cefotaxime and Fever

Moraxella osloensis has been reported in the literature as a human pathogen, particularly among immunocompromised adults. In contrast to the adult population, most pediatric cases are among patients with no underlying immunological defect; however, no patient underwent further investigation and no data about the long-term follow-up are available. We report the case of a 2-month-old previously healthy girl infected with Moraxella osloensis. Here, we review case reports and case series of children and adults with Moraxella osloensis infection and compare them with our experience. On the basis of our findings, we recommend further investigations (immunological or other underlying diseases) when a child is found to be infected with these bacteria.

Topics: Administration, Intravenous; Cefotaxime; Female; Fever; Humans; Infant; Moraxella; Moraxellaceae Infections; Treatment Outcome

Mycoplasma hominis is a commensal organism in the genitourinary tract that can cause life-threatening CNS infections in neonates after intrauterine infection or through vertical transmission during birth. We present a case of an 11-day-old neonate presenting with fever and supporting laboratory evidence of a CNS infection. No systemic maternal infection or maternal genitourinary tract infection occurred at the time of delivery. Empirical treatment was initiated, consisting of amoxicillin, cefotaxime, and aciclovir. After clinical deterioration, 16S ribosomal DNA PCR in cerebrospinal fluid detected M hominis, antibiotic treatment was switched to moxifloxacin, and pharmacokinetic data were obtained. This Grand Round illustrates the challenges that exist in the diagnosis and treatment of M hominis meningoencephalitis: bacterial cultures are often negative and recommended empirical antimicrobials do not provide adequate antimicrobial coverage. Optimal antimicrobial treatment regimens for M hominis meningoencephalitis are unknown. Although we describe successful treatment of a neonate with a complicated M hominis meningoencephalitis with moxifloxacin, caution with fluoroquinolone monotherapy (including moxifloxacin) has to be taken into account because resistance to fluoroquinolones has previously been described.

Topics: Acyclovir; Amoxicillin; Anti-Bacterial Agents; Antiviral Agents; Cefotaxime; Cerebrospinal Fluid; Female; Fever; Fluoroquinolones; Humans; Infant, Newborn; Meningoencephalitis; Moxifloxacin; Mycoplasma hominis; Polymerase Chain Reaction

A prospective, randomized, controlled monocentric trial was performed to evaluate the efficacy and safety of once daily ceftriaxone 2 g plus tobramycin 5 mg/kg in comparison to cefotaxime 2 g t.i.d. plus tobramycin 5 mg/kg qd in the treatment of neutropenic fever. In cases of fever > or = 38.5 degrees C and a neutrophil count below 1000/microliter, patients with hematological malignancies were assigned to ceftriaxone or cefotaxime, each with tobramycin. The primary endpoint was defined as defervescence < 37.5 degrees C on day 4-6 followed by at least 7 afebrile days. Secondary endpoints were overall response, defined as defervescence on day 25 and toxicity. There were 160 episodes of 114 patients included. Fever of unknown origin accounted for 79 episodes (51%), microbiologically defined infection for 36 (23%), clinically defined infection for 27 (17%), and both clinically and microbiologically defined infection for 14 episodes (9%). On an intent-to-treat basis 156 episodes could be evaluated for the primary endpoint. Ceftriaxone plus tobramycin and cefotaxime plus tobramycin resulted in a primary response in 46.9% and 45.3%, respectively. Overall response was achieved on study day 25 in 87.7% and 80%, respectively. No significant difference in toxicity was observed. Once-daily ceftriaxone plus tobramycin was not inferior to cefotaxime t.i.d. plus tobramycin qd in the empirical treatment of neutropenic fever.

Topics: Adult; Aged; Cefotaxime; Ceftriaxone; Drug Therapy, Combination; Female; Fever; Humans; Male; Middle Aged; Neutropenia; Time Factors; Tobramycin

Topics: Adult; Aged; Antineoplastic Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Fever; Hematologic Neoplasms; Humans; Infusions, Intravenous; Middle Aged; Neutropenia; Treatment Outcome

To reduce drug acquisition costs, the clinical and bacteriological efficacy of low-dose ceftazidime i.v. (1 g tid) was compared with cefotaxime i.v. (2 g tid). Both regimens were combined with netilmicin i.v. (2 mg/kg bodyweight tid), in an open, randomized, multicentre trial in febrile neutropenic patients. The addition of antibiotics for gram-positive coverage was part of the protocol; alteration in the antibiotics for gram-negative cover or premature discontinuation of the study antibiotics were judged as failure. One hundred and eighty six patients were randomized by nine German centres, the patients matched for age, underlying diseases and duration of neutropenia (median duration 14 days) in both treatment arms. Infections were documented microbiologically in 29% of the patients, clinically in 16% and suspected (fever of unknown origin) in 102/186 patients (55%). The 82 pathogens isolated were predominantly gram-positive bacteria. In an intent-to-treat analysis, the overall response rate without modification at the final evaluation was 58% in the ceftazidime group and 34% in the cefotaxime group (P < 0.01). The success rates with modification were 84% and 64%, respectively. The failure rate in a highly immunosuppressed subgroup of the patients (bone marrow transplant recipients) was higher for cefotaxime (53%) than for the ceftazidime arm (14%) (P < 0.001). Response rates were significantly higher in the ceftazidime group for patients with microbiologically documented and possible infections. No major bacterial superinfections occurred in the low-dose treatment arm. The tolerability was good for both regimens. Low-dose ceftazidime combined with netilmicin proved to be superior to recommended doses of cefotaxime/netilmicin in febrile neutropenic patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftazidime; Cephalosporins; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Fever; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Neutropenia; Superinfection; Treatment Outcome

The efficacy and safety of two different regimens for parenteral treatment of presumed severe febrile urinary tract infection were compared in a randomized study. One hundred fifty-eight patients were treated with either cefotaxime 2 g i.v. twice daily for at least two days followed by norfloxacin 400 mg twice daily orally or one bolus dose of gentamicin 3 mg/kg i.v. and norfloxacin from the start. Three patients randomized to cefotaxime died. Of the 101 patients with verified urinary tract infection, clinical response to assigned therapy was seen in 79% and 74%, respectively. There was no difference in fever duration between the two regimens. The results indicate that one bolus dose of gentamicin with early oral therapy is a safe and effective alternative to common parenteral regimens for empirical treatment of febrile urinary tract infection.

