cefotaxime and Ischemia

The efficacy and safety of ceftizoxime and cefoxitin were compared in a randomized, double-blind study of therapy for lower extremity infections in patients with diabetes mellitus or peripheral vascular disease. Overall clinical responses were satisfactory in 82% (23/28) of patients treated with ceftizoxime and in 68% (17/25) of patients treated with cefoxitin. The difference was not statistically significant. Ceftizoxime had superior in vitro activity against Enterobacteriaceae, especially Enterobacter cloacae, whereas cefoxitin had better activity against the Bacteroides fragilis group. Relapses of infection were common in both groups during long-term follow-up; only about one third of patients in either group maintained satisfactory outcomes after one year. More than half of the patients in both groups responded to one or more courses of medical therapy and avoided major amputations for one year following entry into the study.

Topics: Aged; Bacterial Infections; Cefotaxime; Cefoxitin; Ceftizoxime; Clinical Trials as Topic; Diabetes Complications; Double-Blind Method; Female; Follow-Up Studies; Foot; Foot Diseases; Humans; Ischemia; Male; Middle Aged; Prospective Studies; Random Allocation; Recurrence

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

We report on a 54-year-old man with chronic lower back pain after recent streptococcus pneumoniae pulmonary infection, resulting in a mycotic aortic aneurysm and spondylodiscitis of the eighth vertebrae 6 months later. Successful surgical treatment and recurrence-free survival after 4 years are described.. Osteomyelitis by Streptococcus pneumoniae of the spine combined with contained rupture of a mycotic aortic aneurysm into lung and spine has not been reported to date. Mycotic aneurysms with pulmonary fistulas are reported to carry a mortality rate of up to 100%. Few cases have been reported with different operative and conservative strategies.. The mycotic aortic aneurysm was excised using extracorporeal circulation and replaced by a Dacron graft. The spondylitic section of the eighth thoracic vertebrae was radically resected, and a tricortical bone block from the iliac crest was inserted into the defect. To keep compartments separated, collagen sponges with antibiotic supplementation were used. A triple antibiotic therapy (Metronidazol 3 x 0.5 g/day, Cefotaxim 3 x 2 g/day, and Flucloxacillin 3 x 2 g/day) was prescribed for 6 weeks and changed to Clindamycin for 1 year thereafter.. The patient made a good recovery and is free of recurrence 4 years after surgery.. Lower back pain might be a projected pain. Particularly in older patients or in the presence of comorbidities resulting in an immunocompromised status, an aggressive workup may be indicated. Radical resection of inflammatory tissues, sparse use of implant material, and prolonged administration of antibiotics proved a successful strategy in this patient.

Topics: Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Cefotaxime; Combined Modality Therapy; Discitis; Fistula; Floxacillin; Humans; Ischemia; Lung Diseases; Male; Metronidazole; Middle Aged; Nervous System Diseases; Osteomyelitis; Pneumococcal Infections; Pneumonia, Pneumococcal; Postoperative Complications; Respiratory Tract Fistula; Spinal Cord; Spinal Diseases; Spondylitis; Streptococcus pneumoniae; Thoracic Vertebrae; Tomography, X-Ray Computed; Tracheal Diseases; Treatment Outcome

In patients with peripheral arterial occlusive disease, it is difficult to attain an adequate antibiotic concentration in poorly perfused infected lesions. The antibiotic concentrations prevailing in the ulcer secretion with the different routes of administration were investigated in 7 patients. The patients received 1 g of cefotaxim on consecutive days: intravenously on the first day, intraarterially on the second day and by retrograde venous injection on the third day. Significantly higher concentrations in the secretion were found after retrograde venous antibiotic administration than after intravenous or intraarterial injection. Clinical experience up to now indicates that far better results of treatment can be attained if the antibiotic is administered by retrograde venous injection (in addition to the surgical measures required).

Topics: Biological Availability; Cefotaxime; Chemotherapy, Cancer, Regional Perfusion; Humans; Infusions, Intra-Arterial; Infusions, Intravenous; Ischemia; Leg Ulcer; Male; Metabolic Clearance Rate; Middle Aged