cefotaxime and Pneumonia

Cefodizime has been shown to possess high in vivo antibacterial activity in a variety of experimental infection models involving different body systems and animal species: systemic infections, pneumonia and urinary tract infections in normal mice, intrauterine infections in normal rats, and meningitis in normal rabbits, as well as systemic infections in immunosuppressed animals. Most investigations found that the therapeutic efficacy of cefodizime frequently exceeded the one expected from its in vitro values and in many cases compared favorably with those of other cephems, even when the in vitro susceptibility of the infecting organism to these drugs was markedly higher. These findings have been attributed either to the superior kinetic profile of cefodizime--prolonged serum half-life and excellent tissue penetration with long-lasting levels--or to a synergy between its high bactericidal activity and host defence mechanisms. The parallel consideration of the MIC90 values of cefodizime and the pharmacokinetic profile of this agent in humans indicate that the vast majority of the relevant respiratory and urinary pathogens are covered by once-a-day cefodizime dosage regimens of either 1 or 2 g.

Topics: Animals; Bacterial Infections; Cefotaxime; Mice; Pneumonia; Rabbits; Rats; Urinary Tract Infections

Although there have been a number of studies in adults, to date there has been little research into sequential antimicrobial therapy (SAT) in paediatric populations. The present study evaluates the impact of a SAT protocol for the treatment of severe lower respiratory tract infection in paediatric patients. The study involved 89 paediatric patients (44 control and 45 SAT). The SAT patients had a shorter length of hospital stay (4.0 versus 8.3 days), shorter duration of inpatient antimicrobial therapy (4.0 versus 7.9 days) with the period of iv therapy being reduced from a mean of 5.6 to 1.7 days. The total healthcare costs were reduced by 52%. The resolution of severe lower respiratory tract infection with a short course of iv antimicrobials, followed by conversion to oral therapy yielded clinical outcomes comparable to those achieved using longer term iv therapy. SAT proved to be an important cost-minimizing tool for realizing substantial healthcare costs savings.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bronchitis; Cefixime; Cefotaxime; Child; Child, Preschool; Clinical Protocols; Drug Administration Schedule; Female; Health Care Costs; Humans; Infant; Injections, Intravenous; Length of Stay; Male; Pneumonia; Treatment Outcome

The objective of this multicentre, randomized, prospective and comparative study was to evaluate and compare the efficacy and safety of 1 g intravenous ceftriaxone (active ingredient of Rocephin), 3 g intravenous cefoiaxime (active ingredient of clafron), and 2.25 g intavenous cefuroxime (active ingredient of Zinacef).. In this multicentre, randomized, prospective and comparative study, patients received 1 g of ceftriaxone intravenously once a day (group A), or 1 g of cefotaxime intravenously three times a day (group B), or 0.75 g of cefuroxime intravenously three time a day (group C). 197 patients were enrolled in the study, and in 142 (48 in group A, 46 in group B and 48 in group C) we were able to make an evaluation.. The overall efficacy (bacteriological eradication plus clinical cure or clear improvement) of ceftriaxone, cefotaxime and cefuroxime were 81%, 83%, 79% respectively (P > 0.05). The eradication rate for three groups were 80%, 78%, 75% (P > 0.05). No adverse events occured.. Data obtained in our study indicate that for the majority of patients with lower respiratory tract infections, 1 g ceftriaxone, 3 g cefotaxime and 2.25 g cefuroxime are effective and safe, and 7 days therapy is enough, but the use of 1 g ceftriaxone is more convenient.

Topics: Adolescent; Adult; Aged; Bronchitis; Cefotaxime; Ceftriaxone; Cefuroxime; Cephalosporins; Female; Gram-Negative Bacterial Infections; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia; Prospective Studies

The treatment of bacterial pneumonia commands a large segment of hospital resources, and economic concerns are dictating shorter hospital stays. This study was designed to determine whether outpatient therapy with intravenous (IV) antibiotics (a third-generation cephalosporin, cefotaxime, delivered via an ambulatory delivery system [ADS]) is as effective as traditional hospital management of pneumonia. A subgroup of 62 patients from three centers, with bacterial pneumonia, were enrolled in a multicenter, open-label study of outpatient IV cefotaxime therapy. Doses of cefotaxime were 1 g IV every 12 hours, 1 g IV every 8 hours, or 2 g IV every 8 hours, based on severity of infection. Of 62 patients, 53 (85%) completed the study. All 22 bacteriologically evaluable patients showed eradication of pathogen or clinical cure with no obtainable follow-up culture; no relapses, reinfections, or superinfections were reported. Overall clinical success rate was 94.8% (satisfactory 75.9%; improved 19.0%, n = 58). Average length of hospital stay was 2.3 +/- 4.83 days. In conclusion, clinical success rates with outpatient IV cefotaxime therapy were comparable to previous studies with IV cefotaxime for pneumonia treatment in the hospital. Outpatient IV antibiotic therapy has the potential to significantly reduce length of hospital stay for pneumonia without sacrificing clinical efficacy.

Topics: Adult; Bacterial Infections; Cefotaxime; Female; Home Care Services; Humans; Infusion Pumps; Male; Middle Aged; Pneumonia

Studies have documented the efficacy and safety of antibiotic infusion in the home as a cost-effective alternative to in-hospital infusion. The present analysis focuses on home treatment of pneumonia with cefotaxime delivered via an ambulatory infusion pump and the potential of this therapy to reduce the length of hospital stay. Data presented here and in previously published studies of a variety of serious infections show that admitting patients into home intravenous antibiotic therapy programs can significantly reduce, and sometimes eliminate, hospital stay, while providing efficacy and safety comparable to that expected from hospital treatment. Analysis of hospitalization patterns for pneumonia patients placed on cefotaxime therapy delivered via portable infusion pump revealed that length of stay was only 10% of that for the reference diagnosis-related group. Despite the great potential cost savings, there are reimbursement barriers to the use of home infusion antibiotics. However, healthcare reform may promote greater acceptance, use, and support of home infusion technology.

Topics: Bacterial Infections; Cefotaxime; Cost Savings; Diagnosis-Related Groups; Home Care Services; Humans; Infusion Pumps; Insurance, Health, Reimbursement; Length of Stay; Pneumonia

A multicenter Canadian study enrolled 74 persons to compare low-dose cefotaxime at 1 g every 8 hr to ceftriaxone 1 g every 12 hr in patients with nosocomial pneumonia. Of 57 evaluable patients (30 cefotaxime and 27 ceftriaxone) in this preliminary report, 93% responded to therapy in both groups. Ceftriaxone patients tended to have more side effects (14.2%). This study is continuing to accrue patients to achieve 100 evaluable patients. Interim data, however, support the continued use of low-dose cefotaxime as an appropriate alternative for clinically effective and cost-effective management of nosocomially acquired pneumonia.

Topics: Adult; Aged; Aged, 80 and over; Cefotaxime; Ceftriaxone; Cross Infection; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia

In a European open, multicentre, prospective clinical trial, 100 hospitalized adult patients (61 males; 18-91 years old (mean age 62] with bacterial pneumonia, diagnosed clinically and radiographically, were randomized to receive either oral temafloxacin 600 mg twice daily (n = 49) or intravenous cefotaxime 2 g thrice daily (n = 51). Signs, symptoms and chest radiographs were assessed during, at the end of therapy and at follow-up eight to ten days after the last dose. Patients were treated for a maximum of ten days. Sputum was obtained for culture before, during and after therapy. The clinical cure rate for the temafloxacin treatment group was 90%, the bacteriological cure rate was 91% and the radiological response rate was 95%. The respective rates for the cefotaxime-treated group were 92%, 96% and 100%. There were no significant differences between the treatment groups for clinical or microbiological outcome, premature study discontinuation, or adverse events. Oral temafloxacin was clinically and bacteriologically equivalent to intravenous cefotaxime in the treatment of hospitalized adults with bacterial pneumonia.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Infective Agents; Cefotaxime; Female; Fluoroquinolones; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia; Quinolones

In a multicentre clinical trial involving 32 hospitals, 588 adult patients diagnosed with nosocomial pneumonia and not receiving mechanical ventilation were treated randomly with monotherapy with cefotaxime or the antibiotic combination routinely used in each particular hospital. Both groups of patients were similar regarding demographic data, concurrent diseases, additional therapies and causative organism. Protocol violations were recorded in 40 patients, and these patients were excluded from the evaluation of treatment efficacy. The cure rate was 79% in the cefotaxime group and 71% in the group receiving antibiotic combinations; this difference is statistically significant (p = 0.03, Fisher's two-tailed test). In the patients receiving combinations of cephalosporins having activity predominantly against gram-positive organisms plus aminoglycosides, the cure rate obtained was very low. The frequency of serious adverse reactions was significantly higher in the group treated with antibiotic combinations. It is concluded that monotherapy with cefotaxime is the regimen that offers better results for the empirical treatment of nosocomial pneumonia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefotaxime; Cross Infection; Drug Administration Schedule; Drug Therapy, Combination; Humans; Middle Aged; Pneumonia; Prospective Studies

In a prospective randomised study, the effects of two different colonisation prophylaxis techniques on colonisation and pulmonary infection were investigated in 40 critically ill patients with long-term ventilatory support (greater than or equal to 4 days). 20 patients were selectively decontaminated with 4 x 100 g polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and with an antimicrobial sticky paste in the oropharynx (group I). 20 patients received 50 mg of polymyxin B and 80 mg of gentamicin dissolved in 10 ml of 0.9% saline at 6 h intervals into nose, oropharynx and stomach as well as 300 mg of amphotericin B in the oropharynx only (group II). All patients received cefotaxime systemically in the first 3 days. In group I gram-negative aerobic bacteria in the pharynx decreased from 35% to 0%, in group II from 40% to 10% and in the rectum from 80% to 61% (10% in the second week) in Group I and from 100% to 73% (33% in the second week) in group II. The decrease in gram-negative microorganisms was accompanied by an increase in the frequency of Staphylococcus epidermidis. In group I, two patients developed pneumonia and two patients urinary tract infections, in group II two patients suffered from pneumonia and 3 patients urinary tract infections. Both regimes are effective methods of prophylaxis for lowering colonisation with gram-negative aerobic bacteria and the frequency of pneumonia in patients requiring long-term mechanical ventilation. A possible selection of gram-positive bacteria must be appropriately monitored.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Colistin; Critical Care; Female; Gentamicins; Humans; Male; Middle Aged; Pneumonia; Polymyxin B; Prospective Studies; Respiration, Artificial; Time Factors; Tobramycin

In a prospective, open clinical trial 21 patients suffering from lower respiratory tract infections were treated with the new oral cephalosporin cefixime. The antibiotic was given at a dosage of 200 mg b. i. d. for seven to eleven days. Seventeen of 18 evaluable patients were cured or distinctly improved at the end of therapy as well as two days after the end of treatment. Clinical results correlated well with the results of the lung function tests, especially with the significant decrease of resistance. At the end of therapy all initially isolated pathogens were eradicated. The tolerability of cefixime was good, only in two patients treated mild and transient side effects were noticed (1 x diarrhea, 1 x epigastric pain).

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Bronchitis; Bronchopneumonia; Cefixime; Cefotaxime; Citrobacter; Drug Resistance, Microbial; Drug Tolerance; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Haemophilus Infections; Humans; Male; Middle Aged; Pneumonia; Pneumonia, Pneumococcal; Prospective Studies; Proteus Infections

The combination aztreonam + cefotaxime (AZ + CE) was compared to amikacin + cefotaxime (AM + CE) in the treatment of nosocomial pneumonia acquired at the intensive-care unit. This study included a total of 33 patients fulfilling criteria for nosocomial pneumonia. 16 of them were randomly allocated to the AZ + CE group and 17 to the AM + CE group. The empirical treatment was effective for 78% of AZ + CE cases and 92% of AM + CE cases (p = NS). Clinical care was observed in 77% of cases (10 out of 13 evaluable) in the AZ group and in 75% of the group treated with AM (12 cases out of 16 evaluable; p = NS). In the evaluable cases, treatment failure was associated with injections due to the following organisms: Acinetobacter calcoaceticus (1) and Pseudomonas aeruginosa (1) in the AZ group and A. calcoaceticus (1) in the AM group. Superinfections were observed only in the AM group P. aeruginosa. A. calcoaceticus, Streptococcus viridans, Candida albicans, Aspergillus fumigatus and Serratia marcescens. Both the peak and through serum concentrations of AZ and AM were maintained within normal ranges. Finally, an impairment of renal tubular function was observed in the group of patients treated with AM, as measured by urinary levels of N-acetyl-beta-D-glucosaminidase and leucine aminopeptidase sequentially during the treatment. These changes in renal functions alterations mentioned were not observed in the AZ group. It is concluded that the AZ + CE combination is an effective empirical and active antibiotic treatment against severe nosocomial pneumonia. Aztreonam has no renal toxicity, which is an advantage to take into account in patients with altered renal function.

Topics: Adult; Aged; Amikacin; Aztreonam; Cefotaxime; Clinical Trials as Topic; Cross Infection; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia; Random Allocation

Clinical usefulness of cefixime (CFIX), a new oral cephalosporin antibiotic, in pediatric field was investigated. The results obtained were summarized as follows. 1. The clinical efficacy of CFIX was investigated in a total of 138 children including 49 with upper respiratory tract infections (RTI), 22 with acute bronchitis, 18 with pneumonia, 19 with scarlet fever and 21 with urinary tract infections (UTI). 2. Clinical effectiveness was excellent in 58, good in 60, fair in 14 and poor in 3, with an overall efficacy rate of 87.4%. The efficacy rate classified according to types of infection were 85.7% in upper RTI, 89.5% in acute bronchitis, 94.4% in pneumonia, 78.9% in scarlet fever, and 90.5% in UTI. 3. Out of the suspected causative organisms, 43 strains of a total of 50 strains isolated were eradicated. The bacteriological eradication rate was 86.0%. (Haemophilus influenzae 100%, Haemophilus parainfluenzae 100%, Streptococcus pyogenes 88.5%, Escherichia coli 85.7%). 4. One hundred forty four children were analyzed for side effect. Side effects were observed in 2 children (1.4%) with diarrhea in 1 and anorexia in another. Abnormal laboratory test results were recorded in 4 children (3.3%). The above results suggest that CFIX is a very useful new oral cephalosporin for the treatment of bacterial infections in children.

