ro13-9904 and Bacterial-Infections

Pelvic inflammatory diseases (PID) must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to rule out tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1 g, once, IM or IV, doxycycline 100 mg ×2/day, and metronidazole 500 mg ×2/day PO for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1-2 g/day until clinical improvement, doxycycline 100 mg ×2/day, IV or PO, and metronidazole 500 mg ×3/day, IV or PO for 14 days (grade B). Drainage of TOA is indicated if the pelvic fluid collection measures more than 3 cm (grade B). Follow-up is required in women with sexually transmitted infections (STIs) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3-6 months after PID (grade C), before the insertion of an intrauterine device (grade B), and before elective termination of pregnancy or hysterosalpingography. When specific bacteria are identified, antibiotics targeted at them are preferable to systematic antibiotic prophylaxis.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Ceftriaxone; Doxycycline; Female; France; Genitalia, Female; Humans; Metronidazole; Pelvic Inflammatory Disease; Pelvic Pain; Practice Guidelines as Topic; Sexually Transmitted Diseases; Ultrasonography

The subcutaneous route is a widely used route of administration in routine clinical practice, particularly in elderly patients, when the intravenous route cannot be used. This review of the literature highlights the lack of randomized studies and the lack of pharmacokinetic data on the use of this route of administration. Three antibiotics administered subcutaneously can be used for severe infections, with acceptable pharmacokinetic and pharmacodynamic data, when the intravenous administration is not possible: ceftriaxone, ertapenem, and teicoplanin.

Topics: Age Factors; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Clinical Trials as Topic; Cohort Studies; Ertapenem; Humans; Infusions, Intravenous; Injections, Intravenous; Injections, Subcutaneous; Microbial Sensitivity Tests; Teicoplanin

Antimicrobial resistance (AMR) is widely acknowledged as a global problem, yet in many parts of the world its magnitude is still not well understood. This review, using a public health focused approach, aimed to understand and describe the current status of AMR in Africa in relation to common causes of infections and drugs recommended in WHO treatment guidelines.. PubMed, EMBASE and other relevant databases were searched for recent articles (2013-2016) in accordance with the PRISMA guidelines. Article retrieval and screening were done using a structured search string and strict inclusion/exclusion criteria. Median and interquartile ranges of percent resistance were calculated for each antibiotic-bacterium combination.. AMR data was not available for 42.6% of the countries in the African continent. A total of 144 articles were included in the final analysis. 13 Gram negative and 5 Gram positive bacteria were tested against 37 different antibiotics. Penicillin resistance in Streptococcus pneumoniae was reported in 14/144studies (median resistance (MR): 26.7%). Further 18/53 (34.0%) of Haemophilus influenza isolates were resistant to amoxicillin. MR of Escherichia coli to amoxicillin, trimethoprim and gentamicin was 88.1%, 80.7% and 29.8% respectively. Ciprofloxacin resistance in Salmonella Typhi was rare. No documented ceftriaxone resistance in Neisseria gonorrhoeae was reported, while the MR for quinolone was 37.5%. Carbapenem resistance was common in Acinetobacter spp. and Pseudomonas aeruginosa but uncommon in Enterobacteriaceae.. Our review highlights three important findings. First, recent AMR data is not available for more than 40% of the countries. Second, the level of resistance to commonly prescribed antibiotics was significant. Third, the quality of microbiological data is of serious concern. Our findings underline that to conserve our current arsenal of antibiotics it is imperative to address the gaps in AMR diagnostic standardization and reporting and use available information to optimize treatment guidelines.

Topics: Africa; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Enterobacteriaceae; Escherichia coli; Humans; Neisseria gonorrhoeae

In chronic persistent asthma and severe acute exacerbations of bronchial asthma, infectious agents are the predominant triggers that drive disease and airway pathobiology. In acute exacerbations of bronchial asthma (AEBA) including near fatal and fatal asthma, viral agents, particularly human rhinovirus-C, respiratory syncytial virus and influenza A appear to be the more prevalent and recurring threats. Both viral, and to a lesser extent bacterial agents, can play a role, and co-infection may also be present and worsen prognosis in hospitalized patients, placing a portion at risk for critical asthma syndrome. During severe acute exacerbations, infectious agents must be treated empirically, but the initial treatment regimens can vary and viral coverage may also vary based on seasonality and patient age. Early treatment with ceftriaxone and azithromycin, along with oseltamivir in winter months, should be initiated with all cases of severe exacerbations where infection is suspected, and definitely in critical asthma syndrome until infection is excluded by appropriate diagnostic testing. In this manuscript we will outline the impact of the major viral agents on severe asthma including the data from the 2009 H1N1 influenza pandemic. The role of bacterial infections in acute exacerbations of asthma will also be reviewed as well as the benefit of empiric antibiotics and the role of macrolides in both acute and chronic asthma.

Topics: Animals; Asthma; Azithromycin; Bacterial Infections; Ceftriaxone; Coinfection; Critical Illness; Disease Progression; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Oseltamivir; Seasons; Syndrome

Current (1999) World Health Organization guidelines recommend giving routine antibiotics (AB) for all children with severe acute malnutrition (SAM), even if they have uncomplicated disease with no clinically obvious infections. We examined the evidence behind this recommendation.. OVID-MEDLINE, EMBASE, COCHRANE, GLOBAL-HEALTH, CINAHL, POPLINE, AFRICA-WIDE-NiPAD, and LILACS were searched for AB efficacy, bacterial resistance, and infection rates in SAM. Following PRISMA guidelines, a systematic review and meta-analysis were performed. Three randomised controlled trials (RCT), five Cochrane reviews, and 37 observational studies were identified. One cohort-study showed no increase in nutritional-cure and mortality in uncomplicated SAM where no AB were used. (p>0.05). However, an unpublished RCT in this setting did show mortality benefits. Another RCT did not show superiority of ceftriaxone over amoxicilllin for these same outcomes, but adressed SAM children with and without complications (p = 0.27). Another RCT showed no difference between amoxicillin and cotrimoxazole efficacies for pneumonia in underweight, but not SAM. Our meta-analysis of 12 pooled susceptibility-studies for all types of bacterial isolates, including 2767 stricly SAM children, favoured amoxicillin over cotrimoxazole for susceptibility medians: 42% (IQR 27-55%) vs 22% (IQR 17-23%) and population-weighted-means 52.9% (range 23-57%) vs 35.4% (range 6.7-42%). Susceptibilities to second-line AB were better, above 80%. Prevalence of serious infections in SAM, pooled from 24 studies, ranged from 17% to 35.2%. No study infered any association of infection prevalence with AB regimens in SAM.. The evidence underlying current antibiotic recommendations for uncomplicated SAM is weak. Susceptibility-studies favour amoxicillin over cotrimoxazole. However, given that these antibiotics have side-effects, costs, and risks as well as benefits, their routine use needs urgent testing. With reliable monitoring, we believe that there is sufficient equipoise for placebo controlled RCTs, the only robust way to demonstrate true efficacy.

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Ceftriaxone; Child; Child Nutrition Disorders; Child, Preschool; Humans; Practice Guidelines as Topic

Ceftaroline fosamil, the prodrug form of ceftaroline, is a novel broad-spectrum parenteral cephalosporin that exhibits antibacterial activity against typical respiratory pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus and common Gram-negative pathogens. In particular, ceftaroline has activity against resistant Gram-positive cocci, including penicillin- and multidrug-resistant S. pneumoniae, as well as methicillin-resistant S. aureus. The activity of ceftaroline against these phenotypes is attributed to its ability to bind to modified penicillin-binding proteins with high affinity when compared with other β-lactams. The activity of ceftaroline is not compromised by the ability of H. influenzae to produce β-lactamase. Ceftaroline fosamil was compared with ceftriaxone for safety and efficacy in two randomized, double-blinded, controlled Phase III clinical trials for the treatment of community-acquired pneumonia (CAP). Microbiological assessments at baseline included respiratory specimen cultures, blood cultures, urinary antigen testing and atypical pathogen serology testing. By-subject and by-pathogen microbiological outcomes were assessed in the microbiologically evaluable population at the test-of-cure visit. The favourable microbiological response rates by subject for ceftaroline were 87.0% compared with 81.0% for ceftriaxone. The by-pathogen microbiological response rates of ceftaroline and ceftriaxone were 87.3% and 72.9% for S. pneumoniae, 83.3% and 85.0% for H. influenzae and 76.0% and 70.4% for S. aureus, respectively. Key baseline pathogens such as S. pneumoniae, H. influenzae and methicillin-susceptible S. aureus were susceptible to ceftaroline, with MIC(90)s of 0.03, 0.03 and 0.25 mg/L, respectively, supporting its utility as a promising new agent for treatment of CAP.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Treatment Outcome

Due to their wide spectrum of activity, good pharmacokinetics, established clinical efficacy and high tolerability, cephalosporins are among the most widely used antibiotics worldwide. The third and fourth generation cephalosporins are predominantly parenteral agents, administered two or three times daily, used in the treatment of a wide range of moderate to severe infections. Ceftriaxone, a third generation cephalosporin, is unique in exhibiting an unusually long elimination half-life that allows for once-daily administration. Among third generation cephalosporins, ceftazidime and cefoperazone are unusual among cephalosporins in possessing activity, albeit moderate, against Pseudomonas aeruginosa. However, both of these agents also exhibit marked loss of activity against Gram-negative organisms producing high levels of Class A or C beta-lactamases. Sulperazone, a 1:1 combination of cefoperazone and the beta-lactamase inhibitor sulbactam, is more resistant to attack by Class A beta-lactamases but remains vulnerable to isolates producing Class C beta-lactamases. Ceftriaxone exhibits the widest antibacterial spectrum of third generation cephalosporins and this is reflected in clinical responses. Cefoperazone and sulperazone exhibit the poorest clinical responses. Although the fourth generation cephalosporins cefpirome and cefepime exhibit enhanced stability to bacterial beta-lactamases and marginally enhanced in vitro antibacterial activity over ceftriaxone, there is no clinical advantage in terms of clinical or bacteriological success. The cephalosporins are well tolerated, with few and generally transient adverse effects; the major exception being haematological abnormalities including blood coagulation disorders associated with cefoperazone. Several pharmacoeconomic studies indicate that the once-daily dosing regimen required for ceftriaxone is the major factor responsible for its cost-effectiveness over third and fourth generation cephalosporins.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cephalosporins; Economics, Pharmaceutical; Humans; In Vitro Techniques; Safety; Treatment Outcome

Fever of unknown origin (FUO) is a rare but important disease. The definition of FUO has not changed in the last 50 years. Classical FUO is defined by an illness of at least 3 weeks duration with fever greater than 38 masculine C, and no established diagnosis after 1 week of hospital investigation. The causes of FUO can be divided in four categories: infectious diseases, noninfectious inflammatory diseases, neoplasms, and others (miscellaneous). Recent studies have surprisingly shown that despite improved diagnostic procedures the percentage of patients with FUO, in which no diagnosis after intensive investigations in specialized centres can be found, has increased. However, finding the correct diagnosis in FUO is essential for these patients for psychological and vital reasons. Therefore and because of economic reasons patients with FUO should be investigated in specialized centres with a department for rheumatology and infectious diseases.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Diagnosis, Differential; Fever of Unknown Origin; Glucocorticoids; Humans; Male; Medical History Taking; Middle Aged; Mucocutaneous Lymph Node Syndrome; Mycoses; Parasitic Diseases; Q Fever; Sprue, Tropical; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Diseases; Whipple Disease

Ertapenem is a Group 1 carbapenem that was licensed in the USA in November 2001 and in Europe in April 2002. Its safety profile has been assessed in 240 healthy volunteers participating in 12 clinical pharmacology studies and in 2046 patients enrolled in five Phase IIa and eight Phase IIb/III clinical trials. The most common drug-related adverse events (AEs) reported in trials comparing ertapenem and piperacillin-tazobactam and in trials comparing ertapenem and ceftriaxone were: diarrhoea (ertapenem versus piperacillin-tazobactam 5.0% versus 7.0%; ertapenem versus ceftriaxone 5.6% versus 5.9%); infused vein complications (ertapenem versus piperacillin-tazobactam 4.5% versus 7.9%; ertapenem versus ceftriaxone 3.2% versus 4.6%); nausea (ertapenem versus piperacillin-tazobactam 2.5% versus 3.4%; ertapenem versus ceftriaxone 3.4% versus 3.3%); and elevations in alanine aminotransferase levels (ertapenem versus piperacillin-tazobactam 8.8% versus 7.3%; ertapenem versus ceftriaxone 8.3% versus 6.9%). Most ertapenem-related AEs were reported as mild-to-moderate in intensity. Ertapenem was not associated with prolongation of the QTc interval. Local reactions of moderate-to-severe intensity at the infusion site were infrequent and occurred with similar frequency in the ertapenem and comparator treatment groups. No overall differences in safety were observed between elderly (aged > or = 65 years and > or = 75 years) and younger patients. Ertapenem, 1 g once a day given by intravenous infusion or intramuscular injection, was generally well tolerated and had overall safety and tolerability profiles similar to those of piperacillin-tazobactam and ceftriaxone.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; beta-Lactams; Ceftriaxone; Clinical Trials as Topic; Community-Acquired Infections; Ertapenem; Female; Humans; Lactams; Male; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Randomized Controlled Trials as Topic

Topics: Anemia, Hemolytic; Anemia, Sickle Cell; Bacterial Infections; Ceftriaxone; Cephalosporins; Child; Follow-Up Studies; Humans; Male; Severity of Illness Index

The diagnostic approach to the young febrile infant is a common dilemma for anyone caring for children. While historically these patients have been considered for automatic admission to the hospital, it seems prudent, because of the iatrogenic risks of hospitalization and in the interest of cost management, to identify those infants who can be safely, and effectively treated as outpatients. A clinical and laboratory process has been described to assist the clinician in this process. A thorough clinical examination accompanied by screening laboratory data will result in excellent results even in the youngest of our patients.

Topics: Ambulatory Care; Analgesics, Non-Narcotic; Bacterial Infections; Ceftriaxone; Fever of Unknown Origin; Hospitalization; Humans; Infant; Infant, Newborn; Physical Examination; Risk Factors; Severity of Illness Index

Topics: Adult; Bacterial Infections; Ceftriaxone; Child; Global Health; Humans; Osteoarthritis; Respiratory Tract Infections; Urinary Tract Infections

In many pediatric infectious disease programs, ceftriaxone or cefotaxime is now the preferred drug for bacterial meningitis caused by H. influenzae, meningococci, and pneumococci. Ceftriaxone reaches a high bactericidal titer in the cerebrospinal fluid and persists at the site of infection longer than any other beta-lactam antibiotic. Short-course, once-daily therapy with ceftriaxone requires more study; currently, many pediatricians administer the agent twice daily for suspected or proven meningitis. Given the association of sequelae with prolongation of positive CSF cultures, ceftriaxone's rapid bactericidal activity is an advantage, which may require an adjunctive agent to block the inflammatory response due to antibiotic-induced release of endotoxin and other cell wall components. As empiric therapy, ceftriaxone is effective in infants and children three months to 18 years old. It is not yet recommended in neonates, because of concerns about bilirubin displacement. Thus, infants up to three months of age should receive ampicillin plus cefotaxime. In adults, ceftriaxone is effective therapy for presumed bacterial meningitis but must be combined with ampicillin initially, since L. monocytogenes meningitis cannot be excluded in most cases until CSF culture results are available.

Topics: Adolescent; Adult; Animals; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Meningitis; Meningitis, Haemophilus; Meningitis, Pneumococcal; Middle Aged

Ceftriaxone is generally recognized to be safe and effective when administered either intravenously or intramuscularly to both adults and children as a single drug for skin and skin structure infections. An advantage of ceftriaxone over the other third-generation cephalosporins is its long serum half-life, which allows it to be given every 12 hours in children and every 24 hours in most adults. There is no question that ceftriaxone is effective for skin and soft tissue infections, particularly those caused by staphylococci and streptococci. The drug's sales to home infusion companies around the country attest to its widespread use for such infections. The fact remains, however, that the data required to substantiate efficacy and safety for ceftriaxone or for any of the other third-generation cephalosporins are just not available in large numbers.

Topics: Adult; Bacterial Infections; Ceftriaxone; Cellulitis; Child; Humans; Infant; Skin Diseases, Infectious; Skin Ulcer

Ceftriaxone is an effective and safe agent for the treatment of osteomyelitis. It is active against most of the causative organisms. Combined with surgery, it is useful for all types of osteomyelitis. In addition, its once-daily dosing has made outpatient therapy feasible for most patients. Questions that remain are whether full treatment with 2 gm every 24 hours for four to six weeks is needed for osteomyelitis or whether 1 gm/day would provide comparable results. The relevance of minimal inhibitory/bactericidal concentrations and serum inhibitory/bactericidal concentrations has not been-determined. Some questions remain about the cure rate of ceftriaxone against S. aureus osteomyelitis, although most cases do well. Comparative studies with agents such as cefazolin or oxacillin would be helpful to resolve this issue. Long-term follow-up of patients treated for osteomyelitis outcome has not been done in sufficient detail to be certain of the comparative results of different antimicrobials. The success rate of the quinolones against gram-negative osteomyelitis appears good, but their activity against gram-positive organisms is uncertain, and development of resistance is a problem. Questions still linger in regard to how much can be accomplished with antimicrobial therapy without surgery and how long antimicrobials are needed once effective surgery has been performed.

Topics: Bacterial Infections; Ceftriaxone; Follow-Up Studies; Humans; Osteomyelitis; Outpatients

One gram once daily of ceftriaxone is as effective as 2 gm for the common causative organisms of community-acquired and nosocomial pneumonias. It should not be used alone against L. pneumophila, the TWAR pneumoniae, and possibly anaerobic pathogens. Preliminary study suggests that a regimen of 500 mg a day may be effective in selected patients with simple pneumonias caused by sensitive pathogens. Ceftriaxone is safe, well tolerated, and cost-effective, which means it can play a significant therapeutic role in nursing homes and other long-term care facilities as well as in outpatient therapy.

Topics: Bacterial Infections; Ceftriaxone; Drug Administration Schedule; Humans; Pneumonia; Respiratory Tract Infections

Ceftriaxone is active against many gram-negative bacillary uropathogens. It achieves very high levels in urine and proximate tissue following single daily doses. Clinical and bacteriologic results in infections due to susceptible organisms have been excellent. Additional comparative studies with longer follow-up may assist in further delineating the relative role of ceftriaxone in management of infections of the urinary tract.

Topics: Bacterial Infections; Ceftriaxone; Drug Resistance, Microbial; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Multicenter Studies as Topic; Urinary Tract Infections

Ceftriaxone fulfills many of the qualities of an ideal antibiotic: a prolonged elimination half-life, which results from a "restrictive" excretion pattern; saturable protein binding, which provides the theoretical basis for administering the total daily dose as a single bolus; and once-a-day dosing, which provides plasma and tissue concentrations that exceed the MIC for most susceptible pathogens for 24 hours.

Topics: Bacterial Infections; Ceftriaxone; Half-Life; Humans; Protein Binding

Third-generation cephalosporins are important additions to the range of antibiotics available for treating children with serious bacterial infections. They are highly active against the common pathogens, which cause bacterial meningitis in children. Strains of Haemophilus influenzae type b resistant to both ampicillin and chloramphenicol, and Streptococcus pneumoniae relatively resistant to penicillin remain susceptible to cefotaxime and ceftriaxone. Escherichia coli, Klebsiella pneumoniae, Citrobacter diversus, as well as the other more common gram-negative bacilli isolated from neonates and children are susceptible to these agents. However, Listeria monocytogenes is not cephalosporin-sensitive. Ceftazidime is the only third-generation cephalosporin useful for treating serious infections due to Pseudomonas aeruginosa in children. As with other beta-lactam antibiotics, the clearance of cephalosporins is prolonged in neonates, particularly premature babies. Cefotaxime and ceftriaxone are equivalent to ampicillin and chloramphenicol for the treatment of bacterial meningitis in children over two to three months of age with respect to neurologic outcome and safety, despite the in vitro activity of cefotaxime and ceftriaxone being much greater than the standard antibiotics for the meningeal pathogens. Cefotaxime and ceftriaxone are effective in the treatment of serious gram-negative infections in children. In many instances, ceftriaxone can be administered once daily, which allows for more convenient therapy, particularly on an outpatient basis. Although controversial, ceftazidime has been used as single-agent therapy for empiric treatment of neutropenic immunocompromised children with fever.

Topics: Bacterial Infections; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Humans; Infant; Infant, Newborn

We analysed eight prospective randomized trials describing the use of ceftriaxone (Rocephin) in short-term prophylaxis in patients undergoing urologic surgery. The results of these trials show that chemoprophylaxis with ceftriaxone is effective. In the therapy of postoperative infections in urologic surgery the single daily dose of ceftriaxone represents a considerable advantage both regarding patients' compliance and clinical convenience. From March 1987 to January 1988, 25 patients with postoperative infections after urologic surgery were treated with ceftriaxone 1 g i.m. once daily. Quick resolution of signs and symptoms of infection occurred in all cases.

Topics: Bacterial Infections; Ceftriaxone; Humans; Postoperative Complications; Premedication; Urinary Tract Infections; Urogenital System

The results of 13 clinical trials were analysed in order to define the efficacy of ceftriaxone (Rocephin) when given alone and in a single daily dose in the treatment of postoperative infections. In a total of 306 evaluable patients, many of whom were suffering from severe infections, the global clinical success rate was about 90%. The drug was very well tolerated. Minor transient effects occurred only in a few patients. In 8 out of the 13 trials, ceftriaxone was compared with other standard antibiotics. In these comparative studies, the global clinical success rate with ceftriaxone (93.8%) was higher than with other drugs (81%). The microbiological response to ceftriaxone was extremely satisfactory for almost all pathogenes.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Humans; Postoperative Complications; Surgical Wound Infection

Present data available on ceftriaxone (Rocephin) dealing with microbiology, pharmacokinetics (long half-life, tissue penetration ability, tissue concentration present during vulnerable period, etc.), results of clinical trials, and world-wide experience seem to be in favor of ceftriaxone as the antimicrobial of choice for single-dose antibiotic prophylaxis in abdominal and biliary surgery. Single-dose surgical prophylaxis is cost-effective, has a low rate of adverse drug events, and so far does not increase danger of resistance.

Topics: Abdomen; Bacterial Infections; Biliary Tract Surgical Procedures; Ceftriaxone; Humans; Postoperative Complications; Premedication

Since ceftriaxone was first reviewed in the Journal, further studies have confirmed its broad antibacterial spectrum in vitro and extended its clinical documentation in comparative studies with other widely used drugs in infections of the urinary and lower respiratory tract, meningitis in infants and children, uncomplicated gonorrhoea, perioperative prophylaxis in patients undergoing surgery, and in several other types of infection. As in earlier studies, which primarily used a twice-daily dosage regimen, few significant differences were found between therapeutic groups in comparative studies and results have demonstrated the efficacy of once-daily ceftriaxone in all but the most serious infections, such as sole antibiotic therapy in pseudomonal infections. Wider clinical experience has established that ceftriaxone is generally well tolerated. Thus, ceftriaxone now has a well-defined place as an appropriate alternative for the parenteral treatment of a variety of infections due to susceptible organisms, as well as for perioperative prophylaxis of surgery, and may offer advantages of greater convenience over other parenteral antibiotics which are administered more frequently.

Topics: Bacterial Infections; Ceftriaxone; Clinical Trials as Topic; Drug Administration Schedule; Humans

Topics: Bacterial Infections; Ceftriaxone; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Evaluation; Female; Genital Diseases, Female; Genital Neoplasms, Female; Humans; Postoperative Complications; Surgical Wound Infection

Topics: Absorption; Animals; Bacterial Infections; Ceftriaxone; Drug Resistance, Microbial; Escherichia coli; Humans; Infusions, Intravenous; Respiratory Tract Infections; Staphylococcus

Ceftriaxone is a new third-generation cephalosporin with excellent activity against many gram-negative, and reasonable activity against most gram-positive microorganisms. Clinical studies have demonstrated its efficacy and safety in patients with bacterial meningitis; respiratory tract, urinary tract, soft tissue, bone and joint infections; and gonorrhea. Ceftriaxone has been well tolerated except for diarrhea, which in most cases has not required a change in therapy. The long elimination half-life of ceftriaxone has allowed twice- and once-daily administration, the latter potentially resulting in substantial cost savings. Because of its documented efficacy, safety, and convenient dosing schedule, ceftriaxone may become the preferred third-generation cephalosporin for the treatment of a variety of serious infections.

Topics: Adult; Bacteria; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Clinical Trials as Topic; Humans; Kinetics; Premedication; Surgical Wound Infection

Ceftriaxone possesses potent activity, both in vitro and in vivo, against a broad range of bacteria. MIC50 and MIC90 geometric means were calculated using the results of broth and agar dilution assays performed worldwide. The MIC90 for ceftriaxone overall was 8 micrograms/ml or less for Enterobacteriaceae and 0.024 microgram/ml or less for Neisseria and Hemophilus species. Moderate activity was noted against Pseudomonas and Acinetobacter species (MIC50 12 to 28 micrograms/ml). Ceftriaxone was extremely active against nonenterococcal streptococci (MIC90 0.07 microgram/ml or less) and quite active against methicillin-susceptible Staphylococcus aureus (MIC90 5 micrograms/ml or less). Ceftriaxone generally was inactive against enterococci and methicillin-resistant staphylococci. Activity against anaerobes was good, except for many strains of Bacteroides fragilis and B. thetaiotaomicron (MIC greater than 64 micrograms/ml). Ceftriaxone exhibited excellent stability to beta-lactamases. The effect of medium and inoculum on in vitro testing was minimal. Excellent activity was demonstrated in vivo. Against Enterobacteriaceae, nonenterococcal streptococci, and H. influenzae, the PD50 in mice generally was less than 1 mg/kg. S. aureus strains responded moderately (mean PD50 6.5 mg/kg), whereas against most P. aeruginosa strains, PD50s ranged from 5 to greater than 250 mg/kg. The superior pharmacokinetic profile of ceftriaxone compared with that of other new cephalosporins was demonstrated by use of a prophylactic treatment schedule. The ability of ceftriaxone to penetrate the cerebrospinal fluid and provide excellent therapeutic coverage was confirmed in experimental meningitis models.

Topics: Aminoglycosides; Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Bacterial Proteins; Carrier Proteins; Cefotaxime; Ceftriaxone; Cell Membrane Permeability; Drug Resistance, Microbial; Hexosyltransferases; Humans; Meningitis; Mice; Microbial Sensitivity Tests; Muramoylpentapeptide Carboxypeptidase; Penicillin-Binding Proteins; Peptidyl Transferases

Topics: Animals; Bacterial Infections; Ceftriaxone; Cephalosporins; Child; Clinical Trials as Topic; Dose-Response Relationship, Drug; Humans; Infant; Kinetics; Microbial Sensitivity Tests

For the treatment of spontaneous bacterial peritonitis (SBP), cefotaxime, ceftriaxone, and ciprofloxacin were used as first-line agents. However, considering the increasing rate of antibiotic resistance, it is unclear which of these drugs can be initially recommended. This study aimed to compare the current efficacy of the 3 antibiotics, namely cefotaxime, ceftriaxone, and ciprofloxacin, for the treatment of SBP in patients with cirrhosis with ascites, when guided by therapeutic responses.. This study was a multicenter, prospective, randomized controlled trial. The inclusion criteria were 16- to 75-year-old patients with liver cirrhosis with ascites, having polymorphonuclear cell count of >250/mm 3 . We performed a follow-up paracentesis at 48 hours to decide continuing or changing the assigned antibiotics and then assessed the resolution rates at 120 and 168 hours of treatment.. A total of 261 patients with cirrhosis who developed SBP were enrolled. Most of the patients were diagnosed as those with SBP within 48 hours of admission. The resolution rates at 120 hours, which is the primary endpoint, were 67.8%, 77.0%, and 73.6% in the cefotaxime, ceftriaxone, and ciprofloxacin groups, respectively ( P = 0.388), by intension-to-treat analysis. The 1-month mortality was similar among the groups ( P = 0.770). The model for end-stage liver disease score and the SBP resolution were significant factors for survival.. The efficacy of empirical antibiotics, such as cefotaxime, ceftriaxone, and ciprofloxacin, against SBP was not significantly different. In addition, these antibiotics administered based on response-guided therapy were still efficacious as initial treatment for SBP, especially in those with community-acquired infections.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ascites; Bacterial Infections; Cefotaxime; Ceftriaxone; Ciprofloxacin; End Stage Liver Disease; Humans; Liver Cirrhosis; Middle Aged; Peritonitis; Prospective Studies; Severity of Illness Index; Young Adult

Although prophylactic antibiotics have been recommended for cirrhotic patients with upper gastrointestinal bleeding, the duration of its use remains an inconclusive issue. We designed this study to investigate the duration of antibiotic prophylaxis for cirrhotic patients with acute esophageal variceal bleeding.. We enrolled those patients suffering from acute esophageal variceal bleeding and receiving band ligation. They were randomly allocated to two groups to receive prophylactic antibiotics; Group I: receiving intravenous ceftriaxone 500 mg every 12 hours for 3 days, and Group II: same regimen for 7 days. We used rebleeding rate within 14 days as the primary end point and also evaluated the survival rate within 28 days and the amount of transfusion during admission.. There were 38 patients in Group I and 33 patients in Group II that completed the study course for analysis. Overall, there was no significant difference in the baseline characteristics between these two groups. There were three patients both in Group I and Group II who developed rebleeding within 14 days (8% vs. 9%, p > 0.99). There was also no difference between Group I and Group II in transfusion amount (2.71 ± 2.84 units vs. 3.18 ± 4.07, p = 0.839) and survival rate in 28 days (100 vs. 97%, p = 0.465).. Our small scale study demonstrated that there was no difference in the rebleeding rate between 3-day and 7-day ceftriaxone prophylaxis for cirrhotic patients with acute esophageal variceal bleeding. There was also no difference in 28 day survival rate between these two groups.

Topics: Administration, Intravenous; Adult; Aged; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Ligation; Liver Cirrhosis; Logistic Models; Male; Middle Aged; Recurrence; Taiwan

The Preventive Antibiotics in Stroke Study (PASS), a randomized open-label masked endpoint trial, showed that preventive ceftriaxone did not improve functional outcome at 3 months in patients with acute stroke (adjusted common OR 0.95; 95% CI 0.82-1.09). Post-hoc analyses showed that among patients who received intravenous thrombolysis (IVT), patients who received ceftriaxone had a significantly better outcome as compared with the control group. This study aimed to gain more insight into the characteristics of these patients.. In PASS, 2,550 patients were randomly assigned to preventive antibiotic treatment with ceftriaxone or standard care. In current post-hoc analysis, 836 patients who received IVT were included. Primary outcome included functional status on the modified Rankin Scale, analyzed with adjusted ordinal regression. Secondary outcomes included infection rate and symptomatic intracerebral hemorrhage (sICH) rate.. For all patients in PASS, the p value for the interaction between IVT and preventive ceftriaxone regarding functional outcome was 0.03. Of the 836 IVT-treated patients, 437 were administered ceftriaxone and 399 were allocated to the control group. Baseline characteristics were similar. In the IVT subgroup, preventive ceftriaxone was associated with a significant reduction in unfavorable outcome (adjusted common OR 0.77; 95% CI 0.61-0.99; p = 0.04). Mortality at 3 months was similar (OR 0.75; 95% CI 0.48-1.18). Preventive ceftriaxone was associated with a reduction in infections (OR 0.43; 95% CI 0.28-0.66), and a trend towards an increased risk for sICH (OR 3.09; 95% CI 0.85-11.31). Timing of ceftriaxone administration did not influence the outcome (aOR 1.00; 95% CI 0.98-1.03; p = 0.85).. According to the post-hoc analysis of PASS, preventive ceftriaxone may improve the functional outcome in IVT-treated patients with acute stroke, despite a trend towards an increased rate of post-IVT-sICH.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Cerebral Hemorrhage; Disability Evaluation; Drug Administration Schedule; Female; Fibrinolytic Agents; Humans; Infusions, Intravenous; Male; Middle Aged; Odds Ratio; Risk Factors; Stroke; Thrombolytic Therapy; Time Factors; Tissue Plasminogen Activator; Treatment Outcome

Stroke-associated infections occur frequently and are associated with unfavorable outcome. Previous cohort studies suggest a protective effect of beta-blockers (BBs) against infections. A sympathetic drive may increase immune suppression and infections.. This study is aimed at investigating the association between BB treatment at baseline and post-stroke infection in the Preventive Antibiotics in Stroke Study (PASS), a prospective clinical trial.. We performed an exploratory analysis in PASS, 2,538 patients with acute phase of stroke (24 h after onset) were randomized to ceftriaxone (intravenous, 2 g per day for 4 days) in addition to stroke unit care, or standard stroke unit care without preventive antibiotic treatment. All clinical data, including use of BBs, was prospectively collected. Infection was diagnosed by the treating physician, and independently by an expert panel blinded for all other data. Multivariable analysis was performed to investigate the relation between BB treatment and infection rate.. Infection, as defined by the physician, occurred in 348 of 2,538 patients (14%). Multivariable analysis showed that the use of BBs at baseline was associated with the development of infection during clinical course (adjusted OR (aOR) 1.61, 95% CI 1.19-2.18; p < 0.01). BB use at baseline was also associated with the development of pneumonia (aOR 1.56, 95% CI 1.05-2.30; p = 0.03). Baseline BB use was not associated with mortality (aOR 1.14, 95% CI 0.84-1.53; p = 0.41) or unfavorable outcome at 3 months (aOR 1.10, 95% CI 0.89-1.35; p = 0.39).. Patients treated with BBs prior to stroke have a higher rate of infection and pneumonia.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Drug Administration Schedule; Female; Humans; Immunocompromised Host; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Opportunistic Infections; Pneumonia, Bacterial; Prospective Studies; Risk Factors; Stroke; Time Factors; Treatment Outcome; Urinary Tract Infections

Stroke is a leading cause of death worldwide. Infections after stroke occur in 30% of stroke patients and are strongly associated with unfavourable outcome. Preventive antibiotic therapy lowers infection rate in patients after stroke, however, the effect of preventive antibiotic treatment on functional outcome after stroke has not yet been investigated.The Preventive Antibiotics in Stroke Study (PASS) is an ongoing, multicentre, prospective, randomised, open-label, blinded end point trial of preventive antibiotic therapy in acute stroke. Patients are randomly assigned to either ceftriaxone at a dose of 2 g, given every 24 hours intravenously for four-days, in addition to stroke-unit care, or standard stroke-unit care without preventive antibiotic therapy. Aim of the study is to assess whether preventive antibiotic treatment improves functional outcome at three months by preventing infections.. To date, 2,470 patients have been included in PASS. Median stroke severity of the first 2,133 patients (second interim analysis) is 5 (IQR 3 to 9) on the National Institutes of Health Stroke Scale (NIHSS). Due to the PROBE design, no outcome data are available yet. In the initial trial protocol we proposed a dichotomisation of the mRS as primary analysis of outcome and ordinal regression analysis as secondary analysis of primary outcome, requiring a sample size of 3,200 patients. However, ordinal analysis of outcome data is becoming increasingly more common in acute stroke trials, as it increases statistical power. For PASS, funding is insufficient for inclusion of 3,200 patients with the overall inclusion rate of 15 patients per week. Therefore we change the analysis of our primary outcome from dichotomisation to ordinal regression analysis on the mRS. Power analysis showed that with similar assumptions 2,550 patients are needed using ordinal regression analysis. We expect to complete follow-up in June 2014. A full statistical analysis plan will be submitted for publication before treatment allocation will be unblinded.. The data from PASS will establish whether preventive antibiotic therapy in acute stroke improves functional outcome by preventing infection. In this update, we changed our primary outcome analysis from dichotomisation to ordinal regression analysis.. Current controlled trials; ISRCTN66140176. Date of registration: 6 April 2010.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Clinical Protocols; Disability Evaluation; Drug Administration Schedule; Humans; Patient Selection; Regression Analysis; Research Design; Sample Size; Severity of Illness Index; Stroke; Time Factors; Treatment Outcome

Infections occur in 30% of stroke patients and are associated with unfavorable outcomes. Preventive antibiotic therapy lowers the infection rate after stroke, but the effect of preventive antibiotic treatment on functional outcome in patients with stroke is unknown. The PASS is a multicenter, prospective, phase three, randomized, open-label, blinded end-point (PROBE) trial of preventive antibiotic therapy in acute stroke. Patients are randomly assigned to either ceftriaxone at a dose of 2 g, given every 24 h intravenously for 4 days, in addition to standard stroke-unit care, or standard stroke-unit care without preventive antibiotic therapy. The aim of this study is to assess whether preventive antibiotic treatment improves functional outcome at 3 months by preventing infections. This paper presents in detail the statistical analysis plan (SAP) of the Preventive Antibiotics in Stroke Study (PASS) and was submitted while the investigators were still blinded for all outcomes.. The primary outcome is the score on the modified Rankin Scale (mRS), assessed by ordinal logistic regression analysis according to a proportional odds model. Secondary analysis of the primary outcome is the score on the mRS dichotomized as a favorable outcome (mRS 0 to 2) versus unfavorable outcome (mRS 3 to 6). Secondary outcome measures are death rate at discharge and 3 months, infection rate during hospital admission, length of hospital admission, volume of post-stroke care, use of antibiotics during hospital stay, quality-adjusted life years and costs. Complications of treatment, serious adverse events (SAEs) and suspected unexpected serious adverse reactions (SUSARs) are reported as safety outcomes.. The data from PASS will establish whether preventive antibiotic therapy in acute stroke improves functional outcome by preventing infection and will be analyzed according to this pre-specified SAP.. Current controlled trials; ISRCTN66140176. Date of registration: 6 April 2010.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Clinical Protocols; Cost-Benefit Analysis; Data Interpretation, Statistical; Disability Evaluation; Drug Administration Schedule; Drug Costs; Hospital Mortality; Humans; Length of Stay; Logistic Models; Netherlands; Odds Ratio; Prospective Studies; Quality of Life; Recovery of Function; Research Design; Stroke; Time Factors; Treatment Outcome

This clinical study was designed to evaluate the efficacy and safety of this therapy in the treatment of respiratory and urinary infections caused by ceftriaxone-resistant bacteria in comparison with the effect of cefoperazone/sulbactam on cefoperazone-resistant bacteria.. A total of 285 patients aged from 18 to 65 years old, with a respiratory or urinary tract bacterial infection, were enrolled into this multicentre, open-label, controlled clinical study, and bacteria that were either ceftriaxone-resistant or cefoperazone-resistant were isolated from the patients, whose condition had not improved after three days of treatment with ceftriaxone or cefoperazone. To be selected for the study, bacterial cultures obtained from the patients had to be positive before enrolment, and all of the isolates were required to be β-lactamase-positive. Of these patients, 253 completed the trial, and 263 were enrolled into the intention-to-treat (ITT) analysis. All of the 285 patients were included in the safety analysis.. The cure and effective rates were 39.55% and 85.07% in the ceftriaxone/sulbactam group and 36.43% and 79.84% in the cefoperazone/sulbactam group; the bacterial eradication rates were 83.58% and 83.72%; and the adverse-event rates were 7.48% and 7.80%, respectively. There were no significant differences between the two groups (p > 0.05).. Ceftriaxone/sulbactam is as effective and well-tolerated as cefoperazone/sulbactam for the treatment of intermediate and severe bacterial infections caused by resistant strains.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; beta-Lactam Resistance; Cefoperazone; Ceftriaxone; Female; Humans; Injections, Intravenous; Male; Middle Aged; Respiratory Tract Infections; Sulbactam; Treatment Outcome; Urinary Tract Infections; Young Adult

Sepsis in the neonatal period is a major cause of child mortality in low-income countries. Hospitalization and parenteral penicillin/ampicillin and gentamicin therapy are recommended for management. Many families, however, are unable to access hospital care, and most home-delivered newborns who develop sepsis die without receiving antibiotic therapy. Appropriate community-based therapy in such situations is undefined. We compared failure rates of 3 clinic-based antibiotic regimens in 0- to 59-day-old infants with possible serious bacterial infection whose families refused hospitalization in Karachi communities with high neonatal mortality rates>45/1000 live births.. Eligible infants were randomly assigned to 7 days of: (1) procaine penicillin [50,000 units/kg once daily (OD) by intramuscular injection (IM)] and gentamicin (5 mg/kg OD IM) reference arm, (2) ceftriaxone (50 mg/kg OD IM), or (3) oral trimethoprim-sulfamethoxazole (TMP-SMX) at 10 mg/kg/day divided twice daily and gentamicin IM OD. Primary outcome was treatment failure, defined as death, deterioration in clinical condition during therapy or no improvement after 2 days.. Possible serious bacterial infection was diagnosed in 704 infants, among 5766 screened. Among 434 (61.6%) randomized to clinic-based therapy, there were 13 of 145 failures with penicillin-gentamicin, 22 of 145 with ceftriaxone and 26 of 143 with TMP-SMX-gentamicin. Treatment failure was significantly higher with TMP-SMX-gentamicin compared with penicillin-gentamicin [relative risk 2.03, 95% confidence interval: 1.09-3.79] by intention-to-treat analysis. Differences were not significant in the ceftriaxone versus penicillin-gentamicin comparison [relative risk 1.69, 95% confidence interval 0.89-3.23). By 14 days, there were 2 deaths in the penicillin-gentamicin group, 3 in the ceftriaxone group and 11 in the TMP-SMX-gentamicin group [relative risk 5.58, 95% confidence interval: 1.26-24.72 (group 3 versus 1)].. When hospitalization of sick infants is unfeasible, outpatient therapy with injectable antibiotics is an effective option. Procaine penicillin-gentamicin was superior to TMP-SMX-gentamicin. Ceftriaxone is a more expensive option, and may be less effective, although this requires further research.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Community-Acquired Infections; Female; Gentamicins; Humans; India; Infant; Infant, Newborn; Male; Penicillins; Sepsis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To compare the effectiveness of ceftriaxone versus cefazolin for the prevention of febrile morbidity and postoperative infections among patients after abdominal hysterectomy.. In a double-blind, randomized, controlled trial in Bangkok, Thailand, 320 patients undergoing abdominal hysterectomy between July 2008 and July 2009 were randomly assigned to receive 1g of either ceftriaxone or cefazolin intravenously in a single dose before surgery. The participants were evaluated for postoperative fever and infection for up to 4 weeks. χ(2) or Fisher exact tests were used for statistical analysis.. There was no significant difference between the ceftriaxone and cefazolin groups in incidence of febrile morbidity (9.4% versus 11.2%), wound infection (3.8% versus 1.9%), vaginal cuff infection (3.8% versus 1.9%), or urinary tract infection (1.9% versus 1.9%).. There was no difference between the use of single-dose preoperative ceftriaxone and cefazolin in preventing infectious morbidity among patients undergoing hysterectomy.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefazolin; Ceftriaxone; Double-Blind Method; Female; Fever; Humans; Hysterectomy; Incidence; Middle Aged; Surgical Wound Infection; Thailand; Treatment Outcome; Urinary Tract Infections; Vaginal Diseases

Stroke is a leading cause of death worldwide. Fever after stroke is a strong predictor of a poor outcome. Infections occur in up to 40% of patients with stroke and have also been associated with poor outcomes. Preventive antibiotic therapy lowers the infection rates in patients after stroke, as shown in a recent meta-analysis of randomised studies. Phase III trials evaluating the effect of antibiotic prophylaxis on clinical outcomes in sufficient numbers of patients with stroke have, however, not been performed to date. Ceftriaxone, an off-patent medicine, is an antibiotic with a broad defence against the bacteria that cause the most common infections after stroke. Preventive antibiotic therapy with ceftriaxone may potentially reduce poor outcome after acute stroke and, therefore, a randomised clinical trial is warranted.. The aim of the present study is to investigate whether the preventive use of the antibiotic ceftriaxone improves functional outcome in patients with stroke.. We will conduct a multicentre prospective, randomised, open-label, blinded end point trial of standard care with preventive ceftriaxone treatment and compare it with standard care without preventive ceftriaxone. Adult patients with stroke (both ischaemic and haemorrhagic) and a score ≥ 1 on the National Institutes of Health Stroke Scale will be included. The 3200 patients will be randomly assigned to two groups of 1600 patients. One group will receive standard care and ceftriaxone at a dose of 2 g, given every 24 h intravenously for four-days, and the other group will receive stroke-unit care without preventive antibiotic treatment.. The primary end point will be functional outcome at a three-month follow-up on the modified Rankin Scale, dichotomised as a favourable outcome (0-2) or an unfavourable outcome (3-6). Secondary outcome measures will be death rate at discharge and three-months, infection rate during hospital admission, length of hospital admission, volume of poststroke care, use of antibiotics during the three-month follow-up, functional outcome using the full ordinal scoring range of the modified Rankin Scale, quality-adjusted life years and costs.

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Humans; Recovery of Function; Research Design; Stroke

Ceftaroline fosamil, the prodrug form of ceftaroline, is a novel broad-spectrum parenteral cephalosporin that exhibits antibacterial activity against typical respiratory pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus and common Gram-negative pathogens. In particular, ceftaroline has activity against resistant Gram-positive cocci, including penicillin- and multidrug-resistant S. pneumoniae, as well as methicillin-resistant S. aureus. The activity of ceftaroline against these phenotypes is attributed to its ability to bind to modified penicillin-binding proteins with high affinity when compared with other β-lactams. The activity of ceftaroline is not compromised by the ability of H. influenzae to produce β-lactamase. Ceftaroline fosamil was compared with ceftriaxone for safety and efficacy in two randomized, double-blinded, controlled Phase III clinical trials for the treatment of community-acquired pneumonia (CAP). Microbiological assessments at baseline included respiratory specimen cultures, blood cultures, urinary antigen testing and atypical pathogen serology testing. By-subject and by-pathogen microbiological outcomes were assessed in the microbiologically evaluable population at the test-of-cure visit. The favourable microbiological response rates by subject for ceftaroline were 87.0% compared with 81.0% for ceftriaxone. The by-pathogen microbiological response rates of ceftaroline and ceftriaxone were 87.3% and 72.9% for S. pneumoniae, 83.3% and 85.0% for H. influenzae and 76.0% and 70.4% for S. aureus, respectively. Key baseline pathogens such as S. pneumoniae, H. influenzae and methicillin-susceptible S. aureus were susceptible to ceftaroline, with MIC(90)s of 0.03, 0.03 and 0.25 mg/L, respectively, supporting its utility as a promising new agent for treatment of CAP.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Treatment Outcome

Tigecycline (TGC) has demonstrated clinical efficacy and safety, in comparison with imipenem/cilastatin in phase 3 clinical trials, for complicated intra-abdominal infection (cIAI). The present study comprised a multicentre, open-label, randomized study of TGC vs. ceftriaxone plus metronidazole (CTX/MET) for the treatment of patients with cIAI. Eligible subjects were randomized (1:1) to receive either an initial dose of TGC (100 mg) followed by 50 mg every 12 h or CTX (2 g once daily) plus MET (1-2 g daily), for 4-14 days. The primary endpoint was the clinical response in the clinically evaluable (CE) population at the test of cure (TOC) assessment. Of 473 randomized subjects, 376 were CE. Among these, clinical cure rates were 70.4% (133/189) with TGC vs. 74.3% (139/187) with CTX/MET (95% CI -13.1 to 5.1; p 0.009 for non-inferiority). Clinical cure rates for subjects with Acute Physiological and Chronic Health Evaluation II scores > or =10 were 56.8% (21/37) with TGC vs. 58.3% (21/36) with CTX/MET. The microbiologic response was similar between the two treatment arms, with microbiological eradication at TOC achieved in 68.1% (94/138) of TGC-treated subjects and 71.5% (98/137) of CTX/MET-treated subjects. (The most frequently reported adverse events (AEs) for both treatment arms were nausea (TGC, 38.6% vs CTX/MET, 27.7%) and vomiting (TGC, 23.3% vs CTX/MET, 17.7%). Overall discontinuation rates as a result of an AE were 8.9% and 4.8% in TGC- and comparator-treated subjects, respectively. The results obtained in the present study demonstrate that TGC monotherapy is non-inferior to a combination regimen of CTX/MET with respect to treating subjects with cIAI.

Topics: Abdomen; Anti-Infective Agents; Bacteria; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Gastrointestinal Diseases; Humans; Male; Metronidazole; Middle Aged; Minocycline; Tigecycline; Treatment Outcome

This prospective, randomized, open, international, multicenter study of adults with complicated intra-abdominal infections (cIAI) compared the efficacy and safety of sequential intravenous (i.v.) to oral (p.o.) moxifloxacin 400 mg once daily, with that of i.v. ceftriaxone 2 g once daily, plus metronidazole 500 mg three times daily, followed by p.o. amoxicillin/clavulanate 625 mg three times daily. The primary efficacy variable was clinical cure at test of cure (TOC) (day 28-42 after study entry) in the per protocol (PP) population. Of 595 patients in the study, 511 patients were valid for PP analysis (246 moxifloxacin, 265 ceftriaxone/metronidazole). Sequential moxifloxacin was noninferior to the comparator regimen--clinical cure rates at TOC were 80.9% versus 82.3% (moxifloxacin versus ceftriaxone/metronidazole; 95% CI -8.9, 4.2%). The incidence of adverse events was comparable between the two treatment groups. Therefore, sequential moxifloxacin monotherapy is as effective and safe as combination therapy with i.v. ceftriaxone plus i.v. metronidazole followed by oral amoxicillin/clavulanate for the treatment of cIAI.

Topics: Abdominal Abscess; Administration, Oral; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Appendicitis; Aza Compounds; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Fluoroquinolones; Gastrointestinal Diseases; Humans; Infusions, Intravenous; Intestinal Perforation; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Moxifloxacin; Peritonitis; Prospective Studies; Quinolines

The empirical use of antibiotic therapy is widely accepted for patients with fever and neutropenia during cancer chemotherapy. The use of intravenous monotherapy with broad-spectrum antibiotics in patients at high risk for complications is an appropriate alternative. However, few data are available for pediatric patients. The aim of this study was to compare the efficacy and safety of cefepime (CFP) monotherapy with ceftriaxone plus amikacin (CFT+AK) in children and adolescents with febrile neutropenia (FN).. A prospective randomized open study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy was conducted. Patients were randomized to receive CFP or CFT+AK. The randomization was based on number lists.. Fifty seven patients with 125 episodes of fever and neutropenia were evaluated (CFP, 62 episodes; CFT+AK, 63 episodes). The mean neutrophil count at admission to hospital was 118.6 cells/mm(3) for patients in the CFP group and 107 cells/mm(3) for patients in the CFT+AK group. The mean duration of neutropenia was 9 days for the CFP group and 8 days for the CFT+AK group. Analysis of only the first episodes for each patient showed that CFP treatment was successful for 65.5% of episodes and CFT+AK was successful for 64.3% of episodes. The overall rates of success with modification were 90% for the CFP group and 89% for the CFT+AK group. No major treatment-emergent toxicity was reported.. Monotherapy with CFP seems to be as effective and safe as CFT+AK for initial empirical therapy in children and adolescents with FN.

Topics: Adolescent; Amikacin; Anti-Bacterial Agents; Bacterial Infections; Cefepime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Hematologic Neoplasms; Humans; Immunocompromised Host; Infant; Male; Neutropenia; Treatment Outcome; Young Adult

A multicenter, open labelled, randomized study was carried out to compare the prophylactic efficacy of Cefepime and Ceftriaxone in patients undergoing biliary tract surgery. Two hundred and nine patients were included in the study and randomized to receive preoperative infusion of 2 g Cefepime (n=107) or 2 g Ceftriaxone (n=102) both in a single i.v. administration. Antimicrobial prophylaxis was successful in preventing infections in 98.9% of patients in the Cefepime group and 97.7% in the Ceftriaxone group (p=0.3871). Both regimens were well tolerated without any adverse drug-related reactions. A single dose of Cefepime seems to be a very useful alternative to other regimens for antibiotic prophylaxis of postoperative infectious complications in the elective surgical treatment of cholelithiasis.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefepime; Ceftriaxone; Cephalosporins; Cholelithiasis; Female; Humans; Injections, Intravenous; Male; Middle Aged; Postoperative Complications

Pathogens can infect almost all tissues and cause serious infections. Objective was to evaluate efficacy and safety of fixed-dose combination of Ceftriaxone-Vancomycin in patients with various infections. Patients (n=305) suffering from different bacterial infections (serious respiratory tract disease, bronchitis, gastrointestinal tract infections, urinary tract infection, cellulites and meningitis) were enrolled. Patients were randomized into two groups depending on severity of illness. Group A (n=106) and Group B (n=199) patients were given intravenous dose of fixed-dose combination 1.5 g B.D. and 3.0 g B.D. respectively for 3-10 days. Hemoglobin, total leukocyte count, erythrocyte sedimentation rate, urea, creatinine levels serum glutamyl oxaloacetic transaminase and glutamyl pyruvic transaminase activities were recorded before and on completion of the treatment. Most of patients (70%) were cured in seven or less than seven days of the treatment. Significant decrease in total leukocyte count, erythrocyte sedimentation rate levels were observed indicating patients were cured from the infections. No significant alterations were observed in hemoglobin, serum urea, creatinine levels, glutamyl oxaloacetic transaminase and glutamyl pyruvic transaminase activities on completion of treatment. The fixed-dose combination of Ceftriaxone-Vancomycin, is found to be effective in treating various bacterial infections without any toxic effect on liver and kidney. Patients well tolerated the drug without major adverse effects.

