ro13-9904 and Haemophilus-Infections

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

We report 2 cases of Haemophilus parainfluenzae endocarditis and review 34 cases of HACEK endocarditis from the literature. HACEK organisms are the most common cause of Gram-negative endocarditis in children. They have a propensity to form friable vegetations (especially H. parainfluenzae) that break off and cause symptomatic emboli. HACEK endocarditis (from a review of the 36 published cases) may involve previously normal hearts (33%), may be complicated by embolization (31%) and may require vegetectomy or other surgery (31%). Mortality with HACEK endocarditis was 14%. HACEK organisms may be resistant to penicillins but are susceptible to third generation cephalosporins.

Topics: Ceftriaxone; Child; Endocarditis, Bacterial; Female; Follow-Up Studies; Haemophilus; Haemophilus Infections; Humans; Infant; Risk Assessment; Severity of Illness Index; Survival Rate; Treatment Outcome

Osteomyelitis of the frontal bone may be associated with a purulent collection under the periosteum, causing swelling and edema over the forehead, a condition known as Pott's puffy tumor. We describe an 83-year-old man with a Pott's puffy tumor due to Haemophilus influenzae that was successfully treated with surgery and antibiotics. A review of 22 cases of Pott's puffy tumor shows that this condition usually occurs in children, is spread from frontal or ethmoid sinusitis, and is usually due to streptococci, staphylococci, or anaerobes. Suppurative complications such as epidural, subdural, and intracerebral abscesses are common. Only seven cases of Pott's puffy tumor in adults have been reported, and only one of these cases was caused by H. influenzae. Surgical drainage and antibiotic therapy remain standard therapy for this condition.

Topics: Aged; Aged, 80 and over; Cefprozil; Ceftriaxone; Cephalosporins; Follow-Up Studies; Frontal Bone; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Osteomyelitis; Radiography; Tomography Scanners, X-Ray Computed

A case of septic arthritis due to Haemophilus aphrophilus is presented. This organism has rarely been reported as a cause of bone or joint infections. We believe this is the third reported case of septic arthritis caused by this microorganism. We review the clinical and bacteriologic findings and the previously reported cases of infection caused by H. aphrophilus. Treatment with ceftriaxone was followed by full recovery without sequelae.

Topics: Arthritis, Infectious; Ceftriaxone; Haemophilus; Haemophilus Infections; Humans; Infusions, Intravenous; Knee Joint; Male; Middle Aged; Synovial Fluid

Endophthalmitis due to gram-negative bacilli has been associated with a high degree of vision loss. We report three cases due to the nonenteric gram-negative bacilli Moraxella nonliquefaciens, Haemophilus paraphrophilus, and multidrug-resistant Haemophilus influenzae. The features of these cases are compared with those of other reported cases of endophthalmitis due to unusual nonenteric gram-negative bacilli. Fifty-eight percent of patients had no vision in the affected eye after treatment. Early surgical intervention with vitrectomy and intravitreous antibiotics in addition to parenteral antibiotics should be included in the treatment of endophthalmitis due to gram-negative bacilli.

Topics: Actinobacillus Infections; Adult; Aged; Aggregatibacter actinomycetemcomitans; Ampicillin; Ceftriaxone; Endophthalmitis; Female; Gentamicins; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Moraxella; Neisseriaceae Infections; Postoperative Complications; Vitrectomy

The minimum inhibitory concentration (MIC) of five antibiotics and the presence of resistance genes was determined in 163 Haemophilus influenzae isolates collected over 13 years (1987-2000) in four two-yearly sampling periods from patients with respiratory tract infections. The prevalence of beta-lactamase-negative ampicillin-susceptible strains was approximately 80% over the sampling period although fewer strains (65.9%) were recovered in the period 1995-1997. TEM-1 type beta-lactamase-producing strains were less frequent starting at 15.6% and declining to 2.2% in the final sampling period. Low-beta-lactamase-negative ampicillin-resistant (BLNAR) strains were uncommon in 1987-1989 (2.2%), peaked to 19.5% in 1995-1997, but fell back to 11.1% by 2000. Fully BLNAR strains were not detected until the last sampling period (6.7%). The MICs of ampicillin, levofloxacin, cefditoren and ceftriaxone remained stable but there was an eight-fold increase in the MIC of cefdinir over the sampling period. Pulsed-field gel electrophoresis of DNA digests showed that three representative BLNAR strains were genetically distinct and 11 DNA profiles were identified among 17 low-BLNAR strains. These data suggest that the number of genetically altered BLNAR and low-BLNAR strains are increasing in Japan.

Topics: Ampicillin; Anti-Bacterial Agents; beta-Lactam Resistance; Ceftriaxone; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Japan; Levofloxacin; Male; Microbial Sensitivity Tests; Ofloxacin; Respiratory Tract Infections

The suitability of ceftriaxone for penicillin-resistant Streptococcus pneumoniae (PRSP) and ampicillin-resistant Haemophilus influenzae (especially beta-lactamase-negative ampicillin-resistant (BLNAR) H. influenzae) and the relationship between in vitro antimicrobial activities and pharmacokinetic parameters were evaluated. The values for percentage of time above the MIC (%T>MIC) for ceftriaxone, cefotiam, flomoxef, sulbactam/cefoperazone, sulbactam/ampicillin, and meropenem, using 400 S. pneumoniae isolates and 430 H. influenzae isolates from patients with community-acquired pneumonia (CAP) from more than 100 geographically diverse medical centers during January to July of 2005, were calculated by measuring the MIC for each isolate and by using patameters of pharmacokinetics. A broth microdilution method was used to determine the MIC, using the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Meropenem showed the lowest MIC against penicillin-susceptible S. pneumoniae, followed by sulbactam/cefoperazone and ceftriaxone. Ceftriaxone had the best activity against penicillin-resistant S. pneumoniae and beta-lactamase-negative and beta-lactamase-producing ampicillin-resistant H. influenzae. Ceftriaxone was unique, showing a long elimination half-life and low MIC values where its serum level duration time was above the MIC for longer than other cephalosporins. Accordingly, the %T>MIC of ceftriaxone for a once-daily administration greatly exceeded the efficacy levels of those for the other antibacterial agents tested. Ceftriaxone has an excellent balance between in vitro antimicrobial activities and pharmacokinetic profiles; and therefore remains effective as a therapeutic agent against PRSP and BLNAR H. influenzae in CAP.

