ro13-9904 and Diarrhea

To determine the safety of ceftriaxone in paediatric patients and systematically evaluate the categories and incidences of adverse drug reactions (ADRs) of ceftriaxone in paediatric patients.. We performed a systematic search in Medline, PubMed, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, International Pharmaceutical Abstracts and bibliographies of relevant articles up to December 2018 for all types of studies that assessed the safety of ceftriaxone in paediatric patients aged ≤18 years.. 112 studies met the inclusion criteria involving 5717 paediatric patients who received ceftriaxone and reported 1136 ADRs. The most frequent ADRs reported in prospective studies were gastrointestinal (GI) disorders (37.4 %, 292/780), followed by hepatobiliary disorders (24.6%, 192/780). Serious ADRs leading to withdrawal or discontinuation of ceftriaxone were reported in 86 paediatric patients. Immune haemolytic anaemia (34.9%, 30/86) and biliary pseudolithiasis (26.7%, 23/86) were the two major causes. Haemolytic anaemia following intravenous ceftriaxone led to death in 11 children whose primary disease was sickle cell disease. Almost all biliary pseudolithiasis are reversible. However, the incidence was high affecting one in five paediatric patients (20.7%).. GI ADRs are the most common toxicity of ceftriaxone in paediatric patients. Immune haemolytic anaemia and biliary pseudolithiasis are the most serious ADRs and the major reasons for discontinuation of ceftriaxone. Immune haemolytic anaemia is more likely in children with sickle cell disease and may cause death. Ceftriaxone should be used with caution in children with sickle cell disease.. CRD42017055428.

Topics: Anemia, Hemolytic; Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Diarrhea; Digestive System Diseases; Exanthema; Humans; Nephrolithiasis; Pediatrics; Thrombocytosis; Ureteral Calculi; Urination Disorders

In Kenya, invasive nontyphoidal Salmonella (iNTS) disease causes severe bacteremic illness among adults with human immunodeficiency virus (HIV) and especially among children <5 years of age coinfected with HIV or malaria, or who are compromised by sickle cell disease or severe malnutrition. The incidence of iNTS disease in children ranges from 166 to 568 cases per 100,000 persons per year.. We review the epidemiology of iNTS disease and genomics of strains causing invasive illness in Kenya. We analyzed a total of 192 NTS isolates (114 Typhimurium, 78 Enteritidis) from blood and stools from pediatric admissions in 2005-2013. Testing for antimicrobial susceptibility to commonly used drugs and whole-genome sequencing were performed to assess prevalence and genetic relatedness of multidrug-resistant iNTS strains, respectively.. A majority (88/114 [77%]) of Salmonella Typhimurium and 30% (24/79) of Salmonella Enteritidis isolates tested were found to be multidrug resistant, whereas a dominant Salmonella Typhimurium pathotype, ST313, was primarily associated with invasive disease and febrile illness. Analysis of the ST313 isolates has identified genome degradation, compared with the ST19 genotype that typically causes diarrhea in humans, especially in industrialized countries, adapting a more host-restricted lifestyle typical of Salmonella Typhi infections.. From 2012, we have observed an emergence of ceftriaxone-resistant strains also showing reduced susceptibility to fluoroquinolones. As most cases present with nonspecific febrile illness with no laboratory-confirmed etiology, empiric treatment of iNTS disease is a major challenge in Kenya. Multidrug resistance, including to ceftriaxone, will pose further difficulty in management of iNTS disease in endemic areas.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Diarrhea; Drug Resistance, Multiple, Bacterial; Feces; Female; Genomics; Genotype; Humans; Incidence; Infant; Kenya; Microbial Sensitivity Tests; Salmonella enteritidis; Salmonella Infections; Salmonella typhimurium; Sequence Analysis, DNA

We report 2 cases of Shigella septicaemia in adult patients.. Two 57-year-old women presented with non-bloody diarrhoea and fever. The first patient was an inmate of a long-term care facility who was schizophrenic and the second patient was a diabetic who recently travelled to Medan, Indonesia. Both patients were febrile, hypotensive and dehydrated. The first patient was neutropenic, thrombocytopenic and had acute renal failure. Blood cultures yielded Shigella flexneri and stool cultures gave negative results for both patients.. Rehydration and intravenous ceftriaxone were instituted.. The patients' symptoms and hypotension resolved.. Appropriate antibiotics can decrease the severity and duration of Shigella septicaemia.

Topics: Ceftriaxone; Cephalosporins; Diarrhea; Female; Humans; Middle Aged; Neutropenia; Renal Insufficiency; Risk Factors; Sepsis; Shigella flexneri; Thrombocytopenia

We sought to compare daptomycin with ceftriaxone for the treatment of patients with community-acquired pneumonia (CAP).. Two phase-3 randomized, double-blind trials that enrolled adult patients hospitalized with CAP were conducted. Patients received intravenous daptomycin (4 mg/kg) or ceftriaxone (2 g) once daily for 5-14 days. Aztreonam could be added for patients with gram-negative infections. Clinical responses at the test-of-cure visit among patients in the intent-to-treat and clinically evaluable populations were the primary efficacy end points.. After combining data from the trials, the intent-to-treat population included 413 daptomycin-treated patients and 421 ceftriaxone-treated patients, and the clinically evaluable population included 369 daptomycin-treated patients and 371 ceftriaxone-treated patients. In the intent-to-treat population, the clinical cure rate among daptomycin-treated patients with CAP was 70.9%, compared with 77.4% among ceftriaxone-treated patients (95% confidence interval for the difference between cure rates, -12.4% to -0.6%). In the clinically evaluable population, the clinical cure rate was lower among daptomycin-treated patients (79.4%) than among ceftriaxone-treated patients (87.9%; 95% confidence interval for the difference between cure rates, -13.8% to -3.2%). A posthoc analysis revealed that, among those who had received up to 24 h of prior effective therapy, cure rates were similar among daptomycin-treated (90.7%) and ceftriaxone-treated patients (88.0%; 95% confidence interval for the difference between cure rates, -6.1% to 11.5%).. Daptomycin is not effective for the treatment of CAP, including infections caused by Streptococcus pneumoniae and Staphylococcus aureus. The observation that as little as 24 h of prior effective therapy may impact clinical outcome suggests that trials to evaluate CAP treatment may need to exclude patients who have received any potentially effective therapy before enrollment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Daptomycin; Diarrhea; Double-Blind Method; Female; Headache; Humans; Logistic Models; Male; Middle Aged; Nausea; Pneumonia; Pneumonia, Ventilator-Associated; Sepsis; Treatment Outcome

