cefotaxime and Diarrhea

Clostridium difficile diarrhoea is an increasingly important nosocomial infection. Clostridium difficile infection is associated with antibiotic use. The elderly are at greatest risk. We reported an outbreak associated with the use of cefotaxime, a third-generation cephalosporin. We review the extent of this association, putative causal mechanisms and suggest an integrated approach to the control of C difficile infection which focuses on both limiting environmental contamination and reducing patient susceptibility. Future developments are also considered, especially the potential for vaccination.

Topics: Aged; Cefotaxime; Cephalosporins; Clostridioides difficile; Cross Infection; Diarrhea; Enterocolitis, Pseudomembranous; Forecasting; Humans; Risk Factors

Rates of Clostridium difficile diarrhoea have recently been rising, with the elderly being at highest risk.. To compare the incidence of C. difficile colonization and diarrhoea in elderly patients treated for presumed infection with either empirical cefotaxime (CTX) or piperacillin-tazobactam (PT).. A prospective, ward-based, crossover study was carried out on two well-matched care of the elderly wards at a UK tertiary care hospital, in patients requiring empirical broad-spectrum antibiotic treatment.. There was a highly significant increased incidence of C. difficile colonization (26/34 vs. 3/14, P=0.001) and diarrhoea (18/34 vs. 1/14, P=0.006) in patients who received CTX as opposed to PT. DNA fingerprinting suggested that most infections arose from strains acquired from the hospital environment.. Elderly patients are significantly less likely to develop C. difficile diarrhoea after treatment with PT than after CTX. The source of C. difficile appears to be predominantly from the ward environment.

Topics: Aged; beta-Lactamase Inhibitors; Cefotaxime; Clostridioides difficile; Cross Infection; Cross-Over Studies; Diarrhea; Drug Combinations; Enterocolitis, Pseudomembranous; Enzyme Inhibitors; Female; Humans; Male; Opportunistic Infections; Penicillanic Acid; Piperacillin; Prospective Studies; Tazobactam

In a double-blind study cefixime, an oral cephalosporin of the third generation, was compared to cefaclor in the treatment of acute otitis media in 397 children aged 6 months to 12 years. Clinical evaluation was carried out at the beginning, at day 10-12 and day 28-35 after the start of the treatment. Specimens for bacterial culture and sensitivity testings were taken from the nasopharynx at the initial visit. Patients were randomized either to cefixime in a dose of 8 mg/kg/day or cefaclor in a dose 40 mg/kg/day in the proportion of 2 cefixime patients to 1 cefaclor patient. Two daily doses were administered for 7 days. At day 10-12, 93.5% in the cefixime group and 90.5% in the cefaclor group (p = 0.08) were clinically cured or improved. At day 28-35 the rate of cured or improved patients had decreased, mostly due to reinfections, to 90.1% in the cefixime group and to 86.6% in the cefaclor group (p = 0.12), respectively. 375 patients (69.9%) had positive bacterial culture in the nasopharynx of at least one strain of Haemophilus influenzae, Streptococcus pneumoniae, Branhamella (Moraxella) catarrhalis or combinations of these 3.73.6% of the B. catarrhalis strains were beta-lactamase producing and 11.4% of the H. influenzae strains, respectively. All isolated bacteria were sensitive to cefixime. Adverse events were reported in 17.9% in the cefixime and 10.6% in the cefaclor group. Most reactions were of moderate or mild nature and mostly affected skin or the gastrointestinal region. No serious adverse experiences occurred. In view of the good clinical results obtained cefixime seems to be at least as effective as cefaclor in the treatment of acute otitis media in children.

Topics: Acute Disease; Anti-Bacterial Agents; Cefaclor; Cefixime; Cefotaxime; Child; Child, Preschool; Diarrhea; Double-Blind Method; Female; Haemophilus influenzae; Humans; Infant; Male; Moraxella catarrhalis; Otitis Media with Effusion; Streptococcus pneumoniae

Cefotiam, a second generation cephalosporin and cefoperazone, a third generation cephalosporin have a broad spectrum of activity against a majority of organisms commonly found in the bile. Although cefoperazone is excreted into the human bile to a greater extent than is cefotiam, there are no comparative data available that cefoperazone prophylaxis is safer and more effective than cefotiam for patients undergoing biliary tract surgery. A prospective randomized study was performed to compare the safety and efficacy of cefotiam with those of cefoperazone for prophylaxis in patients undergoing elective biliary tract surgery. The incidence of postoperative infection was not significantly different between the cefotiam group (n = 86) and the cefoperazone group (n = 86). The rate of side effects, however, was significantly different. In the cefotiam group, only one patient had diarrhea whereas in the cefoperazone group, eight had diarrhea and one skin eruption. Clostridium difficile cytotoxin was nil in those with diarrhea. Diarrhea in all patients was mild and recovery was rapid. Cefotiam is thus safer and as effective as cefoperazone in preventing postoperative infections following biliary tract surgery. We suggest that cefotiam is the first choice antibiotic for prophylaxis in biliary tract surgery.

