cefotaxime and Immunologic-Deficiency-Syndromes

A search of the computerized database at the National Taiwan University Hospital was made for cefotaxime-resistant and cefmetazole-susceptible isolates of Escherichia coli and Klebsiella pneumoniae (which may be extended-spectrum beta-lactamase-producing strains) in pediatric wards and intensive care units between 1999 and 2001. Fourteen infectious episodes attributed only to study bacteria were identified, including 7 episodes of bacteremia. Nine patients (64.3%) had underlying medical conditions: 3 were premature babies, 3 were immunodeficient, 2 had malignancy, and 2 had a congenital heart disease with active heart failure even after surgery. Among the 7 patients with bacteremias, 5 may be catheter-related; 6 were treated with carbapenems and 1 was treated with cefmetazole successfully, with or without the removal of the catheter. Before the acquisition of the infection, a history of stay in an intensive care unit within 4 weeks was noted in 10 cases (71.4%); a history of use of extended-spectrum cephalosporins within 4 weeks was also noted in 6 cases (42.9%). Cefmetazole, with or without an aminoglycoside, was clinically effective in 6 cases (42.8%). Except for 1 episode of pneumonia that ended in mortality, all of the infectious episodes were successfully treated. The mortality rate was 7.1%.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; Carbapenems; Catheterization; Cefmetazole; Cefotaxime; Child; Child, Preschool; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Heart Defects, Congenital; Humans; Immunologic Deficiency Syndromes; Infant; Inpatients; Klebsiella Infections; Klebsiella pneumoniae; Male; Neoplasms; Premature Birth; Taiwan

Since the pioneer work by Metchnikoff, the goal of cooperation between therapeutics and the host defence system (HDS) has been sought after. This area of research received less attention after the introduction of antibiotics. Although, the predictive efficacy of antibacterial agents (ABA) is still evaluated in terms of MICs, MBCs, and pharmacokinetics, much evidence derived from clinical studies underlines the need for synergy between HDS and these drugs to obtain optimal therapeutic efficacy. The analysis of the immunomodifying properties of ABA has come under intense study. The majority of ABA does not substantially affect the functioning of the immune system at least in vivo, despite in-vitro observations of enhancement/inhibition of various immune parameters by some cephalosporins, macrolides, cyclins, aminoglycosides, etc. By contrast, chloramphenicol, sulphonamides and various beta-lactams may be responsible for drug-induced neutropenia whereas macrolides and quinolones, due to their high phagocytic uptake, synergize with phagocytes to destroy intracellular pathogens. Recently, the concept of Biological Response Modifier (BRM)-antibiotics has come under the limelight with the introduction of cefodizime, a new parenteral cephalosporin, which seems to be endowed with immunomodulating properties. This latter aspect has been demonstrated in vitro (potentiation of the phagocyte antimicrobial activity), ex vivo in immunocompromised animals and humans (restoration of various immune parameters) and in vivo (infection models using both sensitive and resistant species). Although the underlying mechanism has not been elucitated, the chemical structure responsible for this BRM activity has been recognized as the thio-thiazolyl moiety at C3 position of the cephem nucleus.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adjuvants, Immunologic; Aged; Animals; Anti-Bacterial Agents; Cefotaxime; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes; Immunologic Factors; In Vitro Techniques; Infant, Newborn; Infections; Phagocytes

Topics: Acquired Immunodeficiency Syndrome; Adjuvants, Immunologic; Aged; Anti-Bacterial Agents; Bacteria; Cefotaxime; Humans; Immunity; Immunocompromised Host; Immunologic Deficiency Syndromes; Immunologic Factors; Phagocytosis

66 patients with predominantly community-acquired pneumonia were treated with cefotaxime. The group consisted of 45 males and 21 females, aged 56 to 90 years, 43 of the patients belonging to the age groups 65-80 years. Streptococcus pneumoniae was isolated in 21 of the 34 patients with gram-positive pneumonia, Staphylococcus aureus in six, Staphylococcus epidermidis in five and Streptococcus faecalis in two. Klebsiella pneumoniae was the predominant pathogen in gram-negative pneumonia (eight patients), followed by Enterobacter (n = 6), Pseudomonas aeruginosa (n = 5), Haemophilus influenzae (n = 4), Escherichia coli (n = 3), Serratia marcescens and Citrobacter (two cases each). The in vitro activity of cefotaxime against the isolates was compared to the activity of other beta-lactam antibiotics. Characteristically, the classical signs and symptoms of pneumonia were absent or discrete in some of the elderly patients. There was a delayed clearance of pulmonary infiltrates. 55 of 66 patients responded to cefotaxime within four weeks of treatment; the symptoms were aggravated or remained unchanged in seven patients. Patients with a delayed clinical response displayed decreased peripheral lymphocyte counts and T cell functions in PHA stimulation tests, as well as low immunoglobulin levels. A combination of cefotaxime and gamma-venin cleared the symptoms in some of these patients.

Topics: Aged; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Immunologic Deficiency Syndromes; Leukocyte Count; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia