cefotaxime and Neutropenia

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

Infection is the immediate cause of death in many patients with cancer. Traditionally, combinations of modern beta-lactam antibiotics and aminoglycosides are empirically used in the treatment of patients with neutropenia and presumed infection. However, the new quinolones appear to have become potent combination partners for beta-lactams. Eighty-seven patients with presumed serious infection were blindly randomised to receive either 2 g cefotaxime i.v. plus 200 mg ofloxacin twice daily (group 1) or 2 g cefotaxime i.v. twice daily plus tobramycin i.v. three times daily with dosage adjustment according to renal function and body weight (group 2). The response rate was significantly higher in group 1 (71%) compared to group 2 (47%). The cefotaxime/ofloxacin combination proved to be safe and represented a considerable reduction of workload on the nursing staff.

Topics: Administration, Oral; Cefotaxime; Drug Synergism; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Infusions, Intravenous; Neoplasms; Neutropenia; Ofloxacin; Tobramycin

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

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

Fifty patients with acute non-lymphocytic leukaemia were treated by random allocation with either ceftazidime alone or a combination of piperacillin, netilmicin and cefotaxime for 65 febrile neutropenic episodes. Nineteen of 33 patient episodes (58%) responded to ceftazidime alone compared with 21 of 32 episodes (66%) treated with the combination. There was one infective death in a patient given the combination; rates of documented superinfection were low. The treatment groups appeared identical in terms of patient demography, underlying disease and other risk factors, though patients with a clinical site of infection responded more slowly than those without. Bacteraemia per se did not appear to influence outcome. Bactericidal serum concentrations greater than or equal to 8 X the minimum bactericidal concentration were predictive of a rapid response (within 4 days) to antibiotics. Furthermore, serum from patients treated with ceftazidime maintained adequate cidal activity against Pseudomonas aeruginosa for longer than that obtained from patients treated with the three-drug combination. Ceftazidime was shown to be a safe and effective alternative to the three-drug combination for the initial management of febrile neutropenic episodes in leukaemic patients.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Ceftazidime; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Male; Middle Aged; Netilmicin; Neutropenia; Penicillin Resistance; Piperacillin; Random Allocation; Sepsis

The safety of ceftriaxone was compared with that of amoxicillin in a randomized study of 91 patients with community-acquired pneumonia. The origin of infection was similar in the two groups. It was proven or probable Streptococcus pneumoniae in 50 percent of the patients and remained uncertain in 40 percent. Ninety percent of the patients who received ceftriaxone were clinically cured compared with 69 percent of those given amoxicillin (p less than 0.05). However, this difference was not apparent among the patients with proven or probable pneumococcal pneumonia. No severe clinical side effects were observed. Cutaneous reactions were more prevalent in the amoxicillin group, whereas mild diarrhea and mucosal candidiasis were more frequent in the ceftriaxone group. Reversible neutropenia was observed in two patients treated with ceftriaxone and none of those treated with amoxicillin.

Topics: Adult; Aged; Amoxicillin; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged; Neutropenia; Penicillins; Pneumococcal Infections; Pneumonia

Antibiotic resistance continues to reduce the number of available antibiotics, increasing the need for novel antibacterial drugs. Since the seminal work of Sir Alexander Fleming, antibiotic identification has been based exclusively on the inhibition of bacterial growth in vitro. Recently, inhibitors of bacterial virulence which interfere with bacterial pathogenesis mechanisms have been proposed as an alternative to antibiotics, and a few were discovered using assays targeting specific virulence mechanisms. Here we designed a simple surrogate host model for the measurement of virulence and systematic discovery of anti-virulence molecules, based on the interaction of Tetrahymena pyriformis and Klebsiella pneumoniae cells. We screened a library of small molecules and identified several inhibitors of virulence. In a mouse pneumonia model we confirmed that an anti-virulence molecule displayed antibacterial activity against Klebsiella pneumoniae and Pseudomonas aeruginosa, by reducing dramatically the bacterial load in the lungs. This molecule did not inhibit bacterial growth in vitro but prevented biosynthesis of the Klebsiella capsule and lipopolysaccharides, a key requirement for virulence. Our results demonstrate that anti-virulence molecules represent an alternative to antibiotics and those can be discovered using non-animal host models.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Cefotaxime; Cefpodoxime; Ceftizoxime; Cyclophosphamide; Disease Models, Animal; Female; Klebsiella Infections; Klebsiella pneumoniae; Lung; Mice; Mice, Inbred BALB C; Molecular Structure; Mutation; Neutropenia; Pseudomonas aeruginosa; Tetrahymena pyriformis; Time Factors; Triazines; Virulence

