cefotaxime and Sepsis

Osteofibrous dysplasia is a rare and benign disease that originates from the tibia or fibula. The symptoms of osteofibrous dysplasia include painless enlargement and bowing of the tibia and pain occurring in the presence of pathological fracture. Herein a male infant who was admitted with redness and swelling on the right leg and diagnosed as pathological tibia fracture due to left tibia osteofibrous dysplasia on the third day of life was presented. To our knowledge, this is the earliest presentation of osteofibrous dysplasia with a pathological fracture in a neonate. Therefore, it must be suspected in neonatal bone fractures.

Topics: Amikacin; Anti-Bacterial Agents; Casts, Surgical; Cefotaxime; Clindamycin; Fibrous Dysplasia of Bone; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Sepsis; Tibia; Tibial Fractures; Treatment Outcome

A 26-year-old man addicted to alcohol was admitted to hospital with headache and rhinorrhoea. Investigation revealed Pasteurella ureae meningitis and bacteraemia. A course of intravenous cefotaxime and penicillin G, followed by surgical correction of a nasocranial fistula, led to full recovery. Fourteen cases of serious extrarespiratory infections due to P. ureae are briefly reviewed.

Topics: Actinobacillus; Actinobacillus Infections; Adult; Cefotaxime; Humans; Male; Meningitis; Penicillin G; Sepsis

The new cephalosporin compounds have increased in vitro activity against gram-negative enteric bacilli and penetrate well into cerebrospinal fluid. Moreover, their pharmacokinetic properties are favorable and their safety seems adequate, although insufficiently evaluated to date. Interest has been focused on them as therapeutic agents for neonatal sepsis and meningitis caused by Enterobacteriaceae. In this review the third generation cephalosporins are evaluated for their possible use in the neonates; opinions are based on currently available data. It is concluded that moxalactam and cefotaxime and probably also ceftriaxone and ceftazidime represent valuable alternatives to aminoglycosides for therapy of severe neonatal infection.

Topics: Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Enterobacteriaceae Infections; Humans; Infant, Newborn; Meningitis; Moxalactam; Sepsis

Topics: Bacteria; Cefotaxime; Humans; Microbial Sensitivity Tests; Sepsis

Neural tube defects are the second most common congenital malformation in humans. Despite significant decreases in neural tube defects and related mortality and morbidity with recent developments, infections remain an important problem. Research on the role of topical therapy for managing neural tube defects and associated infections in the neonatal period has been limited. This randomized controlled trial aimed to investigate the efficiency of topical Rifampin on infection control in paraplegic newborns with open neural tube defects.. Thirty-seven patients who underwent an operation for neural tube defects were included. Topical Rifampin and cefotaxime were administered to 19 patients constituting the case group and local saline and cefotaxime were administered to a control group. Patients were examined for ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, and sepsis.. None of the patients using topical rifampin had ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, or sepsis. In the control group, ventriculoperitoneal shunt infection/dysfunction was found in 4 (22.2%) cases, surgical site infection in 3 (27.7%), urinary tract infection in 3 (27.7%), and sepsis in 5 (27.7%), with statistically significant differences between the groups (. Topical Rifampin is effective in minimizing complications like sepsis, surgical site infection, urinary tract infection, and ventriculoperitoneal shunt infection due to neural tube defect operations. Further research with larger numbers of cases is needed to implement this practice routinely.

Topics: Administration, Topical; Anti-Bacterial Agents; Catheter-Related Infections; Cefotaxime; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infections; Male; Neural Tube Defects; Paraplegia; Rifampin; Sepsis; Surgical Wound Infection; Treatment Outcome; Urinary Tract Infections; Ventriculoperitoneal Shunt

Reduced target attainment of β-lactam antibiotics is reported in critically ill patients. However, as target attainment of cefotaxime in severely ill pediatric sepsis patients may differ from adults due to age-related variation in pharmacokinetics, we aimed to assess target attainment of cefotaxime in this pilot study using meningococcal septic shock patients as a model for severe sepsis. Secondary analysis of prospectively collected data from a randomized controlled trial. Children with meningococcal septic shock (1 month to 18 years) included in this study received cefotaxime 100-150 mg/kg/day as antibiotic treatment. Left-over plasma samples were analyzed using LC-MS/MS to determine cefotaxime concentrations. MIC values from EUCAST were used to determine target attainment of cefotaxime for Neisseria meningitidis (0.125 mg/l), but also for Streptococcus pneumoniae (0.5 mg/l), Enterobacteriaceae (1 mg/l), and Staphylococcus aureus (4 mg/l). Target attainment was adequate when all samples exceeded MIC or fourfold MIC values. One thirty-six plasma samples of 37 severe septic shock patients were analyzed for cefotaxime concentrations. Median age was 2 years with a median PRISM-score of 24 and mortality of 24.8%. The median unbound cefotaxime concentration was 4.8 mg/l (range 0-48.7). Target attainment ranged from 94.6% for the MIC of N. meningitidis to 16.2% for fourfold the MIC S. aureus. Creatinine levels were significantly correlated with cefotaxime levels. Target attainment of cefotaxime with current dosing guidelines seems to be adequate for N. meningitidis but seems to fail for more frequently encountered pathogens in severely ill children.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Critical Illness; Female; Humans; Infant; Infant, Newborn; Male; Meningococcal Infections; Neisseria meningitidis; Pilot Projects; Sepsis; Shock, Septic

To compare the effectiveness of two antibiotic regimens among neonates with late onset sepsis (LOS).. This randomized controlled trial conducted in a tertiary care teaching hospital, South India, included 90 babies with LOS. Detailed history, examination and appropriate investigations were done for all the babies. Cloxacillin + Amikacin were administered to 40 and Cefotaxime + Gentamicin to 50 babies. Outcomes including mortality, complications and treatment failure were evaluated. Chi-square test was used for categorical variables and Student's unpaired t-test for continuous variables.. LOS had a male preponderance, and median time of onset was 13 days. Mortality was more among low birth weight babies irrespective of the antibiotics. Predominant bacteria isolated were coagulase-negative staphylococci (26.67%), Escherichia coli (13.33%) and Streptococcus pneumoniae (13.33%). Complications, mortality and cost were similar in both regimens.. There was no significant difference between the two antibiotic regimens with regard to outcome of LOS.

Topics: Amikacin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cloxacillin; Drug Therapy, Combination; Female; Follow-Up Studies; Gentamicins; Hospitals, Teaching; Humans; India; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Length of Stay; Male; Outcome Assessment, Health Care; Sepsis; Single-Blind Method; Time Factors

Considering the already known pharmacological features of cefotaxime, a study with two approaches of pharmacokinetics and clinical efficacy in septicaemic dogs was carried out. Pharmacokinetic variables were defined for doses of 10 mg/kg, and 20 mg/kg, utilising a quantitative bacteriological analysis. Values for half-life (T1/2 beta) at 10 mg/kg were 0.8, 1.48 and 1.52 h for the i.v., s.c. and i.m. routes, respectively. Corresponding values for the 20 mg/kg dose for the same routes were 0.8, 1.49 and 1.53 h, respectively. Relatively fast clearance (ranging from 0.58 to 0.64 L/kg/h) allowed a maximum dose interval of 12 h. The above-stated doses of cefotaxime were administered i.v. to 40 cases of septicaemia, clinically divided into 20 moderately severe cases treated with 10 mg/kg i.v., of cefotaxime bid, and 20 severe ones, treated with 20 mg/kg i.v. of cefotaxime bid. Injections continued until a previously defined criterion of 'clinically recovered' was obtained. Thereafter, a follow-up treatment was established using the same dose and dose-interval but through the s.c. route. Due to the apparent volumes of distribution obtained (ranging from 0.48 to 0.51 L/kg), considering the overall clinical efficacy obtained (90% for the 10 mg/kg dose and 75% for the 20 mg/kg dose), and due to the rapid improvement observed after a few doses of the drug (1.8 to 2.5 doses to 'clinical improvement'), it is safe to postulate such doses of cefotaxime as excellent choices for the treatment of septicaemia in dogs.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Dog Diseases; Dogs; Drug Administration Schedule; Female; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Male; Sepsis; Severity of Illness Index; Tissue Distribution; Treatment Outcome

In a multicentre, prospective, controlled trial 211 patients with suspected septicaemia or pneumonia were allocated at random to either imipenem-cilastatin 500 mg 8-hourly or cefotaxime 1 g 6-hourly combined with amikacin 5 mg/kg 8-hourly. The treatments were administered for at least 5 days. Seventy patients on imipenem and 70 patients on cefotaxime-amikacin were assessable for comparison. There were no statistically significant differences between the two groups in underlying pathology and in the clinical results obtained: septicaemia 20/26 patients of the imipenem group and 20/25 patients of the cefotaxime-amikacin group were cured; pneumonia 38/44 patients of the imipenem group and 34/45 patients of the cefotaxime-amikacin group were cured. There were also no differences in the initial organisms and in the bacteriological cure rate, except for Pseudomonas aeruginosa. At the moment, imipenem administered alone is as effective as the cefotaxime-amikacin combination in the treatment of septicaemia or pneumonia in intensive care patients, with the exception of P. aeruginosa pneumonia in patients under assisted ventilation.

Topics: Adult; Aged; Aged, 80 and over; Amikacin; Anti-Bacterial Agents; Cefotaxime; Cilastatin; Drug Therapy, Combination; Female; Humans; Imipenem; Intensive Care Units; Male; Middle Aged; Prospective Studies; Randomized Controlled Trials as Topic; Respiratory Tract Infections; Sepsis

Biliary sepsis represents a major percentage of fatal complications after endoscopic retrograde cholangiopancreatography. We performed a randomized controlled study to investigate the value of antibiotic prophylaxis, and to assess the frequency and source of infectious complications associated with ERCP. Ninety-six patients who underwent 100 endoscopic retrograde cholangiopancreatographies were included in the study. Half of the patients received antibiotic prophylaxis (Cefotaxime 2 g i.v. 15 min before the procedure). Bacteremia was detected in 2% of the patients receiving antibiotic prophylaxis, as compared with 16% (p less than 0.02) in the control group. In order to determine the source of bacteremia, bile samples and irrigation fluid from the suction channel of the endo-scope were obtained for bacteriological evaluation. Several lines of evidence suggested that bacteremia associated with ERCP was essentially caused by mucosal lesions of the oropharynx. Bacteremia was asymptomatic, with the exception of two patients who subsequently developed fever, but recovered rapidly under antibiotic therapy. The frequency of cholangitis following ERCP was not significantly reduced by antibiotic prophylaxis (4% vs. 2%). Recommendations for antibiotic prophylaxis are discussed.

Topics: Cefotaxime; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Sepsis

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

Topics: Adult; Aged; Aged, 80 and over; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Gram-Negative Bacteria; Humans; Middle Aged; Prospective Studies; Random Allocation; Sepsis

Topics: Aged; Cefotaxime; Female; France; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Otorhinolaryngologic Neoplasms; Random Allocation; Sepsis; Surgical Wound Infection; Time Factors

The combination of beta-lactam antibiotics and new quinolones is a form of broad spectrum antibiotic therapy rapidly bactericidal in vitro which could be an alternative to the classical combination of beta-lactam antibiotics and aminoglycosides in the first line treatment of febrile episodes in patients with neutropenia. The treatment of 37 initial febrile episodes (12 cases of septicemia, 7 infectious sites and 38 cases of fever of unknown origin) in 33 neutropenic patients (PMN leucocytes less than 500/mm3) using the combination of a third generation cephalosporin (cefotaxime or ceftazidime) and a new quinolone (pefloxacin) resulted in an 86% immediate success rate (32 cases/37). Results and course during treatment were similar in both groups (cefotaxime or ceftazidime). A second febrile episode occurred in 11 cases (4 superinfections, 2 chest infections, 5 fevers of unknown origin). Clinical acceptability was satisfactory in both groups. Minimal and transient changes in liver function tests were observed in 19% of the successfully treated patients. Study of quantitative aerobic stool cultures revealed the emergence of resistant bacterial strains, essentially Pseudomonas sp. (6 cases). More extensive trials should provide a better view of the role of this new combination in the first line treatment of febrile episodes in the neutropenic patient.

Topics: Agranulocytosis; Anti-Infective Agents; Cefotaxime; Ceftazidime; Drug Evaluation; Drug Therapy, Combination; Escherichia coli Infections; Feces; Fever; Focal Infection; Humans; Leukemia; Neutropenia; Norfloxacin; Pefloxacin; Pseudomonas Infections; Sepsis; Staphylococcal Infections

In a prospective, randomized study we compared cefotaxime (C) with tobramycin plus cefazolin (C + T) in the treatment of Enterobacterial septicemia. Twenty-five patients received C and twenty two C + T. There are 8 treatment failures, in C + T group, 3 in C group. We observed 5 adverse effects, 2 in the C group (1 reversible collapse and 1 Pseudomonas aeruginosa superinfection) and 3 in the C + T group (acute renal failures). We conclude that C may be more effective and less toxic than cefazolin plus tobramycin for patients with Enterobacterial septicemia.

Topics: Aged; Cefazolin; Cefotaxime; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Middle Aged; Prospective Studies; Random Allocation; Sepsis; Tobramycin

Rapid eradication of bacteria in bloodstream is critical for the outcome in neonatal bacterial sepsis. Two groups of neonates with E. coli K1 sepsis without purulent meningitis were studied. Group I (n = 14) received cefotaxime IV (100 mg.kg-1 D-1) plus netilmicin (4 mg.kg-1 D-1); group II (n = 8) received amoxicillin/clavulanic acid IV (100/10 mg.kg-1 D-1) plus netilmicin (4 mg.kg-1 D-1). Both groups were identical. For all strains MICs of cefotaxime, amoxicillin/clavulanic acid, netilmicin were less than 0.2, 4 and 1 mg/l respectively. Serum bactericidal activity (SBA) was determined for each patient (peak sample). The SBA was defined as the greatest dilution in which 99,99% of the inoculum was killed. Time-kill curves were performed with 1:16 dilutions of peak serum samples to measure the kinetic of bacterial killing. The minimal bactericidal time of serum (MBTS) was defined as the minimal time required to observe a decrease of more than 4 log CFU/ml of the bacterial inoculum. Samples (10 microliters) were taken at 1 h intervals over a 6 h period and at 24 h for quantitative culture. All patients cured. Median SBA were respectively 1/128 and 1/64 for group I and II. However, mean MBTS for groups I and II were respectively 1.2 h +/- 0.8 and 3.9 h +/- 1.4. Killing was more rapid in group I (p less than 0.01). The MBTS may be a clinically useful adjunctive test when optimal therapy would be expected.

Topics: Amoxicillin; Blood Bactericidal Activity; Cefotaxime; Clavulanic Acids; Drug Therapy, Combination; Escherichia coli Infections; Humans; Infant, Newborn; Netilmicin; Sepsis; Time Factors

Topics: Amikacin; Cefotaxime; Clinical Trials as Topic; Drug Therapy, Combination; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Sepsis

In a prospective, observer-blind study, the authors assessed the efficacy of cefotaxime (2 gm IV) as auxiliary therapy to the currently used antimicrobial prophylaxis in transurethral prostatectomy. Cefotaxime was administered to 48 patients. From these, 188 blood specimens were drawn and eight blood cultures from eight patients were positive. From an untreated control group of 50 patients 196 specimens were drawn. Thirty-one of these specimens (from 17 patients) were positive (P less than 0.05). This significant reduction was due mainly to fewer pathogen isolates (1 versus 16). The number of postoperative complications was reduced from 21 in 15 patients to 12 in 10 patients (P less than 0.05). It is concluded that a single IV dose of 2 gm of cefotaxime protects against the immediate perioperative complications.

Topics: Aged; Aged, 80 and over; Bacteriuria; Cefotaxime; Drug Evaluation; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Prostatectomy; Random Allocation; Sepsis

93 patients were enrolled into a prospective randomised study to determine the efficacy and safety of netilmicin, cefotaxime or their combination in the treatment of sepsis caused by susceptible strains of Enterobacteriaceae or staphylococci. 83 patients were evaluable for safety, 74 for clinical efficacy and 63 for microbiological response including 36 patients (57%) with positive blood cultures. There were significantly more clinical failures with cefotaxime than with netilmicin even when urinary tract sepsis was excluded. Microbiological failures occurred more frequently in the cefotaxime arm and were associated with Klebsiella and Enterobacter spp. Four cefotaxime failures were subsequently successfully treated with netilmicin. More mixed infections were however enrolled by chance into the cefotaxime arm. The statistical difference between netilmicin and cefotaxime is not significant if mixed infections are excluded. There was no difference in efficacy between the netilmicin and combination groups although superinfection was seen in the latter group. The incidence of nephrotoxicity was greater in the netilmicin group but not significantly so. Only one minor case of ototoxicity was detected in the 41 patients receiving netilmicin who had serial audiograms. The results suggest that netilmicin is a more effective agent than cefotaxime for treating life-threatening infections with susceptible Enterobacteriaceae or staphylococci particularly with infections in non-urinary tract sites. If dosage of netilmicin is closely monitored by measuring serum concentrations, toxicity is minimal.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Cross Infection; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Netilmicin; Random Allocation; Sepsis; Staphylococcal Infections

The effect of short-term antibiotic prophylaxis on postoperative infection with 2 injections of cefotaxime begun preoperatively was evaluated in a double-blind, randomized, placebo-controlled trial at 1 center on 181 patients with preoperative sterile urine undergoing transurethral resection (90) or open prostatectomy (91). Antibiotic prophylaxis reduced the number of urinary infections significantly in both groups without altering the level of resistant pathogens. Cefotaxime lowered the incidence of postoperative infection in the early postoperative period from 30 to 4 per cent in the transurethral resection group and from 46 to 4.5 per cent in the open prostatectomy group. A significant difference was found between the 2 treatment groups in the incidence of perioperative bacteremia and postoperative fever. Among the patients undergoing an open prostatectomy a reduced rate of wound infection and a shorter duration of hospital stay were witnessed in the treated group. Thus, short-term chemoprophylaxis by cefotaxime is of benefit in reducing morbidity and hospital cost for prostatectomy by either procedure.

