cefotaxime and Pneumonia--Bacterial

Bacterial infections are well described complications of cirrhosis that greatly increase mortality rates. Two factors play important roles in the development of bacterial infections in these patients: the severity of liver disease and gastrointestinal haemorrhage. The most common infections are spontaneous bacterial peritonitis, urinary tract infections, pneumonia and sepsis. Gram-negative and gram-positive bacteria are equal causative organisms. For primary prophylaxis, short-term antibiotic treatment (oral norfloxacin or ciprofloxacin) is indicated in cirrhotic patients (with or without ascites) admitted with gastrointestinal haemorrhage (variceal or non-variceal). Administration of norfloxacin is advisable for hospitalized patients with low ascitic protein even without gastrointestinal haemorrhage. The first choice in empirical treatment of spontaneous bacterial peritonitis is the iv. III. generation cephalosporin; which can be switched for a targeted antibiotic regime based on the result of the culture. The duration of therapy is 5-8 days. Amoxicillin/clavulanic acid and fluoroquinolones--patients not on prior quinolone prophylaxis--were shown to be as effective and safe as cefotaxime. In patients with evidence of improvement, iv. antibiotics can be switched safely to oral antibiotics after 2 days. In case of renal dysfunction, iv albumin should also be administered. Long-term antibiotic prophylaxis is recommended in patients who have recovered from an episode of spontaneous bacterial peritonitis (secondary prevention). For "selective intestinal decontamination", poorly absorbed oral norfloxacin is the preferred schedule. Oral ciprofloxacin or levofloxacin (added gram positive spectrum) all the more are reasonable alternatives. Trimethoprim/sulfamethoxazole is only for patients who are intolerant to quinolones. Prophylaxis is indefinite until disappearance of ascites, transplant or death. Long-term prophylaxis is currently not recommended for patients without previous spontaneous bacterial peritonitis episode, not even when refractory ascites or low ascites protein content is present.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ascites; Bacteremia; Bacterial Infections; Cefotaxime; Cephalosporins; Ciprofloxacin; Fluoroquinolones; Gastrointestinal Hemorrhage; Humans; Infusions, Intravenous; Liver Cirrhosis; Norfloxacin; Peritonitis; Pneumonia, Bacterial; Primary Prevention; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Pneumonia complicates the course of 50% of patients on mechanical ventilation, requiring three or more days of mechanical ventilation and potentially increasing the relative risk of mortality by 20-40%. The predominant potentially pathogenic micro-organisms are Streptococcus pneumoniae, Staphylococcus aureus (sensitive to methicillin in the previously healthy host), Pseudomonas aeruginosa (aerobic gram-negative bacilli), and methicillin-resistant Staphylococcus aureus in the host with underlying disease. Approximately 85% of pneumonias are endogenous, caused by bacteria present in the patient's oropharyngeal flora. Bacteria present on admission cause primary endogenous pneumonia (55%), whereas bacteria acquired in the unit lead to supercarriage or secondary carriage and subsequently secondary endogenous pneumonia (30%). The remaining 15% are exogenous, ie the bacteria causing pneumonia are not carried by the patient. The diagnosis is usually based on clinical, radiological, and microbiological criteria, using the non-invasive method of tracheal aspirate, which yields >/=10(5) micro-organisms. Seven randomized trials have evaluated three non-antibiotic prophylactic maneuvers: hygiene (1 trial), subglottic drainage (4 trials), and semirecumbent position (2 trials). The impact on pneumonia was mixed, whereas mortality was unchanged. Selective digestive decontamination, using parenteral and enteral antimicrobials to control the three types of pneumonia, has been evaluated in 54 trials and showed an absolute mortality reduction of 8%. The therapy of pneumonia relies on six basic principles: (a) surveillance and diagnostic cultures to identify micro-organisms; (b) immediate and adequate antibiotic treatment to sterilize the lower airways, (c) the source of potential pathogens requires elimination for recovery of the original infection and prevention of relapses and/or superinfections; (d) aerosolized antimicrobials; (e) removal or replacement of the endotracheal tube; and (f) surveillance samples are indispensable to monitor efficacy of treatment. The aim of our review was to evaluate up to date facts regarding control of bacterial pneumonias during mechanical ventilation in intensive care unit settings.

Topics: Amphotericin B; Anti-Bacterial Agents; Cefotaxime; Chemoprevention; Cross Infection; Equipment Contamination; Humans; Hygiene; Intensive Care Units; Length of Stay; Pneumonia, Bacterial; Polymyxin B; Respiration, Artificial; Tobramycin