The aim of this study was to evaluate the accuracy of E-test for the detection of synergy or antagonism of antibiotic combinations against Pseudomonas aeruginosa isolates from neutropenic patients. The activity of levofloxacin or grepafloxacin combined with ceftriaxone or cefotaxime against 20 P. aeruginosa clinical strains was assessed by checkerboard technique in comparison with results performed by E-test. The combination grepafloxacin + ceftriaxone appeared to be most effective (synergy, 55%) by checkerboard technique. The agreement between checkerboard and E-test results was 71.2%. Synergy was detected by checkerboard and E-test methods in 35 (43.8%) and 23 (31.3%) of 80 possible combinations, respectively. Antagonism was detected once (1.2%) by checkerboard method only. No major errors were recorded. E-test was preferable to checkerboard method for the total cost (reagent cost + cost of technologist time) (8,60 vs 21,80 euros/test, respectively). E-test appeared a promising alternative for testing antibiotic combinations although further testing should be performed to better refine this metodology.

Topics: Anemia; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cost-Benefit Analysis; Drug Synergism; Drug Therapy, Combination; Fluoroquinolones; Hematologic Neoplasms; Humans; Levofloxacin; Microbial Sensitivity Tests; Neutropenia; Ofloxacin; Piperazines; Pseudomonas aeruginosa; Pseudomonas Infections

Topics: Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Gram-Positive Bacterial Infections; Humans; Male; Meningitis, Bacterial; Micrococcaceae; Neutropenia; Rifampin; Vancomycin

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacteria; Humans; Infant, Newborn; Macrolides; Meningitis, Bacterial; Neutropenia; Penicillin Resistance; Penicillins; Pneumonia, Bacterial; Sepsis; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Topics: Administration, Oral; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Cephalosporins; Community-Acquired Infections; Costs and Cost Analysis; Cross Infection; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Humans; Macrolides; Meningitis, Bacterial; Meningitis, Meningococcal; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Neutropenia; Pneumococcal Infections; Pneumonia, Bacterial; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Erythromycin; Gram-Negative Bacteria; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Neutropenia; Penicillins; Pneumonia, Mycoplasma; Pneumonia, Staphylococcal; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

The in vitro activity of two new beta-lactam agents, cefpirome (CPO) and cefepime (FEP), was investigated against 295 Gram-negative bacilli (250 enterobacteriaceae and 45 P. aeruginosa) isolated from neutropenic patients. They were compared with ceftazidime (CAZ), piperacillin-tazobactam (TZP), imipenem (IPM) and cefotaxime (CTX). All enterobacteriacae were susceptible to IPM, 16 strains were intermediately susceptible or resistant to CAZ (1 strain of E. coli, 4 of Morganella morganii and 11 of Enterobacter. The 250 strains of enterobacteriacea were susceptible to FEP (MIC < 1 mg/l) and only one strain among them was intermediately susceptible to CPO. Among 45 strains of P. aeruginosa, 21 strains were susceptible to CPO, 30 to FEP, 31 to TZP, 32 to CAZ and 34 to IPM. All the strains were inhibited by less than 32 mg/l of FEP and IPM.

Topics: Cefepime; Cefotaxime; Cefpirome; Ceftazidime; Cephalosporins; Drug Resistance, Microbial; Drug Therapy, Combination; Enterobacteriaceae; Humans; Imipenem; In Vitro Techniques; Neutropenia; Penicillanic Acid; Penicillins; Piperacillin; Pseudomonas aeruginosa; Tazobactam; Thienamycins

Effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) against severe infections in cyclophosphamide (CY)-induced neutropenic mice were investigated by its single use or by its combination with cephem antibiotics. Treatment with rhG-CSF increased the number of peripheral blood leucocytes and strikingly shortened the duration of the neutropenic state. Most of the regained population in the peripheral blood leucocytes were neutrophils. Functions of neutrophils, such as phagocytic activity, superoxide release, and expression of Mac-1 molecules, were remarkably enhanced by administration of rhG-CSF. When rhG-CSF was administered to CY-induced neutropenic mice before infection, protective effects against various kinds of bacteria were remarkable. On the other hand, such remarkable effects were not observed when rhG-CSF was administered after infections. However, even in the case of post-infectious treatment, a combination therapy of rhG-CSF with cephem antibiotics, particularly with Cefodizime (CDZM), showed a significant improvement in the survival rate and a decrease in the number of viable bacteria in the liver. These results suggest that a combination therapy of rhG-CSF with cephem antibiotics, especially with CDZM, is an efficient regime against severe infections in patients with neutropenia induced by a heavy anti-tumour chemotherapy.

Topics: Animals; Bacterial Infections; Cefotaxime; Cyclophosphamide; Female; Granulocyte Colony-Stimulating Factor; Leukocyte Count; Macrophage-1 Antigen; Mice; Mice, Inbred ICR; Neutropenia; Neutrophils; Phagocytosis; Recombinant Proteins; Respiratory Burst

The dual-action antibacterial R 23-9424 (desacetylcefotaxime linked to the quinolone fleroxacin) is a new antibacterial agent with excellent in vitro activity. It was evaluated for in vivo efficacy in comparison with the cephalosporin cefotaxime and the quinolone component, fleroxacin. Ro 23-9424 demonstrated significant activity against all strains tested in systemic infections, including those strains resistant in vivo to cefotaxime (Staphylococcus aureus 753, Serratia marcescens SM and Pseudomonas aeruginosa 8780) and fleroxacin (Streptococcus pneumoniae 6301 and Streptococcus pyogenes. In prophylactic studies, Ro 23-9424 compared favorably with fleroxacin against Escherichia coli and with cefotaxime against S. pyogenes, but Ro 23-9424 was considerably more active than cefotaxime against E. coli and more active than fleroxacin against S. pyogenes. In a murine pneumonia model, Ro 23-9424 was equivalent in activity to cefotaxime against S. pneumoniae and more active than cefotaxime against Klebsiella pneumoniae. Fleroxacin was inactive against S. pneumoniae and about 20-fold more active than Ro 23-9424 against K. pneumoniae. In a murine meningitis infection caused by S. pneumoniae, Ro 23-9424 was 3 times as active as cefotaxime, while fleroxacin was inactive. When meningitis was induced by K. pneumoniae, Ro 23-9424 was as active as the quinolone, while cefotaxime was inactive. In a neutropenic (immunocompromised) model, Ro 23-9424 was more active than cefotaxime against P. aeruginosa and 5-fold less active than fleroxacin. In the control normal (immunocompetent) mouse infection, Ro 23-9424 was 3-fold more active than cefotaxime, but 10-fold less active than fleroxacin.

Topics: Animals; Anti-Infective Agents; Bacterial Infections; Cefotaxime; Ciprofloxacin; Drug Evaluation, Preclinical; Enterobacteriaceae; Fleroxacin; Fluoroquinolones; Klebsiella pneumoniae; Meningitis; Mice; Neutropenia; Penicillin Resistance; Pneumonia; Pseudomonas aeruginosa; Staphylococcus aureus; Streptococcus pneumoniae; Streptococcus pyogenes; Time Factors

From 1984 to 1987 two consecutive groups of juvenile cancer patients (n = 45) with fever and neutropenia corresponding in all criteria were examined. In half of the total of 90 febrile episodes and septicemias, a conventional antibiotic combination therapy (Pseudomonas-active penicillin/cephalosporin of the third generation/aminoglycoside) was instituted. In the remaining half imipenem was used as an antibiotic monoagent. In 66% and 60% of the febrile episodes treated with antibiotic combination therapy and with imipenem, respectively, septicemia was confirmed by positive blood cultures. Nineteen febrile episodes occurred in the myeloaplastic phase after bone marrow transplantation. In a comparative study of imipenem as monotherapy versus an antibiotic combination therapy the results obtained with imipenem were superior in many regards. No resistance developed necessitating change of antibiotic therapy. Coagulase-negative Staphylococci, primarily responsible for catheter-associated septicemia, were susceptible. Duration of fever and thus duration of treatment were shorter. The incidence of side effects and costs were lower. Therefore, imipenem as an antibiotic monotherapy in febrile cancer patients with neutropenia appears to be more efficacious than the conventional combination therapy, even during myeloaplasia following bone marrow transplantation. The results and rationale of this retrospective analysis are discussed.