Topics: Adult; Aged; Biliary Tract Surgical Procedures; Cefoperazone; Cefotaxime; Cefotiam; Diarrhea; Drug Eruptions; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection

Cefixime, a new third generation oral cephalosporin antibiotic, was evaluated for safety and efficacy in the treatment of 206 children with acute bacterial pharyngitis, cystitis or pneumonia. Each patient had a throat, urine or sputum culture before therapy and was treated with a 10- to 14-day course of cefixime, 8 mg/kg once daily. Bacterial pathogens were isolated in 167 of 206 (81.1%). Streptococcus pyogenes (73.7% of isolates) and Escherichia coli (9.6%) were the most common Gram-positive and Gram-negative organisms, respectively. All patients were evaluable for safety, and 109 (52.9%) with pharyngitis (96) or cystitis (13) were evaluable for efficacy. Clinical failure occurred in 2 of 109 (1.8%) patients, both with pharyngitis; bacteriologic failure occurred in 1 patient with pharyngitis and 1 with cystitis. Five patients with pneumonia caused by possible pathogens also improved while taking cefixime. Drug-related adverse side effects occurred in 50 of 206 patients (24.3%); these were generally mild and led to discontinuing the antibiotic in only 4 patients (1.9%). The most common were diarrhea or loose stools (33 of 206, or 16%). Results of this study suggest that cefixime given once daily to children is safe and effective in the treatment of streptococcal pharyngitis and bacterial cystitis.

Topics: Adolescent; Cefixime; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Cystitis; Diarrhea; Female; Humans; Infant; Male; Pharyngitis; Pneumonia

The clinical and laboratory safety of cefixime based on analysis of data from 1575 adults (1118 treated daily and 457 treated twice a day) and 615 children (299 treated daily and 316 treated twice a day) in studies of urinary tract and lower and upper respiratory tract infections (including otitis media) is reviewed. The incidence of adverse clinical experiences and occurrence of laboratory abnormalities were similar to those seen with other beta-lactam antimicrobial agents. Gastrointestinal side effects were the predominant adverse experiences seen in both daily and twice daily programs in adults and children. The incidence of gastrointestinal intolerance was not dependent upon the frequency of the dosage. Symptoms of drug hypersensitivity were infrequently reported. No serious chemical, hematologic or urologic abnormalities were noted. The data confirm the safety of cefiximine in both adults and children, whether it is administered once or twice a day.

Topics: Adult; Cefixime; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Drug Administration Schedule; Drug Hypersensitivity; Feces; Female; Humans; Infant; Male; Respiratory Tract Infections; Urinary Tract Infections

We have attempted to clinically define the therapeutic usefulness of ceftizoxime suppository (CZX-S) in children with bacterial pneumonia, in a randomized trial. Intravenous injection of ceftizoxime (CZX) was used as the control. The results are summarized below. Subjects were inpatients with bacterial pneumonia, ranging in age from 9 months to 7 years and 10 months. As a rule, the daily dose was either four 250 mg (in potency) suppositories given at 6-hour intervals or 60 mg/kg body weight intravenous CZX (control) given in 4 injections at 6-hour intervals over a period of 7 days. The number of children in the study was 67. These children were divided into 2 dosage groups (suppository, 35; injection, 32) with matching pretreatment background factors. The severity of the target disease in the majority of the children was "moderate". The rate of therapeutic effectiveness was 97.1% for the suppository and 93.8% for the injection, and did not differ significantly between the 2 groups. Rates of efficacy by severity, presence or absence of underlying diseases, daily dose and/or complications were high without exception, and did not differ significantly between the 2 groups. Eradication rates for causative microorganisms, as studied in 16 children of each group, were both 93.8%. The 2 most frequently isolated causative organisms were Haemophilus influenzae and Streptococcus pneumoniae. Side effects were examined for 36 children of each group. The frequency of side effects did not differ significantly between the suppository group (2 with diarrhea and 1 with abdominal pain) and the injection group (1 with urticaria), and 8.3% and 2.8%, respectively. The frequency of abnormal laboratory test findings differed significantly (P less than 0.01) with respect to eosinophilia which occurred in 7 (20.6%) of the injected subjects but was not encountered in the subjects treated with suppositories. Other abnormal laboratory findings included thrombocytosis in 3 (14.3%) of the injection group and increased GOT in 1 (3.2%) of the suppository group. The suppository formulation of CZX appears to be a highly useful substitute for the injectable form, and should find a special use in children whose treatment with injections experiences some difficulty.

