cefotaxime and Central-Nervous-System-Diseases

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

The combination of cefotaxime and fosfomycin (CTX-FOS) has been proposed in France for the empirical treatment of postoperative nosocomial meningitis since the late 1980s. The purpose of this work was to evaluate this strategy today, as well as other possible treatments.. Each patient undergoing a neurosurgical procedure was prospectively included in a database designed for the surveillance of surgical site infection (SSI). For each meningitis detected, we analysed the in vitro susceptibility of the causative micro-organisms to cefotaxime alone (CTX), cefotaxime-fosfomycin (CTX-FOS), vancomycin (VAN) and cefotaxime-vancomycin (CTX-VAN) combinations. The patient population was divided into two groups according to the presence or absence of CSF shunting material.. 116 patients had had a postoperative meningitis/ventriculitis during the last 36 months, among 6447 patients undergoing neurosurgery in our department (1.8%). Ten patients had aseptic meningitis (8.6%). Overall sensitivity to CTX was 69.8%, as compared to 77.3% with CTX-FOS combination (NS). This result was due to a large proportion of fosfomycin resistant cocci in our population. The CTX-VAN combination increased the overall in vitro susceptibility up to 91.5%, but the benefit of this combination was only significant in CSF shunting material patients. In these latter patients, VAN was as effective as CTX-FOS combination.. CTX-FOS combination is no longer the best choice for empirical treatment of post neurosurgical meningitis. CTX alone can be safely used in patients without a CSF shunt; in those with either a ventriculostomy or a CSF shunt associated ventriculitis, a CTX-VAN combination could improve treatment efficacy, provided that high doses of vancomycin are used to ensure correct CSF diffusion.

Topics: Adult; Aged; Cefotaxime; Central Nervous System Diseases; Cerebrospinal Fluid Shunts; Craniotomy; Cross Infection; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fosfomycin; Humans; Male; Meningitis, Aseptic; Meningitis, Bacterial; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome; Vancomycin

The central nervous system (CNS) is frequently involved in patients with Whipple's disease and is the most common site of disease relapse. Antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMX) that have reliable CNS penetration, are therefore recommended as first-line therapy. We report a patient with Whipple's disease who was treated with TMP-SMX and presented 14 months after initiation of therapy with visual decline and severe headaches. The patient was also treated concurrently with low-dose weekly methotrexate for severe psoriasis. Evaluation by magnetic resonance imaging revealed bilateral posterior white matter abnormalities that pathologically were consistent with Whipple's disease. He was ultimately treated with cefixime, an orally administered third-generation cephalosporin. Visual function improved on this regimen and follow-up magnetic resonance imaging showed regression of the lesions. This case represents the first report of both CNS relapse during therapy with TMP-SMX and successful treatment with cefixime. We also speculate that methotrexate, which impairs cell-mediated immunity, may have contributed to the relapse.

Topics: Cefixime; Cefotaxime; Central Nervous System Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Recurrence; Remission Induction; Trimethoprim, Sulfamethoxazole Drug Combination; Vision Disorders; Whipple Disease

Borrelia burgdorferi, the etiologic agent of Lyme borreliosis, was isolated from the CSF of a patient with elevated serum IgG antibody titers against B burgdorferi and a history of multiple tick bites. The absence of concurrent inflammatory signs of CSF as well as intrathecal antibody production indicates a phase of latent Lyme neuroborreliosis in which no tissue infection or reaction has yet occurred. Bilateral tinnitus was the only clinical symptom in this patient. The persistence of the bilateral tinnitus after antibiotic therapy did not support a causal relationship between this symptom and the borrelial infection.

Topics: Adolescent; Antibodies, Bacterial; Blotting, Western; Borrelia; Cefotaxime; Central Nervous System Diseases; Cerebrospinal Fluid; Electrophoresis, Polyacrylamide Gel; Fluorescent Antibody Technique; Humans; Lyme Disease; Male; Tinnitus

Cefotiam of 1 to 2 g was intravenously given during 15 to 60 minutes in 10 cases, and blood levels and cerebrospinal fluid (CSF) levels were studied. Following the drip infusion of cefotiam, maximum blood levels of 25.2 to 305 micrograms per ml was an average of 101.2 micrograms per ml were achieved at 15 to 60 minutes in 9 cases. Half life of cefotiam in serum was from 20 to 50 minutes, and mean time was 39.4 minutes. In contrast, maximum CSF levels of cefotiam were ranged 1.4 to 17.2 micrograms per ml and mean value was 5.7 micrograms per ml in 8 cases. The ratios of CSF levels to blood levels were calculated from 1.7 to 6.6% with an average of 4.6%. The CSF levels of cefotiam showed long delay and long decay. The period between the drip infusion and peak levels of cefotiam in CSF showed 60 to 420 minutes and mean time was 194 minutes. Half life varied between 45 and 270 minutes with an average of 178 minutes. No side effects were found in all cases.

Topics: Adult; Aged; Cefotaxime; Cefotiam; Central Nervous System Diseases; Female; Humans; Male; Middle Aged; Time Factors