Topics: Adolescent; Adult; Bone Marrow Transplantation; Cefotaxime; Child; Child, Preschool; Cilastatin; Drug Therapy, Combination; Female; Humans; Imipenem; Infant; Male; Neoplasms; Neutropenia; Piperacillin; Retrospective Studies; Sepsis; Ticarcillin; Tobramycin

Topics: Agranulocytosis; Cefotaxime; Ceftriaxone; Humans; Neutropenia; Time Factors

A significant decrease in resistance to infections caused by gramnegative pathogens was observed in mice with neutropenia induced by cytostatics. Efficacy of schemes for combined chemotherapy with beta-lactams, aminoglycosides and a novel peptide antibiotic was studied on model infections in mice with neutropenia. In the neutropenic mice with sepsis caused by Pseudomonas the peptide antibiotic administered parenterally in a single dose of 50 micrograms/kg provided high therapeutic activity. In combination with azlocillin, cefotaxime and amikacin the peptide antibiotic has a synergistic therapeutic action.

Topics: Agranulocytosis; Amikacin; Animals; Azlocillin; Cefotaxime; Drug Synergism; Drug Therapy, Combination; Escherichia coli Infections; Immune Tolerance; Klebsiella Infections; Mice; Neutropenia; Opportunistic Infections; Pseudomonas Infections

The experience with empirical antimicrobial therapy of septicemia and febrile episodes in pediatric neutropenic patients was analyzed retrospectively. Between January 1985 and March 1988 in 49 patients 77 episodes were observed. Bacteremia was found in 15 (20%), culture proven localized bacterial infection in 11 (14%) and clinically diagnosed bacterial infection was found in 7 (9%) of the febrile episodes. Thus, 33 (43%) documented bacterial infections were observed. For initial therapy a combination of aminoglycoside plus 2nd/3rd generation cephalosporin (60%) or aminoglycoside plus piperacillin (30%) was usually chosen. Both regimens were equally effective. 52% and 56%, respectively, were sufficiently treated with the initial regimen. 95% of all episodes resolved completely, the mortality rate was 5%. Central venous catheters remained in situ in 84% of the cases. The period of time necessary for recovery of granulopoiesis had an influence on the therapy success.

Topics: Adolescent; Agranulocytosis; Antineoplastic Agents; Cefamandole; Cefotaxime; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever of Unknown Origin; Gentamicins; Humans; Infant; Infusion Pumps; Leukocyte Count; Male; Neoplasms; Neutropenia; Piperacillin; Sepsis

Topics: Agranulocytosis; Amikacin; Australia; Cefotaxime; Drug Therapy, Combination; Gentamicins; Hospitals, Teaching; Humans; Neutropenia; Piperacillin; Sepsis; Ticarcillin

Topics: Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Humans; Neutropenia; Tobramycin; Vancomycin

Clinical evaluation of cefmenoxime (CMX, Bestcall) was performed against infections associated with hematological, respiratory tract and other disorders. Clinical effectiveness of CMX against severe infections with hematological disorders including sepsis, pneumonia, pyelitis and so on was 74.4% for good responses and against the respiratory tract infections, 96.2% for good responses was obtained. Neither objective or subjective side effects nor extreme abnormalities in laboratory tests were observed in these patients. It can be concluded, therefore, that CMX is one of the most useful drugs against infectious diseases associated with hematological disorders, respiratory tract and other disorders.

Topics: Bacterial Infections; Biliary Tract Diseases; Cefmenoxime; Cefotaxime; Hematologic Diseases; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Neutropenia; Pneumonia; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Intestinal colonization by members of the family Enterobacteriaceae resistant to cefotaxime was surveyed for 3 years in a hematology-oncology unit. Of 416 patients, 66 (15.9%) were colonized, each with a different strain. The incidence of intestinal carriage was not correlated with cefotaxime consumption in the ward but was strongly associated with individual exposure to cefotaxime.