Malnourished children have several physiologic abnormalities that can affect drug distribution and elimination. The aim of this study was to determine the efficacy, safety and pharmacokinetics of a once-daily dose of gentamicin compared with conventional thrice-daily dosing in malnourished children. To our knowledge, it has not been investigated in this population so far. A total of 310 malnourished children of either gender aged 6 months to 5 years with diarrhea and pneumonia were randomized to receive intramuscular gentamicin 5 mg/kg/day once-daily (OD) (n=148) or the same total daily amount given in three divided doses (TD) (n=162) in addition to ceftriaxone 75 mg/kg/day. After 48 h at steady state, gentamicin pharmacokinetics was assessed by fluorescence polarization immunoassay in a subgroup of 59 children and 43 children in the OD and TD groups, respectively. The groups were equivalent in baseline demographic, clinical and laboratory characteristics. Good and partial clinical responses occurred in 64 per cent vs. 54 per cent and 25 per cent vs. 27 per cent in the OD and the TD children, respectively (p=NS for both comparisons). Five patients in each treatment group died. Renal toxicity defined by change in serum creatinine was not observed in any patient from either group. In the OD group, mean+/-SD serum gentamicin concentrations at 1 (peak), 3, 5, 8, 23, and 24 (trough value) hours after the dose were 11.7+/-4.1, 4.4+/-1.2, 2.08+/-0.9, 1.01+/-0.6, 0.31+/-0.09 and 0.29+/-0.07 mg/l respectively. In the TD group, mean +/-SD serum gentamicin concentration at 1 hour (peak) was 4.7+/-1.8 mg/l and the trough concentration was 0.48+/-0.21 mg/l. In OD group, the gentamicin trough concentration was significantly lower (p<0.001) and the peak concentration was significantly higher (p<0.001) compared to TD group. The results of this study indicate that once-daily gentamicin is effective and safe in malnourished children. Widespread implementation of once-daily dosing in malnourished children is appropriate and will reduce number of intramuscular injections and hospital costs.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Diarrhea; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant; Male; Pneumonia, Bacterial; Protein-Energy Malnutrition

Acute invasive diarrhea is a potentially serious condition in children. Because of the increasing resistance of enteric pathogens to commonly used oral antibiotics, intramuscular ceftriaxone has become the routine drug in the treatment of acute invasive diarrhea requiring an emergency visit in southern Israel. The inconvenience of this parenteral regimen created an increased need for oral pediatric formulations for the treatment of invasive diarrhea.. To evaluate the efficacy and safety of a suspension formulation of ciprofloxacin in the treatment of acute invasive diarrhea in infants and children.. From July 1996 through December 1997, 201 evaluable children ages 6 months to 10 years (35% <1 year; 70% <3 years) presenting with acute invasive diarrhea at the Pediatric Emergency Room were randomized to receive either ciprofloxacin suspension (10 mg/kg twice a day + im placebo; n = 95) or im ceftriaxone (50 mg/kg/day + placebo suspension; n = 106) for 3 days in a double blind manner. Stool cultures for Shigella, Salmonella, Campylobacter spp. and diarrheagenic Escherichia coli were obtained on Days 1, 3, 4 to 5 and 21 +/- 5. Clinical response and safety were assessed on Days 1, 2, 3, 4 to 5 and 21 +/- 5.. We isolated 127 pathogens from 121 (60%) patients: 73 (57%) Shigella; 23 (18%) Salmonella; 18 (14%) E. coli; and 13 (10%) Campylobacter. Overall bacteriologic eradication on Day 4 to 5 was 99% for Shigella, 77% for Salmonella and 77% for Campylobacter, with no difference between the 2 groups. Clinical cure or improvement was observed in 100 and 99% of the ciprofloxacin and ceftriaxone groups, respectively. Serum ciprofloxacin values determined on Day 3 of the treatment were higher in the majority of patients than were the MIC50 and MIC90 values for the Shigella and Salmonella spp. isolated. Possible drug-related adverse events occurred in 13 patients [ciprofloxacin, 8 (8%); ceftriaxone, 5 (4.7%)] and were mild and transient. Joint examination was normal during and after completion of therapy in all patients.. Oral ciprofloxacin was as safe and effective as intramuscular ceftriaxone for the empiric treatment of acute invasive diarrhea in ambulatory pediatric patients requiring an emergency room visit.

Topics: Acute Disease; Administration, Oral; Adolescent; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Ciprofloxacin; Diarrhea; Double-Blind Method; Female; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Male; Prospective Studies

Ceftriaxone as a single daily intravenous dose for 5 days was used to treat seven patients with proven Haemophilus influenzae epiglottitis. All children responded favourably. The serum levels achieved exceeded the MIC by up to 1500 times at the trough level during and for up to 24 h after the completion of the treatment. Side effects were mild and transient and did not disrupt the continuity of the treatment. Ceftriaxone potentially offers a number of clinical and economic advantages in the management of epiglottitis.

Topics: Ceftriaxone; Child, Preschool; Diarrhea; Epiglottitis; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Injections, Intravenous

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

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

We evaluated the burden of Shigella spp from children aged 0-59 months with medically attended moderate-to-severe diarrhea and matched controls at sites in Mali, The Gambia, and Kenya participating in the Vaccine Impact on Diarrhea in Africa (VIDA) study from 2015 to 2018.. Shigella spp were identified using coprocultures and serotyping in addition to quantitative polymerase chain reaction (qPCR). Episode-specific attributable fractions (AFe) for Shigella were calculated using Shigella DNA quantity; cases with AFe ≥0.5 were considered to have shigellosis.. The prevalence of Shigella was determined to be 359 of 4840 (7.4%) cases and 83 of 6213 (1.3%) controls by culture, and 1641 of 4836 (33.9%) cases and 1084 of 4846 (22.4%) controls by qPCR (cycle threshold <35); shigellosis was higher in The Gambia (30.8%) than in Mali (9.3%) and Kenya (18.7%). Bloody diarrhea attributed to Shigella was more common in 24- to 59-month-old children (50.1%) than 0- to 11-month-old infants (39.5%). The Shigella flexneri serogroup predominated among cases (67.6% of isolates), followed by Shigella sonnei (18.2%), Shigella boydii (11.8%), and Shigella dysenteriae (2.3%). The most frequent S. flexneri serotypes were 2a (40.6%), 1b (18.8%), 6 (17.5%), 3a (9.0%), and 4a (5.1%). Drug-specific resistance among 353 (98.3%) Shigella cases with AMR data was as follows: trimethoprim-sulfamethoxazole (94.9%), ampicillin (48.4%), nalidixic acid (1.7%), ceftriaxone (0.3%), azithromycin (0.3%), and ciprofloxacin (0.0%).. A high prevalence of shigellosis continues in sub-Saharan Africa. Strains are highly resistant to commonly used antibiotics while remaining susceptible to ciprofloxacin, ceftriaxone, and azithromycin.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Diarrhea; Dysentery, Bacillary; Humans; Infant; Infant, Newborn; Mali; Microbial Sensitivity Tests; Shigella

Azithromycin is commonly used to treat Neisseria gonorrhoeae. We compared its gastrointestinal side effects using 1 g single, 2 g single or 2 g split (i.e. 1 g plus 1 g 6-12 h later) dosing, representing our clinic's changing guidelines over the study period.. We recruited consecutive sexual health clinic patients who received azithromycin (and 500 mg ceftriaxone) for uncomplicated gonorrhoea. Each patient received a text message 48 h after their attendance to complete a questionnaire.. Patients received 1 g single (n = 271), 2 g single (218) or 2 g split (105) doses. Vomiting was less common for 1 g versus 2 g single dose [1.1% versus 3.7%; risk difference (RD): -2.6%; 95% CI: -0.2 to -5.4] and 2 g split versus 2 g single dose (0.9% versus 3.7%; RD: -2.8%; 95% CI: -0.3 to -5.8). Nausea was less common for 1 g versus 2 g single dose (13.7% versus 43.1%; RD: -29.5%; 95% CI: -21.7 to -37.2) and 2 g split versus 2 g single dose (16.4% versus 43.1%; RD: -26.8; 95% CI: -17.2 to -36.3). Diarrhoea was less common for 1 g versus 2 g single dose (25.5% versus 50.9%; RD: -25.5%; 95% CI: -17.0 to -33.9) and 2 g split versus 2 g single dose (30.9% versus 50.9%; RD: -20.0; 95% CI: -9.1 to -30.9). Almost all were willing to retake the same dosing for gonorrhoea in the future: 97% for 1 g single; 94% for 2 g single; and 97% for 2 g split dose.. Azithromycin 2 g split dose for gonorrhoea resulted in significantly less vomiting, nausea and diarrhoea than a 2 g single dose.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Diarrhea; Drug-Related Side Effects and Adverse Reactions; Gonorrhea; Humans; Nausea; Neisseria gonorrhoeae; Vomiting