Topics: Adolescent; Bacterial Infections; Bronchitis; Cefixime; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male; Multicenter Studies as Topic; Pneumonia; Respiratory Tract Infections; Urinary Tract Infections

One hundred and fourteen hospitalized patients with moderate or severe infections were assigned at random, in four medical centers, to receive either ceftizoxime or cefotaxime, administered intravenously in a dosage of 1 to 2 g every 8 h. Of 96 patients evaluable for efficacy, 24 (25%) had bacteremia, 46 (48%) had urinary tract infections and 9 (9%) had pneumonias. Half the patients had been treated ineffectively by other antibiotics prior to the study drug treatment. The overall clinical efficacy was 90% in both treatment groups and 83% in both groups with bacteremia. All patients with urinary tract infection were cured by both agents. Bacteriological eradication rate was 95% in both groups. Adverse reactions, though mild, were more frequent in the cefotaxime group (13.5%) than in the ceftizoxime group (6.8%); superinfection rate was higher in the ceftizoxime group. Both antibiotics were highly and equally efficacious in the therapy of severe infections in hospitalized patients.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Escherichia coli; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Prospective Studies; Random Allocation; Sepsis; Urinary Tract Infections

In a randomized controlled, clinical study the efficacy of ceftazidime at a dosage of 2 g b. i. d. was compared to that of cefotaxime at a dosage of 2 g t. i. d. or more in the treatment of pneumonia or peritonitis in intensive care patients. 61 of 67 assessable cases were evaluable. In the ceftazidime group ten out of 11 patients with pneumonia and 17 out of 20 with peritonitis showed a clinical success. In the cefotaxime group 15 out of 19 patients with pneumonia and eight out of 11 with peritonitis were clinically cured or improved. With ceftazidime an overall success was achieved in 87% of the patients (27 out of 31) and with cefotaxime in 77% of the patients (23 out of 30). Two patients in the cefotaxime group developed a reinfection. Five of the patients treated with cefotaxime and four of those treated with ceftazidime were therapeutical failures. Escherichia coli, Pseudomonas, Klebsiella, Enterobacter and Proteus species as well as Staphylococcus aureus and enterococci were the most frequent organisms isolated prior to therapy. Following ceftazidime therapy 30 of the 32 gram-negative species were eliminated, whereas in the cefotaxime group the number of gram-negative species isolated was reduced from 28 to ten. Gram-positive species isolated in ten cases prior to therapy, were still present in seven cases after ceftazidime therapy and the number of gram-positive organisms was reduced from 19 to ten following treatment with cefotaxime. In one patient therapy with ceftazidime was stopped due to urticaria. Reversible leukopenia was observed in a patient treated with ceftazidime and a cholestatic reaction in a patient treated with cefotaxime. In both groups a slight elevation of transaminases was seen.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftazidime; Clinical Trials as Topic; Critical Care; Humans; Opportunistic Infections; Peritonitis; Pneumonia; Random Allocation

Cefixime, a new third generation oral cephalosporin antibiotic, was evaluated for safety and efficacy in the treatment of 206 children with acute bacterial pharyngitis, cystitis or pneumonia. Each patient had a throat, urine or sputum culture before therapy and was treated with a 10- to 14-day course of cefixime, 8 mg/kg once daily. Bacterial pathogens were isolated in 167 of 206 (81.1%). Streptococcus pyogenes (73.7% of isolates) and Escherichia coli (9.6%) were the most common Gram-positive and Gram-negative organisms, respectively. All patients were evaluable for safety, and 109 (52.9%) with pharyngitis (96) or cystitis (13) were evaluable for efficacy. Clinical failure occurred in 2 of 109 (1.8%) patients, both with pharyngitis; bacteriologic failure occurred in 1 patient with pharyngitis and 1 with cystitis. Five patients with pneumonia caused by possible pathogens also improved while taking cefixime. Drug-related adverse side effects occurred in 50 of 206 patients (24.3%); these were generally mild and led to discontinuing the antibiotic in only 4 patients (1.9%). The most common were diarrhea or loose stools (33 of 206, or 16%). Results of this study suggest that cefixime given once daily to children is safe and effective in the treatment of streptococcal pharyngitis and bacterial cystitis.

Topics: Adolescent; Cefixime; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Cystitis; Diarrhea; Female; Humans; Infant; Male; Pharyngitis; Pneumonia

Patients enrolled in two double-blind multicenter studies were evaluated for the development of hypoprothrombinemia during treatment with cephalosporins. Patients with pneumonia or peritonitis received ceftizoxime, cefotaxime, or moxalactam. The incidence of hypoprothrombinemia was greater in patients with peritonitis (12 of 49) than in those with pneumonia (5 of 96; P less than 0.05). Overall, moxalactam was associated with a higher incidence of hypoprothrombinemia (13 of 52) than either ceftizoxime (1 of 43; P less than 0.05) or cefotaxime (3 of 50; P less than 0.05), and moxalactam patients incurred the highest average increase in prothrombin time (3.7 s) as compared with either ceftizoxime (0.5 s; P less than 0.05) or cefotaxime (0.9 s; P less than 0.05) patients. The occurrence of hypoprothrombinemia in moxalactam patients with peritonitis was not related to dosage, duration of therapy, age, sex, race, or renal or hepatic function. The degree of ileus was, however, strongly related to the development of coagulopathy in moxalactam-treated patients only.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cefotaxime; Ceftizoxime; Cephalosporins; Double-Blind Method; Female; Humans; Hypoprothrombinemias; Male; Middle Aged; Moxalactam; Peritonitis; Pneumonia; Prothrombin Time; Random Allocation

One hundred and thirty-five patients with bacterial pneumonia who had risk factors (alcoholism, chronic obstructive pulmonary disease, corticosteroid therapy diabetes mellitus, advanced age, solid tumours) were randomly allocated in a double-blind fashion to receive either ceftizoxime (2-4 g every 8 h), cefotaxime (1-2 g every 4 h), or latamoxef (2-4 g every 8 h). Of the 84 patients evaluable for efficacy, clinical cure was achieved in 91%, 85%, and 89% of ceftizoxime- (20/22), cefotaxime-(23/27), and latamoxef-treated (31/35) patients, respectively. Adverse reactions occurred in one of 45 ceftizoxime-treated patients, one of 43 cefotaxime-treated patients, and seven of 47 latamoxef-treated patients. Abnormal laboratory values during therapy were seen in 50% of latamoxef-treated and 43% of cefotaxime-treated patients and in 29% of ceftizoxime-treated patients. Hypoprothrombinaemia occurred in five latamoxef-treated patients and one of these patients experienced an episode of haematemesis. In this study, ceftizoxime, cefotaxime, and latamoxef were similarly effective; however, the incidence of side effects was most frequent with latamoxef.

Topics: Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Moxalactam; Pneumonia; Random Allocation; Risk

In this report, we summarize 929 surgical cases (812 evaluable) receiving preoperatively prophylaxis with either cefoperazone (1 g), or cefotaxime (1 g). The patients were randomized to one of the two single-dose cephalosporin regimens and by operative procedure groups that included hysterectomies, genitourinary procedures, gastrointestinal operations, and the "other procedures" category that was dominated by orthopedic cases, such as total joint replacements and open fracture reductions. The postoperative wound infectious morbidity rates were: cefoperazone 2.2% and cefotaxime 3.0% (overall rate, 2.6%). Most wound infections were superficial, with more than half discovered after patient discharge and unrelated to the surgical prophylaxis. The wound infections associated with colorectal surgery cases given a single-dose of cefoperazone were twofold higher than the control regimen. Non-wound infectious morbidity was 5.8% (p greater than 0.05) for cefoperazone, mostly urinary tract infections causes by Escherichia coli, Streptococcus faecalis, and Staphylococcus spp. Side effects were not considered severe and occurred at a very low rate. Abnormally elevated prothrombin times of patients receiving cefoperazone were not any more frequent than the control regimens. The two prophylaxis regimens were not different statistically (p greater than 0.05) as to the infectious morbidity or adverse reactions. By using either studied single-dose schedule in our prepaid group practice setting, compared with the previously used multi-dose schedules, we could predict an annualized cost savings of $50,000 (cefazolin) and greater than $200,000 (cefoxitin). We propose a single 1-g dose of cefoperazone or cefotaxime (FDA approved) as a cost-effective prophylaxis alternative.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoperazone; Cefotaxime; Costs and Cost Analysis; Female; Health Maintenance Organizations; Humans; Male; Middle Aged; Pneumonia; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection; Urinary Tract Infections

We have attempted to clinically define the therapeutic usefulness of ceftizoxime suppository (CZX-S) in children with bacterial pneumonia, in a randomized trial. Intravenous injection of ceftizoxime (CZX) was used as the control. The results are summarized below. Subjects were inpatients with bacterial pneumonia, ranging in age from 9 months to 7 years and 10 months. As a rule, the daily dose was either four 250 mg (in potency) suppositories given at 6-hour intervals or 60 mg/kg body weight intravenous CZX (control) given in 4 injections at 6-hour intervals over a period of 7 days. The number of children in the study was 67. These children were divided into 2 dosage groups (suppository, 35; injection, 32) with matching pretreatment background factors. The severity of the target disease in the majority of the children was "moderate". The rate of therapeutic effectiveness was 97.1% for the suppository and 93.8% for the injection, and did not differ significantly between the 2 groups. Rates of efficacy by severity, presence or absence of underlying diseases, daily dose and/or complications were high without exception, and did not differ significantly between the 2 groups. Eradication rates for causative microorganisms, as studied in 16 children of each group, were both 93.8%. The 2 most frequently isolated causative organisms were Haemophilus influenzae and Streptococcus pneumoniae. Side effects were examined for 36 children of each group. The frequency of side effects did not differ significantly between the suppository group (2 with diarrhea and 1 with abdominal pain) and the injection group (1 with urticaria), and 8.3% and 2.8%, respectively. The frequency of abnormal laboratory test findings differed significantly (P less than 0.01) with respect to eosinophilia which occurred in 7 (20.6%) of the injected subjects but was not encountered in the subjects treated with suppositories. Other abnormal laboratory findings included thrombocytosis in 3 (14.3%) of the injection group and increased GOT in 1 (3.2%) of the suppository group. The suppository formulation of CZX appears to be a highly useful substitute for the injectable form, and should find a special use in children whose treatment with injections experiences some difficulty.

Topics: Abdomen; Acute Disease; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Humans; Infant; Injections, Intravenous; Pain; Pneumonia; Suppositories; Urticaria

Topics: Cefotaxime; Cephamycins; Chronic Disease; Clinical Trials as Topic; Humans; Lung Abscess; Pneumonia; Respiratory Tract Infections

A single-blind, prospective, randomized comparison of cefotaxime and cefazolin was conducted in 356 patients with gram-positive pneumonias. Clinical cure was achieved in 95.9% of patients receiving cefotaxime and 94% of patients receiving cefazolin. In a sub-group of patients with Staphylococcus aureus pneumonia, clinical cure was obtained in 31 of 37 patients treated with cefotaxime and all of six patients treated with cefazolin. Cefotaxime was well tolerated, safe, and efficacious. These data support the use of cefotaxime as an initial single antibiotic in treating patients with gram-positive pneumonias due to susceptible organisms.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Female; Gram-Positive Bacteria; Humans; Male; Middle Aged; Pneumonia

In 512 patients undergoing major cardiovascular surgery, this prospective, randomized study compared the effectiveness of perioperative prophylaxis with either ceftriaxone or cefuroxime. In the ceftriaxone group, 254 patients received a single 2 g dose given intravenously at the start of anesthesia followed by a 1 g dose 24 hours later. In the cefuroxime group, 258 patients received 1.5 g at the start of anesthesia, followed by 1.5 g given intravenously every 12 hours for 2 days postoperatively. Postoperative infectious complications developed in only 12 patients in each group (4.7 percent). In 53 patients the mean serum concentration of ceftriaxone 24 hours after administration of the 2 g dose was 37.4 micrograms/ml, a level far in excess of the minimal inhibitory concentrations of usual cardiovascular pathogens with the exception of Bacteroides species and Pseudomonas species. We conclude that a single 2 g dose of ceftriaxone given at the time of cardiovascular surgery should provide adequate prophylaxis.

Topics: Bacterial Infections; Cardiac Surgical Procedures; Cefotaxime; Ceftriaxone; Cefuroxime; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Male; Pneumonia; Postoperative Complications; Random Allocation; Sepsis; Surgical Wound Infection; Time Factors; Urinary Tract Infections; Vascular Surgical Procedures

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

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Cellulitis; Clinical Trials as Topic; Humans; Osteomyelitis; Pneumonia

Nephrotoxicity frequently complicates the use of aminoglycosides in severely compromised acute care patients. Therefore, an open clinical trial was initiated to determine if cefmenoxime alone is useful in serious nosocomial pneumonias. Thirty consecutive patients were entered in the trial, and 28 patients with an average age of 66 years were evaluable. Most were malnourished at entry, with serum albumin averaging 2.8 g/dl and prognostic nutritional index values over 70 percent (normal less than 40 percent). One-half the patients had severe chronic obstructive pulmonary disease and 68 percent required ventilators. Fifty-seven percent had concomitant cardiac disease, and 79 percent had previously been treated with antibiotics. Pneumonia was proven to be present by new infiltrate on chest x-ray, new fever, elevated white blood cell count, and gram-negative rods on gram stain and in cultures of tracheal aspirates or sputum. Patients were given cefmenoxime 1 to 2 g every six hours an average of 12 days. Cefmenoxime peak (one hour) and trough concentrations were measured by high pressure liquid chromatography and averaged 58 and 7 micrograms ml, respectively. Pharmacokinetic data in 18 patients were determined from serum profiles. Gram-positive organisms, Escherichia coli, Klebsiella, and Hemophilus influenzae were usually eradicated. Persistence was noted for some Enterobacter, Pseudomonas, Serratia, and Acinetobacter. Persistence in patients with good clinical response was considered colonization rather than superinfection. Overall, a satisfactory clinical response rate was noted in 78.6 percent of evaluable patients, whereas four patients responded satisfactorily with recurrence and two treatments had an unsatisfactory response. No serious adverse effects were observed. Cefmenoxime is a promising agent in the treatment of susceptible pneumonias in critical care patients.