Topics: Ampicillin Resistance; Anti-Bacterial Agents; beta-Lactamases; Ceftriaxone; Community-Acquired Infections; Drug Resistance, Bacterial; Haemophilus Infections; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Streptococcus pneumoniae

Over the last decade or so there has been a growing interest in routes of antimicrobial administration other than by the conventional intravenous route for institutionalized patients and for some outpatients. Both oral (PO) and intramuscular (IM) routes of administration are less costly than giving antimicrobial agents by vein (IV). In addition, fewer complications such as catheter-related sepsis and phlebitis are associated with non-IV routes of administration. Furthermore, a reduced-dosage, reduced-volume IM administration of ceftriaxone may provide a tolerable route of administration and equivalent bactericidal activities compared with higher dose IV ceftriaxone. The purpose of this study was to determine the time that the drug concentration remained in excess of the minimum inhibitory concentration (MIC) (T > MIC) and the duration of bactericidal activities of ceftriaxone one gram administered IV, ceftriaxone 250 mg given IM and cefixime 400 mg given orally against clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in adult volunteers. Single doses of each agent were administered and serum concentrations were collected over the standard dosing period of 24 h for all study regimens. Ceftriaxone, regardless of route of administration and dose, resulted in bactericidal activities and T > MIC for 100% of the dosing period for S. pneumoniae, H. influenzae, and M. catarrhalis. Cefixime maintained at least 50% T > MIC and bactericidal activity against both isolates each of H. influenzae and M. catarrhalis. Against both isolates of S. pneumoniae, cefixime achieved T > MIC for at least 50% of the dosing period, but did not maintain bactericidal activity. Reduced dose ceftriaxone given IM seems to be a viable alternative to ceftriaxone IV if the pathogen, susceptibility and infection site are known. Based on T > MIC exceeding 50% of the dosing interval, cefixime would be considered an effective alternative to IV therapy against common respiratory tract pathogens. Clinical studies need to be conducted to confirm these findings.

Topics: Administration, Oral; Adult; Blood Bactericidal Activity; Cefixime; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Cross-Over Studies; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Moraxella catarrhalis; Neisseriaceae Infections; Pneumococcal Infections; Respiratory Tract Infections; Streptococcus pneumoniae

Clinical studies of ceftriaxone (CTRX) were performed at a dose of 40 mg/kg once daily to evaluate its pharmacokinetics, and clinical and bacteriological efficacies in pediatric patients with respiratory tract infections. The following results were obtained. 1. Of 45 patients, clinical responses to CTRX were excellent in 34 (75.6%), good in 9 (20.0%) and poor in 2 (4.4%), indicating the overall efficacy rate of 95.6%. 2. Haemophilus influenzae (23 strains), Streptococcus pneumoniae (20 strains) and Moraxella catarrhalis (17 strains) were isolated from the patients as the main causative organisms. MIC90 of CTRX against these detected bacteria was < or = 0.06 microgram/ml with H. influenzae [beta-lactamase (-)/ABPC (S)], 0.25 microgram/ml with H. influenzae (BLNAR), 0.05 microgram/ml with PSSP, 1.0 microgram/ml with PISP/PRSP and 2.0 micrograms/ml with M. catarrhalis, respectively. 3. The eradication rate of causative organisms was 90.0% (27/30). 4. Serum levels of CTRX after administration of a 1-hour intravenous drip infusion of 40 mg/kg were investigated in 12 patients. Mean serum level at 24 hours after the administration was 9.4 +/- 2.8 micrograms/ml, which covered the level of MIC90 throughout the 24 hours. 5. No adverse reactions related to CTRX were observed. As the approved dosage of CTRX in pediatric patients is twice daily, while it is once daily in adults, there have been few reports on the efficacy of once-daily CTRX in pediatrics. According to the results of the study, it is suggested that once-daily CTRX for the pediatric patients with respiratory tract infections is useful. Further studies might be required to establish outpatient parenteral antibiotic therapy (OPAT) in pediatric infections.

Topics: Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Administration Schedule; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infusions, Intravenous; Male; Moraxella catarrhalis; Neisseriaceae Infections; Respiratory Tract Infections

Clinical and bacteriological evaluation was performed as follows on ceftriaxone (CTRX) at a dose of 50 mg/kg once daily to pediatric patients with community-acquired pneumonia. Of 48 subject patients, CTRX was markedly effective in 36 (75.0%), effective in 9 (18.7%), slightly effective in 2 (4.2%), and failure in 1 (2.1%), indicating the overall effective rate of 93.7%. In 47 (97.9%) patients with the exception of 1, it was observed during the period of administration that fever was resolved and clinical symptoms as well as radiographically abnormal shadows were found relieved or improved. Patients infected by an isolated strain accounted for 34 (70.8%), while those by multiple strains 14 (29.2%), indicating that either Streptococcus pneumoniae or Haemophilus influenzae, or both were detected in almost all patients (45 cases). Of the 48 patients, bacteriological effect was eliminated in 44 (91.7%), and replacement of the bacteria in the remaining 4 (8.3%). MIC90 of CTRX against detected bacteria was 0.2 microgram/ml with H. influenzae, < or = 0.025 microgram/ml with PSSP, 0.1 microgram/ml with PISP, and 0.39 microgram/ml with PRSP. Blood concentration of CTRX at 50 mg/kg upon completion of 1-hour drip intravenous infusion was 89.7 +/- 25.2 micrograms/ml, and 6.6 +/- 0.9 micrograms/ml at 24 hours after the completion, indicating that the concentrations had been well above the levels of MIC90 throughout the 24 hours. Abnormal symptoms, which were most likely adverse drug reactions, were not observed in any patients, and no abnormal changes were noted in patients, whose clinical lab values were taken before or after the administration. Situations may differ by region in Japan, however, infants under 3 are generally exempted from medical payment regardless of inpatients or outpatients. When hospitalized, psychological burden upon pediatric patients without guardians attended must be enormous. If they are over 3, there is a difference in medical costs between inpatients and outpatients, with greater economic burden on inpatients. Thus, it was considered worth attempting the outpatient treatment as one of new therapies for community-acquired pneumonia, though the outpatient treatment should not be encouraged without due consideration. Based on these results, CTRX dosed once daily to pediatric patients with community-acquired pneumonia is clinically and bacteriologically superior in usefulness. Further review may be necessary, however, it is considered that outp

Topics: Ceftriaxone; Cephalosporins; Child; Child, Preschool; Community-Acquired Infections; Drug Resistance, Microbial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infusions, Intravenous; Male; Pneumonia, Bacterial; Streptococcal Infections; Streptococcus pneumoniae

Epiglottitis in childhood is caused by Haemophilus influenzae type b. The usual antibiotic treatment at the Royal Children's Hospital, Parkville, Victoria is a five day course of chloramphenicol. Increasingly, third generation cephalosporins are being used to treat invasive H influenzae type b infections and preliminary data suggest that they can be used successfully for epiglottitis. In a prospective, randomised trial, the efficacy of a short course (two days) of ceftriaxone was compared with that of five days of chloramphenicol for the treatment of epiglottitis. The ability of these treatment regimens to eradicate H influenzae type b from the throat was also studied. Fifty five children were enrolled over an 18 month period. Epiglottitis was diagnosed clinically and confirmed on inspection of the epiglottis at direct laryngoscopy. Fifty three (96%) of 55 patients had H influenzae type b detected from at least one site: 44/52 (85%) from blood cultures, 41/47 (87%) from throat swab, and 6/8 (75%) as H influenzae type b urinary antigen. Children were randomised to receive either ceftriaxone 100 mg/kg intravenously followed by a single dose of 50 mg/kg 24 hours later (28 patients), or chloramphenicol 40 mg/kg intravenously, then 25 mg/kg eight hourly for five days, intravenously then by mouth (27 patients). All household contacts and patients receiving chloramphenicol received rifampicin 20 mg/kg daily for four days. Index patients randomised to ceftriaxone were not treated with rifampicin. There was no significant difference in outcome between the two groups with respect to the mean duration of fever, the duration of intubation, or the length of hospital admission. The proportion of patients colonised with H influenzae type b four weeks after discharge was not significantly different between the two groups: ceftriaxone 5/22 (23%) versus chloramphenicol and rifampicin 3/23 (13%). A short course of ceftriaxone was successful in treating all patients with no significant side effects and no relapses. A short course of ceftriaxone is a safe, efficacious, and economic alternative to the standard treatment in children with epiglottitis.

Topics: Ceftriaxone; Child, Preschool; Chloramphenicol; Drug Administration Schedule; Epiglottitis; Follow-Up Studies; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Prospective Studies

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

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

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

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

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

In a prospective study 105 children hospitalized with soft tissue infection, 11 children with suppurative arthritis and 9 children with osteomyelitis were treated with either parenterally administered ampicillin/sulbactam or ceftriaxone. Treatment was randomized using a computer-generated table in a 2:1 fashion: 84 patients received ampicillin/sulbactam and 41 patients received ceftriaxone. Organisms isolated from wound site or blood cultures included Staphylococcus aureus (33), Streptococcus pyogenes (19), Haemophilus influenzae (9) including 4 beta-lactamase-positive organisms, Streptococcus pneumoniae (5), Neisseria gonorrhoeae (3) and 9 other organisms. Clinical and bacteriologic response was satisfactory in 100% of the ampicillin/sulbactam-treated patients and in 93% of the ceftriaxone-treated patients. Two patients with S. aureus infections treated with ceftriaxone had a delayed response and required change in therapy to parenterally administered oxacillin. Ampicillin/sulbactam represents a potentially useful single agent for the treatment of cellulitis and bone or joint infections in pediatric patients.

Topics: Acinetobacter Infections; Adolescent; Ampicillin; Arthritis, Infectious; Ceftriaxone; Cellulitis; Child; Child, Preschool; Drug Therapy, Combination; Escherichia coli Infections; Female; Gonorrhea; Haemophilus Infections; Humans; Infant; Male; Osteomyelitis; Prospective Studies; Random Allocation; Staphylococcal Infections; Streptococcal Infections; Sulbactam

Seventy-seven patients with acute bacterial infections were treated with ceftriaxone (1 gm administered intravenously every 12 hours). The 58 patients evaluable for efficacy had 60 infections, including 39 of the respiratory tract, 14 of the urinary tract, and seven of soft tissue. Five patients were bacteremic. The mean duration of ceftriaxone treatment was eight days for patients with respiratory and urinary tract infections and 13 days for patients with other types of infections. A satisfactory clinical response occurred in 56 (93%) of the infections. Eighty-four (94%) of the 89 pretherapy pathogens were bacteriologically eradicated. Included were all 19 isolates of Haemophilus influenzae, all 15 of Streptococcus pneumoniae, all 12 of Escherichia coli, 22 of the 23 isolates of other Enterobacteriaceae species, three of five isolates of Pseudomonas aeruginosa, and three of four isolates of Staphylococcus aureus. Two cases of superinfection (one with bacteremia) occurred with P aeruginosa. There were two cases each of reinfection and colonization with Streptococcus faecalis. One patient developed manifestations of culture-documented S pneumoniae meningitis eight hours after the first dose was administered. Peak and trough plasma levels of ceftriaxone were 142 and 64 micrograms/ml. Ceftriaxone achieved therapeutic levels in infected cerebrospinal fluid and in the abscess fluid of selected patients. Adverse effects, which were mild, included diarrhea in 4% of the patients and elevated transaminase levels in 10%.

Topics: Adult; Aged; Alanine Transaminase; Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Connective Tissue Diseases; Diarrhea; Escherichia coli Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Pneumococcal Infections; Respiratory Tract Infections; Sepsis; Streptococcus pneumoniae; Time Factors; Urinary Tract Infections

Haemophilus influenzae is a human-specific pathogen responsible for respiratory tract infections, meningitis, and sepsis. The study aimed to characterize antibiotic resistance in H. influenzae strains isolated from patients with lower respiratory tract infections over 15 years in Poland. The minimum inhibitory concentrations (MICs) of clinically relevant antibiotics were determined by broth microdilution method. Screening for beta-lactam resistance was performed in all isolates following EUCAST recommendation. Finally, relevant changes in penicillin-binding protein 3 (PBP3) were detected by PCR screening. Of the 1481 isolates collected between 2005 and 2019, 12.6%, 0.2%, 17.1%, and 0.2% were resistant to ampicillin, amoxicillin/clavulanate, cefuroxime, and ceftriaxone, respectively. Among them, 74.4% (1102/1481) of isolates were categorized as BLNAS (β-lactamase negative, ampicillin-susceptible), 13.0% (192/1481) as BLNAS with modified PBP3 (mutations in ftsI gene), 2.6% (39/1481) as BLNAR (β-lactamase negative, ampicillin-resistant), and 0.2% had PBP3 modifications typical for high-BLNAR. Production of β-lactamase characterized 9.7% of isolates (8.6% BLPAR-β-lactamase-positive, ampicillin-resistant, and 1.1% BLPACR-β-lactamase-positive, amoxicillin-clavulanate resistant). Three isolates with PBP3 modifications typical for high-BLNAR proved resistant to ceftriaxone (MIC > 0.125 mg/L). Resistance to ciprofloxacin, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole was observed in 0.1%, 0.5%, 1.6%, and 24.7% of isolates, respectively. This is the first report of Polish H. influenzae isolates resistant to third-generation cephalosporins. Polish H. influenzae isolates demonstrate similar susceptibility trends as in many other countries. The substantial proportion of β-lactam-resistant isolates and the emergence of those resistant to third-generation cephalosporins are of great concern and should be under surveillance.