Acute gastroenteritis is one of the most common causes of hospital admission in children. Treatment regimens differ depending on the pathogen. In our study, we aimed to evaluate the epidemiological and clinical features of pediatric patients whose gastrointestinal agents were detected by multiplex PCR.. The study included 131 pediatric patients who were followed up at Eskişehir Osmangazi University, Pediatric Department between January 2018 and December 2021.Gastrointestinal pathogens were detected in stool samples by multiplex PCR. The epidemiological and clinical features were reviewed retrospectively.. A total of 203 gastrointestinal pathogens were detected from the stool samples of 131 cases. Of these cases, 56% were male and 44% were female. The mean age was 66 (2-204) months. The most common symptoms were diarrhea, fever, vomiting and abdominal pain. The pathogen detection rate was 69% by multiplex PCR. A single pathogen was detected in 85 (65%) cases and multiple pathogens were detected in 46 (35%) cases. The most common pathogens were enteropathogenic Escherichia coli (EPEC, 23%), Clostridium difficile (21%), norovirus (17%), rotavirus (15%), salmonella (12%) and enterotoxigenic E. coli (ETEC, 11%). Stool culture was positive in 16 (12%) cases and microscopic examination positive in 17 (13%) cases. Probiotic treatment was given to 119 (92%) cases and antimicrobial treatment (metroinidazole, ceftriaxone, azithromycin and oral vancomycin) to 34 (26%) cases. Of the cases, 56 (42%) had chronic disease, 40 (30%) had a history of previous antibiotic use and 17 (13%) had a history of hospitalization in the intensive care unit.. The sensitivity of the multiplex PCR in the detection of acute gastroenteritis agents is higher than stool microscopy, stool culture and stool antigen tests. However, due to the inability to distinguish between colonization, carrier state and pathogenicity, it should be evaluated together with other diagnostic tests and clinical findings in order to determine whether the determined agent is pathogenic or not and in the regulation of antimicrobial therapy.

Topics: Aged; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Child; Diarrhea; Escherichia coli; Feces; Female; Gastroenteritis; Gastrointestinal Agents; Humans; Infant; Male; Multiplex Polymerase Chain Reaction; Retrospective Studies; Vancomycin

Topics: Anti-Bacterial Agents; Arthritis; Ceftriaxone; Diagnosis, Differential; Diarrhea; Duodenum; Endoscopy, Digestive System; Fever; Humans; Male; Middle Aged; Tropheryma; Weight Loss; Whipple Disease

Salmonellosis remains an important public health problem globally. The disease is among the leading causes of morbidity and mortality in developing countries that experience poor hygiene and lack of access to clean and safe water. There was an increase in reported cases of Salmonellosis in Njombe Region, Southern Highland of Tanzania between 2015 and 2016 based on clinical diagnosis. Nevertheless, little is known about the factors contributing to the transmission of this disease in the region. This study was conducted to determine the prevalence, antimicrobial susceptibility, and factors associated with Salmonella infection among patients who report gastrointestinal complaints.. A cross-sectional study was conducted from December 2017 to February 2018 among patients with gastrointestinal complaints at Kibena Regional Hospital. Stool samples were submitted for isolation of Salmonella spp. Identification was based on conventional biochemical tests and serotyping to differentiate typhoid and non-typhoid Salmonella (NTS). Antimicrobial susceptibility was performed using the Kirby-Bauer disc diffusion method. Multivariable logistic regression analysis was performed to examine the factors independently associated with Salmonella infection.. The prevalence of Salmonella infection among participants with gastrointestinal complaints was 16.5% (95% CI: 12.7-21.1) of them, 83.7, 95% CI: 70.9-91.5 were NTS while 16.3, 95% CI: 8.5-29.0 were Typhoid Salmonella species. All isolates were sensitive to ceftriaxone and ciprofloxacin, whereas 27.8 and 100% were resistant to co-trimoxazole and ampicillin respectively. The odd of Salmonella infection was fourfold higher among participants with formal employment (AOR 3.8, 95% CI, 1.53-9.40). Use of water from wells/rivers (AOR 2.2, 95% CI, 1.07-4.45), drinking untreated water (AOR 2.6, 95% CI, 1.21-5.48) and often eating at a restaurant (AOR 3.4, 95% CI, 1.28-8.93) had increased odds of Salmonella infection. Likewise, having abdominal pain (AOR 8.5, 95% CI, 1.81-39.78) and diarrhea (AOR 2.3, 95% CI, 1.12-4.68) were independent symptoms that predict Salmonella infection.. There is a high prevalence of Salmonella infection among people who report gastrointestinal complaints and it is clinically predicated by diarhoea and abdominal pain. Employed participants and those eating at restaurant and drinking unsafe water had higher risk of infection. Salmonella spp. causing gastroenteritis has developed resistance to commonly used antibiotics.

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Cross-Sectional Studies; Diarrhea; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Female; Gastrointestinal Diseases; Hospitals; Humans; Infant; Male; Middle Aged; Prevalence; Salmonella; Salmonella Infections; Tanzania; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever; Young Adult

Tularemia, a re-emerging, potential life threatening infectious disease, can present itself with nonspecific clinical symptoms including fever, chills and malaise. Taking a detailed history of exposure and a highly raised index of clinical suspicion are necessary to take the appropriate diagnostic and therapeutic steps in this setting. Here, a case report of typhoid tularaemia is presented.. A 53-year old male forester and farmer with protracted fever, abdominal pain, diarrhoea and loss of weight, who experienced productive cough and a pulmonary infiltrate later in the course of disease, was admitted for further investigation. Tularaemia was suspected only owing to history and confirmed by serologic testing more than three weeks after the beginning of the symptoms. The initial antibiotic therapy with ceftriaxone/doxycycline was switched to ciprofloxacin, resulting in the resolution of fever and symptoms.. Tularaemia has to be considered as a differential diagnosis in febrile patients, even more in cases with protracted fever. Since tularaemia is expanding geographically, involving more animal hosts and causing larger outbreaks, clinicians have to be aware of this potentially fatal disease.