Topics: Aged; Bacteria; Blood Proteins; Cefmenoxime; Cefotaxime; Chromatography, High Pressure Liquid; Clinical Trials as Topic; Critical Care; Cross Infection; Female; Humans; Kinetics; Lung; Male; Middle Aged; Pneumonia; Protein Binding; Radiography; Recurrence

The effect of protein binding on cefmenoxime steady-state kinetics was studied in 20 critical patients with gram-negative pneumonia. Sixteen patients were given 1 gm cefmenoxime every 6 hr, two received 2 gm every 6 hr, and two received 2 gm every 8 hr. Serum protein binding was measured by equilibrium dialysis. Assays were by HPLC. Serum cefmenoxime concentration-time data were characterized by a model-independent method based on statistical moment theory. Despite varying renal function in patients, mean cefmenoxime serum concentration-time curves for all three dosing regimens were closely aligned, reflecting successful empiric dosage adjustment. Terminal phase t 1/2 ranged from 0.8 to 2.9 hr and was significantly related to creatinine clearance. Cefmenoxime total clearance was significantly related to both lambda z (2.303 times the slope of the terminal portion of the log-concentration-time curve) and creatinine clearance (CCr). Plasma clearance of free cefmenoxime was more strongly correlated with CCr than the clearance of total cefmenoxime. Drug recovery from 24-hr urine collections at steady state was 76.9 +/- 19.8% of the daily dose (mean +/- SD, n = 13). Cefmenoxime protein binding in patients differed markedly from normal values. A regression equation derived from data on 11 cephalosporins appeared to predict total volume of distribution in the steady state (Vdss-Total) from the fraction of unbound drug accurately. Since cefmenoxime has a high therapeutic index, no clinical consequences are expected to result from variation in protein binding. Observed differences in protein binding between patients and normal subjects could have clinical consequences for highly bound acidic drugs that, unlike cefmenoxime, have narrow therapeutic indices.

Topics: Aged; Blood Proteins; Cefmenoxime; Cefotaxime; Clinical Trials as Topic; Creatinine; Female; Humans; Kinetics; Male; Middle Aged; Pneumonia; Protein Binding

A clinical trial was designed to evaluate the efficacy and safety of cefotaxime, a new semisynthetic, broad-spectrum cephalosporin, in the therapy of community-and hospital-acquired pneumonias. Thirty-nine males (mean age, 65 years) were treated for 41 episodes of pneumonia. Only five patient did not have a serious underlying disease; 15 had two or more significant disorders. Sixty-six percent of these pneumonias were due to Streptococcus pneumoniae or Haemophilus influenzae. The minimal inhibitory concentrations for all bacterial isolates ranged from 0.008 to 4 micrograms/ml. Peak serum cefotaxime levels during therapy ranged from 12 to 124 micrograms/ml 1 h after a 1-g dose. Satisfactory bacteriological and clinical responses were observed in 85% of the cases. Four episodes of pulmonary superinfections due to cefotaxime-resistant gram-negative bacilli were noted, each in a patient being mechanically ventilated. Pseudomonas was involved in each of these superinfections, and three were fatal. No serious toxicity or adverse reaction to cefotaxime was seen. The results of this study suggest that cefotaxime is an affective and well-tolerated new cephalosporin antimicrobial agent for the therapy of pneumonia due to susceptible organisms.

Topics: Adolescent; Adult; Aged; Cefotaxime; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Haemophilus Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Pneumonia, Pneumococcal; Pseudomonas Infections; Random Allocation

Clinical efficacy and effect of cefuroxime, claforan and pentrexyl used endolymphatically were studied in 85 patients with acute abscess forming and persisting pneumonia. Previous routine antibiotic therapy in these patients was little effective. Administration of the antibiotics into the peripheral lymph nodes provided blocking of the lymphagenic pathway for the infection due to high levels in the lymphatic system. Endolymphatic use of cefuroxime and claforan resulted in a significant improvement of the functions of the T- and B-immunity systems and the indices of natural resistance. The levels of the autoimmune reactions and sensitization to the bacterial antigens decreased. Endolymphatic use of cefuroxime and claforan once every 3 days provided recovery of 9 2.8 per cent of the patients, the treatment periods being decreased 2.5--3 times. Intravenous administration of the drugs according to the routine schemes, endolymphatic use of pentrexyl (5 g once every 3 days) and endolymphatic administration of cefuroxime in a single dose followed by intravenous therapy was less effective. The efficacy of pentrexyl increased, when it was used endolymphatically in combination with lysozyme. Endolymphatic use of claforan in doses of 2--3 g once every 3 days (3--4 infusions during the treatment course) was most effective.

Topics: Adult; Ampicillin; B-Lymphocytes; Cefotaxime; Cefuroxime; Cephalosporins; Clinical Trials as Topic; Female; Humans; Immunity, Cellular; Injections, Intralymphatic; Lung Abscess; Male; Middle Aged; Pneumonia; T-Lymphocytes

Topics: Adult; Aged; Bronchitis; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia

Topics: Adolescent; Adult; Aged; Body Temperature; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Child, Preschool; Female; Humans; Leukocyte Count; Male; Middle Aged; Pneumonia; Radiography

Topics: Adult; Aged; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Female; Hospitalization; Humans; Male; Middle Aged; Pneumonia; Pyelonephritis; Random Allocation; Sepsis; Urinary Tract Infections

Topics: Bacteria; Cefazolin; Cefotaxime; Cephalosporins; Humans; Pneumonia; Respiratory Tract Infections

This paper aims to detect the expression levels of blood platelet (PLT) and C-reactive protein (CRP) in severely pneumonic patients and analyze their correlation. For this purpose, eighty-one severely pneumonic patients were retrospectively selected as an observation group and 106 healthy people as a control group. Pretreatment and post-treatment expression levels of PLT and CRP, their predictive values for efficacy, and correlation of PLT, CRP, and PSI scores in observation group after treatment were analyzed. Before treatment, the expression level of PLT in the observation group was higher than the control group (P< 0.05). In the observation group, the expression level of PLT after treatment was significantly lower than that before treatment (P< 0.05). Before treatment, the expression level of CRP in the observation group was higher than the control group (P< 0.05). In the observation group 1) the pretreatment PLT expression level was higher than that in the control group; 2) the post-treatment PLT expression level was significantly lower than that in the pretreatment one; 3) the pretreatment CRP expression level was higher than that in the control group; and 4) the post-treatment CRP expression level was significantly lower than the pretreatment one (All P-values< 0.05). Based upon the efficacy, the observation group was divided into an effective group and an invalid group. The post-treatment expression levels of PLT and CRP in the effective group were lower than those in the invalid group (P< 0.05). Based upon the ROC curve, the area under curves (AUC) of PLT, CRP, and joint detection were 0.843, 0.864, and 0.886, respectively. When the cut-off point was > 0.579, the best specificity and sensitivity were 98.44 and 70.59%, respectively. According to the Pearson test, positive correlations existed between PLT and CRP, between PLT and PSI scores, and between CRP and PSI scores. In conclusion, the expression levels of PLT and CRP in severely pneumonic patients might be used to evaluate the efficacy and conducive to detection of the disease, which have high application values in clinic.

Topics: Adult; Aged; Anti-Bacterial Agents; Area Under Curve; Blood Platelets; C-Reactive Protein; Case-Control Studies; Cefotaxime; Female; Humans; Male; Middle Aged; Platelet Count; Pneumonia; Predictive Value of Tests; Retrospective Studies; ROC Curve; Severity of Illness Index

To investigate the epidemiology of invasive pneumococcal disease (IPD), prevalent serotypes, and pattern of antimicrobial resistance (AMR) in Indian adults.. Prospective laboratory based surveillance of IPD was carried out in >18 years age group between January 2007 and July 2017, from a tertiary care hospital in South India. All Streptococcus pneumoniae culture positives from blood, CSF and sterile body fluids were characterized to identify the serotypes and AMR.. A total of 408 IPD cases were characterized in this study. The overall case fatality rate in this study was 17.8% (95% confidence interval (CI): 14.1, 22.4). Pneumonia (39%), meningitis (24.3%), and septicaemia (18.4%) were the most common clinical conditions associated with IPD. Serotypes 1, 3, 5, 19F, 8, 14, 23F, 4, 19A and 6B were the predominant serotypes in this study. Penicillin non-susceptibility was low with 6.4% CONCLUSION: Serotype data from this study helped in accurate estimation of pneumococcal conjugate vaccine-13 and pneumococcal polysaccharide vaccine-23 protective coverage against serotypes causing IPD in India as 58.7% (95% CI: 53.8, 63.4) and 67.4% (95% CI: 62.7, 71.8) respectively. Penicillin non-susceptibility in meningeal IPD cases is 27.4%. Empirical therapy for meningeal IPD must be cephalosporin in combination with vancomycin since cefotaxime non-susceptibility in meningeal IPD is 9.9.

Topics: Adult; Aged; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Comorbidity; Drug Resistance, Bacterial; Epidemiological Monitoring; Female; Humans; India; Male; Meningitis; Microbial Sensitivity Tests; Middle Aged; Mortality; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Pneumonia; Prevalence; Prospective Studies; Serogroup; Streptococcus pneumoniae; Vaccines, Conjugate; Vancomycin; Young Adult

Topics: Blindness; Cefotaxime; Endocarditis; Endophthalmitis; Humans; Intravitreal Injections; Male; Meningitis; Middle Aged; Pneumonia; Sepsis; Streptococcal Infections; Streptococcus pneumoniae

Ewingella americana (Ea) is a Gram-negative, lactose-fermenting, oxidase-negative and catalase-positive bacterium that was first described in 1983 as a new genus and species in the family Enterobacteriaceae. It is not known whether Ea is a true pathogen or simply an opportunistic infectious agent, as most of the cases have been described in patients at risk.. This case shows that Ea infections in healthy subjects are mild even in pediatric age, and the need for antibiotic therapy is debated. Cases occurring in subjects with underlying chronic disease can be significantly more complicated and require appropriate antibiotic therapy.

Topics: Administration, Oral; Aminoglycosides; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Enterobacteriaceae; Erythromycin; Female; Fluoroquinolones; Humans; Italy; Pneumonia; Thorax

Topics: Anti-Bacterial Agents; C-Reactive Protein; Cefotaxime; Child; Clindamycin; Drug Hypersensitivity Syndrome; Humans; Male; Methylprednisolone; Pleural Effusion; Pneumonia

Streptococcus pneumoniae causes life-threatening infections such as meningitis, pneumonia, and febrile bacteremia, particularly in young children. The increasing number of drug-resistant isolates has highlighted the necessity for intervening and controlling disease. To achieve this, information is needed on serotype distribution and patterns of antibiotic resistance in children.. All cases of invasive pneumococcal disease (IPD) in children aged less than 15 yr recorded at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, were reviewed for serotyping and antibiotic susceptibility. Isolates were collected from 78 consecutive patients with IPD between 2009 and 2012. All collected isolates were subjected to serotyping by co-agglutination, sequential multiplex PCR, and single PCR sequetyping as previously described.. The most frequently isolated IPD serotypes were 23F, 6B, 19F, 18C, 4, 14, and 19A, which are listed in decreasing order and cover 77% of total isolates. The serotype coverage for the pneumococcal conjugate vaccine (PCV)7, PCV10, and PCV13 was 77%, 81%, and 90%, respectively. Results from sequential multiplex PCR agreed with co-agglutination results. All serotypes could not be correctly identified using single PCR sequetyping. Minimum inhibitory concentration showed that 50 (64%) isolates were susceptible to penicillin, whereas 70 (90%) isolates were susceptible to cefotaxime.. The most common pneumococcal serotypes occur with frequencies similar to those found in countries where the PCV has been introduced. The most common serotypes in this study are included in the PCVs. Addition of 23A and 15 to the vaccine would improve the PCV performance in IPD prevention.

Topics: Adolescent; Anti-Bacterial Agents; Bacterial Proteins; Cefotaxime; Child; Child, Preschool; DNA, Bacterial; Humans; Infant; Meningitis; Microbial Sensitivity Tests; Multiplex Polymerase Chain Reaction; Penicillins; Pneumococcal Vaccines; Pneumonia; Protein Tyrosine Phosphatases; Retrospective Studies; Saudi Arabia; Serotyping; Streptococcus pneumoniae

The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America community-acquired pneumonia (CAP) guideline recommends narrow-spectrum antimicrobial therapy for most children hospitalized with CAP. However, few studies have assessed the effectiveness of this strategy.. Using data from 43 children's hospitals, we conducted a retrospective cohort study to compare outcomes and resource utilization among children hospitalized with CAP between 2005 and 2011 receiving either parenteral ampicillin/penicillin (narrow spectrum) or ceftriaxone/cefotaxime (broad spectrum). Children with complex chronic conditions, interhospital transfers, recent hospitalization, or the occurrence of any of the following during the first 2 calendar days of hospitalization were excluded: pleural drainage procedure, admission to intensive care, mechanical ventilation, death, or hospital discharge.. Overall, 13,954 children received broad-spectrum therapy (89.7%) and 1610 received narrow-spectrum therapy (10.3%). The median length of stay was 3 days (interquartile range 3-4) in the broad- and narrow-spectrum therapy groups (adjusted difference 0.12 days, 95% confidence interval [CI]: -0.02 to 0.26). One hundred fifty-six children (1.1%) receiving broad-spectrum therapy and 13 children (0.8%) receiving narrow-spectrum therapy were admitted to intensive care (adjusted odds ratio 0.85, 95% CI: 0.27 to 2.73). Readmission occurred for 321 children (2.3%) receiving broad-spectrum therapy and 39 children (2.4%) receiving narrow-spectrum therapy (adjusted odds ratio 0.85, 95% CI: 0.45 to 1.63). Median costs for the hospitalization were $3992 and $4375 (adjusted difference -$14.4, 95% CI: -177.1 to 148.3).. Clinical outcomes and costs for children hospitalized with CAP are not different when treatment is with narrow- compared with broad-spectrum therapy.

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child, Preschool; Cohort Studies; Drug Therapy, Combination; Female; Hospitalization; Humans; Infant; Male; Penicillins; Pneumonia; Retrospective Studies

The authors report a 6-year-old boy with fever, rash and cough. He was diagnosed with severe measles pneumonia and admitted to the paediatric intensive care unit with severe dyspnoea 8 days after symptom onset. He received intravenous antibiotics and high dose vitamin A. Three days later, he had recovered and was discharged home. He had not been vaccinated for measles, mumps and rubella according to the schedule. This case highlights the need for rapid diagnosis, appropriate treatment and determination of vaccination status of children with measles in order to prevent complications.

Topics: Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Child; Diagnosis, Differential; Drug Therapy, Combination; Fever; Humans; Male; Measles; Pneumonia; Vitamin A

Acute phlegmonous gastritis is an uncommon disease, often fatal condition characterized by suppurative bacterial infection of the gastric wall. It has a high mortality rate mainly because the diagnosis is usually made late. Until recently, gastrectomy in combination with antibiotics was recommended. We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. At upper gastrointestinal endoscopy, the gastric lumen was narrow, and the mucosa was severely inflamed, which was erythematous, swelled, and showed necrotic areas covered with purulent exudate. Klebsiella oxytoca and Acinetobacter lwoffii were isolated in the gastric tissue culture. Contrast-enhanced computerized tomography scan of abdomen demonstrated diffuse gastric wall thickening and an intramural abscess in the gastric antral wall. Although delayed gastric emptying by gastroparesis prolonged the in-hospital period, the only medical treatment with antibiotics alone successfully cured the patient without gastrectomy.