Topics: Cefotaxime; Clinical Trials as Topic; Double-Blind Method; Fever; Humans; Length of Stay; Male; Premedication; Prostatectomy; Random Allocation; Risk; Sepsis; Surgical Wound Infection; Time Factors; Urinary Tract Infections

The standard regimen used by members of the European Organization for Research on Treatment of Cancer Antimicrobial Therapy Cooperative Group for empiric therapy of febrile neutropenic cancer patients has been treatment with ticarcillin plus amikacin. A three-arm prospective randomized controlled trial was performed to determine whether the extended-spectrum antipseudomonal penicillin azlocillin or the extended-spectrum cephalosporin cefotaxime had more or less efficacy than the beta-lactam in the ticarcillin-plus-amikacin regimen. A total of 742 patients from 22 institutions were evaluated. Single gram-negative rod bacteremias accounted for 83 episodes, and it was among these patients that the prognosis was least satisfactory, leading to a more intensive evaluation of this patient group. In these patients the azlocillin-plus-amikacin regimen resulted in a 66% response rate, compared with a 37% response rate for patients who received cefotaxime plus amikacin (P = 0.080) and a 47% response rate for patients who received ticarcillin plus amikacin (P = 0.207). The patients with gram-negative rod bacteremias and persistently profound granulocytopenia had substantially poorer response rates (37%) than the patients with rising granulocyte counts (73%; P = 0.004). A logistic regression analysis indicated that the following factors also affected infection resolution: beta-lactam utilization in the regimen (azlocillin was better than ticarcillin or cefotaxime), resolution of profound granulocytopenia (less than 100 cells per microliter) during therapy, and susceptibility to the beta-lactam antibiotic.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Azlocillin; Cefotaxime; Child; Clinical Trials as Topic; Drug Therapy, Combination; Female; Fever; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Kanamycin; Male; Middle Aged; Penicillins; Prospective Studies; Random Allocation; Regression Analysis; Sepsis; Ticarcillin

Fifty-nine patients with severe urinary tract infections were treated with either cefotaxime or ampicillin plus netilmicin in a controlled, open randomised study of the clinical and bacteriological effects. The patients responded favourably in both groups. The minimum inhibitory concentrations of cefotaxime against the isolates from blood were low for all bacterial strains except one (Streptococcus faecalis). Time to normalisation of temperature was significantly shorter in the cefotaxime group. The results suggest that cefotaxime is an effective and well-tolerated agent in the treatment of serious infections. However, the difference between the two groups was too small to allow preference of one procedure over the other.

Topics: Ampicillin; Cefotaxime; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Netilmicin; Sepsis; Surgical Wound Infection; Urinary Tract Infections

This study was undertaken to analyse the results in 192 patients who 3 to 4 years earlier had undergone transurethral resection (TUR) in a controlled clinical trial on the value of a short peri-operative course of antibiotics. The survival rate was comparable in both groups. Most deaths were due to cardiovascular disease and/or cancer of the prostate and the gastrointestinal tract. Infectious events predominated in the control group and more antibiotics were prescribed for these patients during follow-up than for the patients in the peri-operative antibiotic group. Bacteriuria was found in 24% of patients, evenly distributed between the groups. Eighty-three per cent were satisfied with the results of prostatectomy but 38% complained of symptoms from the lower urinary tract. The maximum urinary flow rate was not influenced by the presence of bacteriuria and/or symptoms. There was no difference between the groups regarding mortality or morbidity except for the frequency of post-operative urethral stricture formation, which was significantly higher in the controls. It was concluded that prospective long-term follow-up is indicated to assess the effect of short peri-operative antibiotic courses.

Topics: Aged; Bacteriuria; Cefotaxime; Clinical Trials as Topic; Humans; Male; Postoperative Complications; Prostatectomy; Random Allocation; Sepsis; Urethral Stricture; Urinary Bladder Neck Obstruction; Urodynamics

The effect on bacteriologically documented postoperative infection of flash prophylaxis using two intravenous injections of 20 mg/kg cefotaxime each was evaluated in a double blind, randomized trial against placebo. 181 participants free of urinary tract infection prior to surgery had either transurethral prostatic resection (TUR) (n = 90) or open prostatectomy (OP) (n = 91). Urine samples, blood samples, prostate specimens and skin swabs were investigated for pathogens. Rate of urinary tract infection was significantly reduced by cefotaxime (CTX) prophylaxis in both groups. CTX lowered the incidence of early postoperative urinary tract infection from 30% to 4% in TURs and from 46% to 4.5% in OPs. Similarly, a significant difference was demonstrated for incidences of intra and postoperative bacteremia. In open prostatectomy patients, a reduced rate of wound infection and shorter hospital stay were noted in the treated group. Pathogens recovered in this study were Streptococcus (29%), Staphylococcus (20.5%), Enterobacteriaceae (45.75%), Pseudomonas (1.25%), Acinetobacter (3%), and Bacteroides fragilis (0.5%). CTX prophylaxis apparently has no bearing on postoperative emergence of resistant pathogens. Percentage of resistance to CTX in delayed postoperative infections was 33% in the control group and 35% in the treated group. We conclude that flash CTX prophylaxis in transurethral or open prostatectomy is of benefit in reducing morbidity and hospital costs.

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Double-Blind Method; Humans; Male; Postoperative Complications; Prostate; Prostatectomy; Prostatic Diseases; Random Allocation; Sepsis; Urinary Tract Infections; Wound Infection

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

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

Seventy-seven patients with acute bacterial infections were treated with ceftriaxone (1 gm administered intravenously every 12 hours). The 58 patients evaluable for efficacy had 60 infections, including 39 of the respiratory tract, 14 of the urinary tract, and seven of soft tissue. Five patients were bacteremic. The mean duration of ceftriaxone treatment was eight days for patients with respiratory and urinary tract infections and 13 days for patients with other types of infections. A satisfactory clinical response occurred in 56 (93%) of the infections. Eighty-four (94%) of the 89 pretherapy pathogens were bacteriologically eradicated. Included were all 19 isolates of Haemophilus influenzae, all 15 of Streptococcus pneumoniae, all 12 of Escherichia coli, 22 of the 23 isolates of other Enterobacteriaceae species, three of five isolates of Pseudomonas aeruginosa, and three of four isolates of Staphylococcus aureus. Two cases of superinfection (one with bacteremia) occurred with P aeruginosa. There were two cases each of reinfection and colonization with Streptococcus faecalis. One patient developed manifestations of culture-documented S pneumoniae meningitis eight hours after the first dose was administered. Peak and trough plasma levels of ceftriaxone were 142 and 64 micrograms/ml. Ceftriaxone achieved therapeutic levels in infected cerebrospinal fluid and in the abscess fluid of selected patients. Adverse effects, which were mild, included diarrhea in 4% of the patients and elevated transaminase levels in 10%.

Topics: Adult; Aged; Alanine Transaminase; Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Connective Tissue Diseases; Diarrhea; Escherichia coli Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Pneumococcal Infections; Respiratory Tract Infections; Sepsis; Streptococcus pneumoniae; Time Factors; Urinary Tract Infections

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

Ceftriaxone given once-a-day was compared with cefazolin given three times daily as therapy for complicated and uncomplicated urinary tract infections. One hundred ten patients were randomly assigned to receive either 1 g of ceftriaxone every 24 hours or 1 g of cefazolin every eight hours. Standard bacteriologic methods were used to identify the pathogens and their susceptibilities before treatment and at intervals during and after treatment. Clinically, the two regimens were similarly efficacious. Bacteriologic results were significantly better with ceftriaxone in both the proportion of pathogens eradicated and the number of patients cured. The results demonstrate that ceftriaxone compares favorably with cefazolin and is effective when given once-a-day for both complicated and uncomplicated urinary tract infections.

Topics: Adult; Aged; Bacteria; Cefazolin; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Sepsis; Urinary Tract Infections

Forty-two men with urinary tract infection and benign prostatic hyperplasia were randomized into two groups before transurethral resection. One group (22 patients) received Claforan (cefotaxime) peroperatively and thereafter daily for five days. In the other group (20 patients), Hiprex (methenamine hippurate) was given daily from the day before the operation, for a total of six days. All the bacterial isolates were sensitive to cefotaxime. The efficacy of the medication was clinically and bacteriologically evaluated. Postoperative temperature elevation (greater than 38 degrees C) occurred in one of the 22 patients in the cefotaxime group, and in nine of the 20 in the methenamine hippurate group (p less than 0.05). None of the former group, but two patients in the latter, had septicemia. The difference was not statistically significant. The response to treatment was satisfactory in 13 of the 22 patients in the cefotaxime group, but in only one of the 20 treated with methenamine hippurate (p less than 0.005). Antibiotic treatment is recommended for bacteriuric patients undergoing transurethral prostatic resection.

Topics: Aged; Cefotaxime; Clinical Trials as Topic; Hippurates; Humans; Male; Methenamine; Middle Aged; Postoperative Complications; Premedication; Prostatectomy; Prostatic Hyperplasia; Random Allocation; Sepsis; Urethra; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Cefotaxime; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Ireland; Male; Middle Aged; Sepsis; United Kingdom

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

Topics: Bacterial Infections; Biliary Tract Diseases; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Endocarditis, Bacterial; Female; Genital Diseases, Female; Humans; Japan; Kinetics; Meningitis; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Topics: Abdomen; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Gonorrhea; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Osteitis; Respiratory Tract Infections; Sepsis; Skin Diseases, Infectious; United States; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Sepsis; Urinary Tract Infections

Klebsiella pneumoniae is a major pathogen implicated in nosocomial infections. Extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae isolates are a public health concern. We aim to characterize the type of β-lactamases and the associated resistance mechanisms in ESBL-producing K. pneumoniae isolates obtained from blood cultures in a Portuguese hospital, as well as to determine the circulating clones. Twenty-two cefotaxime/ceftazidime-resistant (CTX/CAZR) K. pneumoniae isolates were included in the study. Identification was performed by MALDI-TOF MS and the antimicrobial susceptibility testing by disk-diffusion. The screening test for ESBL-production was performed and ESBL-producer isolates were further characterized. The presence of different beta-lactamase genes (blaCTX-M, blaSHV, blaTEM, blaKPC, blaNDM, blaVIM, blaOXA-48, blaCMY-2, blaDHA-1, blaFOX, blaMOX, and blaACC) was analyzed by PCR/sequencing in ESBL-producer isolates, as well as the presence of other resistance genes (aac(6')-Ib-cr, tetA/B, dfrA, qnrA/B/S, sul1/2/3) or integron-related genes (int1/2/3). Multilocus-sequence-typing (MLST) was performed for selected isolates. ESBL activity was detected in 12 of the 22 CTX/CAZR K. pneumoniae isolates and 11 of them carried the blaCTX-M-15 gene (together with blaTEM), and the remaining isolate carried the blaSHV-106 gene. All the blaCTX-M-15 harboring isolates also contained a blaSHV gene (blaSHV-1, blaSHV-11 or blaSHV-27 variants). Both blaSHV-27 and blaSHV-106 genes correspond to ESBL-variants. Two of the CTX-M-15 producing isolates carried a carbapenemase gene (blaKPC2/3 and blaOXA-48) and showed imipenem resistance. The majority of the ESBL-producing isolates carried the int1 gene, as well as sulphonamide-resistance genes (sul2 and/or sul3); the tetA gene was detected in all eight tetracycline-resistant isolates. Three different genetic lineages were found in selected isolates: ST348 (one CTX-M-15/TEM/SHV-27/KPC-2/3-producer isolate), ST11 (two CTX-M-15/TEM/SHV-1- and CTX-M-15-TEM-SHV-11-OXA-48-producer isolates) and ST15 (one SHV-106/TEM-producer isolate). ESBL enzymes of CTX-M-15 or SHV-type are detected among blood K. pneumoniae isolates, in some cases in association with carbapenemases of KPC or OXA-48 type.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftazidime; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Multilocus Sequence Typing; Sepsis; Sequence Analysis, DNA

Group B Streptococcus (GBS) is an important cause of invasive infection in neonates and infants. Cerebrospinal fluid (CSF) findings and culture may not show evidence of infection early in GBS meningitis. Next-generation sequencing (NGS) has the potential to detect microbial genetic material in patients with infectious diseases. We report two cases of infantile sepsis of GBS meningitis with negative results for CSF culture tests, but positive results for NGS analysis.. Patient 1 was a 22-day-old male infant diagnosed with sepsis and meningitis. His CSF findings showed pleocytosis, decreased glucose, and increased protein levels. However, CSF and blood culture results at admission were negative. He received a total of 3 weeks of treatment with ampicillin and cefotaxime, and showed clinical improvement. GBS was detected through NGS analysis of CSF collected at admission. Patient 2 was a 51-day-old male infant with sepsis. CSF findings on admission were normal, and blood and CSF cultures were also negative. Intravenous ampicillin and cefotaxime treatment were initiated. Treatment was de-escalated to ampicillin alone because Enterococcus faecalis was cultured from urine. He was discharged after a total of 1 week of antibiotic treatment. Six days after discharge, he was re-hospitalized for sepsis. Blood and CSF cultures were negative, and E. faecalis was again cultured from urine. He received a total of 3 weeks of ampicillin treatment for enterococcal-induced nephritis and did not relapse thereafter. NGS pathogen searches were retrospectively performed on both blood and CSF collected at the first and second admission. GBS was detected in the CSF collected at the first admission, but no significant pathogen was detected in the other samples. Inadequate treatment for GBS meningitis at the first admission may have caused the recurrence of the disease.. Infantile sepsis may present bacterial meningitis that is not diagnosed by either culture testing or CSF findings. NGS analysis for CSF may be useful for confirming the diagnosis of bacterial meningitis.

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Cerebrospinal Fluid; Enterococcus faecalis; High-Throughput Nucleotide Sequencing; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Retrospective Studies; Sepsis; Streptococcal Infections; Streptococcus agalactiae; Urine

To describe the clinical presentation and medical management of a cat with perinephric abscessation and urosepsis following urethral obstruction and catheterization.. A 2-year-old intact male domestic shorthaired cat presented to an emergency and referral center for lethargy, vomiting, and hematuria. Severe azotemia and hyperkalemia were observed on a serum biochemistry panel. The patient was diagnosed with urethral obstruction and was treated with urethral catheterization, calcium gluconate, IV fluid therapy, buprenorphine, and prazosin. The patient's azotemia improved, and the hyperkalemia resolved. Urinary catheterization was discontinued. The patient developed pyrexia, worsening azotemia, hypoalbuminemia, hyperbilirubinemia, and dysuria. Urethral catheterization was repeated. Abdominal radiographs showed left renomegaly, and abdominal ultrasound revealed left perinephric fluid. Ultrasound-guided centesis of the perinephric fluid revealed septic inflammation, and the sample was consistent with urine based upon sample creatinine. Fluid from the perinephric abscess and urine from the bladder both grew Pasturella spp. The patient was treated with perinephric catheterization, saline lavage, and a continuous infusion of cefotaxime for 72 h. The patient's azotemia quickly resolved, and the patient was discharged after 6 days of hospitalization. The patient was reported to have made a full recovery.. This is the first described case of perinephric abscess and urosepsis following urethral obstruction in a cat and its successful medical management. Perinephric abscess not associated with intrarenal abscess has not previously been identified. Additionally, continuous antimicrobial infusion to treat overwhelming infection and the use of the RapidBac Vet immunoassay for point-of-care detection of urinary tract infection has not been described in cats.

