cefotaxime and Fetal-Membranes--Premature-Rupture

Preterm premature rupture of the membranes is associated with a high risk of neonatal sepsis. An increase in the incidence of early-onset neonatal sepsis due to ampicillin-resistant Escherichia coli in premature infants has been observed in the past few years. Intrapartum prophylaxis with ampicillin has proven to be efficient for the prevention of early neonatal sepsis due to group B streptococci. To date, there is no strategy for the prevention of early neonatal sepsis due to ampicillin-resistant E. coli. Our aim was to investigate whether a standardized dosage regimen of intrapartum cefotaxime could provide concentrations in the cord blood greater than the cefotaxime MIC(90) for E. coli. Seven pregnant women hospitalized with preterm premature rupture of the membranes and colonized with ampicillin-resistant isolates of the family Enterobacteriaceae were included. Cefotaxime was given intravenously during delivery, as follows: 2 g at the onset of labor and then 1 g every 4 h until delivery. Blood specimens were collected from the mother 30 min after the first injection and just before the second injection, and at birth, blood specimens were simultaneously collected from the mother and the umbilical cord. The concentrations of cefotaxime in the cord blood ranged from 0.5 to 8.5 mg/liter. The MIC(90) of cefotaxime for E. coli strains (0.125 mg/liter) was achieved in all cases. This preliminary study supports the use of cefotaxime for intrapartum prophylaxis in women colonized with ampicillin-resistant isolates of Enterobacteriaceae. The effectiveness of this regimen for the prevention of neonatal sepsis needs to be evaluated with a larger population.

Topics: Ampicillin Resistance; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Enterobacteriaceae Infections; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Microbial Sensitivity Tests; Pregnancy

The authors compared two groups of pregnant women with early loss of amniotic fluid. In the first group Claforan was administered, 3 x 1 g by the i.m. route, and in the second group Ampicillin, 3 x 1 g by the i.m. route. The data were recorded in a special protocol and were divided into three groups: 1. patient before delivery, 2. patient during puerperium, 3. neonate. From the results two conclusions were drawn: 1. The authors did not detect any reasons why antibiotics should not be administered prophylactically in case of premature loss of amniotic fluid. 2. The main differences between the compared groups were found in neonates where after administration of Claforan there was a substantially lower incidence of positive bacterial cultures than after Ampicillin and there was also a lower incidence of RDS II and adnatal infections.

Topics: Adult; Ampicillin; Bacterial Infections; Cefotaxime; Female; Fetal Diseases; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Pregnancy

As part of our management protocol for preterm premature rupture of membranes, ceftizoxime and tocolysis were used to prolong the latent period and prevent or treat concomitant infection. Ceftizoxime was selected for this protocol based on its physiochemical properties, which favor placental transfer of the drug. Patients achieving steady-state pharmacodynamics (more than three doses of the drug) were considered eligible for study. Ceftizoxime levels were determined by reverse-phase high-pressure liquid chromatography. All levels measured after the first hour of treatment were indicative of the relative concentration of ceftizoxime in the fetal and amniotic fluid compartments when compared with the maternal compartment. Mean (+/- SEM) ceftizoxime levels were 11.96 + 2.35 micrograms/ml in maternal serum, 24.54 +/- 4.78 micrograms/ml in cord serum, and 43.45 +/- 4.97 micrograms/ml in amniotic fluid. Based on its broad antibacterial activity and its high concentration in fetal blood and amniotic fluid, ceftizoxime appears to be an ideal agent for treatment of the intrauterine environment.

Topics: Amniotic Fluid; Cefotaxime; Ceftizoxime; Chromatography, High Pressure Liquid; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Humans; Pregnancy; Time Factors

To determine the best method of preventing ascending infection in the management of premature rupture of membranes, antibiotics such as latamoxef sodium, cefoperazone sodium, and cefotaxime sodium were infused directly into the amniotic cavity in 64 patients undergoing induction of labor at term. A single infusion of 100 or 500 mg of each drug resulted in a concentration of 200 to 1000 micrograms/ml immediately after infusion, and the concentration remained above 10 micrograms/ml for about 24 hours without significant increase in fetal or maternal blood levels. Consequently, a daily single dose of 100 mg or more is probably effective prophylaxis in cases of premature rupture of membranes. When intrauterine infection is suspected, the dose can be increased to 500 mg or more, and transplacental administration may be added to achieve a higher concentration in fetal blood. The present study simulates well premature rupture of membranes, and an amnioinfusion of antibiotics will be reliable and effective in managing premature rupture of membranes.

Topics: Amnion; Anti-Bacterial Agents; Catheterization; Cefoperazone; Cefotaxime; Cervix Uteri; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Humans; Moxalactam; Pregnancy