Topics: Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; beta-Lactamases; Ceftriaxone; Drug Resistance, Bacterial; Haemophilus Infections; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Poland; Respiratory Tract Infections

Topics: Ceftriaxone; Child, Preschool; Endocarditis, Bacterial; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Treatment Outcome

BACKGROUND Parainfluenza viruses (PIV) are known to cause mild respiratory tract infections in immunocompetent patients but can cause severe infections in immune-compromised patients such as transplant recipients and children with HIV. PIV infection in HIV-infected adults has rarely been reported. We report a case of PIV pneumonia in an adult with AIDS who was successfully treated with oral ribavirin. CASE REPORT A 64-year-old man with history of acquired immune deficiency syndrome (AIDS) was admitted to the hospital with shortness of breath that began 3 days before. He was in respiratory distress and required mechanical ventilation on arrival. A bronchoalveolar lavage (BAL) culture was positive for Hemophilus influenzae and a respiratory viral panel was positive for Parainfluenza virus. The patient was initially started on Cefepime and Trimethoprim- Sulfamethoxazole and later changed to Ceftriaxone based on culture results. As the patient's condition did not improve after 48 h, oral ribavirin was added to treat PIV. The patient subsequently improved and was extubated after 72 h. CONCLUSIONS Oral ribavirin can have a beneficial effect in AIDS patients who have PIV-associated pneumonia. Further investigation of the benefit of oral ribavirin in similar cases is warranted.

Topics: Acquired Immunodeficiency Syndrome; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Coinfection; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Paramyxoviridae Infections; Pneumonia, Viral; Respiration, Artificial; Respiratory Distress Syndrome; Ribavirin

Among 547 Haemophilus influenzae isolates recovered in our center, 45 displayed a phenotype of loss of PBP 3 affinity (8.2%). Two isolates with 6 substitutions in PBP 3 showed decreased susceptibility to third-generation cephalosporins. Clinical data revealed clinical failure after ceftriaxone treatment in a context of bronchitis in a patient with pulmonary sarcoidosis.

Topics: Amino Acid Substitution; Anti-Bacterial Agents; Bacterial Proteins; Ceftriaxone; France; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin-Binding Proteins

Topics: Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Epiglottitis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Influenza A virus; Influenza, Human; Microbiological Techniques; Middle Aged; Nasal Cavity; Pharynx; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Acute otitis media (AOM) nonresponsive to antibiotics is most commonly caused by antibiotic-resistant Streptococcus pneumoniae and Haemophilus influenzae. A strategy for treating these infections with parenteral ceftriaxone was adopted at the Children's Hospital Iceland. The 10-valent pneumococcal H. influenzae protein D-conjugate vaccine was introduced into the vaccination program in Iceland in 2011. The aim was to study its effect on the incidence of AOM with treatment failure.. This retrospective observational study included children who visited the Children's Hospital Iceland because of AOM or received ceftriaxone, regardless of indication from 2008-2015. Incidence rate was calculated for prevaccine (2008-2011) and postvaccine (2012-2015) periods using person-years at risk within the hospital's referral region. Incidence rate ratio of ceftriaxone treatment episodes of AOM was calculated using the Mantel-Haenzel method adjusting for age. Incidence risk ratio of ceftriaxone treatment if presenting to the hospital with AOM was calculated to adjust for rate of AOM visits.. Visits for AOM decreased from 47.5 to 33.9 visits per 1000 person-years, incidence rate ratio (IRR) 0.86 (95% confidence interval [CI]: 0.81-0.91), P < 0.001. Fewer AOM episodes were treated with ceftriaxone, decreasing from 6.49 to 2.96 treatment episodes per 1000 person-years, with an overall Mantel-Haenzel adjusted IRR 0.45 (95% CI: 0.37-0.54; P < 0.001). This remained significant after adjusting for the decrease in AOM visits, IRR 0.53 (95% CI: 0.44-0.63; P < 0.001).. Visits for AOM and ceftriaxone use decreased significantly after H. influenzae protein D-conjugate vaccine introduction. The observed decrease in ceftriaxone use is presumed to represent a decline in AOM with treatment failure, secondary to a decrease in resistant infections.

Topics: Adolescent; Anti-Bacterial Agents; Bacterial Proteins; Carrier Proteins; Ceftriaxone; Child; Child, Preschool; Haemophilus Infections; Haemophilus Vaccines; Humans; Iceland; Immunoglobulin D; Incidence; Infant; Infant, Newborn; Lipoproteins; Otitis Media; Pneumococcal Infections; Pneumococcal Vaccines; Retrospective Studies; Treatment Failure

Brain abscesses are well-known to neurologic surgeons with well-recognized presentations, which include seizures, neurologic deficit, and headache. Rare symptoms may lead to a delay in diagnosis, which can be life threatening in the setting of a brain abscess.. We present the case of a 46-year-old male with intractable hiccups found to have an abscess of the right basal ganglia. The brain abscess was treated by frameless stereotactic-guided aspiration. The patient's hiccups improved after surgical aspiration and medical management.. A comprehensive literature review confirmed brain abscess as a rare cause of intractable hiccups. In addition, there are few reports of lesions of the basal ganglia causing intractable hiccups. Aspiration and medical therapy resulted in resolution of the hiccups. Knowledge of the hiccup reflex arc and unusual presentation of basal ganglia lesions may shorten time to diagnosis.

Topics: Anti-Infective Agents; Basal Ganglia; Brain Abscess; Ceftriaxone; Central Nervous System Bacterial Infections; Haemophilus Infections; Haemophilus parainfluenzae; Hiccup; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Middle Aged; Treatment Outcome

To describe the characteristics of adult invasive H. influenzae disease, 34 patients diagnosed at a single tertiary center between 2004 and 2017 were analyzed in a retrospective case series study. The annual estimated incidence was 0.1 cases/100.000 inhabitants. Dominant source of infection was pneumonia accompanied by sepsis (62%) and caused by nontypeable strains (74%) with low ampicillin resistance (14%). Survival (94%) and complication rates were high (35%). Main empirical treatments were ceftriaxone or levofloxacine.