Topics: Abdominal Abscess; Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Cefotaxime; Fluid Therapy; Hyperkalemia; Kidney Diseases; Male; Sepsis; Ultrasonography; Urethral Obstruction; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections

To explore the curative effects of vancomycin and cefotaxime combined with gamma globulin respectively in neonatal septicemia and their influences on PCT, CRP, and hs-CRP, so as to provide references for clinical treatment.. 181 patients with neonatal septicemia admitted to Huangshi Maternity and Child Health Hospital from April 2012 to August 2014 were selected as the study subjects. Patients treated with vancomycin combined with gamma globulin were selected as group A (96 cases) and those treated with cefotaxime combined with gamma globulin were selected as group B (85 cases). The improvement time of clinical symptoms (milk rejection, nervous system symptoms, body temperature), hospital stays, mortality, medicine curative effects, adverse reactions, complications, and levels of serum CRP, PCT, and hs-CRP of patients before and after treatment were compared between the two groups.. The improvement time of clinical symptoms like body temperature, milk rejection, and neurological symptoms, as well as hospital stays in group A were lower than those in group B (p<0.05); the total effective rate of medicine curative effects in group B was better than that in group A (p<0.05); there was no significant difference in levels of serum CRP, PCT, and hs-CRP between the two groups before treatment (p>0.05); after treatment, levels of serum CRP, PCT, and hs-CRP in both groups decreased significantly, and levels of serum CRP, PCT, and hs-CRP in group B decreased more significantly than those in group A (p<0.05).. Cefotaxime combined with gamma globulin in the treatment of patients with neonatal septicemia has short improvement time in clinical symptoms, high total effective rate of drugs, low mortality, fewer adverse reactions and complications, and can significantly reduce levels of serum CRP, PCT, and hs-CRP, which is worthy of further promotion and application in clinical practice.

Topics: C-Reactive Protein; Cefotaxime; Drug Therapy, Combination; Female; gamma-Globulins; Humans; Infant, Newborn; Injections, Intravenous; Male; Procalcitonin; Sepsis; Vancomycin

In 2013 German infection surveillance guidelines recommended weekly colonization screening for multidrug-resistant (MDRO) or highly epidemic organisms for neonatal intensive care units (NICUs) and extended hygiene measures based on screening results. It remains a matter of debate whether screening is worth the effort. We therefore aimed to evaluate sepsis related outcomes before and after the guideline update.. The German Neonatal Network (GNN) is a prospective cohort study including data from extremely preterm infants between 22 + 0 and 28 + 6 gestational weeks born in 62 German level III NICUs.. Infants treated after guideline update (n = 8.903) had a lower mortality (12.5% vs. 13.8%, p = 0.036), reduced rates for clinical sepsis (31.4 vs. 42.8%, p <  0.001) and culture-proven sepsis (14.4% vs. 16.5%, p = 0.003) as compared to infants treated before update (n = 3.920). In a multivariate logistic regression analysis, nine pathogens of culture-proven sepsis were associated with sepsis-related death, e.g. Pseudomonas aeruginosa [OR 59 (19-180), p <  0.001)]. However, the guideline update had no significant effect on pathogen-specific case fatality, total sepsis-related mortality and culture-proven sepsis rates with MDRO. While the exposure of GNN infants to cefotaxime declined over time (31.1 vs. 40.1%, p <  0.001), the treatment rate with meropenem was increased (31.6 vs. 26.3%, p <  0.001).. The introduction of weekly screening and extended hygiene measures is associated with reduced sepsis rates, but has no effects on sepsis-related mortality and sepsis with screening-relevant pathogens. The high exposure rate to meropenem should be a target of antibiotic stewardship programs.

Topics: Anti-Bacterial Agents; Antimicrobial Stewardship; Cefotaxime; Female; Germany; Humans; Hygiene; Infant, Extremely Premature; Infant, Newborn; Intensive Care Units, Neonatal; Logistic Models; Male; Meropenem; Mortality; Multivariate Analysis; Population Surveillance; Practice Guidelines as Topic; Prospective Studies; Pseudomonas aeruginosa; Sepsis

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

Optimisation of antibiotic therapy for extracorporeal membrane oxygenation (ECMO) patients remains a pharmacological challenge. The objective of this study was to observe the plasma concentrations of commonly used antibiotics in intensive care for patients treated with extracorporeal membrane oxygenation.. The PHARMECMO study was a pilot, prospective study, conducted in a cardiac surgery intensive care unit. Every adult patient under ECMO support, with known or suspected sepsis and receiving antibiotic therapy, was eligible for inclusion. Plasma concentrations of antibiotics were determined by a combination of liquid chromatography and mass spectrometry.. Forty-four eligible patients were enrolled for 68 inclusions on a twelve-month period. For the association piperacillin-tazobactam (n=19), 68.7% of CT50 and 93.7% of Cmin reached the pharmacokinetic goals defined (64 mg.L-1 for CT50 and 16 mg.L-1 for Cmin). For cefotaxime (n=12), the pharmacokinetic goals (4 mg.L-1 for CT50 and 1 mg.L-1 for Cmin) were achieved in 100% of the cases for CT50 and in 81.8% of the cases for Cmin. Regarding imipenem (n=10), the pharmacokinetic goals were 16 mg.L-1 for CT50 and 4 mg.L-1 for Cmin. Only one CT50 was above 16 mg.L-1. For Cmin, 60% of the doses did not reach the target concentration. In our 10 patients, only one patient was considered as reaching the pharmacokinetic goals. Finally, for amikacin (n=6), four Cmax (66.7%) were infra-therapeutics for a target between 60 and 80 mg.L-1.. These preliminary results suggest that therapeutic drug monitoring could optimise the achievement of pharmacokinetic objectives associated with an effective antibiotic therapy. For most patients, the recommended doses of imipenem and amikacin did not achieve the pK targets.

Topics: Aged; Amikacin; Anti-Bacterial Agents; Cefotaxime; Cilastatin, Imipenem Drug Combination; Coronary Care Units; Drug Monitoring; Extracorporeal Membrane Oxygenation; Female; Gentamicins; Humans; Male; Middle Aged; Pilot Projects; Piperacillin, Tazobactam Drug Combination; Prospective Studies; Sepsis; Tobramycin

The mortality rate associated with

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Ciprofloxacin; Colony Count, Microbial; Disease Models, Animal; Drug Synergism; Drug Therapy, Combination; Female; Humans; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Minocycline; Sepsis; Survival Analysis; Tigecycline; Vibrio Infections; Vibrio vulnificus

In older adults, few studies confirm that adequate concentrations of antibiotics are achieved using current dosage regimens of intravenous β-lactam antibiotics. Our objective was to investigate trough concentrations of cefotaxime, meropenem, and piperacillin in older adults hospitalized with infection. We included 102 patients above 70 years of age. Total trough antibiotic concentrations were measured and related to suggested target intervals. Information on antibiotic dose, patient characteristics, and 28-day outcomes were collected from medical records and regression models were fitted. Trough concentrations for all three antibiotics exhibited considerable variation. Mean total trough concentrations for cefotaxime, meropenem, and piperacillin were 6.5 mg/L (range 0-44), 3.4 mg/L (range 0-11), and 30.2 mg/L (range 1.2-131), respectively. When a target range of non-species-related breakpoint - 5× non-species-related breakpoint was applied, only 36% of patients had both values within the target range. Regression models revealed that severe sepsis was associated with varying concentration levels and increasing age and diminishing kidney function with high concentration levels. The study was not powered to demonstrate consequences in clinical outcomes. Conclusively, in older adults treated with cefotaxime, meropenem, or piperacillin-tazobactam, trough antibiotic concentrations varied considerably. Better predictors to guide dosing regimens of β-lactam antibiotics or increased use of therapeutic drug monitoring are potential ways to address such variations.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Bacterial Infections; beta-Lactams; Cefotaxime; Drug Monitoring; Female; Humans; Length of Stay; Male; Meropenem; Patient Readmission; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prospective Studies; Sepsis; Sweden; Thienamycins

Topics: Aged; Amikacin; Anti-Bacterial Agents; Calcinosis; Cardiomyopathies; Cefotaxime; Female; Humans; Norepinephrine; Sepsis; Treatment Outcome; Vasoconstrictor Agents

To test the synergistic effect of Cpl-711 endolysin and antibiotics for antipneumococcal activity.. A combination of Cpl-711 and different antibiotics (amoxicillin, cefotaxime, levofloxacin and vancomycin) was tested in a checkerboard assay against several multidrug-resistant Streptococcus pneumoniae strains. Mouse and zebrafish models of pneumococcal sepsis were used to confirm the in vitro data.. The activity of Cpl-711 combined with amoxicillin or cefotaxime was synergistic in the bactericidal effect against a serotype 23F multiresistant clinical isolate of S. pneumoniae. Synergy between Cpl-711 and cefotaxime was validated using both mouse and zebrafish models.. Combination of Cpl-711 and cefotaxime may help in the treatment of diseases caused by multiresistant pneumococcal strains.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Disease Models, Animal; Drug Resistance, Multiple, Bacterial; Drug Synergism; Female; Mice; Mice, Inbred BALB C; Muramidase; Pneumococcal Infections; Recombinant Fusion Proteins; Sepsis; Streptococcus Phages; Streptococcus pneumoniae; Zebrafish

Ser/Thr protein kinase (STK1) plays a critical role in cell wall biosynthesis of and drug resistance in methicillin-resistant Staphylococcus aureus (MRSA). MRSA strains lacking STK1 become susceptible to failing cephalosporins, such as Ceftriaxone and Cefotaxime. STK1, despite being nonessential protein for MRSA survival, it can serve as an important therapeutic agent for combination therapy. Here, we report a novel small molecule quinazoline compound, Inh2-B1, which specifically inhibits STK1 activity by directly binding to its ATP-binding catalytic domain. Functional analyses encompassing in vitro growth inhibition of MRSA, and in vivo protection studies in mice against the lethal MRSA challenge indicated that at high concentration neither Inh2-B1 nor Ceftriaxone or Cefotaxime alone was able to inhibit the growth of bacteria or protect the challenged mice. However, the growth of MRSA was inhibited, and a significant protection in mice against the bacterial challenge was observed at a micromolar concentration of Ceftriaxone or Cefotaxime in the presence of Inh2-B1. Cell-dependent minimal to no toxicity of Inh2-B1, and its abilities to down-regulate cell wall hydrolase genes and disrupt the biofilm formation of MRSA clearly indicated that Inh2-B1 serves as a therapeutically important "antibiotic-resistance-breaker," which enhances the bactericidal activity of Ceftriaxone/Cefotaxime against highly pathogenic MRSA infection.

Topics: Adenosine Triphosphate; Amino Acid Sequence; Animals; Anti-Bacterial Agents; Binding Sites; Biofilms; Catalytic Domain; Cefotaxime; Ceftriaxone; Cell Line; Cell Wall; Disease Models, Animal; Drug Resistance, Microbial; Drug Resistance, Multiple, Bacterial; Female; Gene Deletion; Genes, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Mice; Protein Kinase Inhibitors; Protein Serine-Threonine Kinases; Sepsis; Small Molecule Libraries; Virulence Factors

Cefotaxime is one of the most frequently prescribed antibiotics for the treatment of Gram-negative bacterial sepsis in neonates. However, the dosing regimens routinely used in clinical practice vary considerably. The objective of the present study was to conduct a population pharmacokinetic study of cefotaxime in neonates and young infants in order to evaluate and optimize the dosing regimen. An opportunistic sampling strategy combined with population pharmacokinetic analysis using NONMEM software was performed. Cefotaxime concentrations were measured by high-performance liquid chromatography-tandem mass spectrometry. Developmental pharmacokinetics-pharmacodynamics, the microbiological pathogens, and safety aspects were taken into account to optimize the dose. The pharmacokinetic data from 100 neonates (gestational age [GA] range, 23 to 42 weeks) were modeled with an allometric two-compartment model with first-order elimination. The median values for clearance and the volume of distribution at steady state were 0.12 liter/h/kg of body weight and 0.64 liter/kg, respectively. The covariate analysis showed that current weight, GA, and postnatal age (PNA) had significant impacts on cefotaxime pharmacokinetics. Monte Carlo simulations demonstrated that the current dose recommendations underdosed older newborns. A model-based dosing regimen of 50 mg/kg twice a day to four times a day, according to GA and PNA, was established. The associated risk of overdose for the proposed dosing regimen was 0.01%. We determined the population pharmacokinetics of cefotaxime and established a model-based dosing regimen to optimize treatment for neonates and young infants.

Topics: Anti-Bacterial Agents; Body Weight; Cefotaxime; Chromatography, High Pressure Liquid; Computer Simulation; Drug Administration Schedule; Drug Dosage Calculations; Female; Gestational Age; Gram-Negative Bacterial Infections; Humans; Infant; Infant, Newborn; Intensive Care Units; Male; Models, Statistical; Monte Carlo Method; Sepsis; Tandem Mass Spectrometry

Due to the introduction of the conjugate vaccine against serotype b, neonatal sepsis caused by Haemophilus influenzae became very rare. There is little data in Belgium concerning the prevalence of H. influenzae early onset neonatal sepsis and articles about neonatal sepsis and H. influenzae published in the last decade are scarce. We report two invasive infections with a non-typeable H. influenzae. These cases show that neonatal sepsis caused by non-typeable H. influenzae may be underestimated and we believe that there is need for a better registration of this kind of infection.

Topics: Anti-Bacterial Agents; Cefotaxime; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant, Newborn; Microbial Sensitivity Tests; Sepsis; Serotyping; Time Factors; Tobramycin; Treatment Outcome

Acute osteomyelitis of the clavicle accounts for less than 3% of osteomyelitis cases, with its usual location in the middle third. It may be hematogenous, due to contiguity, or secondary to catheterization of the subclavian vein or neck surgery. The diagnosis is often delayed, and clinical symptoms may simulate obstetric brachial plexus palsy in young children. We report a new case of osteomyelitis of the clavicle in a 30-day-old newborn.

Topics: Abscess; Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Catheterization, Central Venous; Cefotaxime; Clavicle; Female; Fever of Unknown Origin; Follow-Up Studies; Fosfomycin; Fractures, Spontaneous; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Infusions, Intravenous; Male; Osteomyelitis; Pregnancy; Pregnancy Complications, Infectious; Radionuclide Imaging; Sepsis; Streptococcal Infections; Ultrasonography

The in vivo efficacy of a cefotaxime-ciprofloxacin combination against Vibrio vulnificus and the effects on rtxA1 expression of commonly used antibiotics are unknown.. In vitro time-kill studies were performed to evaluate synergism. Female BALB/c mice were injected subcutaneously with 1×10(7) or 1×10(8) cfu of V. vulnificus. Antibiotic therapy was initiated at 2 h after inoculation in the following four therapy groups: cefotaxime; ciprofloxacin; cefotaxime-plus-ciprofloxacin; and cefotaxime-plus-minocycline. The cytotoxicity of V. vulnificus for HeLa cells was measured using the lactate dehydrogenase assay; rtxA1 transcription was measured in a transcriptional reporter strain using a β-galactosidase assay.. In vitro time-kill assays exhibited synergism between cefotaxime and ciprofloxacin. In the animal experiments, the 96-h survival rate for the cefotaxime-plus-ciprofloxacin group (85%; 17/20) was significantly higher than that of the cefotaxime-plus-minocycline (35%; 7/20) and cefotaxime alone (0%; 0/20) groups (P<0.05 for both). Bacterial counts in the liver and spleen were significantly lower in the cefotaxime-plus-ciprofloxacin group 24 and 48 h after treatment, relative to the other groups. At sub-inhibitory concentrations, ciprofloxacin inhibited more effectively rtxA1 transcription and mammalian cell cytotoxicity than either minocycline or cefotaxime (P<0.05 for both).. Ciprofloxacin is more effective at reducing rtxA1 transcription and subsequent cytotoxicity than either minocycline or cefotaxime, and the combination of ciprofloxacin and cefotaxime was more effective in clearing V. vulnificus in vivo than previously used regimens. These data suggest that the combination of ciprofloxacin and cefotaxime is an effective option for the treatment of V. vulnificus sepsis in humans.

Topics: Animals; Anti-Bacterial Agents; Bacterial Toxins; Cefotaxime; Cell Death; Ciprofloxacin; Colony Count, Microbial; Drug Therapy, Combination; Female; HeLa Cells; Humans; Mice, Inbred BALB C; Microbial Sensitivity Tests; Sepsis; Survival Analysis; Time Factors; Transcription, Genetic; Vibrio Infections; Vibrio vulnificus

Cutaneous candidiasis is a disease that affects children as well as adults. The presentation may be localized or systemic, and with multiple etiological agents. The most prevalent infecting species in children differs from that of the adult.. A case is presented where a congenital cutaneous candidiasis was transmitted to the child during birth.. A full term newborn was exposed to a subclinical vaginal candidiasis infection, and 24 hr after birth, developed congenital cutaneous candidiasis. The etiological agent was Candida albicans, and was associated with sepsis and respiratory distress. Blood cultures, cutaneous biopsy of vesicular lesions, blood tests and lumbar puncture were performed.. Biochemistry and blood count showed a CRP of 5.7 mg/dl, leukocytosis with left shift and mild anemia. After 24 hr, the blood analyses showed an increase in a CRP (7.8 mg/dl) and increased progressively for three days; consequently, a lumbar puncture was performed. Blood culture was positive for Staphylococcus aureus. Cutaneous biopsy confirmed the cutaneous candidiasis.. The early diagnosis is essential to prevent complications derived by the Candida albicans in newborns.

