cefotaxime and Eosinophilia

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

Drug reaction with eosinophilia and systemic symptom (DRESS) is a severe adverse drug-induced reaction. Commonly related to anticonvulsant and allopurinol, DRESS can affect both adults and children. Cefotaxime is rarely associated with DRESS, especially with children. We report a cefotaxime-induced DRESS in a child and emphasize the role of allergological work-up to point out the culprit drug in exploring cross-reactivity and identifying a possible cosensitization. A 2-year-old boy was treated with cefotaxime, vancomycin and metronidazole for acute otomastoiditis. Metronidazole was withdrawn and vancomycin was changed by teicoplanin 10 and 15 days later, respectively. Nineteen days after ongoing cefotaxime and 4 days after teicoplanin intake, the patient developed hyperthermia, a widespread exanthema, facial oedema with neither mucosal involvement nor palpable lymphadenopathy. Biological tests revealed eosinophilia, atypical lymphocytes, mild cytolysis and a high lactate dehydrogenase level. Serological tests for viral and bacterial infections were negative. DRESS was suspected and the 2 antibiotics were withdrawn. Intradermal tests (IDT) were carried out 2 months later with cefotaxime and teicoplanin. They revealed a positive result at 48-hour reading. To assess cross-reactivity among β-lactams, IDT to penicillins (benzylpenicillin, amoxicillin and oxacillin) was performed showing negative results at 48-hour reading. Nevertheless, IDT to cephalosporins (cefazolin, cefuroxime, ceftazidime and ceftriaxone) displayed positive results at 48-hour reading. As a result, IDT are of great interest and should be performed to confirm the role of cefotaxime and detect a potential cross-reactivity with chemically similar drugs and drugs taken before and during the episode of DRESS.

Topics: Adult; Cefotaxime; Cephalosporins; Child; Child, Preschool; Drug Hypersensitivity Syndrome; Eosinophilia; Humans; Male; Metronidazole; Teicoplanin; Vancomycin

Topics: Acute Disease; Cefotaxime; Child; Drug Hypersensitivity Syndrome; Eosinophilia; Fever; Humans; Hypersensitivity, Delayed; Male; Osteomyelitis; Tibia; Urticaria

We report two cases, one of a 52-year-old man and one of a 32-year-old man, who were treated with cefotaxime. On day 23 and day 28 of the treatment, respectively, the patients manifested clinically with fever, pruriginous skin rash, and facial edema. Blood tests showed marked eosinophilia and atypical lymphocytosis for both patients, and hepatic cytolysis only in the second patient. Cefotaxime was discontinued in both patients; the clinico-biological picture improved gradually and completely disappeared approximately 4 weeks later. Six weeks after complete recovery, both patients underwent intradermal testing which was positive to cefotaxime (2 mg/ml) at the 48-hour reading and negative to benzylpenicillin, amoxicillin, and cefazolin at the 20-minute and 48-hour readings. These clinical pictures suggest drug rash with eosinophilia and systemic symptoms (DRESS) induced by cefotaxime. To the best of our knowledge, only one case of cefotaxime-induced DRESS has been reported in the medical literature. Thus, we add two new cases of cefotaxime-induced DRESS and emphasize the usefulness and safety of intradermal testing in establishing the diagnosis.

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Edema; Eosinophilia; Humans; Lymphocytosis; Male; Middle Aged; Skin Diseases

Hepatitis A virus (HAV) infections occur predominantly in children, and are usually self-limiting. However, 75-95% of the infections in adults are symptomatic (mostly with jaundice), with the illness symptoms usually persisting for a few weeks. Atypical manifestations include relapsing hepatitis, prolonged cholestasis, and complications involving renal injury. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by skin rash, fever, lymph-node enlargement, and internal organ involvement. We describe a 22-year-old male who presented with acute kidney injury and was diagnosed with prolonged cholestatic hepatitis A. The patient also developed DRESS syndrome due to antibiotic and/or antiviral treatment. To our knowledge, this is the first report of histopathologically confirmed DRESS syndrome due to antibiotic and/or antiviral treatment following HAV infection with cholestatic features and renal injury.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Cefotaxime; Cholestasis; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Eosinophilia; Exanthema; Ganciclovir; Hepatitis A; Humans; Hydrocortisone; Immunoglobulins; Male; Syndrome; Young Adult

