cefotaxime and Endocarditis--Bacterial

Cardiobacterium valvarum, a fastidious Gram-negative bacterium, was detected in the aortic valve of a previously healthy 63-year-old man by broad-range PCR and 16S rRNA gene sequencing. In contrast to the patients in five previously published cases, our patient had neither a congenital bicuspid nor a prosthetic aortic valve. Here, we present a case of C. valvarum native tricuspid aortic valve infective endocarditis and a review of the literature.

Topics: Anti-Bacterial Agents; Aortic Valve; Cardiobacterium; Cefotaxime; Endocarditis, Bacterial; Gentamicins; Heart Valve Diseases; Humans; Male; Middle Aged; Polymerase Chain Reaction

Infection by Citrobacter appears in man only in certain circumstances, since it usually acts as contaminant or colonizer. Bacteraemia by this bacillus can affect immunodeficient people, elderly people or those patients who have undergone invasive hospital processes. Although incidence of bacteraemia is low (0.3-0.9%), the death rate is very high, about 48%. This bacillus is seldom the cause of endocarditis. That is why we describe a case of endocarditis by Citrobacter freundii, in an aged person with previous valvulopathy.

Topics: Aged; Aortic Valve; Cefotaxime; Cephalosporins; Citrobacter freundii; Endocarditis, Bacterial; Enterobacteriaceae Infections; Heart Valve Diseases; Humans; Male; Mitral Valve

Topics: Bacteria; Bacterial Infections; beta-Lactamases; Cefotaxime; Ceftizoxime; Drug Evaluation; Drug Stability; Endocarditis, Bacterial; Female; Genital Diseases, Female; Humans; Respiratory Tract Infections; Urinary Tract Infections

Topics: Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Endocarditis, Bacterial; Humans; Streptococcal Infections

Topics: Bacterial Infections; Biliary Tract Diseases; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Endocarditis, Bacterial; Female; Genital Diseases, Female; Humans; Japan; Kinetics; Meningitis; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Prevotella species (i. e. P. intermedia, P. nigrescens, P. pallens, P. oris) are usually responsible for abscesses of head and neck spaces after dental procedures. P. intermedia - related infective endocarditis has never been reported.. A 22-year-old man, with a history of aortic valve replacement 6 years ago, presented with fever and persistent retrosternal chest pain. An empirical antibiotic therapy was started on (cefotaxime, 2gx3 - gentamicin, 5mg/kilo). Five blood cultures were positive at Prevotella Intermedia. Metronidazole was introduced (500mg X 3 by day).The oro-pharyngeal spaces were normal. The evolution was marked by a hypotension, a third degree atrio-ventricular block, and a rapidly growing aortic root abscess complicated this case of Prevotella Intermedia infective endocarditis (IE). Aortic valve redux surgery was performed at day 5 of admission. Post-operative course was unremarkable.. This first reported case of Prevotella Intermedia IE presented suggestive features of anaerobic IE as the patient developed both aortic-ring abscess, third degree atrio-ventricular block and hypotension.

Topics: Abscess; Adult; Anti-Bacterial Agents; Aortic Valve; Cefotaxime; Endocarditis; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis; Humans; Hypotension; Male; Metronidazole; Prevotella intermedia; Young Adult

Aerococcus viridans is a rare human pathogen that occasionally causes endocarditis. Most of the reported cases of endocarditis have been treated with penicillin. Here we describe a patient who was allergic to penicillin and was successfully treated with cefotaxime.