Topics: Adult; Alanine Transaminase; Anti-Bacterial Agents; Aspartate Aminotransferases; Bacterial Infections; Blood Cell Count; Ceftriaxone; Creatinine; Drug Combinations; Female; Hemoglobins; Humans; Male; Urea; Vancomycin

Empirical antibiotic treatment for febrile neutropenia is well established. The best regimen is still controversial. The purpose of this study was to evaluate the efficacy, safety, and cost of a once daily high dose of ceftriaxone plus ciprofloxacin versus thrice daily ceftazidime plus amikacin in neutropenic febrile patients.. Ninety-five patients with febrile neutropenia were included in a prospective, controlled, randomized, non-blind, comparative study. Patients were randomly assigned to one of the treatment groups (63 to the ceftriaxone/ciprofloxacin group and 32 to the ceftazidime/amikacin group) and evaluated as successes or failures according to defined criteria. Daily assessments were made of all patients and all adverse events were recorded.. The overall incidence of documented infections was 45.9%: 24/47 (51.1%) in the ceftriaxone/ciprofloxacin group and 10/27 (37%) in the ceftazidime/amikacin group. There was a significant difference in clinical efficacy between the groups (p=0.011) at the end of therapy. The ceftriaxone/ciprofloxacin group had an overall incidence of resolution and improvement of 95.7% in comparison to 75% in the ceftazidime/amikacin group. Thirty-nine organisms were isolated, 26 (66.67%) gram-negative and 13 (33.33%) gram-positive. There was a low incidence of adverse events in both groups.. The combination of a single, high dose of ceftriaxone plus ciprofloxacin daily was more effective than the standard combination of thrice daily ceftazidime plus amikacin with no significant adverse events in either group.

Topics: Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; Ceftazidime; Ceftriaxone; Ciprofloxacin; Cost-Benefit Analysis; Drug Costs; Drug Therapy, Combination; Female; Fever; Greece; Humans; Male; Middle Aged; Neutropenia; Prospective Studies; Treatment Outcome

Procalcitonin (PCT) is regarded as a specific indicator of bacterial infection. Infectious complications in patients after colorectal surgery are a common cause of morbidity and mortality. The aim of this study was to investigate (a) whether PCT could serve as a negative predictive marker for postoperative complications and (b) whether, in patients with elevated PCT levels, a pre-emptive treatment with the third-generation cephalosporin ceftriaxone is superior to an antibiotic treatment starting later on the appearance of clinical signs and symptoms of infection.. By screening 250 patients with colorectal surgery, we identified 20 patients with PCT serum levels more than 1.5 ng/ml on at least 2 of the first 3 postoperative days. The remaining 230 patients were followed-up for the occurrence of infectious complications. The 20 patients with elevated PCT were included in a prospective randomised pilot study comparing pre-emptive antibiotic treatment with ceftriaxone vs standard treatment.. The negative predictive value of PCT for systemic infectious complications was 98.3%. In patients receiving pre-emptive antibiotic treatment (ceftriaxone), both the incidence and the severity of postoperative systemic infections were significantly lower compared to those in a control group (Pearson's chi(2) test; p=0.001 and p=0.007, respectively). Major differences were also observed with respect to duration of antibiotic treatment and length of hospital stay.. PCT is an early marker for systemic infectious complications after colorectal surgery with a high negative predictive value. A significant reduction in the rate of postoperative infections in patients with elevated PCT serum concentrations was achieved by means of pre-emptive antibiotic treatment.

Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Ceftriaxone; Chi-Square Distribution; Colorectal Neoplasms; Female; Humans; Male; Middle Aged; Pilot Projects; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Protein Precursors; Treatment Outcome

Oral norfloxacin is the standard of therapy in the prophylaxis of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage. However, during the last years, the epidemiology of bacterial infections in cirrhosis has changed, with a higher incidence of infections caused by quinolone-resistant bacteria. This randomized controlled trial was aimed to compare oral norfloxacin vs intravenous ceftriaxone in the prophylaxis of bacterial infection in cirrhotic patients with gastrointestinal bleeding.. One hundred eleven patients with advanced cirrhosis (at least 2 of the following: ascites, severe malnutrition, encephalopathy, or bilirubin >3 mg/dL) and gastrointestinal hemorrhage were randomly treated with oral norfloxacin (400 mg twice daily; n = 57) or intravenous ceftriaxone (1 g/day; n = 54) for 7 days. The end point of the trial was the prevention of bacterial infections within 10 days after inclusion.. Clinical data were comparable between groups. The probability of developing proved or possible infections, proved infections, and spontaneous bacteremia or spontaneous bacterial peritonitis was significantly higher in patients receiving norfloxacin (33% vs 11%, P = .003; 26% vs 11%, P = .03; and 12% vs 2%, P = .03, respectively). The type of antibiotic used (norfloxacin), transfusion requirements at inclusion, and failure to control bleeding were independent predictors of infection. Seven gram-negative bacilli were isolated in the norfloxacin group, and 6 were quinolone resistant. Non-enterococcal streptococci were only isolated in the norfloxacin group. No difference in hospital mortality was observed between groups.. Intravenous ceftriaxone is more effective than oral norfloxacin in the prophylaxis of bacterial infections in patients with advanced cirrhosis and hemorrhage.

Topics: Administration, Oral; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotic Prophylaxis; Bacteremia; Bacterial Infections; Ceftriaxone; Female; Gastrointestinal Hemorrhage; Humans; Injections, Intravenous; Liver Cirrhosis; Male; Middle Aged; Norfloxacin; Peritonitis; Risk Factors; Treatment Outcome

The administration of albumin improves circulatory function, prevents hepatorenal syndrome, and reduces hospital mortality in patients with cirrhosis and spontaneous bacterial peritonitis. This randomized unblinded pilot study compared the effect of albumin (10 patients) and the synthetic plasma expander hydroxyethyl starch 200/0.5 (10 patients) on the systemic hemodynamics of patients with spontaneous bacterial peritonitis. Baseline measurements were performed within 12 hours after diagnosis of infection. Patients then received 2 doses of the volume expander (1.5 g/kg body weight after baseline measurements and 1 g/kg body weight on day 3). Measurements were repeated after infection resolution. Treatment with albumin was associated with a significant increase in arterial pressure and a suppression of plasma renin activity, indicating an improvement in circulatory function. This occurred in the setting of a significant expansion of central blood volume (increase in cardiopulmonary pressures and atrial natriuretic factor) and an increase in systolic volume and systemic vascular resistance. In contrast, no significant changes were observed in these parameters in patients treated with hydroxyethyl starch. Von Willebrand-related antigen plasma levels significantly decreased in patients treated with albumin but not in those treated with hydroxyethyl starch. Serum nitrates and nitrites increased in patients treated with hydroxyethyl starch but not in those treated with albumin. These data suggest an effect of albumin on endothelial function. In conclusion, albumin but not hydroxyethyl starch improves systemic hemodynamics in patients with spontaneous bacterial peritonitis. This effect is due not only to volume expansion but also to an action on the peripheral arterial circulation.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Female; Hemodynamics; Humans; Hydroxyethyl Starch Derivatives; Kidney Function Tests; Liver Function Tests; Male; Middle Aged; Peritonitis; Pilot Projects; Plasma Substitutes; Serum Albumin; von Willebrand Factor

Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations and uncontrolled infections represent a major risk factor. This open prospective, multicenter trial compared the efficacy of two antibiotic regimens for treatment of foot infections Wagner stage II or III in diabetic adults. Three hundred diabetic patients with severe, limb-threatening foot infection were consecutively enrolled in a prospective, observational, matched pairs controlled study to test two different antibiotic regimes (ceftriaxone vs chinolones) in addition to standard treatment of foot infection. After matching, 90 patients--each receiving ceftriaxone or chinolones--were analyzed. Our study demonstrated that treatment with a third generation cephalosporine is as effective as a treatment with chinolones. Response (reaching Wagner I or 0) was achieved in 58.0% in the ceftriaxone group and in 51.1% in the chinolone group (NS.). Fourteen days after initiation of treatment, the number of patients with microbiological isolates decreased in both groups (52 to 5 in the ceftriaxone group and 60 to 12 in the chinolone group). At hospital discharge, 66.0% of ceftriaxone and 64.4 of chinolone-treated diabetic ulcers were cured or improved. In summary, both substances proved to be effective in the primary antibiotic treatment of the diabetic foot; an early broad spectrum antibiotic treatment, that covers both gram-positive and gram negative bacteria as well as anerobes is undisputedly an imperative therapeutic intervention for the treatment of diabetic foot infection.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Diabetic Foot; Female; Humans; Male; Middle Aged; Ofloxacin; Prospective Studies; Treatment Outcome

Albumin administration prevents renal failure and improves survival in spontaneous bacterial peritonitis. This study characterizes the mechanisms of action of albumin in this condition.. Systemic and splanchnic hemodynamics, plasma renin activity and plasma concentration of interleukin-6, serum concentration of nitric oxide and ascitic fluid levels of nitric oxide and interleukin-6 were assessed at diagnosis and resolution of infection in 12 patients with spontaneous bacterial peritonitis treated with ceftriaxone plus albumin. At infection resolution there was a significant improvement in circulatory function, as indicated by a significant increase in mean arterial pressure (+8%, P=0.02), a fall in heart rate (-10%, P=0.01), a suppression of plasma renin activity (-67%, P=0.002) and a decrease in creatinine levels. These changes were related to both an increase in cardiac work (stroke work index: +18%, P=0.005) and in peripheral vascular resistance (+14%, P=0.05). The improvement in cardiac function was due to an increase in filling. No significant changes were observed in portal pressure or hepatic blood flow.. These results indicate that the beneficial effects of albumin administration on systemic hemodynamics and renal function in spontaneous bacterial peritonitis are related to both an improvement in cardiac function and a decrease in the degree of arterial vasodilation.

Topics: Adult; Aged; Albumins; Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Ceftriaxone; Female; Hemodynamics; Humans; Injections, Intravenous; Interleukin-6; Liver Circulation; Liver Cirrhosis; Male; Middle Aged; Nitric Oxide; Peritonitis; Renin

Patients with diabetes mellitus, particularly those with poor glucose control, commonly experience various medical complications related to the disease (eg, renal impairment, decreased peripheral vascular circulation, suppressed immune function). Infections of the lower extremities can range from superficial cellulitis to ulcerative, deep soft-tissue infections to osteomyelitis that necessitates some degree of amputation.. This study compared the efficacy, tolerability, and cost differences associated with the use of metronidazole plus ceftriaxone (MTZ/CTX) given once daily with those of ticarcillin/clavulanate potassium (T/C) given every 6 hours in hospitalized older males with diabetic lower-extremity infections.. This prospective, open-label study was conducted at a Veterans Affairs Medical Center. Male patients with diabetes and a lower-extremity infection were randomized to receive MTZ/CTX 1 g once daily or T/C 3.1 g every 6 hours. Treatment success was determined at 96 hours or on discontinuation of antibiotic. Success was measured in terms of body temperature <38.3 degrees C (100.6 degrees F), normalization of the finger-stick blood sugar concentration, improvement in wound staging, or a white blood cell count <10,000 cells/mm3. Medication acquisition costs per treatment arm were calculated and compared.. Seventy patients were enrolled in the study (36 MTZ/CTX, 34 T/C). The study population had a mean (SD) age of 63.8 (10.8) years, a duration of diabetes of 12.4 (9.1) years, 0.5 (0.7) diabetes-related comorbidities, and an initial creatinine clearance of 67.1 (26.0) mL/min. There were no significant differences between groups at randomization. At 96 hours, treatment success was achieved in 31 (86%) patients in the MTZ/CTX group, compared with 28 (82%) patients in the T/C group (P=NS). Twenty-six patients were considered successfully treated on the final day of therapy in both the MTZ/CTX group (72%) and the T/C group (76%) (P=NS). There were no significant differences in primary or secondary measures of success between the 2 groups. No single or multiple baseline factors predicted treatment success or failure. No patient experienced adverse events considered related to study medication. MTZ/CTX was associated with savings of $61.06 per hospital admission, or $2198.05 for all patients who received this combination.. In this population of older males, once-daily MTZ/CTX was as well tolerated and effective as T/C in the treatment of diabetic lower-extremity infections and was associated with reduced institutional costs.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Clavulanic Acids; Cost Savings; Diabetic Foot; Drug Administration Schedule; Drug Combinations; Drug Costs; Drug Therapy, Combination; Hospital Costs; Hospitalization; Humans; Male; Metronidazole; Prospective Studies; Ticarcillin; Treatment Outcome

In a randomized, open-label, controlled, multicentre study, the clinical and bacteriological efficacy, safety and tolerability of oral gemifloxacin (320 mg once daily, 5 days) was compared with sequential intravenous (i.v.) ceftriaxone (1 g once daily, maximum 3 days) followed by oral cefuroxime axetil (500 mg twice daily, maximum 7 days) in adult hospitalized patients with acute exacerbations of chronic bronchitis (AECB) (n = 274). The clinical success rates at follow-up (21-28 days post-therapy) in the clinical per-protocol population (the primary endpoint) were 86.8% (105/121) for gemifloxacin vs. 81.3% (91/112) for ceftriaxone/cefuroxime (treatment difference = 5.5,95% CI -3.9,14.9). The corresponding clinical results in the clinical intention-to-treat (ITT) population were 82.6% (114/138) vs. 72.1% (98/136), respectively (treatment difference = 10.5,95% CI 0.7, 20.4).Thus, gemifloxacin had significantly higher clinical success rates than ceftriaxone/cefuroxime. The median time to discharge was 9 days in the gemifloxacin group vs. 11 days in the ceftriaxone/cefuroxime group (P = 0.04, Wilcoxon test). At follow-up, 120/138 (87.0%) gemifloxacin-treated patients had been discharged from hospital, compared with 111/136 (81.6%) ceftriaxone/cefuroxime-treated patients in the clinical ITT population. Both treatments were generally well tolerated and there was no significant difference between the treatment groups in the incidence or type of adverse events reported. A 5-day course of oral gemifloxacin was shown by this study to be at least equivalent to sequential i.v. ceftriaxone/cefuroxime axetil (for up to 10 days) in patients with AECB who require hospital treatment.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; Bronchitis, Chronic; Ceftriaxone; Cefuroxime; Drug Therapy, Combination; Female; Fluoroquinolones; Forced Expiratory Volume; Gemifloxacin; Hospitalization; Humans; Infusions, Intravenous; Length of Stay; Male; Middle Aged; Naphthyridines; Treatment Outcome

The empirical use of antibiotic treatments is widely accepted as a means to treat cancer patients in chemotherapy who have fever and neutropenia. Intravenous monotherapy, with broad spectrum antibiotics, of patients with a high risk of complications is a possible alternative.. We conducted a prospective open-label, randomized study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy. Patients received either monotherapy with ticarcillin/clavulanic acid (T) or ceftriaxone plus amikacin (C+A).. Seventy patients who presented 136 episodes were evaluated, 68 in each arm of the study. The mean neutrophil counts at admission were 217cells/mm(3) (T) and 201cells/mm(3) (C+A). The mean duration of neutropenia was 8.7 days (T) and 7.6 days (C+A). Treatment was successful without the need for modifications in 71% of the episodes in the T group and 81% in the C+A group (p=0.23). Treatment was considered to have failed because of death in two episodes (3%) in the T group and three episodes (4%) in the C+A group, and because of a change in the drug applied in one episode in the T group and two episodes in the C+A group. Overall success was 96% (T) and 93% (C+A). Adverse events that occurred in group T were not related to the drugs used in this study.. In pediatric and adolescent patients with leukemia or lymphoma, who presented with fever and neutropenia, during chemotherapy, ticarcillin/clavulanic acid was as successful as the combination of ceftriaxone plus amikacin. It should be considered an appropriate option for this group of patients at high risk for infections.

Topics: Adolescent; Amikacin; Bacterial Infections; Brazil; Ceftriaxone; Child; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Epidemiologic Methods; Female; Fever; Humans; Infant; Leukemia; Lymphoma, Non-Hodgkin; Male; Neutropenia; Ticarcillin; Treatment Outcome

The results of the use of cefepime (Maxipime) combination with amikacin vs ceftriaxon combination with amikacin in the treatment of 80 patients with different forms of hemoblastosis are presented. Severe infectious complications in the patients were associated with prolonged and deep neutropenia during inductive or antirelapsing chemotherapy. All the patients in the trial were from the group of high risk of infectious complications with the blood neutrophil count under 100 cells/microliter. The duration of neutropenia averaged 12 days (7 to 15). The average period of the treatment with cefepime and amikacin equaled to 13 days (8 to 16). The treatment with cefepime + amikacin was successful in 38 out of 40 patients (95%). The average period of the treatment with ceftriaxon and amikacin equaled to 14 days (7 to 18). The efficacy of the treatment with ceftriaxon + amikacin was 60% (24 patients out of 40).

Topics: Amikacin; Anti-Bacterial Agents; Bacterial Infections; Cefepime; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Hematologic Neoplasms; Humans; Leukocyte Count; Neutropenia; Neutrophils; Time Factors; Treatment Outcome

The efficacy and safety of intravenous (IV) ertapenem, 1 and 1.5 g once a day, for treatment of adults with complicated intra-abdominal infection were compared with those of IV ceftriaxone 2 g once a day plus IV metronidazole 500 mg every 8 h. After at least 3 days of IV therapy and satisfactory clinical response, patients could be switched to oral ciprofloxacin plus metronidazole. Fifty-nine patients were randomized to receive ertapenem 1 g and 51 to receive ertapenem 1.5 g; 55 patients were randomized to each comparator group. At the test of cure, 4-6 weeks post therapy, in the 1 g cohort, 84% (26/31) of patients treated with ertapenem and 85% (35/41) with comparator therapy had a favourable clinical and microbiological assessment. Success rates in the 1.5 g cohort were 83% (22/29) and 77% (24/31) in the ertapenem and comparator groups, respectively. Drug-related adverse events were generally similar in both treatment groups. Ertapenem 1 or 1.5 g once a day followed by optional oral therapy appeared similar to combined therapy with ceftriaxone plus metronidazole with the same optional oral switch for treatment of complicated intra-abdominal infections in adults. Although not compared directly in a randomized fashion, the efficacy and safety profiles of ertapenem 1 and 1.5 g appeared comparable. Ertapenem was generally well tolerated and had an overall safety profile similar to ceftriaxone plus metronidazole.

Topics: Abdomen; Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; beta-Lactams; Ceftriaxone; Double-Blind Method; Drug Therapy, Combination; Ertapenem; Female; Humans; Injections, Intravenous; Lactams; Male; Metronidazole; Middle Aged

The objective of a multicentric observational study, that was performed in Germany between 1(st) September 1996 and 30(th) September 1997, was to assess postoperative infections as a function of risk factors and antibiotic prophylaxis under everyday clinical conditions. 2 481 patients from 114 centres who received infection prophylaxis prior to elective colonic resection were included. In the descriptive analysis of the study it was noted that 36.1 % of the patients had received no prophylaxis with metronidazole despite the fact that the study protocol recommended the use of this drug in preoperative antibiotic combinations. The present analysis therefore considers the influence of metronidazole on the postoperative infection rate.. In order to exclude any bias due to intergroup differences in risk profile, the groups with and without metronidazole were subjected to a matched-pair analysis. Matching parameters were: duration of operation, blood loss, age, diabetes mellitus, hepatic, renal, or chronic airways disease, immunosuppressive therapy, and rectal resection. This led to the formation of 800 pairs that were matched with respect to these parameters. The 800 pairs were then stratified into the following treatment groups: Group 1 a and b: long-acting cephalosporine (ceftriaxone) with or without metronidazole (n = 2 x 491); Group 2 a and b: short-acting cephalosporines with or without metronidazole (n = 2 x 133); Group 3 a and b: broad-spectrum penicillines with or without metronidazole (n = 2 x 176).. In all three treatment groups combination therapy with metronidazole was found to be significantly superior. Postoperative infection rates were 9.4 % and 18.7 % (p = 0.000) respectively in Group 1 a and b, 12.0 % and 25.6 % (p = 0.008) respectively in Group 2 a and b, and 19.9 % and 29.0 % (p = 0.009) respectively in Group 3 a and b.. Preoperative administration of metronidazole in addition to an effective beta-lactam antibiotic is strongly advised in elective colonic surgery, as absence of antibiotic cover against anaerobic colonic flora leads to a significantly higher postoperative infection rate.

Topics: Aged; Anti-Infective Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Cephalosporins; Colon; Drug Therapy, Combination; Female; Germany; Humans; Male; Metronidazole; Middle Aged; Penicillins; Postoperative Complications; Prospective Studies

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Bacterial Infections; Ceftriaxone; Cephalosporins; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged; Neutropenia; Treatment Outcome

Topics: Adult; Aged; Antineoplastic Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Fever; Hematologic Neoplasms; Humans; Infusions, Intravenous; Middle Aged; Neutropenia; Treatment Outcome

Hospitalization and empirical broad-spectrum, intravenous antibiotics are the standard treatment for febrile cancer patients. Recent evidence supports the suggestion that febrile episodes in a low-risk population can be managed successfully in an outpatient setting, but the optimal drug regimen is unknown. In a prospective randomized clinical trial we compared ciprofloxacin 750 mg p.o. twice a day with ceftriaxone 2 g i.v. as a single daily dose for the empiric domiciliary treatment of febrile episodes in low-risk neutropenic and nonneutropenic cancer patients. A total of 173 patients, accounting for 183 febrile episodes, were enrolled in the study. Overall, successful outcomes were recorded for 76 of 93 (82%) febrile episodes in patients who were randomized to the oral regimen and for 68 of 90 (75%) febrile episodes in patients randomized to the i.v. regimen: this difference was not statistically significant. The success rate was similar in all subgroups of patients: neutropenic and nonneutropenic, with documented infection and with fever of unknown origin. There were 3 deaths in the group of patients treated with the parenteral regimen, and two of these were related to treatment failure. Both treatments were well tolerated, and the cost of the oral regimen was lower. This prospective study suggests that domiciliary antibiotic empiric monotherapy is feasible in febrile nonneutropenic or low-risk neutropenic outpatients in whom a bacterial infection is suspected, and that either an oral or a parenteral regimen can be used. A number of factors may influence the choice between an orally and an i.v.-administered antibiotic, but owing to the easier administration and lower cost, the oral regimen seems to be preferable.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Bacterial Infections; Ceftriaxone; Cephalosporins; Ciprofloxacin; Female; Fever; Humans; Infusions, Parenteral; Male; Middle Aged; Neoplasms; Neutropenia; Outpatients; Prospective Studies; Treatment Outcome

The efficacy of antibiotic prophylaxis in cardiac surgery was compared between 97 patients receiving a single 2 g dosage of ceftriaxone and 103 receiving 500 mg of vancomycin i.v. every 6 h for 48 h. The overall infection rate was 13.4% in the ceftriaxone and 10.7% in the vancomycin group. Four (4%) wound infections, including one mediastinitis, occurred in the ceftriaxone group and five (5%) in the vancomycin group, with no statistically significant difference. The findings of this study support the adequacy of a simple single dose of ceftriaxone prophylaxis in cardiac surgery, at least in hospitals with low incidence of vancomycin-resistant staphylococcal infections.

Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Cephalosporins; Coronary Artery Bypass; Female; Humans; Male; Middle Aged; Prospective Studies; Surgical Wound Infection; Vancomycin

We evaluated the effect of selective decontamination of the digestive tract (SDD) on the incidence of ventilator-associated pneumonia (VAP) and its associated morbidity and cost in a mixed population of intubated patients. Two hundred seventy-one consecutive patients admitted to the intensive care units (ICUs) of five teaching hospitals and who had an expected need for intubation exceeding 48 h were enrolled and received topical antibiotics or placebo. Uninfected patients additionally received ceftriaxone or placebo for 3 d. VAP occurred in 11.4% of SDD-treated and 29.3% of control-group patients (p < 0.001; 95% confidence interval [CI]: 7.8 to 27.9). The incidence of nonrespiratory infections in the two groups was 19.1% and 30.7%, respectively (p = 0.04; 95% CI: 0.7 to 22.7). Among survivors, the median length of ICU stay was 11 d (interquartile range: 7 to 21.5 d) for the SDD-treated group and 16. 5 d (10 to 30 d) for the control group (p = 0.006). Mean cost per survivor was $11,926 for treated and $16,296 for control-group patients. Mortality was 38.9% and 47.1%, respectively (p = 0.57). In decontaminated patients, the prevalence of gram-negative bacilli fell within 7 d from 47.4% to 13.0% (p < 0.001), whereas colonization with resistant gram-positive strains was higher (p < 0. 05) than in the placebo group. In a mixed population of intubated patients, SDD was associated with a significant reduction of morbidity at a reduced cost. Our findings support the use of SDD in this high-risk group.

Topics: Bacteria; Bacterial Infections; Cause of Death; Ceftriaxone; Cephalosporins; Colony Count, Microbial; Confidence Intervals; Critical Care; Critical Illness; Digestive System; Double-Blind Method; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Health Care Costs; Humans; Incidence; Intubation, Intratracheal; Length of Stay; Male; Middle Aged; Oropharynx; Placebos; Pneumonia, Bacterial; Respiration, Artificial; Survival Rate

Selective intestinal decontamination with norfloxacin is useful in the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding. However, bleeding cirrhotic patients with ascites, encephalopathy, or shock are at high risk to develop bacterial infections in spite of prophylactic norfloxacin. The aim of this study was to assess whether the addition of intravenous ceftriaxone could improve the efficacy of prophylaxis with norfloxacin in these patients.. Fifty-six cirrhotic patients with gastrointestinal hemorrhage and ascites, encephalopathy, or shock were randomized into two groups: Group 1 (n = 28) received oral norfloxacin 400 mg/12 h for 7 days, and group 2 (n = 28) received norfloxacin plus intravenous ceftriaxone 2 g daily during the first 3 days of admission.. Ten patients were excluded because of community-acquired infection, surgery, or death within the first 24 h. The incidence of bacterial infections during hospitalization was 18.1% in group 1 and 12.5% in group 2 (p = NS). The incidence of severe infections (spontaneous bacterial peritonitis, bacteremia, or pneumonia) was also similar in both groups: 9% in group 1 versus 8.3% in group 2 (p = NS). There were no statistical differences between the two groups with respect to duration of hospitalization or mortality. The cost of antibiotic therapy (including prophylaxis and treatment of infections) was significantly higher in group 2.. These results suggest that the addition of intravenous ceftriaxone during the first 3 days of hospitalization does not improve the cost-efficacy of oral norfloxacin in the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding and high risk of infection.

Topics: Administration, Oral; Aged; Anti-Infective Agents; Bacterial Infections; Ceftriaxone; Cephalosporins; Cost-Benefit Analysis; Female; Gastrointestinal Hemorrhage; Humans; Incidence; Injections, Intravenous; Liver Cirrhosis; Male; Middle Aged; Norfloxacin

In hospitals in Spain there has been a large increase in the use of wide spectrum antibiotics. The objective of this study was to evaluate the influence of a rational, consensual protocol on the use of ceftriaxone. An observational and prospective study was carried out using information provided by the Servicio de Farmacia on the in-hospital prescriptions for ceftriaxone. The study included two groups as follows: a control group (October-December 1995) not taking into account the protocols for antibiotic treatment; and a study group in the same months in 1996 with the consensual protocols taken into account. The criteria for the type of patient, infection, evolution and antibiotic treatment were evaluated according to the criteria in the international literature on this type of study. The initial characteristics of both groups of patients were similar. Following the use of the protocol there was a significantly associated reduction in use (48 cases in the study group vs. 57 cases in the control group), an increase in the appropriate use (31. 57% in the control group vs. 75% in the study group), an increase in the cure rate (70.17% in the control group vs. 91.7% in the study group) and a decrease in hospital stay of 7.53 days (22.59 days in the control group vs. 15.06 in the study group), producing a savings per cured patient of 617.142 pesetas. It was concluded that the consensual protocol and its proper application make for a highly interesting approach given that it allowed for better quality use of ceftriaxone with greater cost-effectiveness.

Topics: Bacterial Infections; Ceftriaxone; Cephalosporins; Clinical Protocols; Cost-Benefit Analysis; Female; Hospitals, General; Humans; Male; Middle Aged; Prospective Studies; Spain

Children with sickle cell disease are at increased risk for bacterial sepsis and, when febrile, are usually hospitalized for intravenous antibiotic therapy pending results of blood cultures. In this study, we prospectively identified a group of febrile patients with sickle cell disease who were at low risk for sepsis and treated them with outpatient therapy.. Children identified as low risk for sepsis were treated with an initial dose of intravenous ceftriaxone, followed by outpatient therapy with oral cefixime, and were monitored for 14 days after the initial visit. Compliance was assessed by phone calls to parents and by analysis of urine samples.. In 107 eligible febrile episodes (80 patients) over a 21-month period, no patient developed sepsis. One child developed bacteremia 3 days after completing the course of cefixime, and one had splenic sequestration on the fourth study day. Both patients did well. Side effects of cefixime were modest, and overall compliance was excellent (approximately 95%), although urine samples were returned by only 56% of parents.. We conclude that outpatient therapy is safe and effective in febrile patients with sickle cell disease who meet the criteria for a low risk of sepsis.

Topics: Administration, Oral; Adolescent; Anemia, Sickle Cell; Anti-Infective Agents; Bacteremia; Bacterial Infections; Cefixime; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Humans; Infant; Male; Outpatients; Patient Compliance

Concentrations of ceftriaxone (CTRX) in the serum and the cerebrospinal fluid (CSF) were serially investigated after an intravenous drip infusion of 2 g per day to 14 patients with acute cerebrovascular diseases, as they were determined at 30 minutes, 3, 6, 24 hours, 3 and 7 days after first administration. The results obtained are summarized as follows: 1. Serum levels; Peak levels of CTRX in the serum were 162.0 +/- 51.2 (SD) micrograms/ml at 30 minutes after administration. Even at 24 hours after intravenous drip infusion, concentrations of CTRX were 14.9 +/- 6.15 (SD) micrograms/ml. 2. CSF levels; The CTRX concentrations in the CSF rose to 1.70 +/- 1.84 (SD) micrograms/ml at 30 minutes, 3.51 +/- 3.31 (SD) micrograms/ml at 3 hours and then decreased to 0.74 +/- 0.67 (SD) micrograms/ml at 24 hours after first infusion. 3. CTRX concentrations in serum in CSF after serially repeated infusion for 3 to 7 days were quite similar to the those obtained after the first administration. The above results indicates that CTRX is useful for the prevention of postoperative infections in the field of neurosurgery.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Cephalosporins; Cerebrovascular Disorders; Drainage; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Postoperative Complications

Ceftriaxone penetration into heart tissues (valves, myocardium, auricles and pericardium) and mediastinal tissues (fat and sternal bone) was evaluated after two regimens of ceftriaxone administration. Ten patients were given 1,000 g intravenously of ceftriaxone 30 min. before anesthesia. Ten other patients received the same dose and then a second 1,000 mg dose at the time of initiation of cardiopulmonary bypass. Similar and very satisfactory ceftriaxone tissue penetrations were observed in both groups. However, for some patients in the two groups and mainly in the sternal bone at the time of thorax closure, ceftriaxone levels in tissues were less than the MICs for some potential pathogens (Methicillin susceptible Staphylococcus aureus and Staphylococcus epidermidis). During the different steps of the surgical procedures all patients in both groups had tissue levels greater than the MICs for Gram negative aerobic bacilli, except for Pseudomonas spp.

Topics: Adult; Aged; Aortic Valve; Bacterial Infections; Ceftriaxone; Cephalosporins; Extracorporeal Circulation; Female; Heart; Heart Valve Prosthesis; Humans; Injections, Intravenous; Intraoperative Care; Male; Mediastinum; Middle Aged; Mitral Valve; Preoperative Care; Prospective Studies

To evaluate the economic benefit associated with the early conversion of therapy from intravenous ceftiaxone to the comparable oral third-generation cephalosporin, cefpodoxime proxetil.. Open-label, unblind, nonrandomized clinical trial.. A 360-bed Veterans Affairs Medical Center.. Forty patients who began receiving intravenous ceftriaxone for either a community-acquired pneumonia or a complicated urinary tract infection.. twenty patients were selected, based on clinical assessment, to be converted from intravenous ceftriaxone to oral cefpodoxime proxetil. Twenty other comparable patients who would have been appropriate for step-down therapy, did not receive pharmacy intervention and were used as a control group.. Both groups were assessed and compared for length of ceftiaxone therapy, length of oral follow-up therapy (if any), length of hospitalization, results of culture and sensitivity testing, treatment success and readmissions, and cost of respective therapeutic regimens.. In the cefpodoxime study group, the average time receiving intravenous and oral antibiotics was 9.1 days at a total cost of $3040.26 for the 20 patients. In the control group, the average time receiving intravenous and oral antibiotics was 11.9 days at a total cost of $3961.26. A savings of $46.05 per patient was achieved. Patients receiving step-down therapy averaged 1 fewer day of hospitalization.. Pharmacist intervention and cefpodoxime step-down therapy were associated with decreased overall antibiotic costs in our intravenous-to-oral program.

Topics: Administration, Oral; Aged; Bacterial Infections; Cefpodoxime Proxetil; Ceftizoxime; Ceftriaxone; Colorado; Community-Acquired Infections; Costs and Cost Analysis; Drug Costs; Female; Hospital Bed Capacity, 300 to 499; Hospitals, Veterans; Humans; Injections, Intravenous; Male; Middle Aged; Pharmacy Service, Hospital; Pneumonia; Prodrugs; Urinary Tract Infections

Thirty patients with severe bacterial infections were treated with 50 mg of cefodizime per kg of body weight once daily or 50 mg of ceftriaxone per kg once daily for 10 +/- 3 days. The effect of cefodizime and ceftriaxone on the phagocytic capacity and generation of reactive oxygen intermediates after phagocytosis by granulocytes was assessed prior to, during, and after therapy. Flow cytometry was used to study phagocytic capacity by measuring the uptake of fluorescein-labeled bacteria. The generation of reactive oxygen intermediates after phagocytosis was estimated by the quantification of the intracellular conversion of dihydrorhodamine 123 to rhodamine 123. Prior to therapy, patients in both groups exhibited a decreased capacity to phagocytize Escherichia coli and subsequently to generate reactive oxygen intermediates. Granulocyte function increased after the initiation of therapy and normalized within 7 days for the ceftriaxone-treated patients and within 3 days for the cefodizime group (P < 0.05). In the cefodizime group, an enhancement of phagocytic capacity was observed 14 days after the initiation of therapy (P < 0.05). Prior to therapy, phagocytic capacity was significantly correlated with the generation of reactive oxygen products (r = 0.674 and P < 0.005).

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Escherichia coli; Female; Flow Cytometry; Granulocytes; Humans; In Vitro Techniques; Male; Middle Aged; Neutrophils; Phagocytes; Phagocytosis; Reactive Oxygen Species

Broad-spectrum versus narrow-spectrum antibiotic prophylaxis for patients who undergo cardiac operations is variously advocated to reduce the incidence of all infections or, conversely, to prevent resistant superinfections. Previous studies of prophylaxis have shown a reduction in the incidence of staphylococcal infections with some increased resistance. We studied preoperative and postoperative wound colonization as a surrogate for infection. Among 78 patients undergoing cardiac procedures, the type of prophylaxis was allocated as follows: narrow-spectrum (nafcillin), 24 patients; midspectrum (cephapirin), 26 patients; and broad-spectrum (ceftriaxone), 28 patients. Seventeen patients who underwent other procedures received no antibiotics and served as controls. Cultures of the operative site were done preoperatively, and 3 and 6 days postoperatively. The incidence of preoperative skin colonization with staphylococci was identical (95%) in all groups. Postoperatively, more patients receiving nafcillin (48%) were culture-negative for all organisms than were either of the other groups receiving antibiotics (27% and 22%) (p < 0.05). Gram-negative bacilli were infrequent colonizers and neither did the incidence of infection with these organisms increase nor did resistance develop in any group. The infection rates were not different among the treatment groups. Thus, a narrow-spectrum antistaphylococcal penicillin may offer an advantage in terms of both prophylaxis for cardiac operations and hospital costs.

Topics: Bacteria; Bacterial Infections; Ceftriaxone; Cephapirin; Colony Count, Microbial; Coronary Artery Bypass; Heart Valves; Humans; Incidence; Male; Middle Aged; Nafcillin; Postoperative Care; Premedication; Surgical Wound Infection; Wound Infection

Because of high rates of neonatal gram-negative sepsis in many Latin American countries, we prospectively enrolled 784 high-risk pregnant women in a study designed to evaluate the effect of a single 1-g dose of ceftriaxone (n = 390) vs. that of no antibiotic prophylaxis (n = 394) on oral, rectal, and umbilical colonization and fatality rates among newborn infants. The mean ceftriaxone concentration in cord blood samples was 26 microgram/mL (range, 9-40 microgram/mL). Compared with infants of untreated mothers, children born to women who were given ceftriaxone were colonized at a lesser rate by gram-negative bacilli (54% vs. 35%; P < .001) and by group B streptococci (54% vs. 21%; P = .03) and endured significantly fewer sepsis-like illnesses in the first 5 days of life (8.1% vs. 3.1%; P = .004). There was also a tendency for them to have fewer episodes of culture-proven early-onset sepsis (2.8% vs. 0.5%; P = .06). Sepsis-related case-fatality rates (0.8% and 0.3%, respectively) were not significantly different. Although intrapartum administration of a single dose of ceftriaxone to high-risk mothers could be a safe and potentially useful strategy for reducing early-onset neonatal infections, additional information is required before this approach can be recommended for routine prophylaxis.

Topics: Bacterial Infections; Ceftriaxone; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Neonatal Screening; Pregnancy; Prospective Studies; Sepsis; Treatment Outcome

Due to their uremic state and altered host response induced by immunodepressive therapy, renal transplant recipients are particularly susceptible to infectious complications with high morbidity and mortality. We here report the results of a prospective study with 170 renal transplant patients, undertaken to evaluate the efficacy of ceftriaxone in the prevention of wound and early urinary tract infection. No wound infection was observed, however, 12 patients (7.1%) developed urinary tract infections. On the basis of these data, we recommend ceftriaxone prophylaxis as a safe and effective measure to prevent transplant wound infection and to reduce the incidence of postoperative urinary tract infection.

Topics: Adult; Bacterial Infections; Ceftriaxone; Female; Humans; Kidney Transplantation; Male; Prospective Studies; Surgical Wound Infection; Urinary Tract Infections

The feasibility and efficacy of a once daily antibiotic regimen were assessed in children with malignant tumours. Over a 44 month period, 296 febrile episodes were treated with a regimen of once daily ceftriaxone-amikacin (and teicoplanin or vancomycin if the patient had a central line). The treatment was successful in 272 (92%) episodes without modification of the antibiotic regimen, and only one patient died of uncontrolled sepsis. A once daily antibiotic regimen is therefore feasible and worthwhile in the treatment of febrile episodes in children with cancer.

Topics: Adolescent; Adult; Amikacin; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Feasibility Studies; Humans; Infant; Neoplasms; Teicoplanin; Vancomycin

We studied 599 evaluable patients with benign prostatic hypertrophy at 7 urological units. Before transurethral prostatectomy the patients were randomized into 3 groups: group 1--197 patients given single-dose ceftriaxone (2 gm.), group 2--203 patients given 160/800 mg. trimethoprimsulfamethoxazole and group 3--199 controls given no antimicrobial prophylaxis. Patients with a preoperative indwelling catheter, positive urine culture, signs of active infection or preoperative antibiotic treatment were excluded. Postoperative infectious complications were demonstrated in 15 of 197 (7.6%), 25 of 203 (12.3%) and 43 of 199 (21.6%) patients in the study groups, respectively. The difference in infectious complications between groups 1 and 3 was statistically highly significant (p < 0.01) and between groups 2 and 3 it was significant (p < 0.05). Single-dose antibiotic prophylaxis proved to be useful in the prevention of serious infectious complications after transurethral prostatectomy.

Topics: Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Prostatectomy; Prostatic Hyperplasia; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy of perioperative antibiotic prophylaxis in cesarean section with a single dose of ceftriaxone, a long-acting cephalosporin not widely used for prophylaxis, was tested. Ceftriaxone as a single dose of 1 g i.v. versus three doses of cefoxitin 1 g i.v. respectively were used in a prospective, randomized, controlled study consisting of 1052 patients undergoing cesarean section. Postoperative infection rate as measured by fever, endometritis and wound infection was 6.5% with ceftriaxone and 6.4% with cefoxitin. Urinary tract infections were significantly more frequent in the cefoxitin than in the ceftriaxone group (17.8% vs. 9.7%, p < 0.001). Enterococci and Escherichia coli accounted for urinary tract infections 1.86-, respectively, 4.3-fold more frequently with cefoxitin than with ceftriaxone. The time of hospitalization in patients with urinary tract infections was significantly lower with ceftriaxone than with cefoxitin (11 vs. 12 days, p < 0.05). The tolerance in both groups was equally satisfactory. A single dose of ceftriaxone, which is simple, reliable (compliance), well tolerated, inexpensive (fewer urinary tract infections and therefore fewer treatment costs than with cefoxitin) and safe (no overgrowth of pathogens) in our opinion is the antibiotic regimen of choice for prophylaxis in cesarean section in the described circumstances.

Topics: Adult; Bacterial Infections; Ceftriaxone; Cesarean Section; Endometritis; Female; Fever; Humans; Postoperative Complications; Pregnancy; Prospective Studies; Surgical Wound Infection; Urinary Tract Infections

A single-institution, randomised pilot trial was conducted to compare the clinical efficacy, microbiological efficacy and possible toxicity of empirical single daily antibiotic administration in febrile neutropenic patients with haematologic disorders (absolute neutrophil count < 1 x 10(9)/l). Upon the development of signs of sepsis, patients received either single daily dose tobramycin (5 mg/kg per day) plus ceftriaxone (2 g/day) (C + T, n = 47) or tobramycin (1.5 mg/kg, every 8 h) plus azlocillin (4 g, every 6 h) (A + T, n = 45). In addition, flucloxacillin (1-2 g, every 4 h) could be added if there was clinical suspicion of staphylococcal infection (17 in each arm). Analysis was performed for the whole group and for the subset which did not receive flucloxacillin. When evaluated at 96 h, 62% of patients randomised to C + T and 67% randomised to A + T had responded (95% confidence interval (CI) for the difference in rates, -25% to +15%). Ninety-six hour response rates for those who did not receive flucloxacillin were 73% and 78%, respectively (95% CI, -17% to +27%). Overall, 42 (89%) and 41 (91%) patients, respectively, eventually became afebrile (95% CI, -14 to 10%) and there was no evidence of altered renal function or electrolyte imbalance in patients randomised to single daily antibiotic therapy compared with the conventional (multi-daily dose) arm. Within 10 days of antibiotic commencement there was 1 death in the C + T arm and 4 deaths in the A + T arm, although overall there were 4 deaths in each arm. Our results suggest that single daily empirical antibiotic therapy with tobramycin and ceftriaxone is efficacious and is not associated with an increased incidence of renal dysfunction or electrolyte imbalance compared with conventional administration schedules of azlocillin plus tobramycin. Single daily therapy has the potential to lead to savings in nursing-staff time and materials and may well contribute to an improved quality of life for febrile neutropenic patients.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Ceftriaxone; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever; Humans; Male; Middle Aged; Neutropenia; Pilot Projects; Tobramycin

121 patients with 132 febrile episodes were randomised to ceftriaxone or latamoxef monotherapy in order to compare antibiotic efficacy in neutropenic patients treated with cytotoxic chemotherapy for solid tumours. In 80 evaluable episodes no significant differences were observed between the two groups with respect to efficacy and fatal failure rates. Of episodes treated with ceftriaxone, 67% showed a favourable clinical response vs. 61% in the latamoxef group. The clinical response rates in episodes with documented bacterial infections were 67 and 56% in the two treatment groups. In 18% of the episodes with documented initial infections the patients died of presumably uncontrolled infection. The convenient once daily dosage schedule combined with fewer severe adverse reactions favours the use of ceftriaxone instead of latamoxef. Although a relative high degree of response was seen, empirical antibiotic monotherapy apparently does not offer a sufficient antibacterial cover in infections in this type of patient with defective host immunity.

Topics: Adult; Aged; Antineoplastic Agents; Bacteremia; Bacterial Infections; Ceftriaxone; Female; Fever; Humans; Male; Middle Aged; Moxalactam; Neutropenia; Prospective Studies; Respiratory Tract Infections; Urinary Tract Infections

To compare the efficacy and toxicity of single daily dosing of amikacin and ceftriaxone with that of multiple daily dosing of amikacin and ceftazidime for febrile episodes in patients with cancer and granulocytopenia.. A prospective, randomized, unblinded, multicenter trial.. Twenty-one tertiary care or university medical centers.. Six hundred seventy-seven patients with cancer and granulocytopenia (858 febrile episodes).. Random assignment to empiric therapy with a single daily dose of amikacin (20 mg/kg) and ceftriaxone (adults, 30 mg/kg; children, 80 mg/kg) (24-hour group) or with multiple daily doses of amikacin (6.5 mg/kg every 8 hours) and ceftazidime (33 mg/kg every 8 hours) (8-hour group).. Percentage response to each regimen and occurrence of nephrotoxicity and ototoxicity.. Single daily dosing of amikacin and ceftriaxone was as effective as multiple daily dosing of amikacin and ceftazidime (71% compared with 74%; difference, -3%; 95% Cl, -10% to 3%; P > 0.2). Equivalent responses also were noted for each category of infection. Median peak (30 minutes after a 60-minute infusion) serum concentrations of amikacin were higher in the 24-hour group than in the 8-hour group (45.6 compared with 21 micrograms/mL, P < 0.001), whereas trough (preinfusion) levels were lower (0.9 compared with 2 micrograms/mL, P < 0.001). Nephrotoxicity was 3% in the 24-hour group and 2% in the 8-hour group (difference, 1%; Cl, -1% to 4%). Increases in serum creatinine, however, were delayed (P = 0.048) and smaller (P = 0.06) in the 24-hour group than in the 8-hour group and occurred almost exclusively after other nephrotoxic drugs were added. Audiometry was only done in 144 patients (21%). Ototoxicity was 9% in the 24-hour group and 7% in the 8-hour group (difference, 2%; Cl, -7% to 11%; P > 0.2). Further infections developed in 15% and 12% of patients, respectively (difference, 3%; Cl, -2% to 9%). The overall mortality rate was 11% in both treatment groups (difference, 0%; Cl, -5% to 5%).. Single daily dosing of amikacin and ceftriaxone was as effective and no more toxic than multiple daily dosing of amikacin and ceftazidime for the empiric therapy of infection in patients with cancer and granulocytopenia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Agranulocytosis; Amikacin; Bacterial Infections; Ceftazidime; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Ear Diseases; Female; Humans; Infant, Newborn; Infections; Kidney Diseases; Male; Middle Aged; Neoplasms; Prospective Studies; Treatment Outcome

To compare the efficacy and safety of intramuscular cefoperazone and intramuscular ceftriaxone in the treatment of nursing home-acquired pneumonia in the nursing home setting.. A randomized clinical trial.. Skilled nursing wards at the Veterans Home of California.. 104 residents of skilled nursing wards, aged 65 years or older.. Intramuscular administration of either cefoperazone or ceftriaxone.. The variables analyzed for baseline comparability were demographics (age, sex), clinical variables (duration in nursing home; presence of sputum, fever, cough, or leukocyte count), and clinical symptoms and signs. Efficacy was assessed by days of therapy, final maximum temperature, and clinical and bacteriological response.. Fifty residents received cefoperazone, 1 gm every 12 hours, intramuscularly. Fifty-four residents received ceftriaxone, 1 gm every 24 hours, intramuscularly. The total duration of treatment was scheduled for 10 days. Clinical cure was seen in 45 (90%) of the cefoperazone treatment group and 51 (94%) of the ceftriaxone treatment group, with a mean duration of therapy of 10.30 and 9.90 days, respectively. Satisfactory sputum specimens were collected in 71% of the treated residents; the most common isolate was Streptococcus pneumoniae, followed by Haemophilus influenzae and Staphylococcus aureus, respectively. The overall mortality was 4.5% at long-term follow-up. Both agents were well tolerated and no therapy was discontinued due to intramuscular pain or abnormal laboratory values.. Intramuscular cefoperazone and intramuscular ceftriaxone are safe and effective in the treatment of nursing home-acquired pneumonia. The clinical outcomes in both treatment groups support their use within this select population without the need for transferring the patient to an acute care hospital. Clinical studies are needed to evaluate the impact of such therapy on the control of health care expenditures within the nursing home facility.

Topics: Aged; Aged, 80 and over; Bacterial Infections; Cefoperazone; Ceftriaxone; Cross Infection; Female; Humans; Injections, Intramuscular; Male; Nursing Homes; Pneumonia

Instrumentation of lower urinary tract is a predisposing factor for the development of urinary infection. Incidence of infective complications following urethrocystoscopy has been evaluated in a multicenter, prospective, comparative and randomized study in 2,284 patients, who had a previous negative urine culture. Patients were randomized into two groups: one to be used as control and the other one to received antimicrobial prophylaxis prior to instrumentation (ceftriazone, 1 gr intramuscular). Clinical and microbiological responses were evaluated at 48-72 hours and 4 weeks after cystoscopy. Symptomatic bacteriuria was observed in 10.2% of patients in the control group and in 2.5% in the prophylaxis group (p < 0.000); asymptomatic bacteriuria in 3.02% and 1.52% (p > 0.05) and irritative syndrome with sterile urine in 2.93% and 2.60% (p > 0.05), respectively. Thus, the use of prophylaxis reduced the incidence of infective complications in these patients.

Topics: Adolescent; Adult; Bacterial Infections; Bacteriuria; Ceftriaxone; Cystoscopy; Female; Humans; Incidence; Male; Prospective Studies; Sex Factors; Urethra; Urinary Tract Infections

Two hundred and eighty-four febrile episodes in immunocompromised patients were treated with ceftriaxone alone or in combination with amikacin. In the ceftriaxone-treated group, 60 out of 143 febrile episodes were microbiologically documented, while in the group receiving the combination therapy, there were 32 out of 140 (p = 0.0007). Gram-positive microorganisms were more common than gram-negative ones, accounting for 59 of the 101 isolated bacteria. The ceftriaxone regimen appeared to have a response rate comparable to the combination regimen (73.91 vs. 78.88%). Superinfections occurred under both regimens.

Topics: Adult; Amikacin; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Immunocompromised Host; Male

The aim of this study was to investigate the controversial issue of the use of prophylactic antibiotics in open and basilar fractures of the skull. A series of 157 patients were randomized to receive no antibiotics (group A = 46 patients) or ceftriaxone for 3 days (group B = 50 patients), or the combination ampicillin/sulphadiazine for 3 days (group C = 61 patients). The incidence of meningitis was similar in both the antibiotic and non-antibiotic groups. However, the overall incidence of infectious complications in the non-antibiotic group was significantly higher than in the antibiotic group (8.7 per cent vs 0.9 per cent, P < 0.05). There was no significant difference between the ceftriaxone group and the ampicillin/sulphadiazine group. The results of the study suggest that antibiotic prophylaxis has a role in the management of open and basilar fractures.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Fractures, Open; Humans; Male; Meningitis; Occipital Bone; Skull Fractures; Sulfadiazine; Time Factors

Topics: Adult; Bacterial Infections; Ceftriaxone; Child; Global Health; Humans; Osteoarthritis; Respiratory Tract Infections; Urinary Tract Infections

In this randomized trial, 100 patients received ceftriaxone or amoxicillin-clavulanic acid in phlegmonous or abscess-forming ENT infections. Clinical and bacteriological results confirm that both antibiotics are equally effective, the advantage of ceftriaxone being one administration a day. Drainage surgery is necessary when an abscess has already formed. In 4 cases (ceftriaxone: 3; amoxicillin-clavulanic acid: 1), no positive response could be observed. Systemic and local tolerance was, as a general rule, excellent, and side effects were reported in 3 cases of the ceftriaxone group and in 3 cases of the amoxicillin-clavulanic acid group.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cellulitis; Clavulanic Acid; Clavulanic Acids; Drug Therapy, Combination; Ethmoid Sinusitis; Female; Humans; Male; Middle Aged; Otitis Externa; Peritonsillar Abscess; Tonsillitis

In a prospective randomized double-blind trial, the efficacy and safety of cefotaxime and ceftriaxone were compared in intensive care unit (ICU) patients with serious infections requiring systemic antimicrobial therapy. Patients were randomly assigned to receive either cefotaxime 1 g i.v. t.i.d. or ceftriaxone 2 g every 24 hr. Clinical and bacteriologic assessments were made before treatment, at 48 hr and 5 days during treatment, and 48 hr after treatment. At the time of reporting, a total of 34 patients had been entered into the trial, 27 of whom were evaluable; 23 patients (85%) completed a minimum of 5 days antibiotic treatment. At the end of treatment, using current statistics 67% of cefotaxime and ceftriaxone patients demonstrated clinical cure or improvement. Bacteriologic responses appeared greater in the cefotaxime group (55% vs 42%). The incidence of adverse effects, which were usually minor, was similar in each group. From these preliminary results, it would appear that at the doses used in this study, cefotaxime and ceftriaxone are equally effective in the treatment of infections in the ICU.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Double-Blind Method; Female; Humans; Intensive Care Units; Male; Middle Aged; Prospective Studies; Treatment Outcome

In a prospective, controlled, double-blind study, 496 patients undergoing abdominal surgery were given antibiotic prophylaxis with a single dose of either ceftriaxone or ampicillin + metronidazole. No significant intergroup difference was found between the respective overall rates of infectious complications (3.2% and 4.9%). Analysis of the microbiologic findings showed incisional wound infections, mainly caused by gram-negative rods, to be more common in the ampicillin-metronidazole group, whereas deep wound infections were more frequent in the ceftriaxone group. It is concluded that ceftriaxone seems to be more efficient than ampicillin-metronidazole as prophylaxis against incisional wound infection, but should preferably be supplemented with an antianaerobic agent to prevent deep wound infections.

