ro13-9904 and Fever

Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown.. A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse.. We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bacteremia; Blood Culture; Cefmetazole; Ceftriaxone; Doripenem; Fever; Humans; Immunocompetence; Male; Pneumonia, Bacterial; Shock, Septic; Yersinia pseudotuberculosis; Yersinia pseudotuberculosis Infections

Although hemodialysis-hypersensitivity reactions have various causes, only a few cases of hypersensitivity to acetate dialysate accompanied by fever have been reported. We present the case of a 69-year-old hemodialysis patient who was admitted due to fever after dialysis. He had undergone online hemodiafiltration using acetate-free citrate-containing dialysate. After admission, we switched to acetate-containing bicarbonate dialysate. He was diagnosed with pneumonia and treated with ceftriaxone. However, fever that occurred post dialysis persisted, displaying a gradual elevation in CRP level and eosinophils (up to 9.7 mg/dL and 3774 cells/μL, respectively). After a series of negative workups for infection and dialysis membrane allergy, we suspected that acetate-containing bicarbonate dialysate to be the cause of the allergic reaction and switched to acetate-free bicarbonate dialysate. Consequently, eosinophil count decreased and the fever abated. The drug-induced lymphocyte stimulation test finding (for acetate dialysate) was positive, and he was diagnosed with acetate dialysate-induced hypersensitivity reactions. The condition was not detected earlier due to the complications associated with pneumonia.

Topics: Acetates; Aged; Anti-Bacterial Agents; Bicarbonates; C-Reactive Protein; Ceftriaxone; Dialysis Solutions; Drug Hypersensitivity; Eosinophils; Fever; Hemodiafiltration; Humans; Male; Pneumonia; Renal Dialysis

Development of secondary haemophagocytic lymphohistiocytosis (sHLH) in the context of typhoid fever (TF) is a very rare but serious complication.. Description of the first pediatric case of typhoid fever acquired in a non-endemic area complicated by sHLH. A systematic literature review of sHLH in the context of TF was performed with extraction of epidemiological, clinical and laboratory data.. The literature search revealed 17 articles (22 patients). Fifteen patients were eligible for data analysis (53.4% children). All patients had fever and pancytopenia. Transaminases and LDH were frequently elevated (46.6%). Salmonella typhi was detected mainly by blood culture (64.3%). All the patients received antibiotics whereas immunomodulation (dexamethasone) was used in two cases.. A high suspicion index for this condition is needed even in non-endemic areas. The addition of immunmodulation to standard antimicrobial therapy should be considered in selected cases.

Topics: Abdominal Abscess; Abdominal Pain; Age Distribution; Appendicitis; Asia; Ceftriaxone; Child; Developed Countries; Diagnosis, Differential; Endemic Diseases; Fever; Hepatomegaly; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Methylprednisolone; Middle East; Sex Distribution; Spain; Splenomegaly; Typhoid Fever

A 39-year-old previously healthy man was referred to our hospital because of acute onset of fever and consciousness disturbance. Neurological examinations revealed deteriorated consciousness, nuchal rigidity and Kernig's sign. A lumbar puncture yielded clouded fluid with a WBC 1,012/μl (polynuclear cell 96%), 147.3 mg/dl of protein, 44 mg/dl of glucose and Gram positive cocci. At first, he was treated with ceftriaxon and ampicillin. At Day 2, meropenem was added. Streptococcus agalactiae was isolated from blood and cerebrospinal fluid. He responded promptly to antimicrobial therapy, and within 2 days, he became lucid and afebrile. S. agalactiae was sensitive to ceftriaxone, ampicillin and meropenem. After Day 3, he was treated with meropenem only. We diagnosed his condition as S. agalactiae meningitis and was discharged from our hospital at Day 18. Many cases of S. agalactiae meningitis are known to occur in neonates, pregnant women, elderly, and persons with underlying disease such as diabetes, malignant disorders, liver dysfunction. But cases occurring in a previously healthy adult are rare. Neurologists should be aware that S. agalactiae may be cause bacterial meningitis in a previously healthy adults.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Consciousness Disorders; Drug Therapy, Combination; Fever; Humans; Immunocompetence; Male; Meningitis, Bacterial; Meropenem; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

Infectious aortitis is a rare clinical entity that most often manifests itself by an aortic aneurysm. The syphilitic or tubercular forms can be subacute. When it is caused by Salmonella sp., Staphylococcus sp. or Streptococcus pneumoniae, the aortitis is acute with alarming symptoms. Germs found in most cases are Salmonella and Staphylococcus aureus. S. pneumoniae rarely causes infectious aortitis. We report the case of a 75-year-old patient seen in an emergency setting for sudden-onset abdominal pain with fever. An abdominal angio-computed tomography (CT) scan showed a sacciform infrarenal abdominal aortic aneurysm, with an inflammatory aspect and periaortic hematoma. Surgical cure was undertaken because of the impending rupture. An interposition aortic replacement graft was implanted. Blood cultures and bacteriological study of the aortic wall isolated a S. pneumoniae. The anatomical pathology study reported fibrin clot leukocyte remodeling of the aortic wall. An intravenous antibiotic regimen was started. Several organisms, including Streptococcus, can cause infectious aortitis. We found 36 cases described in the literature in addition to our patient.

Topics: Abdominal Pain; Aged; Amoxicillin; Aneurysm, Infected; Anti-Bacterial Agents; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortitis; Bacteremia; Blood Vessel Prosthesis Implantation; Ceftriaxone; Combined Modality Therapy; Fever; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Pneumococcal Infections; Streptococcus pneumoniae; Tomography, X-Ray Computed

Topics: Amiodarone; Autoimmunity; Blepharoptosis; Ceftriaxone; Cerebrospinal Fluid; Delayed Diagnosis; Dexamethasone; Emergencies; Female; Fever; Heart Valve Prosthesis Implantation; Humans; Hypoxia; Immunocompetence; Magnetic Resonance Imaging; Meningitis, Pneumococcal; Myelitis; Oxygen Inhalation Therapy; Postoperative Complications; Quadriplegia; Spinal Cord; Streptococcus pneumoniae; Tachycardia; Young Adult

We present the case of a man with a bicuspid aortic valve who presented with persistent fever. Blood cultures yielded Neisseria gonorrhoeae, and the diagnosis of infected mycotic aneurysm was confirmed by detection of the bacterial genome in the aortic wall. The patient was cured with surgery and intravenous ceftriaxone.

Topics: Aged; Aneurysm, Infected; Anti-Bacterial Agents; Aorta; Ceftriaxone; Combined Modality Therapy; Fever; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Travel; Treatment Outcome

We report a case of Lemierre syndrome secondary to Streptococcus pyogenes in a 22-month-old girl. This case report and literature review took place at a pediatric intensive care unit at a freestanding tertiary children's hospital. Diagnosis occurred after the discovery of left internal jugular thrombus and multiple metastatic infection sites including the right knee, kidneys, lungs, and brain. Lemierre syndrome can occur in young children secondary to S. pyogenes, and a classic presentation may not occur. A high index of suspicion is crucial to the diagnosis.

Topics: Ampicillin; Anti-Bacterial Agents; Arthritis, Infectious; Bacteremia; Ceftriaxone; Child, Preschool; Female; Fever; Genetic Predisposition to Disease; Heterozygote; Humans; Jugular Veins; Lemierre Syndrome; Methylenetetrahydrofolate Reductase (NADPH2); Osteomyelitis; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Thrombophilia

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Child, Preschool; Fever; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Infant; Pneumococcal Infections; Pneumococcal Vaccines; Practice Guidelines as Topic; Risk Factors; Urinary Tract Infections; Vaccines, Conjugate

Standard management of febrile neutropenia requires prompt administration of empirical, broad-spectrum antibiotic therapy, since febrile neutropenia is associated with a significant risk of infectious complications and mortality. Risk-assessment models have been developed that differentiate febrile patients with neutropenia according to their risk for infectious complications and/or mortality and have prompted a change in the management of these patients. Ceftriaxone is a long-lasting, broad spectrum cephalosporin which has demonstrated efficacy in this indication in many publications. The role of ceftriaxone in febrile neutropenia will be discussed based on literature analysis and on the author's experience.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever; Humans; Male; Neutropenia; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Treatment Outcome

The object of this work was to compare the efficacy of antibiotic combinations including ceftriaxone with that of combinations including an antipseudomonal beta-lactam for the empirical treatment of febrile neutropenia in cancer patients. We identified all published randomised trials comparing two antibiotic combinations differing only in the beta-lactam, being ceftriaxone in one treatment group and an antipseudomonal beta-lactam in the other. The quality of individual trials was formally evaluated. A meta-analysis was performed using the Peto-modified Mantel-Haenszel method for combining binary data. Primary analysis was done, for both febrile episodes and bacteraemic episodes, using failure of empirical antibiotic treatment defined as modification of the initial allocated regimen or death during treatment. Secondary analysis was done using death from any cause in the two treatment groups. Data relating to 1,537 febrile neutropenic episodes recorded in eight randomised clinical trial were pooled s. Overall, there were 256 treatment failures out of 782 febrile episodes treated with ceftriaxone-containing combinations (32.7%), and 243 out of 755 treated with antipseudomonal beta-lactam regimens (32.1%). The pooled odds ratio of failure for ceftriaxone-containing combinations for febrile episodes was 1.04, with the 95% confidence interval ranging from 0.84 to 1.29, and that for bacteraemic episodes was 0.93 (95% confidence interval 0.58-1.49). With regard to overall mortality, there were 54 deaths among 782 febrile episodes treated with ceftriaxone-containing combinations (6.9%) and 62 deaths among 755 febrile episodes treated with antipseudomonal beta-lactam-containing regimens (8.2%). The pooled odds ratio of death for ceftriaxone regimens was 0.84 (95% confidence interval 0.57-1.24). Results of this meta-analysis show that in the empirical treatment of febrile neutropenia, antibiotic combinations containing ceftriaxone are as effective as those in which the beta-lactam has specific activity against Pseudomonas aeruginosa, such as ureidopenicillin or ceftazidime.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Fever; Humans; Middle Aged; Mortality; Neutropenia; Odds Ratio; Pseudomonas aeruginosa; Pseudomonas Infections; Treatment Outcome

We report an unusual case of Streptococcus pneumoniae sacroiliitis in a previously healthy 31-year-old woman. Six cases of pneumococcal sacroiliitis have been reported; the only two cases in adults occurred in young women in the preantibiotic era. Our patient had fever and a depressed level of consciousness, with subsequent right buttock and thigh pain. Blood cultures revealed S pneumoniae, and a bone scan showed increased tracer activity in the right sacroiliac joint. Although the cerebrospinal fluid white blood cell count was only 3/microL, culture of cerebrospinal fluid grew S pneumoniae. Our patient was successfully treated with a 6-week course of intravenous antibiotics (penicillin G after an initial week of ceftriaxone), followed by 2 weeks of oral penicillin therapy.

Topics: Administration, Oral; Adult; Arthritis, Infectious; Bacteremia; Buttocks; Ceftriaxone; Cephalosporins; Consciousness; Drug Therapy, Combination; Female; Fever; Humans; Injections, Intravenous; Pain; Penicillin G; Penicillins; Pneumococcal Infections; Sacroiliac Joint; Streptococcus pneumoniae; Thigh

Topics: Ceftriaxone; Cefuroxime; Cephalosporins; Dose-Response Relationship, Drug; Female; Fever; Haemophilus influenzae; Humans; Infant; Meningitis, Haemophilus; Recurrence

Pediatric oncology patients with fever, even when not neutropenic, are known to be at an increased risk of bloodstream infections. However, there are no standard guidelines for management of fever in non-neutropenic patients, resulting in variability in practice across institutions.. We retrospectively analyzed the clinical characteristics, management, and outcome of all febrile non-neutropenic episodes in pediatric oncology patients at a single institution over the two-year period 2011-2012, to identify predictors of bloodstream infections. We assessed the efficacy of a uniform approach to outpatient management of a defined subset of patients at low risk of invasive infections.. A total of 254 episodes in 83 patients were identified. All patients had implanted central venous catheters (port). Sixty-two episodes (24%) were triaged as high-risk and admitted for inpatient management; five (8%) had positive blood cultures. The remaining 192 episodes were triaged as low risk and managed with once daily outpatient intravenous ceftriaxone; three (1.6%) were associated with bacteremia, and 10% required eventual inpatient management. Of all the factors analyzed, only signs of sepsis (lethargy, chills, hypotension) were associated with positive bloodstream infection.. Treatment of a defined subset of patients with outpatient intravenous ceftriaxone was safe and effective. Signs of sepsis were the only factor significantly associated with bloodstream infection. This study provides a baseline for future prospective studies assessing the safety of withholding antibiotics in this subset of patients.

Topics: Bacteremia; Ceftriaxone; Child; Child, Preschool; Female; Fever; Follow-Up Studies; Humans; Infant; Male; Neoplasms; Retrospective Studies; Risk Factors

To compare the efficacy of prophylactic antibiotics in reducing post-surgical infections in patients undergoing ureterorenoscopic lithotripsy (URSL).. The study was a double-blind, prospective, randomized controlled trial. Between 2009 and 2012, 212 patients with preoperative sterile urine undergoing URSL were randomly allocated, in a ratio of 1:1:1:1, to receive prophylactic antibiotics with single-dose i.v. cefazolin (1 g), ceftriaxone (1 g) or oral levofloxacin (500 mg), or no treatment (control group), respectively. Urine analysis and urine cultures were obtained between postoperative days 5 and 7. Pyuria was defined as ≥10 white blood cells/high power field. Significant bacteriuria was defined as ≥100,000 colony-forming units uropathogens/mL. Febrile urinary tract infection (fUTI) was defined as a body temperature of 38.5 °C with pyuria or significant bacteriuria ≤7 days after surgery.. In total, 206 patients were eligible for analysis. The rates of postoperative pyuria were significantly lower in patients with prophylaxis than in the control group (48.4 vs 64.7%, P = 0.04). Patients receiving prophylaxis with levofloxacin and ceftriaxone had a significantly lower risk of pyuria compared with the control group (52.0 and 36.5 vs 64.7%, respectively; P < 0.05). The rates of bacteriuria and fUTI tended to be lower in patients with prophylaxis, although the difference was not significant (4.5 vs 11.8%, P = 0.09, 1.3 vs 5.9%, P = 0.09). There was no significant difference in rates of bacteriuria and fUTI between the four groups. Patients with proximal stones had a higher risk of developing postoperative fUTI (odds ratio 9.35; P = 0.03).. Antibiotic prophylaxis significantly reduces the incidence of pyuria after URSL and tends to diminish the risk of bacteriuria and fUTI.

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Bacteriuria; Cefazolin; Ceftriaxone; Double-Blind Method; Female; Fever; Humans; Levofloxacin; Lithotripsy; Male; Middle Aged; Odds Ratio; Postoperative Complications; Practice Guidelines as Topic; Preoperative Care; Prospective Studies; Pyuria; Treatment Outcome; Ureteroscopy; Urinary Tract Infections

To compare the efficacy of ceftriaxone before skin incision and after cord clamping in preventing post-operative infectious morbidity and neonatal outcome in elective caesarean section and to determine the effect of antibiotic prophylaxis before skin incision on neonatal outcome.. Our study was a randomised controlled trial conducted among 874 women undergoing elective caesarean section from October 2010 to July 2012. These women were randomly categorised into two groups with 437 women in each group. Group 1 received single dose of ceftriaxone 1 g intravenously 15-45 min before skin incision. Group 2 received the antibiotic after cord clamping. Primary outcome measures were maternal post-operative infectious morbidities like surgical site wound infection, febrile morbidity, endometritis, urinary tract infections and neonatal sepsis. Results were analysed using Chi-square test and unpaired t test.. Surgical site wound infection occurred in 3 women in group 1 (0.7%) and 6 women in group 2 (1.4%). Fever occurred in 9 women in group 1 (2.1%) and 5 in group 2 (1.1%) with the p value of 0.419, not statistically significant. Urinary tract infection occurred in 9 women in group 1 (2.1%) and 7 women in group 2 (1.6%) with the p value of 0.801. None of the women in either group developed endometritis. About 20 neonates [10 neonates (2.3%) in group 1 and 10 neonates (2.3%) in group 2] required NICU admission after caesarean delivery. The reasons for admission were respiratory distress, prematurity and congenital anomaly. About 0.9% of neonates in group 1 and 1.8% in group 2 developed neonatal sepsis with positive blood culture (p = 0.388).. Timing of administration of prophylactic antibiotics for elective caesarean section either before skin incision or after cord clamping did not have significant difference in the occurrence of post-operative infectious morbidity. No adverse neonatal outcome was observed in women who received the antibiotic before skin incision.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Cesarean Section; Drug Administration Schedule; Endometritis; Female; Fever; Humans; Infant, Newborn; Infant, Newborn, Diseases; Morbidity; Perioperative Care; Postoperative Complications; Pregnancy; Sepsis; Surgical Wound Infection; Time Factors; Treatment Outcome; Urinary Tract Infections

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

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

Outpatient oral therapy is infrequently used in pediatric low-risk febrile neutropenia (LRFN) as there is insufficient data regarding its equivalence as compared with parenteral therapy.. This is a single institutional, randomized control trial in pediatric LRFN aged 2 to 15 years, in which 123 episodes in 88 patients were randomized to outpatient oral ofloxacin 7.5 mg/kg 12 hourly and amoxycillin-clavulanate 12.5 mg/kg 8 hourly or outpatient intravenous (IV) ceftriaxone 75 mg/kg and amikacin 15 mg/kg once daily after blood cultures.. Out of 119 evaluable episodes, one-third were leukemia patients in maintenance and rest were solid tumors. Success was achieved in 55/61 (90.16%) and 54/58 (93.1%) in oral and IV arms, respectively, (P=0.56). There were 3 hospitalizations but no mortality. Median days to resolution of fever, absolute neutrophil count >500/mm(3) and antibiotic use were 3, 5, and 6 days in both arms. There were 5 blood culture isolates (3 gram-positive and 2 gram-negative bacteria). Failure of outpatient therapy was associated with perianal infections, bacteremia, febrile neutropenia onset before day 9 of chemotherapy in solid tumors and Vincristine, actinomycin-D, and cyclophosphamide chemotherapy for rhabdomyosarcoma. All gram-positive isolates were successes, whereas both gram-negative isolates were failures. Diarrhea in IV arm and Vincristine, actinomycin-D, and cyclophosphamide chemotherapy in the oral arm predicted failure in subgroup analysis.. Outpatient therapy is efficacious and safe in pediatric LRFN. There was no difference in outcome in oral versus IV outpatient therapy. Amoxycillin-clavulanate and ofloxacin may be the oral regimen of choice.

