ro13-9904 and Bronchitis

Complex treatment with ceftriaxone (or ceftazidime) and intravenous immunoglobulin G (Biaven V. I.) was performed at 21 patients with severe pneumonia and tracheobronchitis complicated by immunedeficient status (myasthenia, diabetes mellitus etc). The results of the treatment proves strong tendency to normalization of the immune system (ceruloplasmin level, CIC, catalase, immunoglobulins) along with clinical signs regression.

Topics: Aged; Anti-Infective Agents; Bronchitis; Ceftazidime; Ceftriaxone; Combined Modality Therapy; Cross Infection; Drug Resistance, Microbial; Humans; Immunoglobulin G; Injections, Intravenous; Middle Aged; Pneumonia, Bacterial

In this study the efficacy and cost-effectiveness of i.v. ceftriaxone 1 g once daily (CTX) was compared with standard i.v. antibiotic treatment (STD) for lower respiratory tract infections (LRTI). STD was given according to the guidelines of the American Thoracic Society and consisted of either cefuroxime 1500 mg three times daily (q8h), amoxicillin/clavulanic acid 1200 mg q8h or ceftriaxone 2 g once daily; each with or without a macrolide. After a minimum of 5 days i.v. therapy, patients could be switched to oral therapy. One hundred patients were enrolled in the study; 52 patients received CTX and 48 STD. Groups were comparable with respect to demographic and baseline characteristics. Seventy patients had a confirmed diagnosis of pneumonia. Twenty-nine patients had a severe type I exacerbation of chronic bronchitis. In one patient the diagnosis of LRTI could not be confirmed. In approximately 50% of the patients a microbiological diagnosis could be made. The most important isolated pathogens from sputum and blood were (positive blood cultures in brackets): Streptococcus pneumoniae 14 (9) and Haemophilus influenzae 16. Mean duration of i.v. therapy was 7.4 days in both groups. Average duration of hospitalisation was 15.0 days for CTX patients and 15.9 days for STD patients. Overall cure and improvement rate at the end of treatment was 47 (90%) for patients receiving ceftriaxone 1 g compared to 37 (77%) for patients receiving standard therapy. Pathogens were eradicated or presumed to be eradicated in 84% of the CTX patients and in 76% of the STD patients. Mean total costs per treatment were lower for CTX than for STD treatment: NLG 169 versus 458. These results show, that i.v. ceftriaxone 1 g once daily is as effective as standard therapy in the treatment of LRTI and that its use reduces treatment costs, in view of the multiple daily dosing regimens of most standard therapies.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bronchitis; Ceftriaxone; Cephalosporins; Chronic Disease; Drug Administration Schedule; Drug Costs; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pneumonia

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

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

Two hundred and thirty-eight in-patients with signs and symptoms of acute purulent bronchitis or purulent exacerbation of chronic bronchitis at stage 1 and 2 of Anthonisen's classification were enrolled in 11 Centers and randomly assigned to one of the following 3 treatment groups: group A, cefodizime 1 g i.m. qD; group B, cefodizime 1 g i.m. BID; group C, ceftriaxone 1 g i.m. qD. Bacteriological results after treatment were satisfactory in 64 patients (91.4%) of group A, 64 (92.8%) of group B and 74 (94.9%) of group C. Global clinical results after treatment showed satisfactory efficacy in 57 patients (79.2%) of group A, 59 (85.5%) of group B and 63 (80.8%) of group C. There was no statistically significant difference in improvement in single symptoms, global bacteriological or clinical results between the 3 groups. Mild adverse events occurred in only 3 patients (one per group).

Topics: Acute Disease; Bronchitis; Cefotaxime; Ceftriaxone; Cephalosporins; Chronic Disease; Drug Administration Schedule; Female; Humans; Injections, Intramuscular; Male

