cefotaxime and Drug-Hypersensitivity

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 performed a survey of clinical experience of cefotiam (CTM: Pansporin) as postmarketing surveillance (PMS), and evaluated the efficacy and safety of CTM in 10,499 cases of data which were collected during the first 2 years after approval. The following results were obtained. The efficacy rate of CTM in the treatment of various infections was 83.2%, which was equal or superior to the clinical results obtained before approval. A total of 472 adverse drug reactions was reported by 10,499 patients (4.50%). The commonest adverse drug reactions was liver function abnormality (230 cases), followed by dermal symptoms (103 cases), gastrointestinal symptoms (53 cases) and renal function abnormality (20 cases) in the order mentioned. All of these adverse drug reactions had already been known for cephem antibiotics, and no remarkable adverse drug reactions specific to CTM was found. The above PMS results indicate the same efficacy of CTM that obtained from premarketing studies. As regards safety, there was no remarkable unexpected adverse drug reaction and their profile was also the same as that found in premarketing studies. Thus, the utility of CTM was confirmed.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Clinical Trials as Topic; Drug Hypersensitivity; Evaluation Studies as Topic; Female; Hematologic Tests; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Middle Aged; Neurotic Disorders; Product Surveillance, Postmarketing; Skin; Skin Tests

New antigens deriving from -lloyl and -llanyl, major and minor determinants, respectively, were produced for β-lactam antibiotics cefuroxime, cefotaxime, ceftriaxone, meropenem and aztreonam. Twenty β-lactam antigens were produced using human serum albumin and histone H1 as carrier proteins. Antigens were tested by multiplex in vitro immunoassays and evaluated based on the detection of specific IgG and IgE in the serum samples. Both major and minor determinants were appropriate antigens for detecting specific anti-β-lactam IgG in immunised rabbit sera. In a cohort of 37 allergic patients, we observed that only the minor determinants (-llanyl antigens) were suitable for determining specific anti-β-lactam IgE antibodies with high sensitivity (< 0.01 IU/mL; 24 ng/L) and specificity (100%). These findings reveal that not only the haptenisation of β-lactam antibiotics renders improved molecular recognition events when the 4-member β-lactam ring remains unmodified, but also may contribute to develop promising minor antigens suitable for detecting specific IgE-mediated allergic reactions. This will facilitate the development of sensitive and selective multiplexed in vitro tests for drug-allergy diagnoses to antibiotics cephalosporin, carbapenem and monobactam.

Topics: Anti-Bacterial Agents; Aztreonam; beta-Lactams; Carbapenems; Cefotaxime; Ceftriaxone; Cefuroxime; Cephalosporins; Cross Reactions; Drug Hypersensitivity; Humans; Immunoglobulin E; Immunoglobulin G; Meropenem; Monobactams; Penicillins; Skin Tests

Patients with DiHS show an increased risk of sensitization to multiple drugs. We report a case of a young woman who developed cutaneous rash, lymphoadenopathy, malaise and fever after the introduction of phenobarbitale. Because of these symptoms, she was treated with ceftriaxone and she experienced a severe flare-up of the cutaneous and general reaction. Allergological work-up, by cutaneous and lymphocyte transformation test, confirmed a double sensitization to phenobarbital and ceftriaxone. In conclusion, the high risk of DiHS during anticonvulsive therapy should suggest caution in using additional drugs, because of an increased risk of multiple reactions.

Topics: Adult; Cefotaxime; Ceftriaxone; Drug Hypersensitivity; Female; Humans; Lymphocyte Activation; Phenobarbital; Skin Tests

Topics: Anti-Bacterial Agents; Cefotaxime; Drug Hypersensitivity; Female; Humans; Hypersensitivity, Immediate; Immunoglobulin E; Middle Aged; Skin Tests

Cefuroxime is a second-generation lactamase-stable cephalosporin. Its use is on the increase, and in recent years several reactions to this compound have been reported.. To describe a case of selective reaction to cefuroxime, showing a boosted immunoglobulin (Ig)E response after administration of this drug.. Specific serum IgE antibodies to several cephalosporins were monitored in a 52-year-old man after a selective systemic anaphylaxis attributable to cefuroxime, who showed a good tolerance to penicillin V during a single-blind, placebo-controlled challenge.. Specific IgE levels to cefuroxime were not detected at the moment of the reaction but became positive 1 day after, increasing to peak at day 51, and still positive after 115 days. Through radioallergosorbent test inhibition, cross-reactivity between cefuroxime and cefotaxime was demonstrated.. IgE-mediated reaction attributable to cefuroxime with cross-reactivity to cefotaxime was reported. A prompt evaluation undertaking skin tests and additional radioallergosorbent test studies with different betalactam derivatives improves the evaluation of subjects with allergic reactions to betalactams.