Topics: Aerococcus; Anti-Bacterial Agents; Cefotaxime; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Humans; Hypersensitivity; Male; Middle Aged; Penicillins; Treatment Outcome

We present a rare case of endocarditis in a 33-year-old woman with a splenectomy. The patient presented with meningeal symptoms and was diagnosed with endocarditis on the medical admissions unit using a portable echocardiography machine. Bordetella holmesii was cultured from the blood on admission and the patient underwent subsequent aortic valve replacement. We discuss the importance of echo skills within the specialty of acute medicine and the benefits of swift senior review at the front door. We emphasise the guidelines on antibiotic prophylaxis for the post-splenectomy patient as well as discuss the pathogen B holmesii and its growing association of septicaemia in asplenic individuals.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bordetella; Bordetella Infections; Cefotaxime; Combined Modality Therapy; Diagnosis, Differential; Echocardiography, Doppler; Endocarditis, Bacterial; Female; Heart Valve Prosthesis Implantation; Humans; Splenectomy

Topics: Adult; Anti-Bacterial Agents; Aortic Valve; Cefotaxime; Endocarditis, Bacterial; Humans; Male; Streptococcal Infections; Streptococcus constellatus; Treatment Outcome

There is a paucity of data regarding the treatment of endocarditis caused by penicillin-resistant viridans group streptococci (PR-VGS). We report a 16-year-old girl who had native-valve endocarditis due to PR-VGS which was identified as Streptococcus mitis. She also had unusual reactions to vancomycin. Eighteen hours after initiation of 50 mg/kg/day vancomycin, she developed a maculopapular rash, then at 48 hours she developed an intermittent high fever and a progressive decrease in peripheral leukocytes and platelets. She developed hypotension on Day 8. Her serum C-reactive protein and procalcitonin levels were high. All reactions improved after vancomycin was discontinued and oral prednisolone was started. This unusual combination of reactions to vancomycin was likely caused by immune and nonimmune mechanisms. Her endocarditis was successfully treated with cefotaxime 200 mg/kg/ day for 4 weeks.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Endocarditis, Bacterial; Female; Glucocorticoids; Humans; Penicillin Resistance; Prednisolone; Streptococcal Infections; Streptococcus mitis; Vancomycin

We report a 54 year old female whose successful treatment of cerebral lupus with rituximab was complicated by the development of streptococcus intermedius, on valves damaged by Libman-Sacks endocarditis more than 20 years previously.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antirheumatic Agents; Cefotaxime; Endocarditis, Bacterial; Female; Humans; Lupus Erythematosus, Systemic; Middle Aged; Penicillin G; Rituximab; Streptococcal Infections; Streptococcus intermedius

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

To compare the in vitro and in vivo activity of penicillin, cefotaxime and ceftriaxone, using three strains of Streptococcus pneumoniae with different susceptibilities to penicillin (MICs of 0.015, 0.25 and 2 mg/L, respectively).. Time-kill curves and an experimental model of endocarditis in rabbits.. Penicillin was efficacious in clearing bacteria from vegetations and blood irrespective of whether infections were caused by penicillin-susceptible or penicillin-resistant strains (P < 0.01 with respect to control groups). The same efficacy was shown with cefotaxime and ceftriaxone. Comparing the results of the in vivo model with those obtained in time-kill curves, penicillin showed the best results.. These results confirm that penicillin is efficacious in the treatment of pneumococcal infections, including those produced by strains with MICs < or = 2 mg/L (with the exception of pneumococcal meningitis). These results also suggest that the breakpoints to define susceptibility and resistance of S. pneumoniae to penicillin must be reviewed, as has been done with amoxicillin and third-generation cephalosporins.

Topics: Animals; Anti-Bacterial Agents; beta-Lactams; Cefotaxime; Ceftriaxone; Endocarditis, Bacterial; Half-Life; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Pneumococcal Infections; Rabbits; Streptococcus pneumoniae

We performed a clinical study of pneumococcal endocarditis (PE) in adults at 15 major Spanish hospitals during a 21-year period (1978-1998). During this time, 63 patients had PE due to Streptococcus pneumoniae diagnosed. Of the 63 isolates recovered from these patients, 24 (38%) and 6 (10%) showed resistance to penicillin (minimum inhibitory concentration [MIC], 0.1-4 microg/mL) and cefotaxime (MIC, 1 microg/mL), respectively. Twenty-two (35%) of the patients died. Left-side heart failure, but not penicillin resistance, was independently associated with a higher risk of death (odds ratio, 1.33; 95% confidence interval, 1.04-1.71; P=.026). Patients without meningitis who had PE due to penicillin-resistant S. pneumoniae could be treated with high-dose penicillin or a third-generation cephalosporin if the MIC for penicillin was < or =1 microg/mL. For patients with concurrent meningitis, high doses of cefotaxime could be used if the MIC for cefotaxime was < or =1 microg/mL. Early recognition of heart failure and surgery may help to decrease mortality.