Topics: Acinetobacter; Acute Disease; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Gastritis; Gastroparesis; Gastroscopy; Humans; Imipenem; Klebsiella oxytoca; Male; Ofloxacin; Pneumonia; Tomography, X-Ray Computed

Topics: Adult; Anti-Bacterial Agents; Antigens, Bacterial; Bioterrorism; Cefotaxime; Ceftriaxone; Chlamydophila pneumoniae; Community-Acquired Infections; Humans; Legionnaires' Disease; Macrolides; Microbial Sensitivity Tests; Pneumonia; Pneumonia, Pneumococcal; Severe Acute Respiratory Syndrome; Streptococcus pneumoniae

Topics: Administration, Oral; Anti-Infective Agents; Cefixime; Cefotaxime; Cephalosporins; Community-Acquired Infections; Hospitalization; Humans; Infusions, Intravenous; Pneumonia; Treatment Outcome; United Kingdom

During a one year prospective study of Haemophilus influenzae infections in patients treated in hospitals in the metropolitan area of Cape Town. H. influenzae type b accounted for 81.7% of 126 invasive isolates, whereas 86.1% of the 280 non-invasive isolates were non-typeable. Ampicillin resistance was detected among 10.8% of strains of which all but one produced beta-lactamase. All strains were susceptible to cefotaxime as were more than 95% to chloramphenicol, rifampicin, tetracycline but 20.4% were resistant to co-trimoxazole and 87.2% to erythromycin.

Topics: Adult; Arthritis; beta-Lactamases; Cefotaxime; Cellulitis; Child; Child, Preschool; Drug Resistance, Microbial; Erythromycin; Haemophilus Infections; Haemophilus influenzae; Humans; Meningitis; Microbial Sensitivity Tests; Pneumonia; Respiratory System; Serotyping; South Africa

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Bacterial Infections; Cefixime; Cefotaxime; Cefuroxime; Clarithromycin; Fluoroquinolones; Humans; Pneumonia

Due to changes of humoral immunity, patients with rheumatic heart disease present, even before the operation, a high-risk group with regard to the development of infectious complications. Contamination of intraoperative material was revealed in 61.7% of cases during the operation. Extracorporeal circulation increases the cefotaxime half-life period which is in direct proportional dependence of the period of time between the beginning of the administration of the agent and the beginning of extracorporeal circulation. Immunocorrection by means of myelopid in the early postoperative period accelerates restoration of cellular and humoral immunity, and reduces the frequency of pneumonia occurrence and suppuration of the postoperative wound. Therefore, the prevention of infectious complications after operations on an open heart should be complex and should include broad-spectrum antibiotics and immunocorrective therapy.

Topics: Activins; Adjuvants, Immunologic; Adolescent; Adult; B-Lymphocytes; Bacterial Infections; Cefotaxime; Extracorporeal Circulation; Heart Valve Diseases; Humans; Intraoperative Complications; Middle Aged; Oligopeptides; Peptides; Pneumonia; Postoperative Care; Rheumatic Heart Disease; Risk Factors; Surgical Wound Infection; T-Lymphocytes

Fifty-eight consecutive patients with severe community-acquired pneumonia were studied prospectively during a three-year period. The group included 44 men and 14 women (mean age: 45.0 +/- 15.7 years). The cause of pneumonia was diagnosed in 35 (60.3 percent) cases, and the most common pathogens were Streptococcus pneumoniae (37.1 percent), Legionella pneumophila (22.8 percent) and Gram-negative bacilli (11.4 percent). The fact that Mycobacterium tuberculosis was present in four (11.4 percent) patients and Pneumocystis carinii in three (8.5 percent) is worthy of note. The overall death rate was 22.4 percent. More than 50 percent of deaths occurred within the first five days and were caused by septic shock, hemoptysis (tuberculosis) or hypoxia. However, hypoxia remains the main fatal complication and all late-occurring deaths (> 5 days) observed were due to this cause. These data could be important in planning strategies and protocols to improve prognosis.

Topics: Adult; Aged; Aged, 80 and over; Bacteremia; Cefotaxime; Critical Care; Erythromycin; Female; Humans; Legionnaires' Disease; Length of Stay; Male; Middle Aged; Pneumonia; Pneumonia, Pneumococcal; Pneumonia, Pneumocystis; Prognosis; Prospective Studies; Tuberculosis, Pulmonary

Cefotaxime has been used to treat serious bacterial infections in children since 1982. With the predominant use of cephalosporins in pediatrics, reports of adverse effects of certain compounds have increased. A retrospective review is presented of 2,243 cases of children receiving therapy with cefotaxime in order to evaluate the safety profile and efficacy of cefotaxime in the treatment of serious infections in hospitalized children. Overall, 57 (2.5%) children experienced adverse reactions. These included local reactions in 6 (0.3%), rash in 28 (1.2%), diarrhea in 15 (0.97%), vomiting in 10 (0.7%), abdominal pain in 1 (0.1%), headache in 3 (0.4%), and drug fever in 1 (0.1%). No cases of hemolytic anemia, bleeding, or hyperbilirubinemia were found. Efficacy of treatment for different disease categories ranged from 90.5% to 100%. The percentage of children in any treatment group with a particular laboratory abnormality following initiation of cefotaxime therapy ranged from 0% to 2.6%, and rates of superinfection with bacteria or Candida were 0.4% to 1.7%. Cefotaxime has the distinct advantage of high rates of efficacy and low rates of complications and superinfection among children hospitalized for serious infections.

Topics: Adolescent; Arthritis, Infectious; Bacteremia; Bacterial Infections; Cefotaxime; Cellulitis; Child; Child, Preschool; Female; Humans; Infant; Male; Meningitis, Bacterial; Osteomyelitis; Pneumonia; Retrospective Studies; Treatment Outcome

Cefotaxime 1 g intramuscularly (i.m.) 12-hourly was compared with ceftriaxone 1 g i.m. 12-hourly in adult patients requiring hospitalization with uncomplicated community-acquired pneumonia. Fifty-two patients were enrolled and two were subsequently withdrawn, leaving 50 patients who completed the study; 23 received cefotaxime and 27 received ceftriaxone. Clinical cure was achieved in 49 of the 50 patients (98%). One treatment failure occurred in a patient who received ceftriaxone. The only significant pathogen isolated from the pretreatment sputum cultures was Streptococcus pneumoniae (50%). All isolates were sensitive to both drugs. Cefotaxime 1 g i.m. 12-hourly was as effective as ceftriaxone in the treatment of patients with uncomplicated community-acquired pneumonia requiring hospital admission.

Topics: Adult; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Humans; Injections, Intramuscular; Male; Middle Aged; Pneumonia

Topics: Adult; Aged; Cefotaxime; Cross Infection; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Pneumonia; Sputum

Ro 24-4383 contains desacetylcefotaxime linked by a carbamate bond at the 3' position to ciprofloxacin. Ro 24-4383 was active against 99% of the 363 gram-positive and gram-negative aerobes tested in vitro, while the comparative agents cefotaxime and ciprofloxacin were active against 77 and 97%, respectively. The activities (ED50: mg/kg s.c.) of Ro 24-4383, cefotaxime and ciprofloxacin in systemic murine infections were: Escherichia coli 257, 1.4, less than 0.5, less than 0.2; Klebsiella pneumoniae A, 11, 30, 0.7; Enterobacter cloacae 5699, 3.2, 35, less than 0.2; Citrobacter freundii BS16, 3, 41, less than 0.5; Serratia marcescens SM, 35, greater than 100, 1.6; Pseudomonas aeruginosa 5712, 67, 100, 10; P. aeruginosa 8780, 33, 193, 3; Staphylococcus aureus Smith (oxacillin-susceptible), 12, 3.7, 1; S. aureus 753 (oxacillin-resistant), 28, greater than 100, 2; Streptococcus pneumoniae 6301, 10, 15, greater than 50, and S. pyogenes 4, 3.3, 1.6, 54. Ro 24-4383, although inactive against the S.-pneumoniae-induced pneumonia following one administration of the agent, was highly active (ED50 = 1.5) when three treatments were given following infection. Ro 24-4383 was active against the K.-pneumoniae-induced pneumonia (ED50 = 37), as well as the meningitis induced by S. pneumoniae (ED50 = 158) or K. pneumoniae (ED50 = 100). The protective effect of Ro 24-4383 was demonstrated when administered 8 h before infection with E. coli (ED50 = 37) and 4 h before infection with S. pyogenes (ED50 = 199).

Topics: Animals; Anti-Infective Agents; Cefotaxime; Ciprofloxacin; Gram-Negative Bacteria; Gram-Positive Bacteria; Meningitis; Mice; Microbial Sensitivity Tests; Pneumonia

In a pilot study with a limited number of patients the efficacy and tolerance of cefixime, a new oral cephalosporin antibiotic, were investigated in 15 children with the clinical diagnosis of bacterial respiratory tract infection, otitis media or urinary tract infection. The dosage was 2 x 4 mg/kg body weight daily for a period of seven to 11 days. Clinical efficacy was good in 13 cases, and subjective tolerance was good in all cases. The results support the assumption that cefixime is suited for the treatment of children with bacterial infections of the airways and urinary tract with sensitive pathogens.

Topics: Anti-Infective Agents; Bronchitis; Cefixime; Cefotaxime; Child; Child, Preschool; Humans; Lymphadenitis; Otitis Media; Pneumonia; Respiratory Tract Infections; Sinusitis; Urinary Tract Infections

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

In systemic and local infections, the therapeutic efficacy of cefpirome was compared to that of imipenem and cefotaxime. Murine septicemia induced with methicillin-sensitive and methicillin-resistant Staphylococcus aureus strains responded well to cefpirome and imipenem therapy, the ED50 values ranged from 0.8 to 28.40 mg/kg and 0.5 to 15.58 mg/kg, respectively. The carbapenem also displayed high efficacy against Enterococci and was more potent than cefpirome. Cefotaxime, however, exhibited lower activity or proved to be inactive against these strains. With ED50 values of 0.03 to 31.33 mg/kg, cefpirome was the most active of the three antibiotics in protecting mice challenged with Enterobacteriaceae. The corresponding ED50 values of imipenem and cefotaxime ranged from 0.72 to 70.95 mg/kg and 0.06 to 66.30 mg/kg, respectively. Despite distinctly lower in vitro activity against the infecting organism, cefpirome showed efficacy similar to imipenem in the treatment of subcutaneous S. aureus abscesses in mice. It was more effective than imipenem and cefotaxime against experimental Klebsiella pneumonia in mice and the Escherichia coli infected granuloma pouch in rats.

Topics: Abscess; Animals; Bacterial Infections; Cefotaxime; Cefpirome; Cephalosporins; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Granuloma; Imipenem; Male; Mice; Mice, Hairless; Mice, Inbred C3H; Pneumonia; Rats; Rats, Inbred Strains; Sepsis; Staphylococcal Skin Infections; Staphylococcus aureus; Streptococcal Infections

Colonization of the oropharynx with potentially pathogenic microorganisms (PPM) is a highly significant factor in the pathogenesis of bacterial pneumonia in intensive care patients. Via colonization of the oropharynx, bacteria pass into the tracheobronchial tree, where they can give rise to pneumonia after overcoming pulmonary resistance mechanisms. By a new, prophylactic antibiotic treatment schedule consisting in selective decontamination of the digestive tract (SDD) with locally applied nonabsorbable antibiotics, Stoutenbeek achieved drastic lowering of the colonization and infection rate in trauma patients. In the present study, we wanted to check whether this new prophylactic antibiotic schedule can be applied on a surgical intensive care ward in all patients with long-term ventilation, irrespective of the diagnosis, and whether it affords advantages over a conventional antibiotic schedule. MATERIALS AND METHODS. All patients on a surgical intensive care ward in whom it was expected that mechanical ventilation would be necessary for more than 4 days were included in the study. During the first 6 months 83 patients were investigated, in whom antibiotics were only administered when the presence of infection had been confirmed, in accordance with generally accepted guidelines (control group). In the second 6-month period, 82 patients were selectively decontaminated with 4 x 100 mg polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and in an antimicrobial paste in the oropharynx (SDD group). The SDD schedule entailed systemic administration of cefotaxime in the first 3-4 days. RESULTS. In the control group, enterobacteria/Pseudomonas spp. were isolated significantly more frequently than in the SDD group (P less than 0.001): in the pharyngeal smear in up to 53%, in the tracheal secretion up to 36%, and in the rectal smear in up to 93% of the patients In the SDD group in the 1 week the frequency of gram-negative aerobic bacteria in the pharynx decreased from 33% to 5%, in the tracheal secretion from 23% to 14% and in the rectum from 86% to 52% (24% in the second week). However, the decrease in gram-negative microorganisms was accompanied by significant increase in the frequency of Staphylococcus epidermidis and enterococci. The SDD schedule proved to be effective with regard to the rate of infection. In the control group, 35 patients developed pneumonia (42%) as against 5 patients receiving SDD prophylaxi

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Anti-Bacterial Agents; Bacteria; Cefotaxime; Colistin; Critical Care; Digestive System; Female; Humans; Male; Middle Aged; Oropharynx; Pneumonia; Respiration, Artificial; Time Factors; Tobramycin

Cefodizime (THR-221, CDZM), a new parenteral cephalosporin, was evaluated for its efficacy and safety in 20 children with bacterial infections (Table 1), and the following results were obtained. 1. CDZM was administered in 3 or 4 divided doses at daily dosages ranging from 54.5 to 84.2 mg/kg administered by 30 minutes drip infusion or intravenous injection to 20 patients (7 cases of acute tonsillitis, 6 cases of pneumonia, 2 cases each of bronchitis and suppurative cervical lymphadenitis, and 1 case each of acute pharyngitis, acute enteritis and furunculosis) and the following clinical results were obtained: excellent, 7 cases; good, 11 cases; fair, 2 cases. The overall efficacy rate was 90% (Table 4). 2. MICs of CDZM against 15 strains of isolated organisms are shown in Table 2. MICs against all 7 strains of Haemophilus influenzae were less than 0.025 micrograms/ml. MIC against 1 out of 5 strains of Streptococcus pneumoniae was 0.05 micrograms/ml and those against 2 strains were 0.10 micrograms/ml and against the other 2 were 0.20 micrograms/ml. MICs against 3 strains of Staphylococcus aureus were 1.56, 25 and higher than 100 micrograms/ml, respectively. 3. No clinical adverse reaction was observed in any of the 20 patients. Eosinophilia was observed in 2 cases. A slight elevation of S-GOT was found in 1 patient (case No. 8) and moderate elevation of S-GOT and S-GPT in another (case No. 18) (Table 4). In case No. 18, the S-GOT and S-GPT activity improved after the administration of the drug was stopped.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Pneumonia; Tonsillitis

Topics: Aged; Aged, 80 and over; Amikacin; Cefotaxime; Female; Humans; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Pneumonia

Topics: Adolescent; Cefotaxime; Child; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Pneumonia; Pneumonia, Pneumococcal; Streptococcal Infections; Streptococcus pyogenes

A study was conducted of the effects of cefotaxime, a third generation cephalosporin antibiotic, on the function of the kidney, using several indices of renal function including urinary concentrations of the renal enzyme N-acetyl-beta-D-glucosaminidase (NAG). In 6 patients with respiratory infections and normal renal function (group I), the urinary concentrations of NAG before and after the administration of cefotaxime 2 to 4g daily were 5.7 +/- 0.6 U/L and 5.5 +/- 0.9 U/L, respectively (NS). Similarly, 9 patients with chronic renal failure who were not undergoing haemodialysis showed pre- and post-treatment urinary NAG concentrations of 8.7 +/- 4.0 U/L and 6.6 +/- 1.7 U/L, respectively (NS), while the corresponding values in 12 renally impaired patients undergoing haemodialysis (group III) were 8.1 +/- 3.5 U/L and 8.9 +/- 3.8 U/L, respectively (NS). With regard to other parameters of renal function (serum creatinine, BUN, beta 2M, and creatinine clearance), no statistically significant differences were found between the values obtained before and after therapy with cefotaxime. Therefore, it was concluded that the influence of cefotaxime on renal function is slight, and that this antibiotic can be safely used to treat patients with infections in the presence of renal dysfunction.