Topics: Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Hungary; Incidence; Levofloxacin; Male; Middle Aged; Retrospective Studies; Sepsis

We present a case of endocarditis with embolic stroke and digital infarction due to the recently renamed Aggregatibacter aphrophilus. The isolation and identification of this organism can be problematic but was achieved in this case using both older phenotypic and newer genotypic methods. A benign tongue lesion is suggested as the likely portal of entry for this oropharyngeal organism. The patient made a good recovery with six weeks of intravenous ceftriaxone but will need cardiac valvular surgery at some point in the future.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebral Infarction; Endocarditis; Fingers; Haemophilus Infections; Haemophilus paraphrophilus; Humans; Infarction; Male; Middle Aged

Acute otitis media is the most common respiratory tract infection in infancy and early childhood that is managed with antimicrobial agents. Ninety-three per cent of the cases diagnosed in Spain are treated with antibiotics, and Streptococcus pneumoniae and untypeable Haemophilus influenzae are the most frequently isolated pathogens. The aim of this work was to evaluate the usefulness of amoxicillin, amoxicillin/clavulanate and ceftriaxone for the empirical treatment of acute otitis media, looking at the pharmacokinetic variability and the antimicrobial susceptibility of paediatric strains of the two main pathogens responsible for AOM in Spain, Streptococcus pneumoniae and Haemophilus influenzae.. Free-drug plasma concentrations were simulated and the probability of target attainment at each minimum inhibitory concentration and the cumulative fraction of response (CFR) were determined. Microbiological susceptibility information was extracted from SAUCE 3 surveillance.. CFR with amoxicillin varied from 83% to 96% against S. pneumoniae and from 78% to 86% against H. influenzae. CFR was always >85% with amoxicillin/clavulanate. With the 3-day ceftriaxone regimen, the probability of achieving free concentrations above MIC at 72 hours significantly increased compared to the single dose, with which CFR ranged from 70% to 84%.. High-dose amoxicillin (at least 80 mg/kg/day) should be the first-line therapy in uncomplicated infections, whereas amoxicillin/clavulanate (40 mg/kg/day) should be the choice when additional coverage for H. influenzae is desired. Administration of 3 daily doses of ceftriaxone increases bacteriological eradication probability when compared with one-day regimen, although additional clinical evaluations are necessary to establish the best target attainment with ceftriaxone.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; beta-Lactam Resistance; Ceftriaxone; Child; Computer Simulation; Dose-Response Relationship, Drug; Haemophilus Infections; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Monte Carlo Method; Otitis Media; Pneumococcal Infections; Streptococcus pneumoniae

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; DNA, Bacterial; Endocarditis; Female; Haemophilus Infections; Haemophilus parainfluenzae; Humans; Infusions, Intravenous; Sequence Analysis, DNA; Treatment Outcome

Invasive infections due to Aggregatibacter aphrophilus mainly include negative blood culture endocarditis and osteoarticular infections. The authors present herein a rare case of posterior septic arthritis related to A aphrophilus involving lumbar spine with contiguous abscesses of psoas and paravertebral muscles. The infection likely originated from oral cavity. A good outcome was observed after a prolonged and targeted antibiotherapy.

Topics: Aged; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Haemophilus; Haemophilus Infections; Humans; Lumbar Vertebrae; Male; Psoas Abscess

The aim of this study is to examine the internalization of nontypeable Haemophilus influenzae (NTHi) into human epithelial cells.. Bactericidal assay was applied to examine the effects of antibiotics against cell-adherent NTHi using HEp-2 cells. A trans-well chamber assay was applied to examine the internalization and penetration of NTHi using Detroit562 cells.. The adherence of NTHi to HEp-2 cells was noted after 2h of incubation. Azithromycin had a strong bactericidal effect against both cell-associated and non-adherent NTHi, while ceftriaxone did not show bactericidal effects on NTHi adhered to the HEp-2 cells. Three (60.0%) out of five NTHi isolates from the nasopharynx of children with intractable acute otitis media (AOM) internalized into and subsequently penetrated through the epithelial cells at various degrees. Azithromycin had a strong bactericidal effect against the cell-internalized NTHi, while ceftriaxone was bactericidal only against extracellular NTHi.. The potential of NTHi as the intracellular pathogen may contribute to the persistent existence of this pathogen that result in the prolonged and intractable clinical course of AOM. Azithromycin may be a therapeutically significant antibiotic for patients with prolonged respiratory tract infections due to NTHi.

Topics: Acute Disease; Anti-Bacterial Agents; Azithromycin; Bacterial Adhesion; Bacterial Physiological Phenomena; Ceftriaxone; Cell Line; Child; Dose-Response Relationship, Drug; Epithelial Cells; Gentamicins; Haemophilus Infections; Haemophilus influenzae; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Microbial Viability; Otitis Media with Effusion

Because cardiac device infections may include fastidious pathogens, extended incubation of blood cultures is suggested. A patient with an infection of a right ventricular lead implantable cardioverter defibrillator (ICD) system is described. The device was implanted 6 months earlier. The pathogen was identified as Haemophilus parainfluenzae, which was cultured within 72 hours and was presumably from a respiratory tract infection. Extended incubation was not necessary to culture this fastidious pathogen. Two large retrospective studies suggest that prolonged incubation for fastidious organisms is generally not necessary because of advances in culture media and automated blood culture systems.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Defibrillators, Implantable; Device Removal; Echocardiography, Transesophageal; Female; Haemophilus Infections; Humans; Prosthesis-Related Infections

Haemophilus influenzae (H. influenzae) is the most frequent bacterial pathogen of respiratory tract infections in children. Detection of antimicrobial susceptibility of H. influenzae is necessary for institution of appropriate antibiotic treatments.. A total of 281 strains of H. influenzae isolated from sputum samples of 281 pediatric patients with respiratory tract infections were recruited for study. Antibiotic susceptibility was determined by assessing minimum inhibitory concentrations (MIC) of antimicrobial agents. MIC were measured by utility of Agar dilution susceptibility test.. Of the total, 38 (13.5%) strains produced beta-lactamase (BLP), 56 (19.9%) strains were beta-lactamase non-producing, ampicillin resistant (BLNAR). The overall resistant proportion to ampicillin was 33.4%. The data indicated that sulbactam/ampicillin, cefotaxime, ceftriaxone and cefditoren are effective against BLP strains. In addition, a high prevalence of BLNAR H. influenzae strains was identified, with an overall isolation rate of 19.9%. Those strains mainly demonstrated intermediate level to ampicillin (ampicillin-MIC