Topics: Administration, Oral; Adolescent; Ambulatory Care; Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Ceftriaxone; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Injections, Intravenous; Male; Neoplasms; Neutropenia; Ofloxacin; Treatment Outcome

To describe the feasibility, effectiveness and safety of intravenous (iv) outpatient treatment in 2 to 24 month-old children with febrile urinary tract infection (UTI).. Children presenting to the ER, between April 2003-2005, with fever and no identifiable focus who had a diagnosis of UTI were randomized to receive iv antibiotic in the hospital or in an outpatient facility. Children were started on amikacin or ceftriaxona according to physician criteria followed by antimicrobial adjustment based on urine culture result and a later switch to an oral antimicrobial. Urine cultures were performed during and after completing the antimicrobial course. Adherence and effectiveness of antimicrobial treatment and treatment-associated complications were analyzed.. The study included 112 patients, 58 inpatient children and 54 outpatient children, with an average age of 7.7 months. Duration of iv treatment did not differ among groups (2.8 days (SD 1.2) 2.7 +0.91 days in inpatients vs 2.9 + 1.9 days in outpatients (p = 0.22). In 100% of outpatient children and 100% of inpatient children (overall 101/101) urine cultures were negative on day 5. None of the children had a treatment-associated complication. Cost analysis yielded 73% of saving money (overall cost for inpatient treatment US 9,815 vs outpatient treatment US 2,650).. Outpatient iv treatment in patients between 2 and 24 months with UTI and fever was effective, safe and of lower cost.

Topics: Ambulatory Care; Amikacin; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Female; Fever; Hospitalization; Humans; Infant; Infusions, Intravenous; Male; Medication Adherence; Prospective Studies; Time Factors; Treatment Outcome; Urinary Tract Infections

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

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

Patients with low-risk neutropenic fever as defined by the Multinational Association of Supportive Care in Cancer (MASCC) score might benefit from ambulatory treatment. Optimal management remains to be clearly defined, and new oral antibiotics need to be evaluated in this setting.. Cancer patients with febrile neutropenia and a favorable MASCC score were randomized between oral moxifloxacin and intravenous ceftriaxone. All were fit for early hospital discharge. The global success rate was related to the efficacy of monotherapy, as well as to the success of ambulatory monitoring.. The trial was closed prematurely because of low accrual. Ninety-six patients were included (47 in the ceftriaxone arm and 49 in the moxifloxacin arm). A total of 65% were women, 30.2% had lymphoma, 34.4% had metastatic, and 35.4% had non-metastatic solid tumors. The success rates of home antibiotics were 73.9% and 79.2% for ceftriaxone and moxifloxacin, respectively. Seven patients were not discharged, and 14 required re-hospitalization. There were 17% of microbiologically documented infections that were, in most cases, susceptible to oral monotherapy.. These results suggest that MASCC is a valid and useful tool to select patients for ambulatory treatments and that oral moxifloxacin monotherapy is safe and effective for the outpatient treatment of cancer patients with low-risk neutropenic fever.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Antineoplastic Agents; Aza Compounds; Ceftriaxone; Female; Fever; Fluoroquinolones; Humans; Infusions, Intravenous; Male; Middle Aged; Moxifloxacin; Neoplasms; Neutropenia; Patient Discharge; Quinolines; Risk Factors; Time Factors

One of the most significant limitations of at-home autologous stem-cell transplantation (ASCT) is the necessity for hospital readmission. We developed an at-home ASCT program in which prophylactic ceftriaxone and treatment of febrile neutropenia with piperacillin and tazobactam was introduced to minimize the readmission rate.. Between November 2000 and February 2005, 178 consecutive patients underwent ASCT for a hematologic malignancy. Of these, 50 patients fulfilled the requirements for at-home ASCT. Results were compared with those observed in a control group of 50 patients individually matched to the group of patients treated at home for age, sex, diagnosis, stage of disease, conditioning, and source of stem cells.. Febrile neutropenia occurred in fewer patients in the at-home group as compared with the hospitalized group (76% v 96%: P = .008), and duration of fever was also shorter in the at-home group (median, 2 and 6 days, respectively; range, 1 to 11 and 1 to 20 days, respectively; P = .00003). Hospital readmission in the at-home group was required in only four cases (8%). This resulted in a reduction of 18.6 days of hospitalization per patient. Likewise, total median charges were approximately half in the at-home group as compared with the in-hospital group (3,345 euro v 6,250 euro, respectively; P < .00001).. Results of at-home ASCT with prophylactic administration of ceftriaxone and domiciliary treatment of febrile neutropenia with piperacillin and tazobactam are highly satisfactory and significantly cheaper compared with those obtained with conventional in-hospital ASCT.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antineoplastic Agents, Alkylating; Busulfan; Ceftriaxone; Female; Fever; Health Care Costs; Hematologic Neoplasms; Home Care Services; Hospital Charges; Humans; Inpatients; Male; Middle Aged; Neutropenia; Patient Readmission; Penicillanic Acid; Piperacillin; Stem Cell Transplantation; Tazobactam; Transplantation, Autologous

We compared the efficacy of ceftriaxone (CA regimen) and piperacillin-tazobactam (PTA regimen) in association with amikacin in the treatment of febrile episodes in severely neutropenic hematological patients.. A total of 252 febrile episodes in 224 patients were randomized.. The CA regimen was effective in 62/122 evaluable episodes (50.8%), and the PTA regimen was effective in 64/121 (52.9%; P>0.2). Median time to failure was 4 and 5 days (P>0.1). Further infections developed in 21/122 episodes (17.2%) with the CA regimen and in 12/121 (9.9%) with the PTA regimen (P=0.06). The overall mortality at the end of the febrile episode was 11/243 (4.5%); seven deaths were considered to be related to infection.. Patients treated with piperacillin-tazobactam and amikacin tended to become afebrile sooner and to suffer a lower rate of further infections, even though our data did not show any statistically significant differences between the two groups.

Topics: Adult; Aged; Amikacin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Female; Fever; Hematologic Neoplasms; Humans; Male; Middle Aged; Neutropenia; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Treatment Outcome

We carried out a prospective, randomized, controlled clinical trial to evaluate the clinical efficacy of ceftriaxone and ampicillin/cloxacillin prophylaxis in decreasing the frequency of post-caesarean section infection-related morbidity. Two hundred patients randomly received either ceftriaxone (single dose) or ampicillin/cloxacillin (3 doses) intravenously at induction of anaesthesia. There was no statistical difference in incidence of endometritis (P = 0.34), wound infection (P = 0.44), or other febrile morbidity (P = 0.5). Eleven babies had a low Apgar score (< 8) in the ceftriaxone group and 13 in the ampicillin/cloxacillin group (P = 0.82). There were 2 perinatal deaths in each group. One dose of ceftriaxone was as effective as ampicillin/ cloxacillin in preventing post-caesarean section complications and is easier to administer.

Topics: Ampicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Apgar Score; Ceftriaxone; Cesarean Section; Cloxacillin; Cross Infection; Elective Surgical Procedures; Endometritis; Female; Fever; Hospitals, Teaching; Humans; Incidence; Infusions, Intravenous; Morbidity; Pregnancy; Pregnancy Outcome; Sudan; Surgical Wound Infection; Treatment Outcome

Recent reports and previous randomized trials conducted at the authors' institution suggested that children with lower risk febrile neutropenic (LRFN) may benefit from substitution of oral antibiotic therapy for parenteral therapy. The objective of this study was to determine the efficacy of parenteral-oral outpatient therapy in the management of children with LRFN who were receiving treatment for malignant disease.. From August 2000 to April 2002, 135 children with a median age of 7.5 years (range, 1.6-15.8 years) who had a total of 177 episodes of LRFN were included in a prospective, randomized, single-institution trial. Children with LRFN received a single dose of ceftriaxone and amikacin and completed a risk-assessment work-up. All patients were discharged immediately and, at 24 hours, were allocated randomly to two groups: Group A (89 episodes) received oral ciprofloxacin, and Group B (88 episodes) received intravenous ceftriaxone.. Most patients (61% in Group A and 51% in Group B) were receiving treatment for leukemia (P value not significant [NS]). Twenty-eight children (31%) in Group A and 22 children (25%) in Group B displayed unexplained fever (P value NS). No significant differences in sites of initial infection were found between the two groups. The median duration of neutropenia was 4.2 days and 4.7 days for Group A and Group B, respectively (P value NS); the median duration of fever was 2.3 days and 2.6 days, respectively (P value NS); and the median duration of antibiotic treatment was 4.5 days and 4.8 days, respectively (P value NS). The overall results of the study were excellent. Only four treatment failures in Group A (5%) and 6 treatment failures in Group B (7%) were observed. These patients were readmitted to the hospital and did well with appropriate treatment.. In children with LRFN who are receiving treatment for malignant disease, outpatient oral ciprofloxacin after 24 hours of a single dose of intravenous ceftriaxone and amikacin was as safe and efficacious as parenteral ceftriaxone. Outpatient management and early antibiotic withdrawal were safe for both groups.

Topics: Administration, Oral; Adolescent; Ambulatory Care; Amikacin; Anti-Bacterial Agents; Antineoplastic Agents; Argentina; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Female; Fever; Humans; Infant; Leukemia; Male; Neutropenia; Risk

Efficacy and costs of empirical antibacterial therapy in febrile neutropenic patients are important issues. Several strategies have been reported to be similarly effective: monotherapy with cefepime, ceftazidime or a carbapenem or duotherapy with an antipseudomonal beta-lactam antibiotic or ceftriaxone in combination with an aminoglycoside. Piperacillin-tazobactam monotherapy is promising, but its role in this setting still has to be defined.. Of 212 consecutive febrile episodes in 130 neutropenic patients with hematological malignancies randomized to receive either piperacillin-tazobactam (4.5 g every 8 h; group A) or ceftriaxone (2 g once daily plus gentamicin 5 mg/kg once daily; group B), 183 episodes (98 group A, 85 group B) were evaluable for response.. Defervescence within 72 h without modification of the antibiotic therapy was achieved in 56/98 episodes (57.1%) in group A and in 30/85 (35.3%) in group B (P=0.0047). If fever persisted, teicoplanin plus gentamicin (group A) or teicoplanin plus ciprofloxacin (group B) were added. All patients still febrile then received meropenem, teicoplanin and amphotericin B. With these modifications of antibiotic therapy, 89.8% of patients in group A had responded at 21 days but only 71.8% in group B (P=0.005). The mean total antibiotic drug cost in group A was only 39.4% of that in group B (euro 445 versus euro 1129; P=0.010).. Piperacillin-tazobactam monotherapy is significantly more effective and cost-efficient than ceftriaxone plus gentamicin as first-line therapy in febrile neutropenic patients with hematological malignancies.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Cost-Benefit Analysis; Drug Therapy, Combination; Enzyme Inhibitors; Female; Fever; Gentamicins; Hematologic Neoplasms; Humans; Male; Middle Aged; Neutropenia; Penicillanic Acid; Penicillins; Piperacillin; Tazobactam; Treatment Outcome

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

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

A prospective, randomized, controlled monocentric trial was performed to evaluate the efficacy and safety of once daily ceftriaxone 2 g plus gentamicin 5 mg/kg in comparison to cefepime 2 g t.i.d. plus gentamicin 5 mg/kg q.d. in the treatment of neutropenic fever. In case of fever (oral temperature > or =38.5 degrees C on one occasion or > or =38.0 degrees C twice within 24 h) and a granulocytopenia (neutrophil count below 500 or below 1000/microl when expected to fall below 500 within 72 h), patients with hematological malignancies or solid tumors were assigned to ceftriaxone or cefepime, each with gentamicin. The primary endpoint was defined as defervescence on day 4-6 followed by at least 7 afebrile days. Secondary endpoints were overall response, defined as defervescence on day 28 and toxicity. Two hundred eleven episodes were included. Fever of unknown origin (FUO) accounted for 124 episodes (58.8%), microbiologically defined infection (MDI) for 39 (18.5%), clinically defined infection (CDI) for 25 (11.8%), and both clinically and microbiologically defined infection (CMDI) for 19 episodes (9%). On an intent-to-treat basis 207 episodes were evaluable for the primary endpoint. Ceftriaxone plus gentamicin and cefepime plus gentamicin were successful in 49.5% and 51%, respectively. Overall response was achieved on study day 28 in 92.5% and 91%, respectively. Diarrhea was more frequent with ceftriaxone/gentamicin (6.5% vs 17%), while nausea/vomiting was less (12.1% vs 5%). Once-daily ceftriaxone plus gentamicin was not inferior to cefepime t.i.d. plus gentamicin q.d. in the empirical treatment of neutropenic fever.

Topics: Anti-Bacterial Agents; Cefepime; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Fever; Gentamicins; Humans; Neutropenia; Prospective Studies; Treatment Outcome

To determine whether the addition of a single dose of ceftriaxone sodium to a 10-day course of trimethoprim and sulfamethoxazole hastens urine sterilization or resolution of clinical symptoms in febrile children with urinary tract infections.. Prospective, single-blind, randomized study.. Tertiary care children's hospital emergency department.. Febrile children aged 6 months to 12 years with a presumptive urinary tract infection based on history, physical examination, and urinalysis findings.. A history was taken, a physical examination and urinalysis and culture were performed, and a white blood cell count and erythrocyte sedimentation rate were obtained. Children were randomized to receive an intramuscular dose of ceftriaxone then 10 days of trimethoprim-sulfamethoxazole (IM + PO group) or oral trimethoprim-sulfamethoxazole alone (PO group). After receiving study medication, patients were discharged from the hospital to return in 48 hours for a follow-up evaluation and urine culture. Treatment failure was defined as the persistence of a positive culture at 48 hours or the need for hospital admission for intravenous rehydration or antibiotic therapy.. Sixty-nine children were enrolled, 34 in the IM + PO group and 35 in the PO group. The 2 groups were similar at the initial visit with respect to age, sex, clinical degrees of illness, white blood cell count, and erythrocyte sedimentation rate (P>.05). At the 48-hour follow-up visit, there were no differences between the 2 treatment groups in resolution of vomiting, fever, general appearance, abdominal tenderness, and hydration state (P>.05). There were 9 treatment failures, 4 in the IM + PO group and 5 in the PO group (P =.93).. The addition of a single dose of intramuscular ceftriaxone to a 10-day course of oral trimethoprim-sulfamethoxazole for urinary tract infection with fever resulted in no difference at 48 hours in the urine sterilization rate, degree of clinical improvement, or subsequent hospital admission rate.

Topics: Administration, Oral; Anti-Infective Agents, Urinary; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Humans; Infant; Injections, Intramuscular; Male; Outcome Assessment, Health Care; Single-Blind Method; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A prospective, randomized, controlled monocentric trial was performed to evaluate the efficacy and safety of once daily ceftriaxone 2 g plus tobramycin 5 mg/kg in comparison to cefotaxime 2 g t.i.d. plus tobramycin 5 mg/kg qd in the treatment of neutropenic fever. In cases of fever > or = 38.5 degrees C and a neutrophil count below 1000/microliter, patients with hematological malignancies were assigned to ceftriaxone or cefotaxime, each with tobramycin. The primary endpoint was defined as defervescence < 37.5 degrees C on day 4-6 followed by at least 7 afebrile days. Secondary endpoints were overall response, defined as defervescence on day 25 and toxicity. There were 160 episodes of 114 patients included. Fever of unknown origin accounted for 79 episodes (51%), microbiologically defined infection for 36 (23%), clinically defined infection for 27 (17%), and both clinically and microbiologically defined infection for 14 episodes (9%). On an intent-to-treat basis 156 episodes could be evaluated for the primary endpoint. Ceftriaxone plus tobramycin and cefotaxime plus tobramycin resulted in a primary response in 46.9% and 45.3%, respectively. Overall response was achieved on study day 25 in 87.7% and 80%, respectively. No significant difference in toxicity was observed. Once-daily ceftriaxone plus tobramycin was not inferior to cefotaxime t.i.d. plus tobramycin qd in the empirical treatment of neutropenic fever.

Topics: Adult; Aged; Cefotaxime; Ceftriaxone; Drug Therapy, Combination; Female; Fever; Humans; Male; Middle Aged; Neutropenia; Time Factors; Tobramycin

Infections are one of the major complications in children undergoing chemotherapy. Monotherapy with either ciprofloxacin or ceftriaxone is safe and efficient in low-risk patients (solid tumors and stage I/II lymphomas). The same drugs may be used in an outpatient setting, decreasing costs and the risk of nosocomial infections.. Low-risk patients (N = 70) with episodes of fever and neutropenia (N = 116) were randomized to receive either oral ciprofloxacin or intravenous ceftriaxone as outpatients. Only one patient had a central venous catheter.. Episodes of fever and neutropenia were classified as fever of unknown origin (41% vs. 32%) or clinically documented infection (56% vs. 63%) in the ciprofloxacin and ceftriaxone groups, respectively. Most of these infections were of upper respiratory tract, skin, or gastrointestinal origin. The mean duration of neutropenia was 5 vs. 6 days. Fever persisted for 1-9 days (mean 2 vs. 3 days). Therapy was successful with no modifications in 83% vs. 75% of the episodes. Patients were admitted in 7% vs. 4% of the episodes. No bone or joint side effects were seen in either group. All patients survived.. Outpatient therapy with either oral ciprofloxacin or intravenous ceftriaxone for fever and neutropenia is effective and safe in pediatric patients with solid tumors and stage I/II non-Hodgkin lymphoma (low-risk patients).