Topics: Anaphylaxis; Cefotaxime; Cefuroxime; Cephalosporins; Cross Reactions; Drug Hypersensitivity; Humans; Immunoglobulin E; Male; Middle Aged

Topics: Adult; Cefixime; Cefotaxime; Cephalosporins; Drug Hypersensitivity; Female; Humans; Urticaria

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacteria; Humans; Infant, Newborn; Macrolides; Meningitis, Bacterial; Neutropenia; Penicillin Resistance; Penicillins; Pneumonia, Bacterial; Sepsis; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Currently in many centres the extended spectrum cephalosporins (e.g. cefotaxime and ceftriaxone) are being used empirically for patients with suspected bacterial meningitis. We present a case of meningitis in a penicillin allergic paediatric renal transplant patient from whose cerebrospinal fluid (CSF) Listeria monocytogenes was cultured, despite four days of cefotaxime therapy. The patient was successfully treated with meropenem but required neuro-endoscopic intervention for hydrocephalus.

Topics: Amoxicillin-Potassium Clavulanate Combination; Cefotaxime; Cephalosporins; Cerebrospinal Fluid; Child; Drug Hypersensitivity; Female; Humans; Immunocompromised Host; Kidney Transplantation; Listeria monocytogenes; Meningitis, Listeria; Meropenem; Thienamycins

Antibiotic prophylaxis is a routine procedure in management of burns. As such it is a safe practice, yet unusual complications can occur with the use of even safest antibiotics and their emergency management may be life saving. Here we present a case of 35% second and third degree burns who was taken for a second sitting of stamp grafting for remnant raw areas, who was administered intraoperative prophylactic antibiotic, developed a series of unusual complications sequentially, which were life threatening. Prompt recognition of signs and symptoms of adverse reactions of the drug used and timely management resulted in the successful outcome. A good team effort by surgeon, anaesthetist and the physician was mandatory.

Topics: Adult; Anaphylaxis; Antibiotic Prophylaxis; Burns; Cefotaxime; Cephalosporins; Disseminated Intravascular Coagulation; Drug Hypersensitivity; Female; Humans; Injections, Intravenous; Postoperative Hemorrhage; Skin Transplantation

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Erythromycin; Gram-Negative Bacteria; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Neutropenia; Penicillins; Pneumonia, Mycoplasma; Pneumonia, Staphylococcal; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Topics: Adolescent; Anaphylaxis; Anti-Bacterial Agents; Anti-Infective Agents; Cefixime; Cefotaxime; Drug Hypersensitivity; Drug Tolerance; Female; Humans

A 64-year-old woman fell ill with generalized pyoderma and fever up to 40 degrees C. White cell count was 600/microliters, with 96% lymphocytes. Granulopoiesis in the bone marrow was markedly diminished. After treatment with cefotaxime, 2 g twice daily for one week, the blood count returned to normal. 8 months later generalized pyoderma, fever and agranulocytosis (white cell count 700/microliters) recurred. Once again the findings improved on ofloxacin 200 mg twice daily for 9 days. On repeat questioning about previous drug intake the patient stated that each time before the onset of the agranulocytosis she had taken calcium dobesilate, 500 mg twice daily for the preceding 15 and 3 weeks, respectively. Thereupon a lymphocyte transformation test was performed which revealed significant stimulation by calcium dobesilate 4, 8 and 14 weeks after the second episode of agranulocytosis. -Allergic side effects of calcium dobesilate have repeatedly been reported, but there has been no previously published report of agranulocytosis induced by this drug.

Topics: Agranulocytosis; Calcium Dobesilate; Cefotaxime; Drug Hypersensitivity; Female; Humans; Lymphocyte Activation; Middle Aged; Ofloxacin; Pyoderma; Recurrence

Topics: Alveolitis, Extrinsic Allergic; Atropine; Cefixime; Cefotaxime; Drug Hypersensitivity; Female; Humans; Lidocaine; Middle Aged; Prednisolone; Pulmonary Eosinophilia

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Drug Hypersensitivity; Drug Resistance; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Middle Aged; Netilmicin; Treatment Outcome

A 35-year-old woman developed pharyngitis with high fever and painful joint swellings. A severe cholestatic hepatitis occurred 40 days later with a rise of bilirubin to 32 mg/dl. "Nuclear dot" antibodies were demonstrated in the immunofluorescence test on cell cultures, confirming a diagnosis of primary biliary cirrhosis which had followed an atypical course. After nine days of cefotaxime administration, commenced because of persistent fever of 40 degrees C, an agranulocytosis was demonstrated, which regressed within a week of discontinuing the drug. The allergic genesis of the agranulocytosis was proven by repeated lymphocyte stimulation tests in the presence of cefotaxime. The autoimmune hepatitis was probably a predisposing factor in the genesis of the allergically induced agranulocytosis.