Topics: Abdominal Pain; Anti-Bacterial Agents; Body Weight; Ceftriaxone; Ciprofloxacin; Cough; Diagnosis, Differential; Diarrhea; Doxycycline; Farmers; Fever; Francisella tularensis; Humans; Male; Middle Aged; Serologic Tests; Tularemia

Topics: Administration, Intravenous; Adolescent; Anti-Bacterial Agents; Brain; Ceftriaxone; Central Nervous System Viral Diseases; Diagnosis, Differential; Diarrhea; Flushing; Guillain-Barre Syndrome; Headache; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Irritable Mood; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Myelitis; Neck Pain; Paresthesia; Peroneal Neuropathies; Pneumonia, Bacterial; Reflex, Abnormal; Spinal Cord; Sweating; Urinary Retention; West Nile Fever

Topics: Acute Retroviral Syndrome; Adult; Anti-HIV Agents; Ceftriaxone; Diarrhea; Dysentery, Bacillary; HIV Infections; Humans; Injections, Intravenous; Male; Shigella flexneri; Treatment Outcome

A 45-year-old man was presented at the emergency department with altered neurological status and a 1-day history of diarrhoea and fever. The patient's sexual history revealed multiple male partners. As bacterial meningitis or viral encephalitis was suspected, treatment was started accordingly. Cerebrospinal fluid investigations only showed a slight increase of leucocytes, and microbiological studies remained negative. Stool culture revealed

Topics: Acyclovir; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Diarrhea; Drug Therapy, Combination; Dysentery, Bacillary; Encephalitis; Feces; Fever; Humans; Male; Middle Aged; Sexual and Gender Minorities; Shigella flexneri; Treatment Outcome; Unsafe Sex

Whipple's disease is a chronic, rare, multisystemic, infectious entity, described for the first time in 1907. Its aetiological agent is the Gram-negative rod,

Topics: Abdominal Pain; Administration, Intravenous; Aged; Anti-Bacterial Agents; Arthralgia; Biopsy; Ceftriaxone; Diarrhea; Duodenum; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

To describe the clinical and microbiological characteristics of women presenting with acute gastroenteritis due to infection with Salmonella spp. or Shigella spp.. A cross-sectional retrospective study was conducted using data for patients with specimens positive for Shigella spp. and Salmonella spp. attending two major women's hospitals in Porto Alegre, Brazil, between January 2003 and July 2014. Women were included if they had symptoms compatible with bacterial acute diarrhea. Isolates were evaluated to determine antimicrobial susceptibility and patient clinical profile.. Among 45 eligible patients, Salmonella spp. was identified in 32 (71%) and Shigella spp. in 13 (29%). The highest antimicrobial sensitivity rates were observed for ciprofloxacin and ceftriaxone (n=44, 98% for both) whereas the greatest resistance rate was seen for ampicillin (n=20, 44%). Seven (16%) of the women were pregnant.. Ciprofloxacin, ceftriaxone, and sulfamethoxazole/trimethoprim are suitable choices for the treatment of bacterial acute diarrhea. However, the maternal and fetal safety profile of prescribed medications should be considered when treating pregnant patients.

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Brazil; Ceftriaxone; Ciprofloxacin; Cross-Sectional Studies; Diarrhea; Dysentery, Bacillary; Female; Humans; Microbial Sensitivity Tests; Pregnancy; Retrospective Studies; Salmonella; Salmonella Infections; Shigella; Sulfamethoxazole; Trimethoprim; Young Adult

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bacteremia; Ceftriaxone; Diagnosis, Differential; Diarrhea; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Paratyphoid Fever; Recurrence; Salmonella paratyphi A; Travel Medicine

Undifferentiated febrile illness in a returning soldier is a common problem encountered by serving medical officers. A 32-year-old soldier presented to Birmingham Heartlands Hospital with fever and acute kidney injury after return from Borneo. Leptospirosis was suspected and empirical antibiotics were started before subsequent confirmation by serology and PCR. Leptospirosis is common in South-East Asia, and troops exercising in jungle areas, and in the UK, are at risk. Advice, including inpatient management when appropriate, is available from the UK Role 4 Military Infectious Diseases and Tropical Medicine Service.

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Borneo; Ceftriaxone; Diarrhea; DNA, Bacterial; Doxycycline; Fever; Humans; Immunoglobulin M; Leptospira; Leptospirosis; Male; Military Personnel; Myalgia; Polymerase Chain Reaction; Serologic Tests; Travel; United Kingdom

Since data about Clostridium difficile infection in sub-Saharan Africa are scarce, we determined its epidemiology and risk factors in a cross-sectional study in Eikwe, a rural community in Ghana. We tested stool samples from 176 hospitalized patients with diarrhoea and from 131 asymptomatic non-hospitalized individuals for C. difficile and some other enteric pathogens. The overall prevalence rate of C. difficile was 4.9% with ribotype 084 being predominant. With 75% of the isolates, a high rate of nontoxigenic strains was present in symptomatic patients, most of whom had no other identified enteric pathogens. All strains were susceptible against metronidazole and vancomycin, respectively. Data on lifestyle and medical history showed that age <5years (p=0.004), and use of ceftriaxone (p=0.023) were the most important risk factors for C. difficile carriage status. Although our data suggest that C. difficile is currently not a major cause of diarrhoea in this setting, the epidemiology of C. difficile in sub-Saharan Africa awaits further investigation.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Toxins; Carrier State; Ceftriaxone; Child; Child, Preschool; Clostridioides difficile; Clostridium Infections; Cross-Sectional Studies; Diarrhea; Feces; Female; Ghana; Hospitalization; Humans; Infant; Infant, Newborn; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Prevalence; Prospective Studies; Ribotyping; Risk Factors; Rural Population; Vancomycin; Young Adult

A 17-year-old male presented with diarrhoea and malaise following his return from Kenya and Tunisia. He was managed as a case of traveller's diarrhoea. Stool cultures were negative for pathogenic bacterial growth. Two weeks later he presented with worsening lower back pain. MRI of lumbosacral spine suggested L1 osteomyelitis. CT-guided spinal aspirate grew no organisms and repeat viral serology and blood cultures (including tuberculosis screening) were negative. He was treated with a 6-week course of ceftriaxone. Back pain did not improve and a repeat MRI scan 8 weeks after his antibiotic course indicated progressive changes in L1 extending to L2 with an intradiscal abscess. Repeat CT-guided spinal aspirate grew Salmonella arizonae sensitive to cotrimoxazole and ceftriaxone. He was treated with intravenous ceftriaxone and cotrimoxazole for 12 weeks. A 4-month follow-up MRI scan showed progressive improvement of the L1/L2 discitis with resolution of intradiscal fluid.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Diarrhea; Epidural Abscess; Fever of Unknown Origin; Humans; Kenya; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Salmonella Infections; Travel; Treatment Outcome; Tunisia

A 90-year-old woman who had bloody diarrhoea, nausea, weakness and reduced urine output was found to have acute kidney injury. Her inflammatory markers were raised and her chest X-ray suggested an inflammatory process. She was initially suspected to have acute kidney injury secondary to dehydration and sepsis but when her autoimmune screen returned positive for antiglomerular basement membrane antibodies our diagnosis and management strategy was reconsidered. This is a case report of Goodpasture disease presenting in an elderly patient.