Topics: Adult; Aged; Cefotaxime; Cephalosporins; Dose-Response Relationship, Drug; Drug Administration Schedule; Endocarditis, Bacterial; Female; Heart Failure; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Penicillins; Pneumococcal Infections; Prognosis; Prospective Studies; Spain; Streptococcus pneumoniae; Treatment Outcome; Ventricular Dysfunction, Left

Topics: Aged; Bacteremia; Cefotaxime; Citrobacter; Discitis; Drug Therapy, Combination; Electrodes, Implanted; Endocarditis, Bacterial; Enterobacteriaceae Infections; Equipment Contamination; Humans; Imipenem; Lumbar Vertebrae; Male; Pacemaker, Artificial; Sacrum; Tobramycin

Topics: Adult; Bioprosthesis; Cefotaxime; Diuretics; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis; Hepatitis C, Chronic; HIV Infections; Humans; Immunocompromised Host; Klebsiella; Klebsiella Infections; Male; Postoperative Complications; Pulmonary Valve; Staphylococcal Infections

Moraxella phenylpyruvica, a gram-negative coccobacillus, is usually considered a nonpathogenic bacterium. Only a few cases of invasive disease caused by this organism were reported in the 1970s. We report a well-documented case of bacteremia and possible endocarditis due to M phenylpyruvica in a previously healthy man.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Bacteremia; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Humans; Male; Moraxella; Neisseriaceae Infections; Ofloxacin; Penicillins

To analyse clinical characteristics of endocarditis for the last 10 years, treatment difficulties and how to overcome them.. 135 patients with infectious endocarditis (IE) were examined according to the routine scheme using modern methods of diagnosis and therapy control: transthoracic and transesophageal echo-CG, test for antibiotics sensitivity of the microflora, etc. Immediate results were assessed in all the patients, some of them were followed up for maximum 5 years.. Last decade was marked for growing difficulties in the treatment of IE related to its polyetiology. It can be caused by such therapy-resistant microbes as Staphylococcus aureus, Pseudomonas aeruginosa, anaerobic infection, nosocomial infection, injections of narcotic drugs, etc.. Current course of IE dictates the necessity of fighting resistant microflora especially in case of nosocomial disease. Recurrences become more frequent. Indications to surgery did not change for the last decade. The best treatment results are achieved after antibacterial treatment of the valve.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Cephalosporins; Ciprofloxacin; Cross Infection; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Follow-Up Studies; Gentamicins; Humans; Male; Oxacillin; Plasmapheresis; Recurrence; Time Factors

Topics: Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefotaxime; Cephalosporin Resistance; Endocarditis, Bacterial; Gentamicins; Humans; Male; Middle Aged; Penicillin Resistance; Streptococcal Infections; Vancomycin

The synergy between amoxicillin and cefotaxime against two strains of Enterococcus faecalis (JH2-2 and 6370) in vitro and in rabbit endocarditis was investigated. In vitro synergy was obtained only when amoxicillin concentrations were below the MBC and when cefotaxime concentrations were above 1 microg/ml. No synergy was observed in vivo, because of the short period of time during which these pharmacologic requirements were achieved.