Topics: Abdomen; Acute Disease; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Humans; Infant; Injections, Intravenous; Pain; Pneumonia; Suppositories; Urticaria

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

Gastroenteritis is one of the leading cause of illnesses through the world, especially in developing countries.Salmonella and Shigella infections are considered as the main public health problems in children. The aim of this study was to detect the prevalence and antimicrobial susceptibility of Salmonella and Shigella spp. among children with gastroenteritis in an Iranian referral hospital.. During April 2013 to April 2014, all medical records of children with gastroenteritis admitted to a pediatric medical center were evaluated. Positive stool cultures of children were evaluated and frequency of Salmonella and Shigella spp. and their antimicrobial susceptibility were detected.. In this study, 676 patients with the mean age of 24.94 months were enrolled. Eighty-eight (42%) Salmonella spp., 85 (40%) Shigella spp., 33 (16%) E. coli and 5(2%) candida albicans were isolated from 211 positive stool cultures. Among 85 Shigella spp. isolates, S. sonnei, S. flexneri and other Shigella spp. were isolated from 39 (46%) isolates, 36(42%) and 10(12%), respectively. Among 88 isolated Salmonella spp., 36 (41%) isolates were Salmonella Serogroup D, 26 (30%) were Salmonella Serogroup B, 20 (23%) isolates were Salmonella Serogroup C and 6 (7%) were other Salmonella spp. isolates. Thirty-eight percent of Salmonella serogroup B were resistant to nalidixic acid, while higher frequency of nalidixic acid resistant was found in Salmonella serogroup C and Salmonella serogroup D. The higher frequency of ampicillin resistant was found in Shigella spp. than Salmonella spp. High frequency of cefotaxime resistant was seen in S. sonei and S. flexneri (77% and 56%, respectively), whereas more than 90% of Salmonella serogroup B, C and D were susceptible to this antibiotic.. In conclusion, Shigella and Salmonella serogroups can be considered as important etiological agents of acute diarrhea in children. Since the prevalence of antibiotic resistance is increasing in recent years in Iran, further studies on the prevalence, antimicrobial susceptibility pattern and mechanisms of antibiotic resistance in these species is highly recommended.

Topics: Adolescent; Anti-Infective Agents; Cefotaxime; Child; Child, Preschool; Diarrhea; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Escherichia coli; Feces; Female; Gastroenteritis; Hospitals; Humans; Infant; Iran; Male; Microbial Sensitivity Tests; Nalidixic Acid; Prevalence; Retrospective Studies; Salmonella; Salmonella Infections; Serogroup; Shigella

Aeromonas species have been reported to cause various illnesses in humans such as wound infections, septicaemia, peritonitis and pneumonia. Their role in causation of cholera-like illness is also being increasingly recognized. This retrospective study was done to know the presence of Aeromonas as a cause of acute diarrhoea in a tertiary care hospital and to find the common species of Aeromonas causing diarrhoea and their antibiotic susceptibility patterns.. Fifty isolates of Aeromonas were obtained over a period of 15 yr from 2000 to 2014 from patients of suspected acute gastroenteritis resembling cholera. Biotyping was done for 35 of these isolates available in culture collection, based on a panel of 13 biochemical reactions. Antibiogram was put up for all of these isolates by disk diffusion methods and interpreted according to the Clinical and Laboratory Standards Institute guidelines.. Of the 50 patients of Aeromonas-related acute gastroenteritis, 13 (26%) had typical features of cholera with rice water stools and severe dehydration. Eight patients (16%) had dysentery-like picture. One patient died of severe dehydration and septicaemia. The most common species were found to be Aeromonas caviae (34%) followed by Aeromonas veronii biovar veronii (29%), Aeromonas veronii biovar sobria (26%) and Aeromonas hydrophila (9%). All tested isolates were uniformly susceptible to cefepime, amikacin, azithromycin and meropenem; 14 per cent were susceptible to amoxicillin, 32 per cent to nalidixic acid, 60 per cent to co-trimoxazole, 54 per cent to ciprofloxacin, 60 per cent to ofloxacin, 74 per cent to chloramphenicol, 76 per cent to ceftriaxone, 74 per cent to cefotaxime, 88 per cent to gentamicin and 86 per cent to furoxone.. Aeromonas is an important, often neglected pathogen capable of causing a variety of gastrointestinal tract symptoms such as acute diarrhoea and dysentery and may even mimic cholera. It is, therefore, pertinent to recognize this pathogen as an important agent in the causation of severe diarrhoea.