Topics: Administration, Oral; Adolescent; Adult; Ambulatory Care; Anti-Infective Agents; Antineoplastic Agents; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Ciprofloxacin; Fever; Humans; Neoplasms; Neutropenia; Prospective Studies; Risk Factors

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

Topics: Adolescent; Adult; Aged; Antineoplastic Agents; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Fever; Humans; Infant; Infusions, Intravenous; Middle Aged; Neoplasms; Neutropenia; Outpatients; Prospective Studies; Treatment Outcome

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

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

Intravenously administered antimicrobial agents have been the standard choice for the empirical management of fever in patients with cancer and granulocytopenia. If orally administered empirical therapy is as effective as intravenous therapy, it would offer advantages such as improved quality of life and lower cost.. In a prospective, open-label, multicenter trial, we randomly assigned febrile patients with cancer who had granulocytopenia that was expected to resolve within 10 days to receive empirical therapy with either oral ciprofloxacin (750 mg twice daily) plus amoxicillin-clavulanate (625 mg three times daily) or standard daily doses of intravenous ceftriaxone plus amikacin. All patients were hospitalized until their fever resolved. The primary objective of the study was to determine whether there was equivalence between the regimens, defined as an absolute difference in the rates of success of 10 percent or less.. Equivalence was demonstrated at the second interim analysis, and the trial was terminated after the enrollment of 353 patients. In the analysis of the 312 patients who were treated according to the protocol and who could be evaluated, treatment was successful in 86 percent of the patients in the oral-therapy group (95 percent confidence interval, 80 to 91 percent) and 84 percent of those in the intravenous-therapy group (95 percent confidence interval, 78 to 90 percent; P=0.02). The results were similar in the intention-to-treat analysis (80 percent and 77 percent, respectively; P=0.03), as were the duration of fever, the time to a change in the regimen, the reasons for such a change, the duration of therapy, and survival. The types of adverse events differed slightly between the groups but were similar in frequency.. In low-risk patients with cancer who have fever and granulocytopenia, oral therapy with ciprofloxacin plus amoxicillin-clavulanate is as effective as intravenous therapy.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Agranulocytosis; Amikacin; Amoxicillin; Antineoplastic Agents; Bacteremia; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Clavulanic Acid; Drug Therapy, Combination; Female; Fever; Humans; Infusions, Intravenous; Male; Middle Aged; Neoplasms; Prospective Studies; Survival Rate

A study was performed in low-risk cancer patients with chemotherapy-induced febrile neutropenia to determine the safety and efficacy of ceftriaxone given in an outpatient setting. A total of 126 episodes of febrile neutropenia in 120 clinically stable outpatients were treated with intravenous ceftriaxone alone (n=100) or in combination with other antibiotics (n=26). The mean neutrophil count was 460/mm3; severe neutropenia (< 100/mm3) was observed in 18 episodes. The initial treatment with ceftriaxone (alone or in combination) was successful in 99 episodes (78%). Ninety-five episodes (76%) were successfully treated in an outpatient setting only; admission to hospital was necessary in 31 episodes (24%), but no infection-related death was observed. Ceftriaxone seems to be safe and effective for outpatient therapy of patients with low-risk febrile neutropenia.

Topics: Adolescent; Adult; Aged; Ambulatory Care; Antibiotic Prophylaxis; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Hematologic Neoplasms; Humans; Infant; Male; Middle Aged; Neoplasms; Neutropenia; Prospective Studies

The combination of ceftazidime plus aminoglycoside is widely used for the treatment of febrile neutropenic patients but requires multiple daily administration. Because the frequency of Pseudomonas aeruginosa is low in many centers, there is a rationale to test other antibiotic regimens that provide appropriate antibacterial coverage with the advantage of reduced dosing frequency, such as once daily ceftriaxone plus amikacin.. Febrile neutropenic children with leukemia, lymphoma or solid tumors after chemotherapy were included in an open, prospective, randomized, multinational study comparing once daily ceftriaxone plus amikacin vs. 8-hourly ceftazidime and amikacin. The response to antimicrobial therapy was defined as complete response, improvement or failure. Assessment of adverse events was supplemented by specific definitions of nephrotoxicity, ototoxicity, hepatotoxicity and hypokalemia. Costs were estimated from published values of acquisition costs, delivery costs and hospitalization costs.. Efficacy was evaluable in 364 of 468 episodes in 265 children. Response rates in ceftriaxone and amikacin vs. ceftazidime and amikacin-treated episodes were 119 of 181 (66%) vs. 121 of 183 (66%), 7 of 181 (4%) vs. 9 of 183 (5%) and 55 of 181 (30%) vs. 53 of 181 (29%) for complete response, improvement and failure, respectively. Safety profiles were similar with both treatment regimens. The acquisition and administration costs were lower for the ceftriaxone and amikacin regimen.. A once daily regimen of ceftriaxone and amikacin is as safe and clinically effective as that of three times daily ceftazidime and amikacin for the treatment of febrile neutropenic children with cancer and is more cost-effective. The once daily regimen of ceftriaxone and amikacin is suitable for outpatient treatment.

Topics: Adolescent; Amikacin; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Cost-Benefit Analysis; Drug Therapy, Combination; Female; Fever; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Infant; Leukemia; Lymphoma; Male; Microbial Sensitivity Tests; Neoplasms; Neutropenia

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

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

To compare the prophylactic efficacy of 1 g ceftriaxone with 1.5 g cefuroxime + 0.5 g metronidazole for febrile morbidity and urinary tract infection in patients undergoing vaginal hysterectomy.. A prospective, randomized, comparative, non-blinded study with at least 100 patients on each side. The two-sample t-test was used for testing equality of two means and the chi 2 test was used for pair differences.. Single dose cefuroxime + metronidazole and ceftriaxone were equally effective in preventing febrile morbidity postoperatively. Additionally ceftriaxone was more effective in sterilizing pre-operatively existing bacteriuria.

Topics: Adult; Aged; Aged, 80 and over; Antitrichomonal Agents; Ceftriaxone; Cefuroxime; Cephalosporins; Enterococcus; Escherichia coli; Female; Fever; Humans; Hysterectomy; Metronidazole; Middle Aged; Prospective Studies; Urinary Tract Infections

Isepamicin is a new aminoglycoside with in-vitro activity superior to amikacin. It is a poor substrate for the 6'-aminoacetyltransferase-I enzyme which inactivates amikacin and therefore organisms possessing this enzyme are not resistant to isepamicin. The aim of this study was to compare the efficacy and safety of co-administration of isepamicin once daily plus ceftriaxone to amikacin twice daily plus ceftriaxone to amikacin twice daily plus ceftriaxone in febrile neutropenic cancer patients. Febrile episodes in 235 patients (156 in isepamicin group and 79 in amikacin group) were treated in this study. They occurred in 218 different patients. Fifteen patients were enrolled twice and one three times. Response rates to the two treatment regimens for microbiologically documented episodes, clinically documented episodes and further unexplained fever were similar. Tolerance of the treatment regimens, as measured by serum creatinine levels, hypoaccousia and cutaneous allergy was also similar in both treatment groups. In conclusion, isepamicin given once daily when combined with ceftriaxone in the treatment of febrile episodes in neutropenic cancer patients was as effective and no more toxic than amikacin.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amikacin; Anti-Bacterial Agents; Bone Marrow Transplantation; Ceftriaxone; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever; Gentamicins; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Neoplasms; Neutropenia; Superinfection

Prompt initiation of empiric antibiotic therapy is the cornerstone in the therapy of chemotherapy-induced neutropenic sepsis in cancer patients. Ceftriaxone plus gentamicin (ceftriaxone/gentamicin) is the most widely used combination of empiric antibiotics in the Department of Medical Oncology, Singapore General Hospital. However, imipenem/cilastatin has been shown to be a practical alternative. To compare the efficacy and cost effectiveness of monotherapy with our usual combination antibiotic therapy, 50 evaluable neutropenic cancer patients admitted for fever were randomised to empiric imipenem/cilastatin or ceftriaxone/gentamicin. Ceftriaxone/gentamicin was started in 24 patients. The initial clinical response rate to ceftriaxone/gentamicin was 62.5% and 84.6% to imipenem/cilastatin (P = 0.075). The average cost of antibiotics per patient started on ceftriaxone/gentamicin including cost of change of antibiotics was S$63 per day of antibiotic use and for imipenem/cilastatin it was S$252 (P < 0.02). In conclusion, although more patients receiving imipenem/cilastatin had an initial clinical response than those receiving ceftriaxone/gentamicin, this difference was not statistically significant. It would appear that imipenem/cilastatin is equivalent to ceftriaxone/gentamicin for the treatment of neutropenic sepsis. However, ceftriaxone/gentamicin was more cost effective.

Topics: Antineoplastic Agents; Ceftriaxone; Cilastatin; Cilastatin, Imipenem Drug Combination; Costs and Cost Analysis; Drug Combinations; Drug Therapy, Combination; Female; Fever; Gentamicins; Humans; Imipenem; Male; Middle Aged; Neutropenia; Sepsis

Because studies of the treatment of children with occult bacteremia have yielded conflicting results, we compared ceftriaxone with amoxicillin for therapy. Inclusion criteria were age 3 to 36 months, temperature > or = 39 degrees C, an acute febrile illness with no focal findings or with otitis media (6/10 centers), and culture of blood. Subjects were randomly assigned to receive either ceftriaxone, 50 mg/kg intramuscularly, or amoxicillin, 20 mg/kg/dose orally for six doses. Of 6733 patients enrolled, 195 had bacteremia and 192 were evaluable: 164 Streptococcus pneumoniae, 9 Haemophilus influenzae type b, 7 Salmonella, 2 Neisseria meningitidis, and 10 other. After treatment, three patients receiving amoxicillin had the same organism isolated from their blood (two H. influenzae type b, one Salmonella) and two from the spinal fluid (two H. influenzae type b), compared with none given ceftriaxone. Probable or definite infections occurred in three children treated with ceftriaxone and six given amoxicillin (adjusted odds ratio 0.43, 95% confidence interval 0.08 to 1.82, p = 0.31). The five children with definite bacterial infections (three meningitis, one pneumonia, one sepsis) received amoxicillin (adjusted odds ratio 0.00, 95% confidence interval 0.00 to 0.52, p = 0.02). Fever persisted less often with ceftriaxone (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.94, p = 0.04). Although the difference in total infections was not significant, ceftriaxone eradicated bacteremia, prevented significantly more definite focal bacterial complications, and was associated with less persistent fever.

Topics: Administration, Oral; Amoxicillin; Arthritis, Infectious; Bacteremia; Ceftriaxone; Child, Preschool; Fever; Humans; Infant; Injections, Intramuscular; Meningitis, Bacterial; Microbial Sensitivity Tests; Osteomyelitis; Otitis Media; Pneumonia; Prospective Studies

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

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

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

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

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

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

This prospective multicenter study was conducted to define more clearly clinical and laboratory criteria that predict a strong probability of occult bacteremia and to evaluate the effect of empiric broad spectrum antimicrobial treatment of these children. Children 3 to 36 months old with fever > or = 40 degrees C (104 degrees F) or, > or = 39.5 degrees C (103 degrees F) with white blood cells (WBC) > or = 15 x 10(9)/liter, and no focus of infection had blood cultures obtained and were randomized to treatment with oral amoxicillin/potassium clavulanate or intramuscular ceftriaxone. Sixty of 519 (11.6%) study patients had positive blood cultures: Streptococcus pneumoniae, 51; Haemophilus influenzae b, 6; Neisseria meningitidis, 2; and Group B Streptococcus, 1. Subgroups of high risk were identified as fever > or = 39.5 degrees C and WBC > or = 15 x 10(9)/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasing increments of degrees of leukocytosis to WBC > or = 30 x 10(9)/liter where 9 of 21 or 42.9% were positive. Subgroups of significantly lower risk were identified as fever > or = 39.5 degrees C and WBC < 15 x 10(9)/liter, 5 of 182 or 2.7% positive and those with WBC < 10 x 10(9)/liter, 0 of 99 or 0.0% positive. Children with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amoxicillin/potassium clavulanate remained febrile. In the 459 culture-negative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Female; Fever; Follow-Up Studies; Haemophilus Infections; Humans; Infant; Injections, Intramuscular; Leukocytosis; Male; Meningococcal Infections; Multivariate Analysis; Pneumococcal Infections; Prospective Studies; Regression Analysis; Treatment Outcome

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

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

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

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

Children with sickle cell disease have a greatly increased potential for developing rapid and at times fatal sepsis from Streptococcus pneumoniae. Hospitalization and parenteral antibiotic treatment in all febrile children with sickle cell disease have thus become the standard of care at most sickle cell centers. As an alternative approach, we managed selected febrile children with sickle cell disease on an ambulatory basis with parenteral ceftriaxone to determine its safety and effectiveness in preventing sepsis and reducing the number of days of hospitalization. Twenty of 40 children who presented with significant fever met the study criteria and received ceftriaxone on an ambulatory basis. Three were subsequently hospitalized. Compared with a previous year, when all febrile children were admitted, ceftriaxone use reduced the days of hospitalization from 214 (6.3 +/- 1.6 days/patient) to 111 days (2.8 +/- 0.7 days/patient). The empiric use of ceftriaxone appears safe and effective, but it requires an expanded study over an extended period.

Topics: Adolescent; Adult; Ambulatory Care; Anemia, Sickle Cell; Ceftriaxone; Child; Child, Preschool; Fever; Humans; Infant; Pilot Projects

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

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

In a prospective, randomized study we compared ceftriaxone (active ingredient of Rocephin) plus amikacin, ceftazidime plus amikacin and imipenem/cilastatin in the empiric therapy of febrile granulocytopenic (less than 500/mm3) patients with cancer or aplastic anemia. Of 27 evaluable episodes, 12 were treated with ceftriaxone plus amikacin, 5 with ceftazidime plus amikacin and 10 with imipenem/cilastatin. 56% were culture-positive. Septicemia was the most frequent site of infection and Escherichia coli was the most frequently isolated organism. The efficacy of the three regimens was comparable. One failure occurring in each treatment group was successfully treated with an alternative antibiotic regimen. A second failure in the first treatment group did not respond to the alternative treatment either. No major adverse effects occurred. This study demonstrates that the three regimens are excellent in the empiric therapy of febrile granulocytopenic patients.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Ceftazidime; Ceftriaxone; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Drug Therapy, Combination; Female; Fever; Humans; Imipenem; Male; Middle Aged; Prospective Studies; Random Allocation; Remission Induction

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

A 35-year-old man was hospitalized with fever, chest pain, and cough of 2 weeks' duration. These symptoms persisted despite 4 days of antibiotic treatment with IV ceftriaxone sodium 2 g/d. The patient was a nonsmoker with an unremarkable medical history who worked as a herdsman and lived in the Shigate region of Tibet, China.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Chest Pain; Cough; Diagnosis, Differential; Fever; Humans; Male

Meningitis caused by Listeria monocytogenes is a rare disease in immunocompetent individuals, however, in the presence of certain risk factors with clinical signs indicating infection of the central nervous system it should not be ignored. In this case report, we present the medical history of a 72-year-old man, suffering from hypertension and liver cirrhosis, who was diagnosed with meningitis caused by L. monocytogenes. The patient was admitted to our Department with the symptoms of weakness, dizziness, high fever and urinary incontinence. Laboratory tests showed elevated inflammatory and liver enzyme values as well as low white blood cell and platelet counts were confirmed. Imaging tests did not prove any abnormalities. Due to septic parameters, after microbiological samples were collected, empiric ceftriaxon and metronidazol treatment was started. Despite our therapeutic efforts, the condition of the patient had not improved significantly. The patient still suffered from high fever; increasing agitation and tremor, coordination disorder appeared, raising the possibility of a bacterial infection of the central nervous system. Examination of the cerebrospinal fluid confirmed the diagnosis of bacterial meningitis. In the meantime, findings of microbiological cultures verified the infection of L. monocytogenes, however, cerebrospinal fluid culture did not detect any pathogen. Following that, the therapy continued with targeted ampicillin which resulted in rapid improvement of the patient's condition; fevers and neurological symptoms have ceased to exist. We considered the case worthy of presentation because of the pitfalls of the diagnosis, the emerging differential diagnostic difficulties and the favorable outcome due to the effectiveness of targeted antibiotic treatment. Orv Hetil. 2023; 164(36): 1437-1441.. A Listeria monocytogenes által okozott meningitis immunkompetens egyénekben ritkán előforduló betegség, bizonyos rizikófaktorok mellett azonban a központi idegrendszer fertőzésére utaló klinikai kép esetén semmiképpen sem szabad figyelmen kívül hagyni. Közleményünkben egy 72 éves, májcirrhosisban és hypertoniában szenvedő férfi beteg L. monocytogenes által okozott agyhártyagyulladásának kórtörténetét mutatjuk be, akit gyengeség, szédülés, magas láz és vizeletincontinentia miatt vettünk fel osztályunkra. A laboratóriumi vizsgálatok emelkedett gyulladásos és májenzimértékeket, alacsony fehérvérsejt- és thrombocytaszámot igazoltak. A képalkotó vizsgálatok kórosat nem igazoltak. A szeptikus állapot miatt a mikrobiológiai mintavételt követően empirikus ceftriaxon- és metronidazolkezelés indult. Terápiás erőfeszítéseink ellenére a beteg állapotában érdemi javulás nem következett be, továbbra is magas láza volt, pszichomotoros nyugtalansága fokozódott, tremora és koordinációs zavara jelentkezett, ezért felmerült a központi idegrendszeri bakteriális fertőzés lehetősége. A liquor vizsgálata megerősítette a purulens meningitis diagnózisát. Az időközben megérkező hemokultúra-lelet L. monocytogenes fertőzést igazolt, a liquor tenyésztése kórokozót már nem jelzett. A továbbiakban célzott ampicillinterápiát folytattunk, melynek eredményeként a beteg állapota gyors javulást mutatott, tartósan láztalanná vált, neurológiai tünetei megszűntek. Az esetet a diagnosztika buktatói, a felmerülő differenciáldiagnosztikai nehézségek és a célzott antibiotikumkezelés eredményességéből adódó kedvező kimenetele miatt tartottuk bemutatásra érdemesnek. Orv Hetil. 2023; 164(36): 1437–1441.