Topics: Agranulocytosis; Cefotaxime; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Feces; Hospital Units; Humans; Intestines; Neutropenia; Sepsis

Topics: Aged; Agranulocytosis; Cefotaxime; Ceftriaxone; Female; Humans; Neutropenia

Closed-space, locally neutropaenic infection sites were simulated in rabbits by implanting subcutaneous semipermeable chambers inoculated with 5 X 10(4) cfu/ml of Escherichia coli (one strain), Citrobacter diversus (one strain), Klebsiella pneumoniae (two strains) or Serratia marcescens (two strains). Four hours after inoculation, treatment was begun with amikacin (15 mg/kg), mezlocillin (100 mg/kg), or ceftizoxime (50 mg/kg) alone or in two-drug combinations. Antibiotics were given intramuscularly every 6 h for 16 doses. Chambers were sampled for bacterial counts at the start of therapy, and 20, 44, and 92 h thereafter. Blood and chamber antibiotic levels were determined during the treatment course. In-vivo results were compared to in-vitro tests of inhibition, killing and synergism. Ceftizoxime alone was successful in vivo (greater than 6 log reduction in count) against the three strains of klebsiella and citrobacter, mezlocillin against one serratia strain, and amikacin alone against none of the strains. The best in-vitro correlation was with the minimum inhibitory concentration (MIC) at a high (10(8] inoculum for the beta-lactams and with the anaerobic MIC for amikacin. Among combinations, amikacin plus mezlocillin alone was successful against the three strains of klebsiella and serratia, but neither amikacin nor mezlocillin added to ceftizoxime were more successful than ceftizoxime alone. In-vitro chequerboard synergism was not predictive of in-vivo success. Mezlocillin alone was inactivated in vivo by all the strains except Ser. marcescens, and the E. coli strain inactivated both mezlocillin and ceftizoxime alone and in combination.

Topics: Agranulocytosis; Amikacin; Animals; Cefotaxime; Ceftizoxime; Drug Combinations; Enterobacteriaceae; Female; Hydrogen-Ion Concentration; Kanamycin; Mezlocillin; Microbial Sensitivity Tests; Neutropenia; Rabbits

Neutropenia is an occasional complication of treatment with cephalosporin antibiotics. This report describes two patients who had neutropenia while receiving high doses of cephalosporins. The neutrophil counts returned to normal after stopping the drug, and cephalosporin-dependent neutrophil antibodies were demonstrated in both cases, using the granulocyte immunofluorescence test. In one patient, the immune neutropenia appeared to be due to a drug adsorption mechanism similar to penicillin-induced haemolytic anaemia, while an immune complex mechanism may have been involved in the second patient.

Topics: Adult; Agranulocytosis; Antibodies; Cefotaxime; Cefuroxime; Cephalosporins; Female; Fluorescent Antibody Technique; Granulocytes; Humans; Leukocyte Count; Neutropenia

Topics: Agranulocytosis; Amikacin; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Enterobacteriaceae; Feces; Gentamicins; Humans; Leukemia; Microbial Sensitivity Tests; Neutropenia; Pseudomonas

Cefotaxime treatment was evaluated in 41 patients with serious bone and joint infections. Septic arthritis and bursitis (8), acute and chronic osteomyelitis (33) were treated with 3 to 12 g of cefotaxime per day for three to 52 days. The diagnosis of osteomyelitis or septic arthritis was made on the basis of clinical and roentgenographic evidence of infection. The diagnosis of a joint infection was confirmed by a positive culture of a joint aspirate sample. The diagnosis of a bone infection was confirmed by either a positive culture of a bone biopsy or of blood in combination with a positive bone scan or roentgenogram. Staphylococcus aureus was the most frequently isolated pathogen. Overall, 36 of 41 patients, who met all criteria for evaluation, had satisfactory responses to cefotaxime. The drug was well tolerated by all patients. However, six patients had a direct Coomb's test, two patients were noted to be neutropenic and two patients developed a macular rash. It is concluded that cefotaxime is a useful and safe antibiotic for the treatment of osteomyelitis and septic arthritis.