To compare the efficacy and safety of ciprofloxacin and ceftriaxone in patients with nursing home-acquired lower respiratory tract infections requiring initial hospitalization.. Prospective, randomized trial.. Extended care nursing homes affiliated with a teaching hospital.. Fifty patients aged 60 years or older with normal or mildly impaired renal function admitted to the hospital for treatment of lower respiratory tract infections.. Twenty-four patients received initial therapy with intravenous ciprofloxacin, 200 mg every 12 hours (19 patients) or 400 mg every 12 hours (5 patients) during the acute phase followed by 750 mg orally every 12 hours during the convalescence phase. Twenty-six patients received initial therapy with intravenous ceftriaxone, 2 g every 24 hours during the acute phase followed by 1 g administered intramuscularly every 24 hours during the convalescent phase. The total duration of therapy was 14 days.. Successful outcome was defined as resolution or marked improvement in clinical signs and symptoms of lower respiratory tract infection upon completion of the treatment course.. Twelve (50%) of the ciprofloxacin-treated and 14 (54%) of ceftriaxone-treated patients had successful outcomes. Recurrent oropharyngeal aspiration was the reason for treatment failure in most patients refractory to either antibiotic. Mortality during therapy was 8% in each group. From 21 satisfactory sputum specimens collected, S. pneumoniae was the most common isolate, followed by H. influenzae and other Gram-negative bacteria. Ciprofloxacin therapy was well tolerated; ceftriaxone therapy was discontinued in two patients (8%) due to adverse reactions (intramuscular pain and drug fever).. Sequential intravenous/oral ciprofloxacin appears to be as safe and effective as sequential intravenous/intramuscular ceftriaxone. The optimal dosage of intravenous ciprofloxacin in this patient population appears to be 400 mg every 12 hours; however, additional clinical and pharmacokinetic studies with this regimen are warranted.

Topics: Administration, Oral; Aged; Aged, 80 and over; Bronchitis; Ceftriaxone; Ciprofloxacin; Cross Infection; Drug Administration Schedule; Female; Haemophilus Infections; Haemophilus influenzae; Homes for the Aged; Humans; Injections, Intravenous; Male; Nursing Homes; Pneumonia; Sputum; Streptococcal Infections; Survival Rate

Topics: Aged; Bacteria; Bronchi; Bronchitis; Ceftriaxone; Clinical Trials as Topic; Haemophilus influenzae; Humans; Injections, Intramuscular; Microbial Sensitivity Tests; Middle Aged; Piperacillin; Random Allocation; Streptococcus pneumoniae

Patients with pneumonia or bronchitis were randomized to receive ceftriaxone or cefamandole. A total of 30 of 38 patients were evaluable, 16 in the ceftriaxone group (average age 66.3 years) and 14 in the cefamandole group (average age 69.4 years). All but one had underlying diseases. Patients usually received 1 g of ceftriaxone intravenously every 12 h (mean duration 8.7 days) or 1.5 g of cefamandole intravenously every 6 h (mean duration 8.2 days). Adverse experiences attributable to the drugs were confined to one episode of discomfort at the infusion site in each group. Bacteriological results with ceftriaxone were 83% cured, 11% superinfected after eradication of pretherapy isolate, and 6% failed. Bacteriological results with cefamandole were 76% cured, 24% failed. Clinical results with ceftriaxone were 38% cured, 56% improved, 6% failed. Clinical results with cefamandole were 57% cured, 21% improved, 21% failed. Emergence of a resistant Serratia marcescens was seen in a ceftriaxone-treated patient. Disc diffusion susceptibility testing identified six of the seven pretherapy nonfastidious Gram-negative isolates as susceptible; however, two of the six could not be eradicated with the assigned drug and another two were eradicated with ensuing super-infection with susceptible isolates of Pseudomonas aeruginosa. In contrast, MBCs were an accurate guide to clinical outcome with nonfastidious Gram-negative bacilli.

Topics: Adult; Aged; Aged, 80 and over; Bronchitis; Cefamandole; Ceftriaxone; Female; Humans; Male; Middle Aged; Pneumonia; Random Allocation; Sepsis

Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis.. This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement.. Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as < 2 months), with an overall mean ± SD duration of symptoms of 33.9 ± 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 ± 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients.. Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bronchitis; Brucellosis; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pleural Effusion; Pneumonia; Prognosis; Retrospective Studies; Rifampin; Streptomycin; Turkey; Young Adult

Topics: Adult; Alanine Transaminase; Anti-Bacterial Agents; Aspartate Aminotransferases; Bronchiectasis; Bronchitis; Ceftriaxone; Chemical and Drug Induced Liver Injury; Drug Substitution; gamma-Glutamyltransferase; Hepatomegaly; Humans; Hyperbilirubinemia; Levofloxacin; Male; Ofloxacin

To describe the first case of a group A beta-hemolytic streptococcus laryngotracheobronchitis as well as the other possible etiologies in a case of acute dyspnea.. We report the case of a 46-year-old woman with a doubtful vaccination status who presented clinical features of croup (laryngotracheobronchitis). She developed respiratory distress and required endotracheal intubation.. The endoscopy demonstrated a great deal of crust and pseudomembrane detachment. Bacterial culture grew group A beta-hemolytic streptococcus. Progression was good with antibiotics and corticosteroid treatment.. Bacterial acute pseudomembranous croup (laryngotracheobronchitis) is rare. We must search for the most frequent diagnoses such as diphtheria and epiglottitis. This is the first case to be reported in the literature.

