cefotaxime and Bacteroides-Infections

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Bacteroides fragilis; Bacteroides Infections; Cefotaxime; Colon; Drug Therapy, Combination; Erythromycin; Escherichia coli Infections; Female; Humans; Injections, Intravenous; Male; Middle Aged; Neomycin; Prospective Studies; Random Allocation; Rectum; Surgical Wound Infection

The in vitro and in vivo antibacterial activities of sulopenem (CP-70,429),a new parenteral penem antibiotic, were compared with those of imipenem (IPM), flomoxef, cefuzonam (CZON) and cefotaxime. Sulopenem possessed broad-spectrum activities against Gram-positive bacteria and Gram-negative bacteria. Antibacterial activities of sulopenem against methicillin-sensitive Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pyogenes and Streptococcus pneumoniae were equivalent to or somewhat superior to those of IPM. Against members of the family Enterobacteriaceae, sulopenem was 4- to 260-fold more active than reference antibiotics with broad-spectra. In a killing kinetics study for Haemophilus influenzae, sulopenem showed a 99.9% decrease of viable cells after 8 hours at a concentration of 0.20 micrograms/ml. This effect was obtained at a concentration 8-fold lower than that of IPM. The protective effects of sulopenem in murine experimental systemic infections were superior to those of imipenem/cilastatin. In murine experimental mixed infection with Escherichia coli and Bacteroides fragilis, sulopenem had lower ED50, in other words stronger antimicrobial activities than IPM. The therapeutic effect of sulopenem are related well with its MIC value. In guinea pigs experimental lung infection with Klebsiella pneumoniae, sulopenem was more effective than CZON or cefotiam.

Topics: Animals; Anti-Bacterial Agents; Bacteroides fragilis; Bacteroides Infections; beta-Lactam Resistance; Cefotaxime; Ceftizoxime; Cephalosporins; Escherichia coli Infections; Gram-Negative Bacteria; Gram-Positive Bacteria; Guinea Pigs; Imipenem; Klebsiella Infections; Lactams; Lung Diseases; Mice; Mice, Inbred ICR; Thienamycins

Necrotizing fasciitis is a potentially fatal, acute bacterial infection characterized by extensive fascial and subcutaneous tissue necrosis. Four factors that contribute significantly to the morbidity and mortality of necrotizing fasciitis are: 1) delayed treatment, due to difficulty in recognizing the condition; 2) inappropriate treatment; 3) host debilitation; and 4) a polymicrobial infection.

Topics: Adult; Bacteroides Infections; Candidiasis; Cefotaxime; Clindamycin; Cloxacillin; Fasciitis; Female; Focal Infection, Dental; Gentamicins; Humans; Metronidazole; Multiple Organ Failure; Neck Muscles; Necrosis; Penicillin G; Periapical Abscess; Shock, Septic; Staphylococcal Infections; Streptococcal Infections; Superinfection

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

Fifty-nine patients were operated or punctured in 60 incidents of brain abscess from 1963-1989, twice as many in men as in women. The number of cases tripled in 1980 to an incidence of 3.6 per million inhabitants per year, supposedly due to the advent of computerized tomography. Simultaneously, the aetiology changed from staphylococci and Gram negative rods to dominance of streptococci and Haemophilus aphrophilus. Apart from temporal abscesses, there was no correlation between localisation in the brain and the bacterial species isolated. Ninety-five per cent of the specimens from untreated patients gave growth, but so did specimens from six of 18 patients treated with relevant antibiotics up to 11 days before puncture. Therefore, we recommend removal of pus by excision or puncture.

Topics: Adolescent; Adult; Aged; Ampicillin; Bacteroides Infections; Brain Abscess; Cefotaxime; Child; Child, Preschool; Chloramphenicol; Denmark; Escherichia coli Infections; Female; Gram-Positive Bacterial Infections; Haemophilus Infections; Humans; Infant; Infant, Newborn; Male; Methicillin; Metronidazole; Middle Aged; Penicillins; Retrospective Studies; Streptomycin; Sulfonamides

The possibility that beta-lactamase-producing strains of Bacteroides fragilis can protect Escherichia coli from cefotaxime was studied in an in-vivo model of peritoneal infection in rats. The protective effect of cefotaxime, aztreonam and gentamicin in peritonitis induced by E. coli alone or combined with B. fragilis was evaluated by analysing mortality at 24 and 48 h after bacterial inoculation and treating the animals with two doses of each antibiotic. Comparisons, by drugs, at 24 and 48 h revealed that a statistically significant high mortality rate was obtained at 48 h when mixed infections were treated with cefotaxime, a drug very active in the infection caused by E. coli alone. Infections by mixed flora or E. coli alone treated with aztreonam or gentamicin did not show any significant difference in mortality rate analysed at 24 or 48 h. These in-vivo results confirm previous in-vitro studies and suggest that cefotaxime could be inactivated in mixed infections if a beta-lactamase-producing strain, such as B. fragilis, is involved in a clinical infection.