Topics: Acute Kidney Injury; Aged, 80 and over; Albuterol; Anti-Bacterial Agents; Anti-Glomerular Basement Membrane Disease; Bronchodilator Agents; Ceftriaxone; Diarrhea; Esomeprazole; Fatal Outcome; Female; Humans; Nausea; Palliative Care; Patient Comfort; Plasma Exchange; Proton Pump Inhibitors

Intravenous pharmacotherapy with the third-generation cephalosporin ceftriaxone is unfortunately associated with a relatively high incidence of Clostridium difficile-associated diarrhoea. Cholestyramine (colestyramine) is an anion-binding resin which can bind luminal C.difficile toxin A (TcdA) and toxin B (TcdB) and which may be beneficial in the treatment of recurrent antibiotic-associated pseudomembranous colitis. We therefore hypothesised that concomitant oral cholestyramine might reduce the risk of C.difficile-associated diarrhoea in patients receiving long-term intravenous ceftriaxone. A pilot study was carried out in which it was found that only three out of 46 (6.5%) such patients being treated with 2 g ceftriaxone daily for Lyme borreliosis, who also received 4 g cholestyramine daily, developed C.difficile-associated diarrhoea. This is smaller than a published report of the incidence of this complication in six out of 26 (23.1%) patients following 1-3 days' treatment with 1 g intravenous ceftriaxone, but without oral cholestyramine (p=0.06). We therefore recommend that a larger, double-blind placebo-controlled trial be carried out to test this hypothesis.

Topics: Bacterial Proteins; Bacterial Toxins; Ceftriaxone; Cholestyramine Resin; Cohort Studies; Diarrhea; Enterotoxins; Humans; Lyme Disease; Models, Biological; Pilot Projects

Aeromonas species can cause a wide spectrum of illnesses varying from intestinal to extra intestinal and vary in their susceptibility to different antibiotics. The current study was undertaken to characterize the third generation cephalosporin-resistant strains of Aeromonas spp. which were isolated from stool specimens.. Out of a total of 2780 stool samples, 29 Aeromonas spp. were identified, out of which, 9 were resistant to ceftriaxone by the Kirby-Bauer antibiotic testing method. These strains were subjected to minimum inhibitory concentration (MIC) determination by agar dilution for ceftriaxone. Phenotypic and genotypic testing of AmpC beta-lactamase and extended spectrum beta-lactamase (ESBL) were performed. Gene transfer was carried out to demonstrate transmissibility of these genetic elements by conjugation experiments.. Out of the 29 strains, 9 showed MIC of ≥4 μg/ml. Seven out of 9 showed presence of blaCTX-M, while 2 more strains showed the presence of inducible AmpC beta-lactamase and presence of MOX gene. Gene transfer experiments showed that these elements were transmissible to recipient (Escherichia coli J53 strain) in the presence of ceftriaxone.. Dissemination of these resistance determinants like plasmids is pivotal in the spread of these resistance genes into the aquatic environment into organisms like Aeromonas. This may further limit the future use of antibiotics for the treatment of diarrhoeal diseases. Hence, detection and antibiotic susceptibility testing of Aeromonas spp. should be performed when isolated from stool samples.

Topics: Adult; Aeromonas; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Ceftriaxone; Child; Developing Countries; Diarrhea; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Dysentery; Escherichia coli; Feces; Gene Transfer Techniques; Humans; India; Isoenzymes; Molecular Typing; Recombinant Proteins; Tertiary Care Centers

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

A 41-year-old lady was investigated by several hospital teams over a 5-year period. She initially presented with arthralgia but over time developed a myriad of signs and symptoms. Later, she was admitted for investigation of profound weight loss, anaemia and a rising C-reactive protein. Extensive gastrointestinal investigations were performed. Duodenal biopsy revealed microscopic evidence of villous blunting with prominent collections of macrophages within the lamina propria and submucosa. These changes were consistent with Whipple's disease and confirmed by polymerase chain reaction on the biopsy sample. Initiation of antibiotic therapy led to normalisation of inflammatory markers and marked clinical improvement. Even in younger female patients, this disease should always be considered.

Topics: Adult; Anti-Bacterial Agents; Arthritis; Biopsy; Ceftriaxone; Diagnosis, Differential; Diarrhea; Dose-Response Relationship, Drug; Drug Therapy, Combination; Duodenum; Female; Humans; Methotrexate; Prednisolone; Sulfasalazine; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Nontyphoidal Salmonella (NTS) species cause self-limiting diarrhea and sometimes severe disease. Antibiotic treatment is considered only in severe cases and immune-compromised patients. The beneficial effects of antibiotic therapy and the consequences for adaptive immune responses are not well understood. We used a mouse model for Salmonella diarrhea to assess the effects of per os treatment with ciprofloxacin (15 mg/kg of body weight intragastrically 2 times/day, 5 days) or parenteral ceftriaxone (50 mg/kg intraperitoneally, 5 days), two common drugs used in human patients. The therapeutic and adverse effects were assessed with respect to generation of a protective adaptive immune response, fecal pathogen excretion, and the emergence of nonsymptomatic excreters. In the mouse model, both therapies reduced disease severity and reduced the level of fecal shedding. In line with clinical data, in most animals, a rebound of pathogen gut colonization/fecal shedding was observed 2 to 12 days after the end of the treatment. Yet, levels of pathogen shedding and frequency of appearance of nonsymptomatic excreters did not differ from those for untreated controls. Moreover, mice treated intraperitoneally with ceftriaxone developed an adaptive immunity protecting the mice from enteropathy in wild-type Salmonella enterica serovar Typhimurium challenge infections. In contrast, the mice treated intragastrically with ciprofloxacin were not protected. Thus, antibiotic treatment regimens can disrupt the adaptive immune response, but treatment regimens may be optimized in order to preserve the generation of protective immunity. It might be of interest to determine whether this also pertains to human patients. In this case, the mouse model might be a tool for further mechanistic studies.

Topics: Adaptive Immunity; Administration, Oral; Animals; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Colony Count, Microbial; Diarrhea; Disease Models, Animal; Drug Administration Schedule; Feces; Infusions, Parenteral; Mice; Mice, Inbred C57BL; Salmonella Infections; Salmonella typhimurium; Severity of Illness Index

Increased incidence and severity of Clostridium difficile infections (CDIs) is of major concern. However, by minimizing known risk factors, the incidence can be decreased. The aim of this investigation was to calculate the incidence and assess risk factors for CDI in our population. A 1-year prospective population-based nationwide study in Iceland of CDIs was carried out. For risk factor evaluation, each case was matched with two age- and sex-matched controls that tested negative for C. difficile toxin. A total of 128 CDIs were identified. The crude incidence was 54 cases annually per 100,000 population >18 years of age. Incidence increased exponentially with older age (319 per 100,000 population >86 years of age). Community-acquired origin was 27 %. Independent risk factors included: dicloxacillin (odds ratio [OR]: 7.55, 95 % confidence interval [CI]: 1.89-30.1), clindamycin (OR: 6.09, 95 % CI: 2.23-16.61), ceftriaxone (OR: 4.28, 95 % CI: 1.59-11.49), living in a retirement home (OR: 3.9, 95 % CI: 1.69-9.16), recent hospital stay (OR: 2.3, 95 % CI: 1.37-3.87). Proton pump inhibitors (PPIs) were used by 60/111 (54 %) versus 91/222 (41 %) (p = 0.026) and ciprofloxacin 19/111 (17 %) versus 19/222 (9 %) (p = 0.027) for cases and controls, respectively. In all, 75 % of primary CDIs treated with metronidazole recovered from one course of treatment. CDI was mostly found among elderly patients. The most commonly identified risk factors were broad-spectrum antibiotics and recent contact with health care institutions. PPI use was significantly more prevalent among CDI patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Toxins; Case-Control Studies; Ceftriaxone; Child; Child, Preschool; Clindamycin; Clostridioides difficile; Clostridium Infections; Community-Acquired Infections; Confidence Intervals; Diarrhea; Dicloxacillin; Enterotoxins; Female; Humans; Iceland; Incidence; Infant; Length of Stay; Male; Metronidazole; Middle Aged; Odds Ratio; Prospective Studies; Proton Pump Inhibitors; Risk Factors; Treatment Outcome; Young Adult