Topics: Acute Disease; Adult; Agranulocytosis; Autoantibodies; Cefotaxime; Drug Hypersensitivity; Female; Fluorescent Antibody Technique; Humans; Liver Cirrhosis, Biliary

Endocarditis secondary to Hemophilus parainfluenzae is an uncommon entity that appears to be increasing in frequency, perhaps due to improved laboratory isolation techniques. Although controversial, most of the published literature recommends a penicillin, with or without concomitant gentamicin, as definitive therapy. We report the first successful use of the third-generation cephalosporin ceftizoxime in an ampicillin-allergic patient. A 55-year-old white female was hospitalized after 5 days of experiencing fever, chills, nausea, and vomiting. A cardiac echocardiogram revealed a large mitral valve vegetation, and the patient was treated with intravenous ampicillin, gentamicin, and clindamycin. Two weeks after emergency mitral valve replacement the patient developed spiking fevers and a macular, erythematous rash while receiving ampicillin. Ceftizoxime was initiated and continued to complete a 4-week period of intravenous antibiotics. Follow-up at 14 months showed no further evidence of infection. Ceftizoxime appears efficacious in eradicating H. parainfluenzae in patients allergic to penicillin.

Topics: Acute Disease; Ampicillin; Cefotaxime; Ceftizoxime; Drug Hypersensitivity; Endocarditis, Bacterial; Female; Haemophilus Infections; Humans; Microbial Sensitivity Tests; Middle Aged

The paper is concerned with a study in which eosinophilic exudative pleuritis was the first sign of drug allergy (penicillin, streptomycin, claphoran), also manifesting itself in fever, hemorrhagic eruption, eosinophilia in the blood. Fast recovery was achieved after discontinuation of antibacterial therapy and prescription of prednisolone. The problem of differential diagnosis of pleuritis in acute pneumonia is discussed.

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Drug Hypersensitivity; Eosinophilia; Humans; Male; Pleural Effusion; Pleurisy; Pneumonia

Topics: Aged; Alveolitis, Extrinsic Allergic; Cefotaxime; Ceftizoxime; Drug Hypersensitivity; Humans; Male

The clinical safety of ceftriaxone administered at various doses for time periods ranging from a single injection to up to six weeks was evaluated in 2,640 patients treated in 153 individual studies. The incidence of clinical adverse effects was greatest for gastrointestinal (3.45 percent), hypersensitivity (2.99 percent), and local (1.86 percent) reactions. When the pediatric population was analyzed separately, the incidence of gastrointestinal and hypersensitivity reactions was 5.63 and 3.3 percent, respectively; all other reactions occurred in fewer than 1 percent of patients. The frequency of adverse effects for the once-daily and twice-daily dosing regimens was comparable, except for a statistically significant increase in local reactions when ceftriaxone was administered twice daily. When ceftriaxone was compared directly with other antibiotic regimens, the incidence of clinical adverse effects was similar. Ceftriaxone appears to be safe and well tolerated from a clinical standpoint.

Topics: Adolescent; Adult; Age Factors; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Digestive System; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Hypersensitivity; Female; Humans; Infant; Male; Sex Factors

Patients having previously not received cefotiam (CTM), a recently introduced cephem antibiotic, were subjected to skin tests with a 300 micrograms/ml solution of CTM in physiological saline before and after CTM therapy to detect sensitization with the drug. Anti-CTM antibody titration was carried out on sera from patients who showed a positive skin test and those who developed signs of hypersensitivity during CTM therapy. The results were as follows: Of 1,927 patients examined by skin test with CTM prior to initiation of CTM therapy, 31 patients (1.61%) showed positive reactions with formation of a wheal and erythema. There were 7 patients (0.36%) who proved negative in the skin test but developed mild symptoms of hypersensitivity in association with the skin test. The 847 patients negative on the CTM skin test were retested after a completion of CTM therapy, of whom 6 (0.71%) were found to have become positive showing formation of a wheal and erythema and 3 others (0.35%) showing a negative skin test developed mild adverse reactions associated with the skin test. Sixty-eight serum samples collected from the patients positive on the CTM skin test and those who developed manifestations of hypersensitivity following CTM therapy were examined for anti-CTM antibody by the Prausnitz-K ustner reaction, passive cutaneous anaphylaxis test and hemagglutination test. All proved negative in these tests. Of various background factors assessed, none was found to have causal relation to the skin reaction in any of the patients showing positive skin reactions to CTM.

Topics: Adolescent; Adult; Aged; Animals; Antibodies; Cefotaxime; Cefotiam; Child; Drug Hypersensitivity; Female; Guinea Pigs; Humans; Immunoglobulin E; Macaca fascicularis; Male; Middle Aged; Skin Tests

Topics: Animals; Cefotaxime; Cefuroxime; Cephalosporins; Cross Reactions; Drug Hypersensitivity; Guinea Pigs; Humans; Passive Cutaneous Anaphylaxis; Penicillins