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Bronchitis; Ceftriaxone; Ciprofloxacin; Croup; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Laryngitis; Laryngoscopy; Methylprednisolone; Middle Aged; Streptococcal Infections; Streptococcus pyogenes; Time Factors; Tracheitis; Treatment Outcome

The United States labeling for gatifloxacin has been updated to include contradictions related to its reported association with dysglycemia. However, adequately controlled studies in acute care settings assessing the magnitude and clinical determinants of dysglycemia are lacking.. To compare the hypoglycemic and hyperglycemic effects of gatifloxacin with ceftriaxone in hospitalized patients.. A retrospective cohort study of hospitalized adult (> or =18 years) patients admitted with Community Acquired Pneumonia (CAP) or Acute Exacerbation of Chronic Bronchitis (AECB) in a US tertiary care hospital between 7/1/01 and 12/31/04 treated with gatifloxacin or ceftriaxone during hospital admission. Outcomes of interests were incidence of hypoglycemia (blood glucose levels <46 mg/dL) or hyperglycemia (>200 mg/dL) during up to 5 days of drug exposure. Risks for gatifloxacin and ceftriaxone were compared adjusting for variables previously reported to be independent predictors of hypoglycemia or hyperglycemia.. 1504 patients met the study inclusion criteria. Compared to ceftriaxone, gatifloxacin was associated with an increased risk of hypoglycemia: (adjusted odds ratio (OR) 2.34, 95% confidence interval (CI) 1.4-4.0). The increased risk of hypoglycemia during exposure to gatifloxacin was similar in patients with and without a diagnosis of diabetes mellitus. Gatifloxacin was not associated with an increased risk for hyperglycemia (adjusted OR: 1.06 95% CI 0.8-1.4) considering the whole study cohort. However, stratification by diagnosis of diabetes, gatifloxacin treated patients appeared to have a reduced risk of hyperglycemia (adjusted OR: 0.4 95% CI 0.2-0.4) while non-diabetic gatifloxacin treated patients appeared to have an increased risk of hyperglycemia (adjusted OR: 1.64 95% CI 1.1-2.4).. The risk of dysglycemia with gatifloxacin in this population of hospitalized patients was not as high as previously reported in ambulatory patients. Although these results suggest gatifloxacin use is safer in acute care settings, we recommend that clinicians monitor blood glucose levels carefully or consider alternatives to gatifloxacin therapy whenever possible.

Topics: Adult; Aged; Anti-Bacterial Agents; Blood Glucose; Bronchitis; Ceftriaxone; Cohort Studies; Community-Acquired Infections; Diabetes Mellitus; Female; Fluoroquinolones; Gatifloxacin; Homeostasis; Hospitalization; Humans; Hyperglycemia; Hypoglycemia; Male; Middle Aged; Pneumonia; Retrospective Studies; Risk Factors; United States

The aim of the current investigation was to evaluate practical impact of modern NCCLS recommendations for the selection of 2nd and 3rd generation cephalosporins in Moscow teaching multi profile hospital. The sensitivity of clinically significant 96 strains from patients with pyelonephritis and 180 strains from patients with lower respiratory tract infections (pneumonia, COPD) was compared for cefuroxime and cefotaxime or ceftriaxone according NCCLS recommendations during 2000-2001 years. At the lower respiratory tract infection total sensitivity of all pathogens was 70.6% and 72.8%, at the pyelonephritis 71.9% and 76.0% for 2nd and 3rd generations respectively. The differences between cephalosporins were not statistically significant. Based on the application of modern NCCLS recommendations in the routine microbiological practice similar clinical efficacy of 2nd and 3rd generations cephalosporin in lower respiratory tract infections and pyelonephritis could be predicted.

