hr-810 and Bacteremia

In-vitro studies with cefpirome or cefepime prove that both agents are highly active against Gram-negative bacilli and Gram-positive cocci. They possess a broader spectrum of activity than ceftazidime. In clinical trials cefpirome at doses ranging from 1 g to 2 g b.i.d. was compared to ceftazidime at a dose ranging from 1 g to 2 g b.i.d. or 2 g t.i.d. Cefepime at a dose of 2 g b.i.d. was compared to ceftazidime at a dose of 2 g t.i.d. Both cefpirome and cefepime were found to be as effective as ceftazidime in patients with septicemia. These new compounds are a valuable addition to the range of drugs available for empiric treatment of serious bacterial infections.

Topics: Bacteremia; Bacteria; Bacterial Infections; Cefepime; Cefpirome; Cephalosporins; Clinical Trials as Topic; Humans; In Vitro Techniques; Microbial Sensitivity Tests

Vancomycin is always the drug of choice for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in spite of his bactericidal kinetic.. The aim of this study was to evaluate in vivo the improvement of bactericidal kinetic of vancomycin associated with cefpirome against MRSA infection in critically ill patients.. The prospective cross-over study was carried out in 20 patients with severe pneumonia or bacteremia. There were randomized to receive vancomycin 2 g per day (Group 1, n = 10) or vancomycin with cefpirome 2 g x 2 (Group 2, n = 10). Clinical recovery, bacteriologic parameters (bactericidal kinetic and bactericidal power in vivo at the peak and the valley), duration of ventilation and stay in ICU were comparatively explored in both groups.. Clinical outcome did not significantly differ between Group 1 and 2. Bactericidal kinetics were better in the Group 2 (40% vs 60% after 6 hours to the dilution for 1/8e) but the difference was not significant. However, bactericidal power in sera was also better in the Group 2 with more bactericidal dilution at 1/16e (68% vs 88.8%: NS) and overall at 1/32e (10.5% vs 50%: p < 0.05) and CRP, an inflammatory marker, was significantly lower in the Group 2 than in the Group 1 (119.5 +/- 24 mg/l vs 198.6 +/- 78 mg/l: p < 0.05) on the third day.

Topics: Adult; Aged; Bacteremia; Cefpirome; Cephalosporins; Critical Care; Drug Therapy, Combination; Female; Humans; Male; Methicillin Resistance; Middle Aged; Pneumonia, Bacterial; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vancomycin

Cefpirome is a fourth-generation cephalosporin with good activity against both gram-positive and gram-negative bacteria. A multicentre trial was performed to study the efficacy and safety of cefpirome 2 g twice daily in the treatment of sepsis. Sixty-three cases were recruited from 10 hospitals from April 1996 to January 1998. Fifty seven cases could be evaluated according to the protocol. The APACHE II score was used to measure severity of illness, with 46.9 per cent of patients having APACHE II score more than 10 and two patients more than 20; both were cured. The most common pathogens were gram-negative bacteria with E. coli predominating 16/40 (40.0%), followed by Klebsiella 8/40 (20.0%). The overall clinical success rates were 54 out of 57 patients (94.7%). In patients with positive blood culture, the clinical cures were achieved for 20/22 (90.9%). Cefpirome showed good efficacy and safety in the empirical treatment of suspected bacteremia or sepsis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Cefpirome; Cephalosporins; Drug Administration Schedule; Female; Follow-Up Studies; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Treatment Outcome

Cefpirome is a fourth-generation cephalosporin with good in-vitro activity against both Gram-positive and Gram-negative aerobes, including Pseudomonas spp. A multicentre, randomized trial was performed to compare cefpirome at a dose of 2 g bd iv with ceftazidime (2 g tds iv) in the empirical treatment of suspected bacteraemia in patients with severe sepsis but not septic shock. The majority of the patients had community-acquired infections. Patients were stratified into high- and low-risk groups using a Simplified Sepsis Score. Metronidazole, an aminoglycoside or a glycopeptide could be added to the treatment as required. In patients with a positive blood culture treated for > or = 48 h, the clinical success rates were 37/48 (77%) for cefpirome and 35/52 (67%) for ceftazidime with no significant difference between the two. In patients with bacteriologically proven infection, 92 (89%) of 103 patients treated with cefpirome were assessed as cured and 94 (89%) of 106 patients with treated ceftazidime. More Gram-positive pathogens, enterococci and staphylococci were resistant in vitro to ceftazidime than to cefpirome (15/90 (17%) and 5/92 (5%) respectively; chi2 = 4.8, P < 0.05) but the bacteriological response was not significantly different between the two groups (cefpirome, 54/60 (90%); ceftazidime, 54/63 (86%)). Cefpirome showed equivalent efficacy and safety to ceftazidime in the empirical treatment of suspected bacteraemia or sepsis. Regarding safety, there were no statistically significant differences between the two treatments, with adverse events thought to be possibly related to the study drug occurring in 55/187 and 40/184 patients on cefpirome and ceftazidime, respectively.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; APACHE; Bacteremia; Cefpirome; Ceftazidime; Cephalosporins; Female; Humans; Male; Middle Aged; Sepsis