A retrospective analysis was conducted to assess the cost-effectiveness of four intravenous antibiotic treatment regimens in the treatment of severe community-acquired pneumonia (CAP) in adults in a private hospital setting. The study compared some third-generation cephalosporin regimens with a second-generation cephalosporin and an amoxicillin/clavulanic acid (co-amoxiclav) regimen to investigate published South African treatment guidelines from a pharmaco-economic point of view.. A pharmaco-economic model of local costs, from a payer perspective, was based on the results of a meta-analysis of clinical papers from peer-reviewed journals. The study compared intravenous (i.v.) ceftriaxone (2 g once daily), cefotaxime (i.v. 2 g 3 times a day), cefuroxime (i.v. 750 mg 3 times a day, followed by 500 mg orally 3 times a day) and amoxicillin/clavulanic acid (1.2 g intravenously 3 times a day, followed by 625 mg orally 3 times a day) [corrected].. An analysis of the odds ratios (ORs) of all two-way comparisons indicated that ceftriaxone ensured significantly higher probabilities of successful outcomes than the other antibiotic treatment regimens (ORs in the order of two were indicated). The pharmaco-economic results suggested that the ceftriaxone treatment regimen was the most cost-effective in the hospital treatment of CAP in adult patients. These results proved to be robust across sensitivity analyses for success rates and treatment days. A sensitivity analysis testing the assumption that patients could be discharged once the oral treatment was initiated indicated that the amoxicillin/clavulanic acid and cefuroxime treatment arms were more cost-effective. The clinical validity of such an assumption is questionable.. Despite the conservative approach followed in terms of ceftriaxone data, both the clinical results and cost-effectiveness supported the use of ceftriaxone in the treatment of CAP in adults in the hospital setting.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Cefotaxime; Ceftriaxone; Cefuroxime; Cephalosporins; Community-Acquired Infections; Cost-Benefit Analysis; Drug Administration Schedule; Drug Therapy, Combination; Hospital Costs; Humans; Infant; Length of Stay; Odds Ratio; Pneumonia, Bacterial; Retrospective Studies; South Africa; Treatment Outcome

To explore the influence of cefodizime on CD4/CD8 and T helper 1(Th1)/Th2 cell ratios in peripheral blood of the senile patients with bacterial pneumonia.. Sixty-three senile patients with bacterial pneumonia were enrolled and divided into two groups randomly. Patients in the control group (n=31) were given intravenous infusion of ceftriaxone sodium, and patients in the observation group (n=32) were given intravenous infusion of cefodizime. The fasting venous blood was taken before and after treatment to detect CD4/CD8 and Th1/Th2 cell ratios with flow cytometry. At the same time, the serum interleukin-2 (IL-2), interferon γ (IFN-γ), IL-4 and IL-10 contents were also detected with ELISA.. Before treatment, there was no significant difference in the above indexes between the two groups. After treatment, CD4⁺ cells and Th1 cells of the observation group increased while Th2 cells decreased; as a result, the CD4/CD8 and Th1/Th2 cell ratios of the observation group were significantly higher than those of the control group. At the same time, serum IL-2 and IFN-γ contents of the observation group were significantly higher than those of the control group, while serum IL-4 and IL-10 contents were significantly lower than those of the control group.. Cefodizime can improve the cellular immune function and rectify CD4/CD8 and Th1/Th2 imbalance in peripheral blood of the senile patients with bacterial pneumonia.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Blood Cell Count; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Cefotaxime; Female; Flow Cytometry; Humans; Interferon-gamma; Interleukin-10; Interleukin-2; Interleukin-4; Male; Middle Aged; Pneumonia, Bacterial; Th1 Cells; Th2 Cells

To evaluate the efficacy and tolerability of levofloxacin (L) as monotherapy in patients with severe community-acquired pneumonia (CAP) in comparison with therapy using a combination of cefotaxime (C) plus ofloxacin (O).. Prospective, randomized 1:1, comparative, open, parallel-group study.. Multinational study with 149 sites.. A total of 398 randomized patients who had been admitted to the ICU with severe CAP without shock, including 308 patients in a modified intent-to-treat population and 271 patients in the per-protocol (PP) population (L group, 139 patients; C + O group, 132 patients).. Therapy with levofloxacin (500 mg IV, q12h) vs therapy with a C + O combination (C, 1g IV, q8h; O, 200 mg IV, q12h) for 10 to 14 days.. The main end point was the clinical efficacy at the end of treatment (ie, the test-of-cure [TOC] visit). The statistical hypothesis was the noninferiority of L therapy to C + O therapy with a 2.5% alpha risk (unilateral) and a 15% maximum set difference. At the TOC visit, a clinical success was observed in 79.1% of patients (L group) and 79.5% of patients (C + O group) in the PP population (difference, -0.4%; 95% confidence interval [CI], -10.79 to 9.97% without adjustment for simplified acute physiology score [SAPS] II at inclusion; difference, -0.3%; 95% CI, -10.13 to 9.58% with adjustment for SAPS II). A satisfactory bacteriologic response was present in 73.7% of L group patients and 77.5% of C + O group patients, including responses of 75.7% and 70.3%, respectively, in the L group and C + O group in the Streptococcus pneumoniae-documented population. In the safety analysis, 20 patients in the L group (10.3%) and 16 patients in the C + O group (8.0%) experienced at least one adverse event that was considered to be treatment-related.. L therapy was at least as effective as the combination therapy of C + O in the treatment of a subset of patients with CAP requiring ICU admission. This conclusion cannot be extrapolated to patients requiring mechanical ventilation or vasopressors (ie, those patients in shock).