Topics: Adolescent; Adult; Aged; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Female; Gram-Positive Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neutropenia; Osteomyelitis

We determined the serum bactericidal activity 1 h after the end of 2 g, 30 min infusions of latamoxef, cefoperazone and cefotaxime in six volunteers against six strains each of Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa. All produced excellent serum bactericidal activity against E. coli. Latamoxef and cefotaxime were superior for K. pneumoniae. Cefoperazone produced the highest titres against Staph. aureus. None of these agents produced sufficient bactericidal activity against Ps. aeruginosa to be useful in initial single agent therapy for the septic, granulocytopenic cancer patient.

Topics: Adolescent; Adult; Bacteria; Cefoperazone; Cefotaxime; Humans; Male; Microbial Sensitivity Tests; Moxalactam; Neutropenia

The efficacy of beta-lactam antibiotics and amikacin alone and in various combinations against Pseudomonas aeruginosa was studied in a rabbit model simulating a closed-space infection in a locally neutropenic site. Six strains of P. aeruginosa were studied in semipermeable chambers placed subcutaneously in rabbits. Therapy was begun 4 h after inoculation of 5 X 10(4) CFU of bacteria per ml of pooled rabbit serum into the chambers. Antibiotics were administered intramuscularly every 6 h for 16 doses. Quantitative bacteriology was measured at the start of therapy and at 20, 44, and 92 h thereafter. Antibiotic concentrations were measured in blood and chamber fluid. Results were compared with in vitro tests of susceptibility and synergy. No single-agent therapy eradicated any of the six test organisms. Azlocillin (100 mg/kg per dose) plus amikacin (20 mg/kg per dose) eliminated five of six organisms by 92 h, and ceftizoxime (100 mg/kg per dose) plus amikacin (20 mg/kg per dose) eliminated three of six test strains. Azlocillin plus ceftizoxime (each 100 mg/kg per dose) failed to eliminate any of the six strains. To eliminate P. aeruginosa in this model, two drugs were required, with one being an aminoglycoside. In vitro susceptibility tests of synergy were predictive of successful therapy whenever the antibiotic concentrations (free and total) at the infection site exceeded the MBC for both the aminoglycoside alone and the beta-lactam when tested in combination with amikacin.

Topics: Agranulocytosis; Amikacin; Animals; Anti-Bacterial Agents; Azlocillin; Cefotaxime; Cefoxitin; Ceftizoxime; Disease Models, Animal; Drug Combinations; Female; Hydrogen-Ion Concentration; Kanamycin; Microbial Sensitivity Tests; Neutropenia; Penicillins; Protein Binding; Pseudomonas Infections; Rabbits

Neutropenia is rarely associated with cephalosporins. We report a case of neutropenia associated with cefotaxime. A seven-year-old boy was admitted to the Chidoribashi Hospital with suspected septicemia. Cefotaxime 2 g/d was started. On day 18, neutropenia associated with cefotaxime was suspected. On day 22, the patient was transferred to Fukuoka Children's Hospital because of continuing neutropenia and eosinophilia. In Fukuoka Children's Hospital, bone marrow puncture revealed severe bone marrow depression. After one month, the patient was discharged. When we considered case reports of granulocytopenia, leukopenia, and agranulocytosis associated with cephalosporins, we found two types of leukopenia. One is the granulocytopenic type and the other is the neutropenic type. In diagnosing leukopenia due to cephalosporins, an increased percentage of eosinophils in white-blood-cell analysis is significant.

Topics: Agranulocytosis; Bone Marrow; Cefotaxime; Child; Humans; Male; Neutropenia

Topics: Adult; Aged; Agranulocytosis; Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Humans; Leukocyte Count; Male; Microbial Sensitivity Tests; Middle Aged; Neoplasms; Neutropenia; Neutrophils

Topics: Animals; Bacterial Infections; Bacteroides Infections; Cefotaxime; Ceftizoxime; Disease Models, Animal; Male; Mice; Neutropenia; Sepsis; Wound Infection

The considerable activity of cefotaxime on enterobacteriaceae is especially useful in neutropenic patients who are particularly at risk of septicaemia complications. The rapidly fatal development of this type of infections necessitates the use of a presumably efficacious therapy even before the result of blood cultures are obtained. The in vitro activity of cefotaxime in enterobacteriaceae has been compared to that of cephalothin, cefazolin, cefamandole, cefoxitin and cefuroxime.

Topics: Cefotaxime; Cephalosporins; Enterobacteriaceae; Humans; Microbial Sensitivity Tests; Neutropenia