From a total of 4180 patients entered in 15 phase II-III clinical trials involving cefpirome, an analysis was carried out on 378 patients with bacteriologically confirmed or suspected septicaemia who were treated with cefpirome (n = 282) or comparator drugs (ceftazidime, n = 80; ceftriaxone, n = 15; imipenem/cilastatin, n = 1). Gram-negative organisms were the causative pathogens in over half of the patients, with Escherichia coli being the most common species found. The most frequently isolated Gram-positive bacterium was Streptococcus pneumoniae. Causative organisms were eradicated in over 90% of patients receiving cefpirome or comparators. Only 4/230 pathogens tested were resistant to cefpirome in vitro. Among patients with bacteriologically confirmed septicaemia, a satisfactory clinical response was documented in 131/176 (74%) cefpirome vs 34/50 (68%) ceftazidime vs 5/10 (50%) ceftriaxone recipients, improvement in 39/176 (22%) vs 11/50 (22%) vs 5/10 (50%), and failure in 6/176 (4%) vs 5/50 (10%) vs 0/10 (0%), respectively. Similar results were achieved in patients with 'suspected' septicaemia. Cefpirome 1 or 2 g twice daily offers an effective treatment option for patients with septicaemia. The higher dosage regimen produced superior bacteriological clearance rates and is therefore preferable in patients with severe septicaemia.

Topics: Anti-Bacterial Agents; Bacteremia; Bacteria; Bacterial Infections; Cefpirome; Cephalosporins; Double-Blind Method; Humans; Microbial Sensitivity Tests; Single-Blind Method

Antibiotics not only support to alleviate the infections but also facilitate to avert the multiplication of microbes. Due to the irrational use of antibiotics, the resistance of antibiotics has been augmented which results may increase in morbidity and mortality with the span of time. World renowned regulatory bodies like Food and Drug Administration (FDA), Center of Disease Control and Prevention (CDC), and World Health Organization (WHO) vigorously advocate the surveillance of the resistance of antibiotics. During the present study by Kirby-Bauer disk diffusion method 141 clinical isolates of Staphylococcus aureus (n=47, 33.34%), Escherichia coli (n=54, 38.3%), Proteus species (n=26, 18.4%), and Klebsiella pneumoniae (n=14, 9.92%) are evaluated against cefepime and cefpirome which comes of fourth generation cephalosporin. It has been found that cefpirome has better bactericidal activity than cefepime against E. coli and K. pneumoniae while cefepime has been possessed better antibacterial activity against S. aureus and Proteus species which were isolated from respiratory tract infections, blood stream infection, intra-abdominal and urinary tract infections, and skin and soft tissue infections. K. pneumoniae, E. coli, Proteus species, and S. aureus were 34.8%, 26.3%, 11.3%, and 37.7% resistance against cefepime respectively. S. aureus, E. coli, K. pneumoniae, Proteus species has shown 41.4%, 21.7%, 17.6%, and 8.9% resistance against cefpirome correspondingly.

Topics: Anti-Bacterial Agents; Bacteremia; Cefepime; Cefpirome; Cephalosporins; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; In Vitro Techniques; Intraabdominal Infections; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Pakistan; Proteus; Proteus Infections; Respiratory Tract Infections; Skin Diseases, Bacterial; Soft Tissue Infections; Staphylococcal Infections; Staphylococcus aureus; Urinary Tract Infections

We performed a prospective assessment of the current epidemiology of bacteraemia in cancer patients hospitalized in 70 different adult and paediatric haematology and oncology departments. Over a 1-month period, microbiologists from 54 hospitals collected clinical data relating to patients with at least one positive blood culture. In addition, all strains isolated were assessed for their in vitro susceptibility to three broad-spectrum cephalosporins suitable for empirical treatment in cancer patients: cefpirome, cefepime and ceftazidime. A total of 494 different strains were isolated from 1,038 blood cultures taken from 403 different patients. Seventeen strains were isolated from 13 patients with various nonmalignant diseases, and these cases were excluded from analysis. Overall, 330 (69.2%) of the strains were isolated in patients with haematological malignancy and 147 (30.8%), in patients with solid tumours. There was no difference in the distribution of the species involved in bacteraemia between patients with haematological malignancy and patients with solid tumours: coagulase-negative staphylococci were the leading pathogens (50.6% and 44.9%, respectively), followed by E. coli (11.2% and 12.2% respectively), S. aureus (6.3% vs 7.5%), streptococci (4.8% vs 5.4%) and P. aeruginosa (5.2% vs 4.8%). All other species accounted for less than 5% in both groups. There was no difference in the strain distribution with age (> or = 15 years vs < 15 years) or type of underlying disease. S. aureus and Enterobacteriaceae bacteraemia were more frequent in patients with end-stage disease, while oral streptococci, Enterobacteriaceae and P. aeruginosa infections were more frequent in patients who were severely neutropenic. Digestive tract decontamination was associated with increased frequency of oral streptococci and decreased frequency of Enterobacteriaceae infections. All three cephalosporins demonstrated similar activity against E. coli, while cefpirome and cefepime appeared to be more effective against other Enterobacteriaceae. Ceftazidime had better activity against P. aeruginosa. Cefpirome was the most effective against Gram-positive cocci, especially oral streptococci and methicillin-susceptible staphylococci.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Bacteria; Bacteriological Techniques; Cefepime; Cefpirome; Ceftazidime; Cephalosporins; Child; Child, Preschool; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Neoplasms; Opportunistic Infections; Prospective Studies