Topics: Administration, Cutaneous; Administration, Oral; Anti-Infective Agents; Bacteremia; Bicarbonates; Candidiasis, Cutaneous; Candidiasis, Vulvovaginal; Cefotaxime; Cerebrospinal Fluid; Chlorhexidine; Coinfection; Early Diagnosis; Emollients; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Miconazole; Potassium Permanganate; Pregnancy; Pregnancy Complications, Infectious; Respiration Disorders; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Therapeutic Irrigation

We evaluated the efficacy of NXL104, a novel β-lactamase inhibitor, in combination with ceftazidime (CAZ) in two murine infection models (septicemia and thigh infection). We chose two KPC-producing Klebsiella pneumoniae strains (VA-361 and VA-406) showing MICs of CAZ of ≥256 μg/ml. Septicemia was induced by the intraperitoneal injection of KPC-producing K. pneumoniae followed 30 min later by a single subcutaneous treatment with CAZ alone or CAZ-NXL104 in ratios of 2:1, 4:1, 8:1, and 16:1. In this model, the median effective doses for 50% (ED(50)) of the animals for CAZ alone versus VA-361 and VA-406 were 1,578 and 709 mg/kg of body weight, respectively. When combined with NXL104 at 2:1, 4:1, 8:1, and 16:1 ratios, the CAZ ED(50)s for VA-361 and VA-406 were reduced to 8.1 and 3.5 mg/kg, 15.1 and 3.8 mg/kg, 16.9 and 7.2 mg/kg, and 29.5 and 12.1 mg/kg, respectively. For thigh infection, neutropenia was induced by the intraperitoneal injection of cyclophosphamide at days -4 and -1 preinfection. Infection was established by the intramuscular injection of KPC-producing K. pneumoniae into the right thigh. Mice were treated 1.5 h postinfection with either CAZ alone or CAZ-NXL104 at constant ratios of 4:1. When thighs were removed at 24 h postinfection, a >2-log CFU reduction was observed for mice treated with CAZ-NXL104 at doses of ≥128:32 mg/kg. In contrast, CAZ doses of ≥1,024 mg/kg were unable to reduce the numbers of CFU. Despite resistance to CAZ and possessing a complex β-lactamase background, NXL104 combined with CAZ proved to be very effective in murine models of infection due to contemporary highly resistant KPC-producing K. pneumoniae isolates.

Topics: Animals; Anti-Bacterial Agents; Azabicyclo Compounds; Ceftazidime; Disease Models, Animal; Female; Klebsiella Infections; Klebsiella pneumoniae; Mice; Microbial Sensitivity Tests; Sepsis

Relative to the cefotaxime-gentamicin combination, the moxifloxacin-cefotaxime combination significantly reduced microglial activation and immature oligodendrocyte cell death and delayed myelination in the developing white matter of neonatal rats with experimental Escherichia coli sepsis. These neuroprotective effects were not due to differences in in vivo bactericidal activities or in the systemic inflammatory responses and could be related to the intrinsic immunomodulatory properties of moxifloxacin. Molecular mechanisms underlying the neuroprotective effect of moxifloxacin remain to be elucidated.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Aza Compounds; Cefotaxime; Escherichia coli Infections; Fluoroquinolones; Gentamicins; Leukoencephalopathies; Moxifloxacin; Quinolines; Rats; Rats, Sprague-Dawley; Sepsis

The Capnocytophaga sputigena isolate NOR, responsible for septicemia, was resistant to amoxicillin and narrow-spectrum cephalosporins. In a cloning experiment, a new gene, bla(CSP-1), was identified; this gene encodes a novel extended-spectrum beta-lactamase (ESBL) that shares only 52% and 49% identities with the CME-1 and VEB-1 beta-lactamases, respectively. The G+C content of this gene, its genetic environment, the absence of conjugation transfer, and its detection in two reference strains suggested that it was an intrinsic resistance gene located on the chromosome.

Topics: Amino Acid Sequence; Amoxicillin; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Capnocytophaga; Cephalosporins; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Sepsis

Topics: Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Disseminated Intravascular Coagulation; Fluid Therapy; Humans; Intracranial Hypertension; Meningitis, Meningococcal; Meningococcal Vaccines; Polysaccharides, Bacterial; Sepsis

We reported previously that the use of cephalosporin among premature neonates increased the risk of subsequent fungal sepsis. As a result, we recommended that ampicillin and gentamicin be used as empiric coverage for early-onset neonatal sepsis while culture results are awaited.. To describe antibiotic use during the first 3 days after birth for neonates admitted to the NICU and to evaluate the outcomes for neonates treated with 2 different antibiotic regimens.. We assembled a cohort of inborn neonates, from our deidentified administrative database, who had documented exposure to ampicillin during the first 3 days after birth. Infants treated concurrently with cefotaxime or gentamicin were evaluated, to identify the factors that were associated independently with death before discharge, with both univariate and multivariate analyses.. There were 128,914 neonates selected as the study cohort; 24,111 were treated concurrently with ampicillin and cefotaxime and 104,803 were treated concurrently with ampicillin and gentamicin. Logistic modeling showed that neonates treated with ampicillin/cefotaxime were more likely to die (adjusted odds ratio: 1.5; 95% confidence interval: 1.4-1.7) and were less likely to be discharged to home or foster care than were neonates treated with ampicillin/gentamicin. This observation was true across all estimated gestational ages. Other factors that were associated independently with death included immature gestational age, need for assisted ventilation on the day of admission to the NICU, indications of perinatal asphyxia or major congenital anomaly, and reported use of ampicillin/cefotaxime.. For patients receiving ampicillin, the concurrent use of cefotaxime during the first 3 days after birth either is a surrogate for an unrecognized factor or is itself associated with an increased risk of death, compared with the concurrent use of gentamicin.

Topics: Ampicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefotaxime; Drug Therapy, Combination; Gentamicins; Humans; Infant Mortality; Infant, Newborn; Risk Factors; Sepsis

Epididymitis, or epididymo-orchitis, and infected hydrocele are unusual in the neonatal period. It is critical to differentiate them rapidly from testicular torsion to salvage the affected testis and avoid unnecessary surgical exploration. Escherichia coli is an important gram-negative bacteria causing diverse neonatal infections and is also the common bacteria causing epididymo-orchitis from an ascending route. We report the case of a preterm infant affected with epididymo-orchitis and infected hydrocele caused by early-onset E. coli sepsis. We highlight the importance of sampling proper cultures and using suitable antibiotics after excluding testicular torsion in a neonate with an acute scrotum.

Topics: Acute Disease; Bacteremia; Cefotaxime; Diagnosis, Differential; Epididymitis; Escherichia coli Infections; Humans; Infant, Newborn; Infant, Premature; Male; Orchitis; Scrotum; Sepsis; Spermatic Cord Torsion; Testicular Hydrocele; Tomography, X-Ray Computed; Ultrasonography

Streptococcus agalactiae or group B streptococcus, GBS, is the leading cause of neonatal and maternal infections and an opportunistic pathogen in adults with underlying disease. In the last decade, a dramatic increase in the resistance of this microorganism to erythromycin and clindamycin has been observed.. To determine the serotype distribution and antimicrobial susceptibility of isolates of S. agalactiae collected from infections and colonization and to assess the genetic mechanisms of macrolide and clindamycin resistance.. A total of 100 GBS isolates were collected between 1998 and 2002, in Santiago, Chile. They were isolated from the amniotic fluid from patients with premature rupture of membranes (7 isolates), blood from neonatal sepsis (10 isolates), neonate colonizations (2 strains), skin and soft tissue infections (7 isolates), urinary tract infections (5 isolates), genital infections (3 isolates), articular fluid (one isolate), and 65 strains were recovered from vaginal colonization55.. Serotypes Ia, II and III were the predominant serotypes identified in our study, accounting for 90 (90%) of the strains. Five isolates belonged to serotypes Ib (5%) and two (2%) to serotype V respectively; no strains belonging to serotype IV were found. All strains were susceptible to penicillin G, ampicillin and cefotaxime, and four isolates (4%) were resistant to both erythromycin (MIC >64 microg/ml) and clindamycin (MIC >64 microg/ml). The strains had a constitutive macrolide-lincosamide-streptogramin (cMLSB) resistance phenotype and the erm(A) gene was present in the four isolates.. Serotypes Ia, II and III were the predominant serotypes in this study. All strains were susceptible to penicillin G, ampicillin and cefotaxime, and four (4%) strains were resistant to both erythromycin and clindamycin. The cMLSB resistance phenotype, and the erm(A) gene was detected in resistant strains.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Phenotype; Pregnancy; Sepsis; Serotyping; Streptococcal Infections; Streptococcus agalactiae; Tetracycline

Topics: Cefotaxime; Combined Modality Therapy; Debridement; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Fever; Foot; Gangrene; Hand; Humans; IgA Vasculitis; Immunocompetence; Infant; Ischemia; Male; Physical Therapy Modalities; Plasma; Plastic Surgery Procedures; Pneumococcal Infections; Pneumonia, Pneumococcal; Sepsis; Skin Transplantation; Vancomycin

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

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

A 59-year-old female patient with a history of malignant lymphoma presented with symptoms of septicaemia. The skin of the extremities showed bullous, necrotizing plaques. Blood culture revealed Vibrio vulnificus as the causative organism. The infection was most likely acquired while swimming in the unusually warm Baltic Sea through inadvertent swallowing of sea water. The disease is rare in Europe. It is discussed in view of its typical clinical and histological picture.

Topics: Anti-Bacterial Agents; Cefotaxime; Female; Humans; Injections, Intravenous; Lymphoma, B-Cell; Middle Aged; Remission Induction; Sepsis; Skin; Sweet Syndrome; Swimming; Time Factors; Treatment Outcome; Vibrio Infections; Vibrio vulnificus

Topics: Cefotaxime; Cross Infection; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infant, Premature; Sepsis; Staphylococcal Infections; Vancomycin

A dose-ranging study to investigate the in vivo effects of the presence of specific antibodies on the efficacy of beta-lactam treatment of sepsis caused by Streptococcus pneumoniae (non-beta-lactam-susceptible serotype 6B isolate) was performed with a BALB/c mouse model. Hyperimmune serum was obtained from mice immunized with the heat-inactivated strain. The rate of mortality was 100% in nontreated animals in the absence of specific antibodies. A single injection of a one-half or one-quarter dilution of hyperimmune serum produced 60 to 40% survival rates. In the absence of specific antibodies, the minimal effective doses of amoxicillin and cefotaxime that produced survival rates of 100 and 80% were 25 and 50 mg/kg of body weight (three times a day for up to six doses), respectively. These doses produced times that the levels in serum remained above the MIC (deltaT > MICs) approximately 30% of the dosing interval. When specific antibodies were present (by administration of a one-half or one-quarter dilution of hyperimmune serum), the minimal effective doses of the antibiotics were 3.12 and 6.25 mg/kg ( approximately 8 times lower), with the deltaT > MICs being approximately 3 and 5% of the dosing interval for amoxicillin and cefotaxime, respectively. This in vivo combined pharmacodynamic effect offers possibilities that can be used to address penicillin resistance.

Topics: Amoxicillin; Animals; Antibodies, Bacterial; Antibody Specificity; beta-Lactams; Cefotaxime; Disease Models, Animal; Humans; Immune Sera; Mice; Mice, Inbred BALB C; Pneumococcal Infections; Sepsis; Streptococcus pneumoniae; Treatment Outcome

Meningococcal disease is the leading infective cause of mortality in children. Bronchiolitis and meningococcal disease share some common features. Both are seasonal diseases with epidemics in winter. A preceding history of upper respiratory tract infection is commonly present in both. We report two cases of meningococcal disease in infants whose initial presentation was suggestive of bronchiolitis. We draw attention to tachypnoea as an important but overlooked early sign of meningococcal septicaemia.

Topics: Bronchiolitis; Cefotaxime; Cephalosporins; Diagnosis, Differential; Humans; Infant; Male; Meningococcal Infections; Neisseria meningitidis; Penicillin G; Penicillins; Sepsis

Salmonella worthington is an emerging pathogen and has been implicated in a number of outbreaks of neonatal meningitis and septicemia. Over a period of 5 years, a total of 30 strains of this pathogen were isolated from blood and cerebrospinal fluid of neonates suffering from septicemia with or without meningitis. Most of these strains were resistant to the penicillin group of antibiotics, and many were resistant to cefotaxime. Sixty percent of the isolates were resistant to amikacin; 86% were resistant to chloramphenicol, and none were resistant to ciprofloxacin or norfloxacin. Parenteral fluoroquinolone should be included as part of antibiotic therapy in suspected cases of neonatal meningitis due to S. worthington.

Topics: Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Chloramphenicol; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Norfloxacin; Penicillins; Prevalence; Retrospective Studies; Salmonella; Salmonella Infections; Sepsis; Time Factors

Data on the incidence of Enterobacter infections in neonates over prolonged periods of time are scant. We determined the epidemiology of Enterobacter sepsis and/or meningitis and the trends of infection in a neonatal unit.. Retrospective review of sepsis and/or meningitis in inborn neonates admitted to Son Dureta University Hospital during a 22-year period. Molecular study by ribotyping of the Enterobacter strains isolated from 1995 to 1997.. There were 513 cases of culture-proved sepsis and/or meningitis in neonates. In late onset infections Klebsiella pneumoniae and Staphylococcus epidermidis were the most frequent isolates in the period 1977 through 1991. Enterobacter was the most common isolate in the period 1992 through 1998. During this latter period Candida infections also increased, and the resistance rate of Enterobacter to cefotaxime was higher (59.2%). Decrease in early onset infections and increase in late onsets (4.6/1,000 live births) were observed in the second period. From 1977 to 1998, 45 episodes of sepsis and/or meningitis by Enterobacter species were identified in 44 patients (8.7% of all neonatal bacteremias). Three patients with Enterobacter bacteremia died (6.6%, 0.03/1,000 live births). During 1995 through 1997 5 different clones causing sepsis were identified and 3 were predominant. In 1997 there was an outbreak of Enterobacter disease. After cleaning, cohort nursing and hygiene reinforcement, Enterobacter was not isolated in the next 2 years. No change in the antibiotic policy was made.. We observed a resurgence of Enterobacter infections in our neonatal intensive care unit. The sudden disappearance of this microorganism after reinforcement of hygienic measures, without withdrawing cefotaxime, confirms the importance of patient-to-patient transmission of this nosocomial infection. Further studies are needed to establish the role of antibiotics in the emergence of microorganisms in neonatal intensive care units.

Topics: Cefotaxime; Cross Infection; Drug Resistance, Bacterial; Enterobacter; Enterobacteriaceae Infections; Female; Humans; Hygiene; Infant, Newborn; Intensive Care Units, Neonatal; Longitudinal Studies; Male; Meningitis, Bacterial; Retrospective Studies; Ribotyping; Sepsis

Fear of infection in neonatal intensive care units (NICUs) often leads to early use of empiric broad-spectrum antibiotics, a strategy that selects for resistant bacteria. We investigated whether the emergence of resistant strains could be halted by modifying the empiric antibiotic regimens to remove the selective pressure that favours resistant bacteria.. Two identical NICUs were assigned to different empiric antibiotic regimens. On unit A, penicillin G and tobramycin were used for early-onset septicaemia, flucloxacillin and tobramycin were used for late-onset septicaemia, and no broad-spectrum beta-lactam antibiotics, such as amoxicillin and cefotaxime were used. In unit B, intravenous amoxicillin with cefotaxime was the empiric therapy. After 6 months of the study the units exchanged regimens. Rectal and respiratory cultures were taken on a weekly basis.. There were 436 admissions, divided equally between the two regimens (218 in each). Three neonates treated with the penicillin-tobramycin regimen became colonised with bacilli resistant to the empirical therapy used versus 41 neonates on the amoxicillin-cefotaxime regimen (p<.0001). The relative risk for colonisation with strains resistant to the empirical therapy per 1000 patient days at risk was 18 times higher for the amoxicillin-cefotaxime regimen compared with the penicillin-tobramycin regimen (95% CI 5.6-58.0). Enterobacter cloacae was the predominant bacillus in neonates on the amoxicillin-cefotaxime regimen, whereas Escherichia coli predominated in neonates on the penicillin-tobramycin regimen. These colonisation patterns were also seen when the units exchanged regimens.. Policies regarding the empiric use of antibiotics do matter in the control of antimicrobial resistance. A regimen avoiding amoxicillin and cefotaxime restricts the resistance problem.

