cefotaxime and Chronic-Disease

The focus of a multicenter trial conducted in Germany was to investigate whether a 5-day short course of cefixime 400 mg was equivalent to a 10-day standard therapy of cefixime 400 mg in the treatment of acute exacerbation of chronic bronchitis (AECB). In the 167 patients who were evaluated, on day 11 following treatment with once-daily oral cefixime resulted in clinical success in 91 and 89% of cases in the 5-day and 10-day treatment groups, respectively. At days 6, 11 and 30 after treatment there was no statistically significant difference between the 2 dose groups (p < 0.01). Bacteriological equivalence was also demonstrated. Gastrointestinal adverse events showed a tendency to occur less frequently in the 5-day group, but the difference was not significant. The results indicate that a short course therapy is equivalent in efficacy to the standard 10-day therapy in patients with AECB, and may thus offer cost advantages.

Topics: Administration, Oral; Bronchitis; Cefixime; Cefotaxime; Cephalosporins; Chronic Disease; Cost-Benefit Analysis; Drug Administration Schedule; Drug Costs; Humans

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

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

Topics: Aged; Anti-Infective Agents; Bronchitis; Cefixime; Cefotaxime; Chronic Disease; Ciprofloxacin; Drug Resistance, Microbial; Female; Follow-Up Studies; Humans; Male

In an open randomized study 218 outpatients (159 males and 59 females) ranging between 18 and 85 years of age (mean 61.9) suffering from bacterial exacerbation of chronic bronchitis have been randomly treated: 79 with co-amoxiclav (amoxicillin 875 mg+clavulanic acid 125 mg) twice daily, 69 with cefixime (400 mg) once daily, and 70 with ciprofloxacin (500 mg) twice daily for an average period of 10 days. Before treatment start, 234 bacterial strains (105 Gram-positive and 129 Gram-negative) were isolated as the cause of exacerbation; the leading pathogens were Streptococcus pneumoniae and Haemophilus spp. Eradication rates at the end of treatment were 82.2% for the co-amoxiclav group, 77.6% for the cefixime group, and 81.2% for ciprofloxacin group. Clinical success (cure+improvement) was obtained in 90.8% of the cases treated with co-amoxiclav, in 80.9% for the cefixime group and in 85.7% of patients treated with ciprofloxacin. Seven adverse events (8.9%) of which 4 cases of diarrhea and 3 of itching, were recorded in the co-amoxiclav group. Eleven adverse events (14.7%) were recorded in the cefixime group including gastrointestinal disturbances in 6 patients and mild to moderate increase of liver function in 2. Nine adverse events (12.9%) occurred in the ciprofloxacin group, including insomnia in 3 patients, gastrointestinal disturbances in 2, and serious increase of liver function tests in one patient. It can be concluded that there were no statistically significant differences among the three treatment groups. However, co-amoxiclav demonstrated a higher efficacy rate than cefixime and ciprofloxacin and was better tolerated. Therefore, it can be used as a first-choice drug in the treatment of exacerbation of chronic bronchitis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bronchitis; Cefixime; Cefotaxime; Chronic Disease; Ciprofloxacin; Clavulanic Acids; Drug Therapy, Combination; Evaluation Studies as Topic; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Treatment Outcome

Betalactams, mainly when orally administered, may lead to intestinal flora modifications related to their spectrum of activity, rate of absorption and degradation. therefore it is important to investigate the possible influence of recently developed oral cephem derivatives on normal human microflora. We have investigated the impact on normal human intestinal flora in a 10-day course with cefetamet-pivoxil (CET, 500 mg BID) in comparison to cefixime (CFX, 400 mg qD) or cefuroxime axetil (CA, 250 mg BID) in 24 patients suffering from acute exacerbation of chronic bronchitis. Stool specimens were taken before (day 0), at the end (day 10) and 14 days after treatment (day 24) and quali-quantitative microflora composition was determined with a detection limit of 10 CFU/g dry weight. Treatment with CET caused slight and non-significant modifications of normal intestinal flora. On the contrary CFX and CA significantly affect Enterobacteriaceae and clostridia with a concomitant increase in enterococci for CFX. With both CFX and CA there was a new appearance of Salmonella spp. as well as Clostridium difficile in 4 and 2 cases, respectively. Therefore CET seems to affect normal bowel flora minimally in comparison to other oral cephalosporins. This aspect might contribute to the low incidence of GI related side effects in patients treated with CEt for longer than 1 week.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria, Anaerobic; Bronchitis; Cefixime; Cefotaxime; Ceftizoxime; Cefuroxime; Cephalosporins; Chronic Disease; Clostridium; Enterobacteriaceae; Enterococcus; Feces; HeLa Cells; Humans; Intestines; Microbial Sensitivity Tests; Middle Aged

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

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

Efficacy and safety of a new oral third generation Cephalosporin, Cefotiam Hexetil (CTM) 200 mg bid were compared with those of Cefixime (CX) 200 mg bid over 10 day duration of treatment. One hundred and twenty two ambulatory adults suffering from chronic sinusitis were randomized by ENT specialists in this multicentre prospective double blind, doubled dummy study. Sinusitis diagnosis evocated in front of fascial pain, purulent nasal discharge and/or obstruction was confirmed with sinus X-ray. Use of antibiotics or corticosteroids concomitantly or 15 days prior inclusion represented one of the major exclusion criterion. One hundred and seventy one patients were evaluated for efficacy analysis (62 and 59 respectively in CTM and CX groups). Regarding demographic data, clinical and radiological signs, the two populations were comparable at inclusion excepted for sex and weight (female: 73% in CTM group versus 47% in CX group). The overall clinical success rate at the end of treatment (cure+improvement) was not significantly different between the two groups (CTM: 82% versus CX: 80%). The incidence of adverse events was less frequent in the CTM group (14.5% versus 19%). In conclusion, CTM 200 mg bid is as efficacious and as well tolerated as CX 200 mg bid in the treatment of chronic sinusitis in adults.

Topics: Anti-Infective Agents; Cefixime; Cefotaxime; Cefotiam; Chronic Disease; Double-Blind Method; Female; Humans; Male; Prodrugs; Prospective Studies; Sinusitis

Twenty-three stabilized chronic uremic patients with no active or recent infection were treated for 10 days with either cefodizime (5 x 2 g intravenously, n = 10) or cotrimoxazole (960 mg orally b.i.d., n = 8) in order to evaluate the effects on the depressed polymorphonuclear metabolic response to phagocytic challenge; a separate group of 5 patients received placebo. Ex vivo evaluation in whole blood of energy delivery to the phagocytosis-associated respiratory burst activity in response to latex and zymosan challenge was determined by measuring hexose-monophosphate shunt NAD(P)H-oxidase-related glycolytic activity. Cefodizime induced a statistically significant increase in the baseline-depressed glycolytic response for both latex and zymosan challenge, in contrast to cotrimoxazole and placebo. Depressed phagocytosis-related metabolic function in hemodialyzed patients was stimulated by cefodizime in recommended therapeutic doses but not by cotrimoxazole, the effect persisting for at least 2 weeks after the end of treatment.

Topics: Adult; Aged; Cefotaxime; Chronic Disease; Dose-Response Relationship, Drug; Energy Metabolism; Female; Glycolysis; Humans; Injections, Intravenous; Latex; Male; Middle Aged; NADH, NADPH Oxidoreductases; NADPH Oxidases; Neutrophils; Phagocytes; Phagocytosis; Renal Dialysis; Respiratory Burst; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Uremia; Zymosan

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

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

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

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

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

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

Topics: Adult; Aged; Cefmenoxime; Cefotaxime; Ceftizoxime; Cephalosporins; Chronic Disease; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Respiratory Tract Infections

Topics: Cefotaxime; Cephamycins; Chronic Disease; Clinical Trials as Topic; Humans; Lung Abscess; Pneumonia; Respiratory Tract Infections

Topics: Bronchitis; Cefotaxime; Cephalosporins; Chronic Disease; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Streptococcus pneumoniae

The purpose of this study was to gather temporal trends on bacteria epidemiology and resistance of intraoperative bone culture from chronic ostemyelitis at an affiliated hospital in South China.. Records of patients with chronic osteomyelitis from 2003 to 2014 were retrospectively reviewed. The medical data were extracted using a unified protocol. Antimicrobial susceptibility testing was carried out by means of a unified protocol using the Kirby-Bauer method, results were analyzed according to Clinical and Laboratory Standards Institute definitions.. Four hundred eighteen cases met our inclusion criteria. For pathogen distribution, the top five strains were Staphylococcus aureus (27.9%); Pseudomonas aeruginosa (12.1%); Enterobacter cloacae (9.5%); Acinetobacter baumanii (9.0%) and Escherichia coli (7.8%). Bacterial culture positive rate was decreased significantly among different year-groups. Mutiple bacterial infection rate was 28.1%. One strain of Staphylococcus aureus was resistant to linezolid and vancomycin. Resistance of Pseudomonas aeruginosa stains to Cefazolin, Cefuroxime, Cefotaxime, and Cefoxitin were 100% nearly. Resistance of Acinetobacter baumanii stains against Cefazolin, Cefuroxime were 100%. Ciprofloxacin resistance among Escherichia coli isolates increased from 25 to 44.4%. On the contrary, resistance of Enterobacter cloacae stains to Cefotaxime and Ceftazidime were decreased from 83.3 to 36.4%.. From 2003 to 2014, positive rate of intraoperative bone culture of chronic osteomyelitis was decreased; the proportion of Staphylococcus aureus was decreased gradually, and our results indicate the importance of bacterial surveilance studies about chronic osteomyelitis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefotaxime; China; Chronic Disease; Drug Resistance, Bacterial; Escherichia coli; Female; Hospitals; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Osteomyelitis; Pseudomonas aeruginosa; Retrospective Studies; Rifampin; Staphylococcus aureus; Young Adult

Topics: Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Chronic Disease; Humans; Immunocompromised Host; Male; Meningococcal Infections; Neisseria meningitidis, Serogroup B

Spontaneous (primary) bacterial peritonitis (SBP) due to S. paratyphi A is relatively uncommon. Clinical manifestations of SBP vary widely from severe to slight or absent, necessitating laboratory investigation of ascitic fluid. The disease is confirmed by number of neutrophils > 250/mm3 associated with or without bacterial growth in ascitic fluid culture from diagnostic abdominal paracentesis. Here, we present a case of S. paratyphi A SBP occurring in a patient with chronic liver disease and portal hypertension.The patient was treated with intravenous cefotaxime with good clinical response.

Topics: Anti-Bacterial Agents; Cefotaxime; Chronic Disease; Esophageal and Gastric Varices; Humans; Hypertension, Portal; Male; Middle Aged; Paratyphoid Fever; Peritonitis; Salmonella paratyphi A

Fungal rhinosinusitis is being recognized and reported with increasing frequency over the last two decades worldwide. Intracranial extension is the most dreaded complication of fungal sinusitis with high mortality rates. We report a case of chronic rhinosinusitis in a 55-year-old diabetic male, caused by Fusarium species. The patient was diagnosed as a case of chronic left maxillary sinusitis with cavernous sinus thrombosis. The sinus lavage showed fungal elements on direct microscopic examination and culture revealed growth of Fusarium species within 4 days of incubation. Conservative therapy with IV amphotericin B resulted in favorable outcome of the patient. This is an extremely rare case where cavernous sinus thrombosis occurred as a complication secondary to Fusarium species rhinosinusitis.

Topics: Amphotericin B; Cavernous Sinus Thrombosis; Cefotaxime; Chronic Disease; Diabetes Mellitus, Type 2; Diplopia; Disease Susceptibility; Fusariosis; Fusarium; Headache; Humans; Insulin; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Middle Aged; Photophobia; Rhinitis; Vomiting

The data on the taxonomic structure and antibiotic resistance of Enterobacteriaceae isolated from bile of patients with various clinical variants of cholangitis are presented. It was shown that bacteriocholia was registered in 53.3-90.9% of the patients during operations and in 88.9-100% of the patients during the postoperative period. Among bilicultures enterobacteria dominated (93.4% of the cases) with predominance of E. coli and Klebsiella spp. (the total about 70%). The enterobacteria isolates were frequently resistant to ampicillin and amoxycillin/clavulanate (92.6 and 70.4% of the strains respectively), gentamicin and amikacin (74.1 and 22.2%), cefazolin and cefotaxime (88.9 and 37.0%). The resistance to imipenem and ciprofloxacin (7.4%) was rare, that should be considered while prescribing drugs for empirical antimicrobial chemotherapy.

Topics: Adult; Aged; Aged, 80 and over; Amikacin; Amoxicillin; Anti-Bacterial Agents; Bile; Cefazolin; Cefotaxime; Cholangitis; Chronic Disease; Ciprofloxacin; Drug Resistance, Bacterial; Enterobacteriaceae; Female; Gentamicins; Humans; Male; Middle Aged

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia burgdorferi; Cefotaxime; Ceftriaxone; Chronic Disease; Diagnosis, Differential; Encephalitis, Herpes Simplex; Humans; Hysteria; Lyme Neuroborreliosis; Male; Recurrence

Topics: Cefotaxime; Cephalosporins; Chronic Disease; Humans; Male; Middle Aged; Parotitis; Salmonella; Salmonella Infections; Suppuration

Topics: Cefotaxime; Cephalosporins; Chronic Disease; Humans; Infant; Injections, Intravenous; Male; Meningococcal Infections; Neisseria meningitidis

Topics: Aeromonas hydrophila; Bacteremia; Cefotaxime; Cephalosporins; Chronic Disease; Female; Gram-Negative Bacterial Infections; Humans; Liver Cirrhosis; Middle Aged; Peritonitis

Topics: Aged; Anti-Infective Agents; Bronchitis; Cefixime; Cefotaxime; Chronic Disease; Drug Tolerance; Humans; Male; Middle Aged; Respiratory Tract Infections; Time Factors

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

1 or 2 g doses of cefodizime i.m. were studied in 287 patients admitted to hospital with acute purulent exacerbations of chronic bronchitis, mostly associated with Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis. Pharmacokinetic studies in serum and sputum on the first treatment day yielded mean peak serum concentrations of 50 to 100 mg/l, with corresponding sputum concentrations of 1.4 and 2.7 mg/l, after the two respective doses. No great differences were found between the clinical and microbiological results in the various dosage groups, and no corresponding improvement was noted with the highest dosages studied. In general, infection was eliminated in 90 to 95% of patients at the end of treatment, and in approximately 70 to 80% after a follow-up week. Some infections associated with beta-lactamase producing M. catarrhalis persisted or relapsed after treatment. Unwanted drug effects were recorded in five patients, leading to discontinuation in two. It is concluded that a single daily intramuscular dose of 1 g cefodizime for seven days produces satisfactory results in most patients.

Topics: Aged; Bacteria; Bronchitis; Cefotaxime; Chronic Disease; Female; Humans; Male; Middle Aged; Sputum; Suppuration

Patients with renal failure are highly susceptible to infection, in part because uremia decreases the killing capacity of phagocytic leucocytes. Phagocytosis-associated respiratory burst activity was investigated at different stages of renal impairment by measuring the 14CO2 production during metabolism of labeled glucose by phagocytic cells. Non-dialyzed end-stage renal failure and haemodialysis patients showed a decrease in phagocytosis to about 50% of normal (p less than 0.05). In a second phase of the study, six haemodialysis patients received 2 g cefodizime (CDZ) i.v. after dialysis for ten days (five doses). Phagocytosis was determined at baseline and was followed until day 29. A clear, long-lasting stimulatory effect of CDZ on phagocytosis after both latex and zymosan challenge was found. It is concluded that a usual CDZ dosage regimen stimulates depressed phagocytosis in haemodialysis patients, and that this stimulatory effect persists for at least two weeks after the end of treatment. Uremic patients with infection may benefit from this additional property of CDZ.

Topics: Cefotaxime; Chronic Disease; Humans; Phagocytosis; Respiratory Burst; Uremia

Concentrations of cefotaxime and its major active metabolite, desacetylcefotaxime, were determined in the serum and bronchial secretion of patients with chronic bronchitis aggravated after intramuscular injection of cefotaxime in a dose of 4 g once a day. Characteristic patterns of cefotaxime metabolism and high peak concentrations of desacetylcefotaxime in the serum (67.6 +/- 17.2 micrograms/ml) defined the prolonged retention of the metabolite both in the blood and bronchial secretion. The metabolite concentrations in more than half of the patients maintained within 2 micrograms/ml in the bronchial secretion by the 12th hour after the injection and in the blood serum by the 24th hour. Therefore, 4 g cefotaxime administered intramuscularly once a day provided the blood concentrations of the metabolite comparable with the MIC for the majority of the pathogens causing nosocomial infections of the respiratory tract practically within the whole period of the daily dosage. In the bronchial secretion such concentrations were attained within half of the period of the daily dosage.

Topics: Adult; Biological Availability; Bronchi; Bronchitis; Cefotaxime; Chronic Disease; Circadian Rhythm; Humans; Injections, Intramuscular; Middle Aged; Sputum; Time Factors

The dispositions of cefotaxime and its metabolite desacetylcefotaxime were investigated in patients with different forms of chronic parenchymal liver disease (CPLD). A total of 31 subjects (27 patients and 4 controls) received a single 2-g dose of cefotaxime by infusion, and serial blood samples were drawn. The area under the concentration-time curve ranged from 176 to 241 micrograms.h/ml, the apparent half-life ranged from 1.49 to 2.42 h, and clearance ranged from 2.06 to 3.10 ml/min/kg in patients with four different forms of CPLD. The area under the concentration-time curve and the apparent half-life of desacetylcefotaxime ranged from 72 to 128 micrograms.h/ml and 7.1 to 13.4 h, respectively. Pharmacokinetic parameters were significantly different in patients with CPLD compared with those in control subjects and were related to clinical indices of hepatic impairment. Modest accumulation of cefotaxime in patients with severe hepatic impairment is unlikely to produce toxicity because of its high therapeutic index, and dosing modifications may not be required.

Topics: Adult; Cefotaxime; Chromatography, High Pressure Liquid; Chronic Disease; Half-Life; Humans; Liver Diseases; Middle Aged

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

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

An experimental model in Wistar rats, of osteomyelitis caused by Escherichia coli, was used to evaluate the efficacy of cefotaxime in two treatment regimens of different durations. Four groups of rats were set up: a group of rats receiving short-term treatment (14 days) with subcutaneous cefotaxime (100 mg bd), killed after 56 days; a control group receiving no treatment, killed after 56 days; a group of rats undergoing long-term treatment (28 days) with subcutaneous cefotaxime as above, killed after 70 days and a control group of rats receiving no treatment, killed after 70 days. Analysis of histopathological and microbiological findings revealed significantly better results in the long-term treatment group. No side-effects were observed during treatment or afterwards.

Topics: Animals; Cefotaxime; Chronic Disease; Disease Models, Animal; Escherichia coli Infections; Female; Osteomyelitis; Rats; Rats, Inbred Strains

Clinical, microbiological and pharmacokinetic studies were carried out after 1 or 2 g intramuscular injections bd of cefodizime (HR 221), a new aminothiazolyl cephalosporin, in 41 patients hospitalized for acute purulent exacerbations of chronic respiratory disease. Treatment was for 10 days. Serum Cmax values of 54.8 and 84.7 mg/l were recorded approximately 2 hours after the injections, the corresponding sputum values averaging 1.01 and 2.58 mg/l. Penetration from blood to sputum was 2 to 3.6%. The elimination phase half-life in serum was approximately 4.5 h. Clinical, microbiological and pharmacokinetic studies were carried out after 1 or 2 g intramuscular injections bd of cefodizime (HR 221), a new aminothiazolyl cephalosporin, in 41 patients hospitalized for acute purulent exacerbations of chronic respirators disease. Treatment was for 10 days. Serum Cmax values of 54.8 and 84.7 mg/l were recorded approximately 2 hours after the injections, the corresponding sputum values averaging 1.01 and 2.58 mg/l. Penetration from blood to sputum was 2 to 3.6%. The elimination phase half-life in serum was approximately 4.5 h.

Topics: Adult; Aged; Aged, 80 and over; Cefotaxime; Chronic Disease; Female; Humans; Kinetics; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Diseases; Suppuration

Topics: Adolescent; Adult; Aged; Cefotaxime; Chronic Disease; Female; Humans; Lung Diseases; Male; Middle Aged; Opportunistic Infections; Respiratory Tract Infections

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

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

Cefmenoxime (2 g) and cefsulodin (1 g) were given twice daily for 5 days by concomitant intravenous drip infusion (mixed infusion) to 135 patients with complicated urinary tract infection (c-UTI) probably caused by Pseudomonas aeruginosa. The clinical efficacy was evaluated according to the criteria proposed by the UTI committee in Japan. Ninety one subjects met the criteria for c-UTI and were evaluable for drug efficacy. P. aeruginosa was detected in 44 cases (including mixed infection with other organisms). The overall efficacy rate was 73% of the 91 cases; 75% of the 44 cases with P. aeruginosa and 70% in the 47 cases without P. aeruginosa infection. As to bacteriological response, the eradication rate was 91% (105/116) for all cases. By organism, the eradication rate for P. aeruginosa, Serratia spp. and Citrobacter spp. were 82 (36/44), 100 (12/12) and 100% (10/10), respectively. The eradication rate for gram-negative rods was 93% (99/107). Twenty-three strains appeared after treatment, and the majority of them (13) were yeast-like organisms. There was only one strain of P. aeruginosa. As for side effects, eruption was found in 2 cases. Cefmenoxime and cefsulodin were administered concomitantly to patients with c-UTI which was suspected to be caused by P. aeruginosa. The high overall efficacy rate of about 70% on the average was obtained regardless of the causative organism and disease state. The eradication rate of as high as about 90% was obtained excluding Enterococcus faecalis. Neither severe side effects nor abnormal laboratory values were found. It appeared, therefore, that this dosage regimen was useful for the treatment of refractory complicated urinary tract infection.