Topics: Anti-Bacterial Agents; Ceftriaxone; Diarrhea; Humans; Infant; Male; Vitamin K Deficiency

Topics: Adult; Anti-Bacterial Agents; Biopsy; Capsule Endoscopy; Ceftriaxone; Colonoscopy; Diarrhea; Humans; Male; Periodic Acid-Schiff Reaction; Rare Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss; Whipple Disease

In the present study, a cross-sectional survey of intestinal parasitic and bacterial infections in relation to diarrhoea in Vhembe district and the antimicrobial susceptibility profiles of isolated bacterial pathogens was conducted. Stool samples were collected from 528 patients attending major public hospitals and 295 children attending two public primary schools and were analyzed by standard microbiological and parasitological techniques. Entamoeba histolytica/E. dispar (34.2%) and Cryptosporidium spp. (25.5%) were the most common parasitic causes of diarrhoea among the hospital attendees while Giardia lamblia (12.8%) was the most common cause of diarrhoea among the primary school children (p < 0.05). Schistosoma mansoni (14.4%) was more common in non-diarrhoeal samples at both hospitals (16.9%) and schools (17.6%). Campylobacter spp. (24.9%), Aeromonas spp. (20.8%), and Shigella spp. (8.5%) were the most common bacterial causes of diarrhoea among the hospital attendees while Campylobacter (12.8%) and Aeromonas spp. (12.8%) were most common in diarrhoeal samples from school children. Vibrio spp. was less common (3% in the hospitals) and were all associated with diarrhoea. Antimicrobial resistance was common among the bacterial isolates but ceftriaxone (91%) and ciprofloxacin (88.6%) showed stronger activities against all the organisms. The present study has demonstrated that E. histolytica/dispar, Cryptosporidium, Giardia, and Cyclospora are common parasitic causes of diarrhoea in Vhembe district while Campylobacter spp. and Aeromonas are the most common bacterial causes of diarrhoea in Vhembe district of South Africa.

Topics: Adult; Animals; Anti-Infective Agents; Bacteria; Ceftriaxone; Child; Ciprofloxacin; Cross-Sectional Studies; Diarrhea; Drug Resistance; Feces; Humans; Intestinal Diseases; Intestinal Diseases, Parasitic; Intestines; Parasites; Prevalence; South Africa

Topics: Acute Disease; Anti-Infective Agents; Ceftriaxone; Child, Preschool; Diarrhea; Drug Prescriptions; Female; Humans; India; Infant; Male; Zinc

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

Clostridium difficile-associated diarrhea (CDAD) is a leading cause of nosocomial diarrhea in the United States, and may be associated with significant morbidity and occasional mortality. Diarrhea is also very common among hospitalized patients and is often related to a variety of factors not related to C difficile infection.. We performed a retrospective case-control study at a tertiary care community medical center to delineate factors that are predictive of CDAD among hospitalized patients with new-onset diarrhea (ie, not present at the time of admission). Controls were selected based on negative C difficile toxin test(s) (CDTTs) (> 95% by cytotoxic assay), presence on the same ward as the patients with first positive CDTT, and hospitalization around the same period as the positive cases.. The study involved 352 patients (88 cases and 264 controls). In univariate analysis, age 75 years or greater, exposure to cefazolin or levofloxacin during the 4-week period preceding CDTT, and hospitalization for 7 days or greater before CDTT were significantly associated with a positive test; male gender and prior ceftriaxone exposure nearly reached statistical significance. Multivariate logistic regression analysis revealed age 75 years or greater (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.3-3.7), hospitalization for 7 days or more (OR 2.3, 95% CI 1.3-3.8], and prior exposure to cefazolin (OR 3.5, 95% CI 1.6-7.5) or levofloxacin (OR 2.1, 95% CI 1.2-3.7) as independent predictors of a positive CDTT; male gender nearly achieved statistical significance (OR 1.6, 95% CI 0.9-2.7).. Among hospitalized patients with diarrhea who underwent testing for C difficile toxin, age 75 years or older, hospitalization for 7 days or greater, and recent exposure to cefazolin or levofloxacin were important predictors of a positive CDTT. These findings may help in the initiation of early presumptive treatment for CDAD, and appropriate isolation of higher risk patients before results become available. In addition, consideration of these risk factors may help in deciding whether a CDTT should be repeated when the first test is negative. Our study also supports more judicious use of antibiotics, particularly cefazolin and levofloxacin, in reducing the risk of CDAD in hospitalized patients.

Topics: Aged; Analysis of Variance; Case-Control Studies; Cefazolin; Ceftriaxone; Clostridioides difficile; Confidence Intervals; Cross Infection; Diarrhea; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Female; Hospitalization; Humans; Incidence; Levofloxacin; Male; Missouri; Multivariate Analysis; Odds Ratio; Ofloxacin; Regression Analysis; Retrospective Studies; Risk Factors

In sub-Saharan Africa community-acquired non-typhoidal Salmonella (NTS) is a major cause of high morbidity and death among children under 5 years of age especially from resource poor settings. The emergence of multidrug resistance is a major challenge in treatment of life threatening invasive NTS infections in these settings.. Overall 170 (51.2%) of children presented with bacteraemia alone, 28 (8.4%) with gastroenteritis and bacteraemia and 134 (40.4%) with gastroenteritis alone. NTS serotypes obtained from all the cases included S. Typhimurium (196; 59%), S. Enteritidis (94; 28.3%) and other serotypes in smaller numbers (42; 12.7%); distribution of these serotypes among cases with bacteremia or gastroenteritis was not significantly different. A significantly higher proportion of younger children (< 3 years of age) and those from the slums presented with invasive NTS compared to older children and those from upper socio-economic groups (p < 0.001). One hundred and forty-seven (44.3%) NTS were resistant to 3 or more antibiotics, and out of these 59% were resistant to ampicillin, chloramphenicol and tetracycline. There was no significant difference in antibiotic resistance between the two serotypes, S. Typhimurium and S. Enteritidis. Ceftriaxone and ciprofloxacin were the only antibiotics tested to which all the NTS were fully susceptible. Using Pulsed Field Gel Electrophoresis (PFGE) there were 3 main patterns of S. Typhimurium and 2 main patterns of S. Enteritidis among cases of bacteraemia and gastroenteritis.. Serotype distribution, antibiotic susceptibility and PFGE patterns of NTS causing bacteraemia and gastroenteritis did not differ significantly. The high prevalence of NTS strains resistant to most of the commonly used antimicrobials is of major public health concern.