Topics: Abdomen; Aged; Aged, 80 and over; Ampicillin; Bacterial Infections; Ceftriaxone; Digestive System Surgical Procedures; Double-Blind Method; Drug Combinations; Humans; Metronidazole; Middle Aged; Peritonitis; Prospective Studies; Sepsis; Surgical Wound Infection

The efficacy and safety of the two antibiotic combinations, ceftazidime plus amikacin and ceftriaxone plus amikacin were compared in an open randomized trial. 100 episodes of neutropenia caused by malignant diseases and/or cytostatic drugs were evaluated in 66 males and 34 females with a mean age of 49.4 years. The types of infections treated were: septicemia 38, fever of undetermined origin 26, pneumonia 13, ear, nose and throat infections 11 and others 12. 17 episodes were not evaluable (6 protocol violations, 6 doubtful infections and 5 non-bacterial infections). The overall results were comparable, with a 74% success rate for ceftazidime and a 70% rate for ceftriaxone (criteria of the European Organization for Research and Treatment of Cancer). In the patients with septicemia, the success rate was 64% in the ceftriaxone and 57% in the ceftazidime group. Eight patients died during the treatment, in 5 cases due to infectious complications. There were no differences between the two groups in respect of efficacy or toxicity.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Agranulocytosis; Amikacin; Bacterial Infections; Ceftazidime; Ceftriaxone; Drug Therapy, Combination; Female; Fever; Humans; Leukemia; Male; Middle Aged; Neoplasms

Neutropenic patients with underlying hematologic (usually malignant) diseases were randomized to receive either 2 g ceftriaxone once daily +0.5 g amikacin or 2 g ceftazidime twice daily +0.5 g amikacin b.i.d. when fever was higher than 38 degrees C and granulocyte counts less than 0.5 x 10(9)/l. 25 patients were included in each treatment group. Successful outcome of treatment was observed in 28 (13/15) and in an additional 5 (2/3) patients after modification of the therapy. Tolerability was excellent in both groups.

Topics: Adolescent; Adult; Aged; Amikacin; Bacterial Infections; Ceftazidime; Ceftriaxone; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever; Humans; Leukemia; Male; Middle Aged; Neutropenia

Gram-positive infections are being reported with increasing frequency in children with haematological malignancies. Staphylococcus epidermidis, once considered a non-pathogenic skin contaminant, is emerging as a major cause of severe infection. However, in infants Gram-negative septicaemias are more frequent than in older children. A teicoplanin and ceftriaxone combination was assessed for use as empirical therapy of febrile episodes in neutropenic children with acute leukaemias. Of 47 patients, fever was of unknown origin in 21, and documented in 26 with 28 strains isolated; 19 Gram-positive (all sensitive to teicoplanin) and nine Gram-negative. Within 48 h, 41 patients became afebrile and the pathogen was cleared if initially present. Mean duration of treatment was 16 days. Febrile relapse occurred in 24 patients with eight documented superinfections. The need for prophylactic cover against Gram-positive organisms at the time of intravenous catheter insertion is questionable. We studied 71 patients who were randomly allocated to receive teicoplanin when the central line was inserted and if febrile, with added ceftriaxone and amikacin (arm A) or the tri-antibiotic regimen when fever occurred (arm B). In arm A a febrile episode occurred after ten days in 34/35 patients with only one Gram-positive organism isolated. In arm B a febrile episode occurred in all 36 patients after five days and ten Gram-positive strains were isolated. Those patients in arm A also received fluconazole. Amphotericin B was administered in cases of failure or relapses in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Ceftriaxone; Child; Cost-Benefit Analysis; Drug Therapy, Combination; Glycopeptides; Gram-Positive Bacteria; Humans; Leukemia; Neutropenia; Random Allocation; Teicoplanin

The effectiveness of cefazolin or cefotaxime as antibiotic therapy was compared with that of ceftriaxone in a multicentre prospective randomized trial involving 1,254 consecutive patients operated upon for abdominal diseases. Patients about to undergo surgery of the colon or who had localized or generalized peritonitis at the time of operation were excluded from the study. The patients entered were divided into 4 strata according to the degree of operative contamination and to risk factors. In each stratum, the patients were allocated at random to one or the other of 2 treatment groups. Group 1 patients received cefazolin or cefotaxime in 3 doses of 1 g administered 8-hourly, the first dose being injected during induction of general anaesthesia. Group 2 patients received one single 1 g dose of ceftriaxone injected during induction of anaesthesia. There was no significant difference between the two groups in the wound infection rate and in the frequency of post-operative intra-abdominal abscesses. Although the percentage of post-operative pulmonary and urinary tract infections was lower in the ceftriaxone group than in the cefazolin/cefotaxime group, no significant difference was observed between the two groups in the number of patients who required curative antibiotic therapy. This study shows that one single dose of ceftriaxone is as effective as three doses of cefazolin or cefotaxime in preventing would infections and post-operative intra-abdominal abscesses, and that it is more effective in preventing extra-abdominal infections complicating surgery.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefazolin; Cefotaxime; Ceftriaxone; Child; Digestive System Diseases; Drug Therapy, Combination; Female; France; Genital Diseases, Female; Humans; Male; Middle Aged; Postoperative Care; Postoperative Complications; Prospective Studies; Urologic Diseases; Vascular Diseases

A two-stage intervention programme was performed to enable the effective substitution of ceftriaxone for cefotaxime in a teaching hospital with large numbers of transient prescribers. One hundred and sixteen patients with a variety of bacterial infections were randomized to an open, historical control comparative study to determine if ceftriaxone was an acceptable replacement for cefotaxime. For 6 months prior to the intervention, both cephalosporins were available on formulary. Following an initial informational stage, a therapeutic interchange programme was implemented to convert prescriptions for cefotaxime to ceftriaxone. Ceftriaxone and cefotaxime were equivalent in terms of microbiological and clinical efficacy and patient tolerance in 77 evaluable patients. No changes in prescriber service occurred after the changeover. Post-intervention treatment courses required a ceftriaxone/cefotaxime interchange in 28% of the cases. Ceftriaxone appeared to be a suitable and cost-effective alternative to cefotaxime in this hospital. The intervention programme successfully invoked the formulary change with minimal expense and prescriber opposition.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Cost-Benefit Analysis; Drug Administration Schedule; Drug Resistance, Microbial; Drug Utilization; Female; Hospitals, Teaching; Humans; Injections, Intravenous; Male; Middle Aged; Prospective Studies; Retrospective Studies

In the last 2 years, 50 patients who underwent elective colorectal surgery were prospectively studied about antibiotic prophylaxis. Two groups of 25 patients each were randomly selected. Both received: (a) a colic preparation: hypactic drugs and two enemas during the day before surgery and (b) metronidazole 0.5 g plus neomycin 1 g per 8 h orally for 1 day before surgery. Every group also received: group A, metronidazole 0.5 g plus amikacin 500 mg i.v. 2 h before surgery and the same doses per 8 or 12 h, respectively, for 2 days postoperatively; group B, ornidazole 1 g by intravenous infusion plus ceftriaxone 2 g i.v. 2 h before surgery and the same doses of the drugs per 24 h for 2 days postoperatively. Wound infection occurred in 1 case of group A versus 2 cases of group B (p greater than 0.25). Ornidazole plus ceftriaxone prophylactic antibiotic therapy is therefore as effective as a classic therapy (metronidazole plus amikacin) and constitutes an alternative choice for patients undergoing elective colorectal surgery, because the simple manner of its administration (once per 24 h) is resulting in cost saving due to gained nursing time.

Topics: Aged; Amikacin; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Colorectal Neoplasms; Costs and Cost Analysis; Female; Humans; Infusions, Intravenous; Male; Metronidazole; Middle Aged; Ornidazole; Premedication; Prospective Studies

This was a prospective, randomized study of 123 patients with penetrating abdominal injuries. The patients received ceftriaxone or cefoxitin for 24 h (in the presence of colonic injury, 48 h). The overall incidence of abdominal sepsis was 7.3 per cent (ceftriaxone 5 per cent, cefoxitin 9.5 per cent, P greater than 0.05). Colonic injury was the most important risk factor for the development of septic complications. Other factors, such as the weapon used, a prehospital time longer than 4 h, shock on admission, multiple organ injuries, and small bowel perforation, did not influence the incidence of sepsis.

Topics: Abdominal Injuries; Adult; Bacterial Infections; Cefoxitin; Ceftriaxone; Colon; Female; Humans; Male; Multiple Trauma; Postoperative Complications; Premedication; Prospective Studies; Risk Factors; Wounds, Penetrating

Three hundred and twenty patients were enrolled in a prospective randomized trial comparing cefoperazone, ceftizoxime and ceftriaxone for initial therapy of infectious episodes in cancer patients. Patients with neutropenia were excluded. In 286 evaluable episodes, the response rates associated with the three agents were 77% for cefoperazone, 70% for ceftizoxime and 72% for ceftriaxone, with no statistically significant differences between the three treatment groups. The overall response rate for all episodes of pneumonia (64%) was significantly lower than the response rate for all other infections (81%; p = 0.002), and the mortality associated with pneumonia (9%) was higher than that associated with all other episodes (2%; p = 0.01). Patients with infections due to gram-negative organisms responded well to all three agents, whereas patients with gram-positive infections responded more favorably to cefoperazone. Two different schedules of ceftriaxone were used. The clinical response did not differ significantly between patients receiving ceftriaxone once daily and those receiving it twice daily. The incidence of superinfection and relapse was extremely low and all three agents were well tolerated. It is concluded that extended spectrum cephalosporins are effective as single agents for the treatment of infections in cancer patients with adequate neutrophil counts.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoperazone; Ceftizoxime; Ceftriaxone; Costs and Cost Analysis; Drug Administration Schedule; Female; Half-Life; Humans; Male; Metabolic Clearance Rate; Middle Aged; Neoplasms; Pneumonia; Prospective Studies; Remission Induction

The effectiveness of antibiotic prophylaxis was evaluated in the immediate postoperative period of renal transplantation (RT). Before RT, the patients were randomly assigned to one of the following groups: 1) cefotaxime (intravenous infusion of 1 g one hour before the operation). 2) Ceftriaxone (1 g i.v. given in a similar way). 3) Control (without antibiotics). Patients who required antibiotic therapy during the first 3 postoperative weeks were excluded. 20 recipients of cadaveric renal grafts were included in each group. There were 39 males and 21 females with a mean age of 39.9 years. One patient from the cefotaxime group (5%), 2 from the ceftriaxone group (10%) and 2 from the control group (10%) developed infection of the surgical wound, all due to grampositive organisms. 19 patients had urinary tract infections: 7 from the control group (35%), 7 from the cefotaxime group (35%), and 5 from the ceftriaxone group (25%). The development of wound infection was not correlated with urea, creatinine, hemoglobin or total protein levels, or with urinary tract infection or fistula, diabetes or fever. The mean packed red cell volume of the patients who developed wound infection was 24.7 +/- 1.2 vs 28.6 +/- 6.6 in those who did not (p less than 0.01). All patients with visible hematoma and 3 of 10 with perirenal blood collection had wound infection. It was concluded that antibiotic prophylaxis for renal transplantation was useless in our patients.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Kidney Transplantation; Male; Postoperative Complications; Premedication

Efficacy of the cephalosporin, ceftriaxone, was compared with that of the combination of the aminoglycoside, netilmicin, and the penicillin, azlocillin, in the treatment of febrile episodes in immunocompromised neutropenic children undergoing chemotherapy for neoplastic disease. During 100 separate febrile episodes, 40 strains of bacteria were isolated from the blood of 34 patients and a further 55 strains from other sites. Nine strains (four of which were staphylococci) to both netilmicin and azlocillin. There was no difference in clinical response between the two therapeutic regimens as assessed 4 and 7 days after treatment began. Ceftriaxone had the considerable practical advantages of once daily dosage without a need for blood monitoring. Ceftriaxone would appear to be effective as initial monotherapy in the treatment of bacterial infections in severely neutropenic children.

Topics: Adolescent; Agranulocytosis; Azlocillin; Bacteria; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Fever; Humans; Infant; Neoplasms; Netilmicin; Neutropenia; Randomized Controlled Trials as Topic

Ceftriaxone has potent activity against a broad range of Gram-positive and Gram-negative bacteria. While it is eliminated mainly by the kidney, 10-20% of the drug is eliminated in the bile and ceftriaxone salt precipitates have been described in the gallbladder of animals dosed with ceftriaxone. The purpose of the present study was to investigate the incidence of biliary lithiasis 6 and 12 months after treatment with ceftriaxone and to compare it with that in patients treated with amoxycillin/clavulanate. Biliary ultrasonography was performed at the start of treatment, at 6 months and at 12 months after the beginning of the study. One hundred patients were randomized and 74 were evaluable: 34 were given amoxycillin/clavulanate, 40 ceftriaxone. Gallbladder lithiasis developed in one patient 12 months after the amoxycillin/clavulanate treatment and in none in the ceftriaxone treatment arm. Biliary precipitate during ceftriaxone treatment was not looked for because this phenomenon was not known at the beginning of the study, but gallbladder precipitation that was seen in two patients given ceftriaxone during and at the end of treatment, respectively, resolved spontaneously. In conclusion, ceftriaxone treatment does not appear to lead to gallstone formation more often than an antibiotic that is not eliminated through the bile.

Topics: Adolescent; Adult; Aged; Amoxicillin; Bacterial Infections; Ceftriaxone; Cholelithiasis; Clavulanic Acid; Clavulanic Acids; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Randomized Controlled Trials as Topic

Once-daily dosing of aminoglycosides has been suggested to improve their efficacy and reduce their toxicity. To test the clinical validity of this suggestion, we conducted a prospective, randomized trial comparing a conventional multiple-daily-dosing regimen of netilmicin with once-daily administration of the same total daily dose of this aminoglycoside.. We enrolled 141 predominantly elderly patients with severe bacterial infections. All patients received once-daily doses of 2 g ceftriaxone, in addition to netilmicin.. Patients randomized to either of the two dosing strategies were comparable regarding age, APACHE II score, concomitant diseases, infection site, and rate of culture-proven bacteremia. Netilmicin treatment did not differ significantly in mean daily dose per kg body weight and days of therapy between the two treatment arms. Compared to patients receiving conventional doses, patients treated with a once-daily dose had higher serum peak netilmicin levels and lower trough levels. Outcome of infection and mortality were not influenced by dosing strategy. Although the overall incidence of nephrotoxicity was similar in both groups (16%), the occurrence of nephrotoxicity in patients treated with once-daily doses of netilmicin was significantly shifted to those given prolonged treatment, i.e., beyond 9 days. Auditory toxicity was documented in one patient treated with conventional doses and two patients treated with once-daily doses.. Once-daily dosing of an aminoglycoside plus a long-acting cephalosporin in these patients constituted cost-effective and safe treatment for severe bacterial infections. Netilmicin-induced toxicity may be reduced by using once-daily dosing regimens and limiting the duration of treatment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Netilmicin; Prospective Studies; Randomized Controlled Trials as Topic

A prospective study was carried out in 44 patients treated by intensive chemotherapy inducing a prolonged neutropenia (granulocytes less than 0.5.10(9)/l). All the patients were isolated in protected rooms, received a pathogen-free diet and nonabsorbable oral antibiotics. After double-blind randomization, 22 patients received 2 g of Ceftriaxone (Cef) in a daily infusion beginning on the first day of chemotherapy; and 22 patients received 2 g of placebo (P) under the same conditions. Prophylaxis was continued until the neutropenia resolved (granulocytes greater than 0.5.10(9)/l) or until the onset of infectious symptoms. 19 patients in each group developed febrile episodes, occurring significantly later in the Cef group (16.6 days versus 10.6 days in the P group). No Cef-resistant organism was isolated. Finally, the time at which apyrexia was obtained after the beginning of curative antibiotherapy was the same in both groups. The routine intravenous administration of Cef in combination with nonabsorbable antibiotics is a useful approach in reducing the risk of infection in the neutropenic host.

Topics: Adult; Agranulocytosis; Antineoplastic Agents; Bacterial Infections; Ceftriaxone; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Prospective Studies; Risk Factors

To compare ceftriaxone with cefuroxime for the treatment of meningitis, we conducted a study in which 106 children with acute bacterial meningitis were randomly assigned to receive either ceftriaxone (100 mg per kilogram of body weight per day, administered intravenously once daily; n = 53) or cefuroxime (240 mg per kilogram per day, administered intravenously in four equal doses; n = 53). The mean age of the children was 3 years (range, 42 days to 16 years), and the characteristics of the two treatment groups were comparable at admission. Excluded from the study were eight other children who died within 48 hours of admission. After 18 to 36 hours of therapy, cultures of cerebrospinal fluid remained positive for 1 of the 52 children (2 percent) receiving ceftriaxone for whom cultures were available and 6 of 52 (12 percent) receiving cefuroxime (P = 0.11). In both groups the mean duration of antibiotic therapy was 10 days. The clinical responses to therapy were similar in the two treatment groups, and all 106 children were cured. Reversible biliary pseudolithiasis was detected by serial abdominal ultrasonography only in the children treated with ceftriaxone (16 of 35 vs. 0 of 35; P less than 0.001). The treatment of three children was switched from ceftriaxone to alternative antibiotics because these children had upper abdominal pain. Other side effects were infrequent in both groups. At follow-up examination two months later, moderate-to-profound hearing loss was present in two children (4 percent) treated with ceftriaxone and in nine (17 percent) treated with cefuroxime (P = 0.05); other neurologic abnormalities were similar in the two treatment groups. We conclude that ceftriaxone is superior to cefuroxime for the treatment of acute bacterial meningitis in children and that the benefits of milder hearing impairment and more rapid sterilization of the cerebrospinal fluid with ceftriaxone outweigh the problem of reversible biliary pseudolithiasis with this drug.

Topics: Adolescent; Bacterial Infections; Ceftriaxone; Cefuroxime; Cephalosporins; Cerebrospinal Fluid; Child; Child, Preschool; Cholelithiasis; Female; Hearing Loss, Sensorineural; Humans; Infant; Injections, Intravenous; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Multicenter Studies as Topic; Prospective Studies; Random Allocation

Topics: Bacterial Infections; Bile; Biliary Tract Surgical Procedures; Ceftriaxone; Ciprofloxacin; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication

In order to objectively evaluate the efficacy and the safety of ceftriaxone (CTRX) using once daily administration of 1 g to cases of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media, a group comparison study by the envelope method was conducted using cefotiam (CTM) as the control drug (2 g twice daily). The results obtained are summarized as follows. 1. Clinical efficacies evaluated by the committee were 71% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 63% and 60%, respectively, for chronic suppurative otitis media. When all cases were considered both groups evidenced a clinical efficacy of 64%, and no significant difference was observed between the 2 groups. 2. Clinical efficacies evaluated by the physician in charge were 65% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 72% and 60%, respectively, for chronic suppurative otitis media. When all cases were considered efficacies were, respectively, 70% and 64%, showing no significant difference between the 2 groups. 3. Bacteriological efficacies were 88% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 74% and 62%, respectively, for chronic suppurative otitis media. With all cases bacterial eradication rates were, respectively, 76% and 67%. Bacterial eradication rates were always higher for the CTRX group than for the CTM group, but the difference was not significant between the 2 groups. 4. Against infections caused by Staphylococcus aureus alone, CTRX showed equal clinical and bacteriological efficacies to CTM. 5. As side effects, dermatitis, vomiting, and malaise were observed in 5 cases (4%) of the CTRX group and 3 cases (3%) of the CTM group. As clinical testing abnormalities, elevations of GOT, GPT, and Al-P, and thrombocytopenia were noted only in 3 cases (5%) of the CTRX group. Furthermore, all of these abnormalities were temporary and of moderate degree or mild, thus the safety of either drug was considered high. 6. Clinical utilities were 71% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 72% and 62%, respectively, for chronic suppurative otitis media. When all cases were included, they were 72% and 66%, respectively, and there was no significant difference between the 2 groups. It is concluded from the above results that CTRX is a highly useful drug with once daily administration of 1 g in the treatment of suppur

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefotiam; Ceftriaxone; Drug Eruptions; Drug Evaluation; Female; Humans; Japan; Male; Middle Aged; Multicenter Studies as Topic; Otitis Media; Otitis Media, Suppurative; Thrombocytopenia; Vomiting

In a multicentre study, 220 consecutive cases of bacterial meningitis in children older than 3 months were randomised to treatment with chloramphenicol, ampicillin (initially with chloramphenicol), cefotaxime, or ceftriaxone. The drugs were given in four equal daily doses for 7 days, except ceftriaxone which was given only once daily. 200 cases could be assessed; the causative organisms were Haemophilus influenzae type b (Hib) in 146; meningococci (Mnc) in 32; pneumococci (Pnc) in 13; and other or unknown in 9. In patients with Hib meningitis, sterilisation of the cerebrospinal fluid occurred most rapidly with ceftriaxone. Otherwise, in terms of overall clinical recovery, normalisation of laboratory indices, clinically significant adverse reactions, toxic effects, sequelae, and mortality rate, the treatment groups were very similar. However, there were 4 bacteriological failures, all in the chloramphenicol group. Also, the treatment was extended or changed in more cases in the chloramphenicol group than in the other groups. Chloramphenicol was thus inferior to the other three antimicrobials. Ampicillin is a good and cheap alternative, but there are difficulties with resistance. Easy administration tempts the use of ceftriaxone rather than cefotaxime but it causes diarrhoea. A 7-day course of ampicillin, cefotaxime, or ceftriaxone is sufficient in Hib, Mnc, or Pnc meningitis.

Topics: Adolescent; Ampicillin; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Female; Finland; Follow-Up Studies; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Multicenter Studies as Topic; Random Allocation; Recurrence

We conducted a prospective randomized clinical trial to compare the efficacy and tolerability of monotherapy with ceftriaxone (active ingredient of Rocephin) (CRO) versus imipenem/cilastatin (I/C) in febrile cancer patients with or without neutropenia. 120 febrile episodes were randomized and 89 (75%) were evaluable for efficacy analysis. The overall response rates to both regimens were good (86 and 79% improved in response to CRO and I/C, respectively). Overall mortality was low and similar in the two groups. Both regimens were well tolerated. Our preliminary data corroborate the efficacy of CRO or I/C as empirical monotherapy for febrile episodes in cancer patients. It will be up to future investigations to show whether one of these regimens is superior to the other.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Male; Middle Aged; Neutropenia; Prospective Studies; Random Allocation; Remission Induction

The objectives of this open, prospective, randomized and comparative study were to evaluate and compare the efficacy and safety of intravenous ceftriaxone (active ingredient of Rocephin) and cefotaxime in treatment of bacterial pneumoniae. Forty-three patients were enrolled in the study and in 40 (21 in the ceftriaxone group and 19 in the cefotaxime group) we were able to make an evaluation. Bacteriological results were essentially based on a positive culture obtained with transtracheal aspirate (TTA) - 34 out of 40 cases; in the remaining patients, at least an initial positive sputum culture was obtained. Most of the lower respiratory tract infections were secondary to previous chronic respiratory diseases or were nosocomial infections; 25 out of 40 cases were considered to be severe or critical situations. The overall efficacy (bacteriological eradication plus clinical cure or clear improvement) of ceftriaxone and cefotaxime were 90.5% (19/21) and 73.7% (14/19), respectively (p less than 0.05). The tolerability of both drugs was good: 16 (76.2%) patients in the ceftriaxone group and 12 (63.2%) in the cefotaxime group had no adverse events, while in 5 and 7 patients, respectively, tolerability was considered satisfactory (minor side effects, none of which required discontinuation or even reduction of dosage).

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Respiratory Tract Infections

Sixty patients admitted to the hospital for colorectal surgery were randomly assigned to prophylaxis either with a single dose of ceftriaxone (Rocephin) i.v. plus metronidazole given 30 min prior to induction of anesthesia or with multiple doses of ceftazidime plus metronidazole given repeatedly every 8 h up to 24 h after surgery. The overall number of infections observed with the long-acting cephalosporin ceftriaxone was 4 (2 local and 2 remote), with the short-acting ceftazidime the number was 9 (5 local and 4 remote). Neither regimen was associated with adverse reactions.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftazidime; Ceftriaxone; Clinical Trials as Topic; Colon; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Rectum

In this multicentre study, 883 evaluable patients undergoing orthopedic surgery were randomly assigned to receive antiinfective prophylaxis with either ceftriaxone (Rocephin) or cefamandole. 25 patients in the ceftriaxone group and 29 patients in the cefamandole group (5.6 vs 6.5%) presented with infectious complications within the first 60 days after surgery. Delayed deep wound infections developed in only 1 of 435 patients in the ceftriaxone group compared with 4 of 413 patients in the cefamandole group. Both drugs were well tolerated. The infection rate was twice as high after surgery in conventional operating theatres than after treatment in hypersterile operating theatres (3.3 vs 6.5%); this difference is not statistically significant.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Bone Diseases; Cefamandole; Ceftriaxone; Child; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multicenter Studies as Topic; Muscular Diseases; Postoperative Complications; Premedication

A randomized, double-blind study was done to compare the efficacy and toxicity of daily single-dose therapy with intravenous ceftriaxone (2 g every 24 h) with daily multiple-dose therapy with cefotaxime (2 g every 6 h) for treatment of serious bacterial infections in nonneutropenic patients. Of the 325 patients who were evaluable for toxicity, 241 (74.2%) were evaluable for efficacy. Infection sites included lung (106), urinary tract (42), skin and soft tissue (43), bone and joint (23), bacteremia (21), and hepatobiliary (5). Definite infections were present in 173 cases (71.8%) and possible infections in 68 (28.2%). Analysis of clinical and bacteriologic responses and adverse drug reactions showed no significant differences between the regimens. Values for 95% confidence limits on the differences between regimens for positive clinical and bacteriological outcomes in definite infections were -0.8% to 3.0% and -1.9% to 9.1%, respectively. Thus, daily single-dose therapy with ceftriaxone was comparable to daily multiple-dose therapy with cefotaxime in treating these bacterial infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Middle Aged; Multicenter Studies as Topic; Random Allocation

Ceftriaxone was compared with cefotaxime for the treatment of serious bacterial infections in a prospective, randomized, double-blind clinical trial. The dose of ceftriaxone was 2 g once a day, and the dose of cefotaxime was 2 g every 4 h. Metronidazole was added if anaerobic infection was suspected. Explicit criteria were used to define infections, clinical response, and adverse effects. Ceftriaxone was given to 88 patients and cefotaxime to 83. The two treatment groups did not differ in types of infection, infecting organisms, and severity of underlying disease. The response rate was 81% (71/88) for ceftriaxone and 80% (66/83) for cefotaxime. The power of the study to detect a 15% difference in response rate at P less than .1 was 90%. The frequency of diarrhea, thrombophlebitis, prothrombin time, prolongation, colonization, and superinfection did not differ between treatment groups. Ceftriaxone 2 g once a day was as safe and effective as cefotaxime 2 g every 4 h for suspected serious bacterial infections.

Topics: Adult; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Male; Middle Aged

For seventy episodes of infection in hematologic disorders mostly during the phase of severe granulocytopenia, a trial was designed to evaluate the efficacy of a new third-generation cephalosporin, ceftriaxone (CTRX). The regimen consisted mainly of drip infusion of CTRX 2 g every 12 hours. The overall response rate achieved was 54.3 percent. Two episodes of an outpatient with malignant lymphoma were effectively treated by CTRX at a dose of 2-4 g once a day, reflecting its long biological half-life. Gastrointestinal symptoms, hypersensitivity reactions and elevation of hepatic enzyme levels occurred rarely (6.4 and 5.1 percent of the patients, respectively), and these abnormalities were mild and reversible. Thus, CTRX may be recommended as an effective monotherapy in the treatment of infections in immunocompromised patients with hematologic disorders.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Ceftriaxone; Drug Evaluation; Female; Hematologic Diseases; Humans; Infusions, Intravenous; Male; Middle Aged; Multicenter Studies as Topic

Ceftriaxone (CTRX), a new long acting antibiotic in the 3rd generation cephem group, was administered intravenously once or twice a day in daily doses of 1-6 g for at least 3 days to 86 patients with severe infections complicating hematopoietic disorders. Underlying diseases were acute leukemia in 41 cases, chronic leukemia in 3 cases, malignant lymphoma in 19 cases, myeloma in 7 cases and others. Most patients (55 cases) suffered from sepsis or suspected sepsis. As for efficacy rates classified by underlying diseases, the treatment was effective in 61.0% of patients with acute leukemia. As for efficacy rates classified by infections, the treatment was effective in 60.0% of patients with sepsis. No side effects were noted except rash in 2 patients. Abnormal hepatic functions were recognized in 3 patients but were not attributed to the agent in any case. The results indicate that CTRX is a safe and useful antibiotic for the treatment of severe infections accompanied by hematopoietic disorders.

Topics: Bacterial Infections; Ceftriaxone; Drug Evaluation; Female; Hematologic Diseases; Humans; Infusions, Intravenous; Male; Middle Aged; Multicenter Studies as Topic

Ceftriaxone is a new, third-generation cephalosporin that, because of its long half-life, offers potential advantages of cost and convenience over similar agents such as cefotaxime. We compared the two drugs in a prospective, randomized study of the treatment of chest infections in seriously ill patients. Fifty-one patients (90 percent of whom were mechanically ventilated) received either ceftriaxone, 2g IV once daily, or cefotaxime, 2 g IV thrice daily, for five days. The two groups of patients appeared demographically comparable. Ceftriaxone in a single daily dose of 2 g once daily may not be satisfactory for the treatment of serious chest infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged; Prospective Studies; Randomized Controlled Trials as Topic; Severity of Illness Index; Thoracic Diseases

The aim of this research was to collect precise data on the antibacterial activity of ceftriaxone and cefotaxime in the respiratory tract. The diffusion into pulmonary tissue and bronchial secretion and the antibacterial activity of the two antibiotics were evaluated in vivo by means of the inhibitory quotient. Ceftriaxone administered at a dosage of 1 g (i.m.) every 24 h resulted in antibacterial levels against the sensitive pathogens over a period of 24 h after each dose. The antibacterial protection afforded by cefotaxime, given at the dosage of 1 g (i.m.) every 12 h, was not as marked and did not extend over the interval between two administrations.

Topics: Aged; Bacterial Infections; Bronchi; Cefotaxime; Ceftriaxone; Female; Humans; Injections, Intramuscular; Lung; Male; Middle Aged; Respiratory System

Fifty-two children were included in this study to evaluate and compare short- versus standard-length ceftriaxone therapy for bacterial meningitis. The duration of the short-course regimens was 4, 6 and 7 days for Neisseria meningitidis, Hemophilus influenzae and Streptococcus pneumoniae, respectively. The standard-length regimens were twice as long. On the basis of a computer-generated randomization list, 26 children were assigned either to the short- or to the standard-treatment regimen. Ceftriaxone was given intravenously once daily in a dose of 60 mg/kg after an initial loading dose of 100 mg/kg. The population characteristics, the severity of disease and the cerebrospinal fluid (CSF) findings were similar in the two study groups at admission. Bacteriological and clinical response were comparable. There were no significant differences in the incidence of neurological complications, prolonged fever (greater than or equal to 10 days), persistent pleocytosis and side effects between the two groups. Hearing loss occurred in 3 patients in the standard-length group and in no patients in the short-course group. Diarrhea was the only side effect and occurred in 14% of the patients. The results of the study indicate that the short-duration regimen was adequate for the treatment of meningitis caused by the three major meningeal pathogens. However, the small number of patients do not justify the adoption of the short-course regimen for all children with meningitis. At present, prolongation of ceftriaxone therapy or discontinuation of the drug under strict clinical observation of the patient should be considered in some cases.

Topics: Bacteria; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Infant; Male; Meningitis; Prospective Studies; Random Allocation

To determine the clinical importance of CSF cultures that are persistently positive for pathogens in patients treated for meningitis with the new cephalosporins, the records of 301 infants and children with bacterial meningitis enrolled prospectively in four clinical efficacy trials of cefuroxime or ceftriaxone therapy were reviewed. CSF culture results were positive for 20 patients and they were sterile at 18 to 36 hours after start of therapy for 281 patients. Seizures, subdural effusions, and hemiparesis were found significantly more often during hospitalization in those with delayed sterilization of CSF. Children with persistently positive cultures had a significantly higher incidence of neurologic abnormalities at the time of hospital discharge (45% v 19%) and at follow-up (41% v 13%) and of moderate to profound hearing impairment (35% v 15%) than did those with prompt sterilization of CSF. Repeat CSF examination is a useful prognostic indicator in infants and young children with bacterial meningitis.

Topics: Bacteria; Bacterial Infections; Ceftriaxone; Cefuroxime; Cephalosporins; Cerebrospinal Fluid; Child, Preschool; Female; Hearing Loss; Humans; Infant; Male; Meningitis; Prognosis; Prospective Studies; Spinal Puncture

To compare the efficacy of once daily monotherapy with that of standard combination antibiotic therapy for the initial management of patients suspected of serious bacterial infections, 105 patients were randomised to treatment with ceftriaxone alone (53 patients) or to a combination of cefuroxime and gentamicin (52 patients). There was no difference between the groups in proportions responding to therapy or proportions dying from infection, except when non-evaluable patients were excluded from the group with definite bacterial infection, in which case response was better among those treated with ceftriaxone. The groups did not differ in number of side-effects, but therapy had to be discontinued because of treatment failure, an adverse effect, or death in 1 of 53 patients given ceftriaxone and in 11 of 34 given the combination. Use of ceftriaxone was 107.36 pounds ($182.51) cheaper per patient, and saved 40 minutes of nursing and drug administration time per patient per day. Thus 2 g ceftriaxone given once a day is at least as effective and costs less in time and money than gentamicin plus cefuroxime for the initial treatment of patients with serious systemic bacterial infections.

Topics: Adult; Bacterial Infections; Ceftriaxone; Cefuroxime; Cephalosporins; Clinical Trials as Topic; Costs and Cost Analysis; Drug Administration Schedule; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Random Allocation; Time Factors

Since ceftriaxone was first reviewed in the Journal, further studies have confirmed its broad antibacterial spectrum in vitro and extended its clinical documentation in comparative studies with other widely used drugs in infections of the urinary and lower respiratory tract, meningitis in infants and children, uncomplicated gonorrhoea, perioperative prophylaxis in patients undergoing surgery, and in several other types of infection. As in earlier studies, which primarily used a twice-daily dosage regimen, few significant differences were found between therapeutic groups in comparative studies and results have demonstrated the efficacy of once-daily ceftriaxone in all but the most serious infections, such as sole antibiotic therapy in pseudomonal infections. Wider clinical experience has established that ceftriaxone is generally well tolerated. Thus, ceftriaxone now has a well-defined place as an appropriate alternative for the parenteral treatment of a variety of infections due to susceptible organisms, as well as for perioperative prophylaxis of surgery, and may offer advantages of greater convenience over other parenteral antibiotics which are administered more frequently.

Topics: Bacterial Infections; Ceftriaxone; Clinical Trials as Topic; Drug Administration Schedule; Humans

Topics: Adolescent; Bacterial Infections; Blood-Brain Barrier; Ceftriaxone; Child; Child, Preschool; Clinical Trials as Topic; Humans; Infant; Injections, Intravenous; Meningitis

Prophylactic systemic antibiotherapy with ceftriaxone (CRO) alone was tested in aplastic patients receiving total gut decontamination and treated in protected environment. To enter the study, the patients had to be afebrile when their polymorphonuclear (PMN) count fell under 500/cumm. Seventy eight therapeutic aplasias (after allogeneic or autologous bone marrow transplant conditioning regimens or high dose chemotherapy) form the basis of this report. The median duration of aplasia was 19 D (11-93 D). Forty-three patients received during 51 aplasias one single injection of CRO per day as soon as PMN count was under 500/cumm. In 23 cases (45%) the patients remained afebrile until the end of aplasia. There were 3 Staphylococcus epidermidis bacteremias (6%), 3 bacteriologically documented fevers (6%) and 1 Cryptococcus septicemia. Twenty-nine of these aplasias were part of a randomized study between group A (prophylactic CRO) and group B (non prophylactic CRO: 27 cases). In group A, there were significantly more aplasias without fever (34.5% vs 4%), and less bacteremias (10% vs 48%). Fever appeared later in group A (mean 12.5 D vs 6 D). No death was recorded during the whole study. Thus, in protected environment, prophylactic systemic antibiotherapy could still lessen the risk of bacterial infections. The side effects and the cost of such a procedure appeared to be diminished by a monoantibiotherapy.

Topics: Adolescent; Adult; Agranulocytosis; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Humans; Middle Aged; Neutropenia; Patient Isolation; Premedication

Topics: Bacterial Infections; Ceftriaxone; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Evaluation; Female; Genital Diseases, Female; Genital Neoplasms, Female; Humans; Postoperative Complications; Surgical Wound Infection

A parenteral cephem antibiotic ceftriaxone (CTRX) was studied for its pharmacokinetic features and clinical efficacy and safety in various infections in neonates including premature infants at 11 institutions associated with Japan Perinatal Infection Research Group. The following results obtained are summarized as follows. 1. Following single intravenous bolus injections with 10 and 20 mg/kg of CTRX, serum levels of the drug at 30 minutes post-dose 36-42 micrograms/ml and 46-76 micrograms/ml, respectively, and those at 12 hours post-dose were 10-14 micrograms/ml and 13-21 micrograms/ml, respectively, in a total of 105 neonates. Serum levels detected were on very gentle descending curves. 2. Half-lives (T 1/2) of the drug in serum were significantly prolonged in 0-3 day age groups of both mature and premature infants: it was especially long in premature infants with age of 0-3 days; i.e., 17.1 hours. There was no difference in T 1/2 between the 4-7 day and 8-28 day age groups. 3. Urinary excretion rates were 20-30% in the first 6 hours post-dose and 30-40% in 12 hours post-dose, in 80 neonates examined. 4. Clinical efficacy: Clinical efficacies were evaluated in 112 of 168 enrolled excluding infants with 90 days of age or older, who were treated for prophylaxis and unevaluable cases. The safety was evaluated in 161 of the 168. (1) Demographic background of the 112 cases: The 112 cases were composed of 89 neonates with ages of 28 days or younger, 21 premature infants, 57 males and 55 females. The drug was given to 102 of the cases by intravenous bolus injection, with 81 cases administered twice a day and 97 cases receiving 10-50 mg/kg a day. (2) Efficacy rate in the 112 cases: In 60 cases for whom causative pathogens were identified the efficacy rate was 90.0% in total (excellent: 31/60; good: 23/60); efficacy rates of 87.5% were obtained in 8 cases with purulent meningitis and 90.9% in 11 with septicemia. In 52 with causative pathogen not identified, the efficacy rate was 96.2% in total (excellent: 21/52; good: 29/52). (3) Adverse reaction: Adverse reactions were noted in 14 of the 161 cases where the safety was evaluated (8.7%). These reactions included diarrhea in 11, vomiting in 2 and exanthema in 1. Abnormalities in laboratory test values were observed in 25 of the 152 cases (16.4%). They included eosinophilia in 14, elevated GOT in 4 and thrombocytosis in 3 etc.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Age Factors; Bacterial Infections; Ceftriaxone; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Premature; Infusions, Intravenous; Injections, Intravenous; Male; Multicenter Studies as Topic

Twenty-six adults with acute bacterial meningitis were enrolled in an open randomized comparative study. The organisms isolated from CSF were Streptococcus pneumoniae, Staphylococcus epidermidis, Haemophilus influenzae, Escherichia coli and Salmonella typhi. 13 patients (group A) were treated once daily with intravenous ceftriaxone (Rocephin). The 13 patients in group B received ampicillin or ampicillin plus chloramphenicol in 4 doses/day. The mean duration of therapy in groups A and B was 9.9 and 12.3 days, respectively. This difference in the duration of therapy was statistically significant. All patients from group A showed clinical improvement and all were bacteriologically cured. In group B only 12 patients were clinically and bacteriologically cured; 1 patient had to be withdrawn from the therapy because CSF culture remained positive after 48 h of therapy. Ceftriaxone was well tolerated in all patients; ampicillin or ampicillin plus chloramphenicol were associated with diarrhea and skin rash in 6 patients.

Topics: Adolescent; Adult; Ampicillin; Ampicillin Resistance; Bacterial Infections; Ceftriaxone; Chloramphenicol; Drug Resistance, Microbial; Drug Therapy, Combination; Escherichia coli; Female; Haemophilus influenzae; Humans; Male; Meningitis; Middle Aged; Random Allocation; Salmonella typhi; Staphylococcus epidermidis; Streptococcus pneumoniae

The gallbladder wall, gallbladder lumen and bile duct intraoperative sampling materials had been examined in 52 patients with an operation on the biliary tract. All patients were treated by only one infusion before operation: 1 g ceftriaxone was given to 26 patients and 2 g ceftriaxone to the 26 others. Bacterial species were isolated on twenty patients. There was no significant difference in infection rate and organism identity between bacterial flora isolated from patients receiving 1 g ceftriaxone and patients receiving 2 g. Isolated germs were enterobacteriaceae (15) streptococci (14) and anaerobic bacteria (8). The mean count of bacteria in bile is 10(4) germs/ml. Half positive sampling materials contains more than one bacterial strain. The bacterial flora isolated from bile has characteristics of mixed flora infection. Ceftriaxone had a good efficacy in antibiotic prophylaxis.

Topics: Adult; Aged; Aged, 80 and over; Bacteria; Bacterial Infections; Bile; Bile Ducts; Biliary Tract; Biliary Tract Diseases; Biliary Tract Surgical Procedures; Ceftriaxone; Gallbladder; Humans; Middle Aged

To assess the efficacy of once daily monotherapy relative to standard combination antibiotic therapy for the initial management of patients suspected of serious bacterial infections, we conducted a randomized trial comparing ceftriaxone (Rocephin) with a combination of cefuroxime plus gentamicin. Of 105 patients, 53 were treated with ceftriaxone alone and 52 with the combination; 13 patients were considered not evaluable. 42 of 53 patients given ceftriaxone and 33 of 52 given cefuroxime plus gentamicin responded to treatment (p = 0.07). Three patients given ceftriaxone and 6 who received gentamicin plus cefuroxime died (p = 0.28). Definite bacterial infections were identified in 67 patients; of the evaluable patients with a definite infection 27 of 29 who received ceftriaxone and 21 of 31 who were treated with the combination were cured (p = 0.01). No difference was found in the number of side effects. However, therapy had to be discontinued due to treatment failure, an adverse effect or death in 1 of 33 patients given ceftriaxone and in 11 of 34 given the combination (p = 0.002). Ceftriaxone was found to have an impact on the count of E. coli in intestinal microflora. Changes in normal bacterial composition did not lead to the overgrowth with resistant Enterobacteriaceae or Pseudomonas, however, colonization by yeast was observed. Using ceftriaxone reduced the cost of antimicrobial therapy per patient by 107 pounds (US$ 183). Moreover, the total time save per patient due to decreased nursing and drug administration time per day was 40 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Ceftriaxone; Cefuroxime; Cephalosporins; Cost-Benefit Analysis; Drug Administration Schedule; Drug Therapy, Combination; Feces; Female; Gentamicins; Humans; Male; Random Allocation

During ESWL, bacteria which may be contained in the stone gets disintegrated. This study evaluates the role of prophylactic antibiotherapy in preventing such complications. Fifty patients whose urine culture was negative were randomized into two groups: the first group (25 patients) received a placebo, the second group received Ceftriaxone 1 g I.V. as a single injection performed 1 hour previous ESWL. There was no positive blood culture and no positive urine culture in the placebo group arm as well as in the antibiotic group. In this study, the risk of infection induced by ESWL seems to be minimal, so that prophylactic antibiotherapy does not appear to be necessary when urine before ESWL is sterile.

Topics: Bacterial Infections; Ceftriaxone; Female; Humans; Lithotripsy; Male; Premedication; Urinary Calculi

The two antibiotic combinations ceftriaxone (Rocephin)/gentamicin and azlocillin/gentamicin were compared in a randomized study in a total of 49 premature and full-term neonates with the clinical symptoms of sepsis. In both groups, equally good efficacy and reliability and very good tolerability were observed.

Topics: Azlocillin; Bacterial Infections; Ceftriaxone; Drug Combinations; Gentamicins; Humans; Infant, Newborn; Random Allocation

Prophylactic systemic antibiotic therapy with ceftriaxone alone was tested in aplastic patients receiving total gut decontamination and treated in a protected environment. Only patients who were afebrile when their polymorphonuclear (PMN) count fell below 500/cumm were admitted to the study. Seventy-eight episodes of therapeutic aplasia (consecutive to allogeneic or autologous bone marrow transplant conditioning regimens or to high dose chemotherapy) form the basis of this report. The median duration of aplasia was 19 days (range 11-93 days). Twenty patients received, during 22 episodes of aplasia, one single injection of ceftriaxone per day as soon as their PMN count was below 500/mm3. In 13 cases (59%) the patients remained afebrile until the end of aplasia, and no bacteriemia was detected. The second part of the study was randomized between group A (prophylactic ceftriaxone: 29 cases) and group B (no prophylactic ceftriaxone: 27 cases). Patients in group A had significantly more episodes of afebrile aplasia (34.5% vs 4%) and less bacteriemias (10% vs 48%) than those in group B. Also fever developed later in group A (mean: 12.5 vs 6 days). No death was recorded throughout the study. Thus, in a protected environment prophylactic systemic antibiotic therapy could still lessen the risk of bacterial infection. Using one single antibiotic seemed to reduce the side-effects and cost of the prophylactic treatment.

Topics: Adolescent; Adult; Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Clinical Trials as Topic; Drug Therapy, Combination; Environment, Controlled; Humans; Middle Aged; Neutropenia; Random Allocation

Pediatric patients with serious infections are usually hospitalized for parenteral antibiotic treatment. We studied prospectively 74 pediatric patients with community-acquired serious infections and used once daily intramuscular ceftriaxone. Seventeen patients (23%) were initially hospitalized and 57 (77%) patients were treated entirely as outpatients. An initial intramuscular dose of 75 mg/kg was followed by daily doses of 50 mg/kg (maximum, 1.5 g). Infections treated included periorbital/buccal cellulitis, other cellulitis, urinary tract infections, pneumonia, osteomyelitis, mastoiditis, suppurative arthritis and orbital cellulitis. Organisms were recovered from cultures of 37 (50%) patients and 6 (8%) patients were bacteremic. Bacteria included Gram-positive (mostly Staphylococcus aureus) and Gram-negative (mostly enteric bacilli and Haemophilus influenzae organisms). No serious side effects were observed. Of 74 patients 72 (97%) were cured and improvement was usually observed within 24 hours. Two patients did not improve: one with chronic Pseudomonas mastoiditis; and one with lung abscess. Based on previous experience it is estimated that 376 hospitalization days were saved. All 72 successfully treated patients and their parents resumed normal activity within 72 hours of starting therapy. Our data suggest that ceftriaxone can be used for outpatient treatment of some infectious diseases.

Topics: Adolescent; Ambulatory Care; Bacterial Infections; Ceftriaxone; Cellulitis; Child; Child, Preschool; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Male; Mastoiditis; Pneumonia; Prospective Studies; Urinary Tract Infections

Topics: Agranulocytosis; Aztreonam; Bacterial Infections; Cefazolin; Ceftriaxone; Clinical Trials as Topic; Drug Therapy, Combination; Female; Fever; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Neoplasms

Topics: Ampicillin; Bacterial Infections; Ceftriaxone; Child; Chloramphenicol; Clinical Trials as Topic; Drug Therapy, Combination; Humans; Meningitis

Topics: Animals; Bacterial Infections; Cats; Ceftriaxone; Clinical Trials as Topic; Craniotomy; Neomycin; Postoperative Complications

Topics: Adult; Bacterial Infections; Ceftriaxone; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Postoperative Complications; Random Allocation; Surgical Wound Infection

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Drug Administration Schedule; Female; Fracture Fixation, Internal; Hip Fractures; Humans; Male; Random Allocation; Surgical Wound Infection

Ceftriaxone (CTRX), a new injectable cephem antibiotic agent, was evaluated bacteriologically and clinically for its efficacy and safety in the pediatric field by a study group organized with pediatricians from all over the country. The following are a summary of the results of the evaluation. Antibacterial effects: The inhibition of growth was attained for over 90% of strains of K. pneumoniae, H. influenzae and Salmonella spp. at the concentration of 0.10 micrograms/ml and of strains of S. pneumoniae and E. coli at the concentration of 2.0 micrograms/ml. The CTRX was proved to have excellent antibacterial effects. Absorption and excretion: Thirty minutes after one shot intravenous administration with 10, 20, 40 and 50 mg/kg of CTRX, its serum levels were 73, 124, 169 and 190 micrograms/ml, respectively, a clear tendency of dose-response relationship being noticed. The serum levels decreased only gradually and stayed as high as 10 to 20 micrograms/ml even after 12 hours. The half-lives of the drug were 5.5, 6.3, 6.0 and 4.7 hours for the 4 different dose levels, respectively. Following the intravenous injection with 10, 20 and 40 mg/kg, the urinary excretion rates were 55, 52 and 54%, respectively. Following the one shot intravenous administration or by the drip infusion for 30 minutes with about 50 mg/kg, CTRX levels in the cerebrospinal fluid ranged from 1 to 20.3 micrograms/ml in case of purulent meningitis (5 to 10 micrograms/ml in most cases).. A total of 322 cases was enrolled. The efficacy of CTRX was evaluated in 295 cases out of the 322, excluding drop-outs and the cases which did not meet the protocols. The clinical efficacy rate was 94% of 191 cases where the causative bacteria were identified, CTRX being "excellent" in 108 cases and "effective" in 72. In the remaining 104 cases where the causative bacteria were not identified, the efficacy rate was 92%, CTRX being "excellent" in 42 cases and "effective" in 54. Furthermore, the efficacy rate was 89% of 18 cases infected with more than one kind of bacteria. The drug showed "excellent" or better effectiveness in 88% of 75 cases which had not responded to other antibiotics. Bacteriologically, 174 out of 216 strains (93%) which were judged to be causative bacteria disappeared with the use of CTRX. Eighty-five percent of 53 strains which had not responded to other antibiotics disappeared by the CTRX treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adolescent; Bacteria; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Clinical Trials as Topic; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Male

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Clinical Trials as Topic; Female; Humans; Male

Seventy-nine children were enrolled in a study to compare seven vs ten days of ceftriaxone therapy for bacterial meningitis. On the basis of a computer-generated list of therapy assignments, 35 children with Haemophilus, pneumococcal, or group B streptococcal meningitis each were assigned to seven- or ten-day treatment regimens; nine children with meningococcal meningitis received seven days of therapy. The population characteristics and etiologic agents were similar for the two treatment groups, as were also the findings on examination and culture of cerebrospinal fluid at completion of therapy. There were no significant differences in the frequency and types of neurological complications between the two treatment groups; four patients in each group had two or more neurological abnormalities. The rates of nosocomial infections and prolonged and secondary fever were similar in those who received seven days of therapy compared with patients treated for the conventional ten days. Diarrhea occurred in 44% of those receiving the drug. Patients treated with the seven-day regimen were discharged from the hospital approximately two days earlier than those with the ten-day regimen.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Child, Preschool; Female; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Streptococcal Infections; Streptococcus agalactiae

Topics: Adolescent; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Male; Meningitis; Suppuration

Ceftriaxone is a new third-generation cephalosporin with excellent activity against many gram-negative, and reasonable activity against most gram-positive microorganisms. Clinical studies have demonstrated its efficacy and safety in patients with bacterial meningitis; respiratory tract, urinary tract, soft tissue, bone and joint infections; and gonorrhea. Ceftriaxone has been well tolerated except for diarrhea, which in most cases has not required a change in therapy. The long elimination half-life of ceftriaxone has allowed twice- and once-daily administration, the latter potentially resulting in substantial cost savings. Because of its documented efficacy, safety, and convenient dosing schedule, ceftriaxone may become the preferred third-generation cephalosporin for the treatment of a variety of serious infections.