Topics: Anti-Bacterial Agents; Bronchitis; Cefotaxime; Ceftriaxone; Cefuroxime; Gram-Negative Bacteria; Hospitals, General; Hospitals, Teaching; Humans; Microbial Sensitivity Tests; Moscow; Pneumonia, Bacterial; Practice Guidelines as Topic; Pyelonephritis; Staphylococcus aureus

Ceftriaxone, cephalosporin of the third generation, was given to 40 adults admitted to hospital for bronchopulmonary infections. Pneumonia and aggravation of chronic bronchitis were diagnosed in 27 and 13 patients, respectively. The drug was given in a single daily dose 1-2 g intravenously or intramuscularly. Mean duration of the treatment course was 6.13 days. High efficacy of the antibiotic ceftriaxone was observed in 38(95%) patients. One woman failed the treatment. She had pneumonia following polychemotherapy for advanced breast cancer. The drug tolerance was good. Only one allergic reaction occurred. The study of the sensitivity of 333 strains of the bacteria isolated from the sputum of 235 pulmonological patients showed that the absolute majority of the strains (98%) of both gram-positive and gram-negative microorganisms are suppressed by ceftriaxone. Thus, the conclusion is made on efficacy of ceftriaxone against bronchopulmonary infections. The drug is applicable both in hospitals and outpatiently.

Topics: Bacteria; Bronchitis; Ceftriaxone; Cephalosporins; Chronic Disease; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Sputum; Time Factors

We conducted a retrospective clinical evaluation to assess the efficacy of a 1-gram once-daily regimen of intravenously administered ceftriaxone in the treatment of a variety of bacterial infections. Of the 250 patients studied, 167 had infections of the lower respiratory tract, approximately 70% of which were diagnosed as community-acquired pneumonias. The principal identified pathogens were Staphylococcus aureus and Haemophilus influenzae. Forty per cent of community-acquired pneumonias occurred in patients over 69 years of age, who showed a 13% mortality compared to a mortality rate of 4% in younger patients. Once-daily ceftriaxone was effective and well tolerated as empiric therapy for pneumonia likely to be caused by susceptible organisms.

Topics: Aged; Bronchitis; Ceftriaxone; Drug Administration Schedule; Enterobacteriaceae Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Injections, Intravenous; Male; Pneumonia; Pneumonia, Staphylococcal; Retrospective Studies

The study on ceftriaxone penetration into bronchial secretion showed that in patients with a short-term history of chronic bronchitis (no more than 3 years) ceftriaxone used in a dose of 1 g once a day intramuscularly was detectable in the bronchial secretion within 10 hours after the administration, its concentrations being 0.67-2.41 micrograms/ml in 3 hours, 15.87 micrograms/ml in 4.5 hours, 4.58 micrograms/ml in 6.5 hours and 2.29 micrograms/ml in 10 hours. In patients with a long-term history of chronic bronchitis (mean 10 to 20 years) the presence of ceftriaxone in the bronchial secretion was detectable in a concentration of 0.51-3.75 micrograms/ml only in 2 hours after its administration. Beginning from the 5th hour after the administration its detection failed. This is indicative of lower ceftriaxone penetration into the bronchial secretion of such patients. The duration of chronic bronchitis did not influence ceftriaxone pharmacokinetics in blood. The contents of the antibiotic in serum and bronchial secretion were determined by HPLC (the resolving power of 0.5 micrograms/ml).

Topics: Bronchi; Bronchitis; Ceftriaxone; Chromatography, High Pressure Liquid; Chronic Disease; Humans; Middle Aged; Time Factors

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

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

A group of 36 patients, admitted to hospital because of acute purulent exacerbations of chronic bronchitis, were treated with once daily injections of ceftriaxone for 10 days, 17 receiving 1 g injections and 19 patients 2 g doses. At the end of treatment (day 11) six patients remained infected (three with Branhamella catarrhalis and three with Pseudomonas aeruginosa) but during the 7 follow-up days 12 patients developed infections with beta-lactamase producing strains of Bran. catarrhalis, Ps. aeruginosa was cultured from 2 patients and Streptococcus pneumoniae from 3 more. Kinetic studies confirmed the long half-life of ceftriaxone (13 to 14 h in this patient group) and showed average peak serum concentrations of 31 mg/l after 1 g and 43 mg/l after the 2 g dose. The comparable sputum concentrations were 3.5 and 4.8 mg/l, respectively. However, four patients failed to show any ceftriaxone in the sputum despite simultaneous blood concentrations of between 32 and 50 mg/l and in two patients ceftriaxone only appeared in the sputum 12 h after the injection. All except one harboured beta-lactamase-producing Bran. catarrhalis in the sputum, and the possibility of breakdown of ceftriaxone by branhamella beta-lactamases is suggested.

Topics: Acute Disease; Bronchitis; Cefotaxime; Ceftriaxone; Chronic Disease; Haemophilus influenzae; Humans; Kinetics; Microbial Sensitivity Tests; Micrococcus; Pseudomonas Infections; Respiratory Tract Infections; Sputum

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