cefotaxime and Nervous-System-Diseases

Topics: Adult; Antibodies, Bacterial; Borrelia burgdorferi Group; Cefotaxime; Diagnosis, Differential; Female; Humans; Lyme Disease; Male; Middle Aged; Nervous System Diseases; Neurologic Examination; Tetracycline

Broad-spectrum cephalosporins are drugs of choice for the treatment of meningitis in communities which can afford them. The emergence of cephalosporin-resistant pneumococci demands the clinical trial of alternate agents. Carbapenems are active against the bacteria causing meningitis, but the use of imipenem-cilastatin was frustrated by drug-associated seizures. The safety and efficacy of meropenem, a new carbapenem, were compared to those of cefotaxime in a prospective randomized trial of 190 children with bacterial meningitis. Seizures occurred within 24 h before antibiotic therapy in 16 of 98 patients (16%) randomized to receive meropenem and in 6 of 92 patients (7%) randomized to receive cefotaxime. In patients without seizures before therapy, seizures occurred during therapy in 5 of 82 patients (6%) receiving meropenem and in 1 of 86 patients (1%) receiving cefotaxime (95% confidence interval: -0.7%, 10.6%). None were thought to be drug related. Twenty-four meropenem-treated patients (24%) and 11 cefotaxime-treated patients (12%) had neurological abnormalities before therapy. In patients without pretherapy neurological abnormalities, these abnormalities were present after treatment in 4 of 74 meropenem-treated patients (5%) and in 2 of 81 cefotaxime-treated patients (2%) (95% confidence interval: -3.2%, 9.1%). Of 75 meropenem-treated and 64 cefotaxime-treated patients with pretherapy positive cerebrospinal-fluid cultures, 68 and 59, respectively, had repeat lumbar punctures. Bacterial eradication was found to be 100% in both groups. Our data suggest that meropenem may be a carbapenem agent that is well tolerated and effective in the treatment of bacterial meningitis.

Topics: Adolescent; Cefotaxime; Child; Child, Preschool; Dexamethasone; Female; Hearing Tests; Humans; Infant; Male; Meningitis, Bacterial; Meropenem; Nervous System Diseases; Prospective Studies; Seizures; Thienamycins; Treatment Outcome

To evaluate the efficacy of the technique of selective decontamination of the digestive tract (SDD) in preventing secondary infections in patients with neurologic diseases requiring intensive care.. Randomized, double-blind, placebo-controlled trial using amphotericin B, polymyxin E, and tobramycin applied to the oropharynx and enterally; all patients received intravenous cefotaxime for 72 h.. Respiratory ICU.. Forty patients with neurologic diseases requiring ventilation for > 48 h and ICU stay > 5 days. Neurologic diagnosis included acute inflammatory demyelinating neuropathy (15), meningoencephalitis (10), status epilepticus (6), tetanus (6), and myasthenia gravis (3).. Microbiologic surveillance samples of oropharyngeal and tracheal secretions, gastric aspirates, stool, urine, and any other potentially infected sites were taken at the time of ICU admission and twice weekly thereafter until 3 days after discharge from the unit. The SDD was applied every 6 h to the oropharynx and enterally.. Effective decontamination of the gastrointestinal tract was achieved in the patients receiving the active regimen; however, there was no reduction in the incidence of infections (11 in the active group vs 10 in placebo), and duration of ICU stay (30.1 +/- 22.5 vs 20.6 +/- 17.7 days) and hospital stay (49.3 +/- 31.9 vs 40 +/- 33.4 days) were unaffected as was the mortality (15 percent vs 15 percent).. SDD did not reduce the incidence of secondary infection in patients with neurologic disease, nor did it affect morbidity or mortality; however, it adds considerably to the cost of patient care.