Topics: Adult; Bacteria; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Clinical Trials as Topic; Humans; Kinetics; Premedication; Surgical Wound Infection

Topics: Bacterial Infections; Ceftriaxone; Clinical Trials as Topic; Humans; Postoperative Complications; Premedication

Topics: Adult; Aged; Bacterial Infections; Cefoperazone; Ceftriaxone; Female; Hospitalization; Humans; Male; Middle Aged; Pneumonia; Sepsis; Urinary Tract Infections

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

During a 7 month trial for therapy of polymicrobial surgical sepsis, intravenous antibiotic treatment was randomized between gentamicin (1 mg/kg every 8 hours) plus clindamycin (8 mg/kg every 6 hours), and the cephalosporin, ceftriaxone (1 g every 12 hours) in 197 patients, of whom 99 were being treated for peritonitis, 93 for soft tissue sepsis, and 5 for other forms of infection. No significant differences were noted in patient demographics, type of sepsis, associated disease states, surgical procedure, or causative aerobic or anaerobic pathogens. Results demonstrated approximately equivalent efficacy, although cure rates obtained with ceftriaxone in patients with soft tissue sepsis or intraabdominal abscess were superior to those achieved with combination gentamicin and clindamycin. There were no significant side effects with ceftriaxone therapy, such as the renal failure noted in six of the patients treated with gentamicin and clindamycin. We conclude that single agent treatment with ceftriaxone is preferable because of the greater safety and the longer dosing intervals.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Clindamycin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Gentamicins; Humans; Kidney Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Postoperative Complications; Random Allocation; Recurrence

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 is a promising antimicrobial agent in the therapy of bacterial meningitis. The rationale for the clinical evaluation of ceftriaxone in patients with meningitis is based on the following favorable characteristics: ceftriaxone has excellent in vitro activity (MBC90 0.25 microgram/ml or less) against the major meningeal pathogens including meningococci, pneumococci, group B streptococci, Hemophilus influenzae, and Escherichia coli, but it is inactive against Listeria monocytogenes; ceftriaxone is rapidly bactericidal within purulent cerebrospinal fluid in experimental animal models of meningitis induced by pneumococci, group B streptococci, H. influenzae, and E. coli; against most of the major meningeal pathogens, the activity attained in cerebrospinal fluid in human subjects with bacterial meningitis is high (1:512 or greater) and active concentrations of ceftriaxone persist in cerebrospinal fluid for prolonged periods compared with those of other cephalosporins; the results of clinical trials reported to date in patients with meningitis are encouraging. Ceftriaxone deserves further clinical evaluation in the treatment of bacterial meningitis; the optimal dose, frequency of administration, and duration of therapy remain to be determined.

Topics: Animals; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Clinical Trials as Topic; Haemophilus influenzae; Humans; Kinetics; Meningitis; Microbial Sensitivity Tests

A randomized trial to compare the efficacy and safety of 1 g of ceftriaxone daily and 3 to 4 g of cefazolin daily was conducted in 84 hospitalized adults with skin and soft tissue infections. A variety of infections including bacteriologically proven cellulitis, suppurative diabetic foot ulcer, soft tissue abscess, and other miscellaneous infections were treated. Side effects were minimal. Colonization with various microorganisms was observed during therapy with both agents. Clinical cure with or without surgery was achieved in 81 percent (34) of 42 patients treated with ceftriaxone and 77 percent (32) of 42 patients treated with cefazolin. The major difference between antibiotics was the rate of failure in infections caused by multiple organisms: five failures among 13 patients treated with cefazolin compared with no failures among 12 patients treated with ceftriaxone. Ceftriaxone appears to be an effective agent when given once daily as therapy for many serious skin and soft tissue infections.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefazolin; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Skin Diseases, Infectious

The clinical and bacteriologic efficacy of ceftriaxone given once or twice daily was evaluated in 153 studies. A total of 2,635 patients received ceftriaxone given intramuscularly or intravenously, 930 received comparative antibiotics, and 81 received placebo. For the 10 major categories of infections treated (central nervous system, upper and lower respiratory tract, intraabdominal, skin and skin structure, bone and joint, urinary tract, gynecologic, and bacterial sepsis), the clinical response rates were 89 percent or greater. Bacteriologic cure rates were 84 percent or greater overall and 90 percent or greater for seven of 10 categories. Ceftriaxone achieved a satisfactory clinical response (cure or improvement) for 89 (intraabdominal) to 99 percent (urinary tract) of the infections treated. Additionally, pediatric central nervous system infections responded to twice-daily ceftriaxone injection; ceftriaxone, in a single dose as low as 250 mg, cured gonorrhea, and a single dose of ceftriaxone was as effective as multiple doses of cefazolin in surgical prophylaxis.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Middle Aged; Premedication

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

This controlled multicenter study on 407 evaluable patients demonstrates the equal efficacy of two short-term antimi crobial prophylactic regimens in urological surgery involving a single dose of a long-acting cephalosporin, ceftriaxone, in comparison with a multiple dose of cefotaxime. Fifty-three of the 196 patients (27%) on the cefotaxime regimen and 47 of the 211 patients (22.3%) who received ceftriaxone showed postoperative infectious complications. There were no differences in these results.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Drug Administration Schedule; Humans; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Urinary Catheterization; Urinary Tract

This multicenter, prospective and randomized study on 355 patients demonstrates the equal efficacy of two short-term antimicrobial prophylactic regimens in gynecologic and obstetrical surgery involving a single dose of a long-acting cephalosporin, ceftriaxone, in comparison with a multiple cefotaxime dose. Among the cefotaxime and ceftriaxone groups which underwent abdominal hysteroctomy, 15 of 112 (13.4%) and 20 of 97 (20.6%) patients developed infections respectively. Four vaginal hysterectomy patients out of 20 (20%) on cefotaxime regimen and 4 of 25 (16%) who received ceftriaxone, became infected (febrile morbidity, wound infections, bacteriuria and infectious complications at a non-surgical site). Also among the cefotaxime and ceftriaxone groups of emergency or elective cesarean sections the differences on the incidence of infections are not statistically significant.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Cesarean Section; Clinical Trials as Topic; Female; Humans; Hysterectomy; Middle Aged; Postoperative Complications; Pregnancy; Premedication; Prospective Studies; Random Allocation

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Clinical Trials as Topic; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Random Allocation

Ceftriaxone, a broad-spectrum cephalosporin with a markedly extended half-life, was administered to 100 patients with 56 bone and 44 soft tissue infections. Sixty-eight received 1 g twice daily, and 32 received 2 g once daily intravenously. Overall, 91% had a satisfactory clinical response, with similar efficacies in both treatment regimens. In six patients, failure to achieve a cure correlated well with the development of resistance to ceftriaxone during therapy in Enterobacter and Pseudomonas species (two cases) and with superinfection with Bacteroides fragilis (four cases). In 41 patients, intravenous drug therapy was continued after discharge from the hospital. In this group, 1,093 patient-days of hospitalization were saved, amounting to $150,020 in cost savings. The prolonged half-life facilitated the administration of ceftriaxone in this setting.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bone Diseases; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Costs and Cost Analysis; Cross Infection; Female; Humans; Male; Middle Aged; Skin Diseases, Infectious

Ceftriaxone sodium, a new cephalosporin with a very broad spectrum of action and a very long serum half-life, was administered to 127 patients in the treatment of 133 severe infections at our institution in Lausanne, Switzerland. Eighty infections had previously been treated unsuccessfully with other antimicrobials to which the pathogens were most often resistant. Sixty-five episodes were treated with two daily injections until there was an improvement in the patient's clinical condition, while 67 infections were treated from the start by a single daily injection. The results in the two groups were similar. One hundred fifteen infections (86%) were cured or improved, ten (8%) did not respond to therapy or recurred, and eight (6%) were not evaluable. The treatment was well tolerated, even by the 18 patients who received the drug for more than four weeks. The administration of a single daily dose instead of four doses as with standard antibiotic regimens produced a saving of Sfr 84,000 (+42,000) in the 127 patients. The single daily dose also made it possible to treat 25 of the 127 severely ill patients as outpatients, with a saving of Sfr 388,500 (+195,000) with respect to the hospital costs that would have been incurred for the same time period.

Topics: Adolescent; Adult; Aged; Ambulatory Care Facilities; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Clinical Trials as Topic; Cost-Benefit Analysis; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged

Topics: Animals; Bacterial Infections; Ceftriaxone; Cephalosporins; Child; Clinical Trials as Topic; Dose-Response Relationship, Drug; Humans; Infant; Kinetics; Microbial Sensitivity Tests

In two studies, the therapeutic effect of a single intramuscular dose of Ro 13-9904 (Rocephin) of 500 or 250 mg, respectively, was compared with a single intramuscular dose of 80 mg tobramycin in chronic urinary tract infections. 7 days after 500 mg Ro 13-9904, the infections were eradicated in 10 of the 11 patients; 7 days after 250 mg Ro 13-9904, 4 of 11 patients were reinfected with selected resistant Streptococcus faecalis. After tobramycin, 9 of 23 patients were cured. Considering enterococci as dangerous organisms in several respects we recommend a single dose of 500 mg Ro 13-9904 with a satisfactory local tolerance. Tobramycin is unsuitable for single-dose treatment.

Topics: Aged; Bacterial Infections; Ceftriaxone; Cephalosporins; Clinical Trials as Topic; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Tobramycin; Urinary Tract Infections

Temporal changes in common pathogens that cause clinical dysentery have been described in Europe. We aimed to describe the distribution of pathogens and their antibiotic resistance in hospitalised Israeli children.. This study retrospectively studied children hospitalised for clinical dysentery, with or without a positive stool culture, from 1 January 2016 to 31 December 2019.. We diagnosed 137 patients (65% males), with clinical dysentery at a median age of 3.7 (interquartile range 1.5-8.2) years. Stools were cultured in 135 patients (99%), and the results were positive in 101 (76%). These comprised Campylobacter (44%), Shigella sonnei (27%), non-typhoid Salmonella (18%) and enteropathogenic Escherichia coli (12%). Only one of the 44 Campylobacter cultures was resistant to erythromycin and one of the 12 enteropathogenic Escherichia coli cultures was resistant to ceftriaxone. None of the Salmonella and Shigella cultures were resistant to ceftriaxone or erythromycin. We did not find any pathogens that were associated with a typical clinical presentation or laboratory results on admission.. The most common pathogen was Campylobacter, in line with recent European trends. Bacterial resistance for commonly prescribed antibiotics was rare, and these findings support the current European recommendations.

Topics: Anti-Bacterial Agents; Bacterial Infections; Campylobacter; Ceftriaxone; Child; Child, Preschool; Diarrhea; Drug Resistance, Bacterial; Dysentery; Erythromycin; Feces; Female; Humans; Infant; Male; Retrospective Studies; Salmonella; Shigella

Periodic surveillance of antibiotic consumption in the form of point prevalence studies is a quick and robust methodology to evaluate prescribing trends in hospitals. The current study was undertaken to document antibiotic consumption among neonates and children from hospitals in Pakistan.. This large multicenter study using the World Health Organization standardized methodology and AWaRe (Access, Watch, and Reserve) classification examined antibiotic consumption for suspected bacterial infection among neonates and children admitted hospitals in Punjab, Pakistan.. A total of 708 beds of children wards of the 16 health facilities were examined. Almost all (97%) hospitalized children were prescribed antibiotics on the day of the assessment with 2.6 antibiotics per patient. The three most common indications were respiratory tract infections (31.58%), sepsis (26.52%), and prophylaxis for medical problems (10.30%). The three most frequently prescribed antibiotics were ceftriaxone (24.2%), amikacin (23.2%), and ampicillin (16.7%). Almost half of the antibiotics were prescribed from the 'Access' (49.5%) and 'Watch' (45.5%) categories under the AWaRe classification. However, no antimicrobial was prescribed from the 'Reserved' category.. Our findings indicate that empirical antimicrobials use among hospitalized children is highly prevalent in Pakistan. The utilization of 'Watch' category of antimicrobials is frequent, stressing immediate action.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; Ceftriaxone; Child; Hospitalization; Humans; Infant, Newborn; Pakistan

There are reports of high rates of antibiotic prescribing among hospitalized patients with COVID-19 around the world. To date, however, there are few reports of prescribing in relation to COVID-19 in Pakistan. Herein, we describe a point prevalence survey of antibiotic prescribing amongst patients hospitalized with suspected or proven COVID-19 in Pakistan. A Point Prevalence Survey (PPS) was undertaken in seven tertiary care health facilities in Punjab Provence, Pakistan. Baseline information about antimicrobial use according to the World Health Organization (WHO) standardized methodology was collected on a single day between 5

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Bacterial Infections; Ceftriaxone; Coinfection; COVID-19; COVID-19 Drug Treatment; Drug Prescriptions; Female; Humans; Male; Meropenem; Pakistan; Prevalence

The continued rise of Klebsiella pneumoniae resistance to antibiotics is precipitating a medical crisis. Bacteriophages have been hailed as one possible therapeutic option to enhance the efficacy of antibiotics. This study describes the genomic characterization and biological property of a new bacteriophage vB_1086 and its potential for phage therapy application against Klebsiella pneumoniae.. In our study, the double-layer agar plate method isolated a lytic bacteriophage named vB_1086. Besides, we analyzed its biological characteristics and genetic background. Then the antibacterial ability of the bacteriophage vB_1086 combined with antibiotics were analyzed by the combined checkerboard method. The impact on the formation of biofilms was analyzed by crystal violet staining method.. vB_1086 is a lytic bacteriophage with stable biological characteristics and clear genetic background, showing good antibacterial activity in combination with ceftriaxone, and the combination of phage and meropenem can effectively inhibit the formation of biofilm. Besides, the combination of bacteriophage and antimicrobials can effectively alleviate the generation of bacterial resistance and reduce the dosage of antimicrobials.. vB_1086 is a novel phage. To some extent, these results provide valuable information that phage vB_1086 can be combined with antibiotics to reduce the dosage of antimicrobials and alleviate the generation of bacterial resistance.

Topics: Agar; Anti-Bacterial Agents; Bacterial Infections; Bacteriophages; Ceftriaxone; Gentian Violet; Humans; Klebsiella pneumoniae; Meropenem

Inappropriate antibiotic prescriptions contributed to a global issue of antimicrobial resistance. This study aimed to assess the prevalence of bacterial pathogens and antimicrobial resistance isolated from maxillofacial infections (MIs). Two hundred and twenty-two patients with different MIs were included in this study. Swab samples were taken from the site of infections. Samples were cultured, and isolated bacteria were identified using various biochemical tests. Antimicrobial resistance patterns of isolates were assessed by the disk diffusion method. The mean age of the patients was 50.8 years. The male-to-female ratio was 127/95 (P<0.05). Smoking and alcohol consumption were found in 60.36% and 37.38% of patients, respectively. Most patients had a ≤1-week infection duration (P<0.05). Abscess lesion was the most predominant infection type (P<0.05). The prevalence of aerobic bacteria among abscess, pus localization, and deep facial infections was 59.33%, 64.28%, and 46.66%, respectively. The prevalence of anaerobic bacteria among abscess, pus localization, and deep facial infections was 40.66%, 23.80%, and 53.33%, respectively.

Topics: Abscess; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Bacteria; Bacterial Infections; Ceftriaxone; Drug Resistance, Bacterial; Female; Gentamicins; Humans; Linezolid; Male; Microbial Sensitivity Tests; Middle Aged; Penicillins; Surgery, Oral; Tetracyclines

Islet cultures are routinely performed in total pancreatectomy with islet autotransplantation (TPIAT), and the need for empiric antibiotic treatment based on culture results is unknown. We evaluated the effect of postoperative antibiotic treatment for positive islet cultures on clinical infection.. Seventy-nine patients undergoing TPIAT were reviewed. Prophylactic perioperative ceftriaxone and metronidazole were administered, and transplanted islet preparations included ciprofloxacin. Postoperative antibiotics were not routinely given for positive cultures unless a clinical infection was suspected. The primary end point was 30-day infectious complications.. Fifty-one patients (65%) had a positive culture. Overall, 39 patients (87%) had organisms susceptible to our perioperative antibiotic regimen. There was no difference in the infectious complication rate between those with positive compared with negative cultures (16% vs 29%, P = 0.17). Patients with a positive culture had similar 30-day postoperative infectious complication rates whether receiving postoperative antibiotics (n = 7) or not (14% vs 16%, P = 0.91). Only 1 patient had a correlation of clinical and islet cultures.. Beyond prophylactic antibiotics, empiric antibiotic treatment for a positive culture is not warranted and provides a rationale for the abandonment of routine cultures in TPIAT.

Topics: Administration, Intravenous; Adult; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cells, Cultured; Cohort Studies; Female; Humans; Islets of Langerhans; Islets of Langerhans Transplantation; Male; Metronidazole; Middle Aged; Pancreatectomy; Pancreatitis, Chronic; Perioperative Period; Postoperative Complications; Postoperative Period; Transplantation, Autologous

Ceftriaxone is one of the most common antibiotics prescribed for hospitalized children in the United States. However, ceftriaxone is not dosed consistently. Sepsis/serious bacterial infection had high dosing variability. Dosing for central nervous system infection was frequently suboptimal. Future efforts should focus on optimizing and standardizing ceftriaxone dosing.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Child; Child, Hospitalized; Hospitals; Humans; United States

Teicoplanin possesses several convenient properties for use in the delivery of outpatient parenteral antimicrobial therapy (OPAT) services. However, its use is not widespread and data on its efficacy in the OPAT setting are limited. Here we present a case series of patients undergoing OPAT care being treated by either teicoplanin-based (n = 107) or ceftriaxone-based (n = 191) antibiotic regimens. Clinical failure with teicoplanin occurred in five episodes of care (4.7%) compared with only two episodes of ceftriaxone-based OPAT care (1.0%). Teicoplanin-associated clinical failure was observed in 2 (33.3%) of 6 patients with Enterococcus infections compared with 3 (3.0%) of 101 patients with non-Enterococcus infections. Overall, there were four (2.9%) drug-related adverse events for teicoplanin and four (1.8%) for ceftriaxone, prompting a switch to teicoplanin in three patients. These findings support the continued use of teicoplanin in OPAT as well as its consideration in centres where it is not currently being offered.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Humans; Infusions, Parenteral; Outpatients; Teicoplanin

Antimicrobial resistance is a growing threat to the world's ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada.. In this retrospective surveillance study, acute-care adult hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) submitted annual AMU data on all systemic antimicrobials from 2009 to 2016. Information specific to intensive care units (ICUs) and non-ICU wards were available for 2014-2016. Data were analyzed using defined daily doses (DDD) per 1000 patient days (DDD/1000pd).. Between 2009 and 2016, 16-18 CNISP adult hospitals participated each year and provided their AMU data (22 hospitals participated in ≥1 year of surveillance; 11 in all years). From 2009 to 2016, there was a significant reduction in use (12%) (from 654 to 573 DDD/1000pd, p = 0.03). Fluoroquinolones accounted for the majority of this decrease (47% reduction in combined oral and intravenous use, from 129 to 68 DDD/1000pd, p < 0.002). The top five antimicrobials used in 2016 were cefazolin (78 DDD/1000pd), piperacillin-tazobactam (53 DDD/1000pd), ceftriaxone (49 DDD/1000pd), vancomycin (combined oral and intravenous use was 44 DDD/1000pd; 7% of vancomycin use was oral), and ciprofloxacin (combined oral and intravenous use: 42 DDD/1000pd). Among the top 10 antimicrobials used in 2016, ciprofloxacin and metronidazole use decreased significantly between 2009 and 2016 by 46% (p = 0.002) and 26% (p = 0.002) respectively. Ceftriaxone (85% increase, p = 0.0008) and oral amoxicillin-clavulanate (140% increase, p < 0.0001) use increased significantly but contributed only a small component (8.6 and 5.0%, respectively) of overall use.. This study represents the largest collection of dispensed antimicrobial use data among inpatients in Canada to date. Between 2009 and 2016, there was a significant 12% decrease in AMU, driven primarily by a 47% decrease in fluoroquinolone use. Modest absolute increases in parenteral ceftriaxone and oral amoxicillin-clavulanate use were noted but contributed a small amount of total AMU. Ongoing national surveillance is crucial for establishing benchmarks and antimicrobial stewardship guidelines.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antimicrobial Stewardship; Bacterial Infections; Canada; Ceftriaxone; Cross Infection; Drug Resistance; Fluoroquinolones; Hospitals; Humans; Inpatients; Retrospective Studies

The correlation of ceftriaxone nonsusceptibility and ESBL production was evaluated in 40 characterized isolates. Performance of ceftriaxone susceptibility testing on the Accelerate Pheno was evaluated and compared with reference broth microdilution in triplicate. The CLSI ESBL confirmatory test was also evaluated. Ceftriaxone categorical agreement of the Accelerate Pheno was 97.5% with 1 minor error. The ESBL confirmatory disk test resulted in 4 false-negatives and 1 false positive. The Accelerate Pheno provides an expedited and accurate method of ceftriaxone susceptibility testing allowing for optimization of antimicrobial regimens sooner. These data indicate that ESBL production has a high likelihood of ceftriaxone non-susceptibility.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; beta-Lactamases; Ceftriaxone; Drug Resistance, Bacterial; Genome, Bacterial; Genotype; Humans; Microbial Sensitivity Tests

There are few studies addressing the impact of cephalosporin and quinolone resistance on hospital length of stay and mortality in spontaneous bacterial peritonitis (SBP). We aim to describe the shifting epidemiology of SBP at our institution and its impact on clinical outcomes.. We performed a single-center retrospective cohort study of all cases of SBP from 2005 to 2015 at a transplant center. Cases were identified using hospital billing data. Patient data were confirmed using the electronic medical record. Univariate and multivariate logistic regression and Cox proportional hazards models were used to identify factors that were associated with prolonged hospital length of stay and reduced survival. Culture-positive cases (N = 56) were compared to culture-negative cases (N = 104). Subpopulation analysis of the culture-positive cases compared ceftriaxone-resistant (N = 25) to ceftriaxone-susceptible (N = 31) cases.. We identified 160 cases of SBP (56 culture positive and 104 culture negative; 21 nosocomial, 79 hospital associated, and 60 community acquired). Forty-five percent (N = 25 total, 13 hospital associated and 6 nosocomial) of bacterial isolates were resistant to ceftriaxone, with 37.5% (N = 21) being gram positive, including 8 methicillin-resistant staphylococcus and 6 vancomycin-resistant enterococcus. Multivariate analysis identified hospital-associated SBP, age, alcoholic cirrhosis, and MELD-Na score as variables associated with worse survival (P < 0.05), with a trend toward worse survival in culture-positive cases (P = 0.123). Only MELD-Na was associated with prolonged length of stay.. The burden of resistant pathogens causing SBP is significant, notably in hospital-associated SBP. Culture-positive SBP may represent a higher risk group compared to culture-negative SBP.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Boston; Ceftriaxone; Drug Resistance, Bacterial; Female; Humans; Length of Stay; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Quinolones; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cohort Studies; Drug Monitoring; France; Humans; Treatment Outcome

The most important factors determining the prognosis of patients with acute cholangitis (AC) are prompt biliary drainage and appropriate choice of antibiotics. This study was performed to evaluate whether dividing the number of doses based on the PK-PD theory contributes to better clinical outcome in the management of acute cholangitis. We measured ceftriaxone levels in blood and bile in 21 cases diagnosed with moderate-to-severe AC. Eleven cases were administered 2 g of ceftriaxone once-daily (group A) and 10 cases were given 1 g of ceftriaxone twice-daily (group B). The theoretical effect of ceftriaxone was evaluated by pharmacokinetic-pharmacodynamic (PK-PD) parameters. Clinical efficacy was evaluated by body temperature, white blood cell count and serum levels of C-reactive protein. Minimum level of ceftriaxone in serum (in mg/L) in groups A and B at 24 h after the first dose was 9.1 and 9.2, whereas that in bile was 2.9 and 2.5, respectively. The minimum inhibitory concentration (MIC) of ceftriaxone for all isolated bacteria was below the minimum serum and biliary concentration of ceftriaxone 24 h after the first administration (except for Enterococcus species). The MIC for isolated bacterial strains was <16 mg/L, which is the PK-PD breakpoint for ceftriaxone at 2 g/day. Both regimens showed clinical efficacy and did not contradict the effect predicted based on PK-PD.

Topics: Acute Disease; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria; Bacterial Infections; C-Reactive Protein; Ceftriaxone; Cholangitis; Dose-Response Relationship, Drug; Drainage; Drug Administration Schedule; Endoscopy, Digestive System; Female; Humans; Leukocyte Count; Male; Microbial Sensitivity Tests; Middle Aged; Prognosis; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome

Peritoneal dialysis-associated peritonitis (PDAP) is one of the major causes of peritoneal dialysis (PD) failure and death. Therefore, it is important to determine how to effectively treat patients with PDAP.. We analyzed the pathogen spectrum and bacterial resistance in 203 PDAP cases that were enrolled in this study from January 1, 2015 to December 31, 2017. All patients were infected with peritonitis and had been treated with antibiotics while at our center. Bacterial culture results of PD fluid and pathogen drug resistance were collected and analyzed. A total of 159 cases (78.3%) had a positive bacterial culture of PD fluid.. A total of 47 pathogens were identified, including 19 (40.4%) Gram-positive cocci strains (the most common was. Gram-positive cocci are still the primary pathogen of PDAP cases in our center, but demonstrate a high resistance to first-generation cephalosporin, which is the suggested treatment per International Society for Peritoneal Dialysis 2016 Peritonitis Recommendations. Therefore, an individualized treatment based on the distribution of pathogens and drug resistance in different centers is more conducive to improve the cure rate of PDAP.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Cefazolin; Ceftriaxone; Drug Resistance, Bacterial; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Imipenem; Itraconazole; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Peritoneal Dialysis; Peritonitis; Vancomycin; Voriconazole; Young Adult

Ceftriaxone is among the most commonly utilized antibiotics owing to its high potency, wide spectrum of activity, and low risk of toxicity. It is used to treat different types of bacterial infections including pneumonia, bone infections, abdominal infections, Skin and soft tissue infections, urinary tract infections. However, evidence around the globe shows the misuse of Ceftriaxone. This study aimed at evaluating the appropriateness of ceftriaxone use in medical and emergency wards of Gondar university referral hospital (GURH), Northwest Ethiopia. A prospective, cross-sectional study design was employed to evaluate the use of ceftriaxone. The medical records of patients who received ceftriaxone were reviewed prospectively between January 1 and March 30, 2017. Appropriateness of ceftriaxone use was evaluated as per the protocol developed from current treatment guidelines. A total of 390 patients' medical records were reviewed. The utilization rate of ceftriaxone was found to be high with a point prevalence of 59%. Ceftriaxone was empirically used in 79.5% of cases. The most common indications of Ceftriaxone were respiratory tract infections (29.3%), central nervous system infections (24.1%), and prophylactic indications (16.4%). The mean duration of ceftriaxone therapy in our study was 11.47 days, with a range of 1-52 days. More than two-thirds (80.2%) of ceftriaxone use were found to be inappropriate and majority of unjustified ceftriaxone use emanated from inappropriate frequency of administration (78.3%), absence of culture and sensitivity test (68.7%), and duration of therapy (47%). Empiric treatment with ceftriaxone and the presence of coadministered drugs was significantly associated with its inappropriate use. The present study revealed a very high rate of inappropriate use of ceftriaxone which may potentially lead to emergence of drug-resistant microorganisms and ultimately exposes the patient to treatment failure and increased cost of therapy.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cross-Sectional Studies; Drug Costs; Drug Resistance, Bacterial; Drug Utilization Review; Emergency Service, Hospital; Ethiopia; Female; Hospitals, University; Humans; Male; Middle Aged; Prospective Studies; Tertiary Care Centers; Treatment Failure; Young Adult

Frequent use of broad-spectrum antimicrobial classes has been reported in Japan; however, little is known about the long-term trend of national antimicrobial consumption, and that of individual agents. This study analyzed the national sales data of systemic antimicrobials from 2004 to 2016, derived from the IMS Japan Pharmaceutical Market database, to assess the consumption patterns of antimicrobial classes and agents in Japan. The number of defined daily doses per 1000 inhabitants per day (DID) was calculated for each antimicrobial agent. During the last 13 years, total antimicrobial consumption fluctuated by only 5% around the average of 14.41 DID. In 2016, the most used class was macrolides (32%), followed by cephalosporins (28%) and fluoroquinolones (19%). Oral agents comprised a large proportion (93%) of antimicrobial consumption. The most used agent, clarithromycin, accounted for 25% of all oral compounds used in 2016. The consumption of oral agents with high bioavailability, such as fluoroquinolones, amoxicillin, and sulfamethoxazole/trimethoprim increased, whereas that of cephalosporins decreased. In 2016, ceftriaxone was the most consumed parenteral agent, followed by cefazolin. The consumption of parenteral agents increased after 2009 when high-dose regimens of piperacillin/tazobactam, meropenem, and ampicillin/sulbactam were approved by the health insurance system. National antimicrobial consumption has been stable over the last 13 years. Moreover, shifts in the use of agents with high bioavailability and those approved for high-dose regimens were observed. However, the increased use of broad-spectrum agents is worrisome. A multifaceted approach is required to reduce overall antimicrobial consumption.

Topics: Administration, Oral; Amoxicillin; Anti-Infective Agents; Bacterial Infections; Ceftriaxone; Cephalosporins; Clarithromycin; Drug Utilization; Fluoroquinolones; Humans; Infusions, Parenteral; Japan; Macrolides; Product Surveillance, Postmarketing; Sulfamethoxazole; World Health Organization

In sub-Saharan Africa (SSA), the highly albumin-bound β-lactam ceftriaxone is frequently used for the empirical treatment of severe bacterial infections. Systemic drug exposure of β-lactams can be altered in critically ill ICU patients, but pharmacokinetic and pharmacodynamic data for non-ICU SSA populations are lacking.. We performed a population pharmacokinetic study in an adult hospital population in Mozambique, treated with ceftriaxone for presumptive severe bacterial infection from October 2014 to November 2015. Four blood samples per patient were collected for total ceftriaxone (CEFt) and unbound ceftriaxone (CEFu) concentration measurement. We developed a population pharmacokinetic model through non-linear mixed effect analysis and performed simulations for different patient variable, dosing and pharmacodynamic target scenarios.. Eighty-eight participants yielded 277 CEFt and 276 CEFu concentrations. The median BMI was 18.9 kg/m2 and the median albumin concentration was 29 g/L. In a one-compartment model with non-linear protein binding, creatinine clearance was positively correlated with CEFu clearance. For microorganisms with an MIC of 1 mg/L, simulations demonstrated that with a 1 g twice-daily regimen and a 2 g once-daily regimen, 95.1% and 74.8% would have a CEFu concentration > MIC during half of the dosing interval (fT>MIC = 50%), respectively, whereas this was only 58.2% and 16.5% for the fT>MIC = 100% target.. Severely ill adult non-ICU SSA patients may be at substantial risk for underexposure to CEFu during routine intermittent bolus dosing, especially when their renal function is intact.

Topics: Adolescent; Adult; Africa, Northern; Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Critical Illness; Female; Hospitalization; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Models, Statistical; Mozambique; Prospective Studies; Young Adult

The epidemiology of spontaneous bacterial peritonitis (SBP) due to ceftriaxone-resistant organisms has not been well studied in the USA. The primary objective of this study was to assess the prevalence and predictors of ceftriaxone-resistant SBP at a large US tertiary-care centre.. This 1:1:4 case-case-control study included 141 adults with liver cirrhosis admitted from November 2011 to March 2016. Case group 1 were patients with SBP with a ceftriaxone-resistant organism (n=21). Case group 2 were patients with SBP with a ceftriaxone-susceptible organism (n=26). The control group were patients without SBP (n=94). Multiple logistic regression analysis was used to identify predictors of ceftriaxone-resistant SBP.. Fifty isolates were identified from 47 patients with culture-positive SBP (case groups 1 and 2). Of these 50 isolates, 32 (64%) were Gram-negatives [mostly Enterobacteriaceae (91%)], 15 (30%) were Gram-positives and 3 (6%) were Candida spp. The prevalence of ceftriaxone resistance in patients with culture-positive SBP was 45% (21/47). The most common ceftriaxone-resistant organisms were ESBL-producing Enterobacteriaceae (45%). Independent predictors of ceftriaxone-resistant SBP included duration of β-lactam therapy in the past 90days (aOR=1.07, 95% CI 1.01-1.13) and recent invasive gastrointestinal procedure (aOR=12.47, 95% CI 2.74-56.67).. The prevalence of ceftriaxone-resistant SBP was significant at a US tertiary centre. Local epidemiological data and identification of risk factors associated with ceftriaxone-resistant SBP, e.g. increased usage of previous β-lactam therapy and invasive gastrointestinal procedure, may help clinicians identify patients requiring alternative empirical antibiotics.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Case-Control Studies; Ceftriaxone; Drug Resistance, Bacterial; Female; Humans; Male; Middle Aged; Peritonitis; Prevalence; Tertiary Care Centers; United States

Widespread empiric use of antibiotics exists especially in developing countries. This is a concern since inappropriate use of antibiotics, including their extended inappropriate use, will increase resistance rates. Consequently, there is a need to evaluate antibiotic utilisation across healthcare sectors to improve future use. This includes ceftriaxone, widely used among hospitals including those in Ghana.. A cross-sectional study to evaluate the appropriateness of ceftriaxone prescribing in a leading hospital in Ghana. Ceftriaxone prescribing in patient-record cards was assessed using a modified WHO drug-utilization evaluation criteria as well as referencing the national standard treatment guidelines in Ghana and the ceftriaxone package insert.. A total of 251 patients were assessed. Ceftriaxone was most commonly prescribed for comorbid malaria with bacterial infections, urinary tract infections, sepsis and gastroenteritis. The appropriateness of the indication was 86% (n = 218). The doses most prescribed were 1g (41%) and 2g (39%). Stat dose and once-daily dosage regimen constituted 51.4% and 84.5%, respectively. The most common duration of treatment was 1 (51.4%) and 2 days (35.1%). The overall appropriateness of prescribing was 93% against a pre-set threshold of 97%.. The appropriateness of ceftriaxone prescribing was high in this leading hospital in Ghana; however, there is room for improvement with targeted education initiatives, with further research planned.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Coinfection; Cross-Sectional Studies; Drug Utilization Review; Female; Ghana; Humans; Infant; Injections; Malaria; Male; Middle Aged; Pharmacy Service, Hospital; Pilot Projects; Young Adult

We report four adult cases of ceftriaxone (CTRX)-induced pseudolithiasis and nephrolithiasis. With the exception of case 1, none of our cases showed abdominal symptoms. Our patients, who had central nervous system (CNS) infections, had been treated with CTRX (4 g/day) for 35-69 days. CTRX-induced pseudolithiasis and nephrolithiasis can appear depending on the total dose of CTRX and the duration for which it is administered. Patients with bacterial CNS infections who are treated with CTRX are typically treated with higher doses for longer periods. It should be recognized that these patients are at higher risk of developing CTRX-induced pseudolithiasis and nephrolithiasis.

Topics: Administration, Intravenous; Adult; Aged; Bacterial Infections; Ceftriaxone; Central Nervous System Infections; Humans; Male; Nephrolithiasis

Spontaneous bacterial peritonitis (SBP) can be life threatening in patients with liver cirrhosis. In contrast to community-acquired SBP, no standard treatment has been established for healthcare-related and nosocomial SBP.. We prospectively collected healthcare-related and nosocomial SBP cases from March 2012 till February 2016 at the Department of Internal Medicine I of the University of Bonn and analysed the prevalence of antibiotic resistance among the isolated bacteria. SBP was diagnosed according to international guidelines. Ciprofloxacin, ceftriaxone and meropenem were used as reference substance for resistance to quinolones, third-generation cephalosporins and carbapenems, respectively.. Ninety-two SBP episodes in 86 patients were identified: 63 episodes (69%) were nosocomial. Escherichia coli, Klebsiella species, enterococci and streptococci were most frequently isolated. Frequencies of these microorganisms were comparable for healthcare-related and nosocomial SBP (14% vs. 11%, 14% vs. 8%, 14% vs. 5% and 10% vs. 6%, respectively). In general, antibiotic resistance was higher in isolates from nosocomial than from healthcare-related SBP (50% vs. 18% for quinolones, 30% vs. 11% for piperacillin-tazobactam; P > 0·05), but comparable concerning third-generation cephalosporins (30% vs. 33%). All microorganisms were sensitive to carbapenems apart from nosocomial infections with Enterococcus faecium (n = 3) and Candida albicans (n = 1) due to intrinsic resistance or lack of microbiological efficacy, respectively. No multidrug-resistant microorganisms were detected. Resistance to initial antibiotic treatment affected 30-day survival negatively (18% vs. 68%; P = 0·002).. Resistance to initial antibiotic treatment was associated with increased mortality. With resistance to cephalosporins being frequent, piperacillin-tazobactam or carbapenems might be preferred as treatment of SBP.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Cross Infection; Drug Resistance, Bacterial; Enterococcus; Escherichia coli Infections; Female; Gram-Positive Bacterial Infections; Humans; Klebsiella Infections; Liver Cirrhosis; Male; Meropenem; Middle Aged; Peritonitis; Prospective Studies; Streptococcal Infections; Thienamycins

Acute focal bacterial nephritis (AFBN) is a complicated form of acute pyelonephritis (APN) characterized by single or multiple areas of localised infection in the kidney without liquefaction or abscess. Studies investigating AFBN in adults are scarce.. The present study was aimed at evaluating the prevalence, associated factors, and presence of atypical clinical and radiological manifestations in adult AFBN patients. Also, we developed a clinical prediction model to evaluate the probability of AFBN in patients with APN.. The clinical records of 377 patients (mean age 54years, 74.0% females) admitted to a hospital over a 5-year period with APN were reviewed.. A total of 57 cases of AFBN were radiologically identified (prevalence, 15.1%). Patients with AFBN were younger and displayed atypical manifestations more frequently than patients without AFBN; these included both clinical and radiological (pleural effusion, gallbladder wall thickening, fluid around the gallbladder, perirenal fluid, and ascites) manifestations. Patients with AFBN showed lower systolic blood pressure and needed more days of therapy to become afebrile, longer total duration of antibiotic therapy, and longer hospital stay than patients without AFBN. Contraceptive use was more frequent in patients with AFBN. A model based on five clinical variables showed good discrimination performance for the diagnosis of AFBN (Area under the curve, 0.77 (95% CI, 0.69-0.89)).. Patients with AFBN frequently present with atypical clinical and radiological manifestations. Clinical presentation by means of a predictive model may predict the presence of AFBN. Patients with AFBN need more intensive therapy, which is followed by a favourable outcome.

Topics: Acute Disease; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Female; Humans; Kidney; Logistic Models; Male; Middle Aged; Multivariate Analysis; Nephritis; Pyelonephritis; Retrospective Studies; Risk Factors; Spain; Tomography, X-Ray Computed; Ultrasonography; Young Adult

Ceftriaxone is a third generation cephalosporin antibiotic and is one of the most often applicable parenteral drug, which has wide antimicrobial activity range. According to the literature gall bladder lithiasis is a complication which is described in the first days of the treatment with this antibiotic. The cases are seen mostly as undergdiagnosed conditions when ultrasound examination is performed due to the abdominal colics. The aim of the study was to observe Cholelithiasis in ceftriaxone-treated patients. Last year few cases of Cholelithiasis were observed in Children's Infectious Diseases Hospital. All of them were related to the dysentery treatment with ceftriaxone. All of the cases of Cholelithiasis were diagnosed at the beginning of the antibiotic therapy (in first 2-3 days of hospitalization). Gall bladder concernments/sludge were found accidentally. Cholelithiasis in these cases was transitory and in 2 weeks ultrasound investigation revealed no calculi/sludge in the gall bladder. Further findings are supposed to be analyzed on a bigger number of the patients. It is necessary to follow up with gall bladder concernments till their absolute resolution.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Child, Preschool; Cholecystolithiasis; Dysentery; Female; Gallbladder Diseases; Humans; Infant; Male

Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children.. This was a 12-month prospective observational study.. The hospital-in-the-home programme of The Royal Children's Hospital Melbourne.. All patients receiving OPAT.. Data were collected including demographics, diagnosis, type of venous access and antibiotic choice.. Length of stay, adverse events, readmission rate and appropriateness of antibiotic use.. 228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response.. OPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made.

Topics: Adolescent; Ambulatory Care; Anti-Infective Agents; Bacterial Infections; Candidiasis; Catheterization, Central Venous; Catheterization, Peripheral; Ceftriaxone; Cellulitis; Child; Child, Preschool; Cystic Fibrosis; Female; Gentamicins; Humans; Infant; Infant, Newborn; Infusions, Intravenous; Infusions, Parenteral; Length of Stay; Male; Patient Readmission; Prescription Drugs; Prospective Studies; Referral and Consultation; Treatment Outcome; Urinary Tract Infections; Young Adult

We describe the laboratory-confirmed etiologies of illness among participants in a hospital-based febrile illness cohort study in northern Tanzania who retrospectively met Integrated Management of Adolescent and Adult Illness District Clinician Manual (IMAI) criteria for septic shock, severe respiratory distress without shock, and severe pneumonia, and compare these etiologies against commonly used antimicrobials, including IMAI recommendations for emergency antibacterials (ceftriaxone or ampicillin plus gentamicin) and IMAI first-line recommendations for severe pneumonia (ceftriaxone and a macrolide). Among 423 participants hospitalized with febrile illness, there were 25 septic shock, 37 severe respiratory distress without shock, and 109 severe pneumonia cases. Ceftriaxone had the highest potential utility of all antimicrobials assessed, with responsive etiologies in 12 (48%) septic shock, 5 (14%) severe respiratory distress without shock, and 19 (17%) severe pneumonia illnesses. For each syndrome 17-27% of participants had etiologic diagnoses that would be non-responsive to ceftriaxone, but responsive to other available antimicrobial regimens including amphotericin for cryptococcosis and histoplasmosis; anti-tuberculosis therapy for bacteremic disseminated tuberculosis; or tetracycline therapy for rickettsioses and Q fever. We conclude that although empiric ceftriaxone is appropriate in our setting, etiologies not explicitly addressed in IMAI guidance for these syndromes, such as cryptococcosis, histoplasmosis, and tetracycline-responsive bacterial infections, were common.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Ampicillin; Anti-Infective Agents; Bacterial Infections; Ceftriaxone; Child; Cohort Studies; Cryptococcosis; Emergencies; Female; Gentamicins; Histoplasmosis; Humans; Infections; Macrolides; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Respiratory Distress Syndrome; Shock, Septic; Tanzania; Tetracycline; Young Adult

To evaluate the hospitalization rates in 2 pre-prostate biopsy antibiotic protocols.. Two prebiopsy protocols were compared. CiproAlone required ciprofloxacin 500 mg twice daily starting 1 day before biopsy and continuing for 3 days after biopsy (4 days total). Diabetic patients were prescribed ciprofloxacin for 4 days after biopsy. CiproCeft required 1 dose of oral ciprofloxacin 500 mg 1 hour before the biopsy and ceftriaxone 1 g intramuscular at the time of the biopsy. Hospitalization rates between the CiproAlone vs CiproCeft protocols were examined.. A total of 4134 biopsies were identified-2093 in the CiproAlone cohort and 2041 in the CiproCeft cohort. The post-prostate biopsy infection hospitalization rate was 0.6% (14 patients) in the CiproAlone group vs 0.0% (0 patients) in the CiproCeft group (P <.0001). Of the patients hospitalized, 12 fit systemic inflammatory response syndrome (SIRS) criteria. Eight of 14 hospitalized patients fit the sepsis (SIRS and source of infection) criteria. Positive cultures (urine and/or blood) resulted from 71% (n = 10) of hospitalized patients. Antibiotic resistance was analyzed. Diabetes mellitus was associated with hospitalization after prostate biopsy (P = .01) in our population, but there was no difference between the 2 groups in the rates of diabetes mellitus (P = .46). Patient age, prostate-specific antigen level, number of biopsy cores obtained, race, and previous antibiotics exposure were not found to be independent predictors of post-transrectal ultrasonography biopsy hospitalization for infection using a multivariate regression analysis.. A prophylactic prebiopsy protocol including 2 classes of antibiotics, single-dose ciprofloxacin, and single-dose intramuscular ceftriaxone reduced post-transrectal ultrasonography biopsy rates of hospitalizations compared to oral ciprofloxacin alone.

Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Injections, Intramuscular; Male; Patient Admission; Postoperative Complications; Preoperative Care; Prostate; Retrospective Studies

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Male; Patient Admission; Postoperative Complications; Prostate

A total of 84,704 isolates were collected from 191 medical centers in 2009 to 2013 and tested for susceptibility to ceftaroline and comparator agents by broth microdilution methods. Ceftaroline inhibited all Staphylococcus aureus isolates at ≤2 μg/ml and was very active against methicillin-resistant strains (MIC at which 90% of the isolates tested are inhibited [MIC90], 1 μg/ml; 97.6% susceptible). Among Streptococcus pneumoniae isolates, the highest ceftaroline MIC was 0.5 μg/ml, and ceftaroline activity against the most common Enterobacteriaceae species (MIC50, 0.12 μg/ml; 78.9% susceptible) was similar to that of ceftriaxone (MIC50, ≤0.25 μg/ml; 86.8% susceptible).

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Ceftaroline; Ceftriaxone; Cephalosporins; Enterobacteriaceae; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Staphylococcus aureus; Streptococcus pneumoniae; United States

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Health Services Needs and Demand; Hospitals, General; Humans; Japan; Outpatients; Prescription Drug Overuse; Prescriptions; Retrospective Studies

Infections in cirrhotic patients with upper gastrointestinal bleeding are a common event causing severe complication and mortality. This study aimed to identify risk factors that may predict rebleeding, bacterial infections, and the impact of antibiotic prophylaxis on mortality at different stages of cirrhosis following acute peptic ulcer bleeding (PUB).. A hospital-based retrospective cohort study was conducted on 235 cirrhotic patients with acute peptic ulcer hemorrhage who underwent therapeutic endoscopic procedures between January 2008 and January 2014 (n = 235); of these, 88 patients received prophylactic intravenous ceftriaxone (antibiotic group) and 147 patients did not (nil-antibiotic group). The recorded outcomes were length of hospital stay, bacterial infection, rebleeding, and in-hospital mortality.. Forty-eight (20.4%) patients experienced ulcer rebleeding and 46 (19.6%) developed bacterial infections. More patients suffered from infection and recurrent bleeding in the nil-antibiotic group than the antibiotic group (25.2% vs. 10.2%, p = 0.005 and 30.6% vs. 3.4%; p < 0.001, respectively). The predictive risk factors for rebleeding were the Rockall score (p = 0.004), units of blood transfusion (p = 0.031), and no antibiotic prophylaxis (p <0.001); for bacterial infections, they were the Child-Pugh score (p = 0.003), active alcoholism (p = 0.035), and no antibiotic prophylaxis (p = 0.009). Overall, 40 (17%) patients died during hospitalization. The Rockall score and rebleeding were predictive factors for in-hospital mortality. In subgroup analysis, survival was significantly reduced in decompensated patients (p = 0.034).. This study suggests that antibiotic prophylaxis after endoscopic hemostasis for acute PUB prevented infections and reduced rebleeding events in cirrhotic patients. Antibiotic prophylaxis improved survival among decompensated cohort following PUB. The Rockall score and rebleeding were predictive risk factors for in-hospital mortality.

Topics: Aged; Alcoholism; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Blood Transfusion; Ceftriaxone; Female; Hemostasis, Endoscopic; Hospital Mortality; Humans; Length of Stay; Liver Cirrhosis; Male; Middle Aged; Peptic Ulcer Hemorrhage; Recurrence; Retrospective Studies; Risk Factors; Severity of Illness Index; Survival Rate

Topics: Academies and Institutes; Acute Disease; Adolescent; Amoxicillin; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Clavulanic Acid; Humans; Infant; Pediatrics; Sinusitis

The influential roles of antibiotic prophylaxis on cirrhotic patients with peptic ulcer bleeding are still not well documented. The purpose of this study is to clarify these influential roles and to identify the risk factors associated with rebleeding, bacterial infection and in-hospital mortality. A cross-sectional, chart review study was conducted on 210 cirrhotic patients with acute peptic ulcer hemorrhage who underwent therapeutic endoscopic procedures. Patients were divided into group A (with prophylactic intravenous ceftriaxone, n = 74) and group B (without antibiotics, n = 136). The outcomes were length of hospital days, prevention of infection, rebleeding rate and in-hospital mortality. Our results showed that more patients suffered from rebleeding and infection in group B than group A (31.6% vs. 5.4%; p<0.001 and 25% vs. 10.8%; p = 0.014 respectively). The risk factors for rebleeding were active alcoholism, unit of blood transfusion, Rockall score, model for end-stage liver disease score and antibiotic prophylaxis. The risk factors for infection were active alcoholism, Child-Pugh C, Rockall score and antibiotic prophylaxis. Rockall score was the predictive factor for in-hospital mortality. In conclusions, antibiotic prophylaxis in cirrhotic patients after endoscopic interventions for acute peptic ulcer hemorrhage reduced infections and rebleeding rate but not in-hospital mortality. Rockall score was the predictive factor of in-hospital mortality.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Aged; Anti-Bacterial Agents; Anti-Ulcer Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Cross-Sectional Studies; Endoscopy; Female; Hospital Mortality; Humans; Infusions, Intravenous; Length of Stay; Liver Cirrhosis; Male; Middle Aged; Multivariate Analysis; Pantoprazole; Peptic Ulcer Hemorrhage; Recurrence; Retrospective Studies; Risk Factors; Treatment Outcome

Diarrhea is the leading cause of morbidity and mortality in under-five children in developing countries including Ethiopia. Therefore, up-to-date data on etiologic agent and susceptibility pattern are important for the management of bacterial diarrhea in under-five children, which was the main objective of this study.. A cross-sectional study was conducted at Hawassa Adare Hospital and Millennium Health Center from June 6 to October 28, 2011. A total of 158 under-five children with diarrhea were selected using convenient sampling technique. Demographic and clinical data were collected using questionnaire. Fecal samples were collected and processed for bacterial isolation, and antimicrobial susceptibility testing following standard bacteriological techniques.. A total of 158 fecal samples were collected from 81(51.3%) males and 77(48.7%) females of under-five children with diarrhea. Of the 158 fecal samples, 35(22.2%) bacterial pathogens were isolated. The isolated bacteria were Campylobacter species, 20 (12.7%), Shigella species, 11 (7.0%), and Salmonella species, 4 (2.5%). The majority of the isolates were sensitive to chloramphenicol, ciprofloxacin, nalidixic acid and cotrimoxazol and high rate of drug resistance was observed against erythromycin and amoxicillin.. The finding of this study indicates that Campylobacter species were the predominant etiologies and the presence of bacterial isolates resistant to the commonly prescribed drugs for treating diarrhea in children. Therefore, periodic monitoring of etiologic agent with their drug resistant pattern is essential in the management of diarrhea in children.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Campylobacter; Ceftriaxone; Child, Preschool; Chloramphenicol; Cross-Sectional Studies; Developing Countries; Diarrhea; Drug Resistance, Bacterial; Erythromycin; Ethiopia; Female; Humans; Infant; Infant, Newborn; Male; Nalidixic Acid; Prevalence; Salmonella; Shigella; Trimethoprim, Sulfamethoxazole Drug Combination

According to current estimates, Plasmodium malariae is not very common in Senegal, as more than 98% of malaria cases are suspected to be due to Plasmodium falciparum. However, it is possible that other malarial species are being under-reported or misdiagnosed. This is a report of a case of P. malariae in a 30-year-old man previously hospitalized with acute kidney injury after treatment with quinine and re-hospitalized three months later. He was diagnosed with renal cortical necrosis post malaria treatment. Plasmodium malariae was identified with light microscope and confirmed using species-specific small-subunit rRNA (ssrRNA) amplification.The patient was treated for malaria with intravenous quinine for seven days, followed by three days of oral treatment; the bacterial infection was treated using ceftriaxone during the first hospitalization and ciprofloxacin associated with ceftriaxone the second time. He also had four rounds of dialysis after which he partially recovered the renal function. Given the complications that can be caused by P. malariae infection, it should be systematically looked for, even if the predominant species is P. falciparum in Senegal.

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Antimalarials; Bacterial Infections; Ceftriaxone; Humans; Malaria; Male; Microscopy; Nucleic Acid Amplification Techniques; Plasmodium malariae; Quinine; Renal Dialysis; RNA, Ribosomal, 18S; Senegal; Treatment Outcome

We wanted to compare the first line intravenous administration of ceftriaxone to a subcutaneous administration in patients more than 75 years of age.. We performed a retrospective monocentric study on all patients more than 75 years of age admitted to the Ales hospital between January 1 and December 31, 2011, having received at least two doses of ceftriaxone intravenously (IV) or subcutaneously (SC).. One hundred and forty-eight patients (70 females/78 males patients) were included, 110 received ceftriaxone IV and 38 SC. They were a mean age of 84.7 years, older in the SC group (86.9 years) than in the IV group (83.9 years) (P = 0.0052). The SC group patients presented more frequently with dementia (57% vs. 25% P = 0.001), were more often bedridden (22% vs. 7% P = 0.023), had a higher mean World Health Organization status (3.13 vs. 2.76, P = 0.0181), and higher ADL score (7.79 vs. 5.76, P = 0.0056). There was no statistical difference for isolated bacteria, site of infection, death rate, and patients cured.. Subcutaneous ceftriaxone administration seems to be preferred for fragile elderly patients independently of disease severity. This administration is not associated to an impaired effectiveness or to an increased death rate.