Topics: Adult; Aged; Anti-Bacterial Agents; Cefotaxime; Chi-Square Distribution; Community-Acquired Infections; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Intensive Care Units; Levofloxacin; Male; Middle Aged; Ofloxacin; Pneumonia, Bacterial; Prospective Studies; Treatment Outcome

To compare the effectiveness and security of levofloxacin treatment in front betalactamic therapy in patient with community-acquired pneumonia that require hospitalization (CAPH).. A prospective and randomized study along a year from 49 patients diagnosed of (CAPH) that were admitted in the Internal Medicine Service. The patients were assigned randomly to receive.-I: cefotaxime or ceftriaxone, II: amoxicillin/clavulanate (both could be associated or not with a macrolide) or III: levofloxacin. It was accomplished Rx. thorax to 7-10 days, to the month and, other reviews if was necessary.. 29 cases were in standard therapy (I or II) and 20 cases received levofloxacin therapy. Male 84%, half age 70.9 years old, 57% with moderate or severe underlying disease, and 55% with approaches of initial severity criteria. In 47% of the cases we arrived to etiologic diagnosis, in the third of the cases were BGN. The cure took place in 94% of the patients and 2 patients died (5%). No differences were observed regarding demographic characteristics, underlying disease and severity. No differences were detected in: the secondary effects, complications, hospital stay or, mean stay or percentage of cures. The necessity to prolong the therapy was bigger in the standard group in front of the group tried with levofloxacin (52% vs. 15%, p:0.02).. In bigger population and with initial severity the treatment with levofloxacin can be a valid alternative to the standard therapy.

Topics: Aged; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Clavulanic Acid; Community-Acquired Infections; Drug Therapy, Combination; Female; Hospitalization; Humans; Levofloxacin; Male; Ofloxacin; Pneumonia, Bacterial; Prospective Studies; Treatment Outcome

An open, randomized, multicentre clinical trial was conducted to compare the efficacy and safety of cefepime 2 g iv bd (2 g tds daily in cases of Pseudomonas aeruginosa pneumonia) with cefotaxime 2 g iv tds, in the empirical treatment of bacterial pneumonia in HIV-infected patients. The primary end-point was effectiveness after 3-5 days of treatment, taking success to be when the study drug was continued during this period of time. Clinical and bacteriological responses at end of treatment (EOT) were also evaluated. Analyses of the intention-to-treat population (n = 160) and the as-per-protocol groups (n = 150) were carried out. Treatment groups were comparable with regard to sex, age, HIV status and degree of severity of pneumonia. The primary end-point for cefepime was considered successful for the intention-to-treat and as-per-protocol groups in 85.7% and 93.5% of cases, respectively, and for cefotaxime, in 77.6% and 80.8% of cases, respectively (P = 0.22 and P = 0.02). In the as-per-protocol group, cefotaxime treatment was independently related to failure at the primary end-point. A satisfactory clinical response in the intention-to-treat population was observed in 83.3% of cefepime and 82.9% of cefotaxime patients. Bacteriological cure was obtained in 100% of evaluable cefepime and 93.4% of evaluable cefotaxime patients at EOT. Safety of the study drugs was comparable in both treatment groups. Cefepime 2 g iv bd was at least as effective and as well tolerated as cefotaxime 2 g iv tds in the treatment of bacterial pneumonia in HIV-infected patients.

Topics: Adult; Cefepime; Cefotaxime; Cephalosporins; Empiricism; Female; HIV Infections; Humans; Male; Pneumonia, Bacterial; Treatment Outcome

This study compared the efficacy and tolerability of once-daily dosing with either roxithromycin or cefixime in previously healthy adult patients aged between 18 and 60 with markers of uncomplicated community-acquired pneumonia (CAP) in three outpatient clinics in an open, randomized study. Sixty patients were enrolled: 17 males and 13 females received roxithromycin 300 mg once daily for 8-10 days and 22 males and eight females received 400 mg cefixime once daily for the same period. All patients were assessed clinically, radiologically and bacteriologically before inclusion, immediately after the study and approximately 1 month later. The most common pathogen isolated from sputum was Streptococcus pneumoniae (in 26 (43%) of 60 patients), with mixed organisms isolated from the sputum of 18 (30%) of 60 patients. Staphylococcus aureus, Haemophilus influenzae or Moraxella catarrhalis occurred in 11/60 patients, and atypical pathogens were detected by serology in 7/26 cases in the roxithromycin group and 3/23 in the cefixime group. The severity of infection was rated as mild to moderate at the beginning of the trial. At the end of the study treatment period, clinical cure rates were 30/30 (100%) for roxithromycin and 28/30 (94%) for cefixime, with one patient on cefixime being classed as a partial responder and one patient being classed as a failure and withdrawn. However, radiological abnormalities persisted in three patients on roxithromycin and one on cefixime. Of the 59 patients who completed the study, none required further antibiotic therapy. No abnormal laboratory parameters or adverse events were reported in either group. Roxithromycin at a daily dose of 300 mg was an effective and well-tolerated treatment for the empirical treatment of mild to moderate CAP in this group of patients.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefixime; Cefotaxime; Cephalosporins; Community-Acquired Infections; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Roxithromycin; Streptococcus pneumoniae