Topics: Adolescent; Adult; Aeromonas; Cefotaxime; Child; Child, Preschool; Cholera; Ciprofloxacin; Diarrhea; Drug Resistance, Microbial; Female; Humans; India; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Nalidixic Acid; Retrospective Studies; Tertiary Care Centers; Young Adult

To determine the occurrence of bacterial pathogens responsible for diarrhea and to engender information regarding the effectiveness of commonly used antibiotic against diarrhea.. This cross-sectional study was conducted between April and July 2014. Samples were collected from the Divisional Headquarter and Allied Hospital, Faisalabad, Pakistan. The differential and selective media were used to isolate bacterial pathogens, which were identified through cultural characteristics, microscopy, and biochemical tests. Disc diffusion assay was carried out using Muller Hinton agar medium, and minimum inhibitory concentration was determined using broth dilution method against isolated pathogens.. One hundred and forty-one (100%) samples were positive for some bacteria. Frequency of occurrence was Bacillus cereus (B. cereus) (66%), Escherichia coli (E.coli) (48.5%), Salmonella typhi (S. Typhi) (27.7%), Pseudomonas aeruginosa (P. aeruginosa) (8.5%), and Staphylococcus aureus (S. aureus) (4.3%). Single pathogen was detected in 20 (14.2%) samples whereas combinations were found in 121 (85.8%) samples. Bacillus cereus and E.coli were the most frequently detected pathogens followed by the S. Typhi, P. aeruginosa, and Staph. aureus. The percentage occurrence of isolated pathogens was 31% in B. cereus, 31% in E. coli, 18% in S. Typhi, 5% in P. aeruginosa, and 3% in Staph. aureus.. Pseudomonas aeruginosa showed resistance against Amoxicillin and Cefotaxime, whereas S. aureus was found resistant against Cefotaxime. Statistical analysis using one way Analysis of Variance revealed that Ofloxacin and Gentamicin had significant (p less than 0.05) differences against all isolates as compared with other antibiotics used in this study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Bacillus cereus; Cefotaxime; Child; Child, Preschool; Cross-Sectional Studies; Diarrhea; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Middle Aged; Ofloxacin; Pakistan; Pseudomonas aeruginosa; Pseudomonas Infections; Salmonella typhi; Staphylococcal Infections; Staphylococcus aureus; Typhoid Fever; Young Adult

Brachyspira pilosicoli BM4442, isolated from the feces of a patient with diarrhea at the Hospital Saint-Michel in Paris, was resistant to oxacillin (MIC > 256 microg/ml) but remained susceptible to cephalosporins and to the combination of amoxicillin and clavulanic acid. Cloning and sequencing of the corresponding resistance determinant revealed a coding sequence of 807 bp encoding a new class D beta-lactamase named OXA-63. The bla OXA-63 gene was chromosomally located and not part of a transposon or of an integron. OXA-63 shared 54% identity with FUS-1 (OXA-85), an oxacillinase from Fusobacterium nucleatum subsp. polymorphum, and 25 to 44% identity with other class D beta-lactamases (DBLs) and contained all the conserved structural motifs of DBLs. Escherichia coli carrying the bla OXA-63 gene exhibited resistance to benzylpenicillin and amoxicillin but remained susceptible to amoxicillin in combination with clavulanic acid. Mature OXA-63 consisted of a 31.5-kDa polypeptide and appeared to be dimeric. Kinetic analysis revealed that OXA-63 exhibited a narrow substrate profile, hydrolyzing oxacillin, benzylpenicillin, and ampicillin with catalytic efficiencies of 980, 250, and 150 mM(-1) s(-1), respectively. The enzyme did not apparently interact with oxyimino-cephalosporins, imipenem, or aztreonam. Unlike FUS-1 and other DBLs, OXA-63 was strongly inhibited by clavulanic acid (50% inhibitory concentration [IC50] of 2 microM) and tazobactam (IC50 of 0.16 microM) and exhibited low susceptibility to NaCl (IC50 of >2 M). OXA-63 is the first DBL described for the anaerobic spirochete B. pilosicoli.