Topics: Aged; Ampicillin; Ceftriaxone; Fever; Hospitalization; Humans; Male; Meningitis, Listeria

Salmonella meningitis is a rare but serious complication of Salmonella infection, primarily affecting infants, children, and immunocompromised individuals.. We present a case of a two-and-a-half-year-old Asian boy who developed Salmonella meningitis along with pneumonia and respiratory failure. Initially, he experienced symptoms of loose motions, fever, and irritability, which progressed to neck stiffness and brisk reflexes. Cerebrospinal fluid (CSF) analysis confirmed Salmonella typhi in the CSF. Due to the worsening condition, the patient was admitted to the intensive care unit, intubated, and switched to meropenem as the antibiotic of choice after an initial empiric therapy with ceftriaxone and vancomycin. With appropriate treatment, the patient showed significant improvement, including resolution of fever and respiratory symptoms.. Management of Salmonella meningitis is often challenging primarily because of the fact that the empiric therapy for meningitis may not always provide coverage to the multi-drug resistant Salmonella species found in South Asia. Prompt administration of appropriate antibiotics based on sensitivity testing is crucial for successful management. This case emphasizes the importance of early recognition and effective management of this uncommon yet severe complication of Salmonella infection.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Fever; Humans; Infant; Male; Meningitis, Bacterial; Pakistan; Salmonella Infections; Salmonella typhi

Topics: Adult; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Exanthema; Fever; HIV Infections; Humans; Male; Mpox (monkeypox); Pharyngitis; Tonsillitis

Topics: Abscess; Anti-Bacterial Agents; Ceftriaxone; Cough; Diagnosis, Differential; Drainage; Dyspnea; Female; Fever; Humans; Middle Aged; Point-of-Care Testing; Radiography, Thoracic; Salmonella; Salmonella Infections; Splenic Diseases; Ultrasonography

There are a limited number of studies that address non-neutropenic fever episodes in children with cancer, and no standard approach exists.. We opt to retrospectively analyze the efficacy of the current clinical approach for management of non-neutropenic fever episodes and the associated risk factors among children with cancer at the Princess Noorah Oncology Center from May 2016 through December 2017.. A total of 480 non-neutropenic fever episodes were identified in 131 children, of which 62 episodes were triaged as high-risk non-neutropenic fever and 418 as low-risk non-neutropenic fever. Of those 480 non-neutropenic fever, 361 episodes (75.2%) were associated with the presence of central venous catheters. The overall failure rate of ceftriaxone mono-therapy was observed in 75.6% (11.7% in high-risk non-neutropenic fever with a mean C-reactive protein level of 21.1 (±23.2) mmol/L and 63.9% in low-risk non-neutropenic fever with a mean C-reactive protein level of 17.6 (±53.9) mmol/L). The overall bacteremia rate was 14.4%. The type of organisms isolated was mainly high-risk organisms in 59 non-neutropenic fever episodes (85.5%), OR 1.78 (95% CI: 0.45-7.04) p = 0.41. Of note, all bacteremia were associated with the presence of central venous catheter (100%). Of all the examined risk factors of outpatient treatment failure in low-risk non-neutropenic fever, only prolonged fever of more than three days were significantly associated with bacteremia OR 8.107 [95% CI: 1.744-37.691], p = 0.008. Noteworthy is that almost 43% of non-neutropenic fever episodes were associated with respiratory symptoms. This study provides a baseline for future prospective research assessing the pattern of non-neutropenic fever by focusing on associated risk factors.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; C-Reactive Protein; Catheter-Related Infections; Ceftriaxone; Central Venous Catheters; Child; Child, Preschool; Disease Management; Female; Fever; Humans; Infant; Infant, Newborn; Male; Neoplasms; Neutropenia; Respiration Disorders; Retrospective Studies; Risk Factors

A woman in her 70s presented to the emergency department with fever, fluctuating cognition and headache. A detailed examination revealed neurological weakness to the lower limbs with atonia and areflexia, leading to a diagnosis of bacterial meningitis, alongside a concurrent COVID-19 infection. The patient required critical care escalation for respiratory support. After stepdown to a rehabilitation ward, she had difficulties communicating due to new aphonia, hearing loss and left third nerve palsy. The team used written communication with the patient, and with this the patient was able to signal neurological deterioration. Another neurological examination noted a different pattern of weakness to the lower limbs, along with new urinary retention, and spinal arachnoiditis was identified. After more than 10 weeks in the hospital, the patient was discharged. Throughout this case, there were multiple handovers between teams and specialties, all of which were underpinned by good communication and examination to achieve the best care.

Topics: Aged; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Coinfection; Combined Modality Therapy; Communication; Confusion; COVID-19; Critical Care; Diagnosis, Differential; Female; Fever; Headache; Humans; Meningitis, Escherichia coli; Patient Care Team; Physical Therapy Modalities; Physician-Patient Relations; Respiration, Artificial; SARS-CoV-2; Treatment Outcome

We report a rare case of an infective endocarditis by Aerococcus spp in a bioprosthetic aortic valve following a prostate biopsy, in an asymptomatic adult with no additional risk factor for prostate cancer, excepting for age. The diagnosis was based on the presence of vegetations on the bioprosthesis seen on the echocardiogram, positive blood cultures and fever, and a favorable clinical outcome following the treatment with ceftriaxone and gentamicin.

Topics: Aerococcus; Aged; Biopsy; Ceftriaxone; Echocardiography; Endocarditis; Female; Fever; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Prostate; RNA, Ribosomal, 16S; Treatment Outcome

Topics: Administration, Intravenous; Adult; Anti-Bacterial Agents; Ceftriaxone; Exanthema; Fentanyl; Fever; Gonorrhea; Humans; Laryngeal Diseases; Male; Neisseria gonorrhoeae; Polymerase Chain Reaction; Treatment Outcome

Topics: Adult; Analgesics, Opioid; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Clindamycin; Epstein-Barr Virus Infections; Fever; Humans; Lemierre Syndrome; Lymphadenopathy; Male; Neck Pain; Positron Emission Tomography Computed Tomography; Streptococcus anginosus; Tilidine; Young Adult

To describe a term newborn with acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem involvement including seizures associated to ischemic lesions in the brain.. Coronavirus disease 2019 (COVID-19) is predominantly a respiratory infection, but it may affect many other systems. Most pediatric COVID-19 cases range from asymptomatic to mild-moderate disease. There are no specific clinical signs described for neonatal COVID-19 infections. In children, severe central nervous system compromise has been rarely reported.. We describe a 17-day-old newborn who acquired a SARS-CoV-2 infection in a family meeting that was admitted for fever, seizures and lethargy and in whom consumption coagulopathy, ischemic lesions in the brain and cardiac involvement were documented.. SARS-CoV-2 neonatal infection can be associated with multi-organic involvement. In our patient, significant central nervous system compromise associated to ischemic lesions and laboratory findings of consumption coagulopathy were found.. Although neonatal SARS-CoV-2 infections are infrequent, they can be associated with multi-organic involvement. Neonatologists and pediatricians should be aware of this unusual way of presentation of COVID-19 in newborn infants.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Brain; Brain Ischemia; Ceftriaxone; COVID-19; COVID-19 Drug Treatment; Fever; Frontal Lobe; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lethargy; Magnetic Resonance Imaging; Male; Nasopharynx; SARS-CoV-2; Seizures

Topics: Amoxicillin; Ceftriaxone; Central Nervous System Cysts; Diagnosis; Fever; Humans; Infant; Male; Meningitis, Aseptic; Neck Pain; Streptococcal Infections; Vaccination Refusal; Vancomycin

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

Topics: Adult; Anti-Bacterial Agents; Athletic Injuries; Ceftriaxone; Debridement; Diagnosis, Differential; Fever; Groin; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Muscle, Skeletal; Osteomyelitis; Pubic Symphysis; Running

Scrub typhus can present with atypical signs and symptoms such as those of acute kidney injury, gastroenteritis, pneumonitis, and acute respiratory distress syndrome. Meningitis, encephalitis, and hepatic dysfunction have also been reported, particularly in severe cases with multisystem involvement. Scrub typhus has never been reported in the literature to cause urinary tract infections (UTIs) which includes cystitis and pyelonephritis.. A 45-year old male presenting to the outpatient unit with fever, right flank pain, and burning micturition for three days was initially treated for UTI. However, he returned to the hospital on the fourth day of illness with persistent symptoms. He was hospitalized, with intravenous (IV) ceftriaxone. Computerized tomography scan of his abdomen-pelvis showed features of acute pyelonephritis, so his antibiotics were upgraded to meropenem and teicoplanin. Despite this, the patient's condition deteriorated. Laboratory investigations showed multisystem involvement: decreasing platelets, raised creatinine, and deranged liver panel. As Kathmandu was hit by dengue epidemic during the patient's hospitalization, on the seventh day of his illness, blood samples were sent for tropical fever investigation. All tests came out negative except for scrub typhus-IgM antibodies positive on rapid diagnostic test. The patient's symptoms subsided after 48 h of starting doxycycline and he became fully asymptomatic four days later. Fever did not recur even after discontinuing other IV antibiotics, favoring scrub typhus disease rather than systemic bacterial sepsis.. Scrub typhus is an emerging infectious disease of Nepal. Therefore, every unexplained fever cases (irrespective of clinical presentation) should be evaluated for potential Rickettsiosis. Moreover, for cases with acute pyelonephritis, atypical causative agents should be investigated, for example scrub typhus in this case.

Topics: Anti-Bacterial Agents; Ceftriaxone; Communicable Diseases, Emerging; Doxycycline; Fever; Humans; Male; Meropenem; Middle Aged; Nepal; Pyelonephritis; Scrub Typhus; Teicoplanin

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

The worldwide incidence of coronavirus disease 2019 (COVID-19) infection is rapidly increasing, but there exists limited information on coronavirus disease 2019 in pregnancy. Here, we present our experience with 7 confirmed cases of coronavirus disease 2019 in pregnancy presenting to a single large New York City tertiary care hospital. Of the 7 patients, 5 presented with symptoms of coronavirus disease 2019, including cough, myalgias, fevers, chest pain, and headache. Of the 7 patients, 4 were admitted to the hospital, including 2 who required supportive care with intravenous hydration. Of note, the other 2 admitted patients who were asymptomatic on admission to the hospital, presenting instead for obstetrically indicated labor inductions, became symptomatic after delivery, each requiring intensive care unit admission.

Topics: Acute Kidney Injury; Adult; Anesthesia, General; Anti-Bacterial Agents; Antihypertensive Agents; Azithromycin; Bronchial Spasm; Carrier State; Ceftriaxone; Cesarean Section; COVID-19; Diabetes Mellitus, Type 2; Enzyme Inhibitors; Female; Fever; Health Personnel; Hospitalization; Humans; Hydroxychloroquine; Hypertension; Intensive Care Units; Intubation, Intratracheal; Labor, Induced; New York City; Nicardipine; Occupational Exposure; Oxygen Inhalation Therapy; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Infectious; Pregnancy in Diabetics; Respiration, Artificial; SARS-CoV-2; Uterine Inertia

Brucellosis is a zoonotic disease caused by brucella. It has been an increasing trend in recent years (Wang H, Xu WM, Zhu KJ, Zhu SJ, Zhang HF, Wang J, Yang Y, Shao FY, Jiang NM, Tao ZY, Jin HY, Tang Y, Huo LL, Dong F, Li ZJ, Ding H, Liu ZG, Emerg Microbes Infect 9:889-99, 2020). Brucellosis is capable to invade multiple systems throughout the body, lacking in typical clinical manifestations, and easily misdiagnosed and mistreated.. We report a case of a male, 5-year-and-11-month old child without relevant medical history, who was admitted to hospital for 20 days of fever. When admitted to the hospital, we found that he was enervated, irritable and sleepy, accompanied with red eyes phenomenon. After anti-infection treatment with meropenem, no improvement observed. Lumbar puncture revealed normal CSF protein, normal cells, and negative culture. Later, doppler echocardiography suggested coronary aneurysms, and incomplete Kawasaki Disease with coronary aneurysms was proposed. The next day, brucellosis agglutination test was positive. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid suggested B.melitensis, which was confirmed again by blood culture. The child was finally diagnosed as brucellosis with meningocephalitis, coronary aneurysm and keratitis. According to our preliminary research and review, such case has never been reported in detail before. After diagnosis confirmation, the child was treated with rifampicin, compound sulfamethoxazole, and ceftriaxone for cocktail anti-infection therapy. Aspirin and dipyridamole were also applied for anticoagulant therapy. After medical treatment, body temperature of the child has reached normal level, eye symptoms alleviated, and mental condition gradually turned normal. Re-examination of the doppler echocardiographic indicated that the coronary aneurysm was aggravated, so warfarin was added for amplification of anticoagulation treatment. At present, 3 months of follow-up, the coronary artery dilatation gradually assuaged, and the condition is continued to alleviate.. Brucellosis can invade nervous system, coronary artery, and cornea. Brucellosis lacks specific signs for clinical diagnosis. The traditional agglutination test and the new mNGS are convenient and effective, which can provide the reference for clinical diagnosis.

Topics: Agglutination Tests; Animals; Anti-Infective Agents; Anticoagulants; Brucella melitensis; Brucellosis; Ceftriaxone; Child, Preschool; Coronary Aneurysm; Diagnostic Errors; Fever; Humans; Keratitis; Male; Meningoencephalitis; Rifampin; Sulfamethoxazole; Treatment Outcome; Zoonoses

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Diagnosis, Differential; Encephalomyelitis, Eastern Equine; Fever; Humans; Infant; Male; Nervous System Diseases; Seizures

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Confusion; Delirium; Dysuria; Female; Fever; Hospitalization; Humans; Neuroimaging; Pyelonephritis; Surveys and Questionnaires

We describe a ceftriaxone-resistant

Topics: Abdominal Pain; Adult; Agglutination Tests; Anti-Bacterial Agents; Azithromycin; Bacteremia; Carbapenem-Resistant Enterobacteriaceae; Ceftriaxone; Denmark; Drug Resistance; Escherichia coli; Female; Fever; Humans; Meropenem; Microbial Sensitivity Tests; Pakistan; Plasmids; Polymerase Chain Reaction; Pregnancy; Salmonella typhi; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Travel; Typhoid Fever; Whole Genome Sequencing

Invasive S. pyogenes diseases are uncommon, serious infections with high case fatality rates (CFR). There are few publications on this subject in the field of pediatrics. This study aimed at characterizing clinical and laboratory aspects of this disease in Chinese children.. A retrospective study was conducted and pediatric in-patients with S. pyogenes infection identified by cultures from normally sterile sites were included, who were diagnosed and treated in 9 tertiary hospitals during 2010-2017.. A total of 66 cases were identified, in which 37 (56.1%) were male. The median age of these patients, including 11 neonates, was 3.0 y. Fifty-nine (89.4%) isolates were determined from blood. Fever was the major symptom (60/66, 90.9%) and sepsis was the most frequent presentation (64/66, 97.0%, including 42.4% with skin or soft tissue infections and 25.8% with pneumonia. The mean duration of the chief complaint was (3.8 ± 3.2) d. Only 18 (27.3%) patients had been given antibiotics prior to the hospitalization. Among all patients, 15 (22.7%) developed streptococcal toxin shock syndrome (STSS). No S. pyogenes strain was resistant to penicillin, ceftriaxone, or vancomycin, while 88.9% (56/63) and 81.4% (48/59) of the tested isolates were resistant to clindamycin and erythromycin respectively. Most of the patients were treated with β-lactams antibiotics and 36.4% had been treated with meropenem or imipenem. Thirteen (19.7%) cases died from infection, in which 9 (13.6%) had complication with STSS.. Invasive S. pyogenes infections often developed from skin or soft tissue infection and STSS was the main cause of death in Chinese children. Ongoing surveillance is required to gain a greater understanding of this disease.

Topics: Ceftriaxone; Child, Preschool; China; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Female; Fever; Humans; Infant; Infant, Newborn; Male; Penicillins; Pneumonia, Pneumococcal; Retrospective Studies; Sepsis; Shock, Septic; Skin Diseases, Bacterial; Soft Tissue Infections; Streptococcal Infections; Streptococcus pyogenes; Tertiary Care Centers; Vancomycin

Murine typhus is a flea-borne disease caused by Rickettsia typhi, which was first detected in Mexico in 1927. It was not until 1996 that the first systematized study involving this pathogen was conducted in two coastal states of Mexico. We now report the first confirmed case of murine typhus in the state of Campeche, which occurred in a male patient who exhibited fever, thrombocytopenia, hyperbilirubinemia, and a rash. Furthermore, the patient reported having had previous contact with Rickettsia reservoirs.

Topics: Adult; Ceftriaxone; Doxycycline; Exanthema; Fever; Humans; Male; Mexico; Polymerase Chain Reaction; Rickettsia typhi; Thrombocytopenia; Typhus, Endemic Flea-Borne

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Antigens, Viral; Capsid Proteins; Ceftriaxone; Chills; Diagnosis, Differential; Dyspnea; Fatal Outcome; Fever; Humans; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Bacterial; Prednisolone; Shock, Hemorrhagic

Topics: Adenocarcinoma; Amoxicillin-Potassium Clavulanate Combination; Bacteria, Anaerobic; Ceftriaxone; Combined Modality Therapy; Drainage; Drug Resistance, Microbial; Fever; Firmicutes; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Lymph Node Excision; Lymphocele; Male; Middle Aged; Postoperative Complications; Prostatectomy; Prostatic Neoplasms

We present a 4-year-old girl who developed invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup C sequence type (ST)-4821. She was hospitalized due to fever, vomiting, rash and altered consciousness. Serogroup C N. meningitidis was isolated from blood culture taken on admission and was confirmed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry, a biochemical test, and molecular microbiological analysis. The patient was successfully treated with 50 mg/kg ceftriaxone every 12 hours for 7 days without any complications. The isolate was susceptible to a wide variety of β-lactams and rifampin but was resistant to ciprofloxacin. The isolate harbored gyrA T91I and parC S87I mutations at the quinolone-resistance-determining regions. Multi-locus sequence typing revealed the isolates as ST-4821, which was identical to an endemic clone frequently detected in China. However, neither the patient nor her family members had traveled abroad. To our knowledge, this report is the first to describe an IMD patient caused by ciprofloxacin-resistant N. meningitidis ST-4821 in Japan, and is the first community-acquired IMD case due to this strain outside of China. The high proportion of ciprofloxacin resistance and hypervirulent features of this ST-4821 strain raise special public health concerns. We still consider ciprofloxacin is still appropriate drug for post-exposure chemoprophylaxis in Japan. However, nationwide surveillance for susceptibility of IMD isolates is necessary to establish the regional antibiogram, and thereby to avoid chemoprophylaxis failure.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Ciprofloxacin; Diagnostic Tests, Routine; Drug Resistance, Bacterial; Exanthema; Female; Fever; Humans; Meningococcal Infections; Mutation; Neisseria meningitidis; Serogroup; Vomiting

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

Because of high rates of resistance to fluoroquinolones, ceftriaxone has become one of the main options for treating febrile urinary tract infection (FUTI). This study aimed to identify predictors of ceftriaxone resistance in community-acquired FUTIs in men.. Cross-sectional ambispective study enrolling men with FUTIs treated in the emergency department of a local area hospital in Spain.. A total of 552 FUTI episodes were studied; 103 (18.6%) were caused by a ceftriaxone-resistant microorganism. Variables associated with a ceftriaxone-resistant FUTI were older age, health care-associated FUTI, dementia, diabetes mellitus, neoplasms, a history of UTIs, urologic disease, and complicated FUTI. Patients with ceftriaxone-resistant FUTIs also had higher rates of recent antibiotic treatment. Independent variables associated with FUTI due to a ceftriaxoneresistant microorganism were cirrhosis of the liver (odds ratio [OR], 6,00 95% CI, 1.25-28; P = .025), health careassociated FUTI (OR, 2.3 95% CI, 1.23-4.27; P = .009), and prior treatment with antibiotics (OR, 2.15; 95% CI, 1.23-3.76 P = .007). Components of health care-associated FUTI were a history of admission to a long-term residence (OR, 2.90 95% CI, 1.21-7.16; P = .017) and use of penicillins with or without beta-lactamase inhibitors (OR, 2.16; 95% CI, 1.05-4.42; P = .035).. Cirrhosis of the liver; history of health care-associated FUTI, especially in patients residing in a long-term care facility; and recent use of antibiotics, mainly penicillins with or without beta-lactamase inhibitors, are risk factors for ceftriaxone-resistant FUTI in men.. Las elevadas tasas de resistencia a fluoroquinolonas han hecho de la ceftriaxona una de las principales opciones terapéuticas en las infecciones del tracto urinario febriles (ITUF). El objetivo del estudio es identificar factores predictivos de infección por microorganismos resistentes a ceftriaxona (MRC) en ITUF comunitaria en hombres.. Estudio transversal ambispectivo en el que se incluyeron hombres con ITUF atendidos en el servicio de urgencias de un hospital comarcal.. Se incluyeron 552 episodios de ITUF, 103 (18,6%) causadas por MRC. Los pacientes con ITUF por MRC tenían mayor edad, más frecuencia de ITUF relacionada con la atención sanitaria (ITUF-AS), demencia, diabetes mellitus, neoplasia, ITU previa, patología urológica, ITUF complicada y antecedente de tratamiento antibiótico reciente. Las variables independientemente asociadas a ITUF por MRC fueron la cirrosis hepática (OR 6,00; IC 95%: 1,25-28; p = 0,025), tener una ITUF-AS (OR 2,3; IC 95%: 1,23-4,27; p = 0,009) y el consumo previo de antibióticos (OR 2,15; IC 95%: 1,23-3,76; p = 0,007). Entre los componentes de la ITUF-AS, el antecedentes de estancia en centro larga estancia (OR 2,90; IC 95%: 1,21-7,16; p = 0,017) y entre los antibióticos el consumo de penicilinas con/sin inhibidores de betalactamasa (OR 2,16; IC 95%: 1,05-4,42; p = 0,035) se asociaron a ITUF por MRC.. La cirrosis, presentar una ITUF-AS, especialmente provenir de un centro de larga estancia, y el consumo reciente de antibióticos, principalmente de penicilinas con/sin inhibidores de betalactamasa, son factores de riesgo de ITUF por MRC en hombres.