Topics: Adult; Aged; Aged, 80 and over; Cefotaxime; Drug Therapy, Combination; Female; Fever; Gentamicins; Humans; Male; Middle Aged; Norfloxacin; Prospective Studies; Urinary Tract Infections

Children with sickle cell disease are at increased risk for bacterial sepsis and, when febrile, are usually hospitalized for intravenous antibiotic therapy pending results of blood cultures. In this study, we prospectively identified a group of febrile patients with sickle cell disease who were at low risk for sepsis and treated them with outpatient therapy.. Children identified as low risk for sepsis were treated with an initial dose of intravenous ceftriaxone, followed by outpatient therapy with oral cefixime, and were monitored for 14 days after the initial visit. Compliance was assessed by phone calls to parents and by analysis of urine samples.. In 107 eligible febrile episodes (80 patients) over a 21-month period, no patient developed sepsis. One child developed bacteremia 3 days after completing the course of cefixime, and one had splenic sequestration on the fourth study day. Both patients did well. Side effects of cefixime were modest, and overall compliance was excellent (approximately 95%), although urine samples were returned by only 56% of parents.. We conclude that outpatient therapy is safe and effective in febrile patients with sickle cell disease who meet the criteria for a low risk of sepsis.

Topics: Administration, Oral; Adolescent; Anemia, Sickle Cell; Anti-Infective Agents; Bacteremia; Bacterial Infections; Cefixime; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Humans; Infant; Male; Outpatients; Patient Compliance

The aim of this prospective randomized controlled trial was to investigate the need for prophylactic antibiotherapy in patients with cirrhosis and hepatocellular carcinoma who underwent transarterial embolization and to establish the parameters that determine the development of fever > 38 degrees C after this procedure.. Sixty-one consecutive patients with cirrhosis undergoing 75 procedures were randomized into Group I [(n = 37) allocated to receive prophylactic antibiotics (Cefotaxime + Metronidazole)] and Group II [(n = 38) allocated to receive no antibiotic treatment].. Twelve of the 37 patients (32%) in Group I and 13 of the 38 patients (34%) in Group II developed fever > 38 degrees C after treatment. However, none of them developed bacterial infection, and all biological fluid cultures were negative. A logistic regression analysis disclosed that the obtention of an extensive tumor necrosis was the unique parameter independently associated with the development of fever.. Antibiotic prophylaxis is therefore not necessary in patients with cirrhosis and hepatocellular carcinoma undergoing transarterial embolization. The appearance of fever after this procedure does not indicate bacterial infection; it rather represents a clinical marker of extensive tumor necrosis and thus of a favorable response to treatment.

Topics: Aged; Anti-Bacterial Agents; Arteries; Carcinoma, Hepatocellular; Cefotaxime; Drug Therapy, Combination; Embolization, Therapeutic; Female; Fever; Humans; Liver Neoplasms; Male; Metronidazole; Middle Aged; Prospective Studies

In this double-blind multicentre study, using the intention-to-treat approach, a total of 293 patients with fever (> or = 38.5 degrees C), symptoms of sepsis and signs of pneumonia or pyelonephritis were randomly assigned to treatment with ampicillin and mecillinam (A+M) or cefotaxime followed by cefadroxil. In the febrile phase, treatment was given intravenously twice daily, either with 1,200 mg ampicillin together with 600 mg mecillinam or with 2 g cefotaxime alone. When the patients stayed afebrile, the intravenous administration was replaced by oral treatment twice daily for 14 days, either with 500 mg pivampicillin and 400 mg pivmecillinam or 1 g cefadroxil. In the A+M group, 33% (48/144) of the patients did not complete the full course of treatment as compared with 32% (47/149) in the cephalosporin group, the reasons being treatment failure in 27 and 29, respectively, or adverse effects (n = 16 in both groups). The median duration of fever was 47 h in the A + M group and 50 h in the cephalosporin group. Of 135 patients with pneumonia, 68% were completely cured in the A + M group, and 65% in the cephalosporin group, the main reasons for treatment failure being Mycoplasma pneumonia or ornithosis. Of 136 patients with pyelonephritis, 63% were cured in each group. The main reason for failure was bacteriological relapse. Side-effects were reported by 32 patients (22%) of the A+M group, as compared with 41 (28%) of the cephalosporin group. Epigastric complaints were equally frequent in both groups, but there was a tendency for a higher frequency of exanthema in the A+M group, and for antibiotic-associated diarrhoea and fungal superinfections in the cephalosporin group.

Topics: Amdinocillin; Ampicillin; Cefadroxil; Cefotaxime; Cephalosporins; Double-Blind Method; Drug Therapy, Combination; Escherichia coli Infections; Female; Fever; Humans; Male; Middle Aged; Penicillins; Pneumonia, Bacterial; Pyelonephritis

Two dose schedules of the antibiotic cefotaxime were compared in a prospective, randomized 226-center study of 3,670 patients undergoing abdominal, gynecologic, and urologic surgery. Schedule A consisted of a single preoperative dose and schedule B consisted of one preoperative dose followed by two postoperative doses. There was no significant difference in the frequency of wound infection or bacteriuria between the two schedules. Schedule B was associated with a significantly higher incidence of postoperative pyrexia, further antibiotic therapy, local side effects, and extended hospital stay. One dose probably has less impact on the intestinal flora. Therefore, single-dose cefotaxime is as effective and less costly when compared with multiple-dose cefotaxime for common surgical procedures lasting less than 3 hours.