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Blood Coagulation Disorders; Ceftriaxone; Comorbidity; Dementia; Female; Frail Elderly; Hospital Mortality; Hospital Units; Humans; Injections, Intravenous; Injections, Subcutaneous; Kidney Diseases; Male; Mental Disorders; Retrospective Studies

The outpatient parenteral antibiotic therapy (OPAT) program of the Portland Veterans Affairs Medical Center (PVAMC), which has a self-administration model, is staffed by visiting nurses from a specialist infusion company. This study evaluates the clinical outcomes of these patients.. This study was a retrospective chart review of 262 patients at PVAMC who had received OPAT between 2007 and 2009. Patients were included only if they received ongoing care at PVAMC. The data collected included conditions and organisms being treated and types and durations of antibiotics used. Clinical cure was defined as documented cure at the end of treatment and 90 days post-OPAT.. One hundred ninety patients of 262 were analyzed. The mean age was 63.2 years. Diabetes was the main comorbid factor (17%). The most common indications for OPAT were osteomyelitis (38%), urinary tract infection (23%), and skin and soft tissue infection (12.6%). Mixed bacterial culture (26%) and Staphylococcus aureus (31%) were the most common organisms treated. Vancomycin was the most frequently used antibiotic (26%) followed by ceftriaxone (12%). The median duration of OPAT was 30 days. The rate of clinical cure at end of treatment observed for all infections treated was 78%, which then decreased to 58% at 90 days post-OPAT (P < 0.001). Patients with diabetes and osteomyelitis had an increased risk of relapse at 90 days post-OPAT on multivariate analysis (P = 0.025).. An OPAT program using a self-administration model treating patients who were military veterans had successful outcomes. Patients with diabetes and osteomyelitis had worse clinical outcomes 90 days after the completion of OPAT therapy.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Diabetes Complications; Home Infusion Therapy; Humans; Middle Aged; Nafcillin; Osteomyelitis; Patient Care Team; Retrospective Studies; Time Factors; United States; United States Department of Veterans Affairs; Vancomycin

Topics: Adolescent; Anti-Bacterial Agents; Aripiprazole; Bacterial Infections; Ceftriaxone; Humans; Male; Piperazines; Psychotic Disorders; Quinolones

In this study we sought to assess the efficacy of a technetium-99m (Tc-99m)-labeled third-generation cephalosporin as an infection imaging agent in the accurate detection of the sites of bacterial infection in vivo.. Ceftriaxone (CRO) was formulated into a ready-to-use single-vial cold kit with a shelf-life of over 6 months and was successfully labeled with technetium. The radiolabeled drug, Tc-99m-CRO, was subjected to the following preclinical evaluations: radiochemical purity, in vitro and in vivo stability, bacterial binding assay, and pharmacokinetic studies in animals and in human patients.. The kit formulation exhibited excellent radiolabeling efficiency (∼99%) and high in vitro and in vivo stability. The radiolabeled drug exhibited slow blood clearance (12% at 4 h), and the high protein binding and excretion pattern of the labeled formulation mimics the reported pharmacokinetic profile of the drug alone. In the animal model, scintigraphy scans showed higher uptake of the radiopharmaceutical in infectious lesions, even at 1 h post-administration, in comparison to inflammatory lesions. The clinical evaluation of Tc-99m-labeled CRO showed a diagnostic accuracy of 83.3%, and a sensitivity and specificity of 85.2% and 77.8%, respectively.. This kit formulation has the potential for imaging bacterial infections with much higher sensitivity and specificity as compared to other Tc-99m-labeled antibiotics available as convenient ready-to-use kits in routine clinical practice.

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Bone Diseases, Infectious; Ceftriaxone; Diagnostic Imaging; Dogs; Humans; Mice; Models, Animal; Radionuclide Imaging; Sensitivity and Specificity; Technetium

A restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. Monthly consumption of nine antibiotics was monitored in defined daily doses (DDDs) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. Hospital-acquired Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL)-producing coliform cases per month/1000 pt-bds were identified and reviewed throughout the hospital. Between the first and final 6 months of the study, average monthly consumption of ceftriaxone reduced by 95% (from 46.213 to 2.129 DDDs/1000 pt-bds) and that for ciprofloxacin by 72.5% (109.804 to 30.205 DDDs/1000 pt-bds). Over the same periods, hospital-acquisition rates for C. difficile reduced by 77% (2.398 to 0.549 cases/1000 pt-bds), for MRSA by 25% (1.187 to 0.894 cases/1000 pt-bds) and for ESBL-producing coliforms by 17% (1.480 to 1.224 cases/1000 pt-bds). Time-lag modelling confirmed significant associations between ceftriaxone and C. difficile cases at 1 month (correlation 0.83; P<0.005), and between ciprofloxacin and ESBL-producing coliform cases at 2 months (correlation 0.649; P=0.002). An audit performed 3 years after the policy showed sustained reduction in C. difficile rates (0.259 cases/1000 pt-bds), with additional decreases for MRSA (0.409 cases/1000 pt-bds) and ESBL-producing coliforms (0.809 cases/1000 pt-bds). In conclusion, banning two antibiotics resulted in an immediate and profound reduction in hospital-acquired C. difficile, with possible longer-term effects on MRSA and ESBL-producing coliform rates. Antibiotic stewardship is fundamental in the control of major hospital pathogens.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Clostridioides difficile; Cross Infection; Drug Resistance, Bacterial; Drug Utilization; Enterobacteriaceae; Female; Humans; Incidence; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Organizational Policy; Time Factors

Topics: Anti-Bacterial Agents; Australia; Bacterial Infections; Ceftriaxone; Clinical Audit; Emergency Service, Hospital; Humans; Inappropriate Prescribing; Retrospective Studies; Tertiary Care Centers

Empirical antibiotics at the onset of febrile neutropenia are one of several strategies for management of bacterial infections in patients undergoing Hematopoietic Stem Cell Transplant (HSCT) (empiric strategy). Our HSCT program aims to perform HSCT in an outpatient setting, where an empiric antibiotic strategy was employed. HSCT recipients began receiving intravenous antibiotics at the onset of neutropenia in the absence of fever as part of our institutional policy from 01 Jan 2009; intravenous Prophylactic strategy. A prospective study was conducted to compare two consecutive cohorts [Year 2008 (Empiric strategy) vs. Year 2009 (Prophylactic strategy)] of patients receiving HSCT. There were 238 HSCTs performed between 01 Jan 2008 and 31 Dec 2009 with 127 and 111 in the earlier and later cohorts respectively. Infection-related mortality pre- engraftment was similar with a prophylactic compared to an empiric strategy (3.6% vs. 7.1%; p = 0.24), but reduced among recipients of autologous HSCT (0% vs. 6.8%; p = 0.03). Microbiologically documented, blood stream infections and clinically documented infections pre-engraftment were reduced in those receiving a prophylactic compared to an empiric strategy, (11.7% vs. 28.3%; p = 0.001), (9.9% vs. 24.4%; p = 0.003) and (18.2% vs. 33.9% p = 0.007) respectively. The prophylactic use of intravenous once-daily ceftriaxone in patients receiving outpatient based HSCT is safe and may be particularly effective in patients receiving autologous HSCT. Further studies are warranted to study the impact of this Prophylactic strategy in an outpatient based HSCT program.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Female; Fever; Hematopoietic Stem Cell Transplantation; Humans; Injections, Intravenous; Male; Middle Aged; Neutropenia; Outpatients; Prospective Studies; Survival Rate; Transplantation, Autologous; Transplantation, Homologous

Enterococci have recently been recognized as a causative organism of intractable infections, including severe sepsis and infective endocarditis, in immunocompromised patients. This study investigated the epidemiological, microbiological, and prognostic characteristics of high-level gentamicin-resistant (HLGR) enterococcal bacteremia, including severe cases of infective endocarditis, in Japan. A total of 155 enterococcal bacteremia episodes were identified between July 2007 and December 2009. HLGR strains accounted for 28% of all enterococcal strains: HLGR Enterococcus faecalis/Enterococcus faecium strains accounted for 32%/24%. The 30-day mortality rate was 31%. There was no significant difference in the 30-day mortality rates between HLGR and non-HLGR enterococcal bacteremia. There were two cases of HLGR enterococcal endocarditis, which were successfully treated with ampicillin plus ceftriaxone. We consider it important to examine the presence or absence of HLGR strains in all cases of intractable enterococcal infection, especially infective endocarditis.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteremia; Bacterial Infections; Ceftriaxone; Drug Resistance, Bacterial; Endocarditis, Bacterial; Enterococcus; Gentamicins; Humans; Japan

The objective of this study was to build a ceftriaxone population pharmacokinetic model for Japanese paediatric patients and to examine the dosing regimen of ceftriaxone based on pharmacokinetic/pharmacodynamic (PK/PD) analysis.. The population pharmacokinetic analysis using NONMEM was based on published serum concentrations of ceftriaxone. A Monte Carlo simulation was examined to evaluate the time above the minimum inhibitory concentration (TAM) in 20 and 60 mg/kg body weight dose regimen using the population pharmacokinetic parameters.. The time course of the serum concentration of ceftriaxone in paediatric patients was fitted to a two-compartment model and body weight was incorporated to pharmacokinetic parameters as the covariate. Based on the percent TAM estimated from the final population pharmacokinetic model and the minimum inhibitory concentration (MIC) of ceftriaxone in 2004, we have predicted that the once daily administration of 20 mg/kg ceftriaxone would be effective on various infecting organisms.. A population pharmacokinetic model of ceftriaxone was built for Japanese paediatric patients based on the available data. The estimated PK/PD result confirmed the appropriateness of once daily dose of 20 mg/kg. In some patients for whom no efficacy was observed at 20 mg/kg, an increase to 60 mg/kg may be required.

Topics: Adolescent; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Body Weight; Ceftriaxone; Child; Child, Preschool; Computer Simulation; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Infant; Infant, Newborn; Japan; Microbial Sensitivity Tests; Models, Biological; Nonlinear Dynamics; Time Factors

Discography is a controversial diagnostic procedure involving the injection of radiographic contrast medium (RCM) into the intervertebral disc. Iatrogenic bacterial discitis is a rare but serious complication. The intervention has been increasingly performed in our patients here in the United Arab Emirates. Prophylactic intravenous antibiotic administration can reduce post-interventional discitis; however, this may favour the development of bacterial resistance. Direct intradiscal injection of an antibiotic together with the RCM is a potential alternative. To date, there has been only one study on the efficacy of antibiotics added to an RCM. Equally, there are only limited data regarding the potential direct effect of RCM on bacterial growth. The purpose of this study was to determine whether the efficacy of antibiotics is affected when RCM are added. In an in vitro study, the effect of non-ionic RCM on the growth of five laboratory bacterial strains, alone and in combination with three broad-spectrum antimicrobials, was tested. Bacterial growth was assessed in the absence and the presence of RCM, antibiotics and their combinations. All three RCM alone demonstrated some inhibition of bacterial growth at high concentrations. In the presence of the RCM, all three antibiotics retained their inhibitory effect on bacterial growth. In conclusion, our in vitro experiments did not reveal any changes in the antimicrobial efficacy of the three antibiotics in the presence of the three tested RCM. Subsequent clinical trials will need to assess whether intradiscal antibiotic administration may be a suitable substitute for, or a supplement to, prophylactic systemic antibiotics before discography.

Topics: Ampicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Contrast Media; Discitis; Dose-Response Relationship, Drug; Drug Interactions; Escherichia coli; Gentamicins; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Intervertebral Disc; Klebsiella pneumoniae; Pseudomonas aeruginosa; Radiography; Radiopharmaceuticals; Staphylococcus aureus; Staphylococcus epidermidis

The in vitro activities of ceftaroline, a novel, parenteral, broad-spectrum cephalosporin, and four comparator antimicrobials were determined against anaerobic bacteria. Against Gram-positive strains, the activity of ceftaroline was similar to that of amoxicillin-clavulanate and four to eight times greater than that of ceftriaxone. Against Gram-negative organisms, ceftaroline showed good activity against beta-lactamase-negative strains but not against the members of the Bacteroides fragilis group. Ceftaroline showed potent activity against a broad spectrum of anaerobes encountered in respiratory, skin, and soft tissue infections.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Bacteroides fragilis; Ceftaroline; Ceftriaxone; Cephalosporins; Drug Resistance, Bacterial; Gram-Negative Aerobic Bacteria; Gram-Positive Bacteria; Humans; In Vitro Techniques; Microbial Sensitivity Tests

Cirrhotic patients with spontaneous bacterial peritonitis (SBP) have elevated rates of renal impairment and mortality. It has been shown that cefotaxime plus albumin infusion decrease renal impairment compared with antibiotic treatment alone, in patients with serum bilirubin >4 mg/dL or creatinine >1 mg/dL.. To assess clinical outcomes of high-risk cirrhotic patients with SBP who were treated with antibiotics associated with Gelafundin (polygeline) 4%.. Twenty nine cirrhotic patients with SBP and serum bilirubin >4 mg/dL or creatinine >1 mg/dL were enrolled. Ceftriaxone was administered in doses of 2 g/day and Gelafundin 4% was given intravenously at 1.5 g/kg of body weight at the time of the diagnosis, followed by 1 g/kg on day 3. Renal impairment was defined as nonreversible deterioration of renal function during hospitalization.. Eight patients (27.5%) had basal renal failure. Infection resolved in 28 (96.6%) patients. Renal impairment occurred in four patients (13.8%), and three patients (10.4%) died during hospitalization. Mortality within 90 days after discharge was 34.5% (10 patients).. The rates of renal impairment and mortality in high-risk patients with SBP suggest that Gelafundin 4% administration given with ceftriaxone may be a less expensive therapeutic alternative to albumin.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Multivariate Analysis; Peritonitis; Pilot Projects; Plasma Substitutes; Polygeline; Risk Assessment; Treatment Outcome

Zirconium molybdate gel was prepared by mixing (99)Mo, produced from (98)Mo(n,gamma) reaction and Zr solutions in nitrate media with excess H(2)O(2), and used as the base material for (99)Mo/(99m)Tc generator. The prepared generator showed a good performance. (99m)Tc eluted from the prepared generator passed the quality control tests with specifications meeting the requirements of European and US Pharmacopeias. The (99m)Tc eluate was used for labeling of cephalosporin analogue, ceftriaxone, which was then assessed for infection imaging in a mouse model. (99m)Tc-ceftriaxone was prepared at pH 9 with a radiochemical yield of 95+/-2% by adding (99m)Tc to 30 mg ceftriaxone in the presence of 50 microg SnCl(2).2H(2)O. Biodistribution studies in mice were carried out using experimentally induced infection in the left thigh using E. coli. Both thighs of the mice were dissected and counted to evaluate the ratio of bacterial infected thigh/contralateral thigh. (99m)Tc-ceftriaxone showed high uptake in the infectious lesion (T/NT =5.6+/-0.6 at 4h post injection). The abscess to normal muscle ratio indicated that (99m)Tc-ceftriaxone could be used for infection imaging. Besides, in vitro studies showed that (99m)Tc-ceftriaxone can differentiate between bacterial infection and sterile inflammation.

Topics: Animals; Bacterial Infections; Ceftriaxone; Escherichia coli Infections; Inflammation; Mice; Molybdenum; Muscle, Skeletal; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Tissue Distribution; Zirconium

Topics: Adult; Agranulocytosis; Ambulatory Care; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Female; Humans; Injections; Leukocyte Count; Neutrophils

Bacterial infections are the most frequent cause of hospitalization in elderly patients. In the early eighties, the advantages of Outpatient parenteral Antibiotic therapy (OPAT) were identified in the United States, and suitable therapeutic programs were established. In order to understand the different ways of managing OPAT, a National OPAT Registry was set up in 2003 in Italy. This study analyzes data concerning bacterial infections in 176 elderly patients including demographics, therapeutic management, clinical response, and side-effects. Bone and joint infections (48.9%) and skin and soft tissue infections (27.8%) were the most common infections treated with OPAT. Teicoplanin (28.9%) and ceftriaxone (22.1%) were the top two antibiotics chosen. OPAT was mainly performed at a hospital infusion center (52.8%). The clinical success rate was high and side-effects were low (12.6% of cases). Management of bacterial infections in the elderly with an outpatient program is effective and safe.

Topics: Aged; Aged, 80 and over; Ambulatory Care; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Female; Humans; Infusions, Parenteral; Italy; Male; Teicoplanin

Members of the genus Bacillus are Gram-positive bacilli, ubiquitous in the environment. When isolated in clinical practice, it is frequently considered as due to environmental contamination. Bacillus cereus is the most frequent species isolated in clinical practice, nevertheless other Bacillus spp. are sometimes isolated. Bacillus bacteremia is uncommon, the affected patients are severely ill and frequently immunocompromised with hematological malignancies.. Two cases of bloodstream infection due to Bacillus species rarely described before are described, one due to Bacillus macerans and the other to Bacillus pumilus. Both patients presented with severe bacteremia and were immunodepressed after recent chemotherapy. They died a few days after admission to our ICU.. The initial report of Bacillus spp. isolated in blood culture in oncohematological patients indicates a potentially severe infection.

Topics: Amoxicillin; Anti-Bacterial Agents; Bacillus; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Clavulanic Acid; Drug Therapy, Combination; Humans; Immunosuppression Therapy; Male; Middle Aged; Sepsis; Shock, Septic; Treatment Outcome

The need to limit unnecessary antibiotic treatments and recent studies with unusual antibiotics in pediatrics (fluoroquinolones) or in digestive tract infections (azithromycin) have led to update the treatment of acute gastro-enteritis. In 2007, the European Society for Pediatric Infectious Diseases and the European Society for Gastroenterology Hepatology and Nutrition have issued guidelines. The proven shigellosis as well as the strong suspicion have to be treated promptly with antibiotics, mainly azithromycin. There is no argument to treat moderate salmonella gastroenteritis or carriage. However, the severe cases and those occurring in high risk patient must be treated (ciprofloxacin or ceftriaxone). It is recommended to treat diarrhoea due to Campylobacter jejuni in case of early diagnosis. The presumptive antibiotic treatment should be limited but can not be dismissed, in invasive cases gastro-enteritis, especially in traveller children.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Infections; Campylobacter Infections; Campylobacter jejuni; Ceftriaxone; Child; Ciprofloxacin; Diarrhea; Dysentery, Bacillary; Escherichia coli Infections; Gastroenteritis; Humans; Salmonella Infections

Acute pancreatitis is an important cause of morbidity and mortality, mainly due to sepsis. The aim of this study was to determine the incidence of infectious complications and their impact on mortality in patients hospitalized for acute pancreatitis.. Patients admitted for acute pancreatitis were retrospectively included within a period between 1995 and 2000. Incidence of abdominal and extra-abdominal sepsis and specific care were specifically analyzed. Risk factors for death were evaluated by uni- and multivariated analysis.. Two hundreds and twelve consecutive patients (128 males, median age 54 years) were included. Mortality was 10.8%. At least one infectious episode was collected in 25% of the patients with an abdominal sepsis (26.8%), bacteriemia (24.4%), respiratory (24.4%) and urinary tracts (19.5%) infections. Infection was polymicrobial in 37.5%. An antibiotic prophylaxis was administered in 10.8%, more often in patients with severe pancreatitis. It did not alter mortality or incidence of infections but significantly delayed occurrence of sepsis. Mortality of patients treated with more than one line of antibiotics was higher. However in this study infectious complications were not an independent factor for mortality.. Infections are frequent and polymicrobial but are not an independent prognostic factor during acute pancreatitis.

Topics: Acute Disease; Adult; Age Factors; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; APACHE; Azithromycin; Bacterial Infections; Ceftriaxone; Data Interpretation, Statistical; Drug Therapy, Combination; Female; Humans; Incidence; Male; Middle Aged; Pancreatitis; Prognosis; Retrospective Studies; Risk Factors; Sepsis; Time Factors

Spontaneous bacterial peritonitis (SBP) is a severe complication of cirrhotic patients associated with a high mortality.. To develop an available experimental model of induced bacterial peritonitis in cirrhosis.. Sprague-Dawley rats with carbon-tetrachloride-induced cirrhosis with (N=22) or without (N=101) ascites were randomized to receive an intraperitoneal administration of different concentrations of Escherichia coli (E. coli) diluted in 1 mL of sterile water in ascitic rats and in different volumes in nonascitic rats. A subgroup of nonascitic animals received ceftriaxone 4 h after E. coli inoculation. Mortality of rats was evaluated 24 h after bacterial inoculation.. None of the rats receiving sterile water alone and only one infected with 10(7) cfu of E. coli died. Ascitic rats showed a lower mortality rate than nonascitic rats infected with 10(8) or 10(9) cfu of E. coli (P<0.05). Mortality was higher with 10(9) cfu than with 10(8) cfu of E. coli in ascitic (P NS) and nonascitic (P<0.01) rats. A trend was noted to ward higher mortality in nonascitic rats inoculated with 10(8) cfu with increasing water volumes. A marked peritoneal polymorphonuclear cell response was observed 4 h after E. coli injection in both ascitic and nonascitic rats. Antibiotic therapy significantly reduced the mortality rate of rats infected with 10(8) cfu (P<0.01).. This experimental model of induced bacterial peritonitis in cirrhosis with or without ascites may represent a useful tool for the study of pathogenic events postinfection and for the design of new therapeutic strategies to treat patients with SBP.

Topics: Animals; Anti-Bacterial Agents; Ascites; Bacterial Infections; Carbon Tetrachloride; Ceftriaxone; Disease Models, Animal; Escherichia coli Infections; Liver Cirrhosis, Experimental; Male; Peritonitis; Random Allocation; Rats; Rats, Sprague-Dawley

The changing pattern of antimicrobial resistance in the causative microorganisms of urinary tract infection (UTI) in childhood is a growing problem. The aims of this study were to assess the resistance patterns of urinary isolates to commonly used antimicrobials and to evaluate the options for empirical treatment of UTI. A prospective cross-sectional analysis of bacteria isolated from children with UTI was performed between January 2003 and January 2004. Resistance to antibiotics was analysed in three age groups: Group I, < or =12 months; Group II, 13-60 months; and Group III, >60 months. A total of 165 urinary pathogens were isolated from 131 patients. Mean patient age was 63.7+/-49.8 months. The most common causative agent was Escherichia coli (87% of cases) followed by Klebsiella pneumoniae (10%). Resistance to ampicillin (74.2%) and co-trimoxazole (61.3%) was significant in all isolates. Nitrofurantoin was the most active agent against E. coli (2.2% resistant isolates), followed by amikacin (4.9%), ceftriaxone (7.5%) and ciprofloxacin (12%). None of the isolates from Group I patients were resistant to ciprofloxacin and a low resistance rate (7.1%) was noted for amikacin. In Group II patients, none of the isolates were resistant to amikacin, and ceftriaxone was the second most suitable antibiotic (resistance rate 2.2%). In Group III patients, the lowest resistance rate was against nitrofurantoin (2.7%). In conclusion, we observed that the use of ampicillin and co-trimoxazole as a single agent for empirical treatment of a suspected UTI would not cover the majority of urinary pathogens in our region. Whilst amikacin, with a negligible resistance rate, was suitable in all age groups, gentamicin might still be useful as an empirical treatment of UTI in children aged >1 year. Nitrofurantoin could be included as a reasonable alternative in the empirical treatment of lower UTI in older children.

Topics: Adolescent; Age Factors; Amikacin; Ampicillin; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Female; Gentamicins; Humans; Infant; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Nitrofurantoin; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections

Treatment of intra-abdominal infections remains a challenge owing to their polymicrobial nature and associated mortality risk. Treatment regimens must provide broad-spectrum coverage, including Gram-positive and Gram-negative aerobic and anaerobic bacteria of gastrointestinal origin. Ertapenem is a long-acting 1-beta-methyl parenteral group 1 carbapenem antibiotic that has a broad antibacterial spectrum and once-daily dosing supported by clinical studies. It is active against Gram-positive and Gram-negative bacteria, including Enterobacteriaceae, Streptococcus pneumoniae and most species of anaerobic bacteria. The aim of this study was to measure the killing effects of ertapenem against a selected group of strains responsible for intra-abdominal infections. Gram-negative isolates comprised the following species: Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Klebsiella ozaenae, Enterobacter cloacae and Proteus mirabilis (extended-spectrum beta-lactamase (ESBL) producers and non-producers). Gram-positive isolates comprised methicillin-susceptible Staphylococcus aureus (MSSA), Enterococcus faecalis and anaerobic Bacteroides fragilis. Ertapenem activity was tested by determination of minimal inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs). Killing curves were performed in monocultures and co-cultures at selected antibiotic concentrations. Ertapenem showed a rapid and potent bactericidal activity in the first few hours of the kinetic curves against E. coli (6 log(10) colony-forming unit (CFU) reduction in the first 2h), B. fragilis (4 log(10) CFU reduction in 4h), MSSA (3 log(10) CFU reduction in 4-6h), K. ozaenae (ESBL+), K. pneumoniae (ESBL+ and -), E. cloacae (ESBL-) in 1h and P. mirabilis (ESBL+) in the first 2h. The potent bactericidal activity of ertapenem compared with ceftriaxone and piperacillin/tazobactam was well demonstrated in the co-cultures of E. coli-B. fragilis and E. coli-B. fragilis-E. faecalis, whilst ertapenem was shown to be bactericidal at 24h in the mixed culture of S. aureus-P. mirabilis. These results support the potent in vitro bactericidal activity of ertapenem against all multiresistant strains selected in this study and the use of this drug in the treatment of intra-abdominal infections.

Topics: Abdomen; Anti-Bacterial Agents; Bacterial Infections; Bacteroides fragilis; beta-Lactams; Ceftazidime; Ceftriaxone; Digestive System Diseases; Enterobacter cloacae; Enterococcus faecalis; Ertapenem; Escherichia coli; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Klebsiella; Microbial Sensitivity Tests; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Proteus mirabilis; Staphylococcus aureus; Time Factors

The objective of this study was to examine the feasibility of short-term outpatient peripheral intravenous (IV) antibiotic therapy for selected emergency department (ED) patients.. Retrospective analysis of pediatric ED patients presenting with infections of presumed bacterial etiology who received IV ceftriaxone and were discharged with a "capped" IV catheter and instructions to return in 24 hours for reevaluation. Outcome measures included clinical outcome at 24 hours and catheter-related complications.. Twenty-nine patients met study criteria. All returned for reevaluation. In one case, a parent removed the catheter when their child reported "numbness/soreness" at the catheter site. The other 28 patients were judged to be improved, received a second dose of ceftriaxone through the original catheter, and were discharged on oral antibiotic. No adverse events related to the catheter were identified.. Outpatient peripheral IV catheter use appears to be a feasible method for providing serial doses of parenteral antibiotic for the treatment of selected pediatric patients with infectious conditions.

Topics: Adolescent; Anti-Bacterial Agents; Bacterial Infections; Catheterization, Peripheral; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Emergency Service, Hospital; Feasibility Studies; Home Infusion Therapy; Humans; Infant; Infusions, Intravenous; Retrospective Studies; Treatment Outcome

A management protocol for specialist nurses was developed for ambulatory management of uncomplicated cellulitis requiring initial intravenous (i.v.) antibiotic therapy. Patients were all managed through an outpatient parenteral antibiotic therapy (OPAT) service. Those with cellulitis were compared pre- and post-intervention.. One hundred and fourteen patients were compared with 230 retrospective controls all managed through the OPAT service. Protocol management was associated with reduced duration of outpatient i.v. therapy from 4 to 3 days, P=0.02, and reduced need for physician review (100% to 19%). Outcomes, complications and readmissions were similar.. Specialist nurse-led management is safe and effective in the management of uncomplicated cellulitis in the context of an OPAT service and reduces the need for regular medical review without compromising clinical care.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cellulitis; Community Health Nursing; Female; Humans; Infusions, Intravenous; Infusions, Parenteral; Male; Middle Aged; Outpatients; Skin Diseases, Bacterial; Soft Tissue Infections; Treatment Outcome

Topics: Ambulatory Care; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Child; Humans; Reimbursement Mechanisms; Switzerland

This study studied the use of ERCP and nasobiliary tube in the diagnosis of fungal infection of biliary tract and the efficacy of combined use of local administration via nasobiliary tube and intravenous antifungal treatment for severe biliary tract fungal infection. 5 patients in our series, with age ranging from 47 to 68 y (mean 55.8), were diagnosed as having mixed bacterial and fungal infection of biliary tract as confirmed by smear or/and culture of bile obtained by ERCP and nasobiliary drainage. Besides routine anti-bacteria therapy, all patients received local application of fluconazole through nasobiliary tube and intravenous administration of fluconazole or itraconazole in terms of the results of in vitro sensitivity test. The mean duration of intravenous fluconazole or itraconazole was 30 days (24-40 days), and that of local application of fluconazole through nasobiliary drainage tube was 19 days (8-24 days). During a follow-up period of 3-42 months, all patient's fungal infection of biliary tract was cured. It is concluded that on the basis of typical clinical features of biliary tract infection, fungal detection of smear/culture of bile obtained by ERCP was the key for the diagnosis of fungal infection of biliary tract. Local application antifungal drug combined with intravenous anti-fungal drugs might be an effective and safe treatment for fungal infection of biliary tract.

Topics: Aged; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Biliary Tract Diseases; Candidiasis; Ceftriaxone; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Female; Fluconazole; Humans; Male; Middle Aged; Staphylococcal Infections

The incidence and outcome of gallbladder and urinary tract complications in children receiving ceftriaxone therapy were evaluated prospectively. The subjects were given intravenous ceftriaxone, 100 mg/kg/day, in two divided doses infused over 20-30-minute periods, for 5-14 days. Serial abdominal ultrasonography revealed gallbladder and urinary tract precipitations in five of 35 children, three of whom had gallbladder pseudolithiasis, one gallbladder sludge and one gallbladder pseudolithiasis and urinary bladder sludge. The children who had gallbladder sludge and gallbladder pseudolithiasis with urinary bladder sludge had abdominal pain, nausea and vomiting. Three children remained symptom-free. The gallbladder precipitations were found after 4-9 days of ceftriaxone therapy, and resolved completely 7-19 days after the end of treatment. The urinary tract precipitation was found on the 5th day after cessation of ceftriaxone therapy and resolved 7 days later. Ceftriaxone-associated gallbladder pseudolithiasis, gallbladder sludge and urinary bladder sludge usually resolve spontaneously and physicians should be aware of these complications so as to avoid unnecessary therapeutic procedures.

Topics: Adolescent; Anti-Bacterial Agents; Bacterial Infections; Calculi; Ceftriaxone; Child; Child, Preschool; Female; Gallbladder Diseases; Humans; Infant; Infusions, Intravenous; Lithiasis; Male; Prospective Studies; Time Factors; Ultrasonography; Urologic Diseases

To observe the effects of short-term antibiotic treatment in patients with hepatic failure and spontaneous bacterial peritonitis (SBP).. In this prospective study short-term antibiotic treatment was given to 67 cases diagnosed as hepatic failure with spontaneous bacterial peritonitis. Ceftriaxone 2 g, iv drip, q12h for 10 d or ofloxacin 0.2 g, iv drip, q12h for 10 d was given to the patients at random and the efficacy was evaluated on the basis of clinical symptoms, medical examination and ascites after 3, 7, 10 days of therapy.. Seven cases (10.44%) were cured and 57 cases (85%) were improved after 3 days therapy, the total effective rate was 95.52%, but in 3 cases the therapy had no effect. The results of ascites bacterial culture and drug susceptibility test showed that one case had drug resistance to ceftriaxone and two cases had drug resistance to ofloxacin, so antibiotics were changed in time. After 7 days therapy, the results showed that 65 cases (97.01%) cured and 2 cases (2.99%) were improved, the total effective rate was 100%. When the therapy lasted for 10 days, all patients were cured. One patient had oral mucous membrane. Candida albicans infection after 3 days therapy; two cases got thrush and one patient got fungal intestinal infection after 7 days therapy; when the therapy lasted for 10 days, 4 cases had thrush and 2 cases had fungal infection of intestines and one patient had pulmonary fungal infection.. The optimal period of antibiotic treatment of hepatic failure with SBP should be from 7 days to 10 days.

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Liver Failure; Male; Middle Aged; Ofloxacin; Peritonitis; Prospective Studies; Treatment Outcome

The in-vitro susceptibility of an organism and the pharmacokinetics of an antimicrobial agent are two basic factors on which the choice of standardised treatment regimens is based. However, the inter-individual variability of these factors, which modifies the exposure of bacteria to an antibiotic in terms of time and quantity, is not usually taken into account. In 87 patients treated with beta-lactams (ceftriaxone, cefepime or piperacillin), the probability of failure was greater when the infectious process was located in tissues with barriers to the distribution of beta-lactams. Mean MICs of piperacillin and cefepime, but not ceftriaxone, were below the breakpoints in cases of both recovery and failure, but organisms isolated from patients with a poor outcome had higher MICs. Therefore, the use of breakpoints to determine the susceptibility of microorganisms was not satisfactory in predicting the outcome for a large number of patients. If MICs are determined and plasma concentrations are monitored, dosages can be adjusted according to these parameters, thereby allowing antibiotic treatment to be individualised.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; beta-Lactams; Cefepime; Ceftriaxone; Cephalosporins; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Piperacillin; Treatment Outcome

The efficacy and the safety of sequential intravenous/oral (i.v./p.o.) ciprofloxacin (CIPX) plus i.v./p.o. metronidazole (MTR) was compared with i.v. ceftriaxone (CTRX) plus i.v./p.o. MTR in the treatment of complicated intra-abdominal infections. One hundred and forty two patients received study medications. Of these, 135 could be studied. Sixty-nine patients were randomized in the CIPX arm of the study and 66 in the CTRX arm. In the CIPX group 58 patients were switched to oral treatment and 11 patients remained in the intravenous arm. In the CTRX group 57 patients switched to oral MTR continuing i.v. CTRX and 9 patients remained in the i.v. branch. Success rates at the end of treatment in patients who switched to oral were 100% in both the CIPX group and the CTRX group. For validated patients continuing on oral, the success rates at the end of treatment were 63.6 and 33.3% in the CIPX and CTRX groups respectively. Overall success rates at the end of treatment and follow-up in all patients were 94.2% in the CIPX group and 89.4% in the CTRX group. Overall success rates at the end of treatment in patients with proven bacterial infection were 92.9% in the CIPX group and 88.3% in the CTRX group. Duration of hospitalization (days) for studied patients was 22.7+/-8.2 in the CIPX and 19.6+/-14.5 in the CTRX group. There was no statistical difference between the CIPX and CTRX groups in both the intent to treat and in the modified intent to treat populations. Conversion to oral therapy with CIPX/MTR was as effective as continued intravenous therapy with CTRX and oral MTR in those patients able to tolerate oral feeding.

Topics: Abdominal Abscess; Adult; Aged; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Intestinal Perforation; Male; Metronidazole; Middle Aged; Peritonitis; Prospective Studies

To evaluate the role of transrectal ultrasonography (TRUS) in the diagnosis of acute bacterial prostatitis (ABP) and to analyse the possible relationship between sonographic findings and clinical presentation and evolution, a prospective study using TRUS in patients with ABP was conducted. 45 patients (aged 58.2 +/- 14.6 y; mean +/- SD) with a clinical diagnosis of ABP admitted to a university hospital were studied prospectively. Clinical, analytical and microbiological data were recorded. TRUS was performed on admission and after 1 month of antibiotic therapy. Findings were correlated with clinical and evolutive data. The mean prostatic volume on admission was 40.5 +/- 17.9 ml. 21 patients (46.6%) had sonographically demonstrable lesions in peripheral prostatic lobules. One month later, when treatment had ended, lesions had disappeared or improved in 61.1% of patients, and the mean prostatic volume was 24.3 +/- 10.5 ml (p < 0.0005). Clinical, analytical and microbiological data and evolution of ABP were not significantly different in patients with or without sonographically demonstrable lesions. TRUS does not need to be performed in every patient with suspicion of ABP; the only indication for TRUS in ABP is the exclusion of prostatic abscess.

Topics: Acute Disease; Administration, Oral; Adult; Aged; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Drug Administration Schedule; Drug Therapy, Combination; Endosonography; Follow-Up Studies; Humans; Infusions, Intravenous; Male; Middle Aged; Probability; Prostatitis; Sensitivity and Specificity; Severity of Illness Index; Treatment Outcome; Urinalysis

To achieve sustained improvement in use of cefotaxime and ceftriaxone (CEFX) in a major teaching hospital, as measured against national antibiotic guidelines.. Pre- and post-intervention survey of CEFX use in the Royal Melbourne Hospital, a tertiary hospital in Melbourne, Victoria.. Web-based antimicrobial approval system linked to national antibiotic guidelines was developed by a multidisciplinary team and implemented in March 2001.. Change in rate of CEFX use (defined daily doses [DDDs] per 1000 acute occupied bed days) over 8 months pre- and 15 months post-intervention; concordance of indication for CEFX with national antibiotic guidelines pre- and post-intervention.. CEFX use decreased from a mean of 38.3 DDDs/1000 bed days pre-intervention to 15.9, 18.7 and 21.2 DDDs/1000 bed days at 1, 4 and 15 months post-intervention. Concordance with national antibiotic guidelines rose from 25% of courses pre-intervention to 51% within 5 months post-intervention (P < 0.002). Gentamicin use also increased, from a mean of 30.0 to 48.3 DDDs/1000 bed days (P = 0.0001).. The web-based antimicrobial approval system achieved a sustained reduction in CEFX use over 15 months as well as increased prescribing concordance with antibiotic guidelines. It has potential for linking to electronic prescribing and for wider use for other drugs, as well as for research into the epidemiology of antibiotic use.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Therapy, Computer-Assisted; Drug Utilization Review; Formularies, Hospital as Topic; Guideline Adherence; Hospitals, Teaching; Humans; Internet; Practice Guidelines as Topic; Program Evaluation; Software Design

The in vitro activity of ertapenem against bacterial pathogens isolated from patients with moderate to severe complicated intra-abdominal, complicated skin/skin structure, acute pelvic, or complicated urinary tract infection or community acquired pneumonia was compared to ceftriaxone and piperacillin-tazobactam and related to known plasma concentrations of the three agents. Ertapenem was more potent against methicillin-susceptible Staphylococcus aureus (MSSA) than ceftriaxone and piperacillin-tazobactam and was more potent and more active than both of these agents against Enterobacteriaceae and anaerobes. Piperacillin-tazobactam was the most active agent against enterococci and Pseudomonas aeruginosa. All isolates of Enterobacteriaceae (n=1088), Streptococcus pyogenes (n=37), Streptococcus agalactiae (n=48), MSSA (n=187), Haemophilus influenzae (n=59), and Moraxella catarrhalis (n=9) were susceptible to ertapenem; < 1% of 1284 anaerobes and only 1 of 113 Streptococcus pneumoniae (a penicillin-resistant isolate) were resistant to ertapenem. The MIC value at which 90% of all Enterobacteriaceae, streptococci, MSSA, H. influenzae, M. catarrhalis, and anaerobes were inhibited (MIC90) was < or = 1 microg/ml and below the mean plasma concentration of total ertapenem following a 1 g intravenous infusion for at least 24 hours, i.e., the entire recommended dosing interval, and below the free drug concentration for at least 8 h.

Topics: Anti-Bacterial Agents; Bacterial Infections; beta-Lactams; Ceftriaxone; Community-Acquired Infections; Drug Resistance, Microbial; Drug Therapy, Combination; Enterobacteriaceae; Ertapenem; Haemophilus influenzae; Humans; Lactams; Microbial Sensitivity Tests; Moraxella catarrhalis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Staphylococcus aureus; Streptococcus agalactiae; Streptococcus pyogenes

To determine patterns of use of ceftriaxone and cefotaxime (CEFX) in Victorian hospitals and to identify areas for improvement.. A concurrent, observational evaluation of CEFX use in patients commencing a course of these drugs between 8 and 14 September, 1999, in 51 Victorian hospitals.. Proportion of patients treated with CEFX; indications; duration of use; concordance with recommendations of national antibiotic guidelines (Therapeutic guidelines: antibiotic, 10th edition [AG10]).. 671 patients were treated with CEFX. The overall rate of use was 43 patients per 1000 inpatient separations. Treatment of respiratory tract infection accounted for 352 patients (52%) and surgical prophylaxis for 99 patients (15%). Treatment of skin/soft tissue, urinary tract and gastrointestinal tract infections accounted for about 7% of patients each. The median duration of CEFX courses was 3.0 days. The overall rate of concordance with indications recommended in AG10 was 27%. The rate of concordance for empirical treatment of respiratory tract infection was 24%. Of the 195 patients treated empirically with CEFX for community-acquired respiratory tract infection and assessed as non-concordant, 64% did not have radiological evidence of pneumonia, and a further 30% did not fulfill the criteria for severe pneumonia. All courses given for surgical prophylaxis were non-concordant.. CEFX is widely used in Victorian hospitals, mostly to treat lower respiratory tract infection and in surgical prophylaxis of infection. The rate of concordance with AG10 is low. Potential areas for intervention include empirical treatment of respiratory tract infection and use in surgical prophylaxis.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Cross Infection; Drug Utilization Review; Guideline Adherence; Hospitals; Hospitals, Teaching; Humans; Logistic Models; Practice Guidelines as Topic; Victoria

Spontaneous bacterial peritonitis (SBP) is a frequent infection in cirrhotic patients with ascites, with a poor prognosis. The aims of this study were to determine the long-term survival of cirrhotic patients with SBP treated with ceftriaxone and to identify predictive factors related to survival. We studied 47 first episodes of SBP treated with ceftriaxone with a mean follow-up of 272 days. Nineteen variables were recorded to evaluate their relation to survival. The most frequent organism that caused SBP was Escherichia coli (40%). Spontaneous bacterial peritonitis resolution was achieved in 67% of patients. After resolution, SBP recurrence was observed in 44% of patients. The cumulative probability of survival was 68.1% at 1 month and 30.8% at 6 months. After uni-and multivariate analyses of all cases, SBP resolution ( p = 0.0001) and international normalized ratio (INR) ( p = 0.0057) were found to be related to survival. Another analysis performed after SBP resolution and SBP recurrence showed that ascitic fluid-positive culture ( p = 0.0344) and INR ( p = 0.0218) had statistical significance as variables predictive of long-term survival. We conclude that the survival of cirrhotic patients is very short after the first episode of SBP, a fact probably related to advanced liver disease, as liver dysfunction (INR) is the most important factor related to long-term patient survival.

Topics: Adult; Aged; Aged, 80 and over; Ascitic Fluid; Bacterial Infections; Ceftriaxone; Confidence Intervals; Female; Follow-Up Studies; Humans; Liver Cirrhosis; Male; Middle Aged; Multivariate Analysis; Peritonitis; Probability; Prospective Studies; Regression Analysis; Risk Assessment; Survival Analysis; Treatment Outcome

To try efficacy and safety of ophramax (cephtriaxon) made in India ("Ranbaxy") in infectious-inflammatory diseases treated in a general hospital.. Ophramax was given in a dose 1 to 4 g/day to 23 patients with pneumonia, chronic bronchitis, soft tissue infection, enterocolitis, etc. Therapeutic effect was examined with bacteriological identification of the infective agents, antibioticograms, agar diffusion test.. High sensitivity of pathogens to ophramax was observed in bronchopulmonary diseases (90.7%). In other infections sensitivity of the pathogens was 59.3%. Enterococci were the only highly resistant pathogens (40.5%). Ophramax remains in the body in sufficiently high concentrations for 24 hours. This attributes to good therapeutic effect.. Clinico-microbiological and pharmacokinetic findings show that ophramax can be used as a basic drug for treatment of different infectious-inflammatory diseases. Once-a-day regimen is a great advantage of ophramax.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Cephalosporins; Drug Monitoring; Drug Resistance, Bacterial; Humans; Inflammation; Middle Aged

Septic thrombophlebitis of the portal vein is an unusual and serious complication of abdominal infection. We present a patient with thrombophlebitis of the portal vein of unknown origin, suffering from fever, abdominal pain, jaundice, abnormal liver test function and bacteremia related to Bacteroides fragilis. Ultrasonography, with doppler of the portal vein, was performed which showed thrombosis of the portal vein together with signs of portal hypertension. The patient underwent six weeks of antibiotic treatment. The evolution was favourable, the infection was overcome and the portal vein was de-obstructed as a consequence of which the signs of portal hypertension disappeared.

Topics: Aged; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Ceftriaxone; Cephalosporins; Humans; Hypertension, Portal; Male; Ornidazole; Portal Vein; Thrombophlebitis; Ultrasonography

To determine the feasibility and cost of home antibiotic therapy for a select group of neonates.. A cohort of neonates at a university hospital who met criteria for home antibiotic therapy at discharge were prospectively followed (November 1995 to October 1997) for type and duration of antibiotic therapy as well as for hospital readmission.. During the study period, 95 infants diagnosed with sepsis, presumed sepsis, pneumonia, or uncomplicated meningitis (having received > 10 days of in-hospital therapy) met prior, established, criteria for home antibiotic therapy. The mean +/- SD birth weight of the cohort was 3160 +/- 526 gm, with a mean gestational age of 38.4 +/- 2.1 weeks. A total of 59 infants (62%) received antimicrobial therapy for a clinical presentation consistent with sepsis or presumed sepsis, and 24 infants (25%) were treated for pneumonia. Ampicillin and gentamicin were prescribed for 56% of the cohort, and ceftriaxone was prescribed for 21% of the cohort. Four of those infants were switched from intravascular ampicillin/gentamicin therapy to intramuscular ceftriaxone after discharge due to loss of intravascular access. With a bilirubin level of > 8, four additional infants were changed from ceftriaxone back to ampicillin and gentamicin to complete coverage. The mean age at discharge was 5.2 days, with a mean hospitalization cost of $6121 for that period. There were no rehospitalizations or emergency department visits secondary to a worsening clinical course.. In this cohort of neonates who met early discharge and defined home antibiotic therapy criteria, there were no serious complications or treatment failures reported; in addition, there were fewer costs compared with continued inpatient treatment.

Topics: Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Catheters, Indwelling; Ceftriaxone; Cohort Studies; Drug Therapy, Combination; Equipment Failure; Feasibility Studies; Gentamicins; Home Nursing; Humans; Infant, Newborn; Injections, Intramuscular; Injections, Intravenous; Patient Discharge; Prospective Studies; Time Factors; Treatment Outcome

The feasibility and safety of outpatient management of acute promyelocytic leukemia (APL) during the aplastic phase after intensive consolidation chemotherapy, the incidence and types of complications requiring readmission to hospital, and the number of hospital days spared by this policy have been prospectively evaluated. After chemotherapy administration, patients were evaluated on an ambulatory basis. In the event of any complication they referred to the Emergency Unit (EU) of our Department dedicated to outpatients with hematologic diseases. Forty patients with APL observed over a 4 year period were eligible for intensive chemotherapy. After the achievement of complete remission they received a total of 104 consolidation courses and in 98 instances they were followed on an ambulatory basis. There were 41 cases (42%) of rehospitalization for fever (40 cases) or severe anemia (one case). Only one patient died due to a brain hemorrhage. Streptococcus viridans was the organism most frequently isolated from blood. Empiric once-a-day antibacterial therapy with ceftriaxone and amikacin was effective in 87% of the cases and made possible early discharge in 28% of the cases to continue the antibiotic therapy on an outpatient setting. Patients were managed out of the hospital for 76% of the post-consolidation neutropenia period. Thanks to the availability of an EU specifically dedicated to outpatients with hematologic diseases, out-hospital management of APL patients after consolidation therapy appeared to be safe, well accepted, potentially cost-saving, and contributed to saving the risk of developing severe nosocomial infections.

Topics: Adult; Aged; Ambulatory Care; Amikacin; Anemia; Antineoplastic Combined Chemotherapy Protocols; Bacterial Infections; Ceftriaxone; Cerebral Hemorrhage; Cross Infection; Drug Therapy, Combination; Emergency Service, Hospital; Female; Fever; Hospitalization; Humans; Idarubicin; Incidence; Length of Stay; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Neutropenia; Remission Induction; Tretinoin

Because hospitalization and intravenous antibiotics for treatment of a potentially fatal bacterial infection in febrile children with sickle cell disease (SCD) are difficult to apply, outpatient treatment has been considered in developed countries for selected patients. Eligibility criteria and procedures may differ in developing countries because of unique economic and social conditions. After clinical evaluation within 36 hr of the onset of a fever exceeding 38.5 degrees C, children with SCD who are being closely followed as a part of a SCD cohort in Cotonou (West Africa), were treated as outpatients. The antibiotic regimen consisted of intramuscular injection of ceftriaxone 50 mg/kg/day for 2 days followed by amoxicillin 25 mg/kg x 3/day x 4 days and oral hyper-hydration. Patients were observed for 6 hr and thereafter discharged with a medical control at day 2, day 8 + day 15. All 60 children included completed their treatment, and none were lost to follow-up. A definite or a presumed bacterial infection was the cause of the febrile episode in 76.7% of cases. An appreciable decrease in fever was observed from day 2 and only 2 patients were hospitalized at day 3, one for abdominal painful crisis and one other for persistent fever without documented infection. No severe bacterial infections, recurrence of febrile episode, nor death were encountered during the follow-up. The cost of this outpatient approach is US $30 per patient as compared to US $140 per patient if the patient had been hospitalized. Outpatient management of febrile episode in children with SCD is feasible and cost-effective in Sub-Saharan African. It requires, however, improved medical education on SCD and immediate medical attention after the onset of fever.

Topics: Abdominal Pain; Administration, Oral; Ambulatory Care; Amoxicillin; Anemia, Sickle Cell; Bacterial Infections; Benin; Ceftriaxone; Child; Child, Preschool; Cohort Studies; Combined Modality Therapy; Developing Countries; Drug Costs; Drug Therapy, Combination; Female; Fever; Fluid Therapy; Follow-Up Studies; Hospitalization; Humans; Infant; Injections, Intramuscular; Malaria, Falciparum; Male; Pilot Projects; Recurrence

Topics: Amoxicillin; Bacterial Infections; Ceftriaxone; Cephalosporins; Child, Preschool; Dysentery; Humans; Infant; Meningitis; Penicillins; Pneumonia; Practice Patterns, Physicians'; Primary Health Care; Sepsis

Increasing attention to quality of life and to health care costs has recently induced several cancer centers to change in-patient management into an out-patient setting even during high risk phases of disease. The aim of this prospective study was to evaluate feasibility and safety, as well as clinical characteristics, of out-hospital management of AML patients during their post-consolidation phase.. All patients who were treated over a three year period by the three following protocols were included in the study: AML10 EORTC/GIMEMA for patients with AML, except for APL, aged 60 years; AIDA GIMEMA for APL patients. All patients submitted to the AML10 and AML13 protocols and those patients submitted to the AIDA protocol with difficult peripheral vein access had a central venous catheter (CVC) sited. Patients treated as in-patients were discharged at the end of consolidation chemotherapy provided they were in a good clinical condition. They were routinely evaluated on an out-patient basis twice weekly. In the event of any complication they were referred to the Emergency Unit of our Department dedicated to out-patients with hematologic diseases.. One hundred and eleven patients with AML were eligible for intensive chemotherapy. After achievement of complete remission they received a total of 133 consolidation courses and in 127 instances they were followed on an out-patient basis during the aplastic phase. There were 69 cases (54%) of rehospitalization, 68 because of fever and only one because of severe anemia. Rehospitalization occurred in 90%,70% and 38% of courses in AML10, AML13 and AIDA protocols, respectively. Only one patient died: the cause of death was a brain hemorrhage. Coagulase negative staphylococci and viridans streptococci were the organisms most frequently isolated from blood. Most coagulase negative staphylococci were isolated in patients submitted to AML10 and AML13 protocols, who had an indwelling CVC. Empiric once-a-day antibacterial therapy with ceftriaxone and amikacin was effective in 75% of the cases and made early discharge possible in 28% of the cases with antibiotic therapy continued in an out-patient setting. Overall, patients were managed out of the hospital for 66% of the period of post-consolidation neutropenia (77%, 48% and 50% of the post-consolidation neutropenia period in patients treated with AIDA, AML10 and AML13 protocols, respectively).. Thanks to the availability of an emergency unit specifically dedicated to out-patients with hematologic diseases, selected out-hospital management of AML patients during post-consolidation cytopenia is a feasible, well accepted and cost-saving option, and can contribute to lower the risk of developing severe nosocomial infections. The empiric therapy with once-a-day ceftriaxone plus amikacin was effective, with the exception of staphylococcal infections, and made it possible to discharge patients early to continue treatment in an out-patient setting.

Topics: Adult; Ambulatory Care; Amikacin; Anemia; Antineoplastic Combined Chemotherapy Protocols; Bacterial Infections; Ceftriaxone; Cerebral Hemorrhage; Clinical Trials as Topic; Drug Therapy, Combination; Emergency Service, Hospital; Fever; Hospitalization; Humans; Immunocompromised Host; Italy; Leukemia, Myeloid; Leukocyte Count; Middle Aged; Mycoses; Neutropenia; Staphylococcal Infections

Selection of appropriate antibiotic treatment for children with acute otitis media (AOM) is challenging. Although the diagnosis is relatively easy for experienced clinicians, the distinction between AOM and otitis media with effusion is often more subtle. In general therapy is empiric and the pathogen causing disease in a given patient remains unknown. However, this situation is made even more difficult by the dynamic nature of the pathogenesis of AOM. Both the proportion of patients infected with one of the three primary pathogens, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, and the antimicrobial susceptibility patterns of these pathogens are changing. Currently there are 16 antibiotics labeled for use in AOM. Only 2 are reliably effective against penicillin-resistant pneumococcus: high dose amoxicillin (80 to 100 mg/kg/day) and im ceftriaxone. Among the others all are beta-lactamase-stable and have proven clinical effectiveness in AOM patients infected with H. influenzae or M. catarrhalis. Even with the high spontaneous resolution rate reported for AOM, antimicrobial therapy remains the standard of care in the United States. Recognition of the fundamental determinants of effective therapy should permit rational antibiotic selection for each patient.