Topics: Acetylglucosaminidase; Bacterial Infections; Bronchitis; Cefotaxime; Humans; Kidney; Kidney Failure, Chronic; Pneumonia; Radioimmunoassay; Renal Dialysis

Eighty-one febrile episodes in cancer patients with adequate neutrophil counts (greater than 1000/microliter) were treated with a double beta-lactam combination of ceftizoxime plus ticarcillin. Fifty-four episodes were microbiologically documented and 27 were clinically documented. The overall response rate was 75% (61 of 81). The response rate in 38 episodes where a single organism was identified was 71%. Polymicrobial infections were associated with a high response rate of 87%. Responses occurred in six of eight Gram-positive and 21 of 30 Gram-negative infections. Pneumonia was the most frequent infection and was associated with a response of 61%. Septicaemia and urinary tract infections also occurred commonly and had response rates of 76% and 89% respectively. All but one organism were susceptible to at least one of the antibiotics. No resistant organisms emerged during therapy. Side-effects included rash (1), phlebitis (3), and coagulation abnormalities without bleeding (3). Four patients developed superinfections (three bacterial, one fungal). The double beta-lactam combination of ceftizoxime plus ticarcillin was safe and effective therapy for infections in non-neutropenic cancer patients.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Drug Therapy, Combination; Female; Fever; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Middle Aged; Neoplasms; Penicillins; Pneumonia; Sepsis; Ticarcillin

Ceftizoxime (CZX) was given in daily doses of 4 approximately 6 g by intravenous drip infusion to 30 patients with infection accompanying lung cancer to investigate the usefulness of the drug for infectious disease: The rate of effectiveness (marked and moderate) was 73.3% (22/30 patients). Of the 30 patients, 2 had drug fever; 1, arthralgia; and 1, eosinophilia. These side effects improved after the drug was withdrawn. CZX is a very useful antibiotic with high effectiveness and safety in immunocompromised patients with infection accompanying advanced lung cancer.

Topics: Adenoma; Adult; Aged; Bacterial Infections; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Cefotaxime; Ceftizoxime; Female; Fever; Humans; Lung Neoplasms; Male; Middle Aged; Pneumonia; Pyelitis; Respiratory Tract Infections

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Cefotiam; Ceftizoxime; Cephalosporins; Female; Humans; Lung Diseases; Male; Middle Aged; Pneumonia; Suppuration

In order to investigate the frequency of the emergence of resistance during treatment, 1,403 episodes of lower respiratory infection were studied in a General Hospital with three departments of Chest Medicine in a period of four years. In 650 episodes the pathogen was isolated and in 82 of those failure of therapy was accompanied by emergence of resistance to the agent used. Factors associated with this phenomenon were: intensive care, tracheostomy, involvement of Pseudomonas aeruginosa, Enterobacter spp., Serratia marcescens, Staphylococcus aureus or Acinetobacter calcoaceticus, use of antipseudomonas penicillins, cefotaxime (especially when used in P. aeruginosa infections) and co-trimoxazole and monotherapy as opposed to appropriate combination therapy in patients with nosocomial pneumonia.

Topics: Acinetobacter; Anti-Bacterial Agents; Bacteria; Cefotaxime; Cross Infection; Drug Combinations; Drug Therapy, Combination; Drug Utilization; Enterobacteriaceae; Humans; Intensive Care Units; Penicillin Resistance; Penicillins; Pneumonia; Pseudomonas aeruginosa; Respiratory Tract Infections; Retrospective Studies; Staphylococcus aureus; Sulfamethoxazole; Tracheotomy; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bronchitis; Cefotaxime; Cefotiam; Female; Humans; Male; Middle Aged; Pneumonia

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

Pharmacokinetic and clinical studies on cefotiam (CTM) in mature neonates were carried out. The results were summarized as follows: The serum peak level of CTM after intravenous bolus injection at a single dose of 10 mg/kg was found at 15 minutes after the injection. The serum peak level was 32.9 micrograms/ml in a 1 day-old neonate and it was 17.7 micrograms/ml in a 4 day-old neonate. Serum levels at 6 hours after injection were 4.5 micrograms/ml and 0.7 microgram/ml for the 1 day-old and the 4 day-old, respectively. Half-lives were 2.1 and 1.2 hours in the 1 and 4 day-old neonates, respectively. Serum peak levels of CTM at 15 minutes after intravenous bolus injection at a single dose of 20 mg/kg were 40.9 micrograms/ml in a 1 day-old neonate and 36.5 micrograms/ml in a 5 day-old neonate. Serum levels of CTM at 6 hours were 8.0 micrograms/ml in the 1 day-old neonate and 2.3 micrograms/ml in the 5 day-old neonate. Half-lives were 2.5 and 1.5 hours in the 1 and 5 day-old neonates, respectively. With each dosage, the younger showed extended half-lives. A dose-response relationship was observed. In 2 cases of 2 day-old neonates given CTM 20 mg/kg by 30-minute intravenous drip infusion, the mean peak concentration at the termination of the infusion was 25.1 micrograms/ml. Even after 6 hours the concentration was found at 8.7 micrograms/ml. Half-lives were 2.9 and 3.7 hours. Urinary excretion rates of CTM in 1 to 5 day-old neonates were as low as about 20% in any of cases subjected to a 10 mg/kg intravenous bolus injection, a 20 mg/kg intravenous bolus injection a 20 mg/kg 30-minute intravenous drip infusion. It was possible to evaluate the efficacy of CTM in only 1 case of pneumonia. CTM was clinically and bacteriologically effective in this case. No abnormal clinical symptoms and findings were observed in all of the 5 cases.

Topics: Cefotaxime; Cefotiam; Female; Half-Life; Humans; Infant, Newborn; Infusions, Intravenous; Injections, Intravenous; Kinetics; Male; Pneumonia; Sepsis

Pharmacokinetic and clinical studies were carried out regarding the use of cefotiam (CTM) in the treatment of infections in newborn infants. Absorption and excretion: CTM was administered by bolus intravenous injection at a dose of 20 mg/kg to 9 newborns ranging in age from 1 to 28 days (gestational age, 34-40 weeks; birth weight, 2,000-3,380 g) and 6 infants aged 30 to 87 days (gestational age, 33 approximately 40 weeks; birth weight, 2,100-3,600 g) and its serum concentration and urinary excretion were determined. In the newborns, mean serum concentrations were 43.3 micrograms/ml at 1/4 hour, 36.7 microgram/ml at 1/2 hour, 27.8 micrograms/ml at 1 hour, 17.7 micrograms/ml at 2 hours, 8.8 micrograms/ml at 4 hours and 4.8 micrograms/ml at 6 hours, and in the infants, they were 44.5 micrograms/ml, 31.2 micrograms/ml, 19.1 micrograms/ml, 7.6 micrograms/ml, 2.2 micrograms/ml and 0.7 micrograms/ml at the above sampling times, respectively. Mean half-lives were 1.92 hours for the newborns and 0.96 hour for the infants, and mean urinary recoveries within 6 hours were 41.2% and 50.1% for the newborns and the infants, respectively. Taking individual differences into account, serum peak levels (at 1/4 hour) in newborns were very similar to each other irrespective of age (days after birth), and did not appear to be greatly different from those in infants. Half-lives, however, became shorter with aging, and the half-life of the serum CTM level in infants of about 1 month old should be close to those in young children or school-age children. From these observations, it is suggested to establish a standard regimen in which CTM is administered at a dose of 20 mg/kg once or twice a day to newborns within 3 days after birth, twice or 3 times a day to those aged 4 to 7 days, and 3 or 4 times a day to those aged 8 days or older. Clinical study: The CTM was administered to 11 patients with acute pneumonia, 2 patients each with suspected septicemia and with bullous impetigo, 1 patient with purulent lymphadenitis, 3 patients with idiopathic respiratory distress syndrome and 1 patient with pneumothorax, and its clinical effect was investigated. Excellent responses were observed in 12 of the 15 evaluated cases,good responses in 2, and a poor response in 1, thus an overall clinical effectiveness was 93.3%.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Absorption; Acute Disease; Cefotaxime; Cefotiam; Female; Half-Life; Humans; Infant, Newborn; Kinetics; Male; Pneumonia

Using cefotiam (CTM) against infections in neonates and premature infants, we obtained the following results: With intravenous administration of the drug to 2 cases each of pyoderma, pneumonia, and fetal infection, the drug was effective in all the cases except in 1 premature infant with pneumonia. Dose levels at individual injections were between 18.6 and 27.8 mg/kg, per dose, with an exception in 1 case of pyoderma (36.4-54.5 mg/kg), and 2 to 4 doses per day were given to each patient. For prophylactic purposes, the drug was administered to 1 case of turbid amniotic fluid and 3 cases of massive aspiration syndrome, and no infection was observed in any case. In a total of 11 cases consisting of the above mentioned 10 cases and an additional case which had been excluded from the evaluation because of the detection of P. aeruginosa, neither side effects nor abnormal laboratory values were recognized. In 5 cases of 4 to 31-day old infants, CTM concentrations in blood were measured after one-time intravenous injection of the drug at a dose level of about 20 mg/kg. Blood concentrations of CTM were low in 1 case with levels of 14.4 and 4.5 micrograms/ml at 30 minutes and 2 hours after the intravenous injection, respectively, whereas they were high in another case with readings of 82 and 65 micrograms/ml. In the remaining 3 cases, however, 30-minute and 2-hour values were between 41 to 52, and 13.5 to 22.8 micrograms/ml, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Premature; Male; Pneumonia; Pyoderma

Single doses of cefotiam (CTM) by bolus injection of 20 mg/kg of CTM were given to 17 neonates and premature babies (11 prematures) and plasma and urine CTM levels as well as urinary recovery rates of CTM were determined. The CTM was also evaluated clinically with regard to therapeutic and protective effects, bacteriological efficacy as well as safety. A mean daily dose of 56.6 mg/kg of CTM was given intravenously in 2 to 4 divided doses for an average of 8 days to 11 neonates and prematures consisting of 1 case with pneumonia, 2 suspected septicemia, 3 urinary tract infections and 5 for prophylaxis against infections. (In the 6 babies evaluated for clinical effects, a mean dose of 59.8 mg/kg/day of CTM was given for an average 9 days). The findings of these studies are summarized below: The mean peak plasma level of 2 cases of 4-7 day-old neonates was 32.3 mcg/ml 5 minutes after injection. The mean AUC was 96.6 mcg X hr/ml, and the mean half-life was 2.12 hours. In 3 of the 4 neonates of 8-14 day-old group, the mean peak plasma level of 55.6 mcg/ml was obtained after 5 minutes. The mean AUC was 63.0 mcg X hr/ml and the mean half-life was 0.82 hour. Compared to the 4-7 day-old group, AUC was smaller and half-life was shorter in this group. In premature infants, plasma CTM levels were determined in 2, 1, 1, 5 and 2 cases of the 0-3, 4-7, 8-14, 15-21 and 22-28 day-old infants, respectively. In the 8-14 day-old group and one of 15-21 day-old group, peak plasma levels were obtained after 15 minutes. Peak plasma levels in the remaining groups, were attained after 5 minutes. Peak plasma levels in the 5 groups were 40.7, 48.4, 33.9, 38.1 and 45.3 mcg/ml, respectively. Mean or individual AUC's obtained after excluding markedly varying values from the respective groups were 122.0, 96.2, 65.2, 72.8 and 60.4 mcg X hr/ml, respectively. With the increasing age, the AUC tended to decrease. Mean or individual half-lives were 2.31, 1.47, 1.28, 1.41 and 0.96 hours, respectively, showing a tendency to decrease with increasing age. In 6 neonates, high urinary levels continued up to 6 hours after administration. Mean 6-hour urine recoveries in the 4-7 and 8-14 day-old groups were 16.6% and 43.0%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cefotaxime; Cefotiam; Female; Half-Life; Humans; Infant, Newborn; Infant, Premature; Injections, Intravenous; Male; Pneumonia; Urinary Tract Infections

20 patients suffering from severe lower respiratory tract infections were included in the study. 10 patients were given ceftriaxone (1-2 g/day) and the other 10 cefotaxime (2-4 g/day) for a week. The results of microbiological findings and both local and systemic tolerance were found to be similar for both drugs. This indicates that 7-14 g of ceftriaxone and 14-28 g of cefotaxime are equivalent quantities in the treatment of severe respiratory tract infections.