Topics: Amoxicillin; Animals; Cefotaxime; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Gram-Positive Bacterial Infections; Rabbits

Topics: Adult; AIDS-Related Opportunistic Infections; Ampicillin; Cefotaxime; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Gram-Negative Bacterial Infections; Heart Valve Prosthesis; Humans; Male; Prosthesis-Related Infections

Capnocytophaga sp. is a gram-negative bacilli, scarcely documented as the cause of bacteremias. Two cases of bacteremia caused by Capnocytophaga sp, one of them with endocarditis, are reported here. A review of previous published cases is also presented. One of the patients was immunocompromised, because of chemotherapy, the other, suffered from a rheumatic-cardiopathy which was complicated with endocarditis. Both patients developed an alteration of the oral mucosa. Antibiotic therapy proved to be effective with two patients.

Topics: Adult; Aged; Amikacin; Anti-Bacterial Agents; Bacteremia; Capnocytophaga; Cefotaxime; Ceftazidime; Cephalosporins; Endocarditis, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Male

Using two strains of Salmonella enteritidis, one susceptible and one resistant to ampicillin, we studied the efficacies of ampicillin, gentamicin, ampicillin plus gentamicin, ofloxacin, and cefotaxime for the treatment of experimental salmonella endocarditis. Rabbits were treated for 3 days with dosages of antibiotic selected to achieve concentrations in serum equivalent to those obtained in humans during therapy. Aortic salmonella endocarditis seemed to be very difficult to treat, and all antimicrobial regimens failed to achieve the complete sterilization of cardiac vegetations. In vitro studies did not accurately predict the in vivo response to therapy, and no correlations regarding the synergistic activity of the combination of ampicillin plus gentamicin were observed. For the ampicillin-susceptible S. enteritidis isolate, ampicillin and cefotaxime produced the greatest reduction in the number of organisms in vegetations, with no significant differences between them. For the ampicillin-resistant strain, the combination of ampicillin with gentamicin produced a synergistic effect that was not anticipated by the in vitro studies. Both cefotaxime and ofloxacin were effective in reducing the number of microorganisms in the vegetations, although the reduction produced by cefotaxime was less that that produced against the ampicillin-susceptible strain. Monotherapy with gentamicin exhibited only modest activity against the ampicillin-susceptible S. enteritidis strain.

Topics: Ampicillin; Ampicillin Resistance; Animals; Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Endocarditis, Bacterial; Gentamicins; Humans; Microbial Sensitivity Tests; Ofloxacin; Rabbits; Salmonella enteritidis; Salmonella Infections

Topics: Adult; Bacteremia; Cefotaxime; Cloxacillin; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Escherichia coli; Escherichia coli Infections; Fatal Outcome; Female; HIV Infections; Humans; Injections, Intravenous; Male; Substance Abuse, Intravenous; Tobramycin; Urinary Tract Infections

A patient with Haemophilus aphrophilus endocarditis was successfully treated with ciprofloxacin. The response to treatment with cefotaxime and netilmicin for 12 days was poor but was satisfactory to a 6 weeks' course of ciprofloxacin.

Topics: Adult; Cefotaxime; Ciprofloxacin; Endocarditis, Bacterial; Haemophilus Infections; Humans; Male; Microbial Sensitivity Tests; Netilmicin

Topics: Aged; Cefotaxime; Endocarditis, Bacterial; Humans; Male; Recurrence; Staphylococcal Infections

Although human infections with bacteraemia due to Pasteurella multocida are not uncommon, endocarditis associated with P. haemolytica is rare. We describe such a case in which the patient died despite treatment with apparently appropriate antimicrobial agents.