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Decision Making; Drug Resistance, Microbial; Humans; Infant; Otitis Media

Topics: Bacterial Infections; Ceftriaxone; Cephalosporins; Enterobacteriaceae; Humans; Staphylococcus; Streptococcus

Topics: Adolescent; Adult; Ampicillin; Analysis of Variance; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antifungal Agents; Bacterial Infections; Ceftriaxone; Cefuroxime; Child; Child, Preschool; Feces; Graft Rejection; Humans; Infant; Liver Transplantation; Middle Aged; Mycoses; Nystatin; Postoperative Complications; Regression Analysis; Retrospective Studies; Risk Factors; Tobramycin

The Hospital in the Home Unit (HHU) provides home intravenous therapy to acute inpatients. The aim of this audit was to assess the practice of accepting patients for home intravenous therapy directly from the emergency department by describing the frequency and type of clinical conditions managed, and recording the outcome and adverse events of such admissions. Consecutive patient admissions to the HHU directly from the emergency department over a 15-month period were included. The policy of accepting patients for home intravenous therapy from the emergency department will continue. Care with diagnosis and HHU assessment is required. Complications should be expected, and a reliable on-call service is essential.

Topics: Acute Disease; Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cohort Studies; Female; Home Infusion Therapy; Humans; Infusions, Intravenous; Male; Medical Audit; Middle Aged; Treatment Outcome

The purpose of the present study was to retrospectively review the antibiotic therapy of aspiration or tracheostomy-associated pneumonia in 57 neurologically impaired children (NIC). The antimicrobials used were either ticarcillin-clavulanate or clindamycin, which are effective against penicillin-resistant anaerobic bacteria, or ceftriaxone, which is less effective against these organisms. In those with aspiration pneumonia, a satisfactory clinical and microbiological response was observed in 8/9 (89%) patients who received ticarcillin-clavulanate, and 10/11 (91%) who received clindamycin with or without ceftazidime, as compared to 7/14 (50%) who received ceftriaxone (P < 0.05). For those who experienced tracheostomy-associated pneumonia, a positive response to therapy was observed in 5/6 (83%) who received ticarcillin-clavulanate, and 7/7 (100%) who received clindamycin with or without ceftazidime, as opposed to 4/10 (40%) who were treated with ceftriaxone (P < 0.05). The duration of fever was longer in both cases for those who received ceftriaxone. To summarize, this study illustrates the superiority of antimicrobials effective against penicillin-resistant anaerobic bacteria, as compared to an antibiotic without such coverage, in the therapy of aspiration or tracheostomy-associated pneumonia in NIC.

Topics: Adolescent; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Ceftazidime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Clavulanic Acid; Clavulanic Acids; Clindamycin; Female; Fever; Humans; Male; Penicillins; Pneumonia, Aspiration; Pneumonia, Bacterial; Retrospective Studies; Seizures; Ticarcillin; Tracheostomy; Unconsciousness

Outpatient i.v. antibiotic therapy is well developed in the United States, largely because of pressures from third-party payers to reduce costs of medical care. We have developed an outpatient i.v. antibiotic programme in Oxford, that has evolved from a desire to provide high quality i.v. therapy to AIDS patients with cytomegalovirus retinitis. We describe the rationale of the service and report on our first two years' experience. We treated 67 consecutive patients (eight with HIV infection) at home with i.v. antibiotics. This resulted in a saving of 2275 hospital days for those patients without HIV infection. HIV positive patients received 69 months of home i.v. therapy. Minor intravascular catheter complications occurred in only five patients (7.5%). The only serious complications were three episodes of catheter-related sepsis (4.5%), all occurring in AIDS patients who had lines in for more than six months. We have shown that home i.v. antibiotic therapy can be delivered safely to patients with a wide variety of infectious problems using the existing network of community nurses in the National Health Service. Essential components to the programme include a multidisciplinary team working between the hospital and community and a written shared care protocol. Such a programme can result in reduced lengths of hospital stay and patient, community nurse and physician satisfaction.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cost-Benefit Analysis; Cytomegalovirus Retinitis; Ganciclovir; Gentamicins; HIV Infections; Home Care Services; Home Infusion Therapy; Humans; Outcome Assessment, Health Care; United Kingdom; Vancomycin

Topics: Ascitic Fluid; Bacterial Infections; Ceftriaxone; Cephalosporins; Empyema, Pleural; Escherichia coli Infections; Female; Hepatitis C; Humans; Liver Cirrhosis; Middle Aged

We investigated the combination of teicoplanin and ceftriaxone for its bactericidal activity against Staphylococcus aureus, Haemophilus influenzae type b and Streptococcus pneumoniae isolated from bone and joint infections in children. An increase in bactericidal activity was observed against isolates of S. aureus and H. influenzae when the antibiotics were tested at fractional MICs whereas indifference was observed at their MICs. Similar results were obtained at fractional MICs against S.pneumoniae, but the bactericidal activity fell by more than 1 x log 10 cfu/mL when the antibiotics were tested at or above their MICs.

Topics: Bacterial Infections; Bone Diseases; Ceftriaxone; Child, Preschool; Drug Interactions; Drug Resistance, Microbial; Drug Therapy, Combination; Haemophilus Infections; Humans; Infant; Joint Diseases; Microbial Sensitivity Tests; Penicillin G; Pneumococcal Infections; Staphylococcal Infections; Teicoplanin

Topics: Bacterial Infections; Bronchopneumonia; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Cholelithiasis; Female; Humans; Male; Risk Factors; Urinary Tract Infections

Topics: Bacterial Infections; Ceftriaxone; Fever; Neoplasms; Neutropenia; Retrospective Studies; Risk Factors

An open label study was conducted in the department of neurosurgery, Beijing Tiantan Hospital in China to determine the incidence of postoperative infections following the use of one or two doses of ceftriaxone administered perioperatively. A total of 343 patients, who required neurosurgery and had satisfied the inclusion criteria, was recruited during a 12 month study period. Of these 343 patients, there were 97 and 107 cases of malignant and benign tumours, respectively, 52 cases of aneurysm, 34 cases of arteriovenous malformation, and 53 other cases who underwent neurosurgery for drainage of sub-dural haematoma, relief of cerebral oedema and other indications. A total of 6 (1.75%) cases of postoperative infection was observed, of which 4 were found in the malignant tumour group, and 2 in the arteriovenous malformation group. All six patients were suffering from meningitis. During the 12 month period immediately prior to the present study, when postoperative penicillin and gentamicin was administered twice daily for 5-7 days as regular prophylaxis against infection, the incidence of postoperative infection was 7.2% in the same department managed by the same staff. Results of our present study suggest that one to two doses of ceftriaxone administered perioperatively are effective in reducing the rate of postoperative infections.

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Blood-Brain Barrier; Brain; Ceftriaxone; Female; Humans; Injections, Intravenous; Male; Middle Aged; Neurosurgery; Postoperative Care; Staphylococcus

Increased susceptibility to infection is observed in patients with chronic renal failure (CRF). Therefore, when antibiotic therapy is indicated, it is reasonable to use a drug which is usually reserved as a second-choice antibiotic in other patients. Antibiotic prevention before surgical procedures with a high risk of infection, especially before renal transplantation is also often necessary. Evaluation of Biotrakson (ceftriakson) (produced in Poland) efficacy in patients with CRF was the aim of this study. The antibiotic was administered in a single, complete prophylactic dose or once daily when given therapeutically in 25 patients: 13 with end-stage renal disease treated with hemodialysis, 5 with end-stage renal disease treated with peritoneal dialysis, 4 with chronic renal failure, 1 with acute renal failure treated with peritoneal dialysis, 2 after renal transplantation. The antibiotic was given for local and generalised bacterial infections in 10 patients; in 15 the drug was administered prophylactically before serious surgical procedures (including 10 patients before renal transplantation). Resolution of infection was observed in 9 out of 10 treated patients (90%). When the antibiotic was given prophylactically, its efficacy was assessed as good in 8 of 10 patients (80%) after renal transplantation and in 4 of 5 patients (80%) after other surgical procedures. There were no significant adverse side effects in any patient. Biotrakson is, therefore, an effective drug for therapeutic and preventive use in patients with renal failure.

Topics: Adolescent; Adult; Bacterial Infections; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Humans; Infant; Kidney Failure, Chronic; Kidney Transplantation; Peritoneal Dialysis; Premedication; Renal Dialysis

Topics: Bacteria; Bacterial Infections; Ceftriaxone; Drug Resistance, Microbial; Humans

The study included 303 patients subjected to elective cesarean section. Thirty two (11%) patients were classified in group A (with prophylactic ceftriaxone administration), 28 (87.5%) of whom had uneventful postoperative courses and 4 (12.5%) who had complications. Group B (with therapeutical application of ceftriaxone) was composed of 135 (45%) patents, 127 (94.1%) with uneventful postoperative courses and 8 (5.9%) with complications. Group C (in whom other antibiotics were used) consisted of 95 (31%) patients, 72 (75.8%) with uneventful postoperative courses and 23 (24.2%) with complications. Group D (no antibiotics used) was composed of 41 (13%) patients, 31 (75.6%) with uneventful postoperative courses and 10 (24.4%) with complications. Statistical analysis revealed highly significant differences in distribution of complications according to whether any, and which one of the antibiotics was used (X2 = 17.81, p < 0.005). This difference mainly resulted from lower incidence of complications associated with ceftriaxone use than in patients with no antibiotic therapy (X2 = 11.66; p < 0.005) as well as in patients using other antibiotics (X2 = 15.95; p < 0.005). Significant difference was also noted when patients given antibiotics other than ceftriaxone were compared with patients receiving no antibiotics other than ceftriaxone were compared with patients receiving no antibiotic therapy (X2 = 4.45; p < 0.05). Group A of newborns included 17 (89.5%) with high Apgar score, while 2 children (10.5%) had the score below 8. Group B had 2 children (11.7%) with Apgar score below 8, while 15 (88.3%) children had higher scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Bacterial Infections; Ceftriaxone; Cesarean Section; Female; Humans; Infant, Newborn; Postoperative Complications; Pregnancy; Premedication; Treatment Outcome

Twenty-four alcoholic patients with community-acquired pneumonia were studied for 2 years in order to define clinical signs and etiology. Blood cultures and serological profiles were done for all patients in addition to standard blood analyses. All had an invasive procedure -transthoracic puncture with an ultrafine 25G needle (20 patients) or telescopic catheter with bacteriologic brush (4 patients). When we were unable to obtain a good sputum sample (5 patients), a culture was grown. The patients' mean age was 48 and 83% had an acute clinical profile (< or = 7 days with symptoms) with "typical" signs. The X-rays showed an alveolar pattern in all patients, with cavitation in 29%. Etiological diagnosis was reached in 17 (71%) cases, with St. Pneumoniae (25%), anaerobic microorganisms (20%) and C. burnetii (12.5%) being the germs found most frequently. The invasive techniques were more useful (54%) than the blood cultures (17%) or sputum cultures (4%), and they were well tolerated and uncomplicated. Empirical antibiotic treatment was modified for 12 patients (50%). Seventeen percent required intensive care treatment and mortality was 12.5%.

Topics: Adult; Alcoholism; Bacteria; Bacterial Infections; Ceftriaxone; Clindamycin; Community-Acquired Infections; Humans; Male; Middle Aged; Pneumonia; Prospective Studies; Spain

A multi-centre in-vitro study (8625 isolates) was conducted in 13 countries between May and November, 1992 to determine both the current bacterial epidemiology in intensive care and haematology/oncology units and the cross-susceptibility of the organisms to cefpirome, ceftazidime, ceftriaxone, imipenem and piperacillin. Bacterial species with 20 or more isolates resistant to one of the six antibiotics were examined for their susceptibility to the beta-lactams. Cefpirome and imipenem had the smallest total numbers of isolates. Bacteria resistant to ceftazidime or ceftriaxone were often susceptible (> 50%) to cefpirome. Conversely, cefpirome resistant isolates were frequently resistant (> 90%) to ceftazidime and ceftriaxone. P. aeruginosa was an exception, exhibiting cross-resistance to all cephalosporins. beta-lactamase producing Enterobacter, Citrobacter and Klebsiella spp. were especially resistant to piperacillin and ceftazidime but not cefpirome or imipenem. Two-thirds or more of coagulase-negative staphylococci resistant to any single agent, including imipenem, maintained their susceptibility to cefpirome. Cross-class resistance was not exhibited by imipenem and cefpirome against ciprofloxacin resistant isolates but was more evident for piperacillin, ceftazidime and ceftriaxone. Cefpirome was more active than ceftazidime against bacteria resistant to both piperacillin and gentamicin, especially coagulase-negative staphylococci (76% vs. 6%) and Enterobacter spp. (56% vs. 21%). Many coagulase-negative staphylococci and Enterobacter spp. susceptible to cefpirome (50-89%). These results suggest that cefpirome has a potential clinical advantage against gram-positive and gram-negative bacteria resistant to other beta-lactams, including imipenem.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefpirome; Ceftazidime; Ceftriaxone; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Europe; Gram-Negative Bacteria; Gram-Positive Bacteria; Hospital Units; Humans; Imipenem; Intensive Care Units; Microbial Sensitivity Tests; Piperacillin; Prevalence

We report that the results of clinical studies on ceftriaxone (CTRX) in respiratory tract infections (RTIs). Clinical efficacies and side effects of CTRX were as follows; 1. Clinical efficacies of CTRX in a total of 61 cases with RTIs were excellent in 11 cases, good in 23, fair in 11, poor in 12 and unknown in 4. Thus the overall clinical efficacy rate was 59.6%. In cases of patients with lung cancers, the efficacy rate was 42.9%. 2. Clinical efficacy rates with once daily dosage were 50.0% with a dose level of 1 g CTRX and 54.8% with that of 2 g CTRX. 3. Side effects were observed in 2 cases (3.1%) and laboratory abnormalities were observed in 1 case (1.6%). They were not serious, however. These data suggest that CTRX is one of the useful cephalosporins in treatment of RTIs.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Drug Evaluation; Female; Humans; Male; Middle Aged; Respiratory Tract Infections

Topics: Adolescent; Bacterial Infections; Ceftriaxone; Emergency Medicine; Female; Fever; Humans; Infant, Newborn; Male; Patient Admission; Pediatrics; Spinal Puncture

Topics: Age Factors; Aged; Bacterial Infections; Cefazolin; Ceftriaxone; Humans; Research Design; Respiratory Tract Infections

One hundred and one patients undergoing anticancer chemotherapy due to hematologic malignancy were retrospectively divided into two groups: 67 patients were treated with ceftriaxone plus amikacin, receiving once daily (od) 2-4 g ceftriaxone, 1-1.5 g amikacin (those without a peripheral or central venous catheter) and 34 patients with central or peripheral venous catheter (CPVC) receiving ceftizidime 2 g three times daily (tid) plus amikacin 0.5 g tid i.v. Both groups were similar as to their isolated pathogens, localization of infection, and basic diagnoses of hematologic malignancies. There was no significant difference in efficacy between ceftriaxone plus amikacin versus ceftazidime plus amikacin, but the toxicity was lower in once daily ceftriaxone plus amikacin group.

Topics: Amikacin; Antineoplastic Agents; Bacterial Infections; Candidiasis; Catheterization, Central Venous; Catheterization, Peripheral; Ceftazidime; Ceftriaxone; Drug Therapy, Combination; Hearing; Humans; Kidney; Leukemia; Lymphoma; Neutropenia; Retrospective Studies

A study of 534 febrile infants ages 4 to 8 weeks evaluated for sepsis assessed the efficacy of the Milwaukee Protocol (MP) for selecting patients at low risk for serious bacterial infection (SBI) who might benefit from outpatient management. Two groups were compared: 1) Infants with uncompromised presentation (UP) who met all MP criteria received ceftriaxone 50 mg/kg and were discharged, then reevaluated within 24 hours. 2) Infants with compromised presentation (CP) who did not meet MP criteria were hospitalized for antibiotic therapy pending culture results. Of 391 CP patients, 23 (5.9%) had SBI; of 143 UP patients, 1 (0.7%) had SBI (P < .02). The MP criteria had a sensitivity of 96% and a 99% negative predictive value for distinguishing SBI outcome. The only UP patient with SBI was afebrile and had a negative repeat blood culture after 24 hours, and recovered with no complications. Managing UP infants as outpatients avoided 48 to 72 hours of hospitalization, decreasing health-care costs by an estimated total of $465,170.

Topics: Bacterial Infections; Ceftriaxone; Clinical Protocols; Emergency Service, Hospital; Evaluation Studies as Topic; Fever of Unknown Origin; Humans; Infant; Infant, Newborn; Outpatients; Prospective Studies; Risk Factors; Wisconsin

This study examines patients undergoing colorectal surgery for carcinoma, bacteriological data in faecal and systemic immunological data; these patients before surgery received short-term chemoprophylaxis with ceftriaxone (2 g e.v.) and thymopentina (1 phial/day for 15 days) and after surgery thymopentina (1 phial for three time a week). With these data the authors try to create immunomodulation and antibiotic chemoprophylaxis protocol for the reduction of the septic complications due to intestinal bacterial flora and immunological defence reduction.

Topics: Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Colon; Colorectal Neoplasms; Cytokines; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Premedication; Thymopentin; Time Factors

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Bacterial Infections; Ceftriaxone; Female; Gram-Negative Bacteria; Humans; Male; Middle Aged; Spain

Children with community-acquired serious otolaryngologic infections are conventionally hospitalized for parenteral antibiotic therapy. However, effective and safe outpatient therapy is desirable since it is less traumatic and less costly. During a 24-month period outpatient parenteral antibiotic therapy, usually once daily i.m. ceftriaxone, was evaluated in 41 children with serious otolaryngologic infections (acute mastoiditis, complicated otitis media, severe external otitis and severe sinusitis with orbital or periorbital involvement). Daily visits and compliant capable parents were considered essential for outpatient management. Diagnosis, plan for management and daily follow-up evaluations were carried out in cooperation by otolaryngology and infectious disease specialists. Nineteen children (45%) were treated initially in the hospital and 22 children (55%) were treated entirely as outpatients. The mean duration of outpatient treatment, using once daily i.m. ceftriaxone was 5.7 days (range 1-13). The overall clinical cure rate was 98% and no serious side effects were observed. One case of sinusitis-orbital cellulitis relapsed during therapy. Most patients and parents returned to normal life activities within 72 h from starting outpatient therapy. Our data suggest that many children with serious otolaryngologic infections can be managed successfully and safely as outpatients by a combined team of otolaryngology and infectious disease specialists.

Topics: Acute Disease; Ambulatory Care; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Injections, Intramuscular; Otitis; Sinusitis

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Delayed-Action Preparations; Dose-Response Relationship, Drug; Humans; Premedication; Surgical Wound Infection; Time Factors

Topics: Adolescent; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Female; Humans; Infant; Injections, Intramuscular; Male

Authors did the antibiotic-prophylaxis with ceftriaxone in twenty cesarean sections (1 phial EV). Prophylaxis was sufficient in thirteen cases; on the other hand, in the remaining seven prophylaxis was followed by the three days therapy (1 phial EV). A good tolerance of the medicine was revealed in all cases. Moreover, it was tested a wide antimicrobial action with resolution of all the verified infections, except for one bacterial resistance case where some other antibiotic was used.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cesarean Section; Female; Humans; Pregnancy; Preoperative Care; Surgical Wound Infection

Young infants with fever are at risk for serious bacterial infection, but no consensus exists on the optimal approach to diagnosis and treatment. Although the traditional recommendation is always to perform all sepsis tests, including lumbar puncture, and administer intravenous (IV) antibiotics until culture results are negative, recent studies suggest administering intramuscular (IM) ceftriaxone with outpatient follow-up or using laboratory and clinical data to exclude low-risk patients from hospitalization, further testing, and antibiotic treatment. A decision analysis model was used to evaluate six strategies for the diagnosis and treatment of infants aged 28 to 90 days with temperature greater than or equal to 38.0 degrees C. Data from the literature, data from a 1991 study of 503 febrile infants, and direct, short-term costs from the Children's Hospital of Philadelphia were used as model inputs. The model was run for a hypothetical cohort of 100,000 febrile infants who did not require admission for focal infection or for other reasons that clearly necessitated admission. The model included six strategies: (1) no intervention; (2) all sepsis tests (lumbar puncture, blood culture, urine culture, white blood cell count, and urinalysis) followed by hospitalization and IV antibiotics for all infants; (3) all sepsis tests followed by IM ceftriaxone and outpatient management for most infants; (4) blood and urine cultures with white blood cell count and urinalysis followed by either lumbar puncture and IV antibiotics for high-risk infants or outpatient management without antibiotics for low-risk infants; (5) white blood cell count and urinalysis followed by either lumbar puncture, blood and urine cultures, and IV antibiotics for high-risk infants or outpatient management without antibiotics for low risk infants; and (6) clinical judgment followed by either all sepsis tests and IV antibiotics for high-risk infants or outpatient management without antibiotics for low-risk infants. The two "all sepsis tests" strategies prevented the most cases of death or neurologic impairment, 78% (when IV antibiotics were used) and 76% (when IM ceftriaxone was used) of all potential cases. The most cost-effective strategy was to use all sepsis tests followed by IM ceftriaxone for all patients without meningitis, at an incremental cost of only $3900 per sequela prevented relative to no intervention. Strategies under which only those patients selected as high-risk by laboratory

Topics: Ambulatory Care; Bacterial Infections; Ceftriaxone; Cost-Benefit Analysis; Decision Trees; Fever of Unknown Origin; Hospitalization; Humans; Infant; Infant, Newborn; Leukocyte Count; Models, Statistical; Sensitivity and Specificity; Treatment Outcome; Urinalysis

The practice of outpatient intramuscular antibiotic therapy for infants and children at risk for serious bacterial infections is an attractive alternative to hospitalization. The use of this alternative is likely to increase. Pediatric emergency physicians and pediatric residents at our institution were surveyed to determine their knowledge of intramuscular injection techniques. The dorsogluteal site is contraindicated in infants and children, but it was selected for 14 (21%) of the patients presented in the survey. One-inch needles are recommended for children 0 to 24 months of age, but 1 1/2-inch needles were preferred for 13 (30%) of these younger children. A volume of 1 ml to be injected at one site was exceeded 10 (47%) times. Such practices increase the risk for infectious complications and neurovascular and muscle injuries. To avoid these complications, guidelines for pediatric intramuscular injections are presented.

Topics: Ambulatory Care; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Emergency Medicine; Humans; Infant; Injections, Intramuscular; Muscles; Needles

For the treatment of febrile episodes in granulocytopenic cancer patients, a combination of bactericidal and intravenously administered broad spectrum agents is recommended. An aminoglycoside plus a beta-lactame (piperacillin, azlocillin or IIIrd generation cephalosporins) are the drugs of first choice in an empiric approach. Because of frequent parenteral interventions (e.g. catheters, cannulations) in thrombopenic patients with multifactorial immunosuppression, we consider the application of once daily drugs, such as ceftriaxone, netilmicin or amikacin. For single dose treatment (1st day two applications), we used ceftriaxone in combination with netilmicin or amikacin as the first approach and retrospectively evaluated 47 patients for efficacy and safety.

Topics: Adult; Agranulocytosis; Amikacin; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Fever; Humans; Male; Middle Aged; Neoplasms; Netilmicin; Retrospective Studies

To determine the outcome of outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone.. Prospective consecutive cohort study.. Urban emergency department.. Five hundred three infants 28 to 89 days of age with temperatures greater than or equal to 38 degrees C who did not appear ill, had no source of fever detected on physical examination, had a peripheral leukocyte count less than 20 x 10(9) cells/L, had a cerebrospinal fluid leukocyte count less than 10 x 10(6)/L, did not have measurable urinary leukocyte esterase, and had a caretaker available by telephone. Follow-up was obtained for all but one patient (99.8%).. After blood, urine, and cerebrospinal fluid cultures had been obtained, the infants received 50 mg/kg intramuscularly administered ceftriaxone and were discharged home. The infants returned for evaluation and further intramuscular administration of ceftriaxone 24 hours later; telephone follow-up was conducted 2 and 7 days later.. Twenty-seven patients (5.4%) had a serious bacterial infection identified during follow-up; 476 (94.6%) did not. Of the 27 infants with serious bacterial infections, 9 (1.8%) had bacteremia (8 of these had occult bacteremia and 1 had bacteremia with a urinary tract infection), 8 (1.6%) had urinary tract infections without bacteremia, and 10 (2.0%) had bacterial gastroenteritis without bacteremia. Clinical screening criteria did not enable discrimination between infants with and those without serious bacterial infections. All infants with serious bacterial infections received an appropriate course of antimicrobial therapy and were well at follow-up. One infant had osteomyelitis diagnosed 1 week after entry into the study, received an appropriate course of intravenous antimicrobial therapy, and recovered fully.. After a full evaluation for sepsis, outpatient treatment of febrile infants with intramuscular administration of ceftriaxone pending culture results and adherence to a strict follow-up protocol is a successful alternative to hospital admission.

Topics: Ambulatory Care; Bacteremia; Bacteria; Bacterial Infections; Ceftriaxone; Escherichia coli Infections; Feces; Female; Fever; Follow-Up Studies; Gastroenteritis; Hospitalization; Humans; Infant; Injections, Intramuscular; Male; Treatment Outcome; Urinary Tract Infections

Topics: Bacterial Infections; Ceftriaxone; Child, Preschool; Humans; Infant; Infant, Newborn; Premedication

Topics: Aged; Bacteria; Bacterial Infections; Ceftriaxone; Colony Count, Microbial; Female; Humans; Male; Middle Aged; Varicose Ulcer; Wound Healing

Infected pancreatic necrosis was diagnosed clinically and radiologically in a patient admitted for acute pancreatitis. As free gas in the pancreatic area was recognized, antibiotic therapy (ceftriaxone) was empirically introduced, while surgical drainage was being planned. After the second week, the patient rapidly started to improve, to the point that he could be discharged home without operation. Control CT-scans and general laboratory tests, at this phase and later on, confirmed a still enlarged gland but free of infection or ongoing inflammation. Cholelithiasis, which had been identified in an early ultrasound scan, was electively treated by cholecystectomy 2 mo after the onset of pancreatitis, in the absence of sepsis, and with uneventful recovery. This case illustrates the rare possibility of spontaneous regression of infected necrotic pancreatitis, without any type of operation or nonoperative drainage.

Topics: Acute Disease; Aged; Bacterial Infections; Ceftriaxone; Humans; Male; Necrosis; Pancreas; Pancreatitis; Remission, Spontaneous; Tomography, X-Ray Computed

100 febrile patients with chemotherapy-induced neutropenia (less than 0.5 x 10(9)/l) were empirically treated by ceftriaxone (2 g daily in adults, 50 mg/kg daily in children, as a once daily injection) and amikacin (15-20 mg/kg daily). The mean age was 41 years (range 8-72). 51 patients had acute leukemia, 29 non-Hodgkin's lymphoma, 12 Hodgkin's disease, 8 other disorders. 23 febrile episodes were bacteriologically documented (gram-positive: 13 patients; gram-negative: 8 patients; Candida: 2 patients) including 13 cases of bacteremia; 10 were clinically documented, and 67 remained of undetermined origin. Apyrexia was obtained in 39 patients by ceftriaxone plus amikacin alone (success), in 36 patients after the addition of vancomycin and/or amphotericin B (improvement), whereas in the remaining 25 patients it was necessary to substitute the study drug. The failure rate was correlated to the duration of neutropenia: 0/13 when neutropenia less than 6 days; 3/41 (7%) when 6-10 days; 22/46 (48%) when greater than 10 days. Only 2/20 (10%) of patients with neutropenia greater than 20 days were treated with ceftriaxone plus amikacin alone. 9 of the 23 bacteriologically documented episodes were successes (including 6 of the 11 cases due to Staphylococcus), 7 were improvements and 7 were failures (including the 3 cases due to Pseudomonas). No side effects were seen. Ceftriaxone plus amikacin is an effective firstline antibiotic combination in the treatment of febrile neutropenic patients.

Topics: Acute Disease; Adolescent; Adult; Aged; Amikacin; Bacterial Infections; Ceftriaxone; Child; Drug Therapy, Combination; Humans; Leukemia; Lymphoma, Non-Hodgkin; Middle Aged; Neutropenia

The optimal management of fever in granulocytopenic patients remains controversial. This pilot study investigated the potential value of single daily doses of amikacin administered empirically with ceftriaxone in febrile granulocytopenic patients. None of the patients died as a result of infection or toxicity from the prescribed regimen. Serum concentrations failed to show drug accumulation. Modifications of empirical antimicrobial therapy were made at a similar rate to other conventional regimens. Vancomycin seemed to increase the incidence of nephrotoxicity. Overall, this pilot study suggests that empirical therapy with single daily doses of amikacin plus ceftriaxone is safe and effective and should be further investigated in a larger number of patients.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Bacterial Infections; Ceftriaxone; Drug Administration Schedule; Drug Therapy, Combination; Female; Hearing; Humans; Male; Middle Aged; Pilot Projects; Vancomycin

Parenteral ceftriaxone was administered as a once-daily outpatient treatment to a selected low-risk population of neonates, infants, and children with moderate to severe bacterial infections. No incidences of treatment failure were seen in 200 children with uncomplicated infections responsive to ceftriaxone therapy. The mean period of outpatient treatment in initially hospitalized children with non-CNS infections, excluding endocarditis, was 1-3 days. Ceftriaxone outpatient management was successful in the control of organisms causing meningitis (n = 54), periorbital facial cellulitis (n = 16), sinusitis (n = 10), arthritis (n = 6), endocarditis (n = 4), and other infections.

Topics: Ambulatory Care; Bacterial Infections; Ceftriaxone; Child, Preschool; Drug Administration Schedule; Female; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Injections, Intravenous; Male; Meningitis; Sepsis

Topics: Ambulatory Care; Bacterial Infections; Ceftriaxone; Cost-Benefit Analysis; Drug Administration Schedule; Humans; Injections, Intravenous

Since 1981 our physicians' office has developed an outpatient parenteral antibiotic therapy programme which has shown advantages in patient care and provided significant cost savings. While we were able to provide any parenteral antibiotic available, the mainstay of our programme was ceftriaxone because of its broad range of activity, safety, and once-daily administration. Two hundred and ninety cases of outpatient ceftriaxone usage were recorded between January 1989 and March 1990. Ceftriaxone was found to be most useful for bone, soft tissue, and gynaecological infections. Not only was it highly clinically successful, but it was safe to use in the twice-weekly monitoring parameters we routinely perform in our office. The use of ceftriaxone alone during the 15-month period accounted for savings of over US $1.2 million compared to the cost of hospitalization during this period.

Topics: Adolescent; Adult; Aged; Ambulatory Care; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Cost-Benefit Analysis; Drug Therapy, Combination; Female; Humans; Infant; Injections, Intravenous; Male; Middle Aged; Osteomyelitis; Self Administration

The activity of GR69153, a novel catechol-substituted cephalosporin, was compared with those of ceftazidime and ceftriaxone in a multicenter study against 5,203 fresh clinical isolates of gram-negative and gram-positive bacteria. GR69153 was generally very active at concentrations equivalent to or two- to fourfold lower than those of ceftazidime and ceftriaxone against gram-negative bacilli other than Citrobacter freundii, Enterobacter cloacae, and Xanthomonas maltophilia. Against Pseudomonas aeruginosa, MICs of GR69153 and ceftazidime for 50% of isolates tested (MIC50s) were, respectively, 1 and 2 micrograms/ml; the corresponding MIC90s were 4 and 16 micrograms/ml. Although MIC50s of GR69153 for staphylococci were two- to eightfold lower than those of ceftazidime or ceftriaxone, MIC90s against staphylococci and enterococci were greater than or equal to 16 micrograms/ml for all three compounds. Quality control MIC ranges for reference strains are proposed for the broth microdilution method on the basis of the GR69153 data derived from this multicenter study.

Topics: Bacteria; Bacterial Infections; Ceftazidime; Ceftriaxone; Cephalosporins; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests

Topics: Adrenal Cortex Hormones; Ampicillin; Bacterial Infections; Ceftriaxone; Cefuroxime; Child; Chloramphenicol; Dexamethasone; Drug Therapy, Combination; Humans; Meningitis

Prostate biopsy remains the key-test in diagnosing clinically-detected prostatic carcinoma. Easy and efficient, the transrectal approach is credited with major infectious risk. The authors report a conclusive clinical experiment on 180 cases with antibioprophylaxy by injecting a single dose of third generation cephalosporin.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Biopsy, Needle; Ceftriaxone; Humans; Male; Middle Aged; Prostatic Neoplasms

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aminoglycosides; Bacterial Infections; Ceftriaxone; Cost Control; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged

Topics: Aged; Ampicillin; Bacterial Infections; Ceftriaxone; Costs and Cost Analysis; Drug Therapy, Combination; Gentamicins; Humans

Several studies now support outpatient treatment of many serious bacterial infections in children, such as periorbital or buccal cellulitis, urinary tract infection, pneumonia, and abscess. However, an appropriate agent, that is, a third-generation cephalosporin with a long half-life, must be available and its effectiveness properly researched. In addition, children must be free of other illnesses and able to ingest fluids and maintain hydration, and their parents must be willing and able to cooperate with an outpatient treatment regimen. Family physicians can maintain the close patient and family contact needed to facilitate this form of therapy.

Topics: Acute Disease; Ambulatory Care; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cellulitis; Cephalosporins; Female; Humans; Infant; Injections, Intramuscular

Topics: Age Factors; Anemia, Sickle Cell; Anti-Bacterial Agents; Bacterial Infections; Body Temperature; Cefaclor; Ceftriaxone; Cefuroxime; Child, Preschool; Cost-Benefit Analysis; Female; Fever; Humans; Infant; Infant, Newborn; Male; Outpatients; Penicillins

Protein binding, serum kinetics and minimum inhibitory concentrations (MICs) for Staphylococcus aureus were determined for cefoxitin, cefazolin, ceftazidime and ceftriaxone in the rabbit. MICs of cefazolin and cefoxitin were also measured for Escherichia coli. Varying concentrations of the bacteria were administered intradermally to create areas of cellulitis, which were quantified as mean erythematous areas (EAs). Despite large differences in protein binding of the antibiotics (range 12-88%) and antibiotic dosing to allow serum concentrations to drop below the respective MICs, there was no statistical difference in the mean EAs of the animals after bacterial challenge. Antibiotic protein binding did not alter the course of cellulitis nor correlate with bacterial MIC in this model.

Topics: Animals; Bacterial Infections; Biological Availability; Cefazolin; Cefoxitin; Ceftazidime; Ceftriaxone; Cephalosporins; Chromatography, High Pressure Liquid; Escherichia coli Infections; Female; Kinetics; Protein Binding; Rabbits; Staphylococcal Infections

Ceftriaxone, a broad spectrum third-generation cephalosporin with a half-life of six to eight hours, was evaluated prospectively in 147 children with severe community-acquired bacterial pneumonia during the period 11/15/88-5/15/89. Thirty-nine of the children had been unsuccessfully treated with vanous oral antibiotics prior to admission [corrected]. All the patients were initially hospitalized and started on once a day intramuscular ceftriaxone. Mean duration of ceftriaxone therapy was five days. Pathogens were recovered from blood cultures of 17 (11.6%) patients and included S. pneumoniae (13 patients), H. influenzae (three, all resistant to ampicillin) and S. viridans (1) [corrected]. All isolates were sensitive to ceftriaxone. An additional patient had L. pneumophila diagnosed by serology. Cure was achieved in 142 (96.6%) patients; improvement was usually observed within 24-48 hours. After 48 hours, 121 (82.2%) children could be discharged and continued the therapy on ambulatory basis. Based on previous experience we estimated that 383 hospitalization days were saved. No serious side effects were observed. Five patients were considered therapeutic failures; two of them developed empyema and one of them required repeated drainage procedures. A third patient experienced a relapse of pneumonia shortly after completion of therapy. The other two remained febrile for more than seven days; their subsequent improvement was unrelated to the antibiotic therapy, suggesting a viral or mycoplasmal syndrome. Our data suggest that once daily intramuscular ceftriaxone can be successfully used for the outpatient treatment of most community-acquired severe bacterial pneumonias in children. In our opinion it represents the treatment of choice for patients who failed treatment with other antimicrobials and are clinically stable enough not to require hospitalization.

Topics: Adolescent; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Infant; Injections, Intramuscular; Male; Pneumonia; Radiography

Topics: Bacterial Infections; Ceftriaxone; Cefuroxime; Cephalosporins; Cerebrospinal Fluid; Child; Humans; Infant; Meningitis

Topics: Bacterial Infections; Canada; Ceftriaxone; Gonorrhea; Humans; Infant; Infant, Newborn; Meningitis; Pediatrics; Societies, Medical

Topics: Bacterial Infections; Ceftriaxone; Cefuroxime; Cephalosporins; Humans; Meningitis

Topics: Bacterial Infections; Ceftriaxone; Colorectal Surgery; Humans; Premedication

Topics: Bacterial Infections; Ceftriaxone; Cefuroxime; Cephalosporins; Child; Humans; Meningitis

Previously healthy infants younger than 2 months of age without evidence of soft tissue or musculoskeletal infection who had white blood cell counts between 5000 and 15,000/mm3, band form counts less than or equal to 1500/mm3, urinalysis less than or equal to 10 white blood cells/high power field (spun sediment) and stool less than or equal to 5 white blood cells/high power field (if diarrhea) were considered at low risk for a serious bacterial infection. Infants meeting these criteria whose parents were judged to be adequate observers and had a telephone and automobile were eligible for outpatient management. Infants were given ceftriaxone to cover the possibility that the low risk criteria might miss more infants with serious bacterial infections than was predicted. From Jan. 1, 1987 to May 31, 1989, 86 infants younger than 2 months were enrolled. There were no serious complications in these infants. Twelve had transient problems possibly related to the intramuscular ceftriaxone therapy. One low risk infant was hospitalized for Neisseria meningitidis bacteremia and five other infants were hospitalized for medical or social reasons. All six hospitalized infants had short admissions and did well. This study supports the continued use of the low risk criteria to distinguish infants unlikely to have a serious bacterial infection. Furthermore, in a selected group of low risk infants, outpatient management may be an acceptable alternative to inpatient therapy.

Topics: Ambulatory Care; Bacterial Infections; Ceftriaxone; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male

The results obtained after short-term surgical prophylaxis with ceftriaxone in 443 patients of whom 361 operated of choice are reported. In all, only 3 failures were encountered. The drug also proved to be well tolerated and there were no noteworthy side-effects in the treated patients. The effectiveness of prophylactic treatment is attributed to the long half-life of the molecule (about 8 hours) guaranteeing efficient antibacterial cover with just one administration for the whole period that is critical for surgical infections, during and after operation.

Topics: Bacterial Infections; Ceftriaxone; Humans; Premedication; Time Factors

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotetan; Ceftriaxone; Humans; Inpatients; Microbial Sensitivity Tests; Piperacillin

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Patient Selection

Topics: Anti-Bacterial Agents; Bacterial Infections; Bone Diseases, Infectious; Ceftriaxone; Female; Humans; Infusions, Intravenous; Male; Middle Aged

Topics: Anti-Bacterial Agents; Appendectomy; Bacterial Infections; Cefotaxime; Ceftriaxone; Cesarean Section; Female; Humans; Hysterectomy; Pelvic Inflammatory Disease; Pregnancy; Pregnancy Complications, Infectious; Surgical Wound Infection

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefazolin; Ceftriaxone; Colonic Diseases; Digestive System Surgical Procedures; Female; Humans; Infusions, Intravenous; Intraoperative Care; Male; Metronidazole; Middle Aged; Randomized Controlled Trials as Topic; Surgical Wound Infection

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Colonic Diseases; Elective Surgical Procedures; Humans; Ornidazole; Postoperative Complications

The high risk of infection in endourological surgery is caused by manipulation of the occluded and frequently infected upper urinary tract with instruments. The results show a significant decrease of infection by antibiotic prophylasix with ceftriaxone. However prophylaxis is not necessary in ESWL.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Humans; Lithotripsy; Risk Factors

Topics: Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Cesarean Section; Female; Fever; Gynecologic Surgical Procedures; Humans; Postoperative Complications; Pregnancy; Randomized Controlled Trials as Topic; Surgical Wound Infection

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteria; Bacterial Infections; Cefamandole; Ceftriaxone; Cesarean Section; Female; Humans; Hysterectomy, Vaginal; Middle Aged; Pregnancy; Preoperative Care; Surgical Wound Infection

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Bone Diseases, Infectious; Cefazolin; Ceftriaxone; Fractures, Open; Humans; Orthopedic Procedures; Perioperative Care; Surgical Wound Infection

Data are reported of the results of clinical trials of the therapeutic efficacy of longaceph--a drug of the new generation of cephalosporins with a long period of half-decay--in acute pneumonia complicating influenza in 42 patients. The sensitivity of 120 microbial strains to longaceph was also studied. It was established that cephalosporin possesses a high efficacy in diseases caused by gram-positive and gram-negative microorganisms. A high degree of sensitivity to longaceph was observed in pneumococci biogenous and Streptococcus viridans, Staphylococcus aureus and epidermidis, klebsiellae and escherichiae. A new property of longaceph was found, namely, its capacity to stimulate the formation of endogenous interferon.

Topics: Adult; Bacterial Infections; Ceftriaxone; Cephalosporins; Delayed-Action Preparations; DNA; DNA Repair; Drug Evaluation; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Interferons; Lymphocytes; Microbial Sensitivity Tests; Middle Aged; Pneumonia

Sixty-two episodes of bacterial infection were studied in 51 cirrhotic patients. 2 g of ceftriaxone (active ingredient of Rocephin) were given intravenously once daily for 7-10 days. The infections were pneumonia, bacteremia, spontaneous bacterial peritonitis, urinary infection and others. Good responses were seen in 90% of the cases.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Pneumonia; Sepsis; Urinary Tract Infections

We tested the efficacy of a single daily dose of ceftriaxone (active ingredient of Rocephin) for the treatment of severe bacteremic infections in 125 non-neutropenic adult patients. A single daily dose of ceftriaxone ranging from 1 to 4 g was given. Surgical procedures were performed if needed. Seventy-six (60.8%) were males and bacteremia was nosocomially acquired in 45 (36%). Microbiologically proven bacteremia was demonstrated in all patients. The most common microorganisms isolated were Escherichia coli (46 episodes), Streptococcus pneumoniae (17 episodes), Klebsiella pneumoniae, and Haemophilus influenzae, Serratia marcescens, Salmonella sp., and Staphylococcus aureus (9, 7, 6, 6, respectively). The urinary tract was the source of the bacteremia in 45 cases (36%), and the lower respiratory tract in 33 (26.4%). Mean duration of treatment was 10.8 days (range 3-21 days). One hundred and six patients (84.8%) recovered completely, 11 (8.8%) improved, but needed an alternative antibiotic treatment. An alternative treatment was also given to a patient whose condition had initially deteriorated. Seven patients (5.6%) died. Death was directly related to the infection in 2 cases. Three patients (2.4%) developed a superinfection, and 5 (4%) a severe (1 case) or mild (4 cases) adverse effect. In summary, a single daily dose of ceftriaxone proved to be useful for the treatment of selected severe bacteremic infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Sepsis; Urinary Tract 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 our study ceftriaxone plus amikacin were employed as empirical antibiotic therapy. This antibiotic treatment allows for a once daily administration and has a broad spectrum of activity. 21 febrile episodes were treated with an antibiotic regimen of ceftriaxone 50 mg/kg/day and amikacin 30-35 mg/kg/day i.v. An earlier pilot study was carried out in which 47 febrile episodes were treated with an antibiotic regimen of ceftriaxone 80-100 mg/kg/day i.v. and amikacin 30-35 mg/kg/day i.v. in a single dose. The overall response rate was 76% (16/21) and 79% (37/47) for the pilot study. During the treatment no side effects were observed and aminoglycoside related toxicity did not occur. In conclusion, this empiric antibiotic therapy gives a high response rate and allows for a single daily administration.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Humans; Middle Aged

To evaluate the effects of ceftriaxone (CTRX) administered once daily, the biliary concentration of CTRX and daily changes in the bacterial count in bile from an indwelling T-tube were measured concomitantly. The effects on prophylaxis of postoperative infections after biliary tract surgery were also examined mainly due to clinical symptoms. The biliary CTRX levels increased rapidly and were sustained as high as 92.5-219 micrograms/ml in all patients even 24 hours after 2 g of CTRX was infused intravenously once daily. Five of 7 patients whose bile samples were positive for bacteria showed high CTRX levels in bile and almost no bacteria present after treatment. CTRX-sensitive bacteria eliminated 1 or 2 hours after the administration in response to the increase of biliary CTRX levels. The changes in bacteria count of bile may be closely related to CTRX antibiotic activity. As an antibiotic prophylaxis, other 18 patients with biliary diseases received intravenous infusion of 2 g of CTRX once daily for 5-7 days (mean 5.9 days). Thus, once-daily dose treatment of CTRX 2 g may have antibiotic effects on biliary infection and postoperative prophylaxis of biliary infections and it is indicated that the prolonged biliary levels of CTRX are essential for its efficacy.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Bile; Ceftriaxone; Cholecystitis; Colony Count, Microbial; Drug Evaluation; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication

A variety of antimicrobial agents has been shown to induce alterations in the bacterial homeostasis of the human microflora. Although the role of the normal flora is still poorly understood, there is evidence that alterations in the flora have a number of important clinical consequences. The normal flora acts as a natural defence against colonization or infection with pathogens. In addition, the altered flora may assume importance as a reservoir of potential pathogens. Thus, antibiotic-induced colonization predisposes patients to subsequent endogenous infections with these organisms which, in turn, have been rendered partially or totally resistant to formerly highly active agents. Broad spectrum antimicrobials with a high degree of biliary elimination show a marked impact on the faecal flora. Susceptible enteric bacteria are eliminated within 48 hours and are replaced by enterococci and Candida albicans. Recolonization occurs after discontinuation of therapy by multiresistant organisms like Klebsiella/Enterobacter and Pseudomonas. Oral antibiotics also lead to substantial alterations in the composition and resistance patterns of the faecal flora. In clinical medicine we should be aware of the substantial alterations of the human microflora which may accompany the use of antimicrobial agents.

Topics: Administration, Oral; Adolescent; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Candida albicans; Cefoperazone; Ceftriaxone; Child; Child, Preschool; Colony Count, Microbial; Enterobacteriaceae; Feces; Humans; Infant; Infant, Newborn; Intestinal Absorption; Penicillins; Superinfection

Ceftriaxone, a broad-spectrum third-generation cephalosporin with a long half-life, was administered intramuscularly to 23 outpatients who had a variety of infectious diseases. Cure was achieved in 21 of the patients (91%). The results of this study indicate that ceftriaxone is an effective and well-tolerated antimicrobial agent when administered intramuscularly to outpatients with various infections.

Topics: Adult; Aged; Bacterial Infections; Ceftriaxone; Escherichia coli; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Pneumonia; Pyelonephritis; Skin Diseases, Infectious; Staphylococcus aureus; Streptococcus

On the basis of random selection 1 g of Rocephin was given to 36 parturients following Cesarean section to prevent postoperative febrile diseases. The results confirm the role of antibiotic prophylaxis in the prevention of perioperative infections. If only partial prophylaxis may be applied preference has to be given to the so called risk cases.

Topics: Bacterial Infections; Ceftriaxone; Cesarean Section; Female; Humans; Preoperative Care; Risk Factors; Surgical Wound Infection

The efficacy of single-dose (1 g i.v.) ceftriaxone (Rocephin) was evaluated in 175 patients undergoing emergency cesarean section (62 patients) or elective cesarean section (113 patients). The overall rate of postoperative infectious morbidity was 8% (14/175), with 9.6% (6/62) of the group undergoing emergency surgery and 7.0% (8/113) of the patients choosing elective cesarean section.

Topics: Adult; Bacterial Infections; Ceftriaxone; Cesarean Section; Emergencies; Female; Humans; Postoperative Complications; Pregnancy; Premedication

1,480 patients, undergoing elective orthopedic and traumatic surgery, received intragluteal injections of ceftriaxone (Rocephin) to prevent bacterial infections. Postoperative local infections were observed in only 0.5% of the patients. No adverse reactions to the drug were recorded.

Topics: Bacterial Infections; Bone and Bones; Ceftriaxone; Humans; Injections, Intramuscular; Injections, Intravenous; Middle Aged; Postoperative Complications; Premedication; Wounds and Injuries

126 patients with surgical infections of different severity were treated intravenously with ceftriaxone (Rocephin) 2 or 1 g once a day in less serious cases. We did not observe any severe drug reaction; the duration of therapy varied between 1 and 7 days. Ceftriaxone is a very powerful broad-spectrum antibacterial drug. Treatment with a single injection or infusion per day saves costs and avoids hospitalisation: ceftriaxone is thus the ideal antibacterial drug for the ambulatory patient.

Topics: Ambulatory Surgical Procedures; Bacterial Infections; Ceftriaxone; Cephalosporins; Humans; Postoperative Complications; Surgical Wound Infection

Topics: Bacterial Infections; Ceftriaxone; Humans; Premedication

Aeromonas hydrophila as the etiologic agent of endophthalmitis is rare, having only been reported in association with a perforating injury of the eye. We describe a case of isolated spontaneous, endogenous endophthalmitis due to this agent, with no apparent source.

Topics: Aeromonas; Bacterial Infections; Ceftriaxone; Endophthalmitis; Humans; Male; Middle Aged

We prospectively studied 50 paediatric patients (3 months-12 years) who received 50 mg/kg ceftriaxone, i.v. over 20 min every 12 h for 3-14 days. Diarrhoea, as defined by four bowel movements/day for two consecutive days, occurred in 34% (17) of 50 patients. An additional two patients with diarrhoea were excluded due to the presence of enteroviruses. Diarrhoea occurred after 2-14 (8.7 +/- 3.2) doses and persisted for 2-8 (3.1 +/- 1.7) days. The mean number of bowel movements was 1.2/days before diarrhoea and 5.5/day during the period of diarrhoea (P less than 0.001); the mean number of bowel movements was 1.2/day in 33 patients who did not develop diarrhoea. The average time spent for diaper care was 3.8 min/day/patient before diarrhoea compared with 14.8 min/day/patient during days of diarrhoea (P less than 0.001). Two patients were evaluated for Clostridium difficile and findings were negative. Fifteen of 17 with diarrhoea and eight of 33 without diarrhoea required care for diaper rash. Ceftriaxone therapy was not discontinued in any patient. These data should be considered in patients who receive ceftriaxone therapy.

Topics: Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Diarrhea; Humans; Infant; Prospective Studies

Serial abdominal ultrasonography was performed in 37 children being treated with ceftriaxone for serious infections. Biliary concrements developed in 16 patients, causing symptoms in 3, one of whom also had urolithiasis with renal colic and obstructive ureteropyelectasia. After cessation of ceftriaxone treatment, ultrasound abnormalities and symptoms gradually disappeared, with complete sonographic resolution after 2 to 63 days.

Topics: Adolescent; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Cholelithiasis; Diagnosis, Differential; Female; Humans; Infant; Male; Prospective Studies; Ultrasonography; Urinary Calculi

A clinical study and dosages of ceftriaxone were performed during the treatment of 14 ascitic fluid infections. Fourteen cases of ascitic fluid infection were treated with ceftriaxone at doses of 2 grams daily. The isolation of the causative organisms was obtained in 11 out of 14 cases by systematic culture of the ascitic fluid in hemoculture bottles with aerobic and anaerobic medium. Of 11 evaluable infectious episodes ten were cured. Ceftriaxone diffuses rapidly in the ascitic fluid because, within the first hour; mean concentrations were already of 18.6 micrograms/ml largely exceeding the usual MIC for these organisms. A good tolerance for the drug, the well spaced rythm of infections preventing unnecessary parenteral treatment in cirrhotic patients, and its effectiveness against Enterobacteriaceae justify its choice in the treatment of ascitic fluid infections with sensitive organism.