Topics: Amino Acid Sequence; Anti-Bacterial Agents; Base Sequence; beta-Lactamases; Brachyspira; Cloning, Molecular; Diarrhea; Feces; Gram-Negative Bacterial Infections; Humans; Kinetics; Molecular Sequence Data; Oxacillin; Penicillin Resistance; Sequence Analysis, DNA

Topics: Aged; Anti-Bacterial Agents; Cefotaxime; Diarrhea; Endocarditis, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Pacemaker, Artificial

A shiga toxin-producing Escherichia coli (STEC) O26 strain resistant to cefotaxime (CTX) and cefpodoxime (but not ceftazidime) was isolated from the faecal sample of a 17-year-old outpatient with diarrhea. The double disk synergy test, twin test, polymerase chain reaction and sequence analysis confirmed that the strain produced CTX-M-3 type extended-spectrum beta-lactamase (ESBL). Conjugation experiment results suggested that the CTX resistance in this strain was determined by an approximately 85kbp plasmid that was readily transferable to a susceptible recipient E. coli strain. This is the first report from Japan of CTX-M-3type ESBL-producing STEC O26.

Topics: Adolescent; Anti-Bacterial Agents; beta-Lactam Resistance; Cefotaxime; Diarrhea; Escherichia coli; Female; Humans; Shiga Toxin

We followed the effects of changes to a new antibiotic policy favouring a ureidopenicillin as opposed to a third-generation cephalosporin on the long-term incidence of Clostridium difficile diarrhoea (CDD) and antibiotic utilization in a large Elderly Medicine Unit.. In 1999, piperacillin-tazobactam was added to the formulary in Elderly Medicine and its use promoted in preference to cefotaxime. Following review and feedback to clinicians of surveillance data, cefotaxime prescribing was actively restricted during 2000-2001. An audit of prescriber adherence to antibiotic policy was carried out by reviewing the records of 159 patients during February-April 2001. In December 2001, due to manufacturer production problems, supply of piperacillin-tazobactam was stopped. We performed standardized period prevalence surveillance (February-April) allowing comparisons of antibiotic utilization and CDD incidence during the 5 year study period (1998-2002).. CDD incidence did not change significantly (P>0.1) during 1998-1999 despite a marked increase in piperacillin-tazobactam prescribing. However, when cefotaxime prescribing was curtailed in 2001, CDD rates decreased (in four of five wards) and overall by 52% (P=0.008). When piperacillin-tazobactam became unavailable in 2002, despite advice to the contrary cefotaxime prescribing rose five-fold, and CDD rates increased in four of five wards and by 232% (P<0.01) overall. Adherence to antibiotic policy introduced in 2000 was good (81% accordance); 94%, 88% and 73% of patients with cellulitis, urinary tract and respiratory tract infection, respectively, received appropriate antibiotics.. Long-term prescribing of piperacillin-tazobactam in Elderly Medicine in preference to cefotaxime is associated with reduced rates of CDD. However, unless cephalosporin prescribing is curtailed, the beneficial effects on CDD rates may be missed. This is one of few studies to document adverse effects due to loss of antibiotic supply.

Topics: Aged; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Clostridioides difficile; Diarrhea; Drug Prescriptions; Drug Resistance; Drug Utilization; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Public Policy; Retrospective Studies; United Kingdom

Topics: Ampicillin; Cefazolin; Cefotaxime; Diarrhea; Endophthalmitis; Eye; Eye Diseases; Female; Gentamicins; Humans; Infant; Salmonella; Salmonella Infections

Fecal samples from 195 diarrheic patients in different age, rectal and cloacal swabs from 656 normal and diarrheic animals and poultry, 108 visceral materials from the dead animals with diarrhoea were cultured for Compylobacter jejuni. A total of 458 strains of campylobacters (445 strains of C. jejuni, 13 strains of C. coli) were isolated and identified, and some biological characteristics of these strains were observed. Lior's biotyping scheme was used for biotyping 354 strains of campylobacters(253 strains of C. jejuni and 2 strains of C. coli). The results showed the most biological characteristics of these campylobacters accorded with that previously described in the literatures, but it were also found that there were some differences on morphological, cultural, physiological and biochemical characteristics and antibiotic resistances. In these differences, the most main differences were that 48.3% (215/445) of C. jejuni and 23.1% (3/13) of C. coli were resistant to nalidixic acid, and that 1.1% (5/445) of C. jejuni and 7.6(1/13) of C. coli were resistant to cefotaxime. There were relationships between antibiotic resistances and strain sources (P < 0.005). The result of biotyping 352 strains of C. jejuni indicated that biotype I (40.9%) and II (58.2%) were predominant in the bodies of these animals, and there were two biotypes distributed in the body of same animal.