Topics: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Administration Schedule; Female; Fever; Humans; Hysterectomy; Length of Stay; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Surgical Wound Infection; Urinary Tract

Thirty-three children with leukemia who had neutropenia and fever were randomized to receive cefataxim and amikacin, versus the same antibiotics plus intravenous gammaglobulin (i.v. IgG). Duration of neutropenia, hospitalization and the interruption of chemotherapy were not different in the two groups; however, duration of fever was significantly shorter in the i.v. IgG group.

Topics: Agranulocytosis; Amikacin; Antineoplastic Agents; Cefotaxime; Child; Drug Therapy, Combination; Fever; Humans; Immunoglobulin G; Immunoglobulins, Intravenous; Infection Control; Leukemia, Myeloid, Acute; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma

A prospective study was conducted in 10 haematology departments of university hospitals on 174 leukaemic patients with prolonged bone marrow aplasia and presenting with a febrile episode. The patients were allocated at random to either ceftazidime or the cefotaxime-amikacin combination. The two treatment group were similar as regards age, sex, underlying blood disease, duration of neutropenia, presence of a venous catheter, type of digestive tract contamination, clinical and bacteriological findings. Results were assessed mainly on the course of the fever at 48 hours and on the clinical and bacteriological changes observed until the patients came out of aplasia. Documented infections were specifically analyzed. There was no significant difference in terms of success or failure between the two treatment groups. Ceftazidime administered as monotherapy proved as effective as the cefotaxime-amikacin combination in the empirical first-line treatment of febrile episodes in leukaemic patients with neutropenia.

Topics: Adult; Amikacin; Cefotaxime; Ceftazidime; Drug Evaluation; Drug Therapy, Combination; Fever; Humans; Leukemia; Multicenter Studies as Topic; Prospective Studies; Random Allocation

Seventy-one neutropenic patients under cytostatic treatment for malignant hemopathies (neutrophil granulocytes less than or equal to/mm3 with feverish episodes in progress (T greater than or equal to 38.5 degrees C) which were probably of an infectious nature were treated according to two antibiotic protocols (piperacillin + amikacin [P + A] or cefotaxime + amikacin [C + A] in a randomized, comparative, prospective study. Of the 71 patients enrolled, 65 could in the end be evaluated for the purposes of this study (36 treated according to the P + A protocol, 29 according to the C + A protocol). In 16 patients the infection was documented bacteriologically. In these cases the percentages of response were, respectively, 77.7% with the P + A and 71.4% with the C + A protocol. The positive clinical results of the two protocols being studied were, considering the entire survey (bacteriologically documented, clinically documented and FUO infections), respectively, 69.4% in the patients treated with P + A and 62.0% in those treated with C + A. The results of the study seem to indicate that the severity of the neutropenia (N.G. less than 500 or greater than 500) does not affect the response to the antibiotic therapy. Modest and transient side effects (hypokalemia and increase of the ClCr) were noted above all in the patients subjected to the therapy with C + A. The results of this study show, therefore, a superimposable effectiveness of the two therapeutic protocols (P + A and C + A) in the empirical treatment of infections in neutropenic patients with malignant hemopathies.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Agranulocytosis; Amikacin; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Female; Fever; Humans; Leukemia; Lymphoma; Male; Middle Aged; Neutropenia; Piperacillin; Prospective Studies

The combination of beta-lactam antibiotics and new quinolones is a form of broad spectrum antibiotic therapy rapidly bactericidal in vitro which could be an alternative to the classical combination of beta-lactam antibiotics and aminoglycosides in the first line treatment of febrile episodes in patients with neutropenia. The treatment of 37 initial febrile episodes (12 cases of septicemia, 7 infectious sites and 38 cases of fever of unknown origin) in 33 neutropenic patients (PMN leucocytes less than 500/mm3) using the combination of a third generation cephalosporin (cefotaxime or ceftazidime) and a new quinolone (pefloxacin) resulted in an 86% immediate success rate (32 cases/37). Results and course during treatment were similar in both groups (cefotaxime or ceftazidime). A second febrile episode occurred in 11 cases (4 superinfections, 2 chest infections, 5 fevers of unknown origin). Clinical acceptability was satisfactory in both groups. Minimal and transient changes in liver function tests were observed in 19% of the successfully treated patients. Study of quantitative aerobic stool cultures revealed the emergence of resistant bacterial strains, essentially Pseudomonas sp. (6 cases). More extensive trials should provide a better view of the role of this new combination in the first line treatment of febrile episodes in the neutropenic patient.

Topics: Agranulocytosis; Anti-Infective Agents; Cefotaxime; Ceftazidime; Drug Evaluation; Drug Therapy, Combination; Escherichia coli Infections; Feces; Fever; Focal Infection; Humans; Leukemia; Neutropenia; Norfloxacin; Pefloxacin; Pseudomonas Infections; Sepsis; Staphylococcal Infections

Cefmenoxime plus amikacin was compared in a prospective randomized trial with our standard regimen of piperacillin plus amikacin as an empiric therapy for fever in patients with granulocytopenia. Initial profound granulocytopenia (fewer than 100/mm3 mature granulocytes) was present in approximately 45% of the patients in trial of both treatment groups. Of 53 microbiologically and clinically documented infections treated with piperacillin plus amikacin, 36 (68%) showed improvement. Of 48 microbiologically and clinically documented infections treated with cefmenoxime plus amikacin, 23 (48%) showed improvement. The response rate for gram-negative infections treated with cefmenoxime plus amikacin was lower than that for infections treated with piperacillin plus amikacin. Toxicity was minimal, with an equivalent incidence of skin rash, diarrhea and hepatic dysfunction. Although clinical efficacy of the combination of piperacillin plus amikacin may be superior to cefmenoxime plus amikacin therapy, this study demonstrated no statistically significant differences.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Bacterial Infections; Cefmenoxime; Cefotaxime; Drug Therapy, Combination; Female; Fever; Humans; Male; Middle Aged; Neoplasms; Piperacillin; Prospective Studies; Random Allocation

