cefsulodin and Respiratory-Tract-Infections

A modified chocolate blood agar medium incorporating cefsulodin, a semi-synthetic cephalosporin, was developed and compared with non-selective chocolate blood agar and selective haemin-bacitracin blood agar for the routine isolation of Haemophilus influenzae from the respiratory secretions of patients with cystic fibrosis. The results showed that cefsulodin chocolate blood agar improved the recovery rate of H. influenzae in this group of patients. The medium was stable on storage for 10 days at 4 degrees C.

Topics: Agar; Bacitracin; Blood; Cacao; Cefsulodin; Cephalosporins; Culture Media; Cystic Fibrosis; Haemophilus Infections; Haemophilus influenzae; Hemin; Humans; Inhalation; Respiratory Tract Infections; Sputum

We have investigated the effectiveness of seven new beta-lactam antibiotics, azlocillin, piperacillin, ceftazidime, cefsulodin, cefoperazone, latamoxef (moxalactam), and cefotaxime, against acute pulmonary exacerbations caused by Pseudomonas aeruginosa in cystic fibrosis. Three hundred and fifty-five strains of Ps aeruginosa isolated from 310 sputum cultures (190 cystic fibrosis patients) were tested for susceptibility to the drugs by determination of minimal inhibitory concentrations (MIC). The highest activity was shown by ceftazidime (6% resistant strains) followed by cefsulodin and piperacillin (15 and 16% resistant strains); very low activity was found for cefotaxime and latamoxef (moxalactam). Ceftazidime was the most active drug against 32 pseudomonas isolates that were resistant to both carbenicillin and aminoglycosides (78% susceptible). A randomized, double-blind trial of azlocillin, piperacillin, ceftazidime, cefsulodin or cefoperazone was performed in 111 cystic fibrosis patients with predominant and susceptible pseudomonas in their sputum. Results were evaluated by a clinical, radiological and bacteriological scoring system: the best results were obtained with ceftazidime, followed by cefsulodin and piperacillin. However, pseudomonas was eradicated in only 22 (23%) of the cases with the most active drugs and persisted or reappeared in all the cases 1 to 3 months later. Ceftazidime always eradicated Staph. aureus and Haemophilus influenzae associated with pseudomonas. Similar eradication occurred nearly always with cefsulodin but rarely with the other drugs. No serious drug reaction occurred but a later fever and rash with piperacillin, transient diarrhoea with cefoperazone, vomiting with cefsulodin, and very frequent eosinophilia with ceftazidime should be mentioned. These five drugs offer, in varying degree, alternatives to traditional anti pseudomonas antibiotics in cystic fibrosis pulmonary infections, but they should be used only against well-proven resistant strains. Ceftazidime is best and cefotaxime and latamoxef (moxalactam) least useful.

Topics: Adolescent; Alcohol Deterrents; Anti-Bacterial Agents; Azlocillin; Cefoperazone; Cefotaxime; Cefsulodin; Ceftazidime; Cephalosporins; Child; Clinical Trials as Topic; Cystic Fibrosis; Double-Blind Method; Eosinophilia; Humans; Moxalactam; Penicillins; Piperacillin; Pseudomonas Infections; Random Allocation; Respiratory Tract Infections

Cefsulodin, a narrow-spectrum cephalosporin with excellent antipseudomonal activity was used to treat 48 patients with 51 Pseudomonas aeruginosa infections. These included osteomyelitis, infected prostheses, post-operative and post-traumatic superficial wounds, decubitus and stasis ulcers, lower respiratory tract infections and infections of the urinary tract. Many of the patients were compromised by underlying debilitating conditions such as severe trauma, diabetes mellitus, vascular impairment, and abuse of alcohol and drugs. In cases of polymicrobial infections, a concomitant non-antipseudomonal antibiotic was sometimes administered. Cefsulodin was administered intravenously to 47 patients and by intramuscular injections to one individual. The dosage ranged from 0.5 to 2.0 g every six hr and duration of therapy was from 4 to 70 days. A satisfactory clinical response was observed in 88% of the patients. P. aeruginosa was eradicated from 76% of the infection sites. Failures, which included relapse within one year, were generally associated with prior severe trauma or vascular impairment in cases of osteomyelitis. Reinfections and superinfections developed in 12 individuals. Adverse reactions reported for two patients were nausea and vomiting. A third patient had transient increases in alkaline phosphatase and SGOT. These data indicate that cefsulodin is an effective and safe antibiotic in various types of P. aeruginosa infections.

Topics: Adult; Aged; Aged, 80 and over; Cefsulodin; Female; Humans; Male; Middle Aged; Osteomyelitis; Pseudomonas Infections; Respiratory Tract Infections; Urinary Tract Infections; Wound Infection

The pharmacokinetic characteristics of cefsulodin have been studied in 7 patients suffering from cystic fibrosis (CF) and compared to the findings in 6 children without CF. They were given intravenous bolus doses (3 min) of 40 mg/kg. The antibiotic concentrations were assayed by high-pressure liquid chromatography. The serum concentrations were lower in the CF group as reflected by the mean total area under the serum concentration curves of 180 vs. 309 mg h/1, and the serum concentrations after 8 hours which were below the detection limit in the CF patients compared to 4.7 mg/l in the non-CF. The patients with cystic fibrosis had a not significantly lower total body clearance (5.8 vs. 7.0 1/h). The serum half-life was slightly shorter in patients with CF (1.2 vs. 1.4 hours). Consequently, given microbes of the same MIC's, patients with CF should receive higher doses than those recommended for patients without cystic fibrosis.

Topics: Adolescent; Cefsulodin; Child; Child, Preschool; Cystic Fibrosis; Female; Humans; Infant; Kinetics; Male; Respiratory Tract Infections; Urinary Tract Infections