Topics: Animals; Bacterial Typing Techniques; Campylobacter coli; Campylobacter jejuni; Cattle; Cefotaxime; Chickens; Diarrhea; Drug Resistance, Microbial; Humans; Nalidixic Acid; Sheep; Swine

Topics: Aged; Arthritis; Arthritis, Reactive; Cefixime; Cefotaxime; Cephalosporins; Clostridioides difficile; Diagnosis, Differential; Diarrhea; Enterocolitis, Pseudomembranous; Humans; Male

Topics: Cefotaxime; Cephalosporins; Diarrhea; Enterocolitis, Pseudomembranous; Humans

Topics: Aged; Cefotaxime; Cephalosporins; Diarrhea; Enterocolitis, Pseudomembranous; Female; Humans; Male

Enrichment culture in modified buffered peptone water followed by immunomagnetic separation (IMS) with magnetic beads coated with an antibody against Escherichia coli O157 was compared with direct culture on cefixime rhamnose sorbitol MacConkey agar (CR-SMAC) and cefixime tellurite sorbitol MacConkey agar (CT-SMAC) for the isolation of E. coli O157 from human faeces. In total, 690 samples were examined; E. coli O157 was isolated from 25 samples by IMS but from only 15 and 12 by direct culture on CT-SMAC and CR-SMAC, respectively. The difference in sensitivity of detection was at its most marked on screening repeat faecal samples from known cases and samples from asymptomatic contacts, when of 12 strains of E. coli O157 isolated by IMS, only five were isolated by direct culture. IMS is a sensitive and simple technique for the isolation of E. coli O157 from human faecal samples and should prove useful in elucidating further the epidemiology of this micro-organism.

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Bacterial Toxins; Bacteriophage Typing; Cefixime; Cefotaxime; Chlorocebus aethiops; Culture Media; Cytotoxins; Diarrhea; DNA Probes; DNA, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Gastrointestinal Hemorrhage; Humans; Immunomagnetic Separation; Plasmids; Rhamnose; Shiga Toxin 1; Sorbitol; Vero Cells

Topics: Aged; Aged, 80 and over; Cefotaxime; Diarrhea; Enterocolitis, Pseudomembranous; Female; Humans; Male; Risk Factors

Azithromycin, a new azalide antibiotic, is active in vitro against a variety of enteric bacterial pathogens. Since it is concentrated inside human neutrophils and other cells, it might be particularly useful in the treatment of infections caused by enteropathogens that invade host tissues. The intracellular activity of azithromycin against several enteric pathogens that had been phagocytosed by neutrophils was determined. Azithromycin was effective in reducing the intracellular viabilities of almost all strains tested, including representative strains of Salmonella, Shigella, and enteroinvasive, enteropathogenic, enterotoxigenic, and enterohemorrhagic Escherichia coli. Erythromycin was also effective in this model system, although azithromycin was generally more effective than erythromycin against strains of invasive enteric pathogens. Cefotaxime reduced intracellular bacterial viability to a lesser extent than either azithromycin or erythromycin. The presence of neutrophils did not significantly affect the activity of azithromycin in this system. Azithromycin may be a useful agent for the treatment of bacterial diarrhea, and clinical trials should be considered.

Topics: Azithromycin; Cefotaxime; Diarrhea; Enterobacteriaceae; Erythromycin; Escherichia coli; Humans; Intestines; Intracellular Fluid; Microbial Sensitivity Tests; Neutrophils; Phagocytosis

Topics: Anti-Infective Agents; Cefixime; Cefotaxime; Diarrhea; Female; Humans; Middle Aged

Yersinia enterocolitica enteritis is a potentially treatable infection. To understand its seasonal incidence and clinical presentation in children, we reviewed case records of children seen in Cardinal Glennon Children's Hospital in St. Louis, MO. We found the incidence of Yersinia enteritis to be as frequent as enteritis caused by Campylobacter. It occurred more frequently during the winter months (P < 0.002) than during the rest of the year. Fever was common in infants with Yersinia enteritis. Abdominal pain and distention were infrequent. Seventeen (35%) patients were 3 months of age or younger; 4 of 17 (28%) developed Yersinia sepsis as a complication of the enteritis. Physicians should perform stool cultures for Y. enterocolitica in young infants who present with high fever and diarrhea in winter months, especially when there is blood in stools or the patient appears septic.