The effect of short-term antibiotic prophylaxis on postoperative infection with 2 injections of cefotaxime begun preoperatively was evaluated in a double-blind, randomized, placebo-controlled trial at 1 center on 181 patients with preoperative sterile urine undergoing transurethral resection (90) or open prostatectomy (91). Antibiotic prophylaxis reduced the number of urinary infections significantly in both groups without altering the level of resistant pathogens. Cefotaxime lowered the incidence of postoperative infection in the early postoperative period from 30 to 4 per cent in the transurethral resection group and from 46 to 4.5 per cent in the open prostatectomy group. A significant difference was found between the 2 treatment groups in the incidence of perioperative bacteremia and postoperative fever. Among the patients undergoing an open prostatectomy a reduced rate of wound infection and a shorter duration of hospital stay were witnessed in the treated group. Thus, short-term chemoprophylaxis by cefotaxime is of benefit in reducing morbidity and hospital cost for prostatectomy by either procedure.

Topics: Cefotaxime; Clinical Trials as Topic; Double-Blind Method; Fever; Humans; Length of Stay; Male; Premedication; Prostatectomy; Random Allocation; Risk; Sepsis; Surgical Wound Infection; Time Factors; Urinary Tract Infections

The standard regimen used by members of the European Organization for Research on Treatment of Cancer Antimicrobial Therapy Cooperative Group for empiric therapy of febrile neutropenic cancer patients has been treatment with ticarcillin plus amikacin. A three-arm prospective randomized controlled trial was performed to determine whether the extended-spectrum antipseudomonal penicillin azlocillin or the extended-spectrum cephalosporin cefotaxime had more or less efficacy than the beta-lactam in the ticarcillin-plus-amikacin regimen. A total of 742 patients from 22 institutions were evaluated. Single gram-negative rod bacteremias accounted for 83 episodes, and it was among these patients that the prognosis was least satisfactory, leading to a more intensive evaluation of this patient group. In these patients the azlocillin-plus-amikacin regimen resulted in a 66% response rate, compared with a 37% response rate for patients who received cefotaxime plus amikacin (P = 0.080) and a 47% response rate for patients who received ticarcillin plus amikacin (P = 0.207). The patients with gram-negative rod bacteremias and persistently profound granulocytopenia had substantially poorer response rates (37%) than the patients with rising granulocyte counts (73%; P = 0.004). A logistic regression analysis indicated that the following factors also affected infection resolution: beta-lactam utilization in the regimen (azlocillin was better than ticarcillin or cefotaxime), resolution of profound granulocytopenia (less than 100 cells per microliter) during therapy, and susceptibility to the beta-lactam antibiotic.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Azlocillin; Cefotaxime; Child; Clinical Trials as Topic; Drug Therapy, Combination; Female; Fever; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Kanamycin; Male; Middle Aged; Penicillins; Prospective Studies; Random Allocation; Regression Analysis; Sepsis; Ticarcillin

A prospective, randomized trial comparing treatment of 61 febrile episodes with cefotaxime (CTX) versus a combination of ampicillin, methicillin, and netilmicin (AMN) was carried out in 58 patients with leukaemia or malignant lymphoma, of whom 28 had a granulocyte count of less than or equal to 500 X 10(6)/l. The overall response frequency was 63% for CTX against 49% for the AMN combination, the latter figure being lower than generally reported in the literature. The difference was not statistically significant. In 21 episodes pathogens were isolated, 16 of them from the blood. All isolated bacteria but one, a strain of Bacteroides fragilis, were fully sensitive to at least one of the three antibiotics in the combination, and all but one, a strain of Listeria monocytogenes, were fully sensitive to CTX. These results indicate that CTX seems to be a promising alternative as monotherapy for empiric treatment of febrile episodes in patients with haematologic malignancies. Further investigations will, however, be required before completely rational choices between mono and combination therapy of febrile episodes in immunosuppressed patients can be made.

Topics: Adolescent; Adult; Aged; Ampicillin; Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Drug Therapy, Combination; Female; Fever; Humans; Leukemia; Lymphoma; Male; Methicillin; Middle Aged; Netilmicin; Penicillins; Prospective Studies; Random Allocation

A randomized study of gentamicin plus cefotaxime versus ceftazidime alone was performed in 87 patients, with a neutrophil count of less than 1000/mm3 at the start of the treatment. The overall cure rate for the ceftazidime group was 71% and for the gentamicin plus cefotaxime 47%. This difference was shown to be statistically significant at a level of P less than 0.05. The cure rates for the microbiologically proven infections were 90 and 63% respectively. Serious adverse effects, causing preliminary withdrawal of therapy, have not been observed.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Bacterial Infections; Cefotaxime; Ceftazidime; Cephalosporins; Drug Therapy, Combination; Female; Fever; Gentamicins; Humans; Male; Middle Aged; Random Allocation