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Resistance, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Microbial Sensitivity Tests; Respiratory Tract Infections

Topics: Actinobacillus Infections; Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Follow-Up Studies; Haemophilus Infections; Haemophilus parainfluenzae; Humans; Male; Middle Aged; Pleural Effusion; Rifampin; Time Factors; Treatment Outcome

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Haemophilus; Haemophilus Infections; Humans; Middle Aged; Treatment Outcome

Paediatric acute epiglottitis is rare in Asia. The National University Hospital in Singapore has seen only two cases of paediatric acute epiglottitis in the last 10 years. The topic is re-visited here to remind physicians of its acutely dramatic progression.. Both boys presented with a viral prodrome which progressed within hours to life-threatening upper airway obstruction. Examination revealed an inflamed epiglottitis.. They were successfully intubated and treated with intravenous antibiotics.. Both recovered uneventfully.. Paediatric acute epiglottitis has declined markedly in the West with widespread vaccination against HiB. In contrast, the incidence of invasive HiB disease in Asia has always been low despite limited vaccination. Clinicians must remain vigilant of the possibility of acute epiglottitis in a child with "flu".

Topics: Acute Disease; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Epiglottitis; Haemophilus Infections; Haemophilus influenzae type b; Humans; Male

We present a case of bacterial tracheitis in a 6.5 year old girl. Clinical signs and symptoms consisted of severe croup with high grade fever, which were preceded by upper respiratory tract prodrome. Initial treatment with steroids and nebulized epinephrine was unsuccessful. The patient was intubated a few hours after admission. Thick purulent secretions emerging from the trachea and the normal appearance of the epiglottis suggested the diagnosis of bacterial tracheitis, which was confirmed by isolation of Haemophilus influenzae in the culture of the tracheal secretions. The patient was administered a 14 day course of endovenous ceftriaxone and was kept on mechanical ventilation for 7 days. Fever and purulent tracheal secretions continued for the next 5 days. After 48 hours without these signs, laryngotracheobronchoscopy ruled out residual obstruction. Extubation was successfully performed. Fourteen days later physical examination showed no abnormalities and the patient was discharged. No complications were found during followup. The clinical, diagnostic and therapeutic aspects of this potentially life threatening entity that should taken into account in the differential diagnosis of severe croup are discussed.

Topics: Ceftriaxone; Cephalosporins; Child; Croup; Female; Follow-Up Studies; Haemophilus Infections; Haemophilus influenzae; Humans; Respiration, Artificial; Time Factors; Tracheitis

A polymerase chain reaction (PCR) assay with primers from 'bexA' gene was compared with culture for the detection of Haemophilus influenzae type b (Hib) in clinical samples from children with pneumonia and meningitis. Of 200 sera (180 from pneumonia, 20 from non-pneumonia patients) tested by PCR (serum-PCR), Hib was detected in 15 of 16 blood culture-positive and in 6 blood culture-negative pneumonia cases. When compared with the results of blood culture, serum-PCR had sensitivity, specificity, and accuracy index of 93.7%, 96.7%, and 96.5% respectively. Of 120 cerebrospinal fluid (CSF) samples from meningitis patients tested by culture and PCR (CSF-PCR), the latter method could detect Hib in all 15 culture-positive and in 8 of 105 culture-negative cases, showing sensitivity, specificity, and accuracy index of 100%, 92.4%, and 94.4% respectively. The PCR result was available within a day. Antimicrobial susceptibility of Hib was determined by the disc-diffusion method. High rate of resistance to ampicillin (54.8%), chloramphenicol (48.4%), and co-trimoxazole (80.6%) was observed among 31 invasive Hib isolates with resistance to all 3 drugs (multiresistance) in 48.4% of the isolates. All the Hib isolates were susceptible to ceftriaxone. The study has shown that PCR is a rapid, sensitive and specific diagnostic test for Hib from clinical samples, and a combination of culture and PCR is necessary for the detection of Hib infections to the maximum extent for case management to reduce morbidity, mortality, and complications of the invasive Hib infections. A high prevalence of multiresistant Hib strains is a matter of concern.

Topics: Bangladesh; Ceftriaxone; Cephalosporins; Child, Preschool; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae type b; Humans; Infant; Male; Meningitis, Haemophilus; Pneumonia, Bacterial; Polymerase Chain Reaction; Reproducibility of Results; Sensitivity and Specificity

Topics: Ceftriaxone; Cephalosporins; Epiglottitis; Fatal Outcome; Female; Haemophilus Infections; Haemophilus influenzae type b; Humans; Infant; Vaccination

Nontypeable Haemophilus influenzae strain INT1 was isolated from the blood of a young child with clinical signs of meningitis following acute otitis media. No immunologic or anatomic predisposition of this child for invasive bacterial infection with an unusual organism was documented. Sensitive ELISA proved the absence of intra- or extracellular capsular polysaccharide production by INT1 and Southern blot analysis confirmed the lack of an intact capsulation (cap) gene locus within the chromosome. Nevertheless, INT1 established bacteremia and meningitis in infant and weanling rat models of invasive H. influenzae infection. High-molecular-weight DNA isolated from INT1 was shown to confer an invasive phenotype on transformation of a nonencapsulated, avirulent laboratory strain of H. influenzae. Together these findings imply the presence of one or more as-yet-undiscovered, noncapsular virulence factors of H. influenzae that are capable of mediating invasive disease and resistance to immunologic clearance.