Topics: Bacteremia; Ceftriaxone; Cefuroxime; Child; Child, Preschool; Community-Acquired Infections; Diarrhea; Drug Resistance; Electrophoresis, Gel, Pulsed-Field; Female; Hospitalization; Humans; Infant; Infant, Newborn; Kenya; Male; Microbial Sensitivity Tests; Prospective Studies; Salmonella; Salmonella enteritidis; Salmonella Infections; Salmonella typhimurium

Whipple's disease is a rare chronic multi-systemic infectious disorder caused by the Gram-positive bacillus, Tropheryma whippelii. Infection may involve any organ in the body, and most commonly affects white men in the fourth to sixth decades of life. The most common presenting symptoms are gastrointestinal and include abdominal pain, diarrhoea, anorexia and associated weight loss. However, the variability in presentation is considerable and some patients may present with intermittent low-grade fever, neurological abnormalities (nystagmus, ophthalmoplegia, cranial nerve defects), migratory arthralgia, lymphadenopathy, or involvement of the cardiovascular system. In typical Whipple's disease, the most severe changes are seen in the proximal small intestine and biopsy reveals mucosal and lymph node infiltration with large, foamy histocytes, containing granules that stain positive with periodic acid-Schiff (PAS) reagent and represent intact or partially degraded bacteria. Extended antibiotic treatment (up to 1-year) is indicated. Life-long surveillance for recurrence is essential, once primary treatment has been completed. We report the case of a 58-year-old man who developed a rare infection with the actinobacterium, T. whippelii. The patient had suffered intermittent episodes of varying clinical symptoms associated with multiple hospital admissions and clinical diagnoses, spanning a period of 22 years. Historically, arthralgia was the primary manifestation in this patient and also was the chief complaint for which he was first hospitalized 22 years ago. At his most recent admission to our hospital department, his presenting symptoms were persistent fatigue, weight loss, arthralgia and diarrhoea. Thus, it is essential that clinicians retain a high index of suspicion for T. whippelii infection in patients who have a long-term history of arthritis, fever and diarrhoea.

Topics: Anti-Bacterial Agents; Arthralgia; Ceftriaxone; Diagnosis, Differential; Diarrhea; Doxycycline; Drug Therapy, Combination; Duodenoscopy; Duodenum; Fever; Humans; Intestinal Mucosa; Male; Middle Aged; Periodic Acid-Schiff Reaction; Treatment Outcome; Weight Loss; Whipple Disease

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Clostridioides difficile; Diagnosis, Differential; Diarrhea; Edema; Enterocolitis, Pseudomembranous; Esophagus; Female; Fever; Foreign Bodies; Gastritis, Hypertrophic; Humans; Infant; Male; Radiography; Respiratory Sounds; Vomiting

The impact of changes in antibiotic policy on Clostridium difficile-associated diarrhoea (CDAD), over a five-year period between 1995 and 2000, were studied in the Preston Acute Hospitals Trust. In 1996 the policy was changed in the Preston Acute Hospitals Trust from cefotaxime to ceftriaxone for initial treatment of severe sepsis or pneumonia in medical patients. Over the next nine months the average number of patients with C. difficile toxin-positive stools per quarter increased from 16 to 39. The predicted use of ceftriaxone exceeded by 65% an estimate based on prior use of cefotaxime. A policy of restricted duration of ceftriaxone was introduced, and although this reduced usage by over 50%, CDAD continued at an average of 9.2 cases per month, despite withdrawal of oral cephalosporins in December 1998. In August 1999 levofloxacin was substituted for ceftriaxone in the policy. The incidence of CDAD fell progressively to five cases per month by 2000. It would appear that a short (typically three dose) course of third-generation cephalosporin poses a similar risk for CDAD as a more prolonged course. The six-month delay in the decline of CDAD after virtual withdrawal of cephalosporins may reflect a slowly diminishing environmental reservoir.

Topics: Anti-Bacterial Agents; Ceftriaxone; Clostridioides difficile; Clostridium Infections; Cross Infection; Diarrhea; Drug Utilization Review; England; Feces; Hospitals, District; Hospitals, General; Humans; Incidence; Infection Control; Organizational Policy; Patient Selection; Practice Patterns, Physicians'; Risk Factors

The spread of resistant Salmonella strains continues to increase worldwide. It is necessary to establish epidemiologic information to determine an appropriate empiric antibiotic regimen (when indicated) in infants and children with suspected Salmonella infections for whom the results of susceptibility tests are not yet available.. The aim of the present study was to investigate resistance rates and their modifications among Salmonella enterica strains isolated from Italian children hospitalized for acute diarrhea over 5 years. In addition, when antibiotic treatment was indicated, we assessed the in vivo success of parenteral ceftriaxone therapy.. This study included children admitted consecutively for acute diarrhea to the Division of Pediatrics and Infectious Diseases, Department of Pediatrics, University of Florence, Italy, from January 1, 1997, to December 31, 2001. S enterica strains were isolated from stool cultures, biochemically identified, and serotyped. These isolates were tested by disk-diffusion assay, using the Kirby-Bauer method, for susceptibilities to ampicillin, ceftriaxone, ciprofloxacin, chloramphenicol, neomycin, tetracycline, and trimethoprim/sulfamethoxazole. The limits used for definition of resistance were those established by the guidelines of the National Committee for Clinical Laboratory Standards.. A total of 2003 children (1051 boys, 952 girls; median age, 10.3 years; age range, 1 month-16.8 years) with acute diarrhea were admitted to the study. S enterica strains were isolated using stool cultures from 218 (10.9%) children (108 boys, 110 girls; median age, 3.3 years; age range, 2 months-15.8 years). A total of 148 (67.9%) isolates were resistant to at least 1 antibiotic and 57 (26.1%) were multiresistant. The highest rates of resistance were those to tetracycline (132/218 [60.6%]), ampicillin (102/218 [46.8%]), and chloramphenicol (47/218 [21.6%]). The lowest rate of resistance was to ceftriaxone (4/218 [1.8%]). Overall, the rate of resistance to ciprofloxacin (19/218 [8.7%]) was significantly higher than that for ceftriaxone (P = 0.003). Salmonella typhimurium (119/218 [54.6%]) and Salmonella enteritidis (62/218 [28.4%]) were the most frequently identified serotypes. Ceftriaxone was effective in vivo in all 56 children who required antibiotic therapy.. There was a high prevalence of resistant S enterica strains. Ceftriaxone was used effectively in the treatment of S enterica infection in the population studied.

Topics: Acute Disease; Adolescent; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Child; Child, Preschool; Diarrhea; Drug Resistance, Multiple, Bacterial; Feces; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Prospective Studies; Salmonella enterica; Salmonella Infections; Salmonella typhimurium; Serotyping

The emergence of resistance to antimicrobial agents within the salmonellae is a worldwide problem that has been associated with the use of antibiotics in livestock. Resistance to ceftriaxone and the fluoroquinolones, which are used to treat invasive salmonella infections, is rare in the United States. We analyzed the molecular characteristics of a ceftriaxone-resistant strain of Salmonella enterica serotype typhimurium isolated from a 12-year-old boy with fever, abdominal pain, and diarrhea.. We used pulsed-field gel electrophoresis and analysis of plasmids and beta-lactamases to compare the ceftriaxone-resistant S. enterica serotype typhimurium from the child with four isolates of this strain obtained from cattle during a local outbreak of salmonellosis.. The ceftriaxone-resistant isolate from the child was indistinguishable from one of the isolates from cattle, which was also resistant to ceftriaxone. Both ceftriaxone-resistant isolates were resistant to 13 antimicrobial agents; all but one of the resistance determinants were on a conjugative plasmid of 160 kb that encoded the functional group 1 beta-lactamase CMY-2. Both ceftriaxone-resistant isolates were closely related to the three other salmonella isolates obtained from cattle, all of which were susceptible to ceftriaxone.. This study provides additional evidence that antibiotic-resistant strains of salmonella in the United States evolve primarily in livestock. Resistance to ceftriaxone, the drug of choice for invasive salmonella disease, is a public health concern, especially with respect to children, since fluoroquinolones, which can also be used to treat this disease, are not approved for use in children.