Cefotaxime, a new third-generation cephalosporin, was compared with ampicillin and cefazolin in a randomized double-blind trial to evaluate the efficacy of antibiotic prophylaxis of febrile morbidity associated with emergency cesarean sections. A 1-gm intravenous dose of one of the three antibiotics was given by bolus injection immediately after clamping of the umbilical cord and six and 12 hours later. All patients were in labor with membranes ruptured and had a temperature less than or equal to 37.8 C, and none had a history of penicillin or cephalosporin allergy. A total of 195 women were entered into the trial. Initially, the study included a placebo control group which was switched to ampicillin after 30 patients. Of the 188 evaluable patients, 51 of 59 (86.5%) ampicillin recipients, 59 of 67 (88.1%) cefazolin recipients, 48 of 55 (87.3%) cefotaxime recipients, and two of seven (28.5%) placebo recipients had uneventful postoperative courses. During the study, an additional 39 women who were in labor with ruptured membranes but who were allergic to penicillin or who declined antibiotic prophylaxis were classified as untreated patients and observed for postoperative complications. Standard febrile morbidity, primarily related to endometritis or wound infections, occurred in 6 of 59 (10.1%) ampicillin, 5 of 67 (7.5%) cefazolin, 5 of 55 (9.1%) cefotaxime, and 18 (40.0%) of placebo or untreated patients. Cefotaxime, cefazolin, and ampicillin were equally effective in reducing febrile morbidity in emergency cesarean sections.

Topics: Adolescent; Adult; Ampicillin; Cefazolin; Cefotaxime; Cesarean Section; Emergencies; Female; Fever; Humans; Pregnancy; Premedication; Puerperal Infection

Topics: Anti-Bacterial Agents; Cefotaxime; Disseminated Intravascular Coagulation; Female; Fever; Humans; Middle Aged; Pneumococcal Infections; Shock, Septic; Streptococcus pneumoniae

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

To identify the age- and sex-specific antimicrobial susceptibility patterns of Gram-negative bacteria (GNB) in outpatient febrile urinary tract infections (UTIs) in Korea.. A total 2262 consecutive samples collected from patients aged 1-101 years with febrile UTIs, during the period January 2012 to December 2014, were analyzed in this multicentre, retrospective cohort study.. The sensitivities to cefotaxime and cefoxitin were over 85% for females but under 75% for males. Sex played an important role in the susceptibility of GNB to cefotaxime (p<0.001) and cefoxitin (p<0.001). The sensitivity to ciprofloxacin (age >20 years) was under 75% in both sexes, and was not influenced by sex (p=0.204). Age distributions of the incidences of resistance to cefotaxime, cefoxitin, and ciprofloxacin (age >20 years) were similar to the age distribution of the incidence of GNB, which indicates that the resistance patterns to these drugs were not affected by age (Kolmogorov-Smirnov test, female/male: p=0.927/p=0.509, p=0.193/p=0.911, and p=0.077/p=0.999, respectively).. Age is not a considerable factor in determining the antibiotic resistance in febrile UTIs. Ciprofloxacin should be withheld from both sexes until culture results indicate its use. Second- or third-generation cephalosporins such as cefoxitin and cefotaxime can be used empirically only in females.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefoxitin; Child; Child, Preschool; Ciprofloxacin; Cohort Studies; Drug Resistance, Bacterial; Fever; Gram-Negative Bacteria; Humans; Incidence; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Republic of Korea; Retrospective Studies; Sex Factors; Urinary Tract Infections; Young Adult

Topics: Abdominal Pain; Abscess; Anti-Bacterial Agents; Cefazolin; Cefotaxime; Child, Preschool; Drainage; Fever; Humans; Kidney; Kidney Diseases; Male; Pyelonephritis; Staphylococcus aureus; Tomography, X-Ray Computed; Vancomycin

A 67-year-old man with a persistent high fever was diagnosed to have an infective aneurysm in his left internal iliac artery. A blood culture detected a gram-negative spiral rod that was first identified as Campylobacter fetus subsp. venerealis based on a matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) analysis. However, the strain was finally confirmed to be Campylobacter fetus subsp. fetus based on a genetic analysis. The infection was successfully treated with emergency resection of the aneurysm, followed by 4 weeks of antibiotic therapy. Involvement of the peripheral artery is uncommon in cases of C. fetus-infective aneurysm. To figure out the epidemiology and pathogenicity of C. fetus infection, the accurate identification of the responsible organisms is essential.

Topics: Aged; Aneurysm, Infected; Anti-Bacterial Agents; Campylobacter fetus; Campylobacter Infections; Cefotaxime; Fever; Humans; Iliac Aneurysm; Iliac Artery; Levofloxacin; Male; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Treatment Outcome

The burden of neonatal bacterial infections continues. They remain a significant cause of death and morbidity, despite recommendations for prevention. The epidemiology of these infections has changed. Currently the two most causative pathogens for early-onset neonatal sepsis and for late-onset sepsis in term infants are Group B streptococci (GBS) and Escherichia coli. E. coli's role is increasingly important since the widespread use of intrapartum antibiotic prophylaxis. In late-onset infections, one of the suggested pathophysiological mechanisms is microbial translocation in the gut secondary to digestive colonization, particularly when E. coli is isolated in blood cultures. This can occur either before or after birth. Bacterial sepsis can be associated with various non-specific peripheral manifestations involving skin and soft tissues. We report the case of a full-term, 26-day-old newborn admitted to the hospital for fever. She presented with dermohypodermitis of the left trunk and was diagnosed with E. coli septicemia. She was discharged in good condition after appropriate intravenous antibiotic therapy.

Topics: Abdomen; Amikacin; Amoxicillin; Anti-Bacterial Agents; Bacteremia; Bacterial Translocation; Cefotaxime; Escherichia coli; Escherichia coli Infections; Feces; Female; Fever; Humans; Infant, Newborn; Infant, Newborn, Diseases; Skin Diseases; Thorax; Treatment Outcome

The authors report a 6-year-old boy with fever, rash and cough. He was diagnosed with severe measles pneumonia and admitted to the paediatric intensive care unit with severe dyspnoea 8 days after symptom onset. He received intravenous antibiotics and high dose vitamin A. Three days later, he had recovered and was discharged home. He had not been vaccinated for measles, mumps and rubella according to the schedule. This case highlights the need for rapid diagnosis, appropriate treatment and determination of vaccination status of children with measles in order to prevent complications.