Topics: Age Factors; Cefotaxime; Child; Child, Preschool; Diarrhea; Enteritis; Feces; Female; Gentamicins; Hospitalization; Humans; Incidence; Infant; Infant, Newborn; Male; Missouri; Retrospective Studies; Seasons; Trimethoprim, Sulfamethoxazole Drug Combination; Yersinia enterocolitica; Yersinia Infections

Microbial changes including the shedding of Clostridium difficile, fecal beta-lactamase activity, and gastrointestinal symptoms were assessed in 51 healthy volunteers given 200 mg of cefixime twice daily for 8 days. The number of organisms of the family Enterobacteriaceae (means +/- standard deviations) dropped from 6.9 +/- 1.1 to 3.9 +/- 1.8 log CFU/g of feces (P < 0.01), whereas counts of enterococci rose from 7.0 +/- 1.5 to 9.0 +/- 1.0 log CFU/g of feces (P < 0.01). Both counts returned to their initial levels 50 days after the cessation of treatment. Cefixime did not significantly modify the frequency of fecal excretion of Pseudomonas aeruginosa, Staphylococcus spp., yeasts, or members of the Enterobacteriaceae resistant to ceftazidime or ampicillin. The proportion of subjects shedding C. difficile rose from 6% before treatment to 57% (P < 0.01) at the end of treatment but returned to 8% 50 days thereafter. No case of pseudomembranous colitis was observed. Stool changes occurred in 13 volunteers during treatment (25%) and in 2 others more than 10 days after the end of treatment (4%). These changes were not significantly associated with the shedding of toxigenic strains of C. difficile or with the presence of toxin A in feces. By contrast, during treatment, stool changes occurred in 8 of the 18 volunteers (44%) who had antibiotic activity in their feces but in only 5 of the 33 (15%) for whom no such activity was found (P < 0.05). The absence of antibiotic activity in the feces was itself linked with the presence of beta-lactamase activity in the feces. Since we had found earlier that fecal beta-lactamase activity afforded protection against alteration in stool consistency during treatments with oral cephalosporins, the present study confirmed our previous preliminary results in this respect.

Topics: Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; beta-Lactamases; Cefixime; Cefotaxime; Clostridioides difficile; Diarrhea; Digestive System; Feces; Female; Humans; Male

Sorbitol-MacConkey medium has become widely used for the isolation of verotoxigenic (VT+) Escherichia coli O157. However, many organisms other than VT+ E. coli O157, especially other serogroups of E. coli and Proteus spp., may not ferment sorbitol, and thus may be confused initially with VT+ E. coli O157. Rhamnose is not fermented by VT+ E. coli O157, but is by most sorbitol non-fermenting E. coli of other serogroups. Cefixime is a cephalosporin antibiotic that is more active against Proteus spp. than against E. coli. Inclusion of rhamnose and cefixime in sorbitol-MacConkey agar improves its selectivity for the isolation of VT+ E. coli O157.

Topics: Anti-Infective Agents, Urinary; Bacterial Toxins; Cefixime; Cefotaxime; Culture Media; Diarrhea; Escherichia coli; Escherichia coli Infections; Feces; Microbial Sensitivity Tests; Rhamnose; Shiga Toxin 1

In a retrospective study carried out at Norrköping Central Hospital, the incidence of Clostridium difficile-associated diarrhoea and colitis was found to be correlated to in-patient consumption (in terms of defined daily doses) of the implicated anti-microbial agents. The third generation cephalosporin, cefotaxime, was implicated 38 times more often than small spectrum penicillins. In general, the cephalosporins were predominantly responsible, accounting for 46 per cent (67/147) of the episodes but only 12 per cent of overall consumption of antibiotics at the hospital. These findings are in accord with data previously published in the nationwide report by the Medical Product Agency, Uppsala.

Topics: Adolescent; Adult; Aged; Cefotaxime; Cephalosporins; Clostridioides difficile; Colitis; Cross Infection; Diarrhea; Drug Utilization; Humans; Middle Aged; Retrospective Studies; Sweden

Ampicillin (or penicillin G) plus chloramphenicol, cefuroxime, ceftriaxone, and cefotaxime have been used in the treatment of bacterial meningitis beyond the neonatal period. Review of recent data from the USA and Europe indicates that delayed CSF sterilization occurs significantly more often with ampicillin/chloramphenicol and cefuroxime than with ceftriaxone and cefotaxime. Delayed CSF sterilization is associated with an increased morbidity and neurological complications. Previously reported in vitro interactions between chloramphenicol and various beta-lactam antibiotics indicate that for bacteria where chloramphenicol is only bacteriostatic, the combination of chloramphenicol with beta-lactams is antagonistic. Killing rates of various beta-lactams were compared against a number of gram-positive and gram-negative bacteria. Cidal activity of some beta-lactams was inoculum dependent. There was a good correlation between in vitro activity and ability to sterilize CSF. Ceftriaxone is highly protein bound and its use in newborns is discouraged. Diarrhea occurs significantly more often after cefriaxone use than after the use of other agents. Ceftriaxone is uniquely associated with a high frequency of biliary pseudolithiasis which may be symptomatic and can cause measureable morbidity. In selecting the "proper" antimicrobial agent for the treatment of bacterial meningitis considerations should be given to proven clinical efficacy, prompt CSF sterilization, rapid in vitro cidal activity, safety and cost. We recommend cefotaxime as the agent of choice in the treatment of bacterial meningitis.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Cefotaxime; Ceftriaxone; Cefuroxime; Cerebrospinal Fluid; Child; Chloramphenicol; Diarrhea; Gallbladder Diseases; Humans; Meningitis; Protein Binding; Sulbactam