Topics: Animals; Anti-Bacterial Agents; Bacteriophage Typing; beta-Lactamases; Cattle; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Child; Diarrhea; Electrophoresis, Gel, Pulsed-Field; Humans; Male; Microbial Sensitivity Tests; Plasmids; Salmonella enterica; Salmonella Infections; Serotyping; Veterinary Drugs

Neisseria meningitidis infection (meningococcemia) is very common throughout the world. It usually presents as meningitis or sometimes pharyngitis. A gastroenteritis-like syndrome, with diarrhea, vomiting and abdominal pain, may occur in children but is very rare in adults. Search of the medical literature revealed only 3 such cases, all in young adults. We report an 80-year-old woman who presented with fever, diarrhea and abdominal pain. Meningococcus infection was later suspected, and proved by culture. Although treatment was intensive and included ceftriaxone (Rocephin) and garamycin, she did not respond and died 40 hours after admission. We draw attention to the possibility that what is usually a common symptom can be the first presentation of a serious, often fatal condition.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Ceftriaxone; Diagnosis, Differential; Diarrhea; Drug Therapy, Combination; Fatal Outcome; Female; Gastroenteritis; Gentamicins; Humans; Meningitis, Meningococcal; Neisseria meningitidis

Typhoid fever, which is endemic in Malaysia, affects all age groups and it has been stated that classical features described in textbooks were absent in children. The aim of this study was to find out whether this was true in the local setting and hence a retrospective study was undertaken.. Fifty-four paediatric patients satisfied the inclusion criteria and all were seen consecutively during the study period of 10 years. Patients' records were reviewed for demographic data such as age, sex, ethnicity, clinical features, therapy and results of laboratory tests.. Fever was the most common presenting symptom and diarrhoea was more common than constipation. Isolation of S typhi from blood and/or stools was the most important diagnostic tool *85.2%) and of these 99% had significant Widal titres. Clinical and bacteriological relapse occurred in 5 children (3%) who were successfully treated with ceftriaxone. The absence of mortality and low level of complications indicates either a mild nature of the disease or to early recognition or prompt and appropriate therapy.

Topics: Ceftriaxone; Cephalosporins; Child; Child, Preschool; Constipation; Diarrhea; Disease Progression; Female; Humans; Infant; Malaysia; Male; Retrospective Studies; Salmonella typhi; Treatment Outcome; Typhoid Fever

Topics: Anticonvulsants; Brain; Brain Edema; Ceftriaxone; Cephalosporins; Child, Preschool; Diarrhea; Dysentery, Bacillary; Feces; Female; Humans; Phenytoin; Seizures; Shigella flexneri; Tomography, X-Ray Computed

Topics: Amoxicillin; Ceftriaxone; Child; Diarrhea; Drug Therapy, Combination; Humans; Male; Paratyphoid Fever; Salmonella paratyphi A

The influence of long-term ceftriaxone administration on the emergence of Clostridium difficile was studied with 80 patients receiving ceftriaxone for 14 days. In five patients (6.3%) C. difficile was cultured. The appearance of gastrointestinal disturbances during treatment with ceftriaxone was common, but the rate of emergence of C. difficile in immunocompetent patients was not high.

Topics: Adolescent; Adult; Aged; Ceftriaxone; Child; Child, Preschool; Clostridioides difficile; Diarrhea; Drug Resistance, Microbial; Enterocolitis, Pseudomembranous; Feces; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged

Ampicillin (or penicillin G) plus chloramphenicol, cefuroxime, ceftriaxone, and cefotaxime have been used in the treatment of bacterial meningitis beyond the neonatal period. Review of recent data from the USA and Europe indicates that delayed CSF sterilization occurs significantly more often with ampicillin/chloramphenicol and cefuroxime than with ceftriaxone and cefotaxime. Delayed CSF sterilization is associated with an increased morbidity and neurological complications. Previously reported in vitro interactions between chloramphenicol and various beta-lactam antibiotics indicate that for bacteria where chloramphenicol is only bacteriostatic, the combination of chloramphenicol with beta-lactams is antagonistic. Killing rates of various beta-lactams were compared against a number of gram-positive and gram-negative bacteria. Cidal activity of some beta-lactams was inoculum dependent. There was a good correlation between in vitro activity and ability to sterilize CSF. Ceftriaxone is highly protein bound and its use in newborns is discouraged. Diarrhea occurs significantly more often after cefriaxone use than after the use of other agents. Ceftriaxone is uniquely associated with a high frequency of biliary pseudolithiasis which may be symptomatic and can cause measureable morbidity. In selecting the "proper" antimicrobial agent for the treatment of bacterial meningitis considerations should be given to proven clinical efficacy, prompt CSF sterilization, rapid in vitro cidal activity, safety and cost. We recommend cefotaxime as the agent of choice in the treatment of bacterial meningitis.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Cefotaxime; Ceftriaxone; Cefuroxime; Cerebrospinal Fluid; Child; Chloramphenicol; Diarrhea; Gallbladder Diseases; Humans; Meningitis; Protein Binding; Sulbactam

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

Topics: Aged; Ceftriaxone; Ciprofloxacin; Diarrhea; Enterocolitis, Pseudomembranous; Female; Humans; Male

The susceptibility of 424 bacterial isolates causing diarrhoea were tested by agar dilution technique on Mueller-Hinton Agar against amoxicillin, ampicillin, ceftriaxone, chloramphenicol, co-trimoxazole, ciprofloxacin, doxycycline, norfloxacin and ofloxacin. The bacterial species included were Aeromonas hydrophila, Edwardsiella tarda, Pleisomonas shigelloides, Salmonella spp., Shigella spp., Vibrio cholerae and Vibrio parahaemolyticus. The most active compounds were the fluorinated 4-quinolones studied, that is, ciprofloxacin, norfloxacin and ofloxacin, and ceftriaxone. The other antibacterial agents were considerably less active; a substantial portion of tested isolates were resistant to them.

Topics: 4-Quinolones; Ampicillin; Anti-Infective Agents; Bacteria; Ceftriaxone; Chloramphenicol; Diarrhea; Doxycycline; Drug Combinations; Humans; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

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

The efficacy of ceftriaxone, 1 g given intramuscularly once daily, was evaluated in 38 patients with pneumonia (n = 11), pulmonary empyema (n = 2), bronchitis (n = 4), tonsillitis (n = 9), sinusitis (n = 7), and otitis (n = 5). Causative organisms were Streptococcus pneumoniae (n = 11), viridans type streptococcus (n = 1), Haemophilus influenzae (n = 6), group A streptococcus (n = 10), Staphylococcus aureus (n = 3), Klebsiella pneumoniae (n = 2), Pseudomonas aeruginosa (n = 1), Escherichia coli (n = 2), Proteus mirabilis (n = 1), and Proteus vulgaris (n = 1). Sterilization of infected foci was obtained in 89.4% of those treated, with clinical recovery in 86.8%. The ceftriaxone regimen was well tolerated.

Topics: Adolescent; Adult; Aged; Ceftriaxone; Child; Diarrhea; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Otitis; Respiratory Tract Infections; Tonsillitis