Topics: Adult; Ampicillin; Cefotaxime; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Humans; Male; Pasteurella Infections; Saudi Arabia

Topics: Cefotaxime; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged

We studied the effect of a nonsteroidal anti-inflammatory drug, diclofenac, in rabbits on the kinetics of three cephalosporins: cefotiam, cefmenoxime and ceftriaxone, and compared the antibacterial effect of these antibiotics, given alone or with diclofenac, in experimental endocarditis. Diclofenac significantly increased (P less than .05) the area under the curve in tissue-cage fluid of ceftriaxone and cefotiam-treated animals, and the terminal half-life of ceftriaxone in their sera (3.45 +/- 0.4 vs. 2.8 +/- 0.5 hr). Diclofenac reduced urinary excretion of cefotiam only. Cefmenoxime pharmacokinetics remained unchanged by diclofenac. The alteration of ceftriaxone kinetics appeared to be due to nonrenal mechanisms and could suggest reduction of biliary excretion. In Escherichia coli endocarditis, diclofenac enhanced the concentration (P less than .05) of cefotiam (23 +/- 16 vs. 8.9 +/- 5 micrograms/g) and ceftriaxone (13.2 +/- 3 vs. 8.5 +/- 4 micrograms/g) in infected vegetations, but not that of cefmenoxime. The antibacterial effect of ceftriaxone increased with diclofenac (5.5 +/- 1 vs. 7.2 +/- 1 log10 colony forming unit/g of vegetation). In vitro, neither protein binding to rabbit serum proteins nor intrinsic activity on the E. coli strain of each antibiotic was modified by diclofenac. These results suggest that anti-inflammatory drugs could increase antibiotic efficacy by altering their pharmacokinetics. The renal and nonrenal site of interaction may be involved for drugs belonging to the same class. Results obtained in tissue-cage fluid were predictive of the interference at the infected site.

Topics: Animals; Cefmenoxime; Cefotaxime; Cefotiam; Ceftriaxone; Diclofenac; Drug Synergism; Endocarditis, Bacterial; Escherichia coli Infections; Injections, Intramuscular; Microbial Sensitivity Tests; Rabbits

Topics: Aspirin; Cefotaxime; Child; Echocardiography; Endocarditis, Bacterial; Gentamicins; Humans; Male; Staphylococcal Infections; Tricuspid Valve

To determine the influence of in vitro activity, pharmacokinetic properties, and therapeutic regimen on the antibacterial effect in vivo, we compared three cephalosporins, cefotiam, cefmenoxime, and ceftriaxone, in a rabbit model of experimental Escherichia coli endocarditis after 4 days of treatment. The MBCs of cefotiam, cefmenoxime, and ceftriaxone for the E. coli strain were 0.5, 0.125, and 0.06 microgram/ml, respectively. Killing curves at 10 times the MBC were similar for the three cephalosporins. In serum, the elimination half-life of ceftriaxone was twice as much as the elimination half-life of cefotiam or cefmenoxime (2.8 +/- 0.45 versus 1.4 +/- 0.25 or 1.3 +/- 0.4 h, respectively). Ceftriaxone was much more effective than cefotiam. The bacterial titer in the vegetations (log10 CFU per gram of vegetation) was 7.56 +/- 1 with cefotiam and 2.41 +/- 2.6 with ceftriaxone, as their concentrations were 18 and 466 times higher, respectively, than their MBCs. Although ceftriaxone and cefmenoxime exhibited a similar rate of killing and percentage of protein binding, ceftriaxone was more effective than cefmenoxime at the same regimen of 15 mg/kg twice a day (3.08 +/- 1.1 versus 4.82 +/- 3.2 log10 CFU/g of vegetation). When antibiotic was given as a single daily injection of 30 mg/kg, the antibacterial effect persisted for ceftriaxone, but not for cefmenoxime. The longer elimination half-life and the higher local concentration/MBC ratio of ceftriaxone explained these results. The bacterial titer measured 24 h after the fourth injection of 30 mg of ceftriaxone per kg confirmed that this regimen prevented regrowth of bacteria. These results suggest that the local antibiotic level/MBC ratio roughly correlated with the antibacterial effect and could represent an adequate basis to explain the differences observed between the drugs in vivo. They also demonstrate that, provided that the dose is sufficient, a long-acting broad-spectrum cephalosporin may be effective in severe gram-negative infections, even when given at relatively long dosing intervals, in contrast with a rapidly cleared drug with the same intrinsic activity.