Cefodizime (CAS 69739-16-8, HR 221) is a new third-generation cephalosporin with pharmacokinetic properties that make it suitable for once-daily administration in the treatment of lower respiratory tract infections (LRTI). Ninety-nine adult hospitalized patients (66 males, 33 females, median age 57.5 years) received a once-daily injection of 2 g cefodizime for LRTI. Median treatment duration was 8 days. Forty-two patients received cefodizime intravenously and 57 intramuscularly. Indications for treatment were as follows; primary lobar pneumonia (n = 36), bronchopneumonia (n = 14), secondary pneumonia (n = 3), aspiration pneumonia (n = 5), acute exacerbation of chronic bronchitis (n = 21), and of bronchiectasis (n = 9) and acute purulent bronchitis (n = 11). General condition was good in 29 patients and poor in 58; 12 patients were critically ill. The following pathogens were isolated at baseline (source: bronchial secretions, sputum or blood): S. pneumoniae (n = 47), Haemophilus spp. (n = 17), M. catarrhalis (n = 6), Streptococcus spp. (n = 9), Staphylococcus spp. (n = 5), Klebsiella spp. (n = 4), Pseudomonas spp. (n = 1), A. calcoaceticus (n = 1) and anaerobic organisms (n = 7). Fifty-nine patients were evaluable for bacteriological response and 82 for clinical response. Bacteriological outcome was satisfactory in 29/30 patients having LRTI with parenchymal involvement (97%) and in 29/29 patients without parenchymal involvement (100%). Clinical cure was achieved in 41/43 evaluable patients with parenchymal involvement (95%) and in 37/39 patients without parenchymal involvement (95%) in the per-protocol analysis and in 54/58 patients (93%) and 37/41 patients (93%), respectively, in the clinical intention-to-treat analysis. Three of the patients with an unsatisfactory clinical response died of infection during the study. Cefodizime was well tolerated. Adverse reactions--all of mild intensity--were tachycardia, lumbalgia and dizziness, each occurring in one patient. Cefodizime 2 g once daily either i.m. or i.v. was effective in the treatment of lower respiratory tract infections in hospitalized patients.

Topics: Adult; Aged; Bronchitis; Cefotaxime; Cephalosporins; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Respiratory Tract Infections

Step-by-step therapy of patients with pneumonia and exacerbated chronic bronchitis with amoxyclav (amoxycillin/potassium clavulanate) in a dose of 1.2 g administered intravenously dropwise every 8 hours for the first 2 days of the treatment with subsequent oral use of the drug in a dose of 625 mg thrice a day for 5 days proved to be highly efficient. The recovery and improvement were stated in 19 (95 per cent) out of 20 patients. The adverse reaction (urticaria) was observed in 1 patient. Identical results were recorded in a comparative randomized trial with the use of cefotaxime in a dose of 1.0 g intramuscularly every 8 hours for 7 days. The pharmacoeconomic estimate showed the expediency of the step-by-step therapy with the use of amoxycillin/potassium clavulanate.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Bronchitis; Cefotaxime; Cephalosporins; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Length of Stay; Male; Middle Aged; Pneumonia, Bacterial; Treatment Outcome

In this double-blind multicentre study, using the intention-to-treat approach, a total of 293 patients with fever (> or = 38.5 degrees C), symptoms of sepsis and signs of pneumonia or pyelonephritis were randomly assigned to treatment with ampicillin and mecillinam (A+M) or cefotaxime followed by cefadroxil. In the febrile phase, treatment was given intravenously twice daily, either with 1,200 mg ampicillin together with 600 mg mecillinam or with 2 g cefotaxime alone. When the patients stayed afebrile, the intravenous administration was replaced by oral treatment twice daily for 14 days, either with 500 mg pivampicillin and 400 mg pivmecillinam or 1 g cefadroxil. In the A+M group, 33% (48/144) of the patients did not complete the full course of treatment as compared with 32% (47/149) in the cephalosporin group, the reasons being treatment failure in 27 and 29, respectively, or adverse effects (n = 16 in both groups). The median duration of fever was 47 h in the A + M group and 50 h in the cephalosporin group. Of 135 patients with pneumonia, 68% were completely cured in the A + M group, and 65% in the cephalosporin group, the main reasons for treatment failure being Mycoplasma pneumonia or ornithosis. Of 136 patients with pyelonephritis, 63% were cured in each group. The main reason for failure was bacteriological relapse. Side-effects were reported by 32 patients (22%) of the A+M group, as compared with 41 (28%) of the cephalosporin group. Epigastric complaints were equally frequent in both groups, but there was a tendency for a higher frequency of exanthema in the A+M group, and for antibiotic-associated diarrhoea and fungal superinfections in the cephalosporin group.

Topics: Amdinocillin; Ampicillin; Cefadroxil; Cefotaxime; Cephalosporins; Double-Blind Method; Drug Therapy, Combination; Escherichia coli Infections; Female; Fever; Humans; Male; Middle Aged; Penicillins; Pneumonia, Bacterial; Pyelonephritis

In this open, randomized and controlled multicenter study involving a total of 100 hospitalized patients with infections of the lower respiratory tract, including pneumonia, the efficacy and tolerability of sequential treatment with cefotaxime i.v./cefixime oral were compared with those of exclusively parenteral treatment with cefotaxime. The patients received either 2 x 2 g cefotaxime i.v. over a period of 7 to 10 days, or 2 x 2 g cefotaxime over a period of 48 to 72 hours followed by oral cefixime treatment (1 x 400 mg/day) for a further 5 to 8 days.. A total of 94 patients were evaluated for efficacy; in 93.6% of the evaluable patients in each treatment group, either a cure or improvement was obtained. In four patients in the cefotaxime group and five patients treated first with cefotaxime and then with cefixime, adverse reactions were observed. For three of these adverse reactions (diarrhea, nausea, aggravation of an pre-existing genital mycosis) an association with the respective test substance was considered to be at least possible.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Cefixime; Cefotaxime; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pneumonia, Bacterial; Respiratory Tract Infections