Topics: Acute Disease; Adult; Aged; Bronchitis; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Drug Tolerance; Haemophilus influenzae; Humans; Middle Aged; Pneumonia; Respiratory Tract Infections; Staphylococcus aureus; Streptococcus; Streptococcus pneumoniae

The activity of ceftazidime was examined in a murine model of Klebsiella pneumoniae pneumonia in which the antibiotic was administered subcutaneously 6 h after intranasal infection and then twice daily for the next three days (i.e. seven doses). In a series of experiments using this test, the dose of ceftazidime giving 50% survival relative to controls (SD50) ranged from 1.0-9.0 mg/kg/dose while the dose required to reduce the log10 cfu/lung by 50% (CD50) ranged from 24-64 mg/kg/dose. Ceftazidime was considerably more effective than cefotiam, amoxycillin-clavulanic acid or kanamycin in the test. Pharmacokinetic studies with ceftazidime showed that no differences in respiratory tract penetration existed between uninfected mice and mice infected for 48 h with K. pneumoniae. The percentage penetration of ceftazidime from serum was 73% for pleural fluid, 44% for tracheal fluid, 27% for tracheal wall tissue and 17% for whole lung tissue after a subcutaneous injection of 100 mg/kg. At this dose, ceftazidime remained at supra-MIC concentrations for 2-3 h in all compartments examined.

Topics: Amoxicillin; Animals; Body Fluids; Cefotaxime; Cefotiam; Ceftazidime; Clavulanic Acid; Clavulanic Acids; Drug Combinations; Female; Kanamycin; Klebsiella Infections; Klebsiella pneumoniae; Lung; Mice; Pleura; Pneumonia; Tissue Distribution; Trachea

The paper is concerned with a study in which eosinophilic exudative pleuritis was the first sign of drug allergy (penicillin, streptomycin, claphoran), also manifesting itself in fever, hemorrhagic eruption, eosinophilia in the blood. Fast recovery was achieved after discontinuation of antibacterial therapy and prescription of prednisolone. The problem of differential diagnosis of pleuritis in acute pneumonia is discussed.

Topics: Adult; Anti-Bacterial Agents; Cefotaxime; Drug Hypersensitivity; Eosinophilia; Humans; Male; Pleural Effusion; Pleurisy; Pneumonia

Satisfactory efficacy of cefotaxime in treatment of premature infants with pneumonia during the first month of their life was shown. Dosing of the drug was studied. It was noted that the filtration function of the kidneys in the newborn premature infants influenced the blood levels of cefotaxime and its renal excretion.

Topics: Cefotaxime; Creatinine; Dose-Response Relationship, Drug; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Kinetics; Male; Pneumonia; Time Factors

Mortality due to serious infections is significantly higher among elderly patients than among younger patients. This differential is particularly striking in some subsets of patients; for example, the mortality rate among older patients with afebrile bacteremia is 65 percent, compared with 25 to 35 percent in younger patients. Although serious underlying disease is an important reason for older patients' difficulties with infection, other problems of these patients include a tendency to deny the presence of disease and some obstacles to interaction with the health care system. Older patients with infection are less likely to present with typical symptoms, which makes early recognition difficult for physicians. For example, typical findings of sepsis (mental obtundation, tachycardia, and fever) may be absent in an elderly patient; the only clue may be the patient's failure to eat. Once sepsis is recognized, its source must be identified. Urinary tract infection is the most common cause of sepsis in the elderly and responds best to antibiotic therapy. Pneumonia is the next most common cause and leads to the highest mortality in this age group; rapid (sometimes invasive) methods must be utilized to identify the etiologic agent. In this life-threatening infection, initial antibiotic therapy should include an aminoglycoside, such as amikacin, to ensure the broadest coverage against the common pathogens. Supportive measures should be instituted for patients with sepsis, including careful monitoring of fluid intake and output and special attention to adequate oxygenation. Fluid volume replacement must be carried out in patients with septic shock, and hemodynamic monitoring with a Swan-Ganz catheter should be performed frequently. Careful consideration should be given to the use of corticosteroids and inotropic agents. After appropriate cultures have been obtained, antibiotics should be started; the time from initial presentation to the administration of the first dose of antibiotic should not exceed one hour. Important considerations in antibiotic selection include the patient's history and environment (community, nursing home, or hospital), anatomic location of the infection, and the pathogen. In our institution, initial empiric antibiotic therapy consists of a combination of amikacin and cefotaxime. When older patients are treated, adjustments in dosing should be based on estimates of kidney function.

Topics: Aged; Amikacin; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cross Infection; Drug Therapy, Combination; Female; Humans; Male; Pneumonia; Risk; Shock, Septic; Urinary Tract Infections

A new beta-lactamase-stable oral cephem antibiotic, cefixime (CFIX), was evaluated for safety, efficacy and pharmacokinetics in children. CFIX was effective in 19 of 20 cases (95%) with bacterial infections. The drug was especially effective against the cases of pneumonia due to beta-lactamase-producing H. influenzae or B. catarrhalis. Pharmacokinetic parameters of CFIX (3 mg/kg) with premeal administration were as follows: Kel 0.328 +/- 0.066 hr-1, T 1/2 2.14 +/- 0.36 hrs, AUC 10.9 +/- 8.7 micrograms X hr/ml, and Vd/F 1.64 +/- 1.42 L/kg. In most of the cases tested, the urinary excretion rate in 12 hours was 5 to 17%. A dose of 3 mg/kg twice daily seems to be adequate for a regular treatment.

Topics: Bacterial Infections; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Haemophilus Infections; Humans; Infant; Kinetics; Male; Pneumonia; Pneumonia, Mycoplasma; Respiratory Tract Infections; Urinary Tract Infections

We used cefixime (CFIX), a newly developed oral cephalosporin antibiotic, to treat 21 children with various infections. The results are summarized as follows. The serum half-lives of CFIX after an administration of 6 mg/kg to each of 2 children were 2.56 and 2.79 hours. The serum concentrations were high enough to ensure the therapeutic response. The clinical response was "excellent" in 16 children and "good" in 5, with a 100% efficacy rate. No side effects were recorded. The only abnormal finding was slight eosinophilia in 1 child.

Topics: Acute Disease; Adolescent; Bronchitis; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Half-Life; Humans; Infant; Kinetics; Male; Pneumonia; Respiratory Tract Infections; Tonsillitis; Urinary Tract Infections

Cefixime (CFIX), a new oral cephalosporin, was administered clinically at a daily dose of 3.4 mg/kg to 10.4 mg/kg to each of 12 children, aged from 2 months to 14 years old. An additional separate study was done to compare the serum and urinary levels of CFIX in 3 children when each was administered with 100 mg of the drug in capsule with the serum and urinary levels of the drug in the same children when each was given the same amount of drug in the form of 5% granules. The results of these trials are summarized below. Peak serum levels of CFIX administered in capsules and 5% granules averaged 1.4 micrograms/ml and 1.9 micrograms/ml, respectively. The half-life of the former was 5.13 hours, while that of the latter was 4.17 hours. The difference in the peak levels was statistically insignificant. The urinary excretion of CFIX in either form of the drug (capsules and granules) was about 14-18% in 12 hours. In 9 cases of respiratory infections, therapeutic results were excellent in 3 cases, good in 6 cases, and the effective rate was 100%. In 2 cases of urinary tract infection, results were excellent in 1 case and good in 1 case. The drug efficacy was poor in 1 case of purulent cervical lymphadenitis, probably caused by Staphylococcus aureus. No adverse reactions attributable to the drug were observed. CFIX may be expected to be a highly effective and safe agent in moderate respiratory and urinary tract infections of children.

Topics: Administration, Oral; Adolescent; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Kinetics; Lymphadenitis; Male; Pharyngitis; Pneumonia; Respiratory Tract Infections; Urinary Tract Infections

In a study of 20 acutely ill elderly patients treated with cefotaxime (1 g, 2 X daily) the pharmacokinetics in serum and tissue fluid were examined. Patients with impaired renal function showed increased values for the area under the curve and half-life in both serum and tissue fluid. Patients with pathological peripheral circulation manifested delayed peak concentrations in tissue fluid. Although the passage of cefotaxime into tissue fluid was slow in the elderly, its concentration was higher than the minimal inhibitory concentration for most bacterial species of clinical importance and lasted for 5.5-7h in tissue fluid and for more than 10h in serum. Thus, this study clearly illustrates that the twice-daily dosage regimen used was quite adequate in elderly patients.

Topics: Acute Disease; Aged; Aged, 80 and over; Bacterial Infections; Cefotaxime; Female; Half-Life; Humans; Injections, Intravenous; Kinetics; Male; Middle Aged; Pneumonia; Regression Analysis; Sepsis; Urinary Tract Infections

The therapeutic effect of ceftizoxime suppositories (CZX-S) was studied in 8 physically handicapped patients, comprising 6 with pharyngitis, 1 with pneumonia, and 1 with urinary tract infection. The clinical effect was "excellent" in 7 and "good" in 1. Neither adverse reactions nor abnormal laboratory test findings attributable to CZX-S were detected. CZX-S proved to be useful in physically handicapped children, especially in those not suited to treatment with oral or intravenous preparations.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Ceftizoxime; Child; Child, Preschool; Disabled Persons; Drug Evaluation; Drug Resistance, Microbial; Enterobacter; Female; Humans; Male; Pharyngitis; Pneumonia; Suppositories; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged; Peritonitis; Pneumonia; Surgical Wound Infection

Topics: Aged; Cefmenoxime; Cefotaxime; Humans; Male; Middle Aged; Piperacillin; Pneumonia; Radiography

Cefotaxime (CTX) was administered to 117 pediatric patients. Although 26 of these patients were excluded from the clinical evaluation of the study because other antimicrobial agents were given concomitantly with CTX or because no infectious diseases were proved, these cases were evaluated for adverse effects of the drug. The remaining 91 cases were evaluated for clinical effect; pneumonia in 56 cases, septicemia in 5, suspected septicemia in 5, meningitis (aseptic cases included) in 3, urinary tract infection in 5 and other diseases in 17. No pathogenic organisms were identified in any of the pneumonia cases, even either by bacterial culture or other laboratory test methods. Pathogens of septicemia were E. coli in 3 cases, K. pneumoniae in 1 and E. agglomerans in 1. Those of urinary tract infections were E. coli in 3 cases, a mixed infection of S. aureus and an unidentified species of Gram-negative rods in 1, and unknown in 1. Clinical effectiveness rates of CTX were 78.6% in pneumonia and 100% in septicemia, suspected septicemia and urinary tract infections. One patient with purulent meningitis caused by H. influenzae was also treated with CTX successfully. Adverse reactions and abnormal laboratory findings were observed in 12 cases (12/117 = 10.3%); rash in 2 cases, vomiting in 1, abdominal pain in 1, diarrhea in 5, granulocytopenia and thrombocytopenia in 1, eosinophilia in 3 and elevation of liver enzymes (GOT and LDH) in 1.

Topics: Bacterial Infections; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Pneumonia; Sepsis; Urinary Tract Infections

12 patients with acute bacterial infections were treated with ceftriaxone, 1.5 g intravenously twice daily for 7-13 days. Pharmacokinetic variables were studied in 11 patients. In older subjects, serum half-lives were longer and serum clearances lower than in younger individuals. After the last dose, a larger increase in AUC compared to the first dose was observed in older patients and a biphasic elimination curve appeared in all patients but 2, with a terminal half-life of 15.6 h and 11.4 in old and young subjects, respectively. Estimated biliary clearances showed large individual variation, with a range of 0-16 ml/min X 1.73 m2. Changes in the colonic microflora were pronounced. Almost total disappearance of staphylococci, streptococci and enterobacteria was found, and there was a marked tendency to overgrowth of yeasts and enterococci. One patient with the highest estimated biliary clearance of ceftriaxone developed diarrhoea after 7 days of therapy. A toxin-producing Clostridium difficile was isolated from the stool.

Topics: Acute Disease; Adult; Aged; Bacteria; Bacterial Infections; Bile; Cefotaxime; Ceftriaxone; Colon; Female; Humans; Kinetics; Male; Middle Aged; Pneumonia; Sepsis; Staphylococcus; Streptococcus; Yeasts

Based on a study of the clinical efficacy of endolymphatic administration of antibiotics in 160 patients with different pulmonary diseases the methods of the use of endolymphatic therapy (ET) as part of a complex of therapeutic measures for lung abscess, pneumonia, chronic purulent bronchitis have been devised. The pharmacodynamics of gentamicin, brulamicin, pentrexyl, ketocef and claforan administered endolymphatically has been explored. Positive shifts have been demonstrated in cyclic nucleotides and immune responsiveness during ET, a constituent part of multiple modality treatment.

Topics: Adolescent; Adult; Aged; Ampicillin; Anti-Bacterial Agents; Bronchitis; Cefotaxime; Cefuroxime; Evaluation Studies as Topic; Female; Humans; Injections, Intralymphatic; Lung Abscess; Male; Middle Aged; Pneumonia; Respiratory Tract Diseases; Tobramycin

66 patients with predominantly community-acquired pneumonia were treated with cefotaxime. The group consisted of 45 males and 21 females, aged 56 to 90 years, 43 of the patients belonging to the age groups 65-80 years. Streptococcus pneumoniae was isolated in 21 of the 34 patients with gram-positive pneumonia, Staphylococcus aureus in six, Staphylococcus epidermidis in five and Streptococcus faecalis in two. Klebsiella pneumoniae was the predominant pathogen in gram-negative pneumonia (eight patients), followed by Enterobacter (n = 6), Pseudomonas aeruginosa (n = 5), Haemophilus influenzae (n = 4), Escherichia coli (n = 3), Serratia marcescens and Citrobacter (two cases each). The in vitro activity of cefotaxime against the isolates was compared to the activity of other beta-lactam antibiotics. Characteristically, the classical signs and symptoms of pneumonia were absent or discrete in some of the elderly patients. There was a delayed clearance of pulmonary infiltrates. 55 of 66 patients responded to cefotaxime within four weeks of treatment; the symptoms were aggravated or remained unchanged in seven patients. Patients with a delayed clinical response displayed decreased peripheral lymphocyte counts and T cell functions in PHA stimulation tests, as well as low immunoglobulin levels. A combination of cefotaxime and gamma-venin cleared the symptoms in some of these patients.

Topics: Aged; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Immunologic Deficiency Syndromes; Leukocyte Count; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia

This paper is a report on our studies on superinfections in respiratory tract infections treated during the years 1981-1984. The isolated strains of Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis, Streptococcus faecium and glucose non-fermentative gram-negative rods such as Pseudomonas aeruginosa were resistant to third-generation cephem antibiotics. These organisms proved to be widely distributed in hospitals and were frequently isolated from the sputum, excised lung and cardiac blood. The colonization of the sputum by bacteria in respiratory tract infections before, during and after treatment with third-generation cephem antibiotics revealed a tendency for these organisms to appear after treatment. Among the gram-positive cocci, S. faecium was most resistant to these antibiotics, followed by S. faecalis, S. epidermidis and S. aureus in that order. The incidence of resistant isolates in 1984 exceeded that in 1983, suggesting an annual increase in resistant bacteria.

