cefotaxime and Ophthalmia-Neonatorum

A review is given of the selection and rational of optimal treatment regimens for patients with sexually transmitted pathogens, e.g. in cases of gonorrhea, chlamydial infections, chancroid, syphilis, pelvic inflammatory diseases and ophthalmia neonatorum. The scientific basis for the selection of a beta-lactam agent is discussed, including dose, MIC, the critical serum level and maintenance interval, and the duration of therapy. Except in the case of penicillinase-producing Neiserria gonorrhoeae, penicillin remained until recently the most effective agent available against many sexually transmitted diseases. However, ceftriaxone, a new third-generation cephalosporin, has been shown to have a long half-life (8 h) and excellent in vitro efficacy against Neiserria gonorrhoeae (including penicillinase-producing strains) and Haemophilis ducreyi. In view of its exceptional clinical efficacy against both gonorrhea and chancroid, clinical studies of its efficacy against other sexually transmitted diseases appear warranted.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Chancroid; Chlamydia Infections; Female; Gonorrhea; Humans; Infant, Newborn; Male; Ophthalmia Neonatorum; Pelvic Inflammatory Disease; Penicillins; Sexually Transmitted Diseases; Syphilis; Time Factors; Urethritis

Between 25% and 50% of children in African countries are exposed to Neisseria gonorrhoeae at birth and are at risk of developing gonococcal ophthalmia neonatorum. The problem is aggravated by the emergence of penicillinase-producing strains of N. gonorrhoeae (PPNG). Twenty-one children (9 boys, 12 girls, mean age 13 days) presenting with gonococcal conjunctivitis were identified during a 47-month period. Nineteen children received a single im injection of 100 mg/kg cefotaxime (maximum dose 1 g) without topical antibiotic therapy. One neonate with concurrent otitis media was treated with cefotaxime for five days and a 17-month old girl received two im injections because of the severity of her symptoms. Eight patients (38%) had received previous antibiotic therapy (penicillin im and/or tetracycline eye ointment). Twelve isolates of N. gonorrhoeae were found to be PPNG strains. At three to seven day follow-up examination all 21 patients were clinically cured without residual eye damage. Cefotaxime offers an effective first line treatment for gonococcal ophthalmia neonatorum in areas where there is a high prevalence of PPNG strains. The advantages of a single-dose treatment over multidose regimens in terms of compliance and cost are discussed.

Topics: Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Male; Ophthalmia Neonatorum

Ophthalmia neonatorum is defined as conjunctivitis appearing during the first month of life. The differential diagnosis includes chemical, bacterial, viral, and other pathogens, including Neisseria gonorrhoeae, herpes simplex, and Chlamydia trachomatis. Neisseria meningitidis is not commonly specifically included in the differential.

Topics: Cefotaxime; Cephalosporins; Conjunctiva; Diagnosis, Differential; Humans; Infant, Newborn; Injections, Intravenous; Meningococcal Infections; Neisseria meningitidis; Ophthalmia Neonatorum

Topics: Cefotaxime; Ceftriaxone; Gonorrhea; Humans; Infant, Newborn; Injections, Intramuscular; Ophthalmia Neonatorum

Nine neonates with culture proved gonococcal ophthalmia neonatorum were treated with a single intramuscular injection of 100 mg/kg of cefotaxime without topical antibiotic therapy. Five of the nine strains were penicillinase-producing Neisseria gonorrhoeae. All nine cases were clinically and microbiologically cured, and no side effects were observed.

Topics: Cefotaxime; Female; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Male; Ophthalmia Neonatorum

Topics: Adult; beta-Lactamases; Cefotaxime; Cervix Uteri; Female; Gonorrhea; Humans; Infant, Newborn; Maternal-Fetal Exchange; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Pregnancy; Pregnancy Complications, Infectious

Topics: Cefotaxime; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Kanamycin; Male; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Penicillinase