Topics: Animals; Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Antineoplastic Agents; Cell Line; Cell Proliferation; Cell Survival; Dose-Response Relationship, Drug; Drug Screening Assays, Antitumor; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Molecular Structure; Pneumonia, Bacterial; Pore Forming Cytotoxic Proteins; Structure-Activity Relationship; Wasp Venoms

Group B Streptococcus is a primary source of pneumonia, which is a leading cause of death worldwide. During the last few decades, there has been news of growing antibiotic resistance in group B streptococci to penicillin and different antibiotic agents. This clinical study retrospectively analyzes antimicrobial resistance in inpatients who were diagnosed with group B streptococcal pneumonia.. All of the required information from inpatients who were identified to have group B streptococcal pneumonia was sourced from the database at the Department of Internal Medicine of HELIOS Clinic Wuppertal, Witten/Herdecke University, in Germany, from 2004-2014. Antimicrobial susceptibility testing was performed for the different antimicrobial agents that were regularly administered to these inpatients.. Sixty-six inpatients with a mean age of 63.3 ± 16.1 years (45 males [68.2%, 95% CI 60.0%-79.4%] and 21 females [31.8%, 95% CI 20.6%-43.0%]) were detected to have group B streptococcal pneumonia within the study period from January 1, 2004, to August 12, 2014. Group B Streptococcus had a high resistance rate to gentamicin (12.1%), erythromycin (12.1%), clindamycin (9.1%), and co-trimoxazole (3.0%), but it was not resistant to penicillin, cefuroxime, cefotaxime, or vancomycin (P < 0.0001).. No resistance to penicillin, cefuroxime, cefotaxime, or vancomycin was detected among inpatients with pneumonia caused by group B streptococci.

Topics: Aged; Cefotaxime; Cefuroxime; Cephalosporin Resistance; Cross Infection; Drug Resistance, Bacterial; Female; Germany; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae; Vancomycin Resistance

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Female; Gonorrhea; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Neisseria gonorrhoeae; Pneumonia, Bacterial; Pregnancy; Premature Birth

Topics: Adenocarcinoma; Aged; Alcoholism; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Diabetes Mellitus, Type 2; Disease Susceptibility; Endometrial Neoplasms; Female; Humans; Iron Overload; Pneumonia, Bacterial; Yersinia enterocolitica; Yersinia Infections

Topics: Anti-Bacterial Agents; Bronchial Fistula; Cefotaxime; Chest Tubes; Combined Modality Therapy; Debridement; Drainage; Drug Therapy, Combination; Empyema, Pleural; Equipment Failure; Female; Humans; Infant; Lung Abscess; Male; Necrosis; Pleural Diseases; Pneumonia, Bacterial; Pneumothorax; Postoperative Complications; Radiography; Respiratory Tract Fistula; Therapeutic Irrigation; Thoracoscopy; Vancomycin

The aim of the study was to evaluate therapeutic efficiency of ceftriabol (Russia) and claforan (both 3d generation cefalosporins) used to manage severe extrahospital pneumonia. Ceftriabol (2 g) was administered one or twice daily, claforan intravenously (2 g b.i.d. or t.i.d). Results of the treatment were assessed from a combination of anamnestic and physical examination data, results of X-ray and laboratory studies. Normalization of major clinical, laboratory, and instrumental parameters in patients treated with ceftriabol and claforan was achieved roughly within the same time period. It means that ceftriabol is at least as efficacious as claforan when applied to the treatment of severe extrahospital pneumonia.

Topics: Adult; Aged; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Community-Acquired Infections; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Young Adult

The algorithms included in most automated systems used for antimicrobial susceptibility testing (e.g., Vitek 2) consider that Escherichia coli isolates resistant to cefoxitin are AmpC-hyperproducers and, consequently, resistant also to amoxycillin-clavulanate. However, a recent study revealed that 30% of E. coli clinical isolates resistant to cefoxitin remained susceptible in vitro to amoxycillin-clavulanate. The aim of the present study was to evaluate the in-vivo efficacy of amoxycillin-clavulanate in the treatment of an experimental model of pneumonia, using two clonally related isolates (with identical repetitive extragenic palindromic sequence (REP)-PCR patterns) of AmpC-non-hyperproducing and OmpF-lacking E. coli (Ec985 and Ec571) that were resistant to cefoxitin and susceptible to cefotaxime and amoxycillin-clavulanate. MICs were determined using a microdilution technique, and in-vitro bactericidal activity was tested using time-kill assays. The in-vivo efficacy of amoxycillin, amoxycillin-clavulanate and cefotaxime against both isolates was tested in a murine pneumonia model using immunocompetent C57BL/6 mice. Ec571 (a TEM-1/2 producer) was resistant to amoxycillin, whereas Ec985 (a TEM-1/2 non-producer) was susceptible. Amoxycillin, amoxycillin-clavulanate and cefotaxime were bactericidal for Ec985, and amoxycillin-clavulanate and cefotaxime were bactericidal for Ec571 at different concentrations and time-points, as determined using time-kill assays. Treatment with amoxycillin, amoxycillin-clavulanate and cefotaxime reduced the bacterial lung concentration of Ec985 compared with non-treated controls (p <0.05), whereas amoxycillin-clavulanate and cefotaxime showed efficacy against Ec571 when compared with the control and amoxycillin groups (p <0.05). Regardless of the exact underlying mechanism(s) of resistance, amoxycillin-clavulanate was effective in the experimental murine model in the treatment of pneumonia caused by AmpC-non-hyperproducing strains of E. coli resistant to cefoxitin.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamase Inhibitors; beta-Lactamases; Cefotaxime; Cefoxitin; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Female; Lung; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Pneumonia, Bacterial; Specific Pathogen-Free Organisms

This work identifies an ISCR1-related bla(CTX-M-14) gene, which has never been reported before, from a clinical isolate of Escherichia coli. The bla(CTX-M-14) gene was preceded by an ISCR1 element that was followed by a class 1 integron containing three different insert gene cassettes, i.e., dfrA12, orfF, and aadA2.