Topics: Aged; beta-Lactam Resistance; beta-Lactamase Inhibitors; Ceftriaxone; Cross Infection; Cross-Sectional Studies; Drug Resistance, Microbial; Emergency Service, Hospital; Fever; Humans; Liver Cirrhosis; Male; Middle Aged; Penicillins; Risk Factors; Urinary Tract Infections

Tropical infections form 20-30% of ICU admissions in tropical countries. Diarrheal diseases, malaria, dengue, typhoid, rickettsial diseases and leptospirosis are common causes of critical illness. Overlapping clinical features makes initial diagnosis challenging. A systematic approach involving (1) history of specific continent or country of travel, (2) exposure to specific environments (forests or farms, water sports, consumption of exotic foods), (3) incubation period, and (4) pattern of organ involvement and subtle differences in manifestations help in differential diagnosis and choice of initial empiric therapy. Fever, rash, hypotension, thrombocytopenia and mild derangement of liver function tests is seen in a majority of patients. Organ failure may lead to shock, respiratory distress, renal failure, hepatitis, coma, seizures, cardiac arrhythmias or hemorrhage. Diagnosis in some conditions is made by peripheral blood smear examination, antigen detection or detection of microbial nucleic acid by PCR. Tests that detect specific IgM antibody become positive only in the second week of illness. Initial therapy is often empiric; a combination of intravenous artesunate, ceftriaxone and either doxycycline or azithromycin would cover a majority of the treatable syndromes. Additional antiviral or antiprotozoal medications are required for some specific syndromes. Involving a physician specializing in tropical or travel medicine is helpful.

Topics: Artesunate; Azithromycin; Ceftriaxone; Child; Communicable Diseases; Critical Care; Dengue; Diagnosis, Differential; Doxycycline; Exanthema; Female; Fever; Geography; Humans; Intensive Care Units; Leptospirosis; Malaria; Male; Nervous System Diseases; Pregnancy; Shock, Hemorrhagic; Syndrome; Travel; Tropical Medicine; Typhoid Fever

Fulminant meningococcemia is a relatively rare life-threatening disease caused by Neisseria meningitidis. The clinical presentation is varied, but, when associated with myocarditis, it carries a particularly poor prognosis. We report a case of a patient with fulminant meningococcemia who subsequently developed severe myocardial dysfunction and successfully recovered within a period of 7 days of hospitalization. A 15-year-old girl presented with headache, fever, body ache for 1 day and few ecchymotic rash over her body for 3 hours. Blood cultures confirmed infection with N. meningitidis. After 2 days in the hospital, the patient developed dyspnea, elevated jugular venous pressure and shock. The patient was managed with intravenous ceftriaxone, furosemide and norepinephrine. Over the next 4 days the patient rapidly improved. Meningococcemia complicated by myocarditis has an extremely poor prognosis with high mortality. Our case suggests that recovery from a severe myocardial dysfunction can occur rapidly within a few days. Prompt recognition and management in this case might have contributed to the patient's rapid recovery from myocarditis.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Diuretics; Female; Fever; Furosemide; Humans; Male; Meningococcal Infections; Myocarditis; Neisseria meningitidis; Norepinephrine; Treatment Outcome

We describe a rare case of infantile meningococcal (serotype B) meningitis in a 3-month-old Chinese boy with an atypical indolent presentation with prolonged persistent fever despite appropriate antimicrobial therapy likely due to drug fever. The case highlights the need for continued vigilance in identifying similar cases in the future.

Topics: Ceftriaxone; Diagnosis, Differential; Fever; Humans; Infant; Male; Meningitis, Meningococcal; Treatment Outcome

Listeria monocytogenes only occasionally causes bacterial meningitis in immunocompetent children. We report a case of L. monocytogenes meningitis associated with rotavirus gastroenteritis. The patient was a previously healthy 20-month-old girl who was admitted because of sustained fever and lethargy after suffering from gastroenteritis for 6 days. The patient's peripheral white blood cell count was 18,600/µL and the C-reactive protein level was 2.44 mg/dL. A stool sample tested positive for rotavirus antigen. A cerebrospinal fluid (CSF) sample showed pleocytosis. Cultures of the CSF and stool samples revealed the presence of L. monocytogenes. The patient was successfully treated with ampicillin and gentamicin. We speculate that translocation of enteric flora across the intestinal epithelium that had been damaged by rotavirus gastroenteritis might have caused bacteremia that disseminated into the CSF. Both listeriosis and secondary systemic infection after rotavirus gastroenteritis are rare but not unknown. Initiation of appropriate treatment as soon as possible is important for all types of bacterial meningitis. This rare but serious complication should be taken into consideration even if the patient does not have any medical history of immune-related problems.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Drug Therapy, Combination; Female; Fever; Humans; Immunocompetence; Infant; Meningitis, Listeria; Rotavirus Infections; Treatment Outcome; Vancomycin

Ebiino, also known as false tooth extraction, is a traditional practice done mainly in the remote areas of African countries, including Uganda. It involves the extraction of tooth buds in babies with common childhood illnesses such as fever, cough, and diarrhea. It is thought that the tooth buds are responsible for the ailments seen in these infants. The practice is performed by traditional healers using unsterile instruments. The complications associated with this dangerous practice have been mentioned in the literature and include anemia and septicemia, among others. This case report describes a baby with noma, an orofacial gangrenous infection.. A 16-month-old girl from western Uganda belonging to the Banyankole ethnic group was admitted to Mbarara University Teaching Hospital with a 5-day history of a dark lesion on the left cheek. The lesion had started from the left upper gum at the site where a tooth bud had been extracted 1 week prior to admission. The child had experienced occasional cough and fever and also had erupting tooth buds. These tooth buds had been seen as the cause of the cough and fever by the traditional herbalist; hence, they were extracted. An unsterile instrument had been used for the procedure. At the hospital, a local examination showed necrotic tissue involving the left cheek and extending into the left upper gingival area of the girl's mouth. A clinical diagnosis of orofacial gangrene (noma) was then made.. Ebiino, or false tooth extraction, is still practiced in some remote areas of Uganda. Noma has been mentioned as a possible complication of this traditional practice; however, case reports in the literature are scant. Public awareness of the dangers of this practice is therefore still required to prevent this dangerous complication.

Topics: Anti-Bacterial Agents; Ceftriaxone; Debridement; Female; Fever; Humans; Infant; Medicine, African Traditional; Noma; Referral and Consultation; Tooth Extraction; Tooth Germ; Uganda

Our patient's signs and symptoms developed one week after being bitten by a rat that she was feeding to her son's pet snake.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Arthralgia; Ceftriaxone; Dyspnea; Female; Fever; Humans; Middle Aged; Purpura; Rat-Bite Fever; Rats

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Exanthema; Fever; Humans; Male; Meningococcal Infections; Young Adult

Tick-borne relapsing fever (TBRF) is a zoonosis caused by spirochetes of the genus Borrelia. The zoonosis is endemic in higher-elevation coniferous forests of the western United States.. We discuss the case of a 44-year-old male residing in the San Juan Mountains of Western Colorado who presented with fever, myalgia, vomiting, and "violent chills" to an emergency department. Laboratory studies were notable for bandemia and thrombocytopenia with mild hyperbilirubinemia. Peripheral smear demonstrated multiple Borrelia spirochetes. The patient was treated with parenteral ceftriaxone and discharged with oral doxycycline therapy and recovered uneventfully. We discuss the clinical and epidemiological features of TBRF and the salient points for clinical diagnosis and management of this rare but important disease entity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TBRF is a rare and potentially life-threatening infectious process, which presents with nonspecific findings and often poses a diagnostic challenge. TBRF should be considered in the differential diagnosis for patients residing or vacationing in high-altitude forested areas in the western United States.

Topics: Adult; Animals; Anti-Bacterial Agents; Borrelia Infections; Ceftriaxone; Colorado; Emergency Service, Hospital; Fever; Humans; Male; Myalgia; Relapsing Fever; Ticks; Vomiting

Endophthalmitis is a feared complication of pyogenic liver abscesses caused by hypervirulent Klebsiella pneumoniae strains. First described in East Asia in the 1980s, this invasive syndrome is only recently emerging in Europe and America.. We describe an 84-year-old man who presented to the emergency department with fever, orbital cellulitis, and bilateral visual loss. Although the patient had no overt abdominal symptoms, computed tomography scan revealed a pyogenic liver abscess. Blood cultures were positive for K. pneumoniae. Initial treatment consisted of intravenous ceftriaxone and intravitreal ceftazidime. A unilateral vitrectomy was performed. The patient survived with severe visual sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: K. pneumoniae pyogenic liver abscess with metastatic endophthalmitis is a relatively new syndrome that should be considered in patients presenting with acute vision loss who appear septic, with or without abdominal complaints. Early recognition prohibits delays in lifesaving treatment.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Emergency Service, Hospital; Endophthalmitis; Fever; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess, Pyogenic; Male; Vision Disorders

Topics: Anti-Infective Agents; Brain; Brain Abscess; Ceftriaxone; Child; Craniotomy; Female; Fever; Humans; Metronidazole; Tomography, X-Ray Computed; Treatment Outcome; Vancomycin

Topics: Acyclovir; Adolescent; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Cough; Diagnosis, Differential; Disorders of Excessive Somnolence; Encephalomyelitis, Acute Disseminated; Fever; Humans; Male; Muscle Weakness

Topics: Acyclovir; Adrenal Cortex Hormones; Anti-Bacterial Agents; Antiviral Agents; Brain Neoplasms; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Electroencephalography; Emergency Service, Hospital; Encephalitis, Herpes Simplex; Fever; Humans; Hypnotics and Sedatives; Infarction; Levetiracetam; Male; Massachusetts; Middle Aged; Phenytoin; Piracetam; Propofol; Status Epilepticus; Temporal Lobe; Tomography, X-Ray Computed; Unconsciousness; Vancomycin

Deep vein thrombosis (DVT) is rare in infancy. In pediatric populations, thrombosis occurs most frequently in hospitalized children and those with central venous catheters. The presence of a DVT in the general pediatric population indicates a hypercoagulable state and requires rapid diagnosis and treatment of both the thrombosis and the underlying process.. A previously healthy 6-month-old male was brought to the emergency department by his family with a chief complaint of left leg swelling. Duplex ultrasonography in the emergency department revealed multiple DVTs in the leg vasculature. The patient was treated with anticoagulation and antibiotic therapy in the emergency department and admitted. Blood cultures revealed the subsequent growth of methicillin-resistant Staphylococcus aureus (MRSA). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: While rare in infants, new-onset swelling in an extremity may be caused by thrombosis and be the initial symptom of an underlying hypercoagulable state. Duplex ultrasonography is a relatively benign test that can be readily performed in most emergency departments, and it allows physicians to rule out thrombosis. When present, DVT in the general pediatric population can indicate a critical illness, such as malignancy or infection, and requires rapid treatment and admission to a pediatric service for management.

Topics: Anti-Bacterial Agents; Anticoagulants; Bacteremia; Ceftriaxone; Clindamycin; Edema; Emergency Service, Hospital; Enoxaparin; Fever; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Ultrasonography; Vancomycin; Venous Thrombosis

Topics: Anti-Bacterial Agents; Ceftriaxone; Emergency Service, Hospital; Female; Fever; Humans; Infant; Lethargy; Male; Meningitis, Pneumococcal; Pneumococcal Vaccines; Seizures; Serotyping; Sinus Thrombosis, Intracranial; Streptococcus pneumoniae; Stroke; Treatment Outcome; Vancomycin

Topics: Adolescent; Bacteremia; Biopsy, Needle; Ceftriaxone; Chronic Disease; Diagnosis, Differential; Exanthema; Fatigue; Female; Fever; Follow-Up Studies; Headache; Humans; Immunohistochemistry; Infusions, Intravenous; Meningococcal Infections; Neisseria meningitidis; Treatment Outcome

A young woman was examined in the Emergency Department for fever, pharyngitis and widespread petechial rash. Physical examination, including neurological evaluation, did not show any other abnormalities. Chest X-ray was negative. Blood exams showed leukocytosis and CPR 20 mg/dL (nv<0.5 mg/dL). On the basis of these results and petechial rash evidence, lumbar puncture was performed. CSF was opalescent; physico-chemical examination showed: total proteins 2.8 (nv 0.15-0.45), glucose 5 (nv 59-80), WBC 7600/μL (nv 0-4/ μL). In the hypothesis of meningococcal meningitis, antimicrobial therapy was started. Blood and cerebrospinal fluid cultures were positive for N. meningitidis. During the first hours the patient experienced hallucinations and mild psychomotor agitation, making a spontaneous recovery. A brain MRI showed minimal extra-axial inflammatory exudates. She was discharged after 10 days in good condition. We underline the need to consider meningococcal meningitis diagnosis when any suggestive symptom or sign is present, even in the absence of the classic meningitis triad, to obtain earlier diagnosis and an improved prognosis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Diffusion Magnetic Resonance Imaging; Fever; Hallucinations; Humans; Immunocompetence; Meningitis, Meningococcal; Neisseria meningitidis; Neuroimaging; Pharyngitis; Psychomotor Agitation; Purpura; Spinal Puncture

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

To compare the outcome of treatment with narrow spectrum versus broad spectrum antibiotics in children hospitalized with community-acquired pneumonia (CAP) who received oral antibiotic treatment prior to their hospitalization.. A review of all previously healthy children from 3 months to 18 years with non-complicated CAP who received an oral antibiotic course in the community and were admitted from 2003 to 2008 to our pediatric departments.. Clinical course and outcome parameters were compared for treatment with narrow and broad spectrum antibiotics.. Of the 337 children admitted with non-complicated CAP after an oral antibiotic treatment course in the community, 235 were treated with broad spectrum, and 102 with narrow spectrum antibiotics. The two groups were similar regarding age, sex, days of fever prior to admission, type of preadmission oral antibiotic treatment, and laboratory indices at admission (P > 0.1). The broad spectrum-treated group had significantly better outcomes in terms of number of febrile days (1.2 ± 1.1 vs. 1.7 ± 1.6, P < 0.001), number of days treated with intravenous antibiotics (3.1 ± 1.3 vs. 3.9 ± 2.0, P < 0.001), and days of hospitalization (3.5 ± 1.5 vs. 4.2 ± 2.0, P < 0.001). The odds ratio for remaining hospitalized at 72 hr and 7 days was significantly higher for the narrow spectrum group (2.0 and 5.5 respectively, P < 0.05).. In previously healthy children hospitalized with CAP after oral antibiotic treatment in the community treatment with broad spectrum antibiotics showed better outcome. Prospective studies are needed for appropriate recommendation.

Topics: Administration, Intravenous; Administration, Oral; Adolescent; Ambulatory Care; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Cefuroxime; Child; Child, Preschool; Community-Acquired Infections; Female; Fever; Hospitalization; Humans; Infant; Length of Stay; Linear Models; Logistic Models; Male; Multivariate Analysis; Penicillins; Pneumonia, Bacterial; Retrospective Studies

Differences among febrile infant institutional clinical practice guidelines (CPGs) may contribute to practice variation and increased healthcare costs.. Determine the association between pediatric emergency department (ED) CPGs and laboratory testing, hospitalization, ceftriaxone use, and costs in febrile infants.. Retrospective cross-sectional study in 2013.. Thirty-three hospitals in the Pediatric Health Information System.. Infants aged ≤56 days with a diagnosis of fever.. The presence and content of ED-based febrile infant CPGs assessed by electronic survey.. Using generalized estimating equations, we evaluated the association between CPG recommendations and rates of urine, blood, cerebrospinal fluid (CSF) testing, hospitalization, and ceftriaxone use at ED discharge in 2 age groups: ≤28 days and 29 to 56 days. We also assessed CPG impact on healthcare costs.. We included 9377 ED visits; 21 of 33 EDs (63.6%) had a CPG. For neonates ≤28 days, CPG recommendations did not vary and were not associated with differences in testing, hospitalization, or costs. Among infants 29 to 56 days, CPG recommendations for CSF testing and ceftriaxone use varied. CSF testing occurred less often at EDs with CPGs recommending limited testing compared to hospitals without CPGs (adjusted odds ratio: 0.5, 95% confidence interval: 0.3-0.8). Ceftriaxone use at ED discharge varied significantly based on CPG recommendations. Costs were higher for admitted and discharged infants 29 to 56 days old at hospitals with CPGs.. CPG recommendations for febrile infants 29 to 56 days old vary across institutions for CSF testing and ceftriaxone use, correlating with observed practice variation. CPGs were not associated with lower healthcare costs.