Topics: Amoxicillin; Cefotaxime; Cephalosporins; Cross-Sectional Studies; Drug Resistance, Microbial; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Organizational Policy; Penicillins; Prospective Studies; Sepsis

Antibiotic susceptibility profiles were analyzed for 119 invasive and 227 colonizing strains of group B streptococci isolated from neonates at 6 US academic centers. All strains were susceptible to penicillin, vancomycin, chloramphenicol, and cefotaxime. The rate of resistance to erythromycin was 20.2% and to clindamycin was 6.9%. Resistance to erythromycin increased in 1997. Type V strains were more resistant to erythromycin than were type Ia (P=.003) and type Ib (P=.004) strains and were more resistant to clindamycin than were type Ia (P<.001), type Ib (P=.01), and type III (P=.001) strains. Resistance rates varied with geographic region: in California, there were high rates of resistance to erythromycin and clindamycin (32% and 12%, respectively), and low rates in Florida (8.5% and 2.1%, respectively). Penicillin continues to be the drug of choice for treatment of group B streptococcus infection. For women who are penicillin intolerant, however, the selection of an alternative antibiotic should be guided by contemporary resistance patterns observed in that region.

Topics: Anti-Bacterial Agents; Bacterial Capsules; Cefotaxime; Chloramphenicol; Clindamycin; Drug Resistance, Microbial; Erythromycin; Female; Humans; Infant, Newborn; Microbial Sensitivity Tests; Ofloxacin; Penicillins; Sepsis; Serotyping; Streptococcal Infections; Streptococcus agalactiae; Tetracycline; Vancomycin

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

It is shown, that tumour and progression of the tumour process cause a change in the normal microflora of the tracheobronchial tree. Highlighted in the article are causes making for an origination of inflammatory processes, infectious complications in those patients presenting with oncological diseases. Regimens of antibacterial therapy are given. The following methods of investigation into bodily endogenous intoxication have been developed: malonic dialdehyde, superoxiddismutase, and coefficient K. Toxic effects of antibiotics on the organism were found out to be dependent on the regimen of their administration. Perioperative antibiotic prophylaxis was proved to be superior from the standpoint of the clinical practice to the postoperative one.

Topics: Antibiotic Prophylaxis; Biomarkers; Cefotaxime; Cephalosporins; Humans; Lung Neoplasms; Malondialdehyde; Postoperative Care; Preoperative Care; Retrospective Studies; Sepsis; Superoxide Dismutase; Time Factors

Complement component C9 is required for rapid complement-mediated killing of Escherichia coli. In this report, the influence of supplemental C9 on the bactericidal and protective effects of beta-lactam antibiotics in neonates was assessed. By rocket immunoelectrophoresis, the intrinsic C9 concentrations of pooled serum from both human and rat neonates was less than 20% of adult levels. Supplemental C9 purified from human plasma enhanced the capacity of ampicillin-treated serum from human neonates to impair the survival of E coli O7:K1:NM (P < 0.02). Similarly, supplemental C9 enhanced the capacity of cefotaxime-treated neonatal rat serum to impair the survival of E coli O1:K1:NM (P < 0.05). Moreover, the intraperitoneal administration of C9 enhanced the survival of cefotaxime-treated neonatal rats that were septic with E coli (P < 0.05). These observations may contribute to the development of new strategies, such as augmentation of complement component serum concentrations, to reduce the morbidity and mortality of neonatal E coli sepsis.

Topics: Adult; Ampicillin; Animals; Animals, Newborn; Anti-Bacterial Agents; Bacteremia; Blood Bactericidal Activity; Cefotaxime; Complement C9; Escherichia coli; Escherichia coli Infections; Female; Fetal Blood; Humans; In Vitro Techniques; Infant, Newborn; Pregnancy; Rats; Rats, Sprague-Dawley; Sepsis

This case report reviews the clinical course of an 11-day-old boy who developed late-onset neonatal sepsis secondary to a rare neonatal pathogen, Morganella morganii. This gram-negative enteric bacterium, within the Enterobacteriaceae family, has most commonly been a nosocomial pathogen in debilitated, postsurgical patients. Like many other Enterobacteriaceae, M. morganii has an inducible beta-lactamase and is resistant to multiple antibiotics. When caring for neonates with culture-proven M. morganii sepsis, the authors recommend administering both a third-generation cephalosporin and an aminoglycoside to ensure that both antibiotics are bactericidal and to reduce the induction of resistance.

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Drug Resistance, Multiple; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Infant, Newborn; Male; Microbial Sensitivity Tests; Penicillins; Sepsis

A case report of a newborn with sepsis due to nontypable H.Influenzae biotype IV is presented. There were no prematurity nor maternal obstetrical complications involved. The child however suffered from severe respiratory distress. With the aspiration of secretions, the resuscitation with mask oxygen and the empirically started combination of ampicillin and cefotaxime, his condition rapidly improved.

Topics: Ampicillin; Bacterial Typing Techniques; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant, Newborn; Male; Meconium Aspiration Syndrome; Oxygen Inhalation Therapy; Penicillins; Pregnancy; Respiratory Insufficiency; Sepsis

Topics: Anti-Bacterial Agents; Cefazolin; Cefotaxime; Emphysema; Endocarditis; Endophthalmitis; Escherichia coli Infections; Fatal Outcome; Gentamicins; Humans; Male; Middle Aged; Oxacillin; Sepsis; Urinary Tract Infections

In order to evaluate the antimicrobial activity of meropenem (MEPM), minimum inhibitory concentrations (MICs) of MEPM and control drugs were determined against clinical isolates from blood and cerebrospinal fluid that were obtained from January, 1993 to December, 1994. The results are summarized as follows; 1. The MIC-range, 50% MIC (MIC50) and 90% MIC (MIC90) of MEPM were equal to those of imipenem (IPM) and panipenem (PAPM) against Streptococcus pneumoniae including benzylpenicillin (PCG)-insensitive or -resistant S. pneumoniae, Streptococcus agalactiae and Listeria monocytogenes which are Gram-positive strains, and were stronger than those of ampicillin (ABPC) and cefotaxime (CTX). 2. The MIC-range, MIC50 and MIC90 of these 3 drugs of carbapenems (MEPM, IPM and PAPM) were different against Escherichia coli and Haemophilus influenzae which are Gram-negative strains. The MIC90 of MEPM was < or = 0.025 microgram/ml and those of IPM and PAPM were 0.2 microgram/ml against E. coli. The MIC90 of MEPM was 0.1 microgram/ml, that of IPM was 25 micrograms/ml and that of PAPM was 6.25 micrograms/ml against H. influenzae. Thus, the antimicrobial activity of MEPM was stronger than those of IPM and PAPM. The MIC90's of IPM and PAPM against H. influenzae were high with the MIC of IPM at 12.5 approximately 25 micrograms/ml and the MIC of PAPM at 3.13 approximately 12.5 micrograms/ml against 3 IPM-resistant strains among 17 isolates. 3. The MIC90 of ABPC was 0.39 microgram/ml and that of CTX was 0.1 microgram/ml against 20 strains of S. pneumoniae including 6 strains of PCG-insensitive or resistant S. pneumoniae. The MIC90 of ABPC and CTX were higher than those of 3 carbapenem drugs. There were E. coli of 8 strains with ABPC-high resistance (the MIC of ABPC was > 100 micrograms/ml) and 2 strains for which MIC of CTX were 0.39 microgram/ml and 3.13 micrograms/ml. It was found that 29.4% of H. influenzae were beta-lactamase producing strains. 4. It appeared that antimicrobial activities of carbapenems, particularly MEPM were strong against clinical isolates from blood and cerebrospinal fluid. MEPM will be first choice drug by empiric therapy in infections including sepsis and purulent meningitis.

Topics: Ampicillin; Blood; Cefotaxime; Cephalosporins; Cerebrospinal Fluid; Escherichia coli; Humans; Imipenem; Listeria monocytogenes; Meningitis, Bacterial; Meropenem; Penicillins; Sepsis; Streptococcus agalactiae; Streptococcus pneumoniae; Thienamycins

Increasing prevalence of multidrug-resistant (MDR) Salmonella typhi strains in pediatric cases of typhoid fever and chemotherapy restrictions in children, such as fluoroquinolones, require ongoing clinical evaluations of different antibiotic regimens. Previously reported clinical trials with oral cefixime therapy given as a 12-day regimen (20-30 mg/kg divided twice daily) demonstrated both safety and efficacy. An open trial was undertaken to investigate a short course (8-day) regimen of oral cefixime in an Egyptian public fever hospital. Eighty children were initially enrolled with blood culture confirmation in 60 children. Clinical cure was documented in 57 (95 per cent) with three children requiring a change in antibiotic regimen due to therapeutic failure and one child with culture-confirmed relapsed 21 days post-therapy. All S. typhi isolates were sensitive to cefixime as measured by disk diffusion. Cefixime was well-tolerated with only mild side-effects, including nausea/vomiting (8 per cent) and abdominal cramping with loose stools (6 per cent), which may have been secondary to typhoid fever. Cefixime given in a short 8-day course is safe and effective in the management of MDR typhoid fever in children.

Topics: Adolescent; Anti-Bacterial Agents; Cefixime; Cefotaxime; Child; Child, Preschool; Drug Resistance, Microbial; Drug Resistance, Multiple; Egypt; Female; Humans; Male; Salmonella typhi; Sepsis; Treatment Outcome; Typhoid Fever

There has been renewed interest in drug-host defence interaction because of increasing numbers of immunocompromised individuals in whom even a marginal influence on host response may have a beneficial effect on clinical outcome. The immunomodulating activity of several antibiotics has been investigated in the past. Unfortunately most of these studies have focussed on in vitro effects. Many controversies arise from the use of non-standardized techniques. In vivo experiments performed in animals might be far from the clinical situation. The effect of antibiotics on pagocyte function has been studied most intensively. Immunostimulating and depressing activities of antibiotics have been described. The clinical relevance is still controversial, e.g., the intracellular uptake of an antibiotic does not necessarily mean better microbial killing. Synergistic activities have been found with some macrolides and newer cephalosporins, but until now clinical studies in humans are still missing. Not only patients with abnormal host defence mechanisms, but also patients with transient immunosuppression during operations or after burns, could benefit from antibiotics with additional immunomodulating activities. More studies in humans are required before optimal clinical applications can be recommended.

Topics: Adjuvants, Immunologic; Animals; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cells, Cultured; Clinical Trials as Topic; Granulocytes; Humans; Immunocompromised Host; Immunologic Factors; Infections; Lymphocytes; Mice; Phagocytes; Rats; Renal Dialysis; Sepsis

In-vitro and clinical efficacy of a combination therapy consisting of 3 antibiotic agents was to be assessed in neonatal septicemia.. From 1980 to 1987, 152 newborns with septicemia as proven by blood culture were treated with an initial antibiotic regimen consisting of azlocillin (150 mg/kg bw), cefotaxime (100 mg/kg bw), and tobramycin (5 mg/kg bw).. According to the microbiologic testing, antimicrobic therapy was effective in each of the 152 organisms: 101/152 bacteria were susceptible to all 3 agents; resistance to 1 or 2 of the antibiotics was evident in 33/152 and in 18/152 organisms, respectively. Mortality due to septicemia was 7.2%.. As no difference was observed in the frequency in which one of the three antibiotic substances was the only effective drug, each of the 3 agents seemed to be necessary for clinical effectiveness of this antibiotic combination.

Topics: Azlocillin; Bacteriological Techniques; Cefotaxime; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Microbial Sensitivity Tests; Risk Factors; Sepsis; Staphylococcal Infections; Streptococcal Infections; Streptococcus agalactiae; Tobramycin

Topics: Administration, Oral; Cefixime; Cefotaxime; Drug Resistance, Microbial; Humans; Infant; Male; Otitis Media; Pneumococcal Infections; Sepsis; Streptococcus pneumoniae

The records of 46 neonates with proven septicaemia were retrospectively studied. Patients could be divided in 2 groups: in group 1 (21 infants) a positive blood culture was obtained before one day of life; in group 2 (25 infants) a positive blood culture was obtained between days 1 and 28. The sensitivity of 9 chemical and bacteriological tests and the efficacy of the initial antibiotic treatment were examined in both groups. Of the 21 germs isolated in patients from group 1, 86% were Gram positive bacteria and 95% were susceptible to ampicillin. Of the 26 germs isolated in patients from group 2, 80% were Gram negative enteric bacteria and 86% were susceptible to cefotaxime. Bacterial tests (gastric aspiration, antigen detection, feces culture) had a better sensibility than biochemical tests (C reactive protein, orosomucoid, fibrinogen).

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Drug Therapy, Combination; Humans; Infant, Newborn; Infant, Newborn, Diseases; Retrospective Studies; Sepsis

In 21 low birth weight infants with two regimens of antibiotic therapy during the first 3 days of life possible hepatotoxic side effects were studied 8 days after the last administration of the tested drugs. Fourteen of the infants were treated with ampicillin/gentamicin and 7 received cefotaxime/gentamicin. The serum concentrations of total bile acids, the activities of transaminases in serum and the cumulative 15N excretion in urine after administration of 3 mg of 15N-labeled methacetin/kg of body weight were used as markers of hepatotoxic side effects. Neither the concentrations of total bile acids (22.6 +/- 12.1 and 19.4 +/- 10.8 mM, respectively) nor the activities of transaminases (alanine aminotransferase, 0.27 +/- 0.06 vs. 0.30 +/- 0.09 mumol/second/liter; aspartate aminotransferase, 0.46 +/- 0.11 vs. 0.49 +/- 0.10 mumol/second/liter) were different between the two groups. In contrast the cumulative 15N excretion in urine was significantly lower in the group treated with cefotaxime/gentamicin than in the group treated with ampicillin/gentamicin (17.2 +/- 6.4 vs. 33.0 +/- 5.1% of intake; P less than 0.01) and also lower than the reported age-related reference values. On the 28th day of life no differences could be found between the cumulative 15N excretion in the urine of the infants treated with cefotaxime/gentamicin and the reported age-related reference values of this test. The results indicate a limited capacity of the monooxygenase system of the liver of low birth weight infants during the first weeks of life and a specific reversible influence of cefotaxime on this hepatocellular system. Further investigations are required to evaluate the clinical relevance of this drug-specific inhibition of the hepatic monooxygenase pathway.

Topics: Acetamides; Ampicillin; Bile Acids and Salts; Bilirubin; Cefotaxime; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Liver; Male; Nitrogen; Prospective Studies; Sepsis; Transaminases

Salmonella typhimurium infections encountered at the neighbourhood of Bursa since January 1987 were evaluated in regard to the antibiotic resistance and treatment. High proportion of resistance was determined to the antibacterial agents such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, tetracycline and more sensitivity to ofloxacin, amikacin, ceftriaxone and cefotaxime was established in 383 Salmonella typhimurium strains isolated within two years of period. No antibiotic therapy was required to adult uncomplicated patients. A combination therapy with cefotaxime and amikacin was found to be satisfactory in the newborn cases with septicemia.

Topics: Adult; Amikacin; Anti-Bacterial Agents; Cefotaxime; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Salmonella Infections; Salmonella typhimurium; Sepsis; Turkey

In 1983 our antibiotic regimen for suspected neonatal septicemia was changed from amoxicillin-gentamicin to cefotaxime-amoxicillin. During the subsequent 5-year period we studied the effect of this change in regimen on the bacterial flora of the infants in the unit and the occurrence of serious infections. This was done with bacteriologic surveillance and analysis of the positive blood cultures from 1978 through 1987. A change in the relative numbers of isolated pathogens was observed; Klebsiella sp. and Escherichia coli decreased whereas Enterobacter sp. increased. The susceptibility of the Enterobacter isolates to cefamandole decreased from 85.3% in 1982 to 52.9% in 1983. The susceptibility of these bacteria to cefotaxime was 55.2% in 1983 and 55.0% in 1987. No change in susceptibilities to cefotaxime, amoxicillin or gentamicin was found in other pathogens. Although colonization with Enterobacter strains has increased and the susceptibility of these bacteria to the cephalosporins has decreased, the incidence of serious infections with Gram-negative bacteria decreased.

Topics: Amoxicillin; Cefotaxime; Drug Resistance, Microbial; Enterobacter; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Gentamicins; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Klebsiella Infections; Male; Sepsis

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

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

A 17-year-old female with a 5-year history of disseminated lupus erythematosus has remained without immunosuppressive therapy for the last 3 years. She was admitted to the hospital for acute abdominal pain, generalized edema, and rapidly developing dyspnea and somnolence. Although all symptoms were consistent with active SLE, septicemia was suspected because of leukocytosis (20,000/microliters), greatly elevated C-reactive protein (45 mg/dl), and normal complement values (C3 0.74 g/l, C4 0.21 g/l). Directly after bacterial blood cultures were prepared, a combined treatment was instituted consisting of plasmapheresis (3 x 2.1 l against fresh frozen plasma), antibiotics, prednisolone, and cyclophosphamide following the last plasmapheresis. Within three days cerebral function returned to normal, edema improved, and CRP fell to 0.5 mg/dl. The blood cultures and pericardial effusion displayed meningococcal colonies.