Topics: Amoxicillin; Animals; Bacteremia; Bacterial Capsules; Blotting, Southern; Ceftriaxone; Cephalosporins; Child, Preschool; DNA, Bacterial; Enzyme-Linked Immunosorbent Assay; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Meningitis, Bacterial; Otitis Media; Penicillins; Phenotype; Polysaccharides, Bacterial; Rats; Rats, Sprague-Dawley; Virulence

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

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

Topics: Bacteremia; Ceftriaxone; Child, Preschool; Female; Haemophilus Infections; Haemophilus influenzae; Hospitalization; Humans; Infant

Topics: Ceftriaxone; Cerebrospinal Fluid Shunts; Drug Therapy, Combination; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Rifampin

Meropenem and comparator antibiotics, including ceftriaxone, ceftazidime, benzyl penicillin and a combination of ampicillin plus gentamicin, were evaluated in a model of bacterial meningitis in the guinea-pig. The model is an acute infection in which challenge with each organism, if untreated, causes an increase in numbers of white blood cells, elevation of protein concentrations and 6-8 log10 cfu/mL of bacteria in the CSF. Infections caused by Haemophilus influenzae, Neisseria meningitidis, three strains of Streptococcus pneumoniae (two penicillin-resistant), Escherichia coli, Pseudomonas aeruginosa and Listeria monocytogenes all responded to meropenem, which was as active as the comparator agents in all studies, and was more active in most. Of particular note were the results seen against S. pneumoniae (penicillin-resistant) infections, in which meropenem was significantly more effective than ceftriaxone. Also notable were results from the P. aeruginosa infection where meropenem, at low doses, was more effective than ceftazidime. Activity against L. monocytogenes was equivalent to that produced by treatment with the combination of ampicillin plus gentamicin, even when treatment was delayed. These results show that, in an animal model, meropenem penetrates into CSF in concentrations sufficient to produce significant reductions in the numbers of common and less common pathogens.

Topics: Ampicillin; Animals; Carbapenems; Ceftazidime; Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Cerebrospinal Fluid Proteins; Drug Evaluation; Drug Resistance, Microbial; Escherichia coli Infections; Gentamicins; Guinea Pigs; Haemophilus Infections; Haemophilus influenzae; Listeriosis; Meningitis, Bacterial; Meropenem; Neisseria meningitidis; Penicillin G; Pneumococcal Infections; Thienamycins

The in vitro activity of cefodizime and two comparative cephalosporins, cefuroxime and ceftriaxone were studied against respiratory pathogens. MIC90s of cefodizime were 0.06-0.512 microgram/ml for Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae. MIC50s of cefodizime for Klebsiella pneumoniae and Staphylococcus aureus isolates were 2 micrograms/ml and 8 micrograms/ml respectively. Cefuroxime and ceftriaxone at a concentration of 2 micrograms/ml and 1 microgram/ml inhibited 50% of Klebsiella pneumoniae and 50% of Staphylococcus aureus strains studied respectively. Cefodizime inhibited many of the important respiratory pathogens and can be suggested as an active antimicrobial agent for respiratory tract infections.

Topics: Cefotaxime; Ceftriaxone; Cefuroxime; Haemophilus Infections; Haemophilus influenzae; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Moraxella catarrhalis; Neisseriaceae Infections; Pneumococcal Infections; Respiratory Tract Infections; Staphylococcal Infections; Staphylococcus aureus; Streptococcus pneumoniae

Haemophilus paraphrophilus was recovered in pure culture from purulent material collected at surgery from a patient presenting with a spinal epidural abscess and a severe neurological deficit. This is the first report of such an occurrence.

Topics: Abscess; Aged; Ceftriaxone; Combined Modality Therapy; Epidural Space; Haemophilus; Haemophilus Infections; Humans; Male; Spinal Cord Diseases

The role of cytokines in the regulation of articular inflammation and cartilage degradation was evaluated in the rabbit model of Haemophilus influenzae type b arthritis. At 6 and 12 h after intraarticular infection, treatment with IB4 monoclonal antibody to the CD18 leukocyte receptor alone or in combination with dexamethasone resulted in significant reduction of synovial fluid (SF) neutrophil concentration. Treatment with dexamethasone alone was associated with lower SF concentrations of interleukin-1 (IL-1), tumor necrosis factor-alpha, and stromelysin than in other groups. At 24 h after infection, increased cartilage degradation was detected in untreated controls and in animals treated with IB4 alone or in combination with dexamethasone compared with those treated with dexamethasone alone. Multiple regression analyses indicated SF concentration of IL-1 and stromelysin as the significant predictors of cartilage degradation. These data suggest that IL-1 mediates cartilage degradation by regulation of metalloproteinases, such as stromelysin, during acute experimental bacterial arthritis.

Topics: Animals; Antibodies, Monoclonal; Antigens, CD; Arthritis, Infectious; Cartilage, Articular; CD18 Antigens; Ceftriaxone; Cytokines; Dexamethasone; Haemophilus Infections; Haemophilus influenzae; Inflammation; Injections, Intra-Articular; Interleukin-1; Male; Matrix Metalloproteinase 3; Metalloendopeptidases; Neutrophils; Proteoglycans; Rabbits; Regression Analysis; Synovial Fluid; Synovial Membrane; Tumor Necrosis Factor-alpha

In an effort to develop a more effective therapy for postsplenectomy sepsis, ceftriaxone and human intravenous immunoglobulin (IVIG), alone and in combination, were evaluated for their efficacy against experimental Haemophilus influenzae type B (Hib) bacteremia in splenectomized and sham-operated infant rats. Five-day-old animals had either a splenectomy or sham operation. At 12 days of age, they were challenged intraperitoneally with Hib. Fifteen hours later blood specimens were obtained for quantitative bacterial cultures, and immediately thereafter therapy was started with ceftriaxone, IVIG, combination of ceftriaxone and IVIG, or albumin (control). Quantitative blood cultures were repeated 24 and 48 hours after the treatment. Prior to the treatments, splenectomized animals had significantly higher bacterial counts in blood when compared with sham-operated animals (P < .001). Splenectomized animals receiving IVIG, ceftriaxone, or the combination of IVIG and ceftriaxone had significantly increased bacterial clearance from blood when compared with the controls (P < .01). In addition, animals treated with ceftriaxone or the combination of IVIG and ceftriaxone had significantly increased bacterial clearance compared with the IVIG alone treatment group (P < .01). Overall, the mortality was significantly higher in splenectomized animals compared with the sham-operated animals (P < .05). The control animals had significantly higher mortality compared with the IVIG, ceftriaxone, and combined ceftriaxone and IVIG treatment groups (P < .05). There were no detrimental effects of combining IVIG and ceftriaxone together.

Topics: Animals; Bacteremia; Ceftriaxone; Colony Count, Microbial; Drug Therapy, Combination; Haemophilus Infections; Haemophilus influenzae; Immunoglobulins, Intravenous; Immunotherapy, Adoptive; Rats; Rats, Sprague-Dawley; Splenectomy

A 4-year-old girl with Legg-Calve Perthes' disease and immunoglobin G1 subclass deficiency developed osteomyelitis of the proximal femur and septic arthritis of the hip secondary to Haemophilus influenzae, type f. This microorganism is a rare cause of invasive infections in children, primarily of the central nervous system (CNS) and respiratory track. It has not previously been associated with bone and joint infections.