Topics: Aged; Ascitic Fluid; Bacterial Infections; Ceftriaxone; Female; Humans; Male; Middle Aged

Twenty ambulatory patients, living in kibbutzim (communal villages, which have a permanent medical staff) were treated with ceftriaxone 1 g daily I.M. for ten days. These patients suffered from moderate to severe infections which were not life-threatening. Twelve had urinary tract infections (UTI), 3 of which were positive blood cultures. Four patients had soft tissue infections (one with a Group A beta-hemolytic Streptococcus bacteremia). Three patients had respiratory infections, and one elderly patient had Salmonella typhimurium gastroenteritis. All the patients in this series were clinically cured. Three patients with a UTI experienced reinfection. The woman with S. typhimurium gastroenteritis had persistent positive fecal cultures, but was asymptomatic. These 4 patients did not require further antibiotic therapy. The only side effect observed was mild diarrhea in one patient. Two other ambulatory patients with typhoid fever were treated with ceftriaxone 2 g daily I.V. for 10 days with excellent results. Our work showed that ceftriaxone 1 g daily can be a safe and inexpensive antimicrobial choice to shorten or prevent hospitalization.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Bacterial Infections; Ceftriaxone; Female; Humans; Male; Middle Aged

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Blood Vessel Prosthesis; Ceftriaxone; Clindamycin; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Postoperative Complications

We report the pharmacokinetic parameters of ceftriaxone in 11 patients on hemodialysis with end-stage renal disease (ESRD; creatinine clearance less than 5 ml/min/1.73 m2). The patients were studied during the interdialysis period and during 4 h of hemodialysis. The mean age was 53.4 years. After the administration of 1 g of ceftriaxone during a constant intravenous infusion over a 30-min period, t 1/2 was 16.6 h, beta was 0.0418 +/- 0.0106 h-1, VD was 14.5 +/- 3.0 liters/1.73 m2 and Clp was 0.40 +/- 0.05 liters/h for the interdialysis period. Hemodialysis started 24 h after the infusion. The initial plasma ceftriaxone concentration was 68.6 +/- 10.8 micrograms/ml. This value dropped to 40.4 +/- 4.7 micrograms/ml at the end of the 4th hour, indicating a significant 41% decay in blood levels during hemodialysis (p less than 0.001). The t 1/2 decreased to 4.88 h, kel rose to 0.142 +/- 0.0250 h-1 and Clp increased to 1.73 +/- 0.44 liters/h. All values were highly significantly different (p less than 0.001) from those during the interdialysis period. The plasma ceftriaxone concentration of 40.4 +/- 4.7 micrograms/ml at the end of hemodialysis was well within the therapeutic range of the drug. We conclude that ceftriaxone has a moderated increase in t 1/2 in patients with ESRD. Ceftriaxone is significantly dialyzable, however, the plasma concentrations are in the therapeutic range by the end of a 4-hour hemodialysis, 28 h after the administration of the drug. We propose that 1 g given intravenously before each hemodialysis will be sufficient to keep the patient's plasma concentrations within the therapeutic range until the next hemodialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Bacterial Infections; Blood Proteins; Ceftriaxone; Drug Administration Schedule; Female; Humans; Infusions, Intra-Arterial; Kidney Failure, Chronic; Male; Middle Aged; Protein Binding; Renal Dialysis

Ceftriaxone (CTRX), a newly developed cephalosporin antibiotic, was administered to patients with various bacterial infections in the field of obstetrics and gynecology, and the following results were obtained. 1. Two grams of CTRX was administered once daily by drip infusion for a total dosage of 6 g to 20 g to each of 3 cases of intrauterine infection, 1 case of adnexitis, 1 case of intrapelvic infection and 2 cases of infection of the external genitalia. 2. Clinical efficacy of CTRX was good in all cases. No laboratory abnormalities were observed nor subjective or objective adverse reactions occurred during the treatment. The administration of CTRX at a dose of 2 g once daily is a clinically convenient treatment regimen, and its results in satisfactory clinical efficacy.

Topics: Adolescent; Adult; Bacterial Infections; Ceftriaxone; Dose-Response Relationship, Drug; Drug Evaluation; Female; Genital Diseases, Female; Humans; Infusions, Intravenous; Middle Aged

Topics: Bacterial Infections; Ceftriaxone; Humans

Ceftriaxone (CTRX) was administered to the newborn and its clinical effectiveness as well as its blood and cerebrospinal fluid levels were studied. 1. Average blood levels of CTRX 1 hour after single intravenous administration were 39 micrograms/ml in 2 cases receiving about 10 mg/kg, 70 micrograms/ml in 2 other cases receiving 20 mg/kg and 208 micrograms/ml in one receiving 52.6 mg/kg. As is apparent from these cases data, blood levels of CTRX were dose dependent. Blood levels of the drug were between 3.7 to 12.4 micrograms/ml 24 hours later. Half-lives of the drug in blood in the 5 newborns ranged from 7.13 to 10.6 hours. In a 53-day-old patient receiving 43.4 mg/kg of CTRX via intravenous injection, the one-hour blood level of the drug was 140 micrograms/ml and the half-life was 3.68 hours. The blood level of the drug 36 hours after single intravenous administration with 17.3 to 20.0 micrograms/ml to 5 other cases 0 to 5 days of age ranged from 4.6 to 13.7 micrograms/ml. 2. The cerebrospinal fluid level of CTRX 4 hours after intravenous administration with 49.6 mg/kg to cases of Escherichia coli meningitis was 9.7 micrograms/ml on the first day following the start of the treatment. It increased to 23.6, 25.2 and 31.0 micrograms/ml on the third, fourth and fifth days, respectively, and then gradually decreased. Cerebrospinal level was still 5.8 micrograms/ml on the 22nd day during the recovery period. These levels were far more than 1,000 times as much as the MIC for the pathogen at the highest level, and more than 100 times even at the lowest level. 3. CTRX was administered via intravenous injection once or twice a day (11.0-39.5 mg/kg in total) to 13 newborns and 3 infants. The efficacy of CTRX was good to excellent in 10 cases for treatment of 11 diseases (sepsis 1, pneumonia 4, urinary tract infection 4 and fetal infection 2) and all the pathogens (Streptococcus agalactiae 1, E. coli 3, Klebsiella pneumoniae 2, Citrobacter diversus 1) disappeared. In 6 cases where CTRX was used prophylactically, infection did not occur at all. The efficacy was excellent in another newborn with E. coli meningitis intravenously receiving 49.6 mg/kg of CTRX twice daily for 25 days. 4. No adverse reactions were observed. Mild eosinophilia was observed in 4 cases. Follow-up examinations of 3 of the 4 cases showed that these abnormal levels were returned to normal.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacterial Infections; Ceftriaxone; Escherichia coli Infections; Female; Humans; Infant, Newborn; Injections, Intravenous; Male; Streptococcal Infections; Urinary Tract Infections

The therapy of osteomyelitis utilizing 481 courses of intravenous antibiotics in outpatients was analyzed to identify the types of bone infection most frequently treated by this form of therapy. The efficacy of this form of treatment is also discussed.

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefazolin; Cefoperazone; Ceftriaxone; Clindamycin; Female; Humans; Male; Osteomyelitis; Outpatient Clinics, Hospital

Convalescent outpatient parenteral antibiotic therapy with ceftriaxone was evaluated in an uncontrolled study of 101 children with documented serious bacterial infections, including meningitis. Criteria for outpatient therapy were established to assure that risks of complications from the illness were minimal at the time of discharge from the hospital. Daily physician visits and motivated, capable parents were considered essential in outpatient management. Ceftriaxone was given once daily to children with non-central nervous system infections and once or twice daily intravenously to children with meningitis. The mean durations of therapy for children with non-central nervous system infections and with meningitis were 2.4 and 4.6 days, respectively. No child enrolled in this study was readmitted to the hospital for medical or social reasons. Probable complications of treatment included diarrhea in 13% of children with meningitis and in 6% of children with non-central nervous system infections. One child with meningitis developed pseudomembranous colitis. For children who are infected with bacteria that are highly susceptible to ceftriaxone, single daily dose outpatient therapy is a reasonable option for management if a good clinical response to initial treatment is demonstrated and the risks of complications of the disease process are negligible.

Topics: Adolescent; Ambulatory Care; Bacterial Infections; Bacterial Toxins; Blood Bactericidal Activity; Ceftriaxone; Child; Child, Preschool; Clostridium Infections; Diarrhea; Feces; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Prognosis; Prospective Studies

A pharmacokinetic study on ceftriaxone (CTRX) was conducted and the results obtained are summarized as follows. 1. CTRX was given in a dose of 20 micrograms/kg by intravenous bolus injection to 13 neonates, and satisfactory blood concentrations of the drug were achieved. However, since even a once daily administration revealed trough values of 10-20 micrograms/ml, CTRX may accumulate if administered to neonates of low weight. 2. The rate of CTRX transfer to cerebrospinal fluid was 5.7% in a neonate given a dose of 20 mg/kg by intravenous bolus injection. 3. The urinary recovery rate was 8.4% up to 12 hours in a neonate given a dose of 20 mg/kg by intravenous bolus injection.

Topics: Bacterial Infections; Ceftriaxone; Female; Half-Life; Humans; Infant, Newborn; Injections, Intravenous; Male

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoxitin; Ceftriaxone; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Risk Factors; Stomach Diseases

Ceftriaxone (CTRX) was clinically evaluated and its pharmacokinetics studied in neonates. The results obtained are summarized below. 1. Blood levels of CTRX at 8 to 12 hours after intravenous injection with a single dose of 10 to 20 mg/kg ranged from 14.9 to 32.8 micrograms/ml, while T1/2 ranged from 8.2 to 24.8 hours. 2. Blood levels of CTRX at 11 hours after the completion of drip infusion which lasted one hour with a dose level 10 to 20 mg/kg, ranged from 10.6 to 25.0 micrograms/ml, while T1/2 was 5.4 to 22.8 hours. 3. Multiple intravenous administrations were given to premature infants, but blood levels did not show evidence of drug accumulation. 4. Urinary excretion in 6 hours after an intravenous injection or a drip infusion with 10 approximately 20 mg/kg of CTRX ranged from 13.8 to 58.5% of the dosage. 5. The subjects in this study were 9 neonates with suspected sepsis, pneumonia, Staphylococcus epidermidis or Staphylococcus aureus infections (sepsis, staphylococcal scalded skin syndrome, pneumonia), acute bronchitis or meconium aspiration syndrome. Efficacies CTRX were excellent or good in all these cases administered in a daily dose of 19.5 to 41.6 mg/kg for 4 to 11 days. 6. No general side effects or abnormalities were observed in blood count, or hepatic or renal function.

Topics: Bacterial Infections; Ceftriaxone; Drug Evaluation; Female; Humans; Infant, Newborn; Infusions, Intravenous; Injections, Intravenous; Male

Ceftriaxone (CTRX) was clinically evaluated and its pharmacokinetics studied in neonates and premature infants, and the results obtained are summarized as follows. 1. Average blood levels of CTRX after intravenous administration of 10 mg/kg in 3 neonates with birth weights of 2,500 g or more were 45.32 mcg/ml at 15 minutes, 28.91 mcg/ml at 1 hour, 15.76 mcg/ml at 6 hours, and 16.28 mcg/ml at 12 hours, and the half-life was 9.93 hours. The half-life in a newly born premature infant (less than 1 day) was 28.90 hours, and in a premature infant 6 days old it was 12.90 hours. 2. Average blood levels after intravenous administration of 20 mg/kg to 2 neonates aged 0 and 3 days with birth weights of 2,500 g or more, were 129.7 mcg/ml at 15 minutes, 60.94 mcg/ml at 1 hour, 32.04 mcg/ml at 6 hours, and 24.23 mcg/ml at 12 hours, and the half-life was 8.95 hours. The half-life in a newly born premature infant (less than 1 day) was 20.70 hours. 3. Urinary recovery rates of CTRX in 12 hours after intravenous administration of 10 or 20 mg/kg to 6 neonates aged 0 to 3 days (including premature infants) ranged from 13.8 to 50.6%. 4. Clinical efficacies of CTRX were excellent or good in 3 of 4 neonates including infants suspected of having infections (efficacy rate: 75%). 5. As a side effect, diarrhea was noted in 1 case.

Topics: Bacterial Infections; Ceftriaxone; Drug Evaluation; Female; Half-Life; Humans; Infant, Newborn; Infant, Premature; Injections, Intravenous; Male

To 39 neonates and premature infants 1 to 28 days old with various bacterial infections or suspected bacterial infections and were nearing cure-stage via ceftriaxone (CTRX) therapy, CTRX 10 mg/kg or 20 mg/kg was intravenously administered by bolus injection, and the changes in serum concentrations and urinary recovery rates of the drug were examined. Because the number of cases included was small, a comparison study was conducted by classifying them into three groups; less than 4 days old, 4 to 7 days, and 8 days or older, rather than dividing them into groups of neonates and premature infants. Clinical evaluation was conducted in 10 male and 6 female cases 1 to 46 days old, whose diseases comprised 1 case each of purulent meningitis, septicemia, pyothorax, phlegmonous cellulitis, and staphylococcal scalded skin syndrome, plus 5 with bronchopneumonia and 6 with urinary tract infection. 1. Changes in serum concentrations and urinary recovery rates (1) Intravenous bolus injection of 10 mg/kg: Serum concentrations in all three groups were the highest immediately after the drug administration, ranging from 32.3 to 35.9 micrograms/ml, with no significant differences noted among the groups. The levels gradually declined thereafter in all groups; to 12.7 to 18.3 micrograms/ml at 6 hours and 8.4 to 13.2 micrograms/ml at 12 hours. Averaged blood half-lives of CTRX were 11.3, 8.8, and 17.3 hours. The urinary recovery rates in the first 6 hours in the 3 groups were 31.0, 27.9, and 26.0%, respectively. (2) Intravenous bolus injection with 20 mg/kg: Serum concentrations were the highest immediately after the drug administration in all 3 groups, ranging from 56.5 to 73.1 micrograms/ml. The levels gradually declined thereafter in all groups, but remained rather high at 17.9 to 21.1 micrograms/ml at 6 hours and 13.2 to 16.8 micrograms/ml at 12 hours. The older the patients were, the shorter the serum half-lives of CTRX were: 25.5 hours in the less than 4 day old group, 11.7 hours in the 4 to 7 day old group, and 10.5 hours in the 8 days or older group. The urinary recovery rates in the first 6 hours in the 3 groups were 25.5, 22.3, and 21.8%, respectively. 2. Clinical results Clinical evaluation was made in 16 cases. CTRX at 11.9 to 60.0 mg/kg/day, was administered once daily or in 2 divided doses, daily. In all cases, including those with presumed severe infections that included 1 case each of purulent meningitis, septicemia and pyothorax, the efficacy was good or excel

Topics: Bacterial Infections; Ceftriaxone; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Premature; Injections, Intravenous; Male

1. Ten neonates 0 to 28 days old (gestation: 37-42 weeks; birth weight: 2,160-3,640 g) received 20 mg/kg CTRX (8 cases) or 10 mg/kg (2 cases) by intravenous bolus injection, while 9 infants 35 days to 9 months old (gestation: 37-43 weeks; birth weight: 2,800-3,560 g) received 20 mg/kg by intravenous bolus injection, and their blood drug concentrations and urinary drug excretions were examined. Average blood levels of CTRX in the 20 mg/kg dosage group were 114 +/- 14.6 micrograms/ml at 30 minutes, 109 +/- 12.8 micrograms/ml at 1 hour, 100 +/- 12.6 micrograms/ml at 2 hours, 87.9 +/- 15.8 micrograms/ml at 4 hours, 72.8 +/- 15.3 micrograms/ml at 6 hours, and 50.1 +/- 12.3 micrograms/ml at 12 hours in the neonates; and 113 +/- 20.0 micrograms/ml at 30 minutes, 101 +/- 14.7 micrograms/ml at 1 hour, 83.6 +/- 9.3 micrograms/ml at 2 hours, 70.3 +/- 10.7 micrograms/ml at 4 hours, 56.9 +/- 8.6 micrograms/ml at 6 hours, and 35.7 +/- 9.2 micrograms/ml at 12 hours in the infants. Average half-lives of CTRX in blood were 10.3 +/- 4.5 hours in the neonates, and 6.6 +/- 1.9 hours in the infants. Average blood concentrations of CTRX in the 10 mg/kg dosage neonate group were 63.8 +/- 6.0 micrograms/ml at 30 minutes, 57.8 +/- 2.5 micrograms/ml at 1 hour, 53.5 +/- 0.7 micrograms/ml at 2 hours, 41.8 +/- 7.4 micrograms/ml at 4 hours, 32.4 +/- 5.9 micrograms/ml at 6 hours, and 20.8 +/- 1.1 micrograms/ml at 12 hours, and the half-life was 7.2 +/- 0.4 hours. These results suggest that blood concentrations are apparently dose-related in the neonate period; that the peak levels of the neonate and infant groups were similar (the levels at 30 minutes) not showing a relationship to age, gestation period or to birth weight; and that the higher the age was the shorter the half-life became with the half-life in the one week old group was 1.5 times as long as that in the older infant group. The half-life in the younger infant group, however, was similar to that in the older infant group. Urinary excretion was examined in 4 neonates and 2 infants. Average urinary recovery rates in 12 hours after intravenous injection were 40.8 +/- 8.3% in the neonate group and 44.8 +/- 12.8% in the infant group, showing that CTRX is excreted well even in the neonate period.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacterial Infections; Ceftriaxone; Drug Evaluation; Female; Half-Life; Humans; Infant, Newborn; Injections, Intravenous

Following a one shot injection with ceftriaxone (CTRX) 10 mg/kg or 20 mg/kg into 23 neonates (1 to 24 days old) including premature infants, plasma levels of CTRX were measured up to 12 hours post-dose in some cases and up to 72 hours post-dose in others and also urinary levels and urinary recovery rates were determined up to 12 hours post-dose. Furthermore, clinical, bacteriological and infection-prophylactic effects of CTRX were evaluated by the intravenous administration with the mean dose of CTRX of 47.7 mg/kg once daily or half the dose twice daily for 9 days on the average into 46 infants (0 to 6 months old) including neonates and premature infants; i.e., 21 cases with actual or suspected bacterial infections for the evaluation of clinical and bacteriological effects and 25 without bacterial infection for the evaluation of prophylactic effects against bacterial infection. The safety of CTRX was evaluated in 53 cases including 7 which were omitted from the efficacy evaluation due to adverse reactions and also in some cases from clinical laboratory parameters. The following is a summary of the results obtained: 1. Following the administration with CTRX 10 mg/kg into each of the neonates 6, 12, 13 and 21 days old (the 21 old one was premature), plasma levels of CTRX in these subjects reached their peaks at 5 minutes post-dose at levels of 59.38, 53.13, 37.50 and 50.00 micrograms/ml, respectively. The peak levels were similar to each other with an exception of the rather low level in the 13 day-old neonate. The plasma half-life times of CTRX in these subjects were 9.762, 7.775, 7.330 and 8.149 hours, respectively: The younger the infant the longer the half-life tended to be except the premature cases. Similarly, the younger the infant the larger the AUC was except for the premature case with the AUC values of 511.169, 324.714, 236.346 and 326.825 micrograms.hr/ml, respectively. The Vds were 0.709, 1.004, 1.316 and 0.696 liters, respectively, and the value for 13 day-old neonate was the largest. Urinary levels of CTRX reached between 42.00 and 298.30 micrograms/ml at some time within 12 hours post-dose in any cases. Urinary recovery rates in 12 hours post-dose were 79.98, 52.00, 56.82 and 60.14%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacteria; Bacterial Infections; Ceftriaxone; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Premature; Injections, Intravenous; Male

Ceftriaxone (CTRX) was studied for its efficacy and safety in 8 cases of infection during the perinatal period; 6 before, and 2 after delivery. The results obtained are recognized as follows: 1. CTRX was administered by intravenous drip infusion at a daily dose between 2 and 4 g for 2 to 10 days (a total dose: 4 to 20 g) each of 8 cases of infections during the perinatal period; 3 of amniotic fluid infection and 1 each of intrauterine infection, puerperal fever, puerperal wound infection, appendicitis and pyelonephritis. CTRX was evaluated to be very effective in 3, effective in 3 and ineffective in 2, with an efficacy rate of 75% (6/8). 2. Two strains of Enterococcus faecalis and 1 each of Pseudomonas cepacia and Streptococcus intermedius were isolated. All of them were eradicated by the CTRX treatment bacteriologically. 3. No adverse reactions were observed subjectively or objectively. A slight transient elevation of GOT, GPT and Al-P was observed in 1 case. No abnormal sign was observed in neonates.

Topics: Adult; Bacteria; Bacterial Infections; Ceftriaxone; Drug Evaluation; Female; Humans; Infusions, Intravenous; Pregnancy; Pregnancy Complications, Infectious; Puerperal Infection

Ceftriaxone treatment (50 to 80 mg/kg once daily) was given to 201 children between 1 month and 18 years of age. There were 201 serious bacterial infections, including epiglottitis, pneumonia, cellulitis, osteomyelitis, septic arthritis, pyelonephritis, sepsis, and meningitis. The common pathogens responsible for pediatric infections isolated from these patients included Haemophilus influenzae, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, and Escherichia coli. The overall clinic cure rate was 94%. Ten patients were clinically improved but not cured. There were two clinical failures. Bacteriologic failure occurred in six patients. The overall bacteriologic cure rate was 97%. Twenty patients (10%) experienced adverse effects; none required discontinuation of therapy. The efficacy, safety, spectrum, and convenience of ceftriaxone monotherapy make this antimicrobial agent a candidate for the treatment of choice of selected serious pediatric infections.

Topics: Adolescent; Bacterial Infections; Ceftriaxone; Cellulitis; Child; Child, Preschool; Humans; Infant; Meningitis; Pseudomonas Infections

Topics: Bacterial Infections; Ceftriaxone; Cote d'Ivoire; Humans; Outpatient Clinics, Hospital

Ceftriaxone was used in 24 medical intensive care patients to treat 8 pulmonary infections, 12 septicaemias, 3 urinary tract infections, 1 meningitis. It was administered at a single intravenous dose of 2 g every 24 h. The therapy was successful, clinically and bacteriologically in 16 patients. The reasons of the failures are analysed. Plasma concentrations were obtained: they demonstrate that ceftriaxone is effective when given once a day in most cases.

Topics: Adult; Aged; Bacterial Infections; Ceftriaxone; Female; Humans; Kinetics; Lung Diseases; Male; Meningitis; Middle Aged; Resuscitation; Urinary Tract Infections

From 1984 to 1986, 13 patients (10 adults, 3 children) with bacterial meningitis following neurosurgery or traumatism were given ceftriaxone alone 6 times at a dose of 40 mg/kg one IV injection per day, or in association 7 times with fosfomycin at a dose of 200 mg/kg/day, 3 IV perfusions every 4 h. The bacteriological diagnosis was confirmed in 9 cases (3 Staphylococcus aureus, 4 Streptococcus pneumoniae, 1 Klebsiella, 1 Peptococcus). In vitro neither synergy nor antagonism were observed between the two antimicrobial agents. The acute infections episode resolved in all patients except on who died with a negative CSF culture. One superinfection meningitis with Achromobacter was seen. CSF concentrations of ceftriaxone were assayed and found to be comparable with those reported by most authors. Tolerance was excellent for all our patients.

Topics: Adult; Bacterial Infections; Ceftriaxone; Child; Drug Therapy, Combination; Fosfomycin; Humans; Meningitis; Neurosurgery; Postoperative Complications; Skull Fractures

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Clindamycin; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Netilmicin; Nitroimidazoles; Ornidazole

Topics: Bacterial Infections; Ceftriaxone; Humans

Topics: Bacteria; Bacterial Infections; Ceftriaxone; Humans; Microbial Sensitivity Tests; Peritonitis; Pneumonia; Urinary Tract Infections

Topics: Bacterial Infections; Cefoperazone; Ceftizoxime; Ceftriaxone; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Neoplasms

Two newly described quaternary heterocyclylamino beta-lactams, L-642,946 and L-652,813, were shown to exhibit potent activity against a broad spectrum of aerobic and anaerobic bacteria in vitro. The activity of these agents in vitro translated well to chemotherapeutic activity in experimental bacteremias in mice. Substitution of the thiadiazine moiety of L-642,946 with a triazine moiety effected a marked change in the pharmacokinetics of the new derivative, L-652,813. In mice given a 20 mg/kg subcutaneous dose, the peak serum concentration and the half-life of L-652,813 were about three times greater than those of L-642,946 and the area under the serum concentration/time curve was increased by about 5-fold. The pharmacokinetics of L-652,813 in mice and in rhesus monkeys more closely resembled those of ceftriaxone which carries the same triazine moiety on the C-3 side chain.

Topics: Animals; Anti-Bacterial Agents; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Ceftriaxone; Cefuroxime; Cephalosporins; Chemical Phenomena; Chemistry; Female; Macaca mulatta; Male; Mice; Microbial Sensitivity Tests

Topics: Ambulatory Care; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Costs and Cost Analysis; Drug Evaluation; Home Care Services; Hospitalization; Humans; Infant; Infant, Newborn; New York; Retrospective Studies

Topics: Administration, Oral; Bacterial Infections; Ceftriaxone; Colon; Drug Therapy, Combination; Erythromycin; Gentamicins; Humans; Infusions, Intravenous; Metronidazole; Neomycin; Postoperative Complications; Premedication; Random Allocation; Rectum

Topics: Adult; Bacterial Infections; Burns; Ceftriaxone; Female; Half-Life; Humans; Male; Prospective Studies

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Child; Costs and Cost Analysis; Humans

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Cephalosporins; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Risk; Stomach Diseases; Time Factors

Thirty-one infants and children aged 1 month to 15 years 3 months were treated with ceftriaxone once a day for the treatment of a meningitis related to Neisseria meningitidis (19 cases), haemophilus influenzae (7 cases), streptococcus pneumoniae (1 case), not identified bacteria (4 cases). All identified bacteria were sensitive to ceftriaxone. Twenty children were treated with 100 mg/kg/day, 11 with 50 mg/kg/day. CSF was sterile at the first control-generally performed 30 h after the onset of treatment-in all cases. Despite a great number of severe forms (fulminans purpura and septic shock; 11 cases; severe neurologic disturbances: 6 cases), all patients survived and recovered after a treatment of 9 to 22 days. Two infants exhibited neurologic sequelae: deafness, delayed development and hydrocephalus. Tolerance to ceftriaxone appeared to be good. With a 100 mg/kg/day dosage, mean CSF level at 6 h was 3.3 mg/l (0.8-7.7), on the first day of treatment. At the end of treatment, mean CSF level at 24h was 0.47 (0.15-2.5). With a 50 mg/kg/day dosage, mean CSF level at 6 h was 2,1 mg/l (1.1-3.9) in the first day of treatment. At the end of the treatment, mean CSF level at 24h was 0.22 mg/l (0.08-0.5). Once a day administration of ceftriaxone is adequate for the treatment of meningitis in infants and children. Though a 50 mg/kg/day dosage is probably sufficient in most cases, it seems to be more secure to use a 100 mg/kg/day dosage.

Topics: Adolescent; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Humans; Infant; Meningitis; Microbial Sensitivity Tests; Time Factors

Topics: Bacterial Infections; Ceftriaxone; Child; Humans; Infant; Infant, Newborn; Meningitis; Outpatients

Ceftriaxone (CTRX) was studied regarding its penetration into the adnexa uteri and uterine tissues, as well as its utility and safety in the treatment of patients with obstetric and gynecologic infections. The results obtained are summarized below. 1. When 1 g of CTRX was administered by intravenous bolus injection, Cmax in tissues of adnexa uteri and uterus ranged from 42.2 to 80.5 micrograms/g, Tmax ranged from 0.42 to 0.81 hour, and the AUC ranged from 314.9 to 606.9 micrograms.hr/g. Thus, drug penetration into these tissues was good. 2. Clinical efficacy of CTRX was evaluated in 29 obstetric and gynecological patients. The clinical efficacy was good in all cases. 3. Bacteriological effects of CTRX were very good, and 90% of the organisms isolated before treatment were eradicated. 4. Laboratory testing revealed an occurrence of mild eosinophilia in 1 case.

Topics: Abortion, Septic; Abscess; Adult; Bacterial Infections; Bartholin's Glands; Ceftriaxone; Endometritis; Fallopian Tube Diseases; Female; Genital Diseases, Female; Humans; Middle Aged; Obstetric Labor Complications; Ovarian Diseases; Pelvic Inflammatory Disease; Pregnancy

Cefonicid (Monocid) and ceftriaxone (Rocephin) are long half-life cephalosporins that may be used for serious infections in the outpatient setting. They may be used as an extension of initial hospital treatment, or therapy can be initiated and completed in many cases with the patient remaining at home. Sufficient clinical experience exists with both ceftriaxone and cefonicid to recommend these agents for selected patients having pyelonephritis, osteomyelitis, or soft tissue infections. Cefonicid, perhaps in combination with erythromycin, will provide excellent coverage for complicated community-acquired pneumonias. Ceftriaxone is effective as single-dose therapy for even complicated gonococcal infections. The use of long half-life cephalosporins in ambulatory practice may result in substantial cost savings for certain patients.

Topics: Ambulatory Care; Bacterial Infections; Cefamandole; Cefonicid; Ceftriaxone; Cellulitis; Cephalosporins; Gonorrhea; Half-Life; Humans; Injections, Intramuscular; Osteomyelitis; Pyelonephritis; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Meningitis

Topics: Abdomen; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Nitroimidazoles; Ornidazole; Surgical Wound Infection

A murine model of peritonitis allowing detection and quantification of in-vivo acquired resistance during short term therapy has been used in order to evaluate the capacity of antimicrobial combinations to limit emergence of resistance, as compared to individual components of the regimens. Mice were challenged intraperitoneally with 10(8) cfu of bacteria. Two hours later, a single antibiotic dose was injected subcutaneously: amikacin (15 mg/kg), ceftriaxone (50 mg/kg), pefloxacin (25 mg/kg), amikacin + ceftriaxone, amikacin + pefloxacin or ceftriaxone + pefloxacin. Escherichia coli and Staphylococcus aureus never became resistant. Single drug therapy yielded resistant mutants in Enterobacter cloacae, Serratia marcescens, Klebsiella pneumoniae and Pseudomonas aeruginosa as follows: 74% of ceftriaxone-treated animals, 57% of pefloxacin treated animals and 27% of amikacin treated animals. All the tested combinations reduced the frequency of in-vivo acquired resistance produced by single drugs, and no combination selected resistance when the separate agents of the combination did not. Combining antimicrobial agents limits the risk of emergence of resistance during antibiotic therapy.

Topics: Amikacin; Animals; Bacteria; Bacterial Infections; Ceftriaxone; Drug Resistance, Microbial; Drug Therapy, Combination; Enterobacter; Escherichia coli; Female; Kanamycin; Klebsiella pneumoniae; Mice; Norfloxacin; Pefloxacin; Peritonitis; Pseudomonas aeruginosa; Serratia marcescens; Staphylococcus aureus

The efficacy of ceftriaxon (Rocephin Roche) therapy has been studied by our team in two groups of patients. The first one consisted of 10 children suffering from a diffuse purulent appendical peritonitis brought about by a mixed aerobe and anaerobe microbial flora, the second one comprising 7 patients with severe infections caused by problematic aerobe pathogens. The clinical effect of the treatment was good in 16 out of the 17 cases, in one patient it could not be evaluated. Even though a high degree of sensitivity to Rocephin could be demonstrated bacteriologically by the disc method in all the aerobe germs present, the results of titration of the bactericide capacity of the sera during treatment indicate the need for laboratory monitoring of the course of therapy of severe infections due to pseudomonas aeruginosa. Parenteral administration of Rocephin was well tolerated and the laboratory alterations seemin the course of therapy of severe infections due to Pseudomonas aeruginosa. Parenteral administration of Recephin was well tolerated and the laboratory alterations seen in the postoperative ileus due to strangulation and adhesions--cannot be recommended.

Topics: Adolescent; Adult; Bacterial Infections; Blood Bactericidal Activity; Ceftriaxone; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Peritonitis; Suppuration; Urinary Tract Infections

Topics: Adult; Aged; Bacterial Infections; Blood Vessel Prosthesis; Ceftriaxone; Drug Evaluation; Female; Humans; Male; Middle Aged; Premedication

Ceftriaxone (CFX) is a new third-generation cephalosporin with interesting characteristics as regards both its antibacterial spectrum and kinetics which make it potentially useful in the empiric treatment of infections in neutropenic cancer patients. However, since its kinetic characteristics in children with leukemia are not known and its pharmacokinetics are reported to be altered in such patients, we studied ceftriaxone's activity in ten leukemic children with fever and neutropenia. Our findings seem to be confirm the potential efficacy of the drug also in this particular type of patient.

Topics: Agranulocytosis; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Fever; Half-Life; Humans; Injections, Intravenous; Kinetics; Leukemia, Lymphoid

Thirty patients (17 male, 13 female; age 17 to 84 years; normal renal function in 23 cases) with severe bacterial infections were treated with ceftriaxone. The infections was septicemia in 20 cases, a septicemia-like condition in 2 and a focal infection in 8 (2 abscesses of the lung, 2 pyelonephritis, 1 abscess of the liver, 1 subphrenic abscess, 1 meningitis developed from an abscess of the brain and 1 acute intestinal infection). 25 infections were bacteriologically documented, with recovery of the following pathogens: 20 Gram negative rods (including 10 E. coli) that were all susceptible to ceftriaxone (MIC = 0.02 to 0.5 mg/l) except 2 (1 Pseudomonas and 1 E. cloacae), 5 susceptible Gram positive cocci (3 Pneumococcus, 1 Streptococcus and 1 Staphylococcus epidermidis) and 3 susceptible anaerobes (2 B. fragilis and 1 B. melaninogenicus). Ceftriaxone was given alone in 15 cases and in association with another antibiotic in 15 cases (aminoglycoside in 10 cases, nitroimidazole in 4 and fosfomycin in 1). The dose of ceftriaxone was 1 to 2 g per day in 28 cases, 3 g per day in 1 case (meningitis with abscess of the brain) and 1 g every other day in 1 case (chronic renal failure under hemodialysis). Duration of treatment ranged from 10 to 62 days (average 17 days). The usual routes of administration were IV and IM; the SC route was used on 4 occasions. Pharmacokinetic studies of serum levels were carried out in several patients including two who had ceftriaxone subcutaneously; results were consistent with those previously reported in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Drug Evaluation; Drug Therapy, Combination; Female; Focal Infection; Humans; Male; Middle Aged; Sepsis

16 patients with bacterial meningitis following a neurosurgical procedure were given a combination of ceftriaxone and fosfomycin. 8 microorganism were isolated: 2 Staphylococcus epidermidis, 1 Staphylococcus aureus, 1 Neisseria meningitidis, 1 Streptococcus pneumoniae, 1 Haemophilus influenzae, 1 Serratia marcescens and 1 Aeromonas hydrophila. No pathogen was identified in the remaining cases. All of the isolated strains were susceptible to both antibiotics. In vitro, neither synergy nor antagonism were observed between the two antimicrobial agents. The acute infectious episode resolved in all patients. One relapse only was observed, in a patient with meningitis related to a ventricular shunt, and successfully treated by the same therapeutic schedule associated with removal of the tubing. Lastly, CSF concentrations of both antibiotics were assayed and found to be comparable with those reported by most author.

Topics: Adult; Bacterial Infections; Blood-Brain Barrier; Ceftriaxone; Drug Combinations; Female; Fosfomycin; Humans; Male; Meningitis; Neurosurgery; Postoperative Complications

Excretion of an antibiotic bile may result in high intraintestinal concentrations and thus alteration in the fecal flora. We investigated the effect of ceftriaxone (45% biliary excretion) and cefotaxime (less than 5% biliary excretion) on the aerobic fecal flora. Ceftriaxone eradicated susceptible enteric organisms and resulted in overgrowth of Candida spp. and resistant enterococci. In some patients multiresistant gram negative bacteria appeared during of after therapy. Cefotaxime had a moderate effect on fecal microecology and did not promote the emergence of resistant organisms.

Topics: Bacteria; Bacterial Infections; Bile; Cefotaxime; Ceftriaxone; Child; Drug Resistance, Microbial; Feces; Humans

Topics: Abdomen; Adolescent; Adult; Aged; Bacterial Infections; Ceftriaxone; Child; Humans; Middle Aged; Premedication; Time Factors

The authors report their experience with prophylactic antibiotic therapy by Ceftriaxone in 30 cases of digestive surgery, the advantage of this new 3rd generation cephalosporin is that only one injection every 24 hours is quite efficient.

Topics: Aged; Bacterial Infections; Ceftriaxone; Digestive System Surgical Procedures; Female; Gram-Negative Bacteria; Half-Life; Humans; Male; Middle Aged; Postoperative Complications; Premedication

Topics: Adolescent; Ampicillin; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Chloramphenicol; Humans; Infant; Meningitis; Penicillin G

A total of 24 pediatric patients with a diagnosis of meningitis, confirmed by positive CFS culture, were enrolled in the study. All patients received ceftriaxone in different doses. No difference in clinical outcome was found between the patients who received ceftriaxone twice a day and the 11 who received the drug as a single daily dose. The latter dosage proves to be preferable. The therapeutic outcome in this series of patients was 22 cured and 2 failures. Bacteriological and pharmacokinetic findings are discussed.

Topics: Bacterial Infections; Ceftriaxone; Female; Glucose; Humans; Infant; Infant, Newborn; Male; Meningitis

Topics: Adult; Aged; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Ornidazole

Topics: Adolescent; Adult; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Meningitis; Middle Aged

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Cefuroxime; Drug Administration Schedule; Humans; Infant; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal

Ceftriaxone a third generation Cephalosporine exhibits a high degree of antimicrobial activity against the most common pathogens causing life threatening infections in premature and newborn infants. Ceftriaxone was used therapeutically in 16 premature and newborn infants with proven or suspected bacterial infections. Pharmakokinetic investigations were performed during this therapeutic trial. 0.1 ml of blood was taken at 2, 6 and 10 hours after intravenous administration of 50 mg/kg BW Ceftriaxone administered as a single daily bolus injection. Again on day two and four 2 hours after readministration of the same dose, serum concentrations were determined by a biologic test method. With these five samples only, we were able to calculate all clinically relevant pharmakokinetic parameters. There was a high degree of agreement between the experimentally determined and the calculated parameters. Premature infants showed a lower Cmax (115 micrograms/ml) which corresponded to the higher volume of distribution of 44% in this age group. Newborn infants in contrast showed a Cmax of 129 micrograms/ml corresponding to a volume of distribution of 39%. The halflife of elimination was 10.4 and 9.6 hours resp. for premature and mature newborn infants. Cumulation of the drug was seen during the first two days of treatment. A steady state however ensued on day three in both age groups after which no further increase in maximum serum concentrations was seen. Our data suggest, that 50 mg/kg BW once daily given intravenously by bolus-injection or short infusion over 30 minutes constitutes sufficient therapy for serious bacterial infections in premature and newborn infants with susceptible organisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Birth Weight; Ceftriaxone; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Injections, Intravenous; Kinetics; Metabolic Clearance Rate; 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

Experience with the use of first-generation cephalosporins in bacterial meningitis has been disappointing; low concentrations were obtained in the cerebrospinal fluid, and therapeutic failures were encountered. Of the second-generation cephalosporins cefamandole, cefuroxime, and cefoxitin, only cefuroxime has proved efficacy in meningitis caused by meningococci, pneumococci, or Hemophilus influenzae. The third-generation cephalosporins offer new advantages in the treatment of meningitis because they are active at the cerebrospinal fluid concentrations obtainable. Cefotaxime has produced high cure rates in patients with meningitis caused by meningococci, pneumococci, or H. influenzae. Several controlled comparative studies indicate that ceftriaxone is as effective as conventional treatment in therapy for neonatal or childhood meningitis caused by Streptococcus agalactiae, Escherichia coli, or H. influenzae. Moxalactam has been found in uncontrolled studies to be effective when the cause was enteric gram-negative bacilli. Ceftazidime is a new cephalosporin with a high degree of beta-lactamase stability and a broad antibacterial spectrum, which includes Pseudomonas aeruginosa that enters the cerebrospinal fluid. Data from 29 patients who received ceftazidime as monotherapy for bacterial meningitis showed an overall cure or improvement rate of 75.9 percent. Therapy failed in three patients with meningitis caused by gram-positive organisms (Staphylococcus aureus, S. epidermidis, S. agalactiae), and in three with gram-negative organisms. Of 14 patients with Pseudomonas meningitis, 11 showed a cure, as did six of six patients with meningitis caused by Enterobacter, Serratia, or Acinetobacter. More, preferably controlled, studies of the efficacy of ceftazidime in the treatment of meningitis should be undertaken.

Topics: Adult; Animals; Bacterial Infections; Cefoperazone; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Disease Models, Animal; Humans; Meningitis

Ceftriaxone administered as a single daily dose of 50 mg/kg was evaluated in the treatment of 35 children with a variety of nonmeningitic bacterial infections. In two of the patients, the drug was discontinued before the response to the drug could be evaluated. All of the remaining patients had a satisfactory response. In 22 of the patients, plasma was available for the determination of ceftriaxone levels 1 h after a dose and immediately before the next dose. All but one of these patients had trough ceftriaxone levels which exceeded the MIC of the infecting organism, although marginally so for Staphylococcus aureus. Ceftriaxone appears to be safe and effective in the treatment of a variety of bacterial pathogens in children when administered at a single daily dose of 50 mg/kg. This drug may be especially useful in those patients in whom outpatient antibiotic therapy is contemplated or in whom maintenance of intravenous access is difficult.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Humans; Infant; Infant, Newborn; Kinetics; Microbial Sensitivity Tests

Ceftriaxone (Ro 13-9904, CTRX) was administered to 3 cases with gynecological infections and following results were obtained. CTRX was administered by intravenous drip infusion or intravenous injection with 2 g per day for 4 to 6 days. The clinical efficacy was good in all cases (2 cases with pyometra, 1 case with adnexitis and endometritis). No side effect could be determined in all cases.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Endometritis; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Middle Aged; Pelvic Inflammatory Disease; Suppuration; Uterine Diseases

Clinical studies were made on ceftriaxone (CTRX, Ro 13-9904), a new long-acting cephalosporin antibiotic, with the following results. Following a single intravenous injection of 1 g, the transfer of CTRX to the internal genital organs was found to be good. The transfer of CTRX to exudate of the dead space of pelvis was also good. Elbow vein and uterine artery blood serum levels revealed marked increase immediately after administration, then followed by gradual reduction at very slow rate. CTRX was given to 3 patients of female genital infections. Efficacy was excellent in 1 case and good in 2 cases. As to side effect, 2 cases of diarrhea and 1 case of leukopenia were observed.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Injections, Intravenous; Pelvic Inflammatory Disease; Pregnancy; Puerperal Infection; Suppuration; Uterine Diseases

Ceftriaxone (Ro 13-9904, CTRX), a newly developed parenteral cephalosporin antibiotic was clinically evaluated in gynecoobstetric infections and the following results were obtained. CTRX was administered by intravenous drip infusion twice a day in a daily dose of 2 to 4 g to 10 cases with gynecoobstetric infections, consisting of 8 with intrauterine infections, 1 with adnexitis and 1 with infection of external genitalia. The global clinical efficacy was excellent in 2 and good in 6 out of 8 cases with intrauterine infections, and in 2 others, the efficacy rate being 100%. Bacteriologically, the eradication of bacteria was observed in 5, unchange in 2 and alternation of bacteria in 2 among 9 cases where the causative strains were detected. Neither adverse reaction nor laboratory test abnormality was observed. The above-mentioned results suggest that CTRX is a highly safe antibiotic expected to be excellent in the clinical efficacy and bacteriological effects.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Endometritis; Female; Humans; Infusions, Parenteral; Middle Aged; Pelvic Inflammatory Disease; Pregnancy; Puerperal Infection; Uterine Diseases

Ceftriaxone (Ro 13-9904, CTRX) was administered to 13 cases with gyneco-obstetric infections and the following results were obtained. The responses were excellent in 4 cases (30.8%) and good in 7 (53.8%) out of the 13 cases, the efficacy rate (good or above) being 84.6% (11/13). Two cases showing a poor response were considered inappropriate for a study on the efficacy of an antibiotic, as they had received anticancer drugs concomitantly for treatment of their underlying disease of peritonitis carcinomatosa due to ovarian cancer. From a bacteriological viewpoint, CTRX was effective against E. coli, S. aureus, S. faecalis, Pseudomonas, Staphylococcus, K. pneumoniae, S. epidermidis, etc. No specific side effects were observed.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Suppuration; Surgical Wound Infection; Uterine Diseases

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

Topics: Bacterial Infections; Cefoperazone; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male

Topics: Adult; Bacterial Infections; Belgium; Cefotaxime; Ceftriaxone; Child; Humans; Infant; Legislation, Drug

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

The efficacy and safety of ceftriaxone (Ro 13-9904, CTRX) a new broad-spectrum semisynthetic cephalosporin with an outstanding long serum half-life, was evaluated in 22 patients with chronic complicated urinary tract infections. Although the overall clinical efficacy evaluated on day 5 and 10 were similar, the rate of excellent effectiveness was higher on day 10 than on day 5. Eighteen bacterial strains were cultured from freshly voided urine. Eighty percent of the bacteria were eradicated on day 5 and 86.2% were eradicated on day 10. Bacterial replacement had occurred in 3 cases on day 5 and in 6 cases on day 10.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Urinary Tract Infections

Topics: Bacterial Infections; Ceftriaxone; Half-Life; Humans; Surgical Wound Infection

The pharmacokinetics and safety of ceftriaxone were examined in 39 neonates who required antibiotics for clinically suspected sepsis. The drug was administered as a once daily dose of 50 mg/kg by the intravenous (IV) or intramuscular (IM) route. Ceftriaxone was assayed in 49 series of blood samples, 3 samples of cerebrospinal fluid (CSF) and 15 samples of urine by a microbiological technique. Blood was collected before, during and after treatment for biochemical analysis. Routine haematological investigations were also monitored. There was no significant difference between the maximum plasma concentrations following IV (153 +/- 39 mg/l) or IM (141 +/- 19 mg/l) administration (first dose). The mean elimination half-life, total body clearance, and volume of distribution following the first dose were 15.4 +/- 5.4 h, 0.28 +/- 0.12 ml/min per kg and 325 +/- 59 ml/kg respectively. Clearance increased with increasing postnatal age and body temperature (P less than 0.0002) and decreasing plasma creatinine concentration (P less than 0.005). Increasing plasma protein concentration was associated with a decrease in volume of distribution (P less than 0.001). There were no drug-associated changes in any of the biochemical or haematological parameters examined. Ceftriaxone is a safe and well tolerated antibiotic for use in the treatment of newborn sepsis and possibly meningitis. A once daily administration of 50 mg/kg by the IV and IM routes provides satisfactory plasma concentrations throughout the dosage interval whilst avoiding accumulation.

Topics: Bacterial Infections; Ceftriaxone; Drug Tolerance; Half-Life; Humans; Infant, Newborn; Injections, Intramuscular; Injections, Intravenous; Kinetics; Tissue Distribution

The clinical efficacy and safety of ceftriaxone when administered twice daily was evaluated in the treatment of serious infections, including 9 episodes of bacteremia, 4 of pneumonia, 7 of intra-abdominal or soft tissue infections, 11 of urinary tract infections, 3 of osteomyelitis, and 5 of meningitis. Causative pathogens were Strep. pneumoniae, other hemolytic streptococci, E. coli, P. mirabilis, K. pneumoniae, and species of Enterobacter, Serratia, and Pseudomonas. The overall clinical cure rate was 87 percent and the bacteriologic cure rate was 77 percent. Cures were achieved in infections due to organisms resistant to ampicillin, cefazolin, cefamandole, carbenicillin, and gentamicin. Peak plasma levels were far in excess of the minimal inhibitory concentrations of Enterobacteriaceae. Adverse effects were infrequent, and in only one instance was it necessary to discontinue treatment. Resistance to ceftriaxone developed during therapy with several Enterobacter and Pseudomonas species isolates. Ceftriaxone appears to be a useful agent for treatment of serious gram-negative infections in seriously ill patients.

Topics: Abdomen; Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Drug Resistance, Microbial; Female; Gram-Negative Bacteria; Humans; Kinetics; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Renal Dialysis; Urinary Tract

Topics: Animals; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Humans

Thirty pediatric and young adult patients with bacterial meningitis were treated with ceftriaxone or "standard therapy" in a comparative trial; 41 other patients with severe bacterial infections were treated with ceftriaxone in an open protocol. Meningitis and brain abscesses were treated successfully with 50 mg/kg of ceftriaxone every 12 hours. In children, other infections were treated with 25 to 37.5 mg/kg of ceftriaxone every 12 hours. Young adults with pneumonia received 1 g of the antibiotic every 12 hours, whereas those with soft tissue infections were treated every 24 hours. All patients responded to therapy, and in all but one was the infectious process sterilized. No significant toxicity was observed. Ceftriaxone appears to be an excellent single agent for the treatment of most severe bacterial infections in pediatric and young adult patients and need not be administered more frequently than once every 12 hours.

Topics: Adolescent; Adult; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Meningitis; Microbial Sensitivity Tests

The pharmacokinetic behavior of ceftriaxone was studied in 60 patients with severe community- or hospital-acquired infections. Serum concentrations one to three hours after a 30-minute intravenous infusion appeared to be dose related. The mean two-hour levels were 110, 138, and 146 mg/liter, and trough values averaged 54.9, 28.5, and 16.1 mg/liter after doses of 1.0, 2.0, and 3.0 g, respectively. At 24 hours, values were at least 10 mg/liter in all but seven patients. The serum half-life of ceftriaxone in all patients and for all dosage regimens varied from 3.5 to 59.4 hours. In patients with normal renal function (serum creatinine 1.30 mg/dl or less) the mean half-life was 8.2 hours. In patients with moderate (creatinine 1.34 to 1.83 mg/dl) and severe (creatinine 2.40 mg/dl or greater) renal insufficiency, the mean serum half-lives were 12.8 and 12.4 hours, respectively. In six patients who had severe renal failure and concomitant hepatic dysfunction, half-lives ranged from 23.7 to 59.4 hours. Single daily doses of 2.0 g of ceftriaxone produced adequate serum concentrations. Dose reductions are recommended in patients with both renal and hepatic dysfunction.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Half-Life; Humans; Kidney Diseases; Kinetics; Liver Diseases; Middle Aged

A single one-gram pre-operative dose of ceftriaxone was compared with seven one-gram doses of cefazolin administered peri-operatively with the aim of preventing infections associated with coronary artery bypass graft surgery. Ninety-four evaluable cases were analyzed; 49 patients received ceftriaxone and 45 received cefazolin. There was no significant difference in the number of infectious complications between the two groups. Ceftriaxone had a terminal half-life of approximately 15.7 hours. There was no toxicity associated with either antibiotic. Because of the reduced number of doses, single-dose prophylaxis may result in considerable savings. Single-dose prophylaxis with ceftriaxone was found to be an effective modality for prevention of infection in open heart surgery.