Topics: Adolescent; Cefotaxime; Combined Modality Therapy; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Meningococcal Infections; Pericardial Effusion; Plasmapheresis; Sepsis

Topics: Aged; Aged, 80 and over; beta-Lactamases; Cefotaxime; Humans; Microbial Sensitivity Tests; Sepsis; Yersinia enterocolitica

A young woman with a history of sick sinus syndrome and placement of a permanent pacemaker 6 months before admission had fever and Haemophilus parainfluenzae bacteremia. A gallium scan localized the infection to the site of the pacemaker wire. Echocardiograms were negative for any vegetations. The patient responded to cefotaxime and trimethoprim-sulfamethoxazole therapy. We believe that this is the first case of H. parainfluenzae bacteremia associated with a pacemaker wire and localized by gallium scan.

Topics: Administration, Oral; Adolescent; Cefotaxime; Female; Gallium Radioisotopes; Haemophilus Infections; Humans; Infusions, Intravenous; Pacemaker, Artificial; Radionuclide Imaging; Sepsis; Sick Sinus Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

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

Two potent third-generation cephalosporins with similar antibacterial spectra but different pharmacokinetics were compared in patients suffering from septicemia due to different organismus. Sixty patients with a variety of underlying diseases were included in the study. They received either 2-4 g ceftriaxone (active ingredient of Rocephin) once a day or 2 g cefotaxime every 8 h for 10-15 days. Our data confirm that a single dose of 2 g ceftriaxone should be sufficient to treat septicemia.

Topics: Adult; Bacterial Infections; Cause of Death; Cefotaxime; Ceftriaxone; Dose-Response Relationship, Drug; Female; Humans; Male; Sepsis

In order to assess the in vivo antibacterial activity of two cephalosporins of third generation, cefotaxime and ceftriaxone, we used the model of experimental bacteremia in chickens we had developed for a few years. 93 chickens were inoculated with 10(7) E. coli K1 coming from a meningitis in a new-born baby. 19 chickens were used as a control group; 29 were given ceftriaxone (50 mg/kg); 28 cefotaxime (50 mg/kg) and 17 cefotaxime (100 mg/kg). The antibiotics were injected 4 hours after the inoculation. The bacterial concentrations found in capillaries by using quantitative blood cultures, were significantly lower in the 3 groups of chickens which were given antibiotics than in the control group, at 24, 48 and 72 hours after inoculation. At 24 hours after the inoculation, the bacterial concentration in the chickens treated by ceftriaxone (50 mg/kg) was significantly lower than that found in chickens treated by cefotaxime (50 mg/kg). At 48 or 72 hours the differences of bacterial concentration in the three groups of chickens were not significant. Over 72 hours following inoculation, 4 control and only one treated chickens died. The efficient clearance of E. coli K1 by a single dose of ceftriaxone, found at 24 hours after inoculation, confirms the possibility of using ceftriaxone once daily for serious infections.

Topics: Animals; Cefotaxime; Ceftriaxone; Chickens; Escherichia coli Infections; Injections, Intravenous; Microbial Sensitivity Tests; Models, Biological; Sepsis; Time Factors

We report a rare case of Klebsiella pneumoniae meningitis associated with liver abscess, which was successfully treated with cefotaxime (CTX), one of the third-generation cephalosporins. A 53-year-old man was admitted to Keio University Hospital on June 13, 1988, because of a fever and a headache. On June 3, he suddenly started shivering and his temperature rose to 39 degrees C. He then began to complain of polydipsia, polyuria, and a weight loss of 4 kg a week. On June 11, he developed a severe headache. Four years prior to this incident, he had been diagnosed as having diabetes after a routine medical examination, but had neglected to undergo medical treatment. On admission, laboratory data showed leukocytosis, hyperglycemia (394 mg/dl) and ketonuria (4+). A lumbar puncture yielded cloudy cerebrospinal fluid (CSF) containing 500/3 cells/mm8, of which about 70% were neutrophils. A diagnosis of diabetic ketoacidosis and purulent meningitis was made. A treatment with ampicillin (ABPC) and CTX, (12 g/day, each) was begun. On the third day, cultures of a blood specimen and CSF yielded both K. pneumoniae. The MICs of CTX to K. pneumoniae isolated from blood and CSF were both 0.05 microgram/ml. ABPC was discontinued, gentamicin was administered for 2 days, CTX was continued at the same dosage level and an administration of prednisolone 40 mg daily was begun.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cefotaxime; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Male; Meningitis; Middle Aged; Sepsis

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

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

Topics: Administration, Oral; Cefotaxime; Delayed-Action Preparations; Female; Ferrous Compounds; Humans; Infant; Male; Sepsis; Yersinia enterocolitica; Yersinia Infections

The in vitro activity of lomefloxacin, a new fluorinated quinolone antimicrobial, was compared to that of enoxacin, norfloxacin, ofloxacin, imipenem, cefotaxime, ceftazidime, and tobramycin against 597 microorganisms isolated from bacteremic patients at a university hospital. Overall, lomefloxacin had activity similar to that of enoxacin and norfloxacin but less than that of ofloxacin. Lomefloxacin had excellent activity against members of the family Enterobacteriaceae and Haemophilus influenzae, and good activity against staphylococci, including oxacillin-resistant strains, as well as many strains of Pseudomonas aeruginosa, P. maltophilia, and Acinetobacter calcoaceticus anitratus ssp anitratus.

Topics: Anti-Bacterial Agents; Bacteria; Cefotaxime; Ceftazidime; Enoxacin; Fluoroquinolones; Humans; Imipenem; Microbial Sensitivity Tests; Norfloxacin; Quinolones; Sepsis; Tobramycin

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

Topics: Catheters, Indwelling; Cefotaxime; Femur; Humans; Male; Middle Aged; Osteomyelitis; Sepsis; Serratia marcescens

Thirteen adult patients (47-81 yr) with gram-negative bacteremia and normal (less than or equal to 1.5 mg/dl) serum creatinines were treated with 1 or 2 gm of cefotaxime every 8 or 12 hr. The infecting organisms were Escherichia coli (9 strains), Klebsiella pneumoniae (2 strains), and one isolate of Salmonella enteritidis and Serratia marcescens. All patients recovered without any serious sequelae. The range of MICs for cefotaxime and desacetyl-cefotaxime were 0.015-0.25 micrograms/ml and 0.015-4.0 micrograms/ml, respectively. The MBC values for cefotaxime and desacetyl-cefotaxime were identical to the MIC values except for two strains. The trough levels of cefotaxime varied from 65.9 to 1.1 micrograms/ml. The serum concentration of desacetyl-cefotaxime varied from 84 to less than 1.0 microgram/ml. All corresponding trough serum inhibitory activities (SIA) were greater than or equal to 1:32. Comparisons of calculated and directly measured serum bactericidal activity (SBA) and SIA results suggest an additive and occasional synergistic benefit of the cefotaxime desacetyl metabolite. This study supports the clinical efficacy and cost-effectiveness of 8- and 12-hr dosing intervals for cefotaxime against bacteremic gram-negative strains having the usual high susceptibility (MICs, less than or equal to 0.25 micrograms/ml) to the newer cephalosporins.

Topics: Aged; Aged, 80 and over; Blood Bactericidal Activity; Cefotaxime; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Gram-Negative Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Sepsis

Endotoxin and monocyte thromboplastin activity were evaluated in rats with gram-negative septicaemia induced by caecal perforation or intravenous Escherichia coli challenge and treated with antibiotics or placebo. Endotoxin burst was not detected in either form of septicaemia during antibiotic treatment. Thromboplastin synthesis in monocytes is known to be stimulated by endotoxin, but the rats showed no increase of monocyte thromboplastin activity after antibiotic treatment, which constituted further evidence against the concept of massive endotoxin liberation during antibiotic therapy for gram-negative septicaemia.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Endotoxins; Escherichia coli Infections; Gentamicins; Male; Monocytes; Rats; Rats, Inbred Strains; Sepsis; Thromboplastin; Tinidazole

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

A case of meningitis and septicaemia caused by a multiply resistant strain of Haemophilus influenzae in a Saudi infant aged 7 months is reported. Haemophilus influenzae, resistant to ampicillin and chloramphenicol, was isolated from the cerebrospinal fluid, the blood and throat. The minimum inhibitory concentrations (MIC) for ampicillin and chloramphenicol were 64 mg/l and 16 mg/l respectively. After failure of initial therapy with high doses of ampicillin and chloramphenicol, the child made a full and uneventful recovery when treated with cefotaxime. The implications of isolating such a strain on the policy for treating meningitis in our situation are discussed.

Topics: Ampicillin; Cefotaxime; Chloramphenicol; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Meningitis, Haemophilus; Penicillin Resistance; Sepsis

Topics: Animals; Animals, Newborn; Bacterial Infections; Cefotaxime; Female; Horse Diseases; Horses; Male; Meningitis; Sepsis

Topics: Cefotaxime; Child; Child, Preschool; Cross Infection; Female; Fosfomycin; Humans; Infant; Infant, Newborn; Intensive Care Units; Male; Sepsis; Staphylococcal Infections

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

Ninety nine patients with leukemia and/or related disorders were treated with cefmenoxime (CMX). Among them, 77 patients had severe infections, while other 22 patients did not suffer from infection, but it was expected that they would fall into serious conditions if they were infected. Sixty of the 77 patients who had severe infection were used in the evaluation of effectiveness. The remaining 17 patients were not evaluated because they were subjected to combined treatments of CMX and other therapeutic agents such as other antibiotics, gamma-globulin or interferon. Excellent responses were found in 26 (43.3%) patients and good responses in 12 (20.0%) patients. In total, the rate of effectiveness was 63.3%. Nineteen of the 22 patients who were treated prophylactically with CMX were used in the evaluation of effectiveness, while 3 patients were excluded from the evaluation because peripheral neutrophils were counted to be more than 1,000/mm3 before CMX was administrated, although these 3 patients were used in the final evaluation to examine side effects. In the prophylactic treatment, the rate of effectiveness was 89.5%. The side effects were seen in 4 patients (4/82:4.9%). A different symptom was identified in each patient. These symptoms were skin rash, mild nausea, mild diarrhea and slight elevation of serum bilirubin. Prompt improvements of these symptoms occurred as soon as CMX administration was stopped. These results show that CMX is a therapeutically effective and safe antibiotics for the treatment of severe infections or for the prophylaxis of infections in patients associated with leukemia and/or related disorders.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Humans; Leukemia; Leukemia, Myeloid, Acute; Lymphoma; Male; Middle Aged; Sepsis

The emergence of ampicillin and chloramphenicol resistant Haemophilus influenzae type b in Denmark has created demands for alternative treatments of serious infections with H. influenzae. In this study 102 strains of H. influenzae recovered from cerebrospinal fluid (85) and blood (17) were tested for susceptibility to ampicillin, piperacillin, erythromycin, rifampicin, chloramphenicol, cefuroxime, cefotaxime, ceftazidime, ceftriaxone, moxalactam, aztreonam, and netilmicin by means of the agar dilution method. The majority (97%) was H. influenzae type b and of these strains 94% belonged to biotype I. Nine of the investigated strains were beta-lactamase producers. Ceftriaxone and cefotaxime were the most active agents (MIC90 less than or equal to 0.025 microliter/ml) followed by moxalactam and aztreonam (MIC90 = 0.1 microgram/ml). Except for ampicillin and piperacillin, the MIC was similar for beta-lactamase producers and non-producers. Several of the investigated antibiotics, especially some of the third generation cephalosporins, might constitute valid therapeutical alternatives to conventional drugs in the treatment of severe H. influenzae infections.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Chloramphenicol; Drug Resistance, Microbial; Haemophilus Infections; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Netilmicin; Rifampin; Sepsis

Cefmenoxime, a new semisynthetic cephalosporin, was evaluated in vitro and in vivo in comparison with penicillin G against a type III group B streptococcal strain. In vitro, the minimal inhibitory and minimal bactericidal concentrations of the two drugs were very close (less than or equal to 2 dilutions). In-vivo studies using experimental bacteraemia and meningitis in newborn rats revealed that despite similar drug levels, cefmenoxime had significantly greater bactericidal titres in blood at 6-7 h after administration and bacterial clearance from blood was significantly faster with cefmenoxime than with penicillin G at the end of one day of treatment. In addition, all animals with cefmenoxime therapy had bactericidal titres in cerebrospinal fluid greater than or equal to 1:8 at 1-2 h after administration, whereas most (67%) animals receiving penicillin G had titres less than 1:8. However, overall efficacy of cefmenoxime was similar to that of penicillin G. These findings suggest that cefmenoxime may be an effective alternative against group B streptococcal infection.

Topics: Animals; Cefmenoxime; Cefotaxime; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Penicillin G; Rats; Sepsis; Streptococcal Infections; Streptococcus agalactiae

Intraperitoneal inoculation in mice of a S. pneumoniae type 3 in beef broth resulted in immediate growth in vivo as evidenced by bacterial counts in peritoneal washings and in blood. Treatment with penicillin 1 hour after inoculation reduced the bacterial counts in vivo; however, different doses of penicillin-G showed a similar effect as measured by bacterial counts, in spite of differences in their effect upon survival of the mice. Therefore, the effect of antibiotics in vivo in this model was better correlated with death/survival of the animals. For comparative purposes the ED50, i.e. the 50% effective dose, should be determined. The effect of cephalosporins, i.e. cefuroxime and cefotaxime, in this model highly depended upon timing of the antibiotic administration as related to inoculation.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Dose-Response Relationship, Drug; Female; Injections, Intraperitoneal; Mice; Penicillin G; Peritoneal Cavity; Sepsis; Streptococcal Infections; Streptococcus pneumoniae; Time Factors

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

Topics: Bacterial Infections; Cefotaxime; Diabetic Angiopathies; Gangrene; Humans; Injections, Intra-Arterial; Osteomyelitis; Sepsis

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

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

Cefotaxime at a dosage of 3 gm intravenously every eight hours was administered to 80 patients with hematological malignancies and suspected septicemia. Blood samples for culturing were taken before and during antibiotic therapy. Nineteen patients had verified bacteremia and ten of them responded completely to cefotaxime. Twelve of the 19 patients had granulocyte counts of less than 0.5 X 10(9)/L. Minimal inhibitory concentrations of cefotaxime, ceftazidime, moxalactam, cefsulodin, cefoxitin, cefuroxime, and cefamandole against the pathogens were measured: cefotaxime was the best cephalosporin against gram-negative isolates and was found acceptable against gram-positive bacteria. In 61 patients no bacteremia could be demonstrated, but specific pathogens were isolated in 11 patients: from the urine in five, from the sputum in five, and from a perianal abscess in one. Complete response was obtained with cefotaxime in seven of these 11 patients. Monotherapy with cefotaxime in septicemic patients with hematological malignancies appears to be a valuable alternative to other antibiotic regimens.

Topics: Aged; Cefotaxime; Drug Resistance, Microbial; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Hematologic Diseases; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Random Allocation; Sepsis

Following a brief review of the main bacteriological and pharmacokinetic properties of ceftriaxone, the authors present a therapeutic evaluation of this new cephalosporin antibiotic. The effects of ceftriaxone in severe infections, such as septicaemia, bacterial meningitis, urinary tract infections, typhoid, bone infections and sexually transmitted diseases, are described on the basis of recent publications. Mention is also made of the adverse reactions to, and benign side-effects of the drug. Finally, the advantages of ceftriaxone in the treatment of some infections are envisaged: the single daily dose and short therapeutic courses may modify therapeutic habits and exert a beneficial effect on costs in some cases.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Humans; Meningitis; Respiratory Tract Infections; Sepsis; Sexually Transmitted Diseases; Typhoid Fever; Urinary Tract Infections

Modern cephalosporins are of considerable importance for the therapy of severe infections by multiresistant organisms. According to in-vitro-findings on ampicillin-resistant E. coli as well as Klebsiella spp., Proteus spp., and serratia spp., altogether 159 strains, instead of cefotaxime nearly always also cefotiam can be used. The two remedies are clearly superior to cephalothin. cefotiam is ineffective to Pseudomonas aeruginosa. But in this case also cefotaxime is clearly inferior to azlocillin. In 6 of 7 casuistic instances the clinical effectiveness of cefotiam could be confirmed with good tolerability. The contemporary establishment of staph. aureus in mixed infections of serratiastaphylococci proved as as particular advantage. A primary therapeutic failure referred to a necrotizing pancreatitis, when no causative organism was proved, in which case also cefotaxime remained without any effect. Despite the improved individual medical possibilities the control of the infectious hospitalism by critical administration of antibiotics and improved hospital hygiene, particularly strict non-infection, must remain the pre-eminent task.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Cefotiam; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Surgical Wound Infection; Urinary Tract Infections

We evaluated the activity of BMY-28142 against a K1 E. coli strain and a type III group B streptococcal strain in vitro and in vivo and compared the results with those of cefotaxime and penicillin G, respectively. In vitro, the MICs and MBCs of BMY-28142 were close to those of cefotaxime (less than or equal to 2-fold difference) for E. coli and fourfold less than those of penicillin G for group B streptococci. In vivo studies with an experimental bacteremia and meningitis model in newborn rats revealed that the mean penetration of BMY-28142 into the cerebrospinal fluid was 15% that of concomitant levels in serum and that significantly greater bactericidal titers were achieved in blood and cerebrospinal fluid for both test organisms with BMY-28142 than with cefotaxime and penicillin G. However, the overall efficacy of BMY-28142 was similar to that of cefotaxime for the E. coli infection and that of penicillin G for the group B streptococcal infection. This was shown by similar rates of bacterial clearance from blood and cerebrospinal fluid and similar mortality rates. These findings indicate that the activity of BMY-28142 is bactericidal in vitro and in vivo against E. coli and group B streptococci, suggesting that this agent may be a suitable alternative for the therapy of E. coli and group B streptococcal bacteremia and meningitis.