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

Acute toxicity of cefodizime sodium (THR-221) was examined in mice of both sexes, rats of both sexes (including 5-day-old young), and male dogs. The LD50 values of THR-221 (mg/kg) were as follows: (1) mice: intravenous, 7200 for males and 5000 for females; intraperitoneal, 10500 for males and 11000 for females; subcutaneous, 17500 for males and 16500 for females; and oral, 28000 for males and 29000 for females. (2) rats (adult): intravenous, 7000 for males and 8200 for females; intraperitoneal, 9500 for males and 8800 for females; subcutaneous, 17000 for males and 15500 for females; oral, more than 20000 for both sexes; and intramuscular, more than 3200 for both sexes. (3) 5-day-old rats: subcutaneous, 5278 for males and 5314 for females. (4) male dogs: intravenous, more than 5000. Major changes in general conditions observed in mice and rats were decreased spontaneous activity, lying prone, respiratory changes, staggering gait, clonic or clonic-tonic convulsions, and cyanosis, and in the animals dosed orally, diarrhea or salivation was also noted. The changes in 5-day-old rats were respiratory changes, agony, loss of reflex to an external stimulus, and congestion at the injection site, and those in dogs were vomiting, dryness of the nose, and soft or mucous stools. Autopsies on the mice and rats which died revealed hemorrhage on the brain surface. In addition, the following were seen: intraperitoneal retention of fluid and dark red spots on the abdominal wall (i.p.), subcutaneous retention of fluid or jellylike material and hemorrhage at the injection site (s.c.), and retention of fluid and dark red spots on the mucosa in the digestive tract (mice p.o.). In 5-day-old rats which died, the subcutaneous tissue at the injection site showed hemorrhage macroscopically and inflammatory changes microscopically. Hematological and blood chemical tests performed in dogs showed an increase in white blood cells and changes suggesting anemia, increases in GOT, LDH and ALP activities, and slight changes in urea nitrogen and inorganic phosphorus. In one animal given a low dose of 2500 mg/kg, an increase in GPT activity was also seen. However, these changes were all transient. Microscopic findings in dogs were slight inflammatory changes in the subcutaneous tissue around the injection site.

Topics: Administration, Oral; Animals; Blood Chemical Analysis; Cefotaxime; Cerebral Hemorrhage; Diarrhea; Dogs; Female; Injections, Intraperitoneal; Injections, Intravenous; Injections, Subcutaneous; Lethal Dose 50; Leukocyte Count; Male; Mice; Mice, Inbred ICR; Motor Activity; Rats; Rats, Inbred Strains; Respiration

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

A patient with rheumatoid arthritis-associated interstitial pneumonitis, treated with prednisolone, developed mild colitis due to Clostridium difficile in association with the use of cefotaxime (CTX). Diarrhea was successfully treated with the discontinuation of CTX and initiation of oral vancomycin.

Topics: Arthritis, Rheumatoid; Cefotaxime; Clostridium Infections; Colitis; Diarrhea; Female; Humans; Middle Aged; Prednisolone; Pulmonary Fibrosis; Vancomycin

beta-Lactam antimicrobial agents have until recently enjoyed a reputation of reliability and safety. Now serious problems have emerged associated with use of some of the newer drugs of this class. Latamoxef (moxalactam) and cefoperazone, both of which have a methyltetrazolethiol side chain, have been reported to cause coagulation abnormalities, clinical bleeding, and disulfiram-like reactions. In addition, an unusually high incidence of diarrhoea has been associated with administration of cefoperazone. Cefotaxime does not have the [methylthiotetrazole] side chain and has not caused bleeding, coagulopathy, or disulfiram-like reactions. Diarrhoea, usually mild, has been observed in only 1% of patients given cefotaxime in clinical trials. The remarkable safety record of cefotaxime is an important consideration for clinicians in the selection of an antimicrobial agent for seriously ill patients.

Topics: Anti-Bacterial Agents; Blood Coagulation Disorders; Cefotaxime; Diarrhea; Disulfiram; Humans