Topics: Animals; Cefmenoxime; Cefotaxime; Cefotiam; Ceftriaxone; Drug Evaluation, Preclinical; Endocarditis, Bacterial; Escherichia coli; Escherichia coli Infections; Kinetics; Rabbits

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

Acinetobacter spp. are uncommon etiologic agents of prosthetic valve endocarditis. Two patients with Acinetobacter calcoaceticus subsp. lwoffi prosthetic valve endocarditis are described. The patients were successfully treated with antibiotics (cefotaxime sodium and gentamicin sulfate); thus, we suggest medical treatment rather than early valve replacement in this particular type of infection.

Topics: Acinetobacter Infections; Aortic Valve; Cefotaxime; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis; Humans; Male; Middle Aged

Neisseria flavescens is a rare cause of human disease. This is the first reported case of endocarditis caused by N. flavescens. The organism produced beta-lactamase, and penicillin therapy failed to cure the infection. Therapy with cefotaxime, to which the organism was highly sensitive, led to a complete and uneventful recovery.

Topics: Aged; Aged, 80 and over; Cefotaxime; Endocarditis, Bacterial; Female; Humans; Neisseria

Kingella species are rarely reported as a cause of endocarditis. We report two cases of K. denitrificans endocarditis occurring in patients with prosthetic valves. K. denitrificans has not been previously reported to cause prosthetic valve endocarditis. Both patients may have developed bacteremia from altered upper respiratory or oral mucosa with subsequent prosthetic valve infection. Treatment with penicillin G and streptomycin was successful in the first patient, whereas ampicillin alone resulted in clinical cure in the second case. Neither patient required further surgery. In vitro antibiotic susceptibility testing indicated that both organisms were highly sensitive to cefotaxime and ampicillin.

Topics: Adult; Aged; Ampicillin; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Dental Prophylaxis; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Neisseriaceae; Penicillin G; Streptomycin

Cefotaxime has little antimicrobial activity in vitro against most strains of enterococci, as measured by conventional MICs and MBCs. However, the MICs of cefotaxime against many enterococci are markedly reduced by the addition of serum to the test medium. To assess the relevance of this observation in vivo, we examined the efficacy of cefotaxime in experimental Streptococcus faecalis endocarditis. Since response to antimicrobial agents may vary with the degree of vegetation development, therapeutic efficacy was assessed both in rabbits with newly formed vegetations and in rabbits with well-developed endocardial lesions. Peak serum levels of cefotaxime (50.1 +/- 20.0 micrograms/ml) exceeded the MIC in medium supplemented with serum (4 micrograms/ml), but not in Mueller-Hinton broth alone (greater than 64 micrograms/ml). After 4 days of therapy, animals with newly formed lesions (therapy initiated 1 h after infection, transvalvular catheters removed) had lower mean vegetation bacterial titers than did untreated controls. Among animals with mature vegetations (therapy initiated 12 h after infection, catheters indwelling), the rate of mortality was significantly reduced by cefotaxime therapy. However, no difference in vegetation titers was observed. Thus, cefotaxime demonstrated antienterococcal activity within newly formed vegetations, but did not inhibit bacterial proliferation within well-established vegetations.

Topics: Animals; Cefotaxime; Endocarditis, Bacterial; Enterococcus faecalis; Heart Valve Diseases; Microbial Sensitivity Tests; Rabbits; Streptococcal Infections

Topics: Adult; Cefotaxime; Ceftizoxime; Endocarditis, Bacterial; Haemophilus Infections; Humans; Male; Mitral Valve Prolapse

Topics: Actinobacillus; Adult; Cefotaxime; Ceftizoxime; Endocarditis, Bacterial; Haemophilus; Humans; Male; Middle Aged; Mitral Valve Insufficiency