Topics: Animals; Aztreonam; Bacteroides fragilis; Bacteroides Infections; Cefotaxime; Escherichia coli Infections; Female; Gentamicins; Microbial Sensitivity Tests; Peritonitis; Rats; Rats, Inbred Strains

The activity of amoxycillin/clavulanic acid was compared with that of cefuroxime and cefotaxime, alone and combined with metronidazole, in preventing the development of infections in the mouse caused by subcutaneous injection of a beta-lactamase-producing strain, Escherichia coli E96, or a mixed inoculum of E. coli E96 and Bacteroides fragilis VPI 8908. Amoxycillin/clavulanic acid, cefuroxime and cefotaxime were equally efficacious in preventing development of the E. coli E96 monoinfection at clinically achievable concentrations. However, the activity of cefuroxime against E. coli E96 in the mixed infection was markedly reduced as was, to a lesser extent, that of cefotaxime. Co-administration of metronidazole improved slightly the activity of cefuroxime against E. coli E96 in the mixed infection, but had no such enhancing effect on cefotaxime. In contrast, amoxycillin/clavulanic acid effectively prevented development of the mixed infection in all treated mice. Results of in-vitro studies showed that cefuroxime and cefotaxime were stable in a culture of E. coli E96, and were rapidly bactericidal against this strain. In contrast, both cephalosporins were hydrolysed in a mixed culture of E. coli E96/Bact. fragilis VPI 8908, which resulted in diminished bactericidal activity, particularly of cefuroxime, which was not restored by addition of metronidazole. Amoxycillin/clavulanic acid was stable in the mixed culture and caused a significant reduction in numbers of both organisms. These in-vitro data explain the findings of the in-vivo studies, and establish that the beta-lactamase activity of Bact. fragilis VPI 8908 was responsible for the diminished activity of cefuroxime and cefotaxime, combined with metronidazole, against a mixed E. coli/Bact. fragilis infection.

Topics: Amoxicillin; Animals; Bacteroides fragilis; Bacteroides Infections; beta-Lactamases; Cefotaxime; Cefuroxime; Cephalosporins; Clavulanic Acids; Escherichia coli; Escherichia coli Infections; Female; Metronidazole; Mice; Microbial Sensitivity Tests

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

Topics: Bacteroides fragilis; Bacteroides Infections; Cefotaxime; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Meningitis; Metronidazole

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

A new mouse model of anaerobic infection with Bacteroides fragilis alone or in a mixed infection with Escherichia coli is described. It is established by implantation under the skin of a filter paper disk saturated with the appropriate bacterial suspension. The penetration of antibiotics into the implantation site can be detected by assaying the disk. The local infection can be both standardized and evaluated by determining the bacterial count on the disk. The antimicrobial efficacy of ceftizoxime was compared with other commercially available antibiotics administered in a single dose, 40 mg/kg subcutaneously, one hour after implantation of the disk. Using such a regimen ceftizoxime was found to be superior to a clindamycin-gentamicin combination and equal to or superior to cefoxitin in these models.

Topics: Animals; Bacteroides fragilis; Bacteroides Infections; Cefotaxime; Cefoxitin; Ceftizoxime; Clindamycin; Cyclophosphamide; Escherichia coli Infections; Gentamicins; Mice

Our clinical experience with new antibiotics giving special consideration to the individual cephalosporin groups is discussed. Although newer cephalosporins from cefamandol and cefoxitin to cefotiam and cefoperazon already showed increased effectiveness (for example, cefoxitin in bacteroides infection) in comparison to older ones, the real breakthrough regarding enterobacteriaceae was only made with cephalosporins of the cefotaxime group. This group's main indication is non-specific initial therapy of severe nosocomial infections, especially processes in which the presence of resistant enterobacteriaceae must be assumed. Because of its broad spectrum of action, cefotaxime can to a large extent replace the combinations with aminoglycosides which were used previously. When required, cefotaxime proves to be a good partner for combinations with pseudomonas antibiotics.

Topics: Bacteroides Infections; Cefotaxime; Cefoxitin; Cephalosporins; Cross Infection; Drug Therapy, Combination; Enterobacteriaceae Infections; Gentamicins; Humans; Pseudomonas Infections; Staphylococcal Infections; Structure-Activity Relationship

Cefamandole resistance in five patients was studied. Microorganisms emerged resistant to cefamandole during therapy with the drug in three patients with complicated infections. This resistance was associated with an enhanced production of beta-lactamase and/or with a change in the substrates and the isoelectric focusing patterns of the enzymes. Cross-resistance to other beta-lactam antibiotics developed concurrently in isolates from these patients. Disk diffusion tests did not detect resistance to cefamandole in the pretreatment isolate from the fourth patient; this isolate produced inactivating enzymes, and resistance was detected only in broth dilution tests. In the fifth patient, infection with a cefamandole-resistant Enterobacter developed during postoperative therapy with the drug. Resistance to cefamandole in the isolate from this patient was unstable and was associated with inducible beta-lactamase activity. These examples emphasize the need for close monitoring of patients who are given cefamandole and for thorough in vitro evaluation of isolates from the patients both before and after treatment.

Topics: Adult; Aged; Bacteroides Infections; beta-Lactamases; Cefamandole; Cefotaxime; Cefoxitin; Cephalosporins; Cephamycins; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Humans; Isoelectric Focusing; Male; Middle Aged; Moxalactam; Penicillin Resistance; Penicillins

Topics: Animals; Bacterial Infections; Bacteroides Infections; Cefotaxime; Ceftizoxime; Disease Models, Animal; Male; Mice; Neutropenia; Sepsis; Wound Infection