Topics: Anti-Bacterial Agents; Blood Chemical Analysis; Ceftriaxone; Cerebrospinal Fluid; Cost Control; Cross-Sectional Studies; Emergency Service, Hospital; Fever; Guideline Adherence; Health Care Surveys; Health Information Systems; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Practice Guidelines as Topic; Retrospective Studies; United States; Urinalysis

An increasing number of travelers from western countries visit tropical regions, questioning western physicians on the prophylaxis, the diagnosis and the therapeutic management of patients with travel-associated infection. In July 2014, a French couple stayed for an adventure-travel in Columbia without malaria prophylaxis. A week after their return the woman presented with fever, myalgia, and retro-orbital pain. Three days later, her husband presented similar symptoms. In both patients, testing for malaria, arboviruses and blood cultures remained negative. An empirical treatment with doxycycline and ceftriaxone was initiated for both patients. Serum collected from the female patient yielded positive IgM for leptospirosis but was negative for her husband. Positive Real-Time PCR were observed in blood and urine from both patients, confirming leptospirosis. Three lessons are noteworthy from this case report. First, after exclusion of malaria, as enteric fever, leptospirosis and rickettsial infection are the most prevalent travel-associated infections, empirical treatment with doxycycline and third generation cephalosporin should be considered. In addition, the diagnosis of leptospirosis requires both serology and PCR performed in both urine and blood samples. Finally, prophylaxis using doxycycline, also effective against leptospirosis, rickettsial infections or travellers' diarrhea should be recommended for adventure travelers in malaria endemic areas.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Colombia; Diagnosis, Differential; Doxycycline; Female; Fever; France; Humans; Leptospirosis; Malaria; Male; Rickettsia Infections; Travel; Treatment Outcome; Typhoid Fever

Topics: Anti-Bacterial Agents; Ceftriaxone; Fever; Humans; Hypotension; Leptospirosis; Male; Middle Aged; Travel

Topics: Anti-Bacterial Agents; Antimalarials; Artemisinins; Artesunate; Ceftriaxone; Child; Confusion; Drug Therapy, Combination; Emergency Service, Hospital; Exchange Transfusion, Whole Blood; Female; Fever; Ghana; Humans; Malaria, Cerebral; Massachusetts; Parasitemia; Travel; Vancomycin

To describe the practical problems related to urinary tract infection (UTI) management in febrile Vietnamese children.. During a prospective 28-month inclusion period, 143 febrile children with significant bacteriuria were treated for UTI in the nephrology department of Nhi Dong 2 children's hospital in Ho Chi Minh City, Vietnam. Patients were treated after blood and urine samples had been taken for culture, according to a local antibiotic protocol, parenterally with ceftriaxone 75mg/kg/day. Oral treatment with cefixime 8mg/kg/day was started after 48h of apyrexia for 2 weeks. According to local protocol, antibiotic therapy was only changed if children did not respond clinically to treatment regardless of antibiogram results.. Among these 143 children, 51% were girls and 80% of them had their first UTI before the age of 2 years. The commonest causative agent was Escherichia coli (80% of cases) with a high resistance rate to ampicillin (91%) and cotrimoxazole (74%). Extended-spectrum β-lactamase (ESBL) production was observed in 52% of Enterobacteriaceae isolates. According to antibiotic susceptibility, the initial treatment with ceftriaxone was found to be inappropriate in 63% of cases.. E. coli was responsible for 80% of UTIs in Vietnamese children with a high rate of resistance to first-line antibiotics. ESBL production was found to be extremely high in this study. Based on these data, we propose a new empiric treatment schedule for Vietnamese children suspected of UTI.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Escherichia coli Infections; Female; Fever; Humans; Infant; Male; Prospective Studies; Urinary Tract Infections

Topics: Abdominal Pain; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal; Cardiomyopathy, Dilated; Ceftriaxone; Child; Clindamycin; Conjunctivitis; Diagnosis, Differential; Fever; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Infliximab; Jaundice; Male; Methylprednisolone; Mucocutaneous Lymph Node Syndrome; Nafcillin; Shock, Septic; Sodium Chloride; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Combined Modality Therapy; Dental Prophylaxis; Diagnosis, Differential; Fasciotomy; Fever; Humans; Levofloxacin; Male; Mobility Limitation; Mouth; Muscle, Skeletal; Myalgia; Myositis; Rhabdomyolysis; Running; Streptococcus sanguis

Mercury intoxication may present in a wide range of clinical forms from a simple disease to fatal poisoning. This article presents a case of acute mercury poisoning, a rare condition that presents challenges for diagnosis with fever of unknown origin.. A 52-year-old Caucasian woman was admitted to the hospital with high fever, sore throat, a rash over her entire body, itching, nausea, and extensive muscle pain. She had cervical, bilateral axillary and mediastinal lymphadenopathies. We learned that her son and husband had similar symptoms. After excluding infectious pathologies, autoimmune diseases and malignancy were investigated. Multiple organs of our patient were involved and her fever persisted at the fourth week of admission. A repeat medical history elicited that her son had brought mercury home from school and put it on the hot stove, and the family had been exposed to the fumes for a long period of time. Our patient's serum and urine mercury levels were high. She was diagnosed with mercury poisoning and treated accordingly.. Mercury vapor is a colourless and odorless substance. Therefore, patients with various unexplained symptoms and clinical conditions should be questioned about possible exposure to mercury.

Topics: Acute Disease; Anti-Bacterial Agents; Bronchodilator Agents; Ceftriaxone; Chelation Therapy; Clarithromycin; Diagnosis, Differential; Doxycycline; Exanthema; Female; Fever; Fever of Unknown Origin; Humans; Mercury; Mercury Poisoning; Middle Aged; Penicillamine; Treatment Outcome

Topics: Acute Disease; Adrenal Gland Diseases; Adrenal Insufficiency; Anti-Bacterial Agents; Antiphospholipid Syndrome; Ceftriaxone; Exanthema; Fever; Fludrocortisone; Hemorrhage; Heparin; Humans; Hydrocortisone; Lyme Neuroborreliosis; Male; Middle Aged; Radiography; Shock; Thrombocytopenia; Thrombophilia

Enteric fever remains a major health problem in the developing world, including Pakistan. Poor sanitation and hygienic conditions are the major predisposing factors. Salmonella infection with different strains in the same patient has rarely been reported previously. We are reporting two cases of bacteraemia with simultaneous detection of two strains of Salmonella in a single episode of infection. In both the cases, 2 different serotypes of Salmonella were causing bacteraemia leading to fever. In highly endemic area, one must be aware of mixed Salmonella infections as inappropriate diagnosis of such infections may lead to treatment failure.

Topics: Anti-Bacterial Agents; Bacteremia; Cefixime; Ceftriaxone; Child, Preschool; Female; Fever; Humans; Male; Microbial Sensitivity Tests; Salmonella Infections; Salmonella paratyphi A; Salmonella typhi

Mycoplasma pneumonia is responsible for multisystemic infection. Pulmonary symptoms are most common in children. We describe herein two unusual severe forms of M. pneumoniae infection without initial pulmonary symptoms. The first case is an 8-month-old boy who was hospitalized in the pediatric intensive care unit with severe sepsis. There were no initial pulmonary symptoms, nor obvious clinical infection. Initial blood tests and x-ray did not aid the diagnosis. The blood tests came back positive for M. pneumonia. Pulmonary symptoms eventually appeared 24h later, and there was a pneumonia outbreak on the chest radiograph. The boy was given josamycin and improved quickly. The second case concerns an 8-year-old child who was hospitalized in the pediatric intensive care unit with toxic shock. No clinical infectious origin was found. A broad-spectrum antibiotic therapy was started with ceftriaxone and josamycin. The M. pneumoniae blood test came back positive, which confirmed the diagnosis of septic shock in M. pneumoniae, requiring adjustment of the antibiotic therapy. Current guidelines for the choice of probabilistic antibiotic therapy in case of severe sepsis do not include the case of M. pneumoniae. The early initiation of antibiotic therapy plays a major role in the prognosis of these patients. It seems useful to search for M. pneumoniae in cases of severe atypical infections, particularly in the absence of pulmonary symptoms.

Topics: Anti-Bacterial Agents; Ceftriaxone; Erythema; Female; Fever; Humans; Infant; Josamycin; Male; Mycoplasma pneumoniae; Natriuretic Peptide, Brain; Pneumonia, Mycoplasma; Sepsis; Severity of Illness Index; Tachycardia

This is a case report of a patient who presented to the Aga Khan University Hospital with generalized abdominal lymphadenopathy and high-grade fever. Due to ambiguous clinical findings, which were suggestive of either abdominal tuberculosis, or a lymphoma, the patient was started on empirical anti-tuberculous treatment due to the endemicity of tuberculosis in this region. The blood culture reports, however, were reported to grow colonies of Salmonella paratyphi A; thus the diagnosis of the patient was changed to enteric fever, and the patient improved on the subsequently started therapy of ceftriaxone 2,000 mg bid. To the best of our knowledge, this is the first reported case of a patient suffering from enteric fever whose primary clinical findings were abdominal lymphadenopathy and fever.

Topics: Anti-Bacterial Agents; Antitubercular Agents; Ceftriaxone; Diagnosis, Differential; Fever; Humans; Lymphatic Diseases; Male; Microbial Sensitivity Tests; Salmonella Infections; Salmonella paratyphi A; Tuberculosis; Typhoid Fever

Topics: Abscess; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Fever; Humans; Lymphatic Diseases; Male; Thymus Gland

Topics: Acetamides; Adolescent; Anti-Bacterial Agents; Ceftriaxone; Electrodiagnosis; Electromyography; Female; Fever; Humans; Linezolid; Meningococcal Infections; Mononeuropathies; Neisseria meningitidis; Neural Conduction; Neurologic Examination; Oxazolidinones; Pain; Sepsis; Sural Nerve

Topics: Acute Disease; Aged, 80 and over; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Female; Fever; Humans; Leukocyte Count; Male; Meningococcal Infections; Middle Aged; Neisseria meningitidis

Cellulitis is an important cause of hospitalization in pediatrics. Because Staphylococcus aureus is the main pathogen of cellulitis, medicinal therapeutics should take the changing resistance profile of this organism into consideration. The aim of this study was to evaluate the progression and outcomes of children hospitalized for cellulitis and treated with oxacillin or cefalotin. This retrospective cohort study enrolled 218 children, hospitalized between 2001 and 2008 in Salvador, Northeast Brazil. All were diagnosed with cellulitis and treated with oxacillin or cefalotin (≥100 mg/kg/day). The median age was 2 years and 56.9% were males. Frequencies of signs and symptoms used in the clinical diagnoses were as follows: swelling (91.3%), redness (81.7%), warmth (47.2%), and tenderness (31.7%). All patients were discharged due to clinical recovery and the mean length of hospitalization was 7 ± 4 days. None of the patients died, needed intensive care, or had sequelae. By comparing the daily frequency of clinical findings during hospitalization, significant decreases were found in the frequencies of fever (admission day [42.2%], first day [20.8%], second day [12.9%], third day [8.3%], fourth day [6.1%]), toxemia, irritability, somnolence, vomiting, tachycardia, and need for intravenous hydration. In conclusion, oxacillin or cefalotin remain the drugs of choice for treating uncomplicated cellulitis in regions where community-acquired methicillin-resistant S. aureus is infrequent (<10%).

Topics: Adolescent; Anti-Bacterial Agents; Brazil; Ceftriaxone; Cellulitis; Cephalothin; Child; Child, Preschool; Drug Evaluation; Female; Fever; Hospitalization; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Oxacillin; Retrospective Studies; Risk Factors; Staphylococcal Infections; Toxemia; Treatment Outcome

Topics: Anemia; Bartonella bacilliformis; Bartonella Infections; Ceftriaxone; Ciprofloxacin; Fever; Hemolysis; Humans; Male; Middle Aged; Peru; Treatment Outcome

In October 2011, a case of leptospirosis was identified in a Dutch traveller returning from the Dominican Republic to the Netherlands. The 51-year-old man had aspired muddy water in the Chavón river on 29 September. Twenty days later he presented with fever, nausea, vomiting, diarrhoea, arthralgia, headache, conjunctival suffusion and icterus. Leptospira serovar Icterohaemorrhagiae or Australis infection was confirmed ten days later by laboratory testing.

Topics: Agglutination Tests; Anti-Bacterial Agents; Antibodies, Bacterial; Ceftriaxone; Dominican Republic; Doxycycline; Enzyme-Linked Immunosorbent Assay; Fever; Humans; Leptospira interrogans; Leptospirosis; Male; Middle Aged; Netherlands; Severity of Illness Index; Travel; Treatment Outcome

An 83-year-old woman presented to us with a 4-week history of general malaise, subjective fever and lower abdominal pain. Despite the intravenous infusion of antibiotics, her blood results and physical condition worsened, resulting in her sudden death. Autopsy study revealed that the medium-sized veins of the mesentery were infiltrated by eosinophil granulocytes, lymphocytes, macrophages and multinucleated giant cells; however, the arteries were not involved. Microscopically, venous giant cell infiltration was observed in the gastrointestinal tract, bladder, retroperitoneal tissues and myocardium. The final diagnosis was giant cell phlebitis, a rare disease of unknown aetiology. This case demonstrates for the first time that giant cell phlebitis involving extra-abdominal organs, including hearts, can cause serious morbidity.

Topics: Abdominal Pain; Aged, 80 and over; Anti-Bacterial Agents; Autopsy; Ceftriaxone; Death, Sudden; Fatal Outcome; Female; Fever; Fluid Therapy; Giant Cells; Humans; Phlebitis

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Fever; Humans; Leptospirosis; Male; Middle Aged; Muscle Rigidity; Penicillin G; Tachycardia

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

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

Acute generalized exanthematous pustulosis (AGEP) is an uncommon adverse cutaneous reaction, most commonly associated with drugs.. A 38-year-old primigravida whose labor had been induced developed erythema over her chest and abdomen. She was transferred to our department after a failed vacuum extraction, and delivered a mature infant by forceps. On day three postpartum she developed a 40.4 degrees C fever. Although ceftriaxone was administered, her fever persisted (>38 degreesC). On day six of the puerperium, diffuse non-follicular pustules appeared over her neck and trunk, and AGEP was suspected. Two days after ceftriaxone was withdrawn, the eruptions started to resolve without any medical intervention.. Once the diagnosis of AGEP has been made, the antibiotics being administered must be discontinued. If continued treatment is required, pharmacologically distinct antibiotics must be used instead to aid the rapid self-limitation of the disease.

Topics: Acute Generalized Exanthematous Pustulosis; Adult; Anti-Bacterial Agents; Ceftriaxone; Female; Fever; Humans; Labor, Induced; Postpartum Period; Pregnancy

Topics: Adolescent; Anti-Bacterial Agents; Arthralgia; Ceftriaxone; Clindamycin; Diagnosis, Differential; Drainage; Empyema; Fever; Follow-Up Studies; Fusobacterium necrophorum; Humans; Knee Joint; Lemierre Syndrome; Lung; Male; Pharyngitis; Pleural Effusion; Shock, Septic; Tomography, X-Ray Computed; Treatment Outcome

Treatment of children with intravenous ceftriaxone on an ambulatory basis is described. This allows a child to remain at home, but also be reviewed regularly when attending the Emergency Department for antibiotics.. Indications for, and length of, treatment and laboratory parameters were recorded. Also, a survey of children's parents was undertaken to ascertain opinions regarding ambulatory treatment.. 36 patients were treated with ambulatory ceftriaxone over 4 months. Indications included fever without focus, tonsillitis, periorbital cellulitis, urinary tract infection, petechial rash and lymphadenitis. Median duration of treatment was 2.3 days. There was no occult bacteraemia but five positive urine cultures. There was one failure of treatment with subsequent admission for alternative intravenous antibiotics.. Parental opinion favours ambulatory treatment, with 94% of parents acknowledging they would choose it again in similar circumstances. Cost analysis favours ambulatory treatment based on predicted costs of a similar length of inpatient stay.

Topics: Adolescent; Ambulatory Care; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Emergency Medical Services; Female; Fever; Humans; Infant; Injections, Intravenous; Male

Here, we demonstrate a first case of tick-borne encephalitis (TBE) associated with an isolated reversible splenial corpus callosum lesion (IRSL) and highlight the wide range of different clinical entities in which such alterations have been observed. A 42-year-old man showed fever, cephalgia and mild disturbance of coordination and gait. Diagnosis was ascertained by slight CSF-pleiocytosis and positive TBE-IgG as well as by positive intrathekal specific antibody index on follow-up. MRI demonstrated a single ovoid hyperintensity in T2 and DWI with reduction in ADC in the splenium of corpus callosum which was abrogated in follow-up after 6 weeks. Most entities of IRSL presented with excellent prognosis, including our novel case of TBE. We discuss different possible pathomechanisms and the so far unexplained propensity of the splenium for such alterations. Clinicians should be familiar with this phenomenon to avoid unnecessary diagnostic or therapeutic efforts.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Ataxia; Ceftriaxone; Corpus Callosum; Diffusion Magnetic Resonance Imaging; Encephalitis, Tick-Borne; Fever; Gait Disorders, Neurologic; Headache; Humans; Image Processing, Computer-Assisted; Immunoglobulin G; Magnetic Resonance Imaging; Male; Neck Pain

Here we describe a case of viral sepsis beyond the neonatal period caused by human parechovirus subtype 3 (HPeV-3), which manifested as cardio-respiratory failure, hepatitis, and necrotizing enterocolitis (NEC). HPeV-1 and 2 were originally classified as enteroviruses but the advent of sequence analysis led to them being recognized as a new genus in the picornavirus family. Subsequently, nine additional HPeV strains have been reported including HPeV-3 in 1999.(1) The spectrum of disease that these viruses may cause is still unknown, and they are rarely screened for in clinical practice.