Topics: Bacterial Infections; Cefazolin; Cefotaxime; Ceftriaxone; Coronary Artery Bypass; Costs and Cost Analysis; Double-Blind Method; Humans; Kinetics; Premedication; Surgical Wound Infection

The pharmacokinetics of ceftriaxone (Ro 13-9904, CTRX) was studied in 14 children receiving a dose of 10, 20 mg/kg or 1 g as a intravenous bolus. The mean half-lives of CTRX were 4.5, 6.3 +/- 0.5 and 5.2 +/- 0.7 hours, respectively, while the urinary recovery rates up to 12 hours were 51.7, 48.6 and 48.9%. Forty-one patients, aged 2 months to 10 years, were treated with an intravenous dosage of 10 to 58 mg/kg CTRX every 12 hours for 2 to 29 days. The diseases consisted of upper respiratory tract infections (4), bronchitis (7), pneumonia (18), pyothorax (2), urinary tract infections (4), pertussis (4), meningitis (1) and endocarditis (1). Clinical cures were achieved in 38 cases, overall clinical response rate being 92.7%. No serious side effects were observed, although mild diarrhea was seen in 2 cases.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Female; Half-Life; Humans; Infant; Injections, Intravenous; Male; Pleural Effusion

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX) was performed and the following results were obtained. As to bacteriological efficacy, bacteria were reduced in the case with S. panama bacteremia, while they were eradicated within 2 to 5 days after CTRX administration in 2 cases with acute urinary tract infections and 1 with recurrent urinary tract infection, both caused with E. coli, and in 1 with acute urinary tract infection with P. mirabilis. The clinical efficacy was excellent in 2 cases and good in 3, the efficacy rate being 100%. No side effects were observed to require the withdrawal of CTRX.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male

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

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX) was performed in the field of pediatrics and the following results were obtained. The antibacterial activity of CTRX was determined against clinically isolated strains at our department. CTRX was definitely superior to CEZ and CMZ and almost equal or slightly superior to CTX in activity against Gram-negative bacteria, while the MIC of CTRX against Gram-positive bacteria was higher than that of CEZ and CMZ and about equal to that of CTX. The blood concentration of CTRX after one shot intravenous injection with 10 mg/kg was 67.98 micrograms/ml at 15 minutes, 51.96 micrograms/ml at 30 minutes, 37.51 micrograms/ml at 1 hour, 28.91 micrograms/ml at 2 hours, 20.71 micrograms/ml at 4 hours, 13.97 micrograms/ml at 6 hours and 6.45 micrograms/ml at 12 hours, while the half-life time was 3.74 hours. The blood concentration of CTRX after one shot intravenous injection with 20 mg/kg was 179.55 micrograms/ml at 15 minutes, 120.01 micrograms/ml at 30 minutes, 100.01 micrograms/ml at 1 hour, 53.75 micrograms/ml at 2 hours, 33.13 micrograms/ml at 4 hours, 26.41 micrograms/ml at 6 hours and 21.49 micrograms/ml at 12 hours, while the half-life time was 4.15 hours. The blood concentration of CTRX after intravenous drip infusion for 1 hour with 10 mg/kg was 19.54 micrograms/ml at 15 minutes, 27.19 micrograms/ml at 30 minutes, 36.57 micrograms/ml at 1 hour, 23.83 micrograms/ml at 2 hours, 19.69 micrograms/ml at 3 hours, 14.46 micrograms/ml at 5 hours, 11.02 micrograms/ml at 7 hours and 7.27 micrograms/ml at 13 hours, while the half-life time was 6.59 hours. The blood concentration of CTRX after intravenous drip infusion for 1 hour with 20 mg/kg was 61.72 micrograms/ml at 30 minutes, 108.1 micrograms/ml at 1 hour, 54.95 micrograms/ml at 2 hours, 35.68 micrograms/ml at 3 hours, 28.13 micrograms/ml at 5 hours, 20.51 micrograms/ml at 7 hours and 11.43 micrograms/ml at 13 hours, while the half-life time was 4.23 hours. There was noticed a tendency of the blood level being elevated by consecutive administration. The urinary recovery rate of CTRX ranged from 36.5 to 71.6%. The excretion rate of CTRX into the cerebrospinal fluid ranged from 5.2 to 11.6%. The excretion rate of CTRX into the pleural fluid was 31.0%. The clinical efficacy rate was 87.5% (excellent or good) in 8 children with infections treated with CTRX. The eradication of bacteria was observed in all of 5 cases bacteriologically evaluation.(ABSTRACT

Topics: Adolescent; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Half-Life; Humans; Infant; Male

Ceftriaxone (Ro 13-9904, CTRX) was evaluated for its safety and efficacy in 33 children with various bacterial infections including 10 cases of bacterial meningitis. CTRX was effective in all but 1 case who had acute mucositis due to a resistant strain of Enterobacter cloacae. The serum half-life (T1/2 beta) was 4.5 +/- 1.6 hours after an intravenous bolus injection in children. Cerebrospinal fluid levels of CTRX in the acute phase of bacterial meningitis were 7.69 +/- 4.75 mcg/ml. The only side effect was mild to moderate diarrhea observed in 10 of the 33 cases, but in no case was it necessary to discontinue the drug.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Half-Life; Humans; Infant; Infant, Newborn; Kinetics; Male

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX) was performed. CTRX was compared with CEZ, CMZ, CTX and LMOX in the antibacterial activity against the clinical isolates such as S. aureus, E. coli, P. mirabilis, K. pneumoniae and S. marcescens. Against S. aureus, the MIC of CTRX ranged from 0.2 to greater than 100 micrograms/ml with a peak of 3.13 micrograms/ml, showing that CTRX was almost equal to CTX in activity, slightly superior to LMOX and much inferior to CMZ and CEZ, although some strains were not susceptible to CEZ. Against the intestinal strains of E. coli, K. pneumoniae and P. mirabilis, the MIC distribution of CTRX was similar to that of CTX and LMOX while CTRX showed the MIC as high as 3.13 micrograms/ml or above against 44% of all strains including the beta-lactamase producing strains of E. coli and K. pneumoniae, indicating a slight tendency of their becoming resistant. The MIC peaks against E. coli, K. pneumoniae and P. mirabilis were less than or equal to 0.1, 0.39 and less than or equal to 0.1 microgram/ml, respectively. As to S. marcescens which is drawing attention as a causative agent for infections inside of hospitals or those among young infants, CTRX inhibited 84% of the strains at 3.13 micrograms/ml, showing a definite superiority to CEZ and CMZ and a slight superiority to CTX and LMOX. The serum concentration after a single intravenous injection with 40 mg/kg reached a mean peak of 168.8 micrograms/ml at the first blood sampling (at 30 minutes) and gradually decreased to 137.5 micrograms/ml at 1 hour, 30.9 micrograms/ml at 6 hours, 12.6 micrograms/ml at 12 hours and 3.8 micrograms/ml at 24 hours, while the half-life time was 6.0 hours. The comparison of the serum level by 1 hour intravenous drip infusion between the dosage groups of 20 mg/kg and 40 mg/kg revealed that the former group reached a peak of 85.4 micrograms/ml at the termination of drip while the latter's peak was 176.6 micrograms/ml observed during the drip (30 minutes after the initiation of drip). The respective levels of the 2 groups were 15.4 and 32.1 micrograms/ml at 6 hours, 5.1 and 15.0 micrograms/ml at 12 hours, and 1.6 and 4.1 micrograms/ml at 24 hours, indicating a distinct dose-response 2 hours after the initiation of drip administration. The half-life times were 4.9 and 6.2 hours, respectively, which are the longest among the cephalosporins presently being developed.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male

Fundamental and clinical evaluation on ceftriaxone (CTRX, Ro 13-9904) was performed in the pediatric field and the following results were obtained. The MIC of CTRX against the recently isolated 10 strains of B. pertussis was less than or equal to 0.05 microgram/ml at inoculum size of 10(6) CFU/ml. The blood level of CTRX after intravenous drip infusion with 10 to 20 mg/kg for 30 minutes to 1 hour reached a peak ranging from 45.3 to 137 micrograms/ml at the end of infusion. The effective blood level was maintained up to 12 hours to be 3.52 to 26.7 micrograms/ml at that time. The half-life time was over 6 hours in most cases, but the multiple intravenous dosage did not cause any elevation of the blood level. The urine excretion rate till 12 to 24 hours after intravenous drip infusion ranged from 58.2 to 84.2%. The excretion of CTRX into the cerebrospinal fluid was favorable in the acute period when administered by intravenous drip infusion in the child with S. pneumoniae purulent meningitis, which was considered to be satisfactory for treatment against the bacteria susceptible to CTRX. The active CTRX was transferred into the feces by the multiple dosage. CTRX was administered by intravenous drip infusion in 26 cases with acute pediatric infections. The clinical efficacy was observed in all the cases with upper/lower respiratory tract infections including bronchopneumonia and pertussis, and the cases with acute urinary tract infections caused by ABPC-resistant E. coli, administered by intravenous drip infusion twice daily with about 40-50 mg/kg/day. The bactericidal efficacy was seen against all bacteria except Salmonella. CTRX by intravenous drip infusion was effective against S. pneumoniae purulent meningitis; the clinical symptom was rapidly improved while the culture of causative strains from the cerebrospinal fluid turned negative. Although CTRX was clinically effective against Salmonella enteritis and typhoid, bacteriological and symptomatological relapses were observed in some cases. An increase in dose of CTRX is considered to be needed for these diseases. No adverse reaction was found clinically but soft stool in 1 case while eosinophilia and thrombocytosis were observed each in 1 out of 30 cases in laboratory test. The efficacy was good or higher in all the 26 cases (100%) administered by intravenous drip infusion. The above-mentioned results indicate that CTRX is useful in the pediatric field.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

Fundamental and clinical evaluation of ceftriaxone (Ro 13-9904, CTRX) was performed in the pediatric field. Antibacterial activity The MIC80 of CTRX against clinical isolates such as S. aureus (23 strains), S. pyogenes (23 strains), E. coli (20 strains), K. pneumoniae (23 strains), H. influenzae (15 strains) and P. aeruginosa (23 strains) were 6.25 micrograms/ml, 0.024 microgram/ml, 0.20 microgram/ml, 0.05 microgram/ml, less than or equal to 0.006 microgram/ml and 12.5 micrograms/ml, respectively. The antibacterial activity of CTRX was therefore poor against S. aureus and P. aeruginosa, but quite excellent against S. pyogenes, E. coli, K. pneumoniae and H. influenzae. Compared with cefotaxime (CTX), cefoperazone (CPZ), cefmetazole (CMZ), cefazolin (CEZ) and ceftazidime (CAZ), CTRX was the highest in the antibacterial activity against H. influenzae, next to CTX against S. pyogenes, E. coli and K. pneumoniae, similar to CTX, CPZ and CAZ against S. aureus and similar to CTX against P. aeruginosa. Absorption, Excretion The mean serum levels of CTRX after an intravenous one shot injection with about 20 mg/kg in 3 children aged 10 to 14 years were 160.0 +/- 23.3 micrograms/ml after 1/4 hour, 134.3 +/- 27.5 micrograms/ml after 1/2 hour, 115.0 +/- 33.2 micrograms/ml after 1 hour, 95.3 +/- 28.4 micrograms/ml after 2 hours, 75.3 +/- 14.5 micrograms/ml after 4 hours, 30.3 +/- 13.5 micrograms/ml after 12 hours and 8.2 +/- 3.1 micrograms/ml after 24 hours, while the half-life time was 5.92 +/- 0.43 hours on the average. The mean urinary levels were 1,060 +/- 461 micrograms/ml from 0 to 2 hours, 309 +/- 122 micrograms/ml from 2 to 4 hours, 375 +/- 83 micrograms/ml from 4 to 6 hours, 237 +/- 77 micrograms/ml from 6 to 12 hours and 122 +/- 23 micrograms/ml from 12 to 24 hours, the mean urinary recovery rate up to 24 hours being 38.9 +/- 13.6%. The concentration in the cerebrospinal fluid The mean levels of CTRX in the cerebrospinal fluid of the patients with purulent meningitis were 4.30 +/- 4.22 micrograms/ml 1 hour after an intravenous one shot injection with 42 to 51 mg/kg, 4.64 +/- 3.53 micrograms/ml after 3 1/2 hours to 6 hours, 3.79 +/- 2.15 micrograms/ml after 7 1/2 hours to 12 hours and 1.79 +/- 0.23 microgram/ml after 19 hours.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adolescent; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Half-Life; Humans; Infant; Male

Ceftriaxone (Ro 13-9904, CTRX), a new parenteral cephalosporin, was used for pediatric infections and the following results were obtained. CTRX was administered twice daily by intravenous injection with about 20 mg/kg in 6 cases consisting of 2 cases with purulent lymphadenitis of the neck, 2 with urinary tract infection, 1 with sepsis and pyelonephritis and 1 with sepsis and purulent lymphadenitis of the neck. The result was excellent in 4 and good in 2. One case with H. influenzae meningitis, receiving 50 mg/kg CTRX by intravenous injection twice daily, showed an excellent response without having any sequela. Among those mentioned above, diarrhea in 2 cases and elevated GOT and GPT in 2 were observed, all of which were transitory and not serious. The blood level of CTRX at 1/2, 1, 2, 4, 6 and 8 hours after intravenous injection with 20 mg/kg to a girl of 8 years and 8 months of age with urinary tract infection was 114, 86, 70, 42, 29 and 21.8 micrograms/ml, respectively. The half-life time was 3.5 hours while the urinary recovery rate up to 6 hours was 58.0%. The concentration in the cerebrospinal fluid of 1 case with H. influenzae meningitis ranged from 2.1 to 8.2 micrograms/ml at 3 hours after administration and from 1.15 to 2.65 micrograms/ml after about 12 hours (prior to the next administration). The above-mentioned results suggest that CTRX is a new antibiotic useful for pediatric infections caused with susceptible bacteria and is effective by intravenous injection with 10 mg/kg twice daily for moderate infections and with 20 mg/kg twice daily for severe ones, except for meningitis. As for purulent meningitis, the administration dosage and frequency will have to be further examined based on the intravenous injection with 50 mg/kg twice daily.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male

The authors have carried out the laboratory and clinical studies of ceftriaxone (Ro 13-9904, CTRX) and obtained the following results. The antibacterial activities of CTRX against the clinical isolates of S. aureus, E. coli, K. pneumoniae, E. cloacae, E. aerogenes, S. marcescens, Citrobacter sp. and P. aeruginosa were measured by the agar dilution method with inoculum size of 10(6) cells/ml. The susceptibility distribution of S. aureus to CTRX ranged from 0.2 to 12.5 micrograms/ml, and the peak of distribution was 3.13 micrograms/ml. The peak of susceptibility distribution of E. coli and K. pneumoniae were 0.1 microgram/ml or lower, and the distribution of E. aerogenes and E. cloacae ranged from 0.1 to 100 micrograms/ml, Citrobacter sp. and S. marcescens, from 0.1 to 12.5 micrograms/ml and that of P. aeruginosa, from 0.39 to 100 micrograms/ml or more. For pharmacokinetic study, CTRX was given in a single dose of 10 mg/kg in 1 child and 20 mg/kg in 2 children by drip infusion for 1 hour. After drip infusion of CTRX in a single dose of 10 mg/kg, the peak serum level was 61.4 micrograms/ml on completion of the infusion, and 8.43 micrograms/ml at 12 hours. Half-life time was 4.6 hours. With drip infusion of CTRX in a single dose of 20 mg/kg, the peak serum level was 105.5 micrograms/ml on completion of the infusion, and 19.1 micrograms/ml at 12 hours. Half-life time was 8.7 hours. CTRX was effective all cases out of 8 cases with bacterial infection. No side effect was observed except for elevation of serum GOT in 2 cases and eosinophilia in 1 case.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX), a newly-developed injectable cephem antibiotic was performed as follows. The serum and urine concentrations of CTRX as well as the urinary recovery rate were determined in 7 children at 3 different dose levels; 3 cases administered with 10 mg/kg, 3 with 20 mg/kg and 1 with 48 mg/kg by one shot intravenous injection. The concentration in the cerebrospinal fluid was determined in 1 case of purulent meningitis associated with bacteremia, administered by one shot intravenous injection with 47.6 mg/kg. CTRX was also examined in its clinical and bacteriological efficacies by one shot intravenous injection for 8 days on average in a mean daily dose of 46.5 mg/kg, divided into twice a day in 31 cases, 3 times in 1 case, and 4 times changed from twice in 1 case; in a total of 33 children consisting of 3 with tonsillitis, 1 with chronic bronchitis, 20 with pneumonia, 2 with purulent meningitis associated with bacteremia, 3 with urinary tract infections, 1 with osteomyelitis associated with phlegmon, 3 with purulent lymphadenitis. The adverse reactions and laboratory test values were examined in a total of 40 cases, i.e., the above-mentioned 33 cases plus the 7 drop-out cases in which the clinical efficacy could not be evaluated. The results were as follows. The serum levels of CTRX in 7 cases consisting of 3 administered with 10 mg/kg, 3 with 20 mg/kg and 1 with 48 mg/kg reached their peaks 5 minutes after one shot intravenous injection and the mean values of them were 93.6 mcg/ml, 143.0 mcg/ml and 558.0 mcg/ml, respectively, indicating the existence of a dose-response among these groups, while the half-life times were 4.41, 5.86 and 4.09 hours. Among the 7 cases examined in the urinary levels as well as the serum levels, the 3 cases administered with 10 mg/kg reached the mean peak of 334.0 mcg/ml 2 to 4 hours after administration, while another 3 cases administered with 20 mg/kg showed peaks of 793.0, 522.0 and 536.0 mcg/ml, respectively, 2 to 4 hours, 4 to 6 hours and 6 to 12 hours after injection; this dispersion being partly because of that the urine specimen was unable to be collected regularly every hour in this dose group. In the case administered with 48 mg/kg, urinary level reached the highest value of 6,100.0 mcg/ml from 0 to 2 hours.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Age Factors; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Female; Half-Life; Humans; Male

Ceftriaxone (Ro 13-9904, CTRX), developed by F. Hoffmann-La Roche Ltd. in Switzerland, was used for the pediatric infections and the following results were obtained. The mean blood level of CTRX in 2 children after a 60-minute intravenous drip infusion with 20 mg/kg was 58.6 micrograms/ml at 30 minutes, 75.0 micrograms/ml at 1 hour, 39.85 micrograms/ml at 2 hours, 27.74 micrograms/ml at 4 hours, 20.71 micrograms/ml at 6 hours, 11.72 micrograms/ml at 12 hours and 3.91 micrograms/ml at 24 hours while the half-life time was 5.9 hours in one child and 7.6 hours in the other. CTRX was used in 22 children with acute infections consisting of 3 with acute pharyngeal tonsillitis, 4 with acute bronchitis, 8 with bronchopneumonia, 6 with infections of skin soft tissue and 1 with salmonellosis. The results were excellent in 5 cases and good in 17, indicating an efficacy rate of 100%. Out of 10 cases where the causative strains were detected, 4 cases were followed about the activities of the respective bacteria, i.e., H. influenzae, Streptococcus group A, S. aureus and Salmonella group B, all of which were eradicated after the end of administration. The daily dose of CTRX ranged from 30 to 50 mg/kg and generally a larger dose was used for serious infections. CTRX was administered twice daily in 20 out of 22 cases, by an intravenous injection in 4 and an intravenous drip infusion in 18, for 2 to 4 days in 16 and 5 to 8 1/2 days in 6. No clinical adverse reactions were observed while the laboratory test found a slight elevation of GOT in one and that of GOT and GPT in another. From the above results, CTRX was judged to be a highly useful drug for treatment of pediatric infections.

Topics: Acute Disease; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male

Ceftriaxone (CTRX), a new cephalosporin antibiotic, was evaluated in the field of obstetrics and gynecology and the following results were obtained. The concentration of CTRX after an intravenous injection with 1 g was determined in the uterine artery, cubital vein and in the intrapelvic genital tissues such as the oviduct, ovary, endometrium, myometrium, cervix uteri and portio vaginalis. The peak level was 160 micrograms/ml at 26 minutes after injection both in the uterine arterial serum and cubital venous serum, 48 and 38 micrograms/g at 1 hour and 18 minutes in the tissues of oviduct and ovary, respectively, 54 and 50 micrograms/g at 48 minutes in the myometrium and cervix uteri, respectively, while 46 micrograms/g at 39 minutes in the portio vaginalis. The mean level 18 to 24 hours after administration was 19 micrograms/ml in the uterine arterial serum and cubital venous serum and 6.3 micrograms/g in the intrapelvic genital tissues. A case of intrapelvic infection clinically showed an excellent response without any side effects by intravenous drip infusion with 2 g divided as twice a day for 7 days. The above results show that CTRX is useful in the field of obstetrics. and gynecology.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Female; Genitalia, Female; Humans; Hysterectomy; Infusions, Parenteral; Injections, Intravenous; Middle Aged; Pelvic Inflammatory Disease; Postoperative Complications

Ceftriaxone (Ro 13-9904, CTRX), a new cephem antibiotic, was studied in the field of obstetrics and gynecology, and the following results were obtained. The absorption and tissue penetration of CTRX into intrapelvic genital organs were good. The peak serum level in the uterine artery after a single intravenous injection and that after an intravenous drip infusion for 30 approximately 60 minutes, both with 1 g, were 162.5 micrograms/ml and 84.4-93.8 micrograms/ml, respectively. High concentrations were obtained also in genital organ tissues; the maximum concentration was 93.8 micrograms/g by intravenous injection and 56.3-59.4 micrograms/g by intravenous drip infusion. Changes in the tissue concentration were similar to those in the serum, the level over MIC80 against main pathogenic organisms being maintained for a long time. The penetration of CTRX into intrapelvic dead space exudate was good. The level reached a peak of 18.8 micrograms/ml 2 hours after an intravenous injection with 1 g and 13.3 micrograms/ml after 12 hours, while the level over MIC80 against main pathogenic organisms was maintained for a long time. CTRX was effective in 15 out of 16 cases (93.8%) with gyneco-obstetric infections such as intrauterine, intrapelvic, adnexal infections, and postoperative would infections, administered with 1 g twice a day. No side effects were observed.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Parenteral; Injections, Intravenous; Kinetics; Middle Aged; Pregnancy; Puerperal Infection; Tissue Distribution

Ceftriaxone (Ro 13-9904, CTRX), a newly developed third-generation cephem antibiotic, reportedly has an antibacterial spectrum of wide-range and shows a much greater activity than cefazolin especially against Gram-negative bacteria and satisfactory effectiveness against anaerobes. In the gyneco-obstetric infections, the relation between the level in the intrapelvic organs and MIC is an important subject in many respects. The levels in the blood and each tissue determined in 54 cases, as presented in Fig. 2, show that a high concentration can be maintained for a long time. In particular the half-life time in the uterine artery and cubital vein was 8.2 hours and 7.8 hours, respectively, which was longer than that of any other existing antibiotics. This fact suggests that CTRX exhibits sufficient efficacy when administered intravenously even in a small dosage of 1 g in the present study. The clinical efficacy was good or above in all the 7 cases treated. There was neither clinical adverse reaction nor laboratory test abnormality found during and after the administration in any of the 54 cases in the fundamental study and 7 cases in the clinical study. It is suggested from the above-mentioned results that CTRX is an unprecedentedly useful antibiotic with an antibacterial spectrum of wide-range.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Parenteral; Middle Aged; Pregnancy; Puerperal Infection

Fundamental and clinical studies on ceftriaxone (CTRX, Ro 13-9904) were performed in the field of obstetrics and gynecology and the following results were obtained. The serum concentration was maintained at a high level to remain 22 micrograms/ml about 24 hours after intravenous injection with 1 g CTRX. The level in each tissue except myometrium reached a peak of 50 micrograms/g or higher at 54 minutes after intravenous injection with 1 g CTRX. The peak level in the dead space exudate, obtained 4 to 6 hours after intravenous injection was 77 micrograms/ml with 1 g, and 125 micrograms/ml and 115 micrograms/ml with 2 g. The clinical efficacy was observed in all the cases (excellent in 1 and good in 3) consisting of 1 with Bartholin's abscess, 2 with adnexitis and 1 with pelvioperitonitis. Neither adverse reaction nor posttreatment laboratory test abnormality was observed in any case.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Cervix Uteri; Drug Evaluation; Endometrium; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Injections, Intravenous; Middle Aged; Pelvis; Uterus

In vitro activity of ceftriaxone (CTRX) was examined by agar plates dilution method against 398 strains isolated from the infections in the field of obstetrics and gynecology. MIC90 of CTRX against Staphylococcus (107 strains), E. coli (54 strains), K. pneumoniae (27 strains), Peptococcus and Peptostreptococcus (106 strains) and Bacteroides (104 strains) was more than 100 micrograms/ml, less than 0.20 micrograms/ml, less than 0.20 micrograms/ml, 6.25 micrograms/ml and 50 micrograms/ml, respectively. The concentrations of CTRX 16.9 hours after 1 hour intravenous drip infusion with 1 g were 46.2 micrograms/ml in the uterine artery, 48.0 micrograms/ml in the cubital vein, 11.0 micrograms/g in the endometrium, myometrium and cervix uteri, and 14.0 micrograms/g in the portio vaginalis. These concentrations of CTRX in the serum and uterine tissues were higher than the level required to inhibit 90% of the strains of E. coli, K. pneumoniae, and Peptococcus and Peptostreptococcus, isolated from the infections in the field of obstetrics and gynecology. Clinical efficacy of CTRX was evaluated in 7 cases consisting of 2 with puerperal fever and one each with puerperal intrauterine infection, intrauterine infection, pyometra, adnexitis and Bartholin's abscess. Clinical and bacteriological efficacies were seen in 6 and 4 cases, respectively. Neither noteworthy adverse reactions nor laboratory abnormalities were observed throughout this study.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Drug Resistance, Microbial; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged; Pregnancy

Fundamental and clinical studies on ceftriaxone (CTRX, Ro 13-9904), a new cephalosporin antibiotic, were carried out with the following results. Concentration of CTRX was examined in serum, internal genital organs and retroperitoneal fluid after single intravenous administration of 1.0 g dose. The venous serum level of CTRX was 156 micrograms/ml at 5 minutes after the administration. The favorable transfer of CTRX to internal genital organs and retroperitoneal fluid was demonstrated. In clinical trial, CTRX was given to 10 cases with obstetrical and gynecological infections such as endometritis, adnexitis, pelvic peritonitis and parametritis. The efficacy was evaluated as excellent in 1 case, good in 8 cases and poor in 1 case. No side effects were observed in any of the cases treated with CTRX.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Half-Life; Humans; Injections, Intravenous; Middle Aged; Pelvis; Pregnancy

Fundamental and clinical studies on ceftriaxone (Ro 13-9904, CTRX), a new cephem antibiotic, were carried out with the following results. Following each 1.0 g of drip infusion, transfer of CTRX to female genital organs was found to be excellent. Transfer of CTRX to exudate of the pelvic dead space was also excellent. And high concentration of CTRX was kept for long time after administration. CTRX was given to 7 cases. It was effective for 5 cases and ineffective for 2 cases. The above results demonstrated that CTRX is a safe and effective drug.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged; Pelvis; Pregnancy

It is reported that ceftriaxone (Ro 13-9904, CTRX) has a half-life time of 7 to 8 hours. In the present study, the serum level 18 hours after intravenous injection with 1 g CTRX was as high as 9.3 micrograms/ml while obviously a higher tissue concentration was maintained compared with other drugs. These facts suggest that CTRX is effective against infections and that the dosage and frequency of administration could be reduced. The global evaluation revealed that CTRX was clinically effective in all the 4 cases with infections. As the adverse reaction, light leukopenia was observed only in 1 case out of the present 4 cases and 20 others administered with CTRX.

Topics: Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Half-Life; Humans; Middle Aged; Pelvis

Ceftriaxone (Ro 13-9904, CTRX), a new cephalosporin antibiotic, was basically and clinically studied in the field of obstetrics and gynecology. The following results were obtained. The pelvic dead space exudate and serum levels of CTRX were measured in patients with radical hysterectomy with pelvic lymphadenectomy for uterine cervical cancer after the intravenous injection of 1 g. Immediately after the injection, the serum level increased to 146 micrograms/ml on average and thereafter declined rapidly. The pelvic dead space exudate level attained the peak of 88 micrograms/ml after 4 hours and thereafter declined gradually but was 74 micrograms/ml even at 8 hours after the injection. A total of 13 cases comprising 2 with intrauterine infection, 5 with pelveoperitonitis, 4 with adnexitis and 2 with external genital organ infection were intravenously treated with CTRX at a dose of 1 g twice daily for 3-7 days. The clinical results were good in 12 cases and unknown in 1 case. Eruption was noted in 1 case.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Humans; Middle Aged; Pelvis; Uterine Cervical Neoplasms

Ceftriaxone (Ro13-9904, CTRX), a newly developed cephalosporin antibiotic, was fundamentally evaluated through determination of the levels in the female genital organ tissues and in the pelvic dead space exudate. CTRX was also studied on its clinical efficacy in 13 cases with gyneco-obstetric infections. The transmission of CTRX into the female genital organ tissues was favorable: the peak level in each tissue was as high as 38 to 63 micrograms/g 18 to 37 minutes after administration. The level in each tissue even after about 18 hours remained around 10 micrograms/g, suggesting its better transmission into the tissues than other drugs. The transmission into the pelvic dead space exudate was also good: the level reached a peak of 100 to 120 micrograms/ml 1 to 3 hours after administration and still ranged from 74 to 76 micrograms/ml even after about 12 hours. The clinical efficacy was excellent in 5, good in 5 and poor in 3 out of 13 cases with gyneco-obstetric infections and the efficacy rate was 76.9%. Neither adverse reaction nor laboratory test abnormality was observed in any case. The above-mentioned results suggest that CTRX is a useful antibiotic for gyneco-obstetric infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged; Pelvis; Pregnancy

Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX), a new cephalosporin antibiotic, was performed in the field of obstetrics and gynecology and the following results were obtained. The concentration of CTRX after intravenous injection was determined in the arterial and venous blood, and in the internal genital organs and a favorable tissue transfer was observed. The clinical efficacy rate was not very high (40%); good in 2 out of 5 cases with gyneco-obstetric infections, but it is notable that efficacy was recognized in the case which B. fragilis was detected. Neither adverse reaction nor laboratory test abnormality was seen to be attributable to CTRX in any case.

Topics: Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Parenteral; Middle Aged

The study was done to evaluate the usefulness of ceftriaxone (Ro 13-9904, CTRX) injection for the treatment of infections in the field of obstetrics and gynecology. Fundamental and clinical studies were made and following results were obtained. When 1 g of CTRX is administered by intravenous single shot, the concentrations in various tissues of female genital organs were as follows: 40 micrograms/g in oviduct, 30 micrograms/g in ovary, 23 micrograms/g and 32 micrograms/g in corpus uteri and cervix uteri, respectively, at 2 hours 20 minutes after single shot. As for the transfer to the exudate in the pelvic dead space, the peak concentrations were 66-69 micrograms/ml after 4-5 hours. In the clinical studies, CTRX was given to 20 cases with female genital organ infections and others. As for the clinical effects, responses were excellent in 2 cases, good in 18 cases among 20 cases in total. The efficacy rate was 100%. As for the clinical effects on causative bacteria, the efficacy rates were 100% for single infections due to Gram-positive bacteria (6/6), due to Gram-negative bacteria (1/1), for mixed infection (3/3). Side effect was observed in 1 case with diarrhea. CTRX showed a satisfactory clinical efficacy and a potent bacteriological effect in treatment of the infections in the field of obstetrics and gynecology, and it has been concluded that CTRX will be a useful addition to the antibiotics for the therapy of these infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Exudates and Transudates; Female; Genital Diseases, Female; Genitalia, Female; Humans; Infusions, Parenteral; Middle Aged; Pelvis; Pregnancy

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Chemical Phenomena; Chemistry; Humans

Ceftriaxone (Ro 13-9904, Rocephin) was given to 67 patients suffering from 74 various infections. Patients had infections of the urinary tract (36), soft tissue phlegmon (12), infections of the respiratory tract (13), osteomyelitis (7), abscesses (5) and meningitis (1). Infecting organisms were E. coli (26), Proteus spp. (20), P. aeruginosa (7), H. influenzae (6), Enterobacter spp. (6), K. pneumoniae (3), C. freundii (2), S. marcescens (1), S. aureus (4), S. pneumoniae (2), Peptostreptococcus spp. (4) and Clostridium spp. (1). The organisms were often multiresistant. Dosage ranged from 1-2 g once or twice daily i.m. or i.v. The clinical response was excellent in 56 infections (75.6%) while 13 (17.6%) infections were improved and in 5 (6.8%) treatment failed. The pathogen was eradicated in 63 (85.1%), and relapsed in 3 (4.0%) while bacteria persisted in 11 (14.9%). No appreciable side effects or toxicity were observed. Sputum, bile, cerebrospinal fluid and prostatic fluid kinetics revealed ceftriaxone concentrations several times above the minimal bactericidal concentrations required to kill the enterobacteriaceae, but mostly inadequate to inhibit P. aeruginosa strains. Ceftriaxone was a safe and effective drug for the treatment of various infections. However, with the exception of urinary tract infections it should be given with caution in P. aeruginosa infections.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Biological Availability; Cefotaxime; Ceftriaxone; Female; Humans; Kinetics; Lidocaine; Male; Middle Aged

The clinical efficacy and safety of ceftriaxone, a long half-life cephalosporin were evaluated in 48 children with a variety of serious bacterial infections. Clinical cure was achieved in 92% (44 of 48) of patients. Peak serum bactericidal titres for Haemophilus influenzae type b, Streptococcus pneumoniae, Str. pyogenes and Escherichia coli were greater than or equal to 1:1024. Mean peak and trough ceftriaxone levels were 173 and 42 mg/l, respectively. Mild and transient diarrhoea was observed in 10% of patients. Laboratory side effects encountered were eosinophilia, thrombocytosis and neutropenia in another 8%. Ceftriaxone is a useful antibiotic for common childhood infections. Its prolonged half-life allows twice daily administration which reduces problems related to intravenous therapy as well as the cost and personnel time.

Topics: Adolescent; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Female; Half-Life; Humans; Infant; Infusions, Parenteral; Male

Topics: Adolescent; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Meningitis

We evaluated the efficacy and safety of ceftriaxone in 50 adults with serious infections, usually giving 1 g every 12 h. Of the 35 patients who could be evaluated for clinical efficacy, 15 had failed on previous therapy, 15 had nosocomial infections, and all but 1 had underlying diseases. One patient had three sites of infection. Favorable responses were seen in 34 of 37 infections, including 11 of 13 respiratory tract infections, all 7 urinary tract infections, all 12 skin and soft tissue infections, 1 of 2 bone and joint infections, a catheter-related septicemia, a liver abscess, and an otitis media and externa. Favorable bacteriological responses were seen for 48 of 58 organisms. This included 6 of 7 Staphylococcus aureus strains, 14 of 16 other aerobic gram-positive cocci, 18 of 20 Enterobacteriaceae, 6 of 9 Pseudomonas aeruginosa, and 1 of 2 anaerobes. Peak plasma ceftriaxone levels on day 1 were 152 micrograms/ml by bioassay and 78 micrograms/ml by high-pressure liquid chromatography. Four of the 31 initial isolates of aerobic gram-negative rods developed resistance to ceftriaxone on disk diffusion testing. Diarrhea occurred in 3 of 50 patients. All three had received a higher than usual dose. Drug administration was stopped twice, once for a thrombocytopenia and once for a thrombocytopenia with leukopenia. Neither problem could be attributed exclusively to ceftriaxone. Other adverse reactions were eosinophilia, abdominal pain, inguinal candidiasis, and nonsuppurative phlebitis. Even among debilitated adults, ceftriaxone was safe and effective in a twice daily regimen.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Skin Diseases, Infectious; Urinary Tract Infections

Ceftriaxone pharmacokinetics were determined in 40 newborn infants who were 1 to 45 days of age. Mean peak plasma concentrations of 136 to 173 micrograms/ml were observed at the completion of a 15-min intravenous infusion of 50 mg of ceftriaxone per kg. Mean half-life values were 5.2 to 8.4 h, and mean plasma clearances were 0.7 to 1.8 ml/min. Rectal swab cultures from 14 of 16 infants had either reduced numbers of aerobic and anaerobic bacteria or no growth during therapy. A once-daily dosage schedule is suggested for ceftriaxone therapy in newborn infants.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases

31 patients received an intravenous 15-min injection of 2 g ceftriaxone at various times before abdominal or vaginal hysterectomy. Ceftriaxone concentrations in salpinges were significantly higher than in myometrium and endometrium. Tissue concentrations of 20 micrograms/g could be maintained for at least 5 h. Due to its high tissue concentrations maintained for the whole operative procedure, ceftriaxone does seem to be one of the antibiotics of choice for single-dose prophylaxis of postoperative infections in gynecology.

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Genitalia, Female; Humans; Hysterectomy; Middle Aged; Postoperative Complications

Pharmacological studies of ceftriaxone, a new semisynthetic cephalosporin, were conducted in 35 cancer patients. This antibiotic was administered in a variety of doses and schedules with no observed toxicity. Intramuscular administration of 500 mg of ceftriaxone to seven patients produced mean peak serum concentrations of 32.9 mug/ml 2.0 h after administration. The terminal serum half-life was 10.9 h. Intravenous infusion of 500 mg of ceftriaxone over 5 min to the same group of seven patients produced a mean peak concentration of the drug in serum of 83 mug/ml at the end of administration which decreased to 16.8 mug/ml at 8 h. A dose of 1 g of ceftriaxone given in identical fashion to the same group of seven patients produced mean peak concentrations in serum of 130 mug/ml at the end of administration and 17.3 mug/ml at 12 h. The mean percentages of drug recovered in urine 12 h after single intravenous doses of 500 mg and 1 g were 30 and 20%, respectively. A 1-g dose of ceftriaxone was administered every 8 h to 10 patients, and a 2-g dose was administered every 12 hours to 9 patients. Drug concentrations in serum were measured for each patient after drug administration on day 1, day 3 or 4, and day 7 or 8. The 1-g dose produced an observed mean peak concentration of 154 mug/ml and a mean terminal-phase half-life of 5.6 h on day 3 or 4. The 2-g dose produced a mean peak concentration in serum of 262 mug/ml and a terminal-phase serum half-life of 6.3 h on day 3 or 4. Continuous infusion studies were performed in nine neutropenic patients for up to 8 days by using a loading dose of 1 g over 30 min, followed by 2 g every 8 h. Mean concentrations in serum were maintained at about 135 mug/ml during the infusion period.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Half-Life; Humans; Kinetics; Male; Neoplasms

Topics: Adolescent; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Humans; Infant; Infant, Newborn

Topics: Bacterial Infections; Cefoperazone; Cefotaxime; Ceftriaxone; Cephalosporins; Cephamycins; Child; Humans; Microbial Sensitivity Tests; Moxalactam

Ceftriaxone (Rocephin 13-9904) was tested against 409 isolates of gram-negative bacilli. No difference was found in the susceptibility of the 262 gentamicin-sensitive or 147 gentamicin-resistant isolates to ceftriaxone. Comparison with other third-generation cephalosporins showed that ceftriaxone was as active as or more active than lamoxactam, cefoperazone, cefotaxime and ceftazidime against Escherichia coli, Proteus mirabilis, Proteus sp., Klebsiella. Ceftriaxone was not as active as ceftazidime against Pseudomonas aeruginosa, but was more active than lamoxactam, cefoperazone and cefotaxime.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Gentamicins; Humans; Microbial Sensitivity Tests

Ceftriaxone, a broad spectrum cephalosporin with a markedly extended half-life, was administered to 68 patients with 71 infections in an open trial. Sixty-three infections (89%) had a satisfactory clinical response with eradication of bacteria present at the initiation of therapy in 62 infections (87%). The eight treatment failures correlated well with the development of resistance to ceftriaxone during therapy in Enterobacter and Pseudomonas species (two cases) and with superinfection with Bacteroides fragilis (three cases). Treatment was discontinued in eight patients because of unwanted effects. Serious side effects included leukopenia, rash, fever, and enterocolitis.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Creatinine; Female; Humans; Male; Middle Aged; Osteitis; Respiratory Tract Infections; Skin Diseases, Infectious

Thirty-four patients admitted for a suspicion of septicaemia were treated with ceftriaxone, a third generation cephalosporin. Ceftriaxone was administered IV at a dose of 2 grams daily, either as a single injection of 2 g or as two injections of 1 g each. 43 organisms were isolated from the blood of the 34 patients: 20 E.coli; 5 Klebsiella; 2 Salmonella; 2 indole positives Proteus; 1 indole negative Proteus; 1 Enterobacter; 2 Acinetobacter; 3 Staphylococcus aureus; 2 Streptococcus; 1 Enterococcus; 1 Meningococcus and 3 anaerobes. The MIC of the enterobacteria for ceftriaxone ranged from less than or equal to 0.097 microgram/ml to 1.56 microgram/ml. Only two staphylococci, one Acinetobacter and the enterococcus were resistant to the drug. Serum assays of ceftriaxone were performed on the second day of treatment for 15 patients. Within the group treated with a single dosis of 2 g per day, the blood levels were: maximal level (10 min, after the injection): 175 to 460 micrograms/ml (average: 315), minimal level (before injection) 12 to 100 micrograms/ml (average 53). Among the patients treated with two doses of 1 g per day, we obtained: maximal levels 121 to 260 micrograms/ml (average 178), minimal levels 31 to 70 micrograms/ml (average 52). A clinically favorable evolution was obtained for 29 patients (85%). In the cases of 4 patients, the antibiotherapy had to be adapted in view of the susceptibility of the organisms isolated. Ceftriaxone was very well tolerated. The only observed secondary effect was a drug fever occurring in 3 patients who remained febrile in spite of a general improvement.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Humans; Microbial Sensitivity Tests; Time Factors

The flora in the throat and the stools of 10 patients receiving chemotherapy for malignant diseases in a laminar air-flow room was studied during the prophylactic administration of ceftazidime. Ten percent of aerobic gram-negative bacilli, 41% of aerobic gram-positive organisms, 59% of anaerobes, and 70% of fungi persisted in stool specimens during ceftazidime administration. This drug had a less pronounced effect on the throat flora; 66% of organisms persisted during antibiotic administration. The throat and fecal flora of another eight patients were studied during the prophylactic administration of ceftriaxone. This antibiotic had a profound effect on the fecal flora; none of the gram-negative bacilli, only 24% of aerobic gram-positive organisms, and only 10% of anaerobes persisted during ceftriaxone administration. Like ceftazidime, ceftriaxone had a less marked effect on the throat flora; 59% of organisms persisted during antibiotic administration. The results show that new, expanded-spectrum cephalosporins can have a major suppressive effect on patients' endogenous microbial flora.

Topics: Adult; Aged; Bacterial Infections; Bacteroides; Candidiasis; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Enterobacteriaceae; Feces; Female; Humans; Male; Middle Aged; Neoplasms; Pharynx; Staphylococcus; Streptococcus

Effective and safe antibiotic control combined with surgical measures is the mainstay of the management of serious sepsis in burn wounds. To determine the effects of the third-generation cephalosporins on the clinical and bacteriological course of burn sepsis, 30 adult patients with a comparable degree of burn sepsis were treated with cefatriaxon (Ro 13-9904 (Rocephin); Roche). No significant side-effects were observed, and clinical observation showed a marked to moderate improvement in wound sepsis in 26 cases. Of 61 wound cultures obtained after completion of the course of cefatriaxon, only 19 yielded a positive growth. The beneficial role of the third-generation cephalosporins indicated by this prospective trial could be very important in the management of extensive burn wound sepsis.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Burns; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged

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

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

Twenty-six children, aged 2 months to 15 years, were treated with intravenous ceftriaxone sodium, 37.5 mg/kg every 12 hours, for an average of seven days. Clinical and microbiologic cures occurred in 19 of 21 patients, from whom bacterial pathogens were cultured. Ceftriaxone was not effective in treating an 18-month-old infant with periorbital cellulitis caused by relatively resistant Staphylococcus aureus. A relapse occurred in a 2-month-old infant with meningitis caused by ceftriaxone-sensitive Salmonella. Eleven patients had transient diarrhea, superficial candidiasis developed in ten patients, and one patient experienced skin flushing during administration of the antibiotic. Transient asymptomatic laboratory abnormalities were detected in 15 patients; nine patients had elevated serum concentrations of transaminases or bilirubin, 11 had thrombocytosis, three experienced eosinophilia, and one had thrombocytopenia. Transient suppression of normal flora of the intestine occurred in 21 patients. Side effects were not serious enough to warrant discontinuing ceftriaxone therapy in any patient.

Topics: Adolescent; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Ceftriaxone; Cellulitis; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Male; Mastoiditis; Meningitis; Recurrence

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Escherichia coli Infections; Gonorrhea; Humans; Pseudomonas 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: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Evaluation; Female; Humans; Injections, Intravenous; Male; Middle Aged

Thirty-four patients aged 1 month to 19 years were treated with ceftriaxone for suspected bacterial infections. Bacterial pathogens were isolated from 25 children. The overall bacterial cure rate was 88%, with an overall clinical response rate of 96%. No side effects requiring cessation of therapy were observed. Ceftriaxone proved to be safe and effective in the treatment of serious infections in children.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Microbial Sensitivity Tests

The in vitro activity of ceftriaxone was compared with those of other recently introduced beta-lactam antimicrobial agents (cefoperazone, cefotaxime, and moxalactam) and with those of cefoxitin, clindamycin, and metronidazole against 227 strains of anaerobic bacteria. The data obtained in this investigation suggest that ceftriaxone, like a majority of the new beta-lactam antimicrobial agents, may be of limited value in the treatment of serious infections involving anaerobic bacteria.

Topics: Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests

Topics: Aerobiosis; Anaerobiosis; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephamycins; Humans; Imipenem; Lactams; Methicillin; Microbial Sensitivity Tests; Moxalactam; Penicillin Resistance

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

Topics: Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged

Ceftriaxone is a wide-spectrum-third generation cephalosporin characterized by outstandingly high efficacy as well as pharmokinetic properties making it suitable for administration in a single daily injection. Ceftriaxone has been found to be useful for treatment of the very severe infectious pathology in countries where hygiene and medical superstructures are still rudimentary. Eighteen of 20 patients with purulent meningitis (13 to Neisseria meningitidis A, 3 to Streptoc. pneumoniae, 1 to Listeria and 3 aseptic) recovered (there being 2 deaths at the 36th hour) after a mean 6 days of hospitalization. Despite the very delicate patient condition, recovery was seen in all 11 cases of very grave bronchopneumopathy, generally due to Streptoc, pneumonia. A dose of 2 g/day in 1 or 2 IV injections is sufficient in the adult, 0.50 g in a single dose being injected to infants weighing less than 10 kg, Meningitis required 4 to 7 days treatment (9 days in a case of Listeria) while the treatment period was longer for respiratory infections. Seven patients had been refractory to treatment with beta-lactamines and/or aminosides, and no adverse drug reactions were noted.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bronchopneumonia; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Injections; Male; Meningitis; Meningitis, Meningococcal; Meningitis, Pneumococcal; Middle Aged; Niger

Two series of patients suffering purulent meningitis were treated: one (137 patients) with amoxycillin (200 mg/kg/day) by 4 intramuscular injections each day, the other with ceftriaxone (163 patients)/42 mg/Kg/day IM by intramuscular injections each day in the first 23 patients and then only one injection by day in the 140 other patients. Bacteriologically the superiority of CFTRX appears the whole studied strains: MIC of CFTRX are four times lower than those of AMOX for pneumococci, ten times lower for H. influenzae, hundred time lower for meningococci. Amongst the add strains the percentage of resistance to AMOX reaches 64 and only 7 to CFTRX. Pharmacologically, after a same dose of 50mg/kg the peak concentrations in CSF has the same level: CFTRX: 6.8 micrograms/ml, AMOX: 6 micrograms/ml. CSF levels remain efficient for 2 hours with AMOX and for 24 hours with CFTRX. The therapeutic index (mean antibiotic concentration in CSF/mean MIC of the strains) is higher with CFTRX than with AMOX (X 4 for pneumococci, X 15 for H. influenzae, X 100 for meningococci). Clinical results are better with CFTRX than with AMOX in each of the aetiological groups except meningococcal meningitis but the only significative difference concerns pneumococcal meningitis. Clinical tolerance of the two treatments was good. However 2 neonates treated with CFTRX has a severe eczematous erythrodermia and 8 other patients treated with CFTRX had diarrhoea due to elimination of the sensitive flora.

Topics: Amoxicillin; Bacterial Infections; Cefotaxime; Ceftriaxone; Haemophilus influenzae; Humans; Meningitis; Neisseria meningitidis; Streptococcus pneumoniae

The in vitro activity of ceftriaxone against 437 clinical isolates of gram-negative bacilli was determined. Ceftriaxone was found to have high in vitro activity against Enterobacteriaceae, with the exception of Enterobacter cloacae. Ceftriaxone was only minimally active against Pseudomonas aeruginosa and Acinetobacter calcoaceticus. We evaluated the clinical efficacy and toxicity of ceftriaxone in 55 adult patients. Bacterial infection was confirmed by the isolation of etiological bacteria in 30 patients. Infectious disorders treated included 10 pneumonias, 13 urinary tract infections, and 7 soft tissue or bone infections. Pathogens identified were 25 isolates of gram-negative bacilli, 5 isolates of Staphylococcus aureus, 5 isolates of pneumococci, and 4 isolates of other streptococci. The overall efficacy of ceftriaxone was excellent. The clinical cure rate was 93%, and the bacteriological cure rate was 93%. A total of 30 adverse reactions were noted in 22 of 55 patients receiving ceftriaxone, but only one necessitated discontinuation of treatment. Adverse effects frequently noted were elevated hepatic enzymes (16%), thrombocytosis (16%), and eosinophilia (8%). Ceftriaxone is an effective and well-tolerated antimicrobial agent that appears promising for the treatment of serious gram-negative bacillary infections.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Urinary Tract Infections

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

Ceftriaxone (Ro 13-9904), a newly developed cephalosporin with a long half-life, was evaluated for efficacy and safety in 19 patients with serious infections. Underlying illnesses were present in 16 patients. Ceftriaxone was given intravenously every 12 h. Infections treated included gram-negative bacillary pneumonias (two cases), staphylococcal and streptococcal soft tissue-skeletal infections (six cases), spontaneous peritonitis (two cases), and complicated urinary tract infections (nine cases). Bacteremia was present in three patients. Microbiological and clinical cures were achieved in all but one case, although three patients with urinary infection had recurrences 6 weeks posttherapy. The only failure occurred in a patient with pneumonia who had a Pseudomonas aeruginosa isolated from sputum with an initial minimal inhibitory concentration of 4 micrograms/ml, but after 9 days of therapy, a repeat isolate had a minimal inhibitory concentration of 32 micrograms/ml. The minimal inhibitory concentrations for the other isolates ranged from less than or equal to 0.6 to 8.0 micrograms/ml. The mean peak plasma level of ceftriaxone was 99.9 micrograms/ml. The only side effects noted were drug fever in one patient, phlebitis in two patients, and thrombocytosis in four patients.

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

Ceftriaxone (Ro 13-9904) was compared with other newer beta-lactam antibiotics for activity in experimental infections of mice with Enterobacteriaceae, Haemophilus influenzae, Pseudomonas aeruginosa, and gram-positive bacteria. Overall, ceftriaxone was equal or superior to cefotaxime and cefoperazone against systemic infections. All three drugs were highly potent against most organisms but were considerably less active against P. aeruginosa. However, ceftriaxone tended to be more active than the other two agents against 8 of the 10 P. aeruginosa strains tested. Ceftriaxone, cefmenoxime (SCE 1365), and moxalactam were all highly active against systemic infections with 16 strains of Enterobacteriaceae, whereas ceftriaxone was more active against infections with two strains of streptococci. When the drugs were administered at various time intervals before infection, ceftriaxone was superior to cefotaxime, cefmenoxime, and moxalactam. This suggested that ceftriaxone might be eliminated from mice more slowly than the other drugs. In the case of cefotaxime, this was directly confirmed by microbiological assays of plasma samples. In a murine meningitis model induced by Klebsiella pneumoniae or Streptococcus pneumoniae, ceftriaxone was more active than ampicillin or cefotaxime. Ceftriaxone was more active than ampicillin, cefotaxime, piperacillin, cefamandole, or carbenicillin in a pneumococcal, pneumonia model in mice. These studies indicate that ceftriaxone is a potent, broad-spectrum cephalosporin with unusual pharmacokinetic properties.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Meningitis; Mice; Microbial Sensitivity Tests

Ro 13-9904, a new broad-spectrum, beta-lactamase-resistant, cephalosporin, was given as a single i.m. injection at doses of 500, 250, and 125 mg in 3 groups of male patients each consisting of 10, 6, and 6 patients respectively, suffering from uncomplicated acute but recurrent gonococcal urethritis. All patients were cured both clinically and bacteriologically without relapsing after a 7-day follow-up. 11 patients suffering from chronic urinary tract infections without flow obstruction but with underlying chronic pyelonephritis in 6, were treated for 7 days with 500 mg of Ro 13-9904 i.m., every 12 h. E. coli and P. mirabilis were the main isolated pathogens. Treatment was successful in all with only one bacteriological relapse during the follow-up period. The drug's tolerance was satisfactory except for moderate local pain in most of the patients.

Topics: Adult; Aged; Bacterial Infections; Bacteroides fragilis; Ceftriaxone; Cephalosporins; Chronic Disease; Enterobacter; Escherichia coli; Gonorrhea; Humans; Klebsiella; Male; Microbial Sensitivity Tests; Middle Aged; Proteus; Pseudomonas; Urinary Tract Infections

Topics: Animals; Bacterial Infections; Ceftriaxone; Cephalosporins; Humans

Two pilot comparative trials in 29 patients suffering from severe lower respiratory tract infections are described. 15 patients received 7-10.5 g ceftriaxone as a total dose and 14 received 28 g amoxicillin, both antibiotics being given by intravenous route during 1 week. The local and systemic tolerance of the drugs were satisfactory; no adverse reactions or relevant laboratory changes were noticed. The clinical response was favourable in all patients. The mot relevant pathogens found in the sputum were Streptococcus pneumoniae in 11 cases and Haemophilus influenzae in 15 cases. Less relevant microorganisms such as Klebsiella pneumonia, Serratia, Pseudomonas sp. and Streptococcus viridans were cultivated prior to therapy. The two main pathogens disappeared from the sputum after therapy in 11 of 13 patients treated with ceftriaxone and in 10 of 13 treated with amoxicillin. The results of these pilot studies indicate that 7-10.5 g ceftriaxone are as active as 28 g amoxicillin in the treatment of severe lower respiratory tract infections.

Topics: Adult; Aged; Amoxicillin; Bacterial Infections; Bronchitis; Ceftriaxone; Cephalosporins; Chronic Disease; Drug Tolerance; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pilot Projects; Pneumonia

Moxalactam, Ro 13-9904, cefotaxime, cefoperazone, older cephalosporins, and four aminoglycosides were tested in vitro against 432 strains of gram-negative bacteria isolated from pediatric patients. The new drugs were uniformly active against coliform bacilli obtained from patients with meningitis and against aminoglycoside-resistant coliform bacilli.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Cephamycins; Child; Drug Resistance, Microbial; Humans; Moxalactam

Ro 13-9904, a new parenteral cephalosporin, was found to have high in vitro activity against Enterobacteriaceae and other gram-negative bacteria, including various isolates resistant to cefuroxime, cefamandole, cefoxitin, and cefazolin. It showed promising activity against Pseudomonas aeruginosa. Although inhibitory against Staphylococcus aureus at concentrations readily achievable in plasma, it was less potent against this pathogen than cefamandole, cefazolin, or cefuroxime. Isolates of Streptococcus faecalis were uniformly resistant to all the cephalosporins tested. Ro 13-9904 was more active than cefotaxime against Proteus mirabilis, Neisseria gonorrhoeae, Neisseria meningitidis, and Haemophilus influenzae, but less active against S. aureus. Ro 13-9904 was stable to various types of beta-lactamases. Its therapeutic efficacy against experimental septicemias in mice was equal to or slightly superior to that of cefotaxime and SCE-1365 when the antibiotics were administered in repeated subcutaneous doses after bacterial challenge. Cefoperazone, and particularly cefamandole nafate, cefazolin, and mezlocillin were less effective. Although structurally related to cefotaxime and SCE-1365, Ro 13-9904 was found to differ from them in one important respect, namely, in having a long duration of action; this was observed with single-dose treatment given before bacterial challenge. Its broad spectrum of activity coupled with favorable pharmacokinetic properties make Ro 13-9904 a promising compound for clinical studies.

Topics: Animals; Bacteria; Bacterial Infections; beta-Lactamases; Ceftriaxone; Cephalosporins; Culture Media; Hydrolysis; Mice; Microbial Sensitivity Tests