Topics: Animals; Cefepime; Cefotaxime; Cephalosporins; Escherichia coli; Female; Meningitis; Microbial Sensitivity Tests; Penicillin G; Pregnancy; Rats; Rats, Inbred Strains; Sepsis; Streptococcal Infections; Streptococcus agalactiae

Cefmenoxime, a new semisynthetic cephalosporin structurally similar to cefotaxime, was evaluated for its activities in vitro and in vivo against a K1 Escherichia coli strain in comparison with activities of cefotaxime and ampicillin. In vitro the MICs and MBCs of both cefmenoxime and cefotaxime were the same, 1/16th and 1/32nd those of ampicillin, respectively. The efficacies of cefmenoxime and cefotaxime against experimentally induced E. coli bacteremia and meningitis in newborn rats were similar and significantly better than that of ampicillin as judged by bactericidal titers of blood and cerebrospinal fluid, rapidity of clearance of bacteria from blood and cerebrospinal fluid, and incidence of meningitis in animals with bacteremias. The efficacy of cefmenoxime or cefotaxime measured by impact on mortality was influenced by the size of bacterial populations. The mortality was significantly greater in rats with bacterial counts before therapy of greater than or equal to 10(6) CFU/ml of blood than in animals with lower counts. Overall, the in vivo efficacy of cefmenoxime was similar to that of cefotaxime; thus it could be useful in the therapy of neonatal E. coli infection.

Topics: Ampicillin; Animals; Cefmenoxime; Cefotaxime; Escherichia coli Infections; Meningitis; Microbial Sensitivity Tests; Rats; Sepsis

In a search for more effective antimicrobial therapy of neonatal Escherichia coli infection, newer beta-lactam antibiotics, cefotaxime and imipenem, were evaluated for their activities against a K1 E. coli strain in vitro and in vivo, and the results were compared with those of conventional therapeutic regimens for neonatal E. coli infection: ampicillin-gentamicin and ampicillin-chloramphenicol. Measured by MICs and MBCs, cefotaxime and imipenem were 8- to 512-fold more active in vitro than the older agents. For in vivo studies, the following daily doses were used: 50 mg/kg for each of imipenem and cilastatin; 100 mg/kg for each of cefotaxime, ampicillin, and chloramphenicol; and 10 mg/kg for gentamicin. At these doses, the mean bactericidal titers in blood and cerebrospinal fluid were significantly greater with newer agents than with ampicillin-gentamicin and ampicillin-chloramphenicol. However, at the doses used, the newer agents were not more effective in vivo than the older agents. This was shown by the similarities in clearance of bacteria from blood and cerebrospinal fluid, incidences of meningitis in bacteremic animals, and mortality rates. Thus, although these two newer antibiotics are more active in vitro and produce greater bactericidal titers in vivo, they do not appear to be superior to conventional regimens for treatment of neonatal E. coli bacteremia and meningitis.

Topics: Ampicillin; Animals; Animals, Newborn; Cefotaxime; Chloramphenicol; Cilastatin; Cyclopropanes; Dose-Response Relationship, Drug; Drug Therapy, Combination; Escherichia coli Infections; Gentamicins; Imipenem; Meningitis; Rats; Sepsis; Thienamycins

One hundred sequential Gram-negative rod isolates from patients with hospital-acquired bloodstream infections were tested against seven new cephalosporins. Duplicate broth microdilution tests indicated superior activity for ceftazidime with 97% of strains susceptible to 16 mg/l. Less in-vitro activity was demonstrated cefotaxime (91% susceptible to 16 mg/l, P = 0.07), latamoxef (moxalactam) (90%, P = 0.04), cefoperazone (90%, P = 0.04), ceftriaxone (87%, P = 0.008), cefmenoxime (80%, P = 0.0001), and ceftizoxime (79%, P less than 0.0001). With the exception of cefoperazone, the newer drugs had mean MICs of less than or equal to 0.6 mg/l against Enterobacteriaceae. Ceftazidime and cefoperazone had highest activities against Pseudomonas aeruginosa with MIC90S of 4 and 16 mg/l, respectively. A comparison of recently published data shows important geographic differences in MIC90 data for the new cephalosporins against specific species.

Topics: Cefmenoxime; Cefoperazone; Cefotaxime; Ceftazidime; Ceftizoxime; Ceftriaxone; Cephalosporins; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Gram-Negative Bacteria; Humans; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis

The synergistic activity of cefotaxime and amikacin against 21 highly resistant Pseudomonas aeruginosa and Serratia marcescens isolates was evaluated in-vitro by the checkerboard tube dilution method and in-vivo in five patients with serious infections caused by these organisms. All isolates were resistant to gentamicin, tobramycin, amikacin, and cefotaxime. Synergy was observed in 90% of isolates and occurred when the MIC of amikacin was less than 256 mg/l and of cefotaxime less than 1024 mg/l. A clinical response occurred in 100% and bacteriological cure in 80% of patients. Our results demonstrate a high degree of synergism between amikacin and cefotaxime in-vitro and clinical efficacy in the treatment of infections due to multiply-resistant Pseudomonas and Serratia species.

Topics: Aged; Amikacin; Aminoglycosides; Cefotaxime; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Kanamycin; Male; Microbial Sensitivity Tests; Middle Aged; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis; Serratia marcescens

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

A group of 104 neonates with clinical signs of infection sufficient to justify treatment with penicillin plus gentamicin received instead monotherapy with ceftriaxone (50 mg/kg once daily). Bacteriological cultures from 20 babies before treatment yielded significant isolates (9 had bacteraemia). Following treatment, infecting bacteria were eradicated from 15/20 babies. Ten of the 104 babies died; all were examined post mortem. Only one death was attributed to bacterial infection. The remaining babies responded well to treatment. No adverse alteration in biochemical or haematological values was associated with ceftriaxone therapy. The incidence of diarrhoea, blood in the stools, necrotising enterocolitis or anti-coagulation problems was the same as in the babies not receiving ceftriaxone. Pharmacokinetic values were determined on 40 babies. Elimination half life (T1/2 beta) and minimum serum concentration (Cmin.) decreased and clearance increased with increasing postnatal age. Postnatal age was the single most significant factor affecting pharmacokinetics. Ceftriaxone is a safe and effective alternative to conventional therapy for infected neonates. Prolonged therapy is associated with superficial colonisation with inherently resistant bacteria.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Male; Respiratory Tract Infections; Sepsis

Fifty-five patients with gram-positive bacteremias were treated with cefotaxime after enrollment in comparative and non-comparative study protocols. Forty-nine of these 55 patients were evaluable and followed for their response to therapy and adverse effects. Most patients were white males 50 years of age or older (69%); 45% had two or more serious underlying diseases. Pneumonias caused 59% of these bacteremias, which were etiologically due to Streptococcus pneumoniae (22 episodes), Staphylococcus aureus (15), coagulase-negative staphylococci (3) and other streptococci (12). Overall, 90% of bacteremias were cured with cefotaxime therapy. Among five treatment failures were included three deaths, one due to cefotaxime-associated pseudomembranous colitis, one caused by a bacteremic superinfection due to Pseudomonas aeruginosa and one due to a progressive pneumonia despite therapy. Adverse effects of therapy were infrequent and noteworthy for only one patient with questionable nephrotoxicity and a lack of cefotaxime-associated coagulopathy.

Topics: Adolescent; Adult; Aged; Cefotaxime; Female; Gram-Positive Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Sepsis

Staphylococcus aureus strains were exposed in vitro to continuously decreasing cefotaxime concentrations. The initial concentration was approximately 4 X MIC and decreased at t1/2 = 60 min. A reduction in the colony count was seen even after the concentration had dropped below the MIC level. Sixteen patients with blood cultures positive for S. aureus were treated with cefotaxime. Four patient died of underlying diseases. The condition of one patient with staphylococcal endocarditis under treatment with vancomycin in combination with cefotaxime deteriorated when cefotaxime was discontinued, suggesting possible synergism between these two drugs against staphylococci.

Topics: Aged; Cefotaxime; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Sepsis; Staphylococcal Infections; Staphylococcus aureus

Agrobacterium radiobacter biovar 2 was repeatedly grown from the blood of an elderly patient receiving artificial ventilation and broad-spectrum antibiotics. No source of the organism was found, but the septicemia ceased when cefotaxime was given. Sera from the patient showed a fourfold rise in antibody against the organism and higher titers than sera from all but 1 of 50 healthy blood donors. The organism did not contain the plasmid associated with plant oncogenicity. This case may be only the second in which Agrobacterium sp. has been clearly linked with human infection.

Topics: Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Cefotaxime; Humans; Male; Plasmids; Rhizobium; Sepsis

We have evaluated the efficacy of cefotaxime and latamoxef against a Kl Escherichia coli strain in vitro and in vivo. In vitro, the minimal inhibitory concentrations (MICs) were close to the minimal bactericidal concentrations (MBCs) for both antibiotics (less than or equal to 2 dilutions). However, with an inoculum of 10(7) CFU/ml, MIC and MBC were significantly greater than those with inocula of 10(3) and 10(5). In vivo study with an infant rat model of bacteremia and meningitis revealed that both cefotaxime and latamoxef penetrated well into the cerebrospinal fluid (CSF), both drugs were bactericidal in blood and CSF, both were effective in prevention of the development of meningitis in bacteremic animals, and the mortality rates were significantly less in the treated than in the control group (p less than 0.001). However, even with cefotaxime or latamoxef treatment, the mortality was significantly greater (p less than 0.001) in rats whose bacterial counts before therapy were greater than or equal to 10(6) CFU/ml of blood. These findings suggest that the effects of cefotaxime and latamoxef may be directly correlated with the size of the bacterial population exposed to these agents and that this variable may be an important factor to influence the therapeutic outcome.

Topics: Animals; Animals, Newborn; Blood Bactericidal Activity; Cefotaxime; Escherichia coli Infections; Female; Meningitis; Microbial Sensitivity Tests; Moxalactam; Rats; Rats, Inbred Strains; Sepsis

Topics: Cefotaxime; Cefotiam; Humans; Male; Middle Aged; Sepsis; Vibrio Infections

Cefmenoxime (SCE 1365), a new broad-spectrum, third generation cephalosporin was used in the treatment of 68 patients with bacteremia. Cefmenoxime was given as monotherapy to 63 patients in a mean daily dosage of 3 g (range: 1 to 6 g). 63 successes were recorded. Results were inconclusive in the remaining five cases. General and biological tolerance of cefmenoxime was excellent.

Topics: Adult; Aged; Blood Bactericidal Activity; Cefmenoxime; Cefotaxime; Female; Humans; Kinetics; Male; Middle Aged; Sepsis

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

Pyogenic meningitis became apparent on the third day of ampicillin and gentamicin therapy for Aeromonas hydrophila sepsis in a patient with severe alcoholic hepatitis. The patient responded clinically to therapy with intravenous cefotaxime sodium and gentamicin sulfate. Antibiotic therapy that provides adequate CSF concentrations should be considered in the treatment of patients with Aeromonas sepsis.

Topics: Adult; Aeromonas; Cefotaxime; Gentamicins; Hepatitis, Alcoholic; Humans; Male; Meningitis; Sepsis

Antistaphylococcal activity of newer beta-lactam antibiotics, cefmenoxime, cefotaxime and latamoxef was compared with that of the more conventional antistaphylococcal agents, nafcillin, cefazolin and vancomycin. 53 strains of Staphylococcus aureus, 40 from patients with endocarditis and 13 from patients with bacteremia from other causes were tested in vitro against each antibiotic using agar dilution methods. Minimal concentration of antibiotic to inhibit 90% of strains tested was 2 micrograms/ml for cefmenoxime and cefotaxime, 8 micrograms/ml for latamoxef and only 0.5 microgram/ml for nafcillin, cefazolin and vancomycin. The newer beta-lactam antibiotics may not be preferred to nafcillin, cefazolin or vancomycin in the treatment of serious staphylococcal infections.

Topics: Anti-Bacterial Agents; Cefazolin; Cefmenoxime; Cefotaxime; Endocarditis, Bacterial; Humans; Microbial Sensitivity Tests; Moxalactam; Nafcillin; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Twenty-seven septicemia, 2 urinary tract infections and 2 meningitis were treated with Cefotaxime. The pathogenic organisms were most often entero-bacteria (16 E. coli, 2 Klebsiella, 2 Enterobacter cloacae, 1 Proteus, 1 Acinetobacter); sometimes they were Streptococcus (5 Streptococcus D, 3 Streptococcus B, 1 Streptococcus Salivarius). Cefotaxime was given alone to 16 patients, in association to an aminoglycoside in 15 cases. It was administered by infusion over 30 minutes every 8 hours in a daily dose of 150 mg/kg (during 10 days in case of septicemia and during 18 days if it was a meningitis). A clinical and bacteriological success was obtained in 86% of the 22 cases caused by Enterobacteria, in one of the 5 septicemia due to Streptococcus D and in the 3 infections caused by Streptococcus B. It may be concluded from these results that cefotaxime may be used in neonate infection due to a Gram-. But when a Listeria or a Streptococcus D is discovered the ampicillin classically prescribed must be maintained.

Topics: Bacterial Infections; Cefotaxime; Humans; Infant, Newborn; Sepsis

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

Ceftriaxone CTRX was evaluated about its antibacterial activity against clinical isolates at our department and tried clinically in 10 children of 6 months to 10 years and 6 months of age. The antibacterial activity was equal to cefotaxime or higher while the clinical results were almost satisfactory. Three out of 4 strains were eradicated (75%). As to the adverse reaction, eosinophilia was observed only in 1 case.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Respiratory Tract Infections; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

Topics: Bacteriuria; Cefotaxime; Epididymitis; Humans; Male; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Prostatic Neoplasms; Sepsis; 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

Cefmenoxime, a new semisynthetic third-generation cephalosporin, was evaluated in 105 patients (45 men and 60 women) with the following infections: skin or skin structure (33), pulmonary (22), urinary tract (30), and septicemia (20). Forty-two infections were hospital-acquired, 85 patients had underlying diseases, 29 patients required concomitant surgery, and 32 patients had positive results of blood culture. Cefmenoxime dosages ranged from 4 to 12 g per day intravenously for one and a half to 51 days. Cultures revealed 183 organisms in the 105 patients. Minimal inhibitory concentrations were obtained for cefmenoxime, cefoperazone, cefotaxime, cefamandole, cefoxitin, and moxalactam. Cefmenoxime and cefotaxime exhibited nearly equivalent activities against all organisms tested and were the most active agents tested against all aerobic and facultative organisms except Staphylococcus aureus. Mean serum peak and trough levels obtained after 2 g every six hours were 84.1 micrograms/ml (peak), 8.3 micrograms/ml (trough); and after 2 g every four hours, 106 micrograms/ml (peak) and 10.9 micrograms/ml (trough). Of 105 infections, 86 were clinically cured, three were not cured, and 16 were not evaluable. Safety studies revealed 24 transient reactions in 23 patients including eosinophilia, diarrhea, leukopenia, rash, elevated liver enzyme levels, Antabuse effect, and phlebitis. On the basis of these clinical and in vitro results, cefmenoxime is a safe drug for the treatment of infections caused by gram-negative and gram-positive aerobic organisms.

Topics: Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Humans; Kinetics; Lung Diseases; Male; Middle Aged; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

The novel beta-lactam, L-640,876, exhibited excellent therapeutic activity when administered parenterally but not orally to mice infected with a variety of pathogenic bacteria. In this respect, the compound was as potent as cefotaxime against representative Gram-positive and Gram-negative organisms, in most cases, equal to or more potent than cefoxitin, and more effective than mecillinam. When administered subcutaneously to normal mice at dose levels ranging from 10 to 50 mg/kg, L-640,876 provided an adequate dose response, recovery of ca. 45% of biological activity in the urine, and excellent distribution at the highest dose level into liver, lung, kidney, heart muscle, but not brain.