Topics: Administration, Oral; Adult; Cefotaxime; Cross Infection; Digestive System; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Intubation, Gastrointestinal; Male; Nervous System Diseases; Premedication; Respiration, Artificial; Respiratory Insufficiency; Severity of Illness Index

In this prospective, randomized, open trial, 33 patients with Lyme neuroborreliosis were assigned to a 10-day treatment with either ceftriaxone, 2 g intravenously (iv) every 24 h (n = 17), or cefotaxime, 2 g iv every 8 h (n = 16). Of the 33 patients, 30 were eligible for analysis of therapeutic efficacy. Neurologic symptoms improved or even subsided in 14 patients of the cefotaxime group and in 12 patients of the ceftriaxone group during the treatment period. At follow-up examinations after a mean of 8.1 months, 17 of 27 patients examined were clinically asymptomatic. In one patient Borrelia burgdorferi was isolated from the cerebrospinal fluid (CSF) 7.5 months after ceftriaxone therapy. CSF antibiotic concentrations were above the MIC 90 level for B. burgdorferi in nearly all patients examined. Patients with Lyme neuroborreliosis may benefit from a 10-day treatment with ceftriaxone or cefotaxime. However, as 10 patients were symptomatic at follow-up and borreliae persisted in the CSF of one patient, a prolongation of therapy may be necessary.

Topics: Adult; Aged; Antibodies, Bacterial; Borrelia burgdorferi Group; Cefotaxime; Ceftriaxone; Child; Female; Follow-Up Studies; Humans; Lyme Disease; Male; Middle Aged; Nervous System Diseases

In experimental models of meningitis and in children with meningitis, dexamethasone has been shown to reduce meningeal inflammation and to improve the outcome of disease.. We conducted a placebo-controlled, double-blind trial of dexamethasone therapy in 101 infants and children admitted to the National Children's Hospital, San José, Costa Rica, who had culture-proved bacterial meningitis or clinical signs of meningitis and findings characteristic of bacterial infection on examination of the cerebrospinal fluid. The patients were randomly assigned to receive either dexamethasone and cefotaxime (n = 52) or cefotaxime plus placebo (n = 49). Dexamethasone (0.15 mg per kilogram of body weight) was given 15 to 20 minutes before the first dose of cefotaxime and was continued every 6 hours thereafter for four days.. The demographic, clinical, and laboratory profiles were similar for the patients in the two treatment groups. By 12 hours after the beginning of therapy, the mean opening cerebrospinal pressure and the estimated cerebral perfusion pressure had improved significantly in the dexamethasone-treated children but worsened in the children treated only with cefotaxime (controls). At 12 hours meningeal inflammation and the concentrations of two cytokines (tumor necrosis factor alpha and platelet-activating factor) in the cerebrospinal fluid had decreased in the dexamethasone-treated children, whereas in the controls the inflammatory response in the cerebrospinal fluid had increased. At 24 hours the clinical condition and mean prognostic score were significantly better among those treated with dexamethasone than among the controls. At follow-up examination after a mean of 15 months, 7 of the surviving 51 dexamethasone-treated children (14 percent) and 18 of 48 surviving controls (38 percent) had one or more neurologic or audiologic sequelae (P = 0.007); the relative risk of sequelae for a child receiving placebo as compared with a child receiving dexamethasone was 3.8 (95 percent confidence interval, 1.3 to 11.5).. The results of this study, in which dexamethasone administration began before the initiation of cefotaxime therapy, provide additional evidence of a beneficial effect of dexamethasone therapy in infants and children with bacterial meningitis.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Cerebrospinal Fluid Pressure; Child; Child, Preschool; Dexamethasone; Double-Blind Method; Female; Hearing Disorders; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Nervous System Diseases; Tumor Necrosis Factor-alpha

We randomly assigned 21 patients with painful Lyme neuroborreliosis radiculitis (Bannwarth's syndrome) and neuroborreliosis meningitis to a 10-day treatment with either penicillin G. 4 x 5 million U/d (n = 10) or cefotaxime sodium, 3 x 2 g/d (n = 11), intravenously. We were not able to demonstrate clinical differences between groups, either during the 10-day treatment period or at follow-up examination a mean of 7.7 months after antibiotic therapy. Cerebrospinal fluid cefotaxime concentrations reached the minimum inhibitory concentration at the 90% level for Borrelia burgdorferi in all patients, while none of the patients treated with penicillin G had cerebrospinal fluid concentrations above the minimum inhibitory concentration at the 90% value. We conclude that patients with acute neurologic manifestations of Lyme borreliosis may benefit from a 10-day treatment with cefotaxime or penicillin G. Cerebrospinal fluid antibiotic concentrations above the minimum inhibitory concentration at the 90% value, as observed in all patients treated with cefotaxime, offer the most hope for long-term prognosis.

Topics: Acute Disease; Aged; Cefotaxime; Female; Humans; Lyme Disease; Male; Middle Aged; Nervous System Diseases; Penicillin G; Prospective Studies; Radiculopathy

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