Topics: Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Gram-Positive Bacteria; Humans; Lung; Pneumonia; Respiratory Tract Infections; Sputum

Nephrotoxicity frequently complicates the use of aminoglycosides in severely compromised acute care patients. Therefore, we initiated an open clinical trial to determine if cefmenoxime alone is useful for serious Gram-negative pneumonias in this population. Thirty consecutive patients were studied. Average age was 66 years. Most were malnourished at entry, with serum albumin averaging 2.8 g/dl and prognostic nutritional index values over 70% (normal less than 40%). One-half of the patients had severe COPD and 67.9% were on ventilators. Fifty-seven per cent suffered concomitant cardiac disease, and 78.6% had been previously treated with antibiotics. Pneumonia was proven by new infiltrates on chest X-ray, new fever, elevated WBC count and Gram-negative rods on Gram's stain and in cultures of tracheal aspirate or sputum. Patients were given cefmenoxime 1-2 g every 6 h for an average of 12 days. Cefmenoxime peak (1 h) and trough concentrations were measured by HPLC and averaged 58 and 7 mg/l respectively. Gram-positive organisms, Escherichia coli, Klebsiella spp. and Haemophilus influenzae were usually eradicated. Persistence was noted for Enterobacter, Pseudomonas and Acinetobacter spp. Persistence in patients with good clinical response was considered colonization rather than superinfection. Overall, satisfactory clinical response rate was noted in 78.6%, while four patients responded satisfactorily with recurrence, and two treatments were unsatisfactory. No serious adverse effects were observed. Cefmenoxime is a promising agent for treatment of susceptible pneumonias in critical care patients.

Topics: Aged; Cefmenoxime; Cefotaxime; Critical Care; Cross Infection; Female; Humans; Male; Middle Aged; Pneumonia; Radiography

Clinical investigation of combination use of cefotiam (CTM), aminoglycoside, or (and) penicillin against complicated infections with hematopoietic disorders was performed, and the results were as follows. Fifty-one patients were administered CTM in combination with aminoglycoside or (and) penicillin. The clinical response was excellent 19.6%, good 27.4%, fair 21.6%, and poor 31.4% showing efficacy rate of 47.1%. The combined therapy of CTM and aminoglycoside was clinical effective in 70% of 10 patients with complicated sepsis. Therefore, combination use of CTM and aminoglycoside is considered to be the first choice for the treatment of complicated sepsis with hematopoietic disorders. The clinical effectiveness of CTM was not influenced by the number of mature neutrophil at the first phase of CTM treatment, but was influenced at the end phase of CTM treatment. Gram-negative bacilli were dominantly isolated from the patients. Pseudomonas sp. was isolated from 70% of the patients with sepsis. No remarkable side effects were observed in this investigation.

Topics: Adolescent; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Drug Therapy, Combination; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged; Penicillins; Pneumonia; Sepsis

Cefmenoxime concentration/effect relationships were retrospectively explored for gram-negative bacteria isolated from 14 critical care patients treated for nosocomial pneumonia. The effects of cefmenoxime concentrations on in vitro growth kinetics of 21 isolated pathogens were studied using the Abbott MS-2 Research System, from which a dynamic response concentration was derived. Serum pharmacokinetic profiles were obtained in each patient. These data were used to calculate the in vivo total area under the curve over dynamic response concentration and the time that cefmenoxime concentrations exceeded the dynamic response concentration for each bacteria. The same determinations were made in 18 patients prospectively treated, except that dosage was optimized on the basis of previous mathematical relations to achieve bacterial eradication in four days. This method of dosage optimization is termed dual individualization. Serial cultures of infected tissues were evaluated to determine the number of days to the eradication of bacteria, and the pharmacokinetic and pharmacodynamic variables were used to describe the bacteriologic response of the original pathogen isolated in pretreatment culture. Bacterial eradication rates could be described from cefmenoxime pharmacokinetics in the patient and from the relation between concentration and bacterial inhibition. Patients who were prospectively treated using these retrospectively derived relationships had a predictable day of bacterial eradication. This, in turn, was associated with a shorter duration of treatment (p less than 0.05). The success of prospective dual individualization is encouraging and suggests that more precise optimization of antibiotic dosage can yield a predictable rate of bacterial eradication from the infection site.

Topics: Aged; Cefmenoxime; Cefotaxime; Computers; Cross Infection; Female; Gram-Negative Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Prospective Studies; Retrospective Studies

Cefmenoxime was evaluated in an open trial consisting of 41 patients. Forty infections in 36 patients could be evaluated. Thirteen patients had pyelonephritis due to Escherichia coli (two bacteremic), Pseudomonas aeruginosa, Klebsiella pneumoniae, or Streptococcus faecalis; all improved and 12 of 13 were clinically cured, but one relapse (S. faecalis) occurred at two weeks. Six patients with cystitis due to E. coli, Citrobacter freundii, Serratia marcescens, P. aeruginosa, or S. faecalis all improved, but relapse or reinfection, or both, occurred in five due to P. aeruginosa, S. faecalis, C. fruendii, or E. coli. Neurogenic bladder or other complications were present in five of 13 patients with pyelonephritis and five of six with cystitis. Ten patients with pneumonia and one with tracheobronchitis due to Hemophilus influenzae, S. pneumoniae, S. agalactiae, or Neisseria meningitidis all improved and seven had resolution without relapse, but P. aeruginosa emerged in two patients, one of whom died. Eight soft tissue infections due to Staphylococcus aureus, Peptococcus prevotti, Streptococcus species, or infections of mixed origin resolved in six. Sterility of blood cultures was obtained in one patient with endocarditis due to S. anginosus, but other therapy was substituted. Clinical resolution of the toxic shock syndrome and subsequent negative endocervical cultures for S. aureus occurred in one. Granulocytopenia of unverified cause in four (with less than 1,500 mm3) and two (with less than 2,000 mm3) was reversible. Headache during treatment occurred in six patients and a possible disulfiram-like effect in three. Elevations of serum glutamic oxalacetic transaminase and alkaline phosphatase occurred in five, Coombs' positivity in two, and diarrhea in three. Clinical efficacy of cefmenoxime was significant. Possible side effects require further study.

Topics: Abscess; Adolescent; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Cellulitis; Cystitis; Drug Resistance, Microbial; Enterobacteriaceae Infections; Female; Humans; Leukopenia; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Urinary Tract Infections

The activity of the aminothiazolyliminomethoxy cephalosporin cefodizime (HR 221) was compared to that of cefotaxime, cefuroxime and cefazolin in experimental pneumonia caused by Klebsiella pneumoniae DT-S in mice. Cefodizime exhibited high and long-acting levels in the blood and lung homogenates of infected mice; the blood and tissue concentrations obtained with the other cephalosporins tested were low by comparison. In the treatment of experimental Klebsiella pneumonia, cefodizime was superior to cefotaxime and cefuroxime. Counts of the number of viable bacteria present in the infected tissue showed that cefodizime exerted a more marked bactericidal effect than cefotaxime or cefuroxime. Hardly any therapeutic activity was seen with cefazolin.

Topics: Animals; Cefotaxime; Cephalosporins; Mice; Pneumonia; Sepsis

Cefotaxime, a third generation cephalosporin antibiotic, was evaluated in 26 infants and children for the treatment of documented or suspected bacterial infections, including pneumonia (10 cases), soft tissue skin infection (13 cases), and urinary tract infection (3 cases). An average daily dose of 60 mg/kg in 3 to 4 divided doses was administered parenterally for an average of 7 days. In 14 of the cases, primary pathogens, including Haemophilus influenzae b (resistant to ampicillin), Staphylococcus aureus, Staphylococcus pyogenes, Streptococcus pneumoniae and Escherichia coli, were eradicated. Clinical recovery occurred in each case. Blood levels at different time intervals and biological half-life were similar to those reported for adults. Mild and transient side effects observed were elevation of SGOT in two cases, alkaline phosphatase in one, and eosinophilia in one case.

Topics: Alkaline Phosphatase; Aspartate Aminotransferases; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Eosinophilia; Female; Humans; Infant; Kinetics; Male; Pneumonia; Urinary Tract Infections

The efficacy and safety of cefmenoxime was evaluated in 50 patients with serious bacterial infections. These included 26 pneumonias, 18 urinary tract infections, 2 soft tissue infections, 2 bacteremias, 1 renal abscess, and 1 peritonitis. A satisfactory clinical response was seen in 47 patients (94%). Eosinophilia and thrombocytosis were seen in several patients but were generally mild and transient.

Topics: Bacterial Infections; Cefmenoxime; Cefotaxime; Humans; Pneumonia; Sepsis; Urinary Tract Infections

The efficacy of endolymphatic route of gentamicin and ceporin administration was studied in 89 patients with neurosurgical pathological processes complicated by acute pneumonia (80 patients) and meningoencephalitis (9 patients) usually after ineffective antibiotic therapy according to the routine methods. The antibiotics were used in accordance with the antibiograms of the causative agents isolated from the bronchial tree or CSF. The endolymphatic use of gentamicin or ceporin once a day in doses of 80 mg or 1 g respectively provided rapid sanation and arresting of the inflammatory foci, lowering of the intoxication level, more rapid promotion of the positive time course of the clinico-roentgenological and laboratory indices and decreasing of the recovery periods by 1.5-2 times in 86 per cent of the patients with pneumonia. The endolymphatic administration of gentamicin in a dose of 80 mg twice a day or ceporin in a dose of 1 g twice a day allowed one to maintain the antibiotic therapeutic levels in the cerebrospinal fluid and to obtain satisfactory clinical results in the combined treatment of meningoencephalitis. The endolymphatic administration of the drugs was well tolerated by the patients and no adverse reactions were observed. This route of administration of antibiotics and in particular broad spectrum antibiotics may be recommended for urgent antibacterial therapy of especially severe neurosurgical patients with pyo-inflammatory complications and patients who did not respond to the routine antibiotic therapy.

Topics: Adolescent; Adult; Aged; Brain Diseases; Cefotaxime; Child; Drug Therapy, Combination; Female; Gentamicins; Humans; Injections, Intralymphatic; Male; Meningoencephalitis; Middle Aged; Pneumococcal Infections; Pneumonia; Pneumonia, Staphylococcal; Postoperative Complications; Proteus Infections; Proteus mirabilis; Staphylococcus aureus

Cefmenoxime is a new syn-methoxyimino cephalosporin antibiotic derived from cefotiam, which has been proved to be a very effective and useful antibiotic for the treatment of respiratory infections. This bacteriological and pharmacokinetic study was therefore performed in order to evaluate the potency of cefmenoxime in the treatment of respiratory infections. The minimum inhibitory concentrations of cefmenoxime against 179 isolates of respiratory pathogens (Streptococcus pneumoniae 53, Haemophilus influenzae 64, Klebsiella pneumoniae 43, Escherichia coli 9, Enterobacter spp. 10) were less than 0.20 micrograms/ml, and 43 (73%) of 60 Pseudomonas aeruginosa were inhibited by 12.5 micrograms/ml. In vitro antibacterial activity of cefmenoxime was superior to 18 other antibiotics, including cefotiam and cefotaxime tested in this study. Pharmacokinetic studies on tissue distribution in rats, serum levels and urinary excretion in 3 healthy volunteers, and penetration into bronchial secretes of 9 patients with respiratory infections, revealed that cefmenoxime has a higher penetration into the lung and bronchial secretes compared with cefotiam and cefotaxime. In 1 patient with chronic bronchiolitis, the concentration of cefmenoxime in the intra-bronchial secrete reached 12.5 micrograms/ml. From these results, it is concluded that cefmenoxime is a highly potent and useful antibiotic, and may be more effective in the treatment of respiratory infections than many other cephalosporins, including cefazolin, cefotiam and cefotaxime.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Cefmenoxime; Cefotaxime; Cefotiam; Humans; Kinetics; Microbial Sensitivity Tests; Pneumonia; Rats; Respiratory Tract Infections; Sputum; Tissue Distribution

This is a simple, precise liquid-chromatographic procedure for determining cefmenoxime in patients' serum and urine. p-Anisic acid is used as the internal standard. Protein is precipitated from 0.5 mL of serum or dilute urine with 100 microL of perchloric acid. The clear supernate is injected directly onto a mu-Bondapak CN reversed-phase column. The mobile phase is acetate buffer, pH 3.8 (25 degrees C). The flow rate is 2.5 mL/min. Column effluent is monitored at 254 nm. Extraction recovery from serum averaged 74.6%. Calibration curves were linear from 0.5 mg/L, the lower limit of quantification, to 100 mg/L. We present cefmenoxime concentrations in serum from a patient being treated for pneumonia. The procedure was evaluated in the clinical setting to determine its applicability to the study of cefmenoxime pharmacokinetics in critically ill patients.

Topics: Aged; Cefmenoxime; Cefotaxime; Chromatography, Liquid; Female; Humans; Hydroxybenzoate Ethers; Hydroxybenzoates; Kinetics; Pneumonia; Reference Standards

Ceftriaxone is an investigational cephalosporin with a half-life of five to eight hours. In an uncontrolled study, we evaluated its efficacy and safety in 30 pediatric and 12 young adult patients with serious bacterial infections. This agent was administered to children at a dosage of 50 to 75 mg/kg/day intravenously in two divided doses. Those with CNS infections received 100 mg/kg/day. In adults, the dosage was 1 g either once or twice daily. The diseases we treated included pneumonia (17), sepsis (eight), ventriculoperitoneal shunt infections (three), osteomyelitis (three), brain abscess (two), peritonitis (two), and miscellaneous (seven). Clinical cures were achieved in all cases, although one child with cystic fibrosis and Pseudomonas pneumonia had persistent colonization in his sputum. No serious side effects were observed. Although not the agent of choice for many of these pathogens, ceftriaxone appears to represent an important alternative to therapy.