Topics: Amdinocillin; Animals; Anti-Bacterial Agents; Cefotaxime; Cefoxitin; Cephalosporins; Gram-Negative Bacteria; Kinetics; Mice; Microbial Sensitivity Tests; Penicillanic Acid; Sepsis; Tissue Distribution

The efficacy of ceftriaxone against group B streptococci was studied in vitro and in vivo with an infant rat model of group B streptococci bacteraemia and meningitis. Twenty-four strains demonstrated minimal inhibitory concentrations of ceftriaxone of 0 . 05-0 . 1 mg/l and minimal bactericidal concentrations of 0 . 1-0 . 4 mg/l. Four strains were selected to induce bacteraemia and meningitis in infant rats by intraperitoneal inoculation. All 45 bacteraemic animals with or without meningitis that were treated with ceftriaxone 2 mg/kg/dose every eight hours for five doses survived, while all 12 control animals died (P less than 0 . 001). When recultured 54 h after the last dose of ceftriaxone, both CSF and blood remained sterile in all treated animals. These results indicate group B streptococci to be sensitive to ceftriazone in vitro and that, in the low dosage used, ceftriaxone effectively eradicates group B streptococcal bacteraemia and meningitis in infant rats.

Topics: Animals; Animals, Newborn; Cefotaxime; Ceftriaxone; Meningitis; Microbial Sensitivity Tests; Rats; Rats, Inbred Strains; Sepsis; Streptococcal Infections; Streptococcus agalactiae

Cefotiam (SCE 963), a new, broad-spectrum, third generation cephalosporin was used in the treatment of 136 patients suffering from respiratory tract infections, urinary tract infections, septicemia, meningitis, biliary tract infections and osteoarthritis infections. Cefotiam was administered in monotherapy to 98 patients at the mean posology of two grams per day (extreme doses: 1 to 6 g). The following clinical effectiveness was noted: 83 successes and 18 failures on 101 available clinical reports. The general, biological tolerance and renal tolerance was good in all patients.

Topics: Adolescent; Adult; Age Factors; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Respiratory Tract Infections; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

Forty-three children (ten neonates, 15 infants and 18 older children) were treated with single daily doses of ceftriaxone (50 to 100 mg/kg) intravenously or intramuscularly for serious bacterial infections. The infections included meningitis (31 patients), brain abscesses (four patients), septicaemia (three patients), pleuro-pneumonia (two patients), septic arthritis and soft tissue phlegmona (three patients). No other antibacterial agents were used except in four patients with brain abscesses, in whom ceftriaxone was combined with ornidazole. The overall bacteriological cure rate was 98%, and sterilisation of the cerebrospinal fluid occurred in 27 of 28 patients (96%) with proven bacterial meningitis. Two patients died, three survived with severe neurological sequelae; one neonate required partial gut resection. A complete clinical cure was achieved in the remaining 37 patients. Only one treatment failure was directly related to the drug therapy. The only side effect noted were sterilisation of the gut with overgrowth of Candida albicans in 35% of neonates and infants, an prolonged fever in 13% of all patients. Ceftriaxone given in a 24-hourly regimen is convenient and highly effective in serious bacterial infections in children and is without significant toxicity.

Topics: Adolescent; Arthritis, Infectious; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Cellulitis; Child; Child, Preschool; Drug Evaluation; Humans; Infant; Infant, Newborn; Meningitis; Pleuropneumonia; Sepsis

Topics: Anti-Bacterial Agents; Cefotaxime; Cross Infection; Digestive System; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Intensive Care Units; Polymyxins; Respiratory Tract Infections; Sepsis; Tobramycin

Thirty-five patients underwent 38 treatment courses with cefotaxime. Documented infections included 11 bacteremias, 7 cases of nosocomial pneumonia, 6 surgical wound infections, 3 bone infections, 1 biliary infection, and 1 urinary tract infection. Granulocytopenic patients with fever received 15 courses of empiric cefotaxime therapy alone; in 8 courses, no definite site of infection or pathogen was isolated. Broad-spectrum antibiotics had been administered to 23 patients before cefotaxime. Thirty-seven bacterial pathogens were isolated from 25 patients. Three such pathogens were resistant to cefotaxime and required alternative therapies. Pathogenic isolates included 13 Serratia marcescens, 12 Pseudomonas aeruginosa, 4 Escherichia coli, 2 Klebsiella pneumoniae, 2 Providencia stuartii, 1 Enterobacter cloacae, 1 Haemophilus influenzae, 1 Enterococcus, and 1 Staphylococcus aureus. Of the treatment courses, 25 of 38 resulted in a favorable response to cefotaxime, including 9 of 15 in granulocytopenic patients. Superinfection was seen in one patient. The emergence of resistance was documented in another patient. Of 15 patients with multiply resistant pathogens, 12 improved with cefotaxime. Of 12 patients with Pseudomonas aeruginosa, 6 favorably responded. Possible complications of cefotaxime were observed in 14 of 42 treatment courses. Cefotaxime is most useful in treatment of infections due to multiply resistant, gram-negative pathogens other than Pseudomonas aeruginosa.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Cross Infection; Female; Humans; Male; Middle Aged; Sepsis

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Female; Humans; Male; Middle Aged; Sepsis

Ceftriaxone is a new semisynthetic cephalosporin with broad-spectrum in vitro activity and an unusually long serum half-life. The clinical efficacy of ceftriaxone was evaluated in 35 infections in 34 patients; 12 of these patients had skin and soft tissue infections, 10 had infections of the urinary tract, 8 had pneumonia, 2 had biliary tract infections, 1 had sinusitis, 1 had diverticulitis, and 1 had a retroperitoneal abscess. Of the 35 infections, 9 were bacteremic. The bacteria isolated included Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus faecalis, other streptococcal species, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Serratia marcescens, Enterobacter cloacae, Haemophilus influenzae, Pseudomonas aeruginosa, Bacteroides fragilis, other Bacteroides species, and anaerobic cocci. Improvement or cure occurred in 32 episodes, for a response rate of 91%. There were three treatment failures in patients with soft tissue infections. No serious drug toxicities were observed. At a dosage regimen of 1 g every 12 h the peak and trough serum antibiotic concentrations were well above the minimal inhibitory concentrations of most pathogens. Our findings suggest that ceftriaxone is a safe and effective antibiotic for therapy of serious bacterial infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Sepsis

We conducted an experimental study using rats to investigate the timing of prophylactic antibiotics in urological surgery and to evaluate the benefit from a single, prophylactic injection of an antibiotic. Another objective was to examine the growth and kill rates of Escherichia coli 06 in operated urinary tract organs. We were unable to demonstrate a short decisive period for the antibiotic treatment; it seems to vary with respect to the infecting organism and the infected organ. Administration of a single dose of antibiotic was sufficient to lower the rate of infection in the kidney and epididymis 24 hours after the operation and to eliminate bacteria completely from the prostate. The rate of growth and kill of E. coli 06 depended on the specific organs in which the infection took place.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Escherichia coli; Escherichia coli Infections; Humans; Male; Premedication; Rats; Sepsis; Time Factors; Urogenital System; Urologic Diseases

Eighteen patients with 21 serious infections were treated with ceftriaxone, 1 g intravenously every 12 h, for a mean duration of 8 days. Eighteen gram-negative and two gram-positive organisms were isolated. Sites of infection included blood (three patients), urinary tract (six patients), respiratory tract (seven patients), biliary tract (three patients), ascitic fluid (one patient), and skin (one patient). Serum, bile, and ascitic fluid concentrations of ceftriaxone were in excess of the minimal bactericidal concentration required for the infecting organism in all cases. A bacteriological response was demonstrated in 94% of the infections. A clinical response occurred in four infections from which no pathogens were recovered. In one patient, ceftriaxone failed to eradicate a peritoneal infection due to Bacteroides fragilis. In two patients, superinfection with enterococci developed both during and after therapy. Systemic tolerance to ceftriaxone was excellent.

Topics: Aged; Bacterial Infections; Biliary Tract Diseases; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Humans; Male; Middle Aged; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

The in vitro activities of azlocillin and cefotaxime in combination and of azlocillin and tobramycin in combination against 100 blood isolates and 50 multidrug-resistant isolates were compared. With both combinations, antibacterial spectrums were complementary. Although synergy against individual strains was infrequently observed (except for azlocillin-cefotaxime against Streptococcus faecalis and azlocillin-tobramycin against Pseudomonas aeruginosa), 97% of blood isolates and 76% of multidrug-resistant isolates were susceptible to azlocillin-cefotaxime, and 94% of blood isolates and 36% of multidrug-resistant isolates were susceptible to azlocyclin-tobramycin.

Topics: Anti-Bacterial Agents; Azlocillin; Bacteria; Cefotaxime; Drug Interactions; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Sepsis; Tobramycin

Cefotiam (CTM) was administered to 52 patients with infectious disease associated with respiratory system, hematological malignancy, urinary system and other system. Good clinical responses were obtained in 38 out of 52 cases (73.1%). Neither objective and subjective side effects nor extreme abnormalities of laboratory tests were observed in these patients. It can be, therefore, concluded that CTM is 1 of the most useful drugs for infectious diseases in respiratory system, hematological malignancy, urinary system and other system.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefotiam; Drug Evaluation; Female; Hematologic Diseases; Humans; Male; Middle Aged; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

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: Adolescent; Adult; Aged; Cefotaxime; Ceftizoxime; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Sepsis; Time Factors

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

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 present study was performed to evaluate the clinical effectiveness and safety of cefmenoxime (CMX), a new cephalosporin antibiotic for injection in the field of pediatrics. Thirty-one cases, including 2 cases with sepsis, 18 cases with respiratory tract infections and 7 cases with urinary tract infections, were given CMX at daily doses of 30 mg/kg to 125 mg/kg divided into 3 or 4 for 3 days to 13 days. Clinical responses were excellent in 16 cases, good in 9 cases and poor in 6 cases, the satisfactory response being 80.6%. No side effects and no abnormal laboratory findings relating to the drug were observed.

Topics: Cefmenoxime; Cefotaxime; Child; Child, Preschool; Female; Humans; Infant; Male; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Cefmenoxime (CMX) was evaluated in 25 children with a suspicion of bacterial infection. Of the 20 confirmed bacterial infections, 19 were cured by CMX therapy (effective rate, 95%). The diagnoses included acute pharyngotonsillitis (4), acute bronchitis (1), pneumonia (7), streptococcal dacryocystitis (1), infections accompanied with acute leukemia (4), and acute urinary tract infections (3). The etiologic pathogens were beta-hemolytic Streptococcus group A (1), and F (1), Staphylococcus aureus (4), Haemophilus influenzae (4), Escherichia coli (4), Klebsiella pneumoniae (2), etc. CMX was very effective for 2 children with respiratory infections due to ampicillin resistant H. influenzae type b. The half life of serum concentration of CMX was 0.76 +/- 0.17 hour after an intravenous bolus injection. A cerebrospinal fluid level of CMX was 5.2 mcg/ml 1 hour after intravenous injection of 1 g (23.8 mg/kg) in a child with inflamed meninges. However this level was not as high as those of cefotaxime, latamoxef, or ceftizoxime measured in the same case. No severe adverse reaction was encountered with CMX therapy. The data suggest that CMX is a safe and effective parenteral antibiotic when used in children with susceptible bacterial infections.

Topics: Adolescent; Bacterial Infections; Cefmenoxime; Cefotaxime; Child; Child, Preschool; Female; Half-Life; Humans; Infant; Leukemia, Lymphoid; Male; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

A new gamma-globulin preparation obtained by partial enzymatic cleavage of Fc-regions (Gamma-Venin), was effective in i.v. monotherapy in mice, infected with Streptococcus Aronson B, Pneumococcus mucosus and Salmonella typhimurium. These septicemias are characterized by protracted mortality. There was no measurable effect of the gamma-globulin preparation monotherapy in infections with acute course (Staphylococcus aureus 108, E. coli 078). But in all five experimental septicemias the additional administration of the gamma-globulin formulation enhanced the effectivity of cefotaxime or ampicillin. In those animals both antibiotics were effective in lower doses than in animals having obtained only chemotherapy.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; beta-Lactams; Cefotaxime; gamma-Globulins; Mice; Sepsis; Time Factors

Cefotaxime was administered as sole treatment (49 cases) or after failure of another previous antibiotic (17 cases) to 66 patients suffering from infectious diseases. The 78 infections thus treated included urinary tract infections (35), septicaemia or endocarditis (25), respiratory tract infections (7), osteitis (5), meningitis (4), biliary infection (1), and skin infection (1). The pathogens identified were more often enterobacteria: Serratia: 23, E. coli: 15, Klebsiella: 7, Proteus: 7, Enterobacter: 1, Providentia: 1, Pseudomonas: 5, Staphylococcus: 7, Pneumococcus: 4, Streptococcus: 2, Branhamella: 1. Cefotaxime was given either intravenously (2/3 of cases) or intramuscularly, at an average daily dose of 3.75 g (mean: 1.5-8 g). It was administered alone to 49 patients suffering from septicaemia and urinary tract infections caused by E. coli, Klebsiella and especially Serratia, and it was combined in 17 cases, particularly in meningitis and bone infections. The overall results of cefotaxime given in serious diseases were especially favourable in debilitated patients (88% therapeutic success). The local tolerance was good and side effects were not observed in any patient. Cefotaxime seems to be an active antibiotic, indicated in many severe septicemic or not septicemic infections, more particularly in diseases with multiresistant Gram negative pathogens.

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

10 patients with septicaemia caused by enterobacteriaceae were successfully treated with cefotaxime. 9 patients had previously received unsuccessful antimicrobial therapy. The pathogen was resistant in vitro to other antibiotics. Cefotaxime was administered alone or in combination with an aminoglycoside. No severe side-effects were noted.

Topics: Adult; Aged; Cefotaxime; Cephalosporins; Enterobacteriaceae Infections; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Sepsis

Cefotaxime was given to 26 patients with serious infections resistant to other antibiotics. 15 patients were suffering from septicaemia due to Gram-negative bacilli, which were caused either by a single organism (13 cases:" of which Serratia in 6, Klebsiella in 3) or by several organisms (2 cases); 7 had upper urinary tract infections (caused by Serratia in 4 patients), and 6 had miscellaneous infections (two of these were purulent post-operative meningitis). The pathogens were usually resistant to ampicillin and cephalothin. Cefotaxime was administered at a daily dose of 3 g in 22 patients, irrespective of the renal function, and of 6 g in 4 patients (2 meningitis). Treatment included an aminoglycoside in 12 cases. The efficacy of cefotaxime was very satisfactory in 23 of the 26 patients.

Topics: Adult; Aged; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Enterobacteriaceae Infections; Female; Humans; Male; Meningitis; Middle Aged; Pseudomonas Infections; Respiratory Tract Infections; Sepsis; Urinary 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

Sixteen patients, 9 to 81 years old, with Gram-negative septicaemia have been treated with cefotaxime. In all cases, the patients were hospitalised in an intensive care unit for a severe infection distinct from septicaemia. Cefotaxime was given alone to 11 patients and was administered by infusion over 20 to 30 minutes, every 4 or 6 hours, in a daily dose of 67 to 94 mg/kg to patients with normal of subnormal renal function. Gram-negative pathogens were sensitive to cefotaxime (MIC less than 1 mcg/ml in most cases). A clinical cure was obtained in 14 patients. In all the cases, tolerance was good. The very low MIC's of cefotaxime and the results in severe Gram-negative septicaemia justify the use of cefotaxime in monotherapy, in patients with severe life-threatening infections, when blood cultures appear to be positive for Gram-negative pathogens, even without awaiting antibiograms.

Topics: Adolescent; Adult; Aged; Cefotaxime; Cephalosporins; Child; Enterobacteriaceae Infections; Humans; Middle Aged; Sepsis

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Female; Humans; Infant; Male; Middle Aged; Sepsis

Topics: Burns; Cefotaxime; Cephalosporins; Child; Drug Resistance, Microbial; Endocarditis, Bacterial; Enterobacteriaceae Infections; Female; Humans; Sepsis; Serratia marcescens; Tricuspid Valve

Topics: Abscess; Adolescent; Adult; Cefotaxime; Cephalosporins; Endometritis; Female; Humans; Middle Aged; Pelvic Inflammatory Disease; Sepsis

Topics: Adolescent; Adult; Aged; Cefotaxime; Cephalosporins; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Sepsis

Topics: Bacterial Infections; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Female; Humans; Male; Meningitis; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Topics: Adult; Aged; Cefotaxime; Cephalosporins; Humans; Male; Middle Aged; Sepsis; Typhoid Fever

Topics: Adolescent; Adult; Age Factors; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Meningitis; Middle Aged; Respiratory Tract Infections; Sepsis; Sex Factors

Topics: Acute Disease; Adult; Aged; Cefotaxime; Cephalosporins; Female; Humans; Male; Middle Aged; Respiratory Tract Diseases; Sepsis; Urinary Tract Infections