Topics: Adult; Anti-Bacterial Agents; Base Sequence; beta-Lactamases; DNA Transposable Elements; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Integrons; Male; Microbial Sensitivity Tests; Molecular Sequence Data; Pneumonia, Bacterial; Sequence Analysis, DNA

A cohort of 1,391 patients with community-acquired pneumonia of unknown etiology, atypical pneumonia, Legionella pneumophila pneumonia, viral pneumonia, or pneumococcal pneumonia was studied according to a standard protocol to analyse whether the addition of a macrolide to beta-lactam empirical treatment decreases mortality rates. Patients admitted to the intensive care unit were excluded. Severity was assessed using the PORT score. An etiological diagnosis was achieved in 498 (35.8%) patients (292 infections due to Streptococcus pneumoniae). Treatment was chosen by the attending physician according to his/her own criteria: beta-lactam agent in 270 and beta-lactam agent plus a macrolide in 918 cases. The mortality rate was 13.3% in the group treated with a beta-lactam agent alone and 6.9% in the group treated with a beta-lactam agent plus a macrolide (p=0.001). The percentage of PORT-group V patients was 32.6% in the group treated with a beta-lactam agent alone compared to 25.7% in the group who received a beta-lactam agent plus a macrolide (p=0.02). After controlling for PORT score, the odds of fatal outcome was two times higher in patients treated with a beta-lactam agent alone than in those treated with a beta-lactam agent plus a macrolide (adjusted OR = 2, 95%CI 1.24-3.23). The results suggest that the addition of a macrolide to an initial beta-lactam-based antibiotic regimen is associated with lower mortality in patients with community-acquired pneumonia, independent of severity of infection, thus supporting the recommendation of a beta-lactam-agent plus a macrolide as empirical therapy.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Azithromycin; Cefotaxime; Ceftriaxone; Clarithromycin; Community-Acquired Infections; Drug Therapy, Combination; Erythromycin; Humans; Pneumonia, Bacterial

Topics: Anti-Bacterial Agents; Cefotaxime; Community-Acquired Infections; Drug Therapy, Combination; Humans; Ofloxacin; Pneumonia, Bacterial; Randomized Controlled Trials as Topic

The aim of the current investigation was to evaluate practical impact of modern NCCLS recommendations for the selection of 2nd and 3rd generation cephalosporins in Moscow teaching multi profile hospital. The sensitivity of clinically significant 96 strains from patients with pyelonephritis and 180 strains from patients with lower respiratory tract infections (pneumonia, COPD) was compared for cefuroxime and cefotaxime or ceftriaxone according NCCLS recommendations during 2000-2001 years. At the lower respiratory tract infection total sensitivity of all pathogens was 70.6% and 72.8%, at the pyelonephritis 71.9% and 76.0% for 2nd and 3rd generations respectively. The differences between cephalosporins were not statistically significant. Based on the application of modern NCCLS recommendations in the routine microbiological practice similar clinical efficacy of 2nd and 3rd generations cephalosporin in lower respiratory tract infections and pyelonephritis could be predicted.

Topics: Anti-Bacterial Agents; Bronchitis; Cefotaxime; Ceftriaxone; Cefuroxime; Gram-Negative Bacteria; Hospitals, General; Hospitals, Teaching; Humans; Microbial Sensitivity Tests; Moscow; Pneumonia, Bacterial; Practice Guidelines as Topic; Pyelonephritis; Staphylococcus aureus

Endophthalmitis subsequent to Klebsiella sepsis leads to functional blindness in most cases and is very difficult to treat. Every successful therapeutic modality can therefore help in creating an optimal therapeutic plan.. A 69-year old diabetic patient exhibited bilateral Klebsiella endophthalmitis with sepsis after a pneumonia. Two intravenous antibiotics were used: aminoglycosides (Gentamycin) and cephalosporins (Cefotaxim or Cefuroxim) with local parabulbar injections of Prednisolon. The long-term follow-up of four years provided some overview of morphological aspects of the development of endophthalmitis. Characteristic greyish hypopyon was seen in both eyes, which was more pronounced in the left eye than in the right. The left eye became phthisic. After resorption of the hypopyon in the right eye and prolonged resorption of the subretinal abscess for 9 months a useful visual acuity at 0.2 was achieved. Two years after the endophthalmitis a cataract surgery with implantation of a posterior chamber silicon lens was performed and good visual acuity (0.6) was achieved. After four years, the subretinal abscess left an extremely large, sharp bordered, unpigmented scar up to the sclera.. An early diagnosis and adequate long-time antibiotic therapy under the co-operative supervision of an ophthalmologist with internist appears to be most important for the therapeutic success in Klebsiella endophthalmitis.