Topics: Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Child; Diagnosis, Differential; Drug Therapy, Combination; Fever; Humans; Male; Measles; Pneumonia; Vitamin A

To investigate the prevalence of leptospirosis among patients from within and outside Kolkata, India, attending the Calcutta School of Tropical Medicine, for treatment during August 2002 to August 2008.. The leptospirosis cases were determined on the basis of clinical, epidemiological, and biochemical factors, and were tested for leptospiral antibodies using IgM ELISA. Serum samples with absorbance ratio ≥ 1.21 were interpreted as reactive.. The commonest presentation involved fever, headache and jaundice. The male-female ratio was 61:46. A total of 65(64.20%) cases had abnormal liver and renal functions respectively, and 57.1% had both the abnormalities. The highest incidence (75, 35.04%) was recorded in September-October followed by July-August (53, 24.77%). The reactive cases had absorbance ratios between 1.21 and 8.21, and 53 showed equivocal result, while IgM non reactivity were seen in 90 patients (absorbance ratios 0.10-0.90). The patients responded to treatment with parenteral antibiotics, penicillin, ceftriaxone and cefotaxime; follow up did not reveal case fatality.. The cardinal signs of leptospirosis help in making clinical diagnosis, but in any hyper-endemic situation any patient reporting with acute fever and signs of pulmonary, hepatic or renal involvement should be suspected to have leptospirosis and investigated accordingly. Increased awareness, and early diagnosis and treatment, can reduce mortality due to leptospirosis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Cefotaxime; Ceftriaxone; Child; Climate; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Fever; Headache; Humans; Immunoglobulin M; Incidence; India; Infusions, Intravenous; Jaundice; Leptospira; Leptospirosis; Male; Middle Aged; Penicillins; Retrospective Studies; Risk Factors; Young Adult

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Cesarean Section; Clavulanic Acid; Female; Fever; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Male; Maternal Exposure; Meningitis, Meningococcal; Neisseria meningitidis, Serogroup B; Penicillin G; Pregnancy; Pregnancy Complications, Infectious; Respiratory Tract Infections; Seizures; Treatment Outcome

Few adverse effects have been reported with adjunctive dexamethasone treatment in pneumococcal meningitis. Nevertheless, we report a case of cerebral vasculitis. A 49-year-old man was admitted for fever and altered mental status. Lumbar puncture revealed a high inflammatory response and Streptococcus pneumoniae was identified by culture. Antibacterial therapy and adjunctive dexamethasone treatment were initiated as recommended. The immediate outcome was favorable but due to the onset of focal cerebral abnormalities, a CT scan was performed on the ninth day showing cerebral vasculitis. The patient died on the thirteenth day despite antibacterial therapy and resuscitation. In our case, a secondary neurological worsening appeared when adjunctive dexamethasone treatment was stopped suggesting a rebound effect. Observation of similar cases may lead to modifying adjunctive dexamethasone treatment protocol in bacterial meningitis.

Topics: Amoxicillin; Anti-Inflammatory Agents; Arthritis, Infectious; Brain Edema; Cefotaxime; Chemotherapy, Adjuvant; Coma; Dexamethasone; Drug Therapy, Combination; Emergencies; Encephalocele; Fatal Outcome; Fever; Humans; Knee Joint; Male; Meningitis, Pneumococcal; Middle Aged; Substance Withdrawal Syndrome; Vancomycin; Vasculitis, Central Nervous System

Fever is a protective and adaptive reaction, an early and obligatory symptom of infectious diseases in the first place. Historically, this term has been used in the names of more than 20 infectious diseases. Fever may also be a manifestation of other diseases accompanied by aseptic inflammation and neurohumoral disturbances. The growth rate of fever and the character of its circadian fluctuations at the beginning of the disease, as well as its total duration, the height and type of temperature curve, and time of onset of organic lesions should be taken into consideration when performing differential diagnostics of fevers of different origins. The authors developed an algorithm of differential diagnostics of febrile conditions. When an infectious process is excluded reasonably, the patient should undergo further examination for early detection of other diseases accompanied by fever.

Topics: Anti-Bacterial Agents; Cefotaxime; Diagnosis, Differential; Fever; HIV Antibodies; HIV Infections; HIV-1; Humans; Immunoblotting; Male; Middle Aged

To clarify the contribution of the doppler and the CT in the balance aetiology of a fever of the post-partum and to connect it with a thrombophlebitis of ovarian vein.. Five patients presented there post-partum a fever with pointed abdominal painful syndrome. A doppler and a CT were performed.. Doppler showed a hypoechoic tubular structure located forward and laterally with regard to the psoas with a flat spectre in pulsed Doppler in every case. CT confirmed the diagnosis of a thrombophlebitis of the right ovarian vein in three cases and left in two cases. Evolution after anticoagulation and an antibiotic therapy was favourable with regression of clinical signs and doppler evaluation.. In front of any fever of the post-partum, it is necessary to evoke a thrombophlebitis of the vein ovarian, although it is about a rare aetiology. In spite of the superiority of the CT-scan and RP imaging for such a diagnosis, doppler is a simple and reproducible diagnostic tool for the monitoring which must be practised in first intention.

Topics: Abdominal Pain; Adult; Cefotaxime; Cephalosporins; Female; Fever; Humans; Ovarian Diseases; Ovary; Postpartum Period; Regional Blood Flow; Thrombophlebitis; Tomography, X-Ray Computed; Ultrasonography

Topics: Cefotaxime; Combined Modality Therapy; Debridement; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Fever; Foot; Gangrene; Hand; Humans; IgA Vasculitis; Immunocompetence; Infant; Ischemia; Male; Physical Therapy Modalities; Plasma; Plastic Surgery Procedures; Pneumococcal Infections; Pneumonia, Pneumococcal; Sepsis; Skin Transplantation; Vancomycin

Intrapartum antibiotic prophylaxis against group B Streptococcus (GBS) has reduced the occurrence of serious bacterial infections (SBI) in young infants caused by GBS. Recommendations for initial antibiotic therapy for the febrile infant 1 to 90 days old were developed when infections with GBS were common and antibiotic resistance was rare.. To document the pathogens responsible for SBI in recent years in febrile infants 1 to 90 days old and the antibiotic susceptibility of these organisms.. The results of bacterial cultures from infants 1 to 90 days old evaluated for fever at Primary Children's Medical Center in Salt Lake City, Utah, between July 1999 and April 2002 were analyzed. Antibiotic susceptibility profiles were collected and patient records were reviewed to determine if initial antibiotic therapy was changed following the identification of the organism.. Of 1298 febrile infants enrolled from the Primary Children's Medical Center emergency department, 105 (8%) had SBI. The mean age of the infants with SBI was 39 days (range 2-82 days) and 2 (2%) were <7 days. SBI included urinary tract infection (UTI; 67%), bacteremia (16%), bacteremia and UTI (6%), bacteremia and meningitis (5%), meningitis (2%), abscess (2%), meningitis and UTI (1%), and meningitis and gastroenteritis (1%). Eighty-three (79%) of 105 episodes of SBI were caused by Gram-negative bacteria, including 92% of UTI, 54% of bacteremia, and 44% of meningitis cases. The most common pathogen was Escherichia coli (61%). Other Gram-negative pathogens were responsible for 19% of SBI. Staphylococcus aureus was the most common Gram-positive pathogen, causing 8% of SBI. GBS accounted for 6% of SBI. Of the 105 pathogens, 56 (53%) were resistant to ampicillin. Of the pathogens causing meningitis, UTI, and bacteremia, 78%, 53%, and 50%, respectively, were resistant to ampicillin. Antibiotic therapy was changed in 54% of cases of SBI following identification of the organism.. In Utah, ampicillin-resistant Gram-negative bacteria are the most common cause of SBI in febrile infants <90 days old. This finding impacts antibiotic selection, especially in cases of meningitis. Local surveillance of pathogens and antibiotic susceptibility patterns is critical to determine appropriate antibiotic therapy.

Topics: Ampicillin Resistance; Bacteremia; Bacterial Infections; Cefotaxime; Drug Resistance, Bacterial; Fever; Gastroenteritis; Gentamicins; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Health Planning Guidelines; Health Status; Humans; Infant; Infant, Newborn; Meningitis; Microbial Sensitivity Tests; Urinary Tract Infections

Topics: Adult; Cefotaxime; Cellulitis; Cephalosporins; Combined Modality Therapy; Disease Susceptibility; Exophthalmos; Female; Fever; Graves Disease; Headache; Humans; Ophthalmoplegia; Orbital Diseases; Sinusitis; Streptococcal Infections; Tomography, X-Ray Computed

A 20-year old man was admitted to hospital with fever and malaise after travel to India. He was soon found to have typhoid fever, caused by a multi-drug resistant Salmonella typhi. According to in-vitro resistance testing he was treated with cefotaxim, but fever and shivering were still present after 7 days of cefotaxim, with liver enzyme disturbances. The physicians caring for him started an extensive search for possible complications of typhoid fever, and they thought of the possibility of an alternative disease to explain the fever. When cefotaxim was stopped all symptoms and signs disappeared. During every medication, drug fever is a possibility. This diagnosis can only be supported by discontinuing the use and if necessary, restarting it (dechallenge and rechallenge).

Topics: Adult; Cefotaxime; Cephalosporins; Diagnosis, Differential; Fever; Humans; Male; Salmonella typhi; Typhoid Fever

The occurrence of an amebic liver abscess (ALA) rupturing into the stomach is reported. ALAs in children can have atypical presentations, resulting in delayed diagnosis and increased morbidity and mortality. Timely treatment is usually followed by complete recovery.

Topics: Amebicides; Anti-Infective Agents; Biopsy; Cefotaxime; Cephalosporins; Chemotherapy, Adjuvant; Child, Preschool; Female; Fever; Humans; Iodoquinol; Liver Abscess, Amebic; Melena; Metronidazole; Rupture, Spontaneous; Stomach Rupture

Topics: Adverse Drug Reaction Reporting Systems; Cefotaxime; Cephalosporins; Fever; Humans; Netherlands; Pharmacopoeias as Topic

Topics: Adult; Cefotaxime; Cephalosporins; Female; Fever; Humans; Male; Salmonella typhi; Typhoid Fever

Topics: Administration, Oral; Anti-Infective Agents, Urinary; Cefixime; Cefotaxime; Cephalosporins; Child, Preschool; Fever; Humans; Infant; Infusions, Intravenous; Randomized Controlled Trials as Topic; Treatment Outcome; Urinary Tract Infections

Topics: Aged; Alcohol Drinking; Ascites; Cefotaxime; Cephalosporins; Citrobacter; Diagnosis, Differential; Diuretics; Enterobacteriaceae Infections; Fever; Humans; Jaundice; Male; Peritonitis; Spironolactone

A retrospective study of infants with bacterial meningitis admitted to our hospital during 1949-52, highlighted the lack of 'classical' signs of meningitis in these infants. We carried out a similar review of 44 infants aged less than three months, admitted during 1982-91. We also determined the causative organisms and their antibiotic sensitivities. Symptoms and signs were similar in the two series. Forty infants in the later series were either febrile, irritable or had seizures on the day of admission. Overall mortality fell from 30% to 11%. Between 1982 and 1991 Group B Streptocococcus and Neisseria meningitidis were the commonest causes of meningitis. All organisms, except one, were sensitive to ampicillin and/or cefotaxime. Bacterial meningitis should be suspected in young infants who are febrile, irritable or having seizures. Initial treatment with ampicillin and cefotaxime is appropriate.

Topics: Ampicillin; Cefotaxime; Fever; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Meningitis, Meningococcal; Retrospective Studies; Seizures; Streptococcal Infections; Streptococcus agalactiae

The role of fever on cefotaxime disposition was studied in ten hyperthermic patients. Each subject received intravenously 1 g of cefotaxime on two separated occasions, first when the body temperature was more than 39 degrees C then during a basal state (37 degrees C). Blood samples were taken over 12 hours and urine was collected for 24 hours after injection. After dosing cefotaxime and its metabolite by high performance liquid chromatography, the pharmacokinetic parameters were calculated, especially: plasma and renal clearance, volume of distribution at steady state, area under the curve, and elimination half-life. There is no significant difference in cefotaxime and desacetylcefotaxime disposition between these two states. Hyperthermia has no influence on pharmacokinetics of this cephalosporin.

Topics: Adult; Aged; Cefotaxime; Female; Fever; Half-Life; Humans; Male; Middle Aged

Eighty-one febrile episodes in cancer patients with adequate neutrophil counts (greater than 1000/microliter) were treated with a double beta-lactam combination of ceftizoxime plus ticarcillin. Fifty-four episodes were microbiologically documented and 27 were clinically documented. The overall response rate was 75% (61 of 81). The response rate in 38 episodes where a single organism was identified was 71%. Polymicrobial infections were associated with a high response rate of 87%. Responses occurred in six of eight Gram-positive and 21 of 30 Gram-negative infections. Pneumonia was the most frequent infection and was associated with a response of 61%. Septicaemia and urinary tract infections also occurred commonly and had response rates of 76% and 89% respectively. All but one organism were susceptible to at least one of the antibiotics. No resistant organisms emerged during therapy. Side-effects included rash (1), phlebitis (3), and coagulation abnormalities without bleeding (3). Four patients developed superinfections (three bacterial, one fungal). The double beta-lactam combination of ceftizoxime plus ticarcillin was safe and effective therapy for infections in non-neutropenic cancer patients.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Drug Therapy, Combination; Female; Fever; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Middle Aged; Neoplasms; Penicillins; Pneumonia; Sepsis; Ticarcillin

Ceftizoxime (CZX) was given in daily doses of 4 approximately 6 g by intravenous drip infusion to 30 patients with infection accompanying lung cancer to investigate the usefulness of the drug for infectious disease: The rate of effectiveness (marked and moderate) was 73.3% (22/30 patients). Of the 30 patients, 2 had drug fever; 1, arthralgia; and 1, eosinophilia. These side effects improved after the drug was withdrawn. CZX is a very useful antibiotic with high effectiveness and safety in immunocompromised patients with infection accompanying advanced lung cancer.

Topics: Adenoma; Adult; Aged; Bacterial Infections; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Cefotaxime; Ceftizoxime; Female; Fever; Humans; Lung Neoplasms; Male; Middle Aged; Pneumonia; Pyelitis; Respiratory Tract Infections

With the cooperation of 13 medical institutions in the Tokyo area, the methods to determine the prophylactic effect on postoperative infections in gynecological surgery were evaluated. Two hundred and ninety-nine patients were enrolled for the study of postoperative infections, febrile morbidity and fever index following abdominal (275) and vaginal (24) hysterectomies. Prophylactic cefotiam (CTM) of 1 gram was intravenously administered twice a day postoperatively for 3 to 5 days. The rates of postoperative infections were 5.1% (14/275) in abdominal hysterectomy and 4.2% (1/24) in vaginal hysterectomy. The febrile morbidity (57.1% = 8/14) and fever index (52.3 +/- 41.1 degree hours) in the infection group were approximately about 4 times higher than those (12.3% = 32/261, and 15.6 +/- 13.7 degree hours, respectively) in the non-infection group. No significant differences were observed in age, body weight, height of patients, period of operation and blood loss between these 2 groups. These data suggested that febrile morbidity and fever index were able to indicate the prophylactic effect of antibiotics on patients undergoing abdominal and vaginal hysterectomies.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Fever; Genital Diseases, Female; Humans; Hysterectomy; Middle Aged; Postoperative Complications

Forty patients with leukemia or aplastic anemia were randomized to receive one of the following antibiotic regimens at the onset of fever during granulocytopenia: cefoperazone + amikacin (regimen A), cefoperazone + sisomicin (regimen B), cefotaxime + amikacin (regimen C), cefotaxime + sisomicin (regimen D). All patients were receiving gut decontamination at the time of randomization. Patients were monitored twice weekly with swabs and cultures for bacteria and fungi. Overall, there were 56 febrile episodes: 31 were proven bacterial, 3 were probable, and 16 were of unknown origin. Response rates were comparable in all 4 treatment regimens: 90%, 91%, 92% and 92%, respectively. Three patients died of bacterial infections (2 Gram+, 1 Gram-), one patient died with probable infection, 6 febrile episodes were related to fungal infection (Candida), and 2 patients died. The mortality rate was comparable in all groups. Two patients died of renal failure. Abnormalities in liver function tests were observed, but were without consequences. There were no statistical differences in renal-hepatic toxicity in the 4 arms.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Anemia, Aplastic; Cefoperazone; Cefotaxime; Drug Therapy, Combination; Female; Fever; Humans; Immunosuppression Therapy; Infections; Kanamycin; Leukemia; Male; Middle Aged; Random Allocation; Sisomicin