Acute interstitial nephritis accounts for about 10 % of the cases of acute renal failure. An adverse drug reaction caused by an immunoallergic mechanism is suggested when fever, skin rash, eosinophilia, and eosinophiluria are associated. The outcome is favorable after withdrawal of drug therapy in most cases. We report a case of acute interstitial nephritis induced by immunoallergic drug mechanisms, in a 3-week-old infant who presented with acute renal failure associated with eosinophilia and hepatitis and who had received cefotaxime and gentamicin. The patient's progression was favorable with normalization of renal and liver function 1 week after suspension of antibiotic drugs.

Topics: Acute Disease; Anti-Bacterial Agents; Cefotaxime; Eosinophilia; Gentamicins; Hepatitis; Humans; Infant, Newborn; Male; Nephritis, Interstitial

Topics: Ampicillin; Anti-Allergic Agents; Anti-Bacterial Agents; Cefotaxime; Child; Diagnosis, Differential; Drug Eruptions; Drug Therapy, Combination; Eosinophilia; Female; Follow-Up Studies; Histamine H1 Antagonists; Humans

Pharmacokinetic and clinical studies of cefixime (CFIX) in children were done and the following results were obtained. Serum and urinary concentrations of CFIX were determined in 6 children aged 5 to 14 years given single doses of 1.5 or 6.0 mg/kg. Mean serum concentrations peaked at 4 hours after the administration of either 1.5 or 6.0 mg/kg, and respective peak values were 0.71 and 4.46 micrograms/ml. Biological half-lives for the low and the high doses were 5.28 and 4.45 hours, respectively. The 12-hours urinary recovery ranged from 7.0 to 13.8% after administration of 1.5 mg/kg, and the 8-hours urinary recovery was 18.1% after administration of 6.0 mg/kg. Therapeutic responses were recorded as excellent or good in 43 (97.7%) of the children, comprising 13 with tonsillitis and 31 with scarlet fever. The microbiological effectiveness of CFIX on identified pathogens comprising 29 strains of S. pyogenes and 2 strains of S. aureus was satisfactory as evidence by a high eradication rate of 93.5%. No clinical side effects were observed. Abnormal laboratory findings were elevation of GOT and/or GPT in 4 patients and eosinophilia in 1 patient. In conclusion, CFIX was found to be efficacious and safe for the treatment of bacterial infections in children.

Topics: Acute Disease; Adolescent; Cefixime; Cefotaxime; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Eosinophilia; Female; Humans; Infant; Male; Scarlet Fever; Staphylococcus aureus; Streptococcus pyogenes; Tonsillitis

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

Cefotaxime, a third generation cephalosporin antibiotic, was evaluated in 26 infants and children for the treatment of documented or suspected bacterial infections, including pneumonia (10 cases), soft tissue skin infection (13 cases), and urinary tract infection (3 cases). An average daily dose of 60 mg/kg in 3 to 4 divided doses was administered parenterally for an average of 7 days. In 14 of the cases, primary pathogens, including Haemophilus influenzae b (resistant to ampicillin), Staphylococcus aureus, Staphylococcus pyogenes, Streptococcus pneumoniae and Escherichia coli, were eradicated. Clinical recovery occurred in each case. Blood levels at different time intervals and biological half-life were similar to those reported for adults. Mild and transient side effects observed were elevation of SGOT in two cases, alkaline phosphatase in one, and eosinophilia in one case.

Topics: Alkaline Phosphatase; Aspartate Aminotransferases; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Eosinophilia; Female; Humans; Infant; Kinetics; Male; Pneumonia; Urinary Tract Infections