, 40% of good and 25% of fair results were obtained in clinical effects. In respiratory infections, however, 92% of good results were obtained. Opportunistic infection due to Gram-negative bacilli are often experienced in patients with leukemia. Since cefotiam has sufficient bacteriocidal effects in broad spectrum, it would be a good therapeutic agent against infectious diseases associated with hematological disorders.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Hematologic Diseases; Humans; Male; Middle Aged

A number of disorders of host resistance to infections occur in cancer patients. Defects in granulocytes, complement synthesis and antibody formation, cellular immunity, and mucocutaneous boundaries are discussed. Most infections in these compromised patients are caused by a few gram-negative rods and gram-positive cocci, although other bacteria, opportunistic fungi, intracellular parasites, and DNA viruses also cause severe disease. Cefotaxime was found to be an effective antimicrobial in the treatment of 40 cancer patients with infections of the urinary or lower respiratory tracts, bacteremia, soft-tissue infections, and fever of undetermined origin. Cefotaxime in combination with ticarcillin or an aminoglycoside may improve response in infections due to opportunistic organisms such as Pseudomonas.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; beta-Lactamases; Cefotaxime; Drug Stability; Humans; Neoplasms

From the laboratory and clinical studies on ceftizoxime (CZX), the following results were obtained 1) CZX was compared with cefazolin (CEZ) for in vitro activity against 6 standard strains and clinically isolated strains of Staphylococcus aureus (19 strains), Staphylococcus epidermidis (14), Proteus sp. (17), Escherichia coli (3), Klebsiella sp. (3) and Pseudomonas aeruginosa (13). While somewhat less active against Gram-positive cocci than CEZ, CZX was far more active than CEZ against Gram-negative bacilli. 2) The time course of mean serum CZX levels in 2 patients given a single intravenous dose of 10 mg/kg was as follows: 24.9 microgram/ml at 15 minutes, 18.5 microgram/ml at 30 minutes, 13.2 microgram/ml at 1 hour, 6.4 microgram/ml at 2 hours and 2.7 microgram/ml at 4 hours. The mean serum half life was 1.36 hours. The mean tonsil concentrations of CZX 30 minutes after a single intravenous dose of 0.5 g and 1.0 g were 5.9 microgram/g and 9.6 microgram/g. respectively, with the ratio to the serum concentration of 0.33 and 0.32. 3) CZX was given to 28 patients with ear, nose, and throat infections, and overall rate of effectiveness was 92.3%. No clinical side effects were observed. Changes in laboratory test findings included slightly elevated GOT and/or GPT in 3 cases.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Diseases; Tissue Distribution

Cefotaxime is a new cephalosporin with a spectrum of activity which may make it appropriate for use in pediatric patients. In 33 infants and children, administration of cefotaxime resulted in cure or improvement in 97% of patients, with eradication of 94% of isolated pathogens. Toxicity was minimal. The disposition of cefotaxime in this age group was similar to that reported for adults, with an elimination half-life of approximately 1.5 h, a volume of distribution of 1 liter/kg, a total serum clearance of 10 ml/min per kg, and a renal clearance of 6 ml/min per kg.

Topics: Bacterial Infections; Cefotaxime; Child; Child, Preschool; Enterobacteriaceae Infections; Humans; Infant; Injections, Intramuscular; Injections, Intravenous; Pseudomonas Infections

Topics: Bacteria; Bacterial Infections; Cefotaxime; Humans; Microbial Sensitivity Tests; Risk

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Meningitis

The kinetics of cefotaxime, a cephalosporin with an unusually broad antibacterial spectrum, were examined in humans after intravenous bolus injection, intravenous infusion every 6 hr for 14 days, and intramuscular injection every 8 hr for 10 days. Mean peak serum level after bolus injection of 500 mg was 37.9 microgram/ml; after 1 gm, 102.4 microgram/ml; and after 2 gm, 214.1 microgram/ml. The half-life (t1/2) was 1 hr for the 3 doses. Total serum clearance was the same for all doses. Overall excretion was 50% to 60%; part of the drug was excreted as the desacetyl derivative. After multiple intravenous infusion the elimination rate constants and t1/2 were the same on days 1 and 15. Assayable levels were present on all days 5 min before injection of a dose. Multiple intramuscular injections of 500 mg produced serum levels of 9.2 to 11.9 microgram/ml. The t1/2 was 0.93 hr. Mean serum levels at 8 hr ranged from 0.08 to 0.55 microgram/ml. Serum levels produced by intravenous infusion or intramuscular injection were inhibitory for most (90%) aerobic gram-positive and gram-negative organisms susceptible to cefotaxime.

Topics: Adult; Bacteria; Bacterial Infections; Cefazolin; Cefotaxime; Cephalosporins; Drug Tolerance; Half-Life; Humans; Injections, Intramuscular; Injections, Intravenous; Kinetics; Male

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Female; Humans; Male; Middle Aged

Topics: Animals; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Humans

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Child, Preschool; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Kinetics

Topics: Adolescent; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Intestines

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Female; Humans; Immunity; Infant; Infant, Newborn; Male

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Surgical Wound Infection

Topics: Animals; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporinase; Cephalosporins; Enterobacteriaceae; Kinetics; Mice

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bone Diseases; Cefotaxime; Cephalosporins; Female; Humans; Joint Diseases; Male; Middle Aged

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Female; Humans; Male; Meningitis; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Female; Genital Diseases, Female; Humans; Microbial Sensitivity Tests; Middle Aged; Pregnancy; Pregnancy Complications, Infectious

Topics: Adolescent; Adult; Age Factors; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Meningitis; Middle Aged; Respiratory Tract Infections; Sepsis; Sex Factors

Topics: Amikacin; Animals; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporins; Drug Synergism; Humans; Kanamycin; Mice; Staphylococcus aureus

Moxalactam, Ro 13-9904, cefotaxime, cefoperazone, older cephalosporins, and four aminoglycosides were tested in vitro against 432 strains of gram-negative bacteria isolated from pediatric patients. The new drugs were uniformly active against coliform bacilli obtained from patients with meningitis and against aminoglycoside-resistant coliform bacilli.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Cephamycins; Child; Drug Resistance, Microbial; Humans; Moxalactam

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Drug Evaluation; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn