cefotaxime and Cystic-Fibrosis

A review of clinical studies of piperacillin shows that it is valuable for the treatment of respiratory infections due to Enterobacteriaceae, Pseudomonas sp, anaerobes, and mixed flora including anaerobes. Various studies of a total of 420 patients treated with piperacillin for lower respiratory tract infections found that 97% of the patients were cured or markedly improved. Piperacillin has also been found as effective as combination therapy (gentamicin or tobramycin plus carbenicillin or ticarcillin) in the treatment of serious infections, including pneumonia and several caused by gram-negative organisms and anaerobic organisms. A review of the literature on bacteriological responses to piperacillin shows that 126 of 153 (82%) of the susceptible strains could be eradicated. Streptococcus pneumoniae, beta-hemolytic streptococci, Haemophilus influenzae, Peptostreptococcus sp, Bacteroides sp, and Fusobacterium sp have been completely eradicated by treatment with piperacillin. Most of the published studies indicate that therapy with the drug is usually well tolerated.

Topics: Amikacin; Carbenicillin; Cefotaxime; Cystic Fibrosis; Drug Therapy, Combination; Enterobacteriaceae; Haemophilus influenzae; Humans; Piperacillin; Pseudomonas Infections; Respiratory Tract Infections; Streptococcus; Streptococcus pneumoniae; Tobramycin

We have investigated the effectiveness of seven new beta-lactam antibiotics, azlocillin, piperacillin, ceftazidime, cefsulodin, cefoperazone, latamoxef (moxalactam), and cefotaxime, against acute pulmonary exacerbations caused by Pseudomonas aeruginosa in cystic fibrosis. Three hundred and fifty-five strains of Ps aeruginosa isolated from 310 sputum cultures (190 cystic fibrosis patients) were tested for susceptibility to the drugs by determination of minimal inhibitory concentrations (MIC). The highest activity was shown by ceftazidime (6% resistant strains) followed by cefsulodin and piperacillin (15 and 16% resistant strains); very low activity was found for cefotaxime and latamoxef (moxalactam). Ceftazidime was the most active drug against 32 pseudomonas isolates that were resistant to both carbenicillin and aminoglycosides (78% susceptible). A randomized, double-blind trial of azlocillin, piperacillin, ceftazidime, cefsulodin or cefoperazone was performed in 111 cystic fibrosis patients with predominant and susceptible pseudomonas in their sputum. Results were evaluated by a clinical, radiological and bacteriological scoring system: the best results were obtained with ceftazidime, followed by cefsulodin and piperacillin. However, pseudomonas was eradicated in only 22 (23%) of the cases with the most active drugs and persisted or reappeared in all the cases 1 to 3 months later. Ceftazidime always eradicated Staph. aureus and Haemophilus influenzae associated with pseudomonas. Similar eradication occurred nearly always with cefsulodin but rarely with the other drugs. No serious drug reaction occurred but a later fever and rash with piperacillin, transient diarrhoea with cefoperazone, vomiting with cefsulodin, and very frequent eosinophilia with ceftazidime should be mentioned. These five drugs offer, in varying degree, alternatives to traditional anti pseudomonas antibiotics in cystic fibrosis pulmonary infections, but they should be used only against well-proven resistant strains. Ceftazidime is best and cefotaxime and latamoxef (moxalactam) least useful.

Topics: Adolescent; Alcohol Deterrents; Anti-Bacterial Agents; Azlocillin; Cefoperazone; Cefotaxime; Cefsulodin; Ceftazidime; Cephalosporins; Child; Clinical Trials as Topic; Cystic Fibrosis; Double-Blind Method; Eosinophilia; Humans; Moxalactam; Penicillins; Piperacillin; Pseudomonas Infections; Random Allocation; Respiratory Tract Infections

In cystic fibrosis (CF) patients, Ear Nose Throat (ENT) pathology is often undiagnosed despite its high prevalence and its possible life-threatening complications. We present the case of an ethmoidal mucocele leading to ocular manifestations in a 2-year-old girl with cystic fibrosis with no previous serious complications. She progressively developed non-axial proptosis, limitation of the adduction and exotropia of her left eye. Paranasal sinus magnetic resonance image (MRI) showed a left ethmoidal mucocele causing displacement of the ocular globe, compression of the medial rectus and the optic nerve. Eye fundus revealed disc edema and diffuse vascular congestion. Endoscopic sinus surgery was performed to remove the mass. The mucocele was drained and the discharge was sent for microbiology assessment. Escherichia coli (E. coli) was found in the culture and treated with cefotaxime and dexamethasone with complete resolution of non-axial proptosis and disc edema.

Topics: Cefotaxime; Child; Child, Preschool; Cystic Fibrosis; Dexamethasone; Escherichia coli; Ethmoid Sinus; Exophthalmos; Female; Humans; Mucocele; Paranasal Sinus Diseases

A series of N-methylthio-β-lactams with antibacterial activity were thoroughly evaluated as antioxidants. We found that only the presence of a polyphenolic moiety anchored to the β-lactam ring ensured an adequate antioxidant potency. New compounds, efficiently combining in one structure antioxidant and antibacterial activity, may provide a promising basis for the development of new leads useful in adverse clinical conditions such as in cystic fibrosis patients, in whom colonization by MRSA and epithelial damage by chronic pulmonary oxidative stress take place.

Topics: Anti-Bacterial Agents; Antioxidants; Azetidines; Cystic Fibrosis; Dose-Response Relationship, Drug; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Molecular Structure; Monobactams; Structure-Activity Relationship; Sulfides

Expression of ampC, oprD, mexA, mexC, mexE, and mexX was studied in 25 Pseudomonas aeruginosa isolates from cystic fibrosis patients, including 14 isolates of the Liverpool epidemic strain. Overexpressed mexA or ampC and reduced oprD were associated with beta-lactam resistance. A specific combination of mexR, nalC, and nalD mutations occurred in 11 Liverpool strain isolates, including 7 with upregulated mexA.

Topics: Bacterial Outer Membrane Proteins; Bacterial Proteins; beta-Lactamases; Cystic Fibrosis; Drug Resistance, Bacterial; Drug Resistance, Multiple; Electrophoresis, Gel, Pulsed-Field; Humans; Membrane Transport Proteins; Mutation; Porins; Pseudomonas aeruginosa; Pseudomonas Infections; Reverse Transcriptase Polymerase Chain Reaction; Up-Regulation

The in vitro antibacterial activity of sulbenicillin against a number of mucoid and non-mucoid strains of Pseudomonas aeruginosa was investigated and compared with that of some other beta-lactam antibiotics. From the data reported it is evident that sulbenicillin showed better anti-microbial activity than carbenicillin in almost all the tests run. Sulbenicillin appears to have a somewhat lower activity than piperacillin and cefotaxime; however, cefotaxime and particularly piperacillin are highly conditioned by the inoculum size and have a less favourable MBC to MIC ratio.

Topics: Ampicillin; Carbenicillin; Cefotaxime; Cystic Fibrosis; Humans; Methods; Microbial Sensitivity Tests; Penicillin G; Piperacillin; Pseudomonas aeruginosa; Sulbenicillin

The in vitro activities of gentamicin, tobramycin, amikacin, azlocillin, carbenicillin, mezlocillin, piperacillin, ticarcillin, cefotaxime, ceftizoxime, cefoperazone, cefsulodin, moxalactam, ceftazidime, ceftriaxone, and N-formimidoyl thienamycin were measured against 62 isolates of Pseudomonas aeruginosa obtained from patients with cystic fibrosis. Ceftazidime and N-formimidoyl thienamycin were the most active of these agents.

Topics: Anti-Bacterial Agents; beta-Lactams; Carbenicillin; Cefoperazone; Cefotaxime; Ceftazidime; Cephalosporins; Cystic Fibrosis; Imipenem; Penicillins; Piperacillin; Pseudomonas aeruginosa; Pseudomonas Infections