cefotaxime and Infant--Newborn--Diseases

Osteofibrous dysplasia is a rare and benign disease that originates from the tibia or fibula. The symptoms of osteofibrous dysplasia include painless enlargement and bowing of the tibia and pain occurring in the presence of pathological fracture. Herein a male infant who was admitted with redness and swelling on the right leg and diagnosed as pathological tibia fracture due to left tibia osteofibrous dysplasia on the third day of life was presented. To our knowledge, this is the earliest presentation of osteofibrous dysplasia with a pathological fracture in a neonate. Therefore, it must be suspected in neonatal bone fractures.

Topics: Amikacin; Anti-Bacterial Agents; Casts, Surgical; Cefotaxime; Clindamycin; Fibrous Dysplasia of Bone; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Sepsis; Tibia; Tibial Fractures; Treatment Outcome

Topics: Acyclovir; Ampicillin; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Cefotaxime; Cells, Cultured; Cephalosporins; Cytomegalovirus Infections; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Erythromycin; Female; Fetal Diseases; Herpes Genitalis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Prenatal Diagnosis; Ultrasonography, Prenatal; Virus Diseases

Neural tube defects are the second most common congenital malformation in humans. Despite significant decreases in neural tube defects and related mortality and morbidity with recent developments, infections remain an important problem. Research on the role of topical therapy for managing neural tube defects and associated infections in the neonatal period has been limited. This randomized controlled trial aimed to investigate the efficiency of topical Rifampin on infection control in paraplegic newborns with open neural tube defects.. Thirty-seven patients who underwent an operation for neural tube defects were included. Topical Rifampin and cefotaxime were administered to 19 patients constituting the case group and local saline and cefotaxime were administered to a control group. Patients were examined for ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, and sepsis.. None of the patients using topical rifampin had ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, or sepsis. In the control group, ventriculoperitoneal shunt infection/dysfunction was found in 4 (22.2%) cases, surgical site infection in 3 (27.7%), urinary tract infection in 3 (27.7%), and sepsis in 5 (27.7%), with statistically significant differences between the groups (. Topical Rifampin is effective in minimizing complications like sepsis, surgical site infection, urinary tract infection, and ventriculoperitoneal shunt infection due to neural tube defect operations. Further research with larger numbers of cases is needed to implement this practice routinely.

Topics: Administration, Topical; Anti-Bacterial Agents; Catheter-Related Infections; Cefotaxime; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infections; Male; Neural Tube Defects; Paraplegia; Rifampin; Sepsis; Surgical Wound Infection; Treatment Outcome; Urinary Tract Infections; Ventriculoperitoneal Shunt

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Humans; Infant, Newborn; Infant, Newborn, Diseases; Virus Diseases

Topics: Abdomen; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Gonorrhea; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Osteitis; Respiratory Tract Infections; Sepsis; Skin Diseases, Infectious; United States; Urinary Tract Infections

Cefotaxime has been used for the management of neonatal infections since the 1990s for suspected meningitis and to mitigate gentamicin-associated renal injury. Its shortage in 2015 and subsequent removal from the U.S. pharmaceutical market forced providers to consider alternatives. Ceftriaxone, a cephalosporin with an identical antibacterial spectrum of activity to cefotaxime, is contraindicated in neonates due to its risk of biliary pseudolithiasis. Ceftazidime was recommended as an alternative by the American Academy of Pediatrics but is inequivalent.. This article addresses indications for cephalosporin use and considerations when selecting an alternative to cefotaxime. Differences among cefotaxime, ceftriaxone, ceftazidime, and cefepime are discussed and compared to the standard-of-care presumptive regimen, ampicillin, and gentamicin. The authors consider the data behind the neonatal contraindication to ceftriaxone and provide recommendations for their application to practice.. The data against ceftriaxone use in neonates remain poor, particularly in the context of the cefotaxime shortage and lack of an equivalent alternative. Ceftriaxone could be considered in low-risk neonates without hyperbilirubinemia or exposure to calcium-containing fluids on a case-by-case basis. Ceftazidime monotherapy for presumptive management of neonatal infections is inappropriate; cefepime should be more frequently utilized in neonates who are poor candidates for ceftriaxone.