Topics: Anti-Bacterial Agents; Blood Coagulation Disorders; Ceftriaxone; Enterocolitis, Necrotizing; Enzyme Inhibitors; Fever; Heart Failure; Hepatitis; Humans; Infant; Male; Parechovirus; Penicillanic Acid; Picornaviridae Infections; Piperacillin; Respiratory Insufficiency; Reverse Transcriptase Polymerase Chain Reaction; RNA, Viral; Sepsis; Sequence Analysis, RNA; Tazobactam

Tularemia is a rare zoonosis. The most common way is ingestion of contaminated meat or water, but the infection may also be acquired by insect bite. The clinical picture of the disease may be nonspecific. Due to polymorphisms of clinical picture, specific treatment is often delayed. In the last 50 years, in Poland, the most infections were acquired by handling hares. In our article, we present the case of a patient who was infected with Francisella tularensis due to arthropod bite. In the presented case, the diagnosis was difficult, because of the nonspecific clinical picture. Information of the epidemiology and the clinical picture changes of tularemia may have great clinical significance. Tularemia requires the special attention of physicians. All patients with lymphadenopathy and arthropod bite history should be screened for tularemia in the outpatient department and, if necessary, treated in hospital.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Arthropod Vectors; Bites and Stings; Ceftriaxone; Fever; Francisella tularensis; Humans; Lymphatic Diseases; Male; Poland; Rifampin; Streptomycin; Treatment Outcome; Tularemia; Zoonoses

To investigate the prevalence of leptospirosis among patients from within and outside Kolkata, India, attending the Calcutta School of Tropical Medicine, for treatment during August 2002 to August 2008.. The leptospirosis cases were determined on the basis of clinical, epidemiological, and biochemical factors, and were tested for leptospiral antibodies using IgM ELISA. Serum samples with absorbance ratio ≥ 1.21 were interpreted as reactive.. The commonest presentation involved fever, headache and jaundice. The male-female ratio was 61:46. A total of 65(64.20%) cases had abnormal liver and renal functions respectively, and 57.1% had both the abnormalities. The highest incidence (75, 35.04%) was recorded in September-October followed by July-August (53, 24.77%). The reactive cases had absorbance ratios between 1.21 and 8.21, and 53 showed equivocal result, while IgM non reactivity were seen in 90 patients (absorbance ratios 0.10-0.90). The patients responded to treatment with parenteral antibiotics, penicillin, ceftriaxone and cefotaxime; follow up did not reveal case fatality.. The cardinal signs of leptospirosis help in making clinical diagnosis, but in any hyper-endemic situation any patient reporting with acute fever and signs of pulmonary, hepatic or renal involvement should be suspected to have leptospirosis and investigated accordingly. Increased awareness, and early diagnosis and treatment, can reduce mortality due to leptospirosis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Cefotaxime; Ceftriaxone; Child; Climate; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Fever; Headache; Humans; Immunoglobulin M; Incidence; India; Infusions, Intravenous; Jaundice; Leptospira; Leptospirosis; Male; Middle Aged; Penicillins; Retrospective Studies; Risk Factors; Young Adult

Septic pylephlebitis or purulent thrombosis of the portal venous system generally results from a progressive extension of suppurated thrombophlebitis, secondary to an intrabdominal infection. Germs most often found are Escherichia coli and Streptococcus, isolation of Enterobacter cloacae is unusual. We report a particular observation of septic pylephlebitis associated with E. cloacae bacteremia, without biliary, digestive or pancreatic lesion on the CT-scan. The antibiotic sensitivity pattern of the isolated germ and the negative epidemiologic investigation pled in favour of community acquired infection. The infection resolved with antibiotics and anticoagulation, followed by total repermeation of the portal system.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Anticoagulants; Bacteremia; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Enoxaparin; Enterobacter cloacae; Enterobacteriaceae Infections; Fever; Gentamicins; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Portal Vein; Tomography, X-Ray Computed; Venous Thrombosis

Topics: Anti-Infective Agents; Aortic Valve; Aortic Valve Insufficiency; Aza Compounds; Blindness; Ceftriaxone; Cough; Echocardiography, Transesophageal; Endophthalmitis; Fever; Fluoroquinolones; Hearing Loss, Sensorineural; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Moxifloxacin; Pneumococcal Infections; Quinolines; Streptococcus pneumoniae; Vancomycin; Vision Disorders

Topics: Adult; Anaplasma ovis; Anaplasmosis; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Bites and Stings; Ceftriaxone; Cilastatin; Cilastatin, Imipenem Drug Combination; Cyprus; DNA, Bacterial; Doxycycline; Drug Combinations; Female; Fever; Genes, Bacterial; Humans; Imipenem; Phylogeny; Ticks

A French foreign legionnaire returning from Djibouti developed feverish polyarthritis with acral purpura. Diagnostic workup demonstrated gonococcemia contracted during unprotected fellatio. Based on this case report, diagnostic and therapeutic management is described.

Topics: Adult; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Diagnosis, Differential; Djibouti; Doxycycline; Drug Therapy, Combination; Exanthema; Fever; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Military Personnel; Neisseria gonorrhoeae; Treatment Outcome; Unsafe Sex

Topics: Aged; Anti-Infective Agents, Local; Ceftriaxone; Erythema; Female; Fever; Humans; Minocycline; Ofloxacin; Povidone-Iodine; Rickettsia Infections; Severity of Illness Index; Treatment Outcome

Topics: Acetaminophen; Analgesics, Non-Narcotic; Ankle Joint; Anti-Bacterial Agents; Arthralgia; Ceftriaxone; Child, Preschool; Diagnosis, Differential; Emergency Nursing; Exanthema; Fever; Fluid Therapy; Humans; Ibuprofen; IgA Vasculitis; Lower Extremity; Male; Sodium Chloride; Triage

Indira Gandhi Medical College, Shimla receives referred patients of pyrexia with multi-organ dysfunction during the monsoon season from all over the state of Himachal Pradesh. Most common etiologies of pyrexia are enteric fever, scrub typhus, malaria, viral, tubercular, and some patients of dengue fever from adjoining states. Leptospirosis has not yet been reported in sub-Himalayan state of Himachal Pradesh, India. We present here a case of leptospirosis presenting as ARDS, proven on IgM Elisa and confirmed by PCR. Leptospirosis is a new etiology in this region for patients presenting with pyrexia and ARDS.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Enzyme-Linked Immunosorbent Assay; Fever; Humans; Incidental Findings; India; Leptospirosis; Male; Oxygen Inhalation Therapy; Polymerase Chain Reaction; Respiratory Distress Syndrome; Treatment Outcome

We describe psoas abscess with concomitant septic hip arthritis in 2 infants, 3 and 7 months old. The common clinical features were a palpable mass in the inguinal region, irritable hip, and delayed treatment. The diagnosis of septic hip was delayed in one child, and they both had residual hip deformity at follow-up. It is possible that initial delay in diagnoses resulted in the concurrent pathologic condition because of spread of infection. These 2 cases demonstrate the first known reports of concurrent psoas abscess and septic hip arthritis in infancy. Magnetic resonance imaging is a valuable method to identify these concurrent pathologic conditions. A proposed etiologic mechanism is also discussed in the article.

Topics: Abscess; Anti-Bacterial Agents; Arthritis, Infectious; Casts, Surgical; Ceftriaxone; Combined Modality Therapy; Delayed Diagnosis; Drainage; Female; Femur; Fever; Hip Joint; Humans; Infant; Joint Deformities, Acquired; Magnetic Resonance Imaging; Male; Psoas Abscess; Shoulder; Staphylococcal Infections; Subcutaneous Tissue

We present a case of pyogenic pubic symphysitis presenting in the third trimester with progressive suprapubic pain, fever and massive vulvar oedema. This case demonstrates a rare, but important cause of sepsis in pregnancy, which, if not recognised and treated promptly, may result in significant morbidity.

Topics: Adult; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Edema; Female; Fever; Gentamicins; Humans; Infant, Newborn; Metronidazole; Pain; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Pubic Symphysis; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vulvar Diseases

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cervical Vertebrae; Epidural Abscess; Fever; HIV Infections; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Neck Pain

Abdominal pain is common feature of Henoch-Schonlein purpura, which may mimic appendicitis, leading to unnecessary laparotomy. Accordingly, the diagnosis must be confirmed by ultrasonography or computed tomography scan before laparotomy is performed. The authors report a case of simultaneous occurrence of Henoch-Schonlein Purpura and gangrenous appendicitis in an 18 year-old boy. The patient was admitted with abdominal pain, cramps, and mild dehydration. He also complained of small reddish purple on his lower limbs, bilateral knee pain, low-grade fever, as well as bloody stools. The symptoms subsided completely. Eight days later, he returned with nonbloody, nonbilious emesis, abdominal cramps, and right lower quadrant abdominal tenderness. Abdominal ultrasound evaluation was performed to rule out an intussusception but demonstrated appendiceal dilatation with a possible appendicolith without any evidence of intussusception. A laparotomy was undertaken, and appendectomy was performed for gangrenous appendicitis. Simultaneous occurrence of Henoch-Schonlein purpura and acute appendicitis is rarely observed. Clinical features of the patients may mislead the clinicians, resulting in delayed diagnosis or misdiagnosis. The use of ultrasonography and computed tomography scan would confirm the diagnosis before surgery.

Topics: Abdominal Pain; Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Arthralgia; Ceftriaxone; Combined Modality Therapy; Diagnosis, Differential; False Negative Reactions; Fever; Gangrene; Gastrointestinal Hemorrhage; Humans; Hydrocortisone; IgA Vasculitis; Intussusception; Male; Metronidazole; Prednisone; Ultrasonography

The brief period of neutropenia and limited nonmarrow toxicity after high-dose melphalan (HDM) provide a rationale for outpatient treatment.. Our experience with HDM (140-200 mg/m(2)) in 90 consecutive transplant episodes was retrospectively reviewed. Most patients were treated in an outpatient setting. Patients without a primary care provider (PCP) were electively admitted before the anticipated onset of neutropenia. Ceftriaxone was added to ciprofloxacin at the onset of neutropenia. All febrile patients were admitted.. The median time from peripheral blood progenitor cell infusion to onset of neutropenia was 5 days (range, 4-6 days), and the mean duration of neutropenia was 5 days (range, 4-7 days). Thirty-eight transplants (42%) were performed entirely in the outpatient setting. The mean duration of hospitalization was 2.2 days in patients not electively admitted. The use of ceftriaxone was associated with a decreased risk for fever (39% vs. 79%) and reduced duration of hospitalization (1.6 days vs. 4.5 days) for nonelectively admitted patients. There was no treatment-related mortality.. Ambulatory therapy with HDM is safe and can be achieved in a general outpatient setting. The predictable time to neutropenia allows even poor candidates for outpatient therapy to be admitted electively on Day +4. The apparent beneficial effect of ceftriaxone needs to be confirmed in randomized trials.

Topics: Adult; Aged; Ambulatory Care; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antineoplastic Agents, Alkylating; Bacteremia; Ceftriaxone; Dose-Response Relationship, Drug; Fever; Hospitalization; Humans; Incidence; Length of Stay; Melphalan; Middle Aged; Multiple Myeloma; Neutropenia; Retrospective Studies; Staphylococcal Infections; Stem Cell Transplantation

Beta-lactam antibiotics are the first practical pharmaceuticals capable of increasing the expression and activity of the glutamate transporter, GLT-1, in the CNS. However, the functional impact of beta-lactam antibiotics on specific drugs which produce their pharmacological effects by increasing glutamatergic transmission is unknown. One such drug is morphine, which causes hyperthermia in rats, mediated by an increase in glutamatergic transmission. Since drugs (e.g. antibiotics) that enhance glutamate uptake also decrease glutamatergic transmission, we tested the hypothesis that ceftriaxone, a beta-lactam antibiotic, would block the glutamate-dependent portion of morphine-evoked hyperthermia.. A body temperature assay was used to determine if ceftriaxone decreased morphine-induced hyperthermia in rats by increasing glutamate uptake.. Body temperatures of rats treated with ceftriaxone (200 mg kg(-1), i.p. x 7 days) did not differ from rats receiving saline. Morphine (1, 4, 8 and 15 mg kg(-1), s.c.) caused significant hyperthermia. Pre-treatment with ceftriaxone, as described above, decreased the hyperthermic response to these doses of morphine. The effects of ceftriaxone were prevented by TBOA (0.2 micromol, i.c.v.), an inhibitor of glutamate transport.. Ceftriaxone attenuated the hyperthermia caused by morphine, an effect prevented by inhibiting glutamate transport. Thus this effect of ceftriaxone was most likely mediated by increased glutamate uptake. These data revealed a functional interaction between ceftriaxone and morphine and indicated that a beta-lactam antibiotic decreased the efficacy of morphine in conscious rats.

Topics: Analgesics, Opioid; Analysis of Variance; Animals; Anti-Bacterial Agents; Aspartic Acid; beta-Lactams; Body Temperature; Ceftriaxone; Dose-Response Relationship, Drug; Excitatory Amino Acid Antagonists; Fever; Glutamic Acid; Injections, Intraperitoneal; Injections, Intraventricular; Injections, Subcutaneous; Male; Morphine; Rats; Rats, Sprague-Dawley; Riluzole; Time Factors

Hepatitis is a rare clinical manifestation of syphilis. In this report a 50 years old male patient who was diagnosed as secondary syphilis presenting with hepatitis has been discussed. The patient was admitted to the hospital with high fever and skin rash, and his history revealed a suspected sexual contact. He indicated that he had been admitted to a health center eight months ago because of the presence of a penile wound, however VDRL (Venereal Disease Research Laboratory) test was negative at that time. Fever (39.5 degrees C), jaundice in skin and sclera, generalized macular and maculopapular skin rash including palms and soles, lymphadenopathy and hepatosplenomegaly were detected in physical examination. Laboratory tests yielded elevated erythrocyte sedimantation rate, high CRP levels and elevated liver enzyme levels, however viral hepatitis markers together with VDRL and TPHA (Treponema pallidum hemagglutination) tests were found negative. Ceftriaxone therapy was initiated because of the presence of high fever (40 degrees C) and 30 leukocyte/mm3 in urine, and the absence of bacteria in Gram staining of urine sample. However, the antibiotic therapy was discontinued since fever persisted. As the clinical signs and symptoms strongly indicated syphilis, the serological tests were repeated and VDRL positivity at 1/8 and TPHA positivity at 1/1280 titers were detected. Ceftriaxone therapy was restarted and continued for 14 days with complete cure. Since the spouse of the patient was also found VDRL and TPHA positive, she was treated with penicilin. The presentation of this case emphasized the importance of repeating the serological tests for syphilis since they might be negative in the early stages of infection. The case also indicates that syphilis should be considered in the differential diagnosis of hepatitis.

Topics: Anti-Bacterial Agents; Cardiolipins; Ceftriaxone; Cholesterol; Diagnosis, Differential; Exanthema; Female; Fever; Hemagglutination Tests; Hepatitis; Hepatomegaly; Humans; Jaundice; Lymphatic Diseases; Male; Middle Aged; Phosphatidylcholines; Splenomegaly; Syphilis; Syphilis Serodiagnosis

Rickettsiae are in many places of the world emerging or reemerging pathogens. The spotted fevers group (SFG) composes a large group of tick- and mite-borne zoonotic infections that are caused by closely related rickettsiae. The SFG rickettsiae of Southeast Asia are yet to be identified. Earlier reports have documented the endemicity of rickettsioses among adults in the Himalayan belt but no confirmed case of spotted fever have been reported from this region of India. We present two cases of SFG rickettsioses; from the northern hilly region of India that were confirmed using specific microimmunofluorescence assay.

Topics: Adolescent; Animals; Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Female; Fever; Humans; Middle Aged; Rickettsia; Rickettsia Infections; Tick-Borne Diseases; Ticks

Topics: Adolescent; Anti-Infective Agents; Bone Marrow; Ceftriaxone; Ciprofloxacin; Female; Fever; Humans; Lymphohistiocytosis, Hemophagocytic; Macrophage Activation; Male; Middle Aged; Risk Factors; Salmonella Infections; Salmonella typhi

We report a case in a 50-year-old male who had been treated with ceftriaxone for 3 weeks to treat meningitis. He was admitted 4 days after cessation of the ceftriaxone treatment with fever, headache, nausea, vomiting, myalgia, arthralgia, pruriginous skin rashes, and with edema on face. Blood tests showed marked eosinophilia and atypic lymphocytosis. He was successfully treated with prednisone p.o. We report this case as we could not recognize a case like this which was induced by ceftriaxone.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Eruptions; Drug Hypersensitivity; Eosinophilia; Fever; Humans; Lymphocytosis; Male; Middle Aged; Prednisone

In 2003, the reported gonorrhea rate among women was 118.8 per 100,000 women. Most gonococcal infections in pregnant women are asymptomatic or produce a mildly symptomatic genital infection. Disseminated infections can occur when gonococcal bacteremia produces extragenital symptoms, most commonly arthritis.. A patient presented in the third trimester of pregnancy with fever, body aches, neck soreness, and skin lesions. There was no arthritis. Cultures performed during evaluation confirmed extragenital Neisseria gonorrhoeae.. A high index of suspicion is necessary to diagnose disseminated gonococcal infection and prevent disease sequelae.

Topics: Adult; Bacteremia; Ceftriaxone; Dermatitis; Female; Fever; Gonorrhea; Humans; Meningitis, Bacterial; Neisseria gonorrhoeae; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome

Topics: Adult; Anesthesia, Spinal; Anti-Bacterial Agents; Anti-Infective Agents; Brain; Ceftriaxone; Cesarean Section; Craniotomy; Empyema, Subdural; Female; Fever; Headache; Humans; Metronidazole; Postoperative Complications; Tomography, X-Ray Computed; Vancomycin

The present study was planned to investigate the pharmacokinetics of ceftriaxone in experimentally induced febrile buffalo calves (n=5). The fever was induced by intravenous injection of E.coli lipopolysaccaride (1 microgram/kg). To study the pharmacokinetics, ceftriaxone was administered at the dose rate of 10 mg/kg body wt. in all animals. At 1 min, the peak concentration of ceftriaxone was 79.4+/-2.37 microgram/ml and the drug was detected up to 6 h. The elimination rate constant was 0.35+/-0.02 /h and elimination half-life was 2.04+/-0.14 h. The apparent volume of distribution (Vd(area)) and total body clearance (Cl(B)) were 1.21+/-0.15 l/kg and 0.41+/-0.03 l/kg/h, respectively. To maintain a minimum therapeutic concentration of 1 microgram/kg, a satisfactory dosage regimen of cefriaxone in febrile buffalo calves is 19 mg/kg followed by 18 mg/kg at 8 h intervals.

Topics: Animals; Anti-Bacterial Agents; Area Under Curve; Buffaloes; Ceftriaxone; Drug Administration Schedule; Fever; Half-Life; Lipopolysaccharides; Male; Metabolic Clearance Rate

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

A previously well 30-year-old man presented with severe progressive back pain, joint pain and fever. Magnetic resonance imaging confirmed an epidural abscess. A sexual history revealed both risk factors for and previous symptoms of a sexually acquired infection. Neisseria gonorrhoeae was isolated from a rectal swab and from a wrist aspirate, consistent with disseminated gonococcal infection. The epidural abscess resolved clinically and radiologically after treatment for N. gonorrhoeae with ceftriaxone.