Topics: Anti-Infective Agents, Urinary; Cefmenoxime; Cefotaxime; Cefsulodin; Chronic Disease; Drug Administration Schedule; Drug Evaluation; Drug Therapy, Combination; Humans; Pseudomonas Infections; Urinary Tract Infections

With the recent development of new potential antibiotics, it has become easier to treat patients with common bacterial infections. However, we find it difficult to handle severe infections due to opportunistic pathogens, developed in the so-called immunocompromised patients. SM-4300 is a newly developed intravenous human gamma-globulin, which is said to be intact without conventional enzyme-treatment and sulfonization. SM-4300 is also free from large molecules of aggregated gamma-globulin. SM-4300 was administered in combination with antibiotics to 2 patients of severe respiratory infections, having refractory underlying diseases. Case No. 1 was a 65-year-old female with bronchopneumonia, who had been suffering from pulmonary fibrosis, chronic bronchitis, chronic congestive heart failure and tricuspid insufficiency for several years. During her hospitalization because of these diseases, she developed cough with slight sputum and exertional dyspnea accompanied by high body temperature of 38 degrees C on January 1983. Chest X-ray revealed infiltration in the right lung field which was compatible with bronchopneumonia. SM-4300 of 5 g was added intravenously on 5th day after 4 day-cefotiam treatment with no improvement. High body temperature subsided and laboratory data became normal around 3 days after single SM-4300 injection. Case No. 2 was a 68-year-old male patient of chronic bronchitis with chronic pulmonary emphysema and bronchial asthma. Around the end of May 1983, he complained of dyspnea on exertion and had mucopurulent sputum, more than 100 ml daily, from which Pseudomonas aeruginosa was cultured in large number. He was afebrile.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Bronchitis; Bronchopneumonia; Cefotaxime; Cefotiam; Cefsulodin; Chronic Disease; Drug Evaluation; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Immunization, Passive; Immunoglobulins; Infusions, Parenteral; Pseudomonas aeruginosa

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

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

The therapeutic efficacy and pharmacokinetics of the cephalosporins ceftazidime, ceftizoxime, cefotaxime and HR 221 were studied in animal experiments. The animal model used was experimental estrogen-induced or non-induced chronic Escherichia coli pyelonephritis in rats. The animals were treated with 5 mg cephalosporin/kg twice daily for one week. Each of the cephalosporins tested led to a significant decrease in renal bacterial counts, in spite of the low doses given. Ceftazidime was significantly more active than HR 221 in both experimental models, although the serum levels of HR 221 were higher and were maintained for a longer period of time than those of ceftazidime. Differences in pharmacokinetic properties (influenced by metabolic stability and protein binding) could be the reason for the differences in therapeutic activity, since the in vitro antimicrobial activity of each of the cephalosporins tested was very similar against the test strain.

Topics: Animals; Cefotaxime; Ceftazidime; Ceftizoxime; Cephalosporins; Chronic Disease; Drug Evaluation, Preclinical; Escherichia coli Infections; Pyelonephritis; Rats

Clinical efficacy and safety of cefotiam were studied. Twelve patients with chronic sinusitis and 14 patients with chronic otitis media were intravenously given cefotiam in daily doses of 2 g for 7 to 10 days. In chronic sinusitis, clinical responses were excellent in 6 patients, good in 3 and fair in 3, the rate of satisfactory clinical responses (excellent and good) being 75%. In chronic otitis media, the responses were excellent in 5, good in 4 and fair in 5, the rate of satisfactory clinical responses being 65%. As for side effects, eruption and abdominal pain were observed in 1 patient.

Topics: Adolescent; Adult; Aged; Cefotaxime; Cefotiam; Child; Chronic Disease; Drug Evaluation; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Otitis Media; Sinusitis

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

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