Topics: Ampicillin; Anti-Bacterial Agents; Calcium; Cefepime; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Communicable Diseases; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Microbial Sensitivity Tests

To study the clinical characteristics, pathogenic bacteria, and antibiotics resistance of neonatal purulent meningitis in order to provide the guide for early diagnosis and appropriate treatment.. A retrospective review was performed and a total of 112 cases of neonatal purulent meningitis (male 64, female 58) were identified in the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical University seen from January 1, 2004 to December 31, 2013. The clinical information including pathogenic bacterial distribution, drug sensitivity, head imageology and therapeutic outcome were analyzed. Numeration data were shown in ratio and chi square test was applied for group comparison.. Among 112 cases, 46 were admitted from 2004 to 2008 and 66 from 2009 to 2013, 23 patients were preterm and 89 were term, 20 were early onset (occurring within 3 days of life) and 92 were late onset meningitis (occurring after 3 days of life). In 62 (55.4%) cases the pathogens were Gram-positive bacteria and in 50 (44.6%) were Gram-negative bacteria. The five most frequently isolated pathogens were Escherichia coli (32 cases, 28.6%), coagulase-negative staphylococcus (CNS, 20 cases, 17.9%), Streptococcus (18 cases, 16.1%, Streptococcus agalactiae 15 cases), Enterococci (13 cases, 11.6%), Staphylococcus aureus (9 cases, 8.0%). Comparison of pathogenic bacterial distribution between 2004-2008 and 2009-2013 showed that Gram-positive bacteria accounted for more than 50% in both period. Escherichia coli was the most common bacterium, followed by Streptococcus in last five years which was higher than the first five years (22.7% (15/66) vs. 6.5% (3/46), χ(2) = 5.278, P < 0.05). Klebsiella pneumoniae was more common isolate in preterm infants than in term infants (13.0% (3/23) vs. 1.1% (1/89), χ(2) = 7.540, P < 0.05). Streptococcus (most were Streptococcus agalactiae) was the most common bacteria in early onset meningitis and higher than those in late onset meningitis (35.0% (7/20) vs. 12.0% (11/92), χ(2) = 4.872, P < 0.05). Drug sensitivity tests showed that all the Gram-positive bacterial isolates were sensitive to linezolid. Staphylococci were resistant to penicillin, and most of them were resistant to erythromycin, oxacillin and cefazolin; 77.8%of CNS isolates were methicillin-resistant staphylococcus. No Streptococcus and Enterococcus faecalis was resistant to penicillin. None of enterococci was resistant to vancomycin. Among the Gram-negative bacterial isolates, more than 40% of Escherichia coli were resistant to commonly used cephalosporins such as cefuroxime, cefotaxime and ceftazidime, and all of them were sensitive to amikacin, cefoperazone sulbactam and imipenem. Isolates of Klebsiella pneumoniae were all resistant to ampicillin, cefuroxime, cefotaxime and ceftazidime, but none of them was resistant to piperacillin tazobactam and imipenem. Of the 112 patients, 69 were cured, 23 improved, 9 uncured and 11 died. There were 47 cases (42.0%) with poor prognosis, they had abnormal head imageology, severe complications and some cases died, 13 of 18 (72.2%) patients with meningitis caused by Streptococcus died.. Escherichia coli, CNS and Streptococcus are the predominant pathogens responsible for neonatal purulent meningitis over the past ten years. There were increasing numbers of cases with Streptococcus meningitis which are more common in early onset meningitis with adverse outcome, therefore careful attention should be paid in clinic. Linezolid should be used as a new choice in intractable neonatal purulent meningitis cases caused by gram positive bacteria.