Antistaphylococcal activity of newer beta-lactam antibiotics, cefmenoxime, cefotaxime and latamoxef was compared with that of the more conventional antistaphylococcal agents, nafcillin, cefazolin and vancomycin. 53 strains of Staphylococcus aureus, 40 from patients with endocarditis and 13 from patients with bacteremia from other causes were tested in vitro against each antibiotic using agar dilution methods. Minimal concentration of antibiotic to inhibit 90% of strains tested was 2 micrograms/ml for cefmenoxime and cefotaxime, 8 micrograms/ml for latamoxef and only 0.5 microgram/ml for nafcillin, cefazolin and vancomycin. The newer beta-lactam antibiotics may not be preferred to nafcillin, cefazolin or vancomycin in the treatment of serious staphylococcal infections.

Topics: Anti-Bacterial Agents; Cefazolin; Cefmenoxime; Cefotaxime; Endocarditis, Bacterial; Humans; Microbial Sensitivity Tests; Moxalactam; Nafcillin; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Antistaphylococcal activity of three beta-lactam antibiotics, i.e. cefmenoxime, cefotaxime and latamoxef (moxalactam) was compared with that of nafcillin by studying cure rates of aortic valvular endocarditis caused by one of three clinical isolates of Staphylococcus aureus in New Zealand white male rabbits. The animals were randomly allocated to a control and four antibiotic treatment groups. Each animal except the controls received 60 mg/kg of one antibiotic intramuscularly twice daily for two weeks, beginning 24 h after induction of endocarditis. The aortic valve was sterilized in 11 of 15 (73%) animals treated with cefmenoxime, nine of 13 (69%) treated with cefotaxime, 11 of 13 (85%) treated with latamoxef and 12 of 15 (80%) treated with nafcillin. All nine animals in the control group developed aortic valvular vegetations with an average of 2.4 X 10(9) cfu/g. The differences in sterility rates resulting from treatment with the four antibiotics were not statistically significant (P greater than 0.70).

Topics: Animals; Cefmenoxime; Cefotaxime; Endocarditis, Bacterial; Humans; Male; Microbial Sensitivity Tests; Moxalactam; Nafcillin; Rabbits; Staphylococcal Infections

Aortic valve endocarditis due to a penicillin G (PNC) and ceftizoxime (CZ)-sensitive group B streptococcus (GBS) was induced in 72 rabbits. Animals received either procaine PNC (300 mg/kg per day) or CZ (150 mg/kg/day) for 3, 6, or 9 days. PNC rapidly sterilized blood cultures (less than or equal to 3 days) and significantly reduced vegetation GBS titers versus controls at all three sacrifice times (p less than 0.0005). In contrast, CZ exerted a slow in vivo bactericidal effect with vegetation titers not significantly different from controls until day 9 of therapy. By day 9 of therapy, 65/89 (73%) of vegetations were sterilized by PNC versus only 24/94 (26%) sterilized by CZ (p less than 0.0005). This marked in vitro-in vivo disparity in CZ-treated animals occurred despite 100% of individual serum bactericidal titers greater than or equal to 1:32 and 100% of individual CZ serum levels greater than or equal to 100 times the GBS MBC. The suboptimal CZ in vivo effect was not related to: (1) development of CZ resistance on therapy; (2) CZ inactivation, or (3) inoculum-growth phase effect.

Topics: Animals; Cefotaxime; Ceftizoxime; Endocarditis, Bacterial; Female; Microbial Sensitivity Tests; Penicillin G; Rabbits; Streptococcal Infections; Streptococcus agalactiae; Time Factors

Topics: Cefotaxime; Drug Combinations; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Middle Aged; Serratia marcescens; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Cross Infection; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Pneumonia; Pyelonephritis; Sepsis; Urinary Tract Infections

Topics: Burns; Cefotaxime; Cephalosporins; Child; Drug Resistance, Microbial; Endocarditis, Bacterial; Enterobacteriaceae Infections; Female; Humans; Sepsis; Serratia marcescens; Tricuspid Valve

Topics: Adolescent; Adult; Aged; Cefotaxime; Cephalosporins; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Sepsis