Topics: Adult; Anti-Bacterial Agents; Arthralgia; Back Pain; Ceftriaxone; Epidural Abscess; Fever; Gonorrhea; Humans; Male; Medical History Taking; Neisseria gonorrhoeae; Treatment Outcome

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

Topics: Abdomen; Aged; Amoxicillin; Anti-Bacterial Agents; Aortitis; Ceftriaxone; Fever; Humans; Male; Pain; Salmonella Infections; Thailand

This study reviewed the clinical outcomes of patients with an aortic aneurysm infected with Salmonella treated by a single centre over 6 years.. Data were collected by a retrospective case-note review.. Between September 1995 and December 2001, 121 patients with non-typhoid Salmonella bacteraemia were treated, of whom 24 patients had an aortic aneurysm infected with Salmonella. Ten had a suprarenal and 14 an infrarenal aortic infection. The most common responsible pathogen was group C Salmonella (12 patients). All of the 20 patients who had combined medical and surgical therapy survived, whereas two of four who had medical therapy alone died. There were two late deaths during a mean follow-up of 23 (range 3-63) months.. The incidence of aortic infection in patients with non-typhoid Salmonella bacteraemia was high in Taiwan. Timely surgical intervention and prolonged intravenous antibiotic therapy resulted in excellent outcomes.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Ambulatory Care; Aneurysm, Infected; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Bacteremia; Ceftriaxone; Cephalosporins; Combined Modality Therapy; Drug Therapy, Combination; Female; Fever; Follow-Up Studies; Hospitalization; Humans; Male; Middle Aged; Retrospective Studies; Salmonella Infections

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Back; Borrelia burgdorferi; Ceftriaxone; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Erythema Chronicum Migrans; Fever; Humans; Infusions, Intravenous; Male; Occupational Diseases

To evaluate the patterns of ceftriaxone use in an urban pediatric emergency department (PED) and to determine if overuse exists based on published guidelines for management of febrile infants.. We conducted a retrospective study of 229 young febrile patients who received ceftriaxone between January 1 and March 31, 1995, in a large urban PED in a teaching hospital in Atlanta. Patients younger than 3 months, patients with chronic illnesses (eg, sickle cell anemia, HIV), and those who received ceftriaxone for sexually transmitted diseases were excluded.. During the study period, ceftriaxone was administered 289 times to 229 patients (53% male) aged 3 months to 18 years. Sixty patients (26%) received ceftriaxone two or more times for the same illness. Data were stratified based on age, source of fever, temperature, leukocyte count, diagnosis of pneumonia, and visit order (initial or follow-up). At the time of their initial visit, 180 of 229 patients had an identifiable focus of infection (76 had pneumonia), but no source could be identified in the remaining 49. Based on temperature, leukocyte count, and the presence or absence of a focus, ceftriaxone use, as compared with practice guidelines, was justified in 40 of 229 (17.5%) patients, questionable in 43 of 229 (18.8%), and not justified in 146 of 229 (63.7%). For the 60 patients who received ceftriaxone more than once, its use was justified in only 13%. Results of blood cultures were positive in 3 of 229 (1.3%) patients. Ceftriaxone was justified according to published guidelines in two of these three patients, whereas one patient with pneumonia and pneumococcal bacteremia could have been treated with oral antibiotics. Overall, for the entire study population (289 encounters at initial and subsequent visit combined), ceftriaxone use was justified in 48 patients (16.6%), questionable in 49 patients (17%), and not justified in 192 patients (66.4%).. Based on published guidelines, ceftriaxone use in the PED was not justified in the majority of cases.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Drug Utilization Review; Emergency Service, Hospital; Female; Fever; Guideline Adherence; Hospitals, Urban; Humans; Infant; Leukocyte Count; Male; Patient Care Management; Pediatrics; Practice Patterns, Physicians'; Retrospective Studies

Topics: Ceftriaxone; Cephalosporins; Child; Exanthema; Fever; Humans; Male; Meningococcal Infections; Neisseria meningitidis; Time Factors; Treatment Outcome

Topics: Abdominal Pain; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Child; Female; Fever; Humans; Penicillins; Pneumonia; Radiography

Evidence shows that the rapid detection of influenza using an enzyme-linked immunosorbent assay decreases antibiotic use in the treatment of pediatric patients. To our knowledge, the effect on other diagnostic testing in an emergency department (ED) has not been examined.. To determine the effect of rapid diagnosis of influenza virus type A on the clinical management of febrile infants and toddlers in a pediatric ED at an urban children's hospital.. A retrospective review of ED records from an electronic database was performed. All children 2 to 24 months of age, with a temperature higher than 39 degrees C who had a positive influenza virus type A test result using an enzyme-linked immunosorbent assay from November 1, 1998, through April 30, 2000 (n = 72), were included in this study. Two groups were compared-those who had positive test results reported before discharge from the ED (early diagnosis) and those who had positive test results after discharge (late diagnosis).. Forty-seven patients (65%) were in the early diagnosis group and 25 (35%) in the late diagnosis group. The groups were similar for age, temperature, and triage category. Fewer patients in the early diagnosis group received ceftriaxone sodium compared with those in the late diagnosis group (2% vs 24%, P =.006); there were fewer urinalyses (2% vs 24%, P =.006) and complete blood cell counts performed (17% vs 44%, P =.02).. Rapid confirmation of influenza virus type A infection seems to decrease ancillary tests and antibiotic use in febrile infants and toddlers in the ED. A prospective study with a larger group is needed to confirm these findings.

Topics: Ceftriaxone; Cephalosporins; Child, Preschool; Drug Utilization; Emergency Service, Hospital; Enzyme-Linked Immunosorbent Assay; Fever; Health Services Research; Hospitals, Pediatric; Hospitals, Urban; Humans; Infant; Influenza A virus; Influenza, Human; Pediatrics; Practice Patterns, Physicians'; Retrospective Studies; Sensitivity and Specificity; Time Factors

Topics: Adult; Anti-Inflammatory Agents; Case Management; Ceftriaxone; Cephalosporins; Deafness; Dexamethasone; Drug Combinations; Exanthema; Fever; Humans; Injections, Intravenous; Male; Meningitis, Meningococcal; Military Personnel; Muscle Rigidity; Neisseria meningitidis

Topics: Anti-Infective Agents; Ceftriaxone; Cephalosporins; Child; Ciprofloxacin; Fever; Humans; Neoplasms; Neutropenia; Risk Factors

We present a case of endocarditis caused by Salmonella in a patient with newly diagnosed diabetes and preexisting rheumatic heart disease. Despite sterilization of the blood with a fluoroquinolone and a third-generation cephalosporin, the patient required surgical intervention.

Topics: Aged; Anti-Infective Agents; Cardiac Catheterization; Ceftriaxone; Cephalosporins; Combined Modality Therapy; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Fatal Outcome; Fever; Headache; Heart Valve Prosthesis Implantation; Humans; Male; Nausea; Ofloxacin; Rheumatic Heart Disease; Salmonella Infections; Vomiting

To determine if a second intramuscular injection of ceftriaxone was necessary in febrile infants who meet low-risk criteria for outpatient therapy.. Children's Hospital Emergency Department.. Febrile infants 4-8 weeks of age.. Outpatient treatment criteria included non-toxic appearance, no identifiable source for infection on physical examination, CSF WBC > or = 10/mm3, peripheral WBC < or = 15,000/mm3, normal UA, and normal chest radiograph study, if obtained. Additional requirements included a reliable caretaker and re-evaluation in 24 hours. Infants who met these criteria received intramuscular ceftriaxone 50 mg/kg with instructions to follow-up in 24 hours. At the follow-up visit, infants with no identifiable source for infection and negative cultures received a second dose of intramuscular ceftriaxone and were discharged. Cultures were read at 48 hours and at the conclusion of the study. Medical records were reviewed to identify delayed complications.. 172 infants were enrolled. The mean age was 45 days. All CBC, UA, CSF analyses were normal. Chest radiographs were obtained in 56 (30%) infants; all were normal. One (.05%) patient was admitted at the follow-up visit. The mean time to follow-up was 25 hours. Two positive cultures were identified at the re-evaluation visit; one blood culture grew Salmonella and a urine culture grew E. coli. The CSF cultures were all negative at follow-up and remained negative.. Febrile infants 4-8 weeks of age who meet outpatient therapy criteria and have negative cultures and no identifiable source for infection at 24 hours may not require the second dose of intramuscular ceftriaxone.

Topics: Ambulatory Care; Ceftriaxone; Cephalosporins; Drug Administration Schedule; Fever; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Patient Care Management; Prospective Studies

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

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

To evaluate the pharmacokinetics of once daily (OD) gentamicin and its effectiveness as part of an OD regimen for the empirical treatment of febrile neutropenia in children with cancer.. 59 children aged 6 months to 16 years (mean (SD) 5.7 (4) years) with febrile neutropenia (neutrophil count < 0.5 x 10(9)/l) after chemotherapy.. Over one year, 113 febrile neutropenic episodes were treated empirically with an OD antibiotic regimen of ceftriaxone (80 mg/kg; maximum 4 g) and gentamicin (7 mg/kg; infused over 60 minutes, no maximum). The patients were assessed after 48 hours.. 86 of the 113 episodes settled with the first line antibiotic regimen. In 29 episodes, blood cultures identified a causative bacterial pathogen; for 17 of these, the first line antibiotic regimen was adequate; in four episodes, although the episode settled, ceftriaxone was replaced by a more appropriate antibiotic and OD gentamicin was continued; in the remaining eight episodes, a glycopeptide antibiotic was deemed necessary. There was no failure of treatment in organisms sensitive to gentamicin, including Pseudomonas aeruginosa. In 27 episodes (24%), resolution was obtained by the empirical introduction of a second line regimen of ceftazidime and a glycopeptide antibiotic, and/or amphotericin. Gentamicin concentrations were measured in 110 episodes and they were all below the 24 hour line indicating that there was no need to change the dosing interval. In two episodes (2%), serum creatinine rose transiently by more than 50% of the baseline concentration. Although there was no vestibular toxicity, three of 30 children who underwent pure tone audiometry reported high frequency hearing loss in one ear.. OD gentamicin can be used safely and effectively to treat febrile neutropenia in children with cancer. When used for a short period (< 5 days), in children not receiving other nephrotoxic drugs and who have normal serum creatinine, serum gentamicin estimations are unnecessary.

Topics: Adolescent; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever; Gentamicins; Humans; Infant; Male; Neoplasms; Neutropenia; Prospective Studies

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

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

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

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

Topics: Adult; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Dysentery, Amebic; Female; Fever; Humans; Liver Abscess, Amebic; Metronidazole; Travel; Ultrasonography

A protocol for management of young febrile children at risk for bacteraemia has been used at Westmead Hospital, a university based hospital in the western Sydney region, since early 1994. Implementation of the protocol was retrospectively evaluated for the 12 month period 1 June 1994 to 31 May 1995, using the emergency department log book as the primary data source. Altogether 498 children, aged from 3 months to 3 years, with a fever > or = 39.5 degrees C were identified over this period, of whom 291 were admitted to hospital because of evidence of sepsis or identified focal infection and 207 children without focal infection were observed in the short stay annexe of the emergency department. Fifty children, considered at high risk of bacteraemia because of a total white cell count > or = 20 x 10(9)/1 received empiric antibiotic treatment with ceftriaxone, of whom 19 subsequently had proved bacteraemia and another 10 had focal infection identified during observation in the short stay annexe. Bacteraemia was due to Streptococcus pneumoniae in 16 cases and Haemophilus influenzae type b in three. No adverse events occurred at follow up. Use of a management protocol and selection on higher white cell count criterion than previously recommended by US centres resulted in restriction of empiric antibiotic treatment to a small proportion of young febrile children presenting to a busy emergency department of whom 38% were bacteraemic.

Topics: Bacteremia; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Clinical Protocols; Emergency Service, Hospital; Evaluation Studies as Topic; Fever; Humans; Infant; Infant, Newborn; Leukocyte Count; Retrospective Studies

Topics: Ceftriaxone; Cephalosporins; Fever; Humans; Infections; Neutropenia; Risk Factors; Time Factors

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

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

Topics: Adolescent; Ceftriaxone; Conjunctivitis; Doxycycline; Drug Therapy, Combination; Fever; Follow-Up Studies; Francisella tularensis; Humans; Insect Bites and Stings; Lymphadenitis; Male; Tularemia

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

A 58-year-old woman developed neurologic and neuroophthalmologic manifestations of Lyme disease, including a radiculomyelitis, cranial neuritis and mild right optic neuropathy. Upon treatment with intravenous ceftriaxone a Jarisch-Herxheimer reaction occurred with encephalopathy, mild fever, worsening radiculomyelitis, and deterioration of her visual acuity. Intravenous methylprednisolone was given, and the visual acuity recovered over 72 hours. This case suggests that transient worsening of optic neuropathy can develop as a sequela of the Jarisch-Herxheimer reaction in the treatment of Lyme disease.

Topics: Ceftriaxone; Encephalomyelitis; Female; Fever; Humans; Lyme Disease; Methylprednisolone; Middle Aged; Optic Nerve Diseases; Radiculopathy; Visual Acuity

Topics: Ceftriaxone; Child; Cholelithiasis; Fever; Hiccup; Humans; Male

We conducted a prospective nonrandomized study of outpatient therapy with ceftriaxone as a single agent in 50 episodes of fever and neutropenia in children treated with various myelosuppressive regimens for different malignancies. All patients underwent clinical and radiological evaluation and blood/urine cultures taken before starting therapy. Patients with dehydration, hypotension, rigor and clinical exit-site infection of indwelling right-sided catheters were excluded. Forty-one patients completed an antibiotic course of 7 days: in 12 patients fever returned to normal on day 2, in 10 patients on day 3, and in 8 patients on day 4. The duration of neutropenia following the initial febrile episode was 3-10 days. In some patients fever returned to normal after 2 days, but neutropenia persisted up to 10 days. Two patients were bacteremic--Escherichia coli in one, and Acinetobacter/Staphylococcus coagulase negative in another; all isolates were sensitive to ceftriaxone. In nine episodes, antimicrobial therapy was modified because of persistent fever > 39 degrees C in five patients, bacteremia in two, enterocolitis in one, breakthrough fever in two, and bronchopneumonia in one. The low incidence of bacterial isolation is probably attributed to the selection of patients with low risk features. Patients and parents complied with and favored outpatient therapy to hospitalization.

Topics: Ambulatory Care; Ceftriaxone; Child; Fever; Humans; Immunosuppressive Agents; Neutropenia; Prospective Studies

Topics: Ambulatory Care; Bacteremia; Ceftriaxone; Fever; Humans; Infant; Meningitis

Topics: Amoxicillin; Bacteremia; Ceftriaxone; Child, Preschool; Fever; Humans; Meningitis, Bacterial

Antibiotic monotherapy is increasingly an option for the initial empiric treatment of febrile neutropenic cancer patients. We noted in a previous study that response to empiric therapy was related more to disease classification (solid tumors vs. leukemia) than to the regimen chosen. In the present study we based empiric monotherapy on the underlying disease in treating 240 episodes of fever and neutropenia in 145 children. Patients with leukemia or Stage III/IV non-Hodgkin's lymphoma (higher risk group) were treated with imipenem-cilastatin, whereas those with solid tumors or Stage I/II non-Hodgkin's lymphoma (lower risk group) received ceftriaxone. The regimens were modified in 15% of lower risk and 45% of higher risk episodes. Overall successful outcomes were obtained in 93.2% of the higher risk (n = 119) and 97.5% of the lower risk (n = 121) episodes. The two groups differed significantly in duration of neutropenia, frequency of positive blood cultures and superinfection and the need for modification of the monotherapy (P < 0.05). Empiric monotherapy based on primary disease appears to be safe and effective for febrile neutropenic children with cancer at our Brazilian institution. Further studies will be needed before these findings can be generalized to patient populations in other settings.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Female; Fever; Humans; Imipenem; Infant; Leukemia; Lymphoma, Non-Hodgkin; Male; Neoplasms; Neutropenia

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

A nine year old boy who had received Ceftriaxone for one week because of suspected bacterial meningoencephalitis developed colicky abdominal pain in the right upper quadrant two days after termination of Ceftriaxone treatment. Stones in the gallbladder were identified as cause of the abdominal symptoms. Ceftriaxone has been reported to result in so-called pseudo-lithiasis of the gallbladder in approximatively 45% of treated patients, 19% of which developed clinical symptoms. Generally, the gallstones dissolve spontaneously when Ceftriaxone treatment was of short duration.

Topics: Ceftriaxone; Child; Cholelithiasis; Colic; Fever; Headache; Humans; Male; Meningoencephalitis; Ultrasonography

Once-a-day ceftriaxone and amikacin was administered in case of fever to 46 neutropenic patients attending day hospital for hematologic malignancies. All patients were admitted to a short-term ward for infective complications, but were discharged in the event of prompt disappearance of fever and of clinical signs of infection continuing their therapy either by daily reporting to the hospital, or at home. Response to the initial empiric therapy was obtained in 37 cases (76%). Twenty-four patients who promptly responded to therapy completed their treatment on an outpatient basis, their mean number of days of hospitalization being reduced to 4.6 versus a mean of 9.6 days in the overall patient population being considered. Since the outpatient treatment accounted for 21% of the antibiotic therapy administered, the above treatment may result in cost containment and better quality of life for patients, provided that these data are confirmed by prospective randomized studies.

Topics: Adolescent; Adult; Aged; Amikacin; Antineoplastic Combined Chemotherapy Protocols; Ceftriaxone; Day Care, Medical; Drug Therapy, Combination; Female; Fever; Hematologic Diseases; Humans; Male; Middle Aged; Neoplasms; Neutropenia; Opportunistic Infections; Pilot Projects

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

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

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

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

Topics: Ambulatory Care; Ceftriaxone; Fever; Hospitalization; Humans; Infant

A new management approach to selected febrile infants 4 to 8 weeks old evaluated for possible sepsis is outpatient ceftriaxone therapy, with subsequent re-evaluation 24 to 48 hours after presentation. This study assessed whether the temperature profile of such infants during the 24- to 48-hour period after treatment distinguished those with from those without serious bacterial infections (SBIs).. Prospective, descriptive clinical study.. One hundred sixty-one febrile infants 4 to 8 weeks old.. An urban pediatric emergency department and hospital.. All infants underwent a sepsis evaluation (lumbar puncture, CBC/blood culture, and urinalysis/urine culture) and were hospitalized for at least 48 hours. Temperatures were measured on presentation and then every four hours during hospitalization. All infants received parenteral third-generation cephalosporin antibiotic therapy, and none received antipyretic medication unless fever was documented. Fever (rectal temperature of more than 38.0 C) was documented during the 24- to 48-hour period after presentation in 28 infants (17.6%)--one of a total of 18 infants (5.6%) with SBI and 27 of a total of 143 infants (19%) without SBI (alpha, more than .2: power .30). All bacterial isolates in cases of SBI were susceptible to third-generation cephalosporin antibiotics. All repeat blood and urine cultures that were performed in infants with bacteremia or urinary tract infections, respectively, were negative 24 hours after presentation.. Infants 4 to 8 weeks old who remain febrile during the 24 to 48-hour period after presentation and initiation of parenteral antibiotic therapy are less likely to have SBI. This study did not have sufficient power for this difference to be statistically significant.

Topics: Body Temperature; Ceftriaxone; Emergency Service, Hospital; Fever; Hospitalization; Hospitals, Pediatric; Hospitals, Urban; Humans; Infant; Infant, Newborn; Prospective Studies; Sepsis

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

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

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

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