Topics: Abscess; Aged; Cefotaxime; Cefuroxime; Drug Therapy, Combination; Endophthalmitis; Follow-Up Studies; Gentamicins; Humans; Klebsiella Infections; Lenses, Intraocular; Long-Term Care; Male; Ophthalmoscopy; Pneumonia, Bacterial; Prednisolone; Retinal Diseases; Sepsis

Topics: Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Citrobacter koseri; Enterobacteriaceae Infections; Gentamicins; Humans; Infant, Newborn; Lung Abscess; Male; Meningitis, Bacterial; Pneumonia, Bacterial

To compare the efficacy of gentamicin, nebulised via the endotracheal tube (ET), with that of parenteral cefotaxime or parenteral cefuroxime in preventing the formation of ET biofilm.. General intensive care units in two university teaching hospitals.. The microbiology of ET biofilm from 36 ICU patients eligible to receive antibiotic prophylaxis was examined. Peak and trough tracheal concentrations of gentamicin, cefotaxime or cefuroxime were measured in each patient group, on the 2nd day of intubation.. Twelve patients received gentamicin (80 mg) nebulised in 4 ml normal saline every 8 h, 12 cefotaxime (1 g, 12 hourly) and 12 cefuroxime (750 mg, 8 hourly). Prophylaxis was continued for the duration of intubation.. Samples of tracheal secretions were taken on the 2nd day of ventilation for determination of antibiotic concentrations. Following extubation, ETs were examined for the presence of biofilm. Pathogens considered to be common aetiological agents for VAP included Staphylococcus aureus, enterococci, Enterobacteriaceae and pseudomonads. While microbial biofilm was found on all ETs from the cephalosporin group, microbial biofilm of these micro-organisms was found on 7 of the 12 ET tubes from patients receiving cefotaxime [ S. aureus (4), pseudomonads (1), Enterobacteriaceae (1), enterococcus (1)] and 8 of the 12 ET tubes from patients receiving cefuroxime [Enterobacteriaceae (6), P. aeruginosa (1) and enterococcus (1)]. While microbial biofilm was observed on five ETs from patients receiving nebulised gentamicin, none of these were from pathogens for ventilator-associated pneumonia (VAP). Tracheal concentrations of both cephalosporins were lower than those needed to inhibit the growth of pathogens recovered from ET tube biofilm. The median (and range) concentrations for cefotaxime were 0.90 (<0.23-1.31) mg/l and 0.28 (<0.23-0.58) mg/l for 2 h post-dose and trough samples, respectively. Two hours post-dose concentrations of cefuroxime (median and range) were 0.40 (0.34-0.83) mg/l, with trough concentrations of 0.35 (<0.22-0.47) mg/l. Tracheal concentrations (median and range) of gentamicin measured 1 h post-nebulisation were 790 (352-->1250) mg/l and then, before the next dose, were 436 (250-1000) mg/l.. Nebulised gentamicin attained high concentrations in the ET lumen and was more effective in preventing the formation of biofilm than either parenterally administered cephalosporin and therefore may be effective in preventing this complication of mechanical ventilation.

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Biofilms; Cefotaxime; Cefuroxime; Cephalosporins; Cross Infection; Female; Gentamicins; Humans; Infusions, Parenteral; Intubation, Intratracheal; Male; Middle Aged; Pneumonia, Bacterial; Statistics, Nonparametric

Evaluate the influence of the anti-anaerobic antimicrobial therapy in the outcome of patients with nosocomial pneumonia.. The population study included 53 intensive care unit patients with nosocomial pneumonia in whom, using a protected specimen brush, anaerobic bacteria were isolated, which were associated or not with aerobes. Current and empirical antibiotherapies were retrospectively analyzed, regarding their efficacy against anaerobic bacteria. Since it was debated, sensitivity to cefotaxime, ceftazidime, and ciprofloxacin was determined in 38 strains of Prevotella species. Outcome was evaluated 10 days after the day of protected specimen brushes. Improvement was defined as a decrease of Murray score or ventilator weaning.. The most frequently isolated bacteria were Prevotella species, which were more frequently resistant to cefotaxime (37%), ceftazidime (50%), and ciprofloxacine (32%) than usually reported in the literature. Sixty-six percent of these strains produced beta-lactamase. The effect of empirical anti-anaerobic antibiotherapy on the outcome at day 10 was evaluable in 39 patients. Twenty-nine patients were improved and 10 patients worsened. Interestingly, patients who had received well-adapted antibiotics against anaerobes had a better outcome after 10 days (P < .02).. This study suggests that specific antianaerobic therapy may be considered in the choice of empirical antibiotherapy in patients with nosocomial pneumonia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Bacteria, Anaerobic; Cefotaxime; Ceftazidime; Cephalosporins; Ciprofloxacin; Cross Infection; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Prevotella; Retrospective Studies; Treatment Outcome

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

Recent studies indicate clinical value of intra-venous to oral switch therapy. The aim of this study was to analyze our results i.v. Cefotaxime to oral Cefetamet Piroxil switch therapy in lower respiratory tract infections. Group consists 35 patients in whom 27 has bacterial pathogen definitely established. Cefotaxim (Tarcefoksym-Polfa) i.v. has been used for 3-4 days followed with oral Cefetamet Pivoxil (Tarcevis-Polfa). Patients has been treated for 7 days in hospital and then as an out-patients afterwards. Excelent result has been observed in 27 cases (77% of the study group). Mild symptoms of medication intolerance has been observed in 8 patients (23% of all patients). Results of our experience with third generation cefalosporin i.v. to oral switch therapy are satisfactory. This method reduced total cost of treatment, reduced in-hospital days and was very well accepted by patients.