Topics: Anti-Bacterial Agents; Cefotaxime; Child; Drug Resistance, Bacterial; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Imipenem; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Male; Meningitis, Bacterial; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Penicillins; Retrospective Studies; Staphylococcus; Staphylococcus aureus; Streptococcal Infections; Streptococcus; Streptococcus agalactiae

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

Sepsis is a major contributor to newborn deaths in the developing world. The objective is to determine the prevalence of newborn sepsis, the bacterial pathogens and antibiotic sensitivity pattern of the isolates.. A study of consecutive babies hospitalised in Sagamu, Nigeria, with risk factors for or clinical features of sepsis was retrospectively done between January 2006 and December 2007, and prospectively between January and December 2008. Positive blood culture defined neonatal sepsis, and the antibiotic sensitivity pattern of the organisms was also determined.. There were 1050 admissions, and 174 (16.5%) babies had positive blood culture. Of the 527 babies with risk factors and clinical features of sepsis, 174 (33.3%) had confirmed sepsis: 119 (22.5%) had early-onset sepsis, while 55 (10.4%) had late-onset sepsis. The incidence of neonatal sepsis in the hospital was 51.3/1000 live births. Weight less than 1.5 kg, prolonged labour, prolonged rupture of membranes and lower socio-economic status were risk factors for sepsis. Staphylococcus aureus (31.0%), Klebsiella (23.0%), and coagulase-negative Staphylococcus (12.6%) and Escherichia coli (11.0%) were the leading aetiologies. The isolates were most sensitive to levofloxacin (95.7%), ofloxacin (95.1%), cefotaxime (86.7%) and ceftazidime (81.3%). Their sensitivity was 56.4% to cefuroxime and gentamicin, which are commonly used.. The prevalence of sepsis was high in this cohort of high-risk infants. The low in vitro sensitivity of the leading microbes to commonly used drugs is challenging. Guidelines on the reduction of emergence of drug resistance must be provided and instituted in newborn units.

Topics: Amikacin; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Female; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Male; Microbial Sensitivity Tests; Nigeria; Obstetric Labor Complications; Pregnancy; Prevalence; Prospective Studies; Retrospective Studies; Risk Factors; Socioeconomic Factors

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

Salmonella worthington is an emerging pathogen and has been implicated in a number of outbreaks of neonatal meningitis and septicemia. Over a period of 5 years, a total of 30 strains of this pathogen were isolated from blood and cerebrospinal fluid of neonates suffering from septicemia with or without meningitis. Most of these strains were resistant to the penicillin group of antibiotics, and many were resistant to cefotaxime. Sixty percent of the isolates were resistant to amikacin; 86% were resistant to chloramphenicol, and none were resistant to ciprofloxacin or norfloxacin. Parenteral fluoroquinolone should be included as part of antibiotic therapy in suspected cases of neonatal meningitis due to S. worthington.

Topics: Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Chloramphenicol; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Norfloxacin; Penicillins; Prevalence; Retrospective Studies; Salmonella; Salmonella Infections; Sepsis; Time Factors

The records of 46 neonates with proven septicaemia were retrospectively studied. Patients could be divided in 2 groups: in group 1 (21 infants) a positive blood culture was obtained before one day of life; in group 2 (25 infants) a positive blood culture was obtained between days 1 and 28. The sensitivity of 9 chemical and bacteriological tests and the efficacy of the initial antibiotic treatment were examined in both groups. Of the 21 germs isolated in patients from group 1, 86% were Gram positive bacteria and 95% were susceptible to ampicillin. Of the 26 germs isolated in patients from group 2, 80% were Gram negative enteric bacteria and 86% were susceptible to cefotaxime. Bacterial tests (gastric aspiration, antigen detection, feces culture) had a better sensibility than biochemical tests (C reactive protein, orosomucoid, fibrinogen).

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Drug Therapy, Combination; Humans; Infant, Newborn; Infant, Newborn, Diseases; Retrospective Studies; Sepsis

Treatment of neonatal necrotizing enterocolitis (NEC) regularly includes broad-spectrum antibiotics but there has been no comparative study of alternative regimens. We have studied 90 infants with definite NEC; 46 cases in 1982-3 were treated with ampicillin and gentamicin, while 44 cases in 1984-5 received cefotaxime and vancomycin. Groups were well matched and managed uniformly. Infants greater than or equal to 2200 g birthweight did well with either regimen. Smaller infants given cefotaxime and vancomycin had a lower risk of culture-positive peritonitis (P = 0.01), and as a result, were less likely to die (P = 0.048) or develop thrombocytopenia (P = 0.004). The better outcome might be explained by the greater suppression by cefotaxime and vancomycin of the gut flora of treated patients (P less than 0.001). Both regimens were well-tolerated. Our data suggest that carefully chosen antibiotic regimens can improve the outcome of NEC.