Topics: Bacteria; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Osteomyelitis; Pneumonia

Plasma levels and distribution in pulmonary and bronchial tissues of CTM following injection into the jugular vein were investigated in rabbits with experimental pleuritis or pneumonitis as well as in normal rabbits. The experiments also included the assessment of the effect of concomitant administration of serratiopeptidase (TSP). The pneumonitis + TSP group, pleuritis group and pleuritis + TSP group showed a tendency to delayed dissipation of CTM from the plasma, as compared with controls. The CTM concentrations in tissues from the apical region of upper lobe (L1), lateral region of middle lobe (L2) and diaphragmatic region of lower lobe (L3) 30 minutes after injection did not differ significantly between the control and the TSP group, pleuritis group or pleuritis + TSP group. In the pneumonitis group, the tissue CTM concentrations at all 3 sites (L1, L2, L3) were lower than those in the control group. They were increased by the concomitant administration of TSP, with statistical significance of increase in regions L2 and L3. Thirty minutes after the injection of CTM, the pneumonitis group and pneumonitis + TSP group displayed essentially comparable CTM levels in pleural fluid, whereas the CTM concentrations in the pleural fluid were prone to be increased in the pleuritis + TSP group as comparing with the pleuritis group. CTM levels in the tissues of trachea (B0), right and left main bronchi (B1) and lobar bronchi (B2) 30 minutes after the injection did not show any significant difference between control and TSP-treated normal groups. CTM concentrations tended to be increased, yet not significantly, in all these regions in the rabbits with pleuritis administered TSP, compared to those without TSP.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Cefotaxime; Cefotiam; Disease Models, Animal; Lung; Male; Peptide Hydrolases; Pleurisy; Pneumonia; Rabbits; Tissue Distribution; Trachea

Topics: Acute Disease; Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Bronchiectasis; Bronchitis; Cefazolin; Cefotaxime; Chronic Disease; Doxycycline; Female; Humans; Lung Abscess; Lung Diseases; Male; Middle Aged; Pneumonia; Premedication; Preoperative Care

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Cross Infection; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Pneumonia; Pyelonephritis; Sepsis; Urinary Tract Infections

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

Topics: Adult; Aged; Cefotaxime; Ceftizoxime; Cellulitis; Hospitalization; Humans; Microbial Sensitivity Tests; Middle Aged; Pneumonia

Two to 6 g of CMX was administered daily to 9 patients who were admitted to ICU, i.e. 5 cases with pneumonia and 4 with sepsis. In all cases, CMX was administered concomitantly with aminoglycoside which had been administered, and additional administration of other antibiotics was avoided. Bacteriologically, P. aeruginosa was isolated from 4 cases, K. pneumoniae from 4 cases, S. marcescens, P. mirabilis and P. cepacia respectively from 1 case. The CMX treatment was considered effective in 4 of 5 pneumonia cases and in 3 of 4 sepsis cases. In total, 7 of 9 cases responded effectively. The clinical effective rate was 77.8%. Elevation of GOT and GPT values was noticed in 1 case, however, the causality with CMX administration was unclear.

Topics: Adult; Aged; Bacteria; Cefmenoxime; Cefotaxime; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infusions, Parenteral; Intensive Care Units; Male; Middle Aged; Pneumonia; Sepsis

The efficacies of several dosage schedules of cefazolin, cefotaxime, and ceftazidime, started 12 or 36 h after infection, were examined in experimental pneumonia caused by Klebsiella pneumoniae in rats. The therapeutic activities of the cephalosporins were compared with the antibacterial activities in vitro and the serum concentration curves. The course of experimental pneumonia was rapid and characterized by tissue necrosis. Response to antimicrobial treatment was evaluated with respect to mortality and numbers of bacteria in lung (left lobe), blood, and pleural fluid. When antibiotic treatment was started early, i.e., 12 h after bacterial inoculation, cefotaxime and ceftazidime were equally effective and superior to cefazolin. Eleven doses of 10 mg of cefotaxime or ceftazidime per kg or 11 doses of 60 mg of cefazolin per kg were required to improve the survival rate. With a delay in administration to 36 h after inoculation, the efficacy of the cephalosporins decreased markedly. In the three dosages tested, cefazolin was ineffective. Survival improved with the administration of nine doses of 60 mg of cefotaxime per kg or nine doses of 10 mg of ceftazidime per kg. These results are not in accordance with the ratio of in vitro activities of cefotaxime and ceftazidime or the serum concentration curves.

Topics: Animals; Cefazolin; Cefotaxime; Ceftazidime; Cephalosporins; Female; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Pneumonia; Rats

Plasma concentrations of cefotaxime and desacetyl cefotaxime were determined by HPLC in geriatric patients with multiple diseases. Comparison with a younger control group of healthy volunteers showed a prolongation of half-life of CTX and dCTX in the older patients. A significant correlation between pharmacokinetic parameters of dCTX and other clinical and chemical parameters was found. Half-life of dCTX was positively correlated with age of the geriatric patients (P less than 0.05). There was also a significant relationship between CHE in serum and plasma peak concentrations of dCTX. Time until reaching plasma peak concentrations correlated closely with total bilirubin (P less than 0.01), CHE (P less than 0.001), cholesterol (P less than 0.01), and urea (P less than 0.01). Accumulation of the pharmacologically active metabolite dCTX could not be excluded in one patient with kidney disease. In accordance with other investigators it is recommended to reduce the dose of cefotaxime in geriatric patients with kidney diseases.

Topics: Aged; Arteriosclerosis; Cefotaxime; Diabetes Complications; Diabetes Mellitus; Diabetic Angiopathies; Female; Half-Life; Heart Failure; Humans; Hypertension; Kidney Diseases; Kinetics; Male; Pneumonia; Urinary Tract Infections

Cefmenoxime (CMX) is a newly developed cephalosporin. Basic and clinical studies on this drug was carried out and the results were as follows. 1. Serum level and urinary recovery A 7 years old male was administered 10 mg per kilogram of CMX by one shot intravenous injection. Serum levels were 23.3 micrograms/ml at the time of 15 minutes after injection, 12.0 micrograms/ml at 30 minutes, 3.9 micrograms/ml at 1 hour, 2.0 micrograms/ml at 2 hours, and 0.3 micrograms/ml at 4 hours. In this same patient, 6-hour urinary recovery was 54.7%. 2. Clinical evaluation and adverse reaction Thirty-seven patients (upper respiratory infection 4, pneumonia 20, pyothorax 1, purulent lymphadenitis 1, cellulitis 2, sepsis 1 and urinary tract infection 8) were treated with CMX in doses of 30 approximately 212 mg/kg divided 3 approximately 4 times per day for 1.5 approximately 21 days intravenously. The overall efficacy rate was 94.6%. As to adverse reaction, exanthema and drug fever were observed in 1 patient respectively. Abnormal laboratory data noted were eosinophilia in 2.3%, and elevation of serum transaminase in 9.8%.

Topics: Cefmenoxime; Cefotaxime; Child; Child, Preschool; Empyema; Female; Humans; Infant; Lymphadenitis; Male; Pneumonia; Urinary Tract Infections

A new cephalosporin antibiotic, cefmenoxime (CMX) was administered to 22 patients aged 5 days to 8 years, and who had moderate or severe pediatric infections, to examine its clinical effect. The infections were 3 of acute bronchitis, 2 cases of asthmatic bronchitis, 6 of acute pneumonia, 1 of Mycoplasma pneumonia, 2 of sepsis (1 accompanied with pneumonia), 3 of vacterial meningitis, 2 of urinary tract infection, 1 of acute appendicitis, 1 of aseptic meningitis and 1 of fever of undetermined origin. The drug was administered by one shot intravenous injection 4 times daily at the dose of 40 approximately 200 mg/kg/day. The drug was administered for 3 approximately 15 days, the total dosage administered being 0.7 approximately 43.5 g. Clinically, excellent, good and fair response was obtained in 2, 11 and 4 cases, respectively, the drug being effective in all cases excluding the 5 cases in which judgement was unknown. The 6 strains of bacteria isolated from the lesion as the assumed causative bacteria (1 strain of S. pneumoniae, 2 of H. influenzae, 2 of E. coli, 1 of K. pneumoniae) were all eradicated after drug administration. No notable side effects were produced.

Topics: Bronchitis; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Injections, Intravenous; Male; Meningitis, Aseptic; Pneumonia; Pneumonia, Mycoplasma; Respiratory Tract Infections

Seventeen septicaemia, 18 urinary tract infections, 13 acute bacterial pulmonary infections and 7 infections at various other site were treated with cefotaxime, and, in 48 cases, with cefotaxime alone. The pathogenic organisms were mainly enterobacteria: 19 E. coli, 10 Klebsiella, 8 Proteus, 2 Serratia, 1 Enterobacter, almost all of them having a MIC less than or equal to 1 mcg/ml. The route of administration used was the i.m. route in 33 cases and the i.v. route in 18 cases, both routes having been used in 4 patients. The mean dosage was 45 mg/kg/day. A cure was obtained in 49 cases were clinical and bacteriological results were interpretable (85,7% of cases). The cure rate was 80% in septicaemia, 88,2% in urinary infections and 91,6% in pulmonary infections. In 19 infections due to beta-lactamase producing strains of Gram-negative bacteria, the percentage of cure was 68,4%. The systemic and local tolerance was excellent. Cefotaxime is a very well tolerated and very effective antibiotic, even in prolonged treatment and even in monotherapy, at a mean dosage of 50 mg/kg/day.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Female; Humans; Male; Middle Aged; Pneumonia; Sepsis; Urinary Tract Infections

Cefotaxime was used to treat 33 patients with serious Gram-negative bacillary infections. The dosage varied between 1.5 g and 4 g/day in patients without renal failure. Eighteen patients had urinary tract infections, 6 had pulmonary infections and 10 had miscellaneous infections. Sixteen patients were also bacteremic. Twenty-five infections were due to pathogens resistant to ampicillin, cephalothin, gentamicin and/or tobramycin, in vitro. Fifteen infections had failed to resolve during ampicillin, cefazolin, gentamicin or tobramycin therapy. Thirty-two patients responded favourably (cure or improvement). Four patients developed superinfection with cefotaxime-resistant bacteria. One patient developed mild reversible renal insufficiency. Cefotaxime is a very active cephalosporin with potential use in serious multi-resistant enterobacteria infections.

Topics: Acinetobacter Infections; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Pneumonia; Urinary Tract Infections

Cefotaxime was administered to 20 patients suffering from severe bacterial infections. Four were newborn babies, seven were infants, and nine were children. The infections treated included 9 bronchopulmonary infections and 6 urinary tract infections. In 9 patients, the infecting organism was identified: E. coli (3), Klebsiella (2), Staphylococcus aureus (3), and Proteus (1). Except in one case, cefotaxime was administered alone at doses of 50 to 100 mg/kg every 12 hours. The route of administration was intramuscular. 4 patients had already received unsuccessful antimicrobial therapy. All patients were clinically cured. In those with pneumonia, the clinical and radiological response was very prompt; in urinary tract infections, the temperature returned to normal in less than 48 hours. The local and general tolerance was always good. It may be concluded from these results that cefotaxime, a new parenteral cephalosporin, is especially useful and should prove particularly effective in severe infectious conditions found in pediatric practice.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Lymphadenitis; Male; Osteoarthritis; Pneumonia; Skin Diseases, Infectious; Urinary Tract Infections

Thirty-nine patients, 17 to 80 years old, were admitted to a pneumology department. The diagnosis was acute serious or severe respiratory tract infection in 25 patients, exacerbation of chronic bronchopulmonary infection in 6, purulent pneumonia in 4, purulent bronchitis in 4. 28 infecting organisms were identified: Gram-positive cocci (Pneumococcus: 6, Streptococcus: 8. Staphylococcus: 1) and 6 Haemophilus influenzae (3 of which were associated with 1 Pneumococcus) 7 Enterobacteria (isolated or associated). Local, biological and systemic tolerance was generally very good in the majority of patients. Cefotaxime at a daily dose of 2 g intramuscularly for 12 days, showed very good efficacy in the treatment of various bacterial infections of the lower respiratory tract. The activity was evident against a variety of organisms in respiratory infections. The in vitro results of the antibiogram which indicated a superiority of cefotaxime in some cases on other antibiotics currently used in these indications were confirmed by the clinical results.

Topics: Adolescent; Adult; Aged; Bronchitis; Cefotaxime; Cephalosporins; Enterobacteriaceae Infections; Female; Haemophilus Infections; Humans; Male; Middle Aged; Pneumonia; Staphylococcal Infections; Streptococcal Infections

The effect of cefotiam and cefazolin on the ultrastructure of Klebsiella pneumoniae DT-S in vitro and in experimental pneumonia in mice was examined by electron microscopy. The action of both cephalosporins against K. pneumoniae DT-S was bactericidal, and a dose response in the action was definite. At the minimal inhibitory concentration of each cephalosporin, filamentation of the cells was induced and the cytoplasm became sparse during the course of incubation. With elevation of the concentration of the cephalosporins, spheroplasts were formed; they subsequently collapsed. In the lungs of mice, the infecting organisms localized in the alveolar space, and each cell was connected by a threadlike material. A fibrous matrix, located on the cell surface of the infecting organisms, was observed in ultrathin sections. By administration of each cephalosporin to mice, several morphological changes, similar to those noted in vitro, were observed in the infecting organisms.

Topics: Animals; Cefazolin; Cefotaxime; Cefotiam; Klebsiella Infections; Klebsiella pneumoniae; Lung; Male; Mice; Mice, Inbred ICR; Microscopy, Electron; Microscopy, Electron, Scanning; Pneumonia

The MICs of cefotiam and cefazolin against K. pneumoniae DT-S were unaffected by the inoculum size and were 0.1 and 1.56 micrograms/ml, respectively. Bactericidal and bacteriolytic activities of the cephalosporins were more potent in bacterial concentrations of 10(7) colony-forming units (CFU)/ml than in concentrations of 10(8) CFU/ml. Both activities of cefotiam were more markedly influenced by bacterial concentrations than those of cefazolin. Therapeutic activity of cefotiam was about 9 approximately 15 times as potent as that of cefazolin in experimental pneumonia caused by K. pneumoniae DT-S in mice, and this finding was in accordance with the ratio of in vitro antibacterial activities of the two cephalosporins as judged by the MICs or the bactericidal and bacteriolytic activities in bacterial suspension of 10(7) CFU/ml. The range of concentrations of cefotiam which induced cell filamentation in vitro, was wider than that of cefazolin. This difference, however, was not reflected on the therapeutic activities of the two cephalosporins in the model infection. In the pneumonic lungs, definite therapeutic doses of both cephalosporins (80 mg of cefotiam per kg and 640 mg of cefazolin per kg) produced mainly bacteriolysis of the challenge organisms.

Topics: Animals; Anti-Bacterial Agents; Cefazolin; Cefotaxime; Cefotiam; Drug Resistance, Microbial; Klebsiella Infections; Klebsiella pneumoniae; Male; Mice; Pneumonia