Topics: Adult; Bacterial Infections; Cefotaxime; Cephalosporins; Community-Acquired Infections; Humans; Pneumonia, Bacterial

Pasteurella multocida is a major pathogen in local wound infections due to animal bites. Pneumonia and bacteremia are less frequent and usually associated with local or general impairment of host defenses. Scarce reports exist about Pasteurella multocida infections in HIV infected patients. We report here a case of hypoxemic pneumonia and bacteremia due to Pasteurella multocida revealing an HIV infection in a young man.

Topics: Adult; Amoxicillin; Animals; Anti-Infective Agents; Bacteremia; Bites and Stings; Cats; Cefotaxime; Cephalosporins; HIV Infections; HIV Seropositivity; Humans; Male; Pasteurella Infections; Pasteurella multocida; Pefloxacin; Penicillins; Pneumonia, Bacterial; Time Factors

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: Adult; Cefotaxime; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Cost-Benefit Analysis; Humans; Pneumonia, Bacterial; Treatment Outcome

We developed an experimental model of pneumonia to evaluate the efficacy of new antibiotic regimens against Enterobacter cloacae. Rats were infected by administering 8.5 log10 cfu E. cloacae intratracheally, and therapy was initiated 24 h later. At that time, animals' lungs showed bilateral pneumonia containing more than 7 log10 cfu/g of tissue. Because rats eliminate amikacin and cefepime much more rapidly than humans, renal impairment was induced in all animals to simulate the pharmacokinetic parameters in humans. Using this model, we compared the bactericidal activities of cefepime and amikacin alone or in combination against the same cefotaxime-susceptible E. cloacae strain. The MICs of cefepime and amikacin for this strain were 0.5 and 2 mg/L, respectively. In-vitro killing studies showed that antibiotic combinations were synergic only at intermediate concentrations. At peak concentrations, the combination was only as effective as amikacin alone. At trough concentrations, a non-significant trend towards the superiority of the combination over cefepime alone was found. In-vivo studies showed that each antibiotic alone failed to decrease bacterial counts in the lungs except at 6 h, whereas the combination of both antibiotics induced a significant decrease in the lung bacterial count 6, 12 and 24 h after the onset of therapy when compared with tissue bacterial numbers in untreated animals or animals treated with either antibiotic alone. In-vivo synergy between cefepime and amikacin was observed at the three time points studied. No resistant clones emerged during treatment with any of the antibiotic regimens studied.

Topics: Amikacin; Animals; Anti-Bacterial Agents; Cefepime; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Drug Synergism; Enterobacter cloacae; Enterobacteriaceae Infections; Kidney; Male; Microbial Sensitivity Tests; Pneumonia, Bacterial; Rats; Rats, Wistar

Topics: Abscess; Bacteremia; beta-Lactam Resistance; beta-Lactamases; Cefepime; Cefotaxime; Ceftazidime; Cephalosporin Resistance; Cephalosporins; Drug Resistance, Microbial; Enterobacter; Enterobacteriaceae Infections; Humans; Mutation; Pneumonia, Bacterial

The in vivo efficacies of piperacillin, piperacillin plus tazobactam, ticarcillin, ticarcillin plus clavulanic acid, piperacillin plus clavulanic acid, and cefotaxime were compared in a mouse model of pneumonia induced by the SHV-1 beta-lactamase-producer Klebsiella pneumoniae. Each antibiotic was injected either once intraperitoneally at 24 h postinfection or at repeated times during 24 h. The efficacies of the drugs and therapeutic protocols were assessed by counting viable bacteria recovered from the lungs of mice sacrificed at selected times. No emergence of beta-lactam-resistant organisms was detected. Ticarcillin at 300 mg/kg was ineffective. Repeated injections of piperacillin at 300 mg/kg, either alone or in combination with tazobactam (8:1), led to a significant decrease in bacterial counts, but this was followed by bacterial regrowth. The pharmacokinetic analysis demonstrated that this short-lasting antibacterial effect was not due to a failure of piperacillin and/or tazobactam to penetrate the lungs. The combinations of ticarcillin at 300 mg/kg plus clavulanic acid (15:1) and piperacillin at 300 mg/kg plus tazobactam (4:1) were proven to be effective in that they decreased the bacterial burden in the lungs from 10(5) to < 10(3) CFU. This dose effect of tazobactam can be explained by its dose-dependent penetration in the lungs. Cefotaxime at 100 mg/kg and the combination of piperacillin (slightly hydrolyzed by SHV-1) at 300 mg/kg plus clavulanic acid (15:1) led to the best efficacy. Both of these treatments induced a decrease in bacterial counts of nearly 4 log10 units. The survival rates correlated with the quantitative measurements of in vivo bacterial killing. These experimental results obtained from the restricted animal model used here may help in the design of further protocols for clinical trials.

Topics: Animals; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Cefotaxime; Cephalosporins; Clavulanic Acid; Clavulanic Acids; Colony Count, Microbial; Drug Combinations; Drug Therapy, Combination; Female; Klebsiella Infections; Klebsiella pneumoniae; Lung; Mice; Microbial Sensitivity Tests; Penicillanic Acid; Penicillins; Piperacillin; Pneumonia, Bacterial; Tazobactam; Ticarcillin