Topics: Ampicillin; Anti-Bacterial Agents; Birth Weight; Cefotaxime; Clinical Protocols; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Feces; Gentamicins; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Vancomycin

Ceftriaxone kinetics were characterized after a single, 2-minute, intravenous infusion of 50 mg/kg to 20 sick infants 1 to 8 days old who weighed 1.78 to 4.36 kg. Plasma binding parameters could be determined by equilibrium dialysis in 16 of the infants, in whom kinetic parameters for free ceftriaxone in plasma were also determined. Compared with corresponding values in adults, the elimination t1/2 was longer in infants (19 and 8.4 hours) because of reduced total systemic clearance (4.48 and 8.51 ml/min/m2). The apparent steady-state volume of distribution was of the same order in infants and adults (5,130 and 5,350 ml/m2). Both renal and nonrenal clearance of free ceftriaxone were reduced in infants, but these decreases were partially offset by an increased free fraction; plasma binding affinity and capacity constants for infants were about half the adult values. The mean fraction of dose excreted unchanged in urine was estimated at 70% in the neonates and 46% in adults. There were no clinically significant correlations between the kinetic parameters and either age since birth or age since conception. The fraction of free ceftriaxone in plasma inversely correlated with age since conception and was lower in female infants, which decreased the systemic clearance and volume of distribution of total drug in the female infants compared with the male infants. Values for the volume of distribution and clearance parameters were not related to body size (weight or body surface area). From our results, a ceftriaxone dosage of 50 to 100 mg/day is recommended during the first week of life for newborn infants who weigh between 1.8 and 4.4 kg. Impaired renal function may require a reduction in dosage.

Topics: Adult; Blood Proteins; Cefotaxime; Ceftriaxone; Female; Glomerular Filtration Rate; Half-Life; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Kinetics; Male; Protein Binding

A group of 104 neonates with clinical signs of infection sufficient to justify treatment with penicillin plus gentamicin received instead monotherapy with ceftriaxone (50 mg/kg once daily). Bacteriological cultures from 20 babies before treatment yielded significant isolates (9 had bacteraemia). Following treatment, infecting bacteria were eradicated from 15/20 babies. Ten of the 104 babies died; all were examined post mortem. Only one death was attributed to bacterial infection. The remaining babies responded well to treatment. No adverse alteration in biochemical or haematological values was associated with ceftriaxone therapy. The incidence of diarrhoea, blood in the stools, necrotising enterocolitis or anti-coagulation problems was the same as in the babies not receiving ceftriaxone. Pharmacokinetic values were determined on 40 babies. Elimination half life (T1/2 beta) and minimum serum concentration (Cmin.) decreased and clearance increased with increasing postnatal age. Postnatal age was the single most significant factor affecting pharmacokinetics. Ceftriaxone is a safe and effective alternative to conventional therapy for infected neonates. Prolonged therapy is associated with superficial colonisation with inherently resistant bacteria.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Male; Respiratory Tract Infections; Sepsis

Topics: Cefoperazone; Cefotaxime; Ceftazidime; Half-Life; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Moxalactam

Topics: Cefotaxime; Enterobacteriaceae Infections; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestines; Parenteral Nutrition, Total; Time Factors

Ceftriaxone pharmacokinetics were determined in 40 newborn infants who were 1 to 45 days of age. Mean peak plasma concentrations of 136 to 173 micrograms/ml were observed at the completion of a 15-min intravenous infusion of 50 mg of ceftriaxone per kg. Mean half-life values were 5.2 to 8.4 h, and mean plasma clearances were 0.7 to 1.8 ml/min. Rectal swab cultures from 14 of 16 infants had either reduced numbers of aerobic and anaerobic bacteria or no growth during therapy. A once-daily dosage schedule is suggested for ceftriaxone therapy in newborn infants.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases

In 66 newborn infants (AGA) suffering from septicemia concentration time courses of gentamicin, ampicillin and cefotaxim were determined to perform and an individual drug monitoring. Gentamicin was analysed from capillar blood samples using EMIT, Ampicillin and Cefotaxim by HPLC-technique. Volumes of distribution, apparent elimination half lives, maximum -, minimum and steady state concentrations were calculated using digital iteration programs. Based on a fixed dose regimen the kinetic parameters of gentamicin were extremely variable. To achieve a median steady state concentration of 3 micrograms/ml gentamicin in serum corrections from -17% to +110% of the foregoing dose were necessary. With 100 mg/kg ampicillin or cefotaxim per day sufficient concentrations in serum were reached. But in some patients a dosage of 5-7 mg/kg/d of gentamicin is too low, while others show concentrations near to the toxic levels. By a combination of gentamicin plus ampicillin pharmacokinetic parameters are not influenced; while if gentamicin is combined with cefotaxim the apparent elimination halflife of gentamicin (beta-slope) is significantly reduced. Therefore an individual drug monitoring of drugs with a small therapeutic range, for example gentamicin, is necessary to optimize therapeutic results.

Topics: Ampicillin; Cefotaxime; Drug Interactions; Gentamicins; Half-Life; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics

The use of cephotaxim in the treatment of obstetric and gynecological patients with various infectious complications, as well as in the treatment of newborn infants in the Department of Intensive Therapy showed it to be highly effective in 100 per cent of the cases. The adverse reactions of cephotaxim were observed in 1 out of 43 patients. It should be noted that cephotaxim did not inhibit the host anaerobic indigenous flora. No cases of dysbacteriosis were recorded. Comparative analysis of the data on determination of the MIC of cephotaxim and cephuroxim with respect to various species of opportunistic microorganisms demonstrated that cephuroxim was more active against Staph. aureus, while cephotaxim against Klebsiella. Cephotaxim displayed activity against part of the strains of Ps. aeruginosa and streptococci of group D, which was not common to cephalosporins of the previous generations.

Topics: Bacterial Infections; Cefotaxime; Cefuroxime; Cephalosporins; Endometritis; Enterococcus faecalis; Escherichia coli; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Klebsiella; Pregnancy; Pseudomonas aeruginosa; Puerperal Infection; Pyelonephritis; Staphylococcus aureus

Bacterial infections are frequent events in premature and newborn infants. The reason is a defective specific and nonspecific defence of bacterial organisms. Some immunoglobulins like IgM and IgA including secretory IgA are absent. Premature infants also show a decreased level of IgG. Cellular immunity is anatomically intact but functionally defective. A number of complement factors are lacking, the activation of the alternative pathway is impaired. Newborn infants with perinatal problems like asphyxia or difficult delivery, show defects of leucocyte function like decreased deformability, defective chemotaxis and defective killing of ingested bacteria. Certain diseases, like hypoxia and malformations of immature organ functions in this age group (decreased acid production in the stomach), facilitate bacterial colonization of surface epithelia and the invasion of tissues. Consequences of these pathogenetic mechanisms are an unimpaired propagation of bacterial organisms into the blood and meninges without localization of the infecting organisms at the entry site. Bacterial meningitis is not considered a separate disease entity but a complication of bacteremia and sepsis. Clinical symptoms are nonspecific at the onset of the infection. Fever is frequently absent; decreased appetite, vomiting, a bloated abdomen, diarrhea, tachycardia, tachypnea are early signs of a bacterial infection, a grey mottled appearance, cyanosis, jaundice, petechiae, apneic spells, seizure activity and a metabolic acidosis are symptoms of advanced infection. Successful treatment at this stage is often not possible. Every sign of a decreased well being of a newborn of premature infant warrants laboratory and bacteriologic work up for septicemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Clindamycin; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Meningitis; Metronidazole; Penicillin G; Pseudomonas Infections; Streptococcal Infections

Topics: Aged; Cefotaxime; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Middle Aged; Pseudomonas Infections

We studied the pharmacokinetics and efficacy of cefotaxime in 32 neonates with severe gram-negative infections. Many of these patients had been treated unsuccessfully with combinations of antibiotics. Eighty-one percent of these patients were cured, 6% improved, and 13% had treatment failures; there were three deaths. Eighteen patients received cefotaxime alone; 16 were cured and two improved. These data indicate an efficacy of cefotaxime sufficient to warrant more rigorous future trials. The elimination half-life of cefotaxime ranged from 2.0 +/- 0.4 hours in term neonates more than one week of age to 5.7 +/- 0.8 hours in preterm neonates less than one week of age. A volume of distribution of approximately 0.63 L was similar for all infants irrespective of age and maturity. These kinetic data can be used in design of future therapeutic regimens in more rigidly controlled trials assessing indications for cefotaxime therapy in neonates. We recommend dosing as follows, using a dose of 25 mg/kg: every 12 hours for preterm infants less than one week of age, every 8 hours for preterm infants one to four and term infants less than one week of age, and every 6 hours for term infants more than one week of age.

Topics: Bacterial Infections; Cefotaxime; Enterobacteriaceae Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Models, Biological; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections

The pharmacokinetics of cefotaxime were determined in newborn infants who were 1 to 7 days of age. Mean peak serum concentrations of 116 and 132 micrograms/ml were observed at completion of a 10-min intravenous infusion of 50 mg of cefotaxime per kg in low and average birth weight infants, respectively. The mean elimination half-lives were 4.6 and 3.4 h and rates of clearance from serum were 23 and 44 ml/min per 1.73 m2, respectively. A dosage schedule for cefotaxime in newborn infants is presented.

Topics: Cefotaxime; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Male

Fundamental and clinical investigations of cefotaxime were carried out in neonates. The following results were obtained. 1. Seven neonates with serious infections caused by identifiable pathogens, including Group B streptococcal meningitis and Group A streptococcal sepsis, were treated by intravenous bolus injection of 20-200 mg/kg of cefotaxime 2 or 3 times daily (60-400 mg/kg/day). The clinical efficacy of cefotaxime was assessed to be good in 6 patients and fair in 1 patient. Bacteriological efficacy was evaluable in 4 patients, all of whom displayed complete eradication of pathogens. 2. Among 22 neonates administered cefotaxime, adverse reactions appeared in 3 patients. Adverse reactions consisted of a transient skin rash in 1 patient and elevation of GOT in 2 patients. 3. Serum concentrations of cefotaxime and desacetyl cefotaxime were investigated in 8 mature infants and 5 immature infants on days 0-7 postpartum. A single intravenous injection of 20 mg/kg produced peak serum concentrations of 31.8-49.7 mcg/ml, associated with a half-life of 1.38-4.47 hours, in mature infants and peak serum concentrations of 35.5-55.0 mcg/ml, associated with a half-life of 3.22-6.43 hours, in immature infants. On days 0-2 postpartum the half-life was longer than on subsequent days. This tendency was particularly remarkable in immature infants. Serum concentrations of desacetyl cefotaxime displayed high individual variations; no consistent trends were noted. 4. Cefotaxime and desacetyl cefotaxime serum concentrations were studied in 3 neonates undergoing exchanged transfusion (exchanged volume 177-180 ml/kg) on 1-4 days postpartum. Serum concentrations of cefotaxime after exchanged transfusion were equivalent to 32.6-63.9% of the pretransfusion level, while those of desacetyl cefotaxime were 75.2-106% of the pretransfusion level. 5. Minimal inhibitory concentration (MICs) and minimal bactericidal concentration (MBCs) of cefotaxime were determined against clinical isolates. MICs for inoculum sizes of 10(8)/ml and 10(6)/ml were respectively 3.13-25 mcg/ml and 3.13-25 mcg/ml against S. aureus, 0.024 mcg/ml and 0.012 mcg/ml against Group A Streptococcus, 0.05 mcg/ml and 0.05 mcg/ml against Group B Streptococcus and 0.39 mcg/ml and 0.1 mcg/ml against E. coli. MBCs for an inoculum size of 10(6)/ml were 3.13-100 mcg/ml or over against S. aureus, 0.012 mcg/ml against Group A Streptococcus, 0.39 mcg/ml against Group B Streptococcus and 1.56 mcg/ml against E. coli.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Feces; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Pharynx

Cefotaxime (CTX) was used in the treatment and prophylaxis of infections in neonates and immature infants. The following results were obtained. 1. Mean serum concentrations (bioassay) 30 minutes after a single intravenous injection of about 20 mg/kg of CTX were 44.5 mcg/ml in neonates and 47.2 mcg/ml in immature infants aged 0-3 days, 45.8 mcg/ml in neonates and 56.4 mcg/ml in an immature infant aged 4-7 days and 40.6 mcg/ml in neonates and 38.1 mcg/ml in immature infants aged 8 or more days. Six hour values were respectively 10.9 mcg/ml, 17.0 mcg/ml, 4.6 mcg/ml, 13.4 mcg/ml, 3.8 mcg/ml and 2.7 mcg/ml. 2. Mean serum concentration half-lives were 3.0 hours in neonates and 3.2 hours in immature infants aged 0-3 days, 1.8 hours in neonates and 3.2 hours in an immature infant aged 4-7 days, and 1.5 hours in neonates and 1.6 hours in immature infants aged 8 or more days. 3. Urinary recovery rates were 0.8-78.0% for 0-6 hours after treatment. 4. Adequate clinical efficacy can be expected by the intravenous injection of CTX in doses of 20 mg/kg 2 times daily, every 12 hours, in neonates and immature infants aged 0-3 days, 20 mg/kg 3 times daily, every 8 hours, in neonates and immature infants aged 4-7 days, and 20 mg/kg 3 to 4 times daily, every 6-8 hours, in neonates and immature infants aged 8 or more days. 5. The clinical efficacy of CTX was good in all 4 cases of sepsis (including suspected case), excellent in 1 case of urinary tract infection, and good in all 4 cases of fever of unknown origin for a cure rate of 100%. 6. Adverse reactions were not noted in any cases.

Topics: Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Injections, Intravenous; Male; Premedication

It has been proven that, when cephem group antibiotics are administered intravenously to neonates, the peak serum level of the drug is higher, and the half-life is longer, compared with the values attained in suckling infants. The same pattern is seen even with cefmetazole. This is, the Post- and Perinatal Period Research Group recently reported that, when 20 mg/kg of cefmetazole was administered intravenously, the mean serum half-life of the drug was 4.18 hours in infants up to 3 days after birth, while by about the age of 2 weeks there was no longer a difference with suckling infants. In the present study, cefotaxime was administered at a dosage level of 20 mg/kg by intravenous drip infusion over a 30-minute period. The administered subjects were a 16-day-old neonate and a 45-day-old suckling infant, and the serum level of cefotaxime was monitored. The peak concentration was found to be higher in the younger subject, and the half-life in the serum was longer, i.e., 2.52 hours compared with 1.5 hours in the suckling infant. In addition, 4 cases of newborn infection were treated with cefotaxime at 120--504 mg/day (approximately 35--300 mg/kg/day), given intravenously for a period of 6 to 21 days. Clear clinical efficacy and bacteriological efficacy were achieved in relation to 1 case of staphylococcal pneumonia, 1 case of septicemia compounded by purulent meningitis caused by Enterobacter aerogenes and 1 case of fever of undetermined origin. The following summarizes the results of the present study. 1) There was no adverse effect exerted on the hepatic or renal functions. 2) Cefotaxime was efficacious in the treatment of neonates suffering from infections caused by staphylococci and a Gram-negative rod.

Topics: Bacterial Infections; Cefotaxime; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Injections, Intravenous; Male

Topics: Age Factors; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Infusions, Parenteral; Injections, Intravenous; Male

Topics: Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Male

Topics: Bacteria; Bacterial Infections; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male

Topics: Age Factors; Bacterial Infections; Biological Assay; Cefotaxime; Child; Chromatography, High Pressure Liquid; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Kinetics

One full-term newborn infant and 2 premature ones were treated with cefotaxime for the treatment of suspected sepsis and umbilical suppurative inflammation. Pathogenic organisms could not be identified in all cases. A good result was obtained with the case of suspected sepsis. But the other 2 cases were not evaluable because underlying diseases such as massive pulmonary atelectasis or respiratory distress syndrome masked the effects of this agent. Serum levels of cefotaxime in 3 of the 4 cases were determined with bioassay. Time courses of the serum levels in 2 of them resulted in peculiar biphasic disappearance curves. This fact implies the possibility that desacetylation of cefroxime proceeds also in newborns as in adults and that desacetyl metabolite accumulates in the body owing to the premature function of the neonatal kidney.

Topics: Bacterial Infections; Cefotaxime; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Time Factors

Topics: Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Child, Preschool; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Kinetics

Topics: Cefotaxime; Cephalosporins; Child; Child, Preschool; Communicable Diseases; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male