Topics: Arthritis, Infectious; Ceftriaxone; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Female; Femur; Haemophilus Infections; Haemophilus influenzae; Hip Joint; Humans; Osteomyelitis; Ticarcillin

Topics: Ceftriaxone; Child, Preschool; Drug Administration Schedule; Epiglottitis; Haemophilus Infections; Haemophilus influenzae; Humans; Infant

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

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

Topics: Ceftriaxone; Child; Haemophilus Infections; Humans; Pneumonia; Streptococcal Infections

The in vitro activity of cefixime was comparatively tested against 232 non-type b and 102 type b isolates of Haemophilus influenzae derived from clinical specimens of pediatric patients, including 10 non-type b strains that did not produce beta-lactamase and demonstrated resistance to ampicillin. Cefixime was active against the ampicillin-susceptible and ampicillin-resistant, beta-lactamase-producing isolates; however, its activity against some non-beta-lactamase-producing, ampicillin-resistant isolates appeared to be limited.

Topics: Ampicillin Resistance; beta-Lactamases; Cefixime; Cefotaxime; Ceftriaxone; Haemophilus Infections; Haemophilus influenzae; Microbial Sensitivity Tests

Topics: Adult; Ceftriaxone; Glottis; Haemophilus Infections; Haemophilus influenzae; Humans; Laryngitis; Male; Opportunistic Infections

A 21-year-old man presented to our emergency department with a two-day complaint of painful swelling and protrusion of the tongue, odynophagia, dysphagia, and difficulty with speech. A nonfluctuant area of tongue swelling was identified; needle aspiration of this site produced 5 mL of pus, with considerable amelioration of symptoms. Culture of the aspirate subsequently grew Hemophilus parainfluenzae, the first such reported case of this pathogen in a glossal abscess. Glossal abscess is a rare clinical entity that may result in airway compromise and disseminated infection to other systems. The presence of a glossal abscess should be considered in all cases of tongue swelling.

Topics: Abscess; Adult; Ceftriaxone; Cephalexin; Emergencies; Haemophilus Infections; Humans; Male; Tongue Diseases

Topics: Adult; Ceftriaxone; Haemophilus Infections; Humans; Male; Osteomyelitis; Spinal Diseases

The bactericidal quotient (BQ) assessed in the site of infection represents an essential parameter for evaluating the real bactericidal potency of an antibiotic in vivo. The assessment and knowledge of BQ values allow us to set up a more accurate and appropriate antibacterial therapy. The two drugs--ceftriaxone (Rocephin) and imipenem plus cilastatin (Tienam)--that have been taken into consideration in this study, having a similar antibacterial spectrum though with different kinetics, may have the same BQ values in bronchial secretion versus Haemophilus influenzae, Klebsiella pneumoniae and Streptococcus pneumoniae, when administered at different dosages, i.e. ceftriaxone 1 g (i.v.) every 24 h, imipenem 0.5 g (i.v.) every 8 h.

Topics: Aged; Bronchial Diseases; Ceftriaxone; Cilastatin; Drug Administration Schedule; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Imipenem; Klebsiella Infections; Klebsiella pneumoniae; Middle Aged; Sputum; Streptococcal Infections; Streptococcus pneumoniae

Topics: Ceftriaxone; Drug Administration Schedule; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Meningitis, Haemophilus; Pneumonia; Sepsis

Second generation cephalosporins are frequently used for the treatment of bacteremic Hemophilus influenzae type b infections. "Breakthrough" meningitis during cefamandole therapy has documented the need for adequate cerebrospinal fluid penetration by these antibiotics if they are to be used in the therapy of Hemophilus infections. A child with H. influenzae type b preseptal cellulitis is reported who initially responded to treatment with intravenous cefuroxime and oral cefaclor. However, while still receiving cefaclor, the child was readmitted with H. influenzae meningitis. Microtiter broth dilution susceptibility testing performed during the second admission showed the isolate to be relatively resistant to cefuroxime (minimum bactericidal concentration [MBC] = 4 micrograms/ml) and resistant to cefaclor (MBC greater than 16 micrograms/ml). This experience documents the need to monitor the clinical response closely during therapy of H. influenzae bacteremic infections with these second generation cephalosporin treatment regimens. In addition, attention should be paid to minimum inhibitory concentrations of these cephalosporins, since variations in H. influenzae type b susceptibility to these agents may limit their efficacy.

Topics: Cefaclor; Ceftriaxone; Cefuroxime; Cellulitis; Cephalexin; Drug Resistance, Microbial; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Meningitis, Haemophilus; Sepsis

The emergence of ampicillin and chloramphenicol resistant Haemophilus influenzae type b in Denmark has created demands for alternative treatments of serious infections with H. influenzae. In this study 102 strains of H. influenzae recovered from cerebrospinal fluid (85) and blood (17) were tested for susceptibility to ampicillin, piperacillin, erythromycin, rifampicin, chloramphenicol, cefuroxime, cefotaxime, ceftazidime, ceftriaxone, moxalactam, aztreonam, and netilmicin by means of the agar dilution method. The majority (97%) was H. influenzae type b and of these strains 94% belonged to biotype I. Nine of the investigated strains were beta-lactamase producers. Ceftriaxone and cefotaxime were the most active agents (MIC90 less than or equal to 0.025 microliter/ml) followed by moxalactam and aztreonam (MIC90 = 0.1 microgram/ml). Except for ampicillin and piperacillin, the MIC was similar for beta-lactamase producers and non-producers. Several of the investigated antibiotics, especially some of the third generation cephalosporins, might constitute valid therapeutical alternatives to conventional drugs in the treatment of severe H. influenzae infections.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Chloramphenicol; Drug Resistance, Microbial; Haemophilus Infections; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Netilmicin; Rifampin; Sepsis

The in vitro activity of new cephalosporins, oxacephems and penicillins against pathogens involved in respiratory and gastrointestinal tract infections is practically equivalent. However, in experimental infections with the same pathogens the superior efficacy of ceftriaxone over all comparative cephems and penicillins, expressed in low 50% effective doses after multiple and particularly after single dosage schedules, and caused by a longer maintenance of blood and tissue levels can be demonstrated. Although mice have an altered pharmacokinetics these experimental results reflect the observed clinical advantage of ceftriaxone in human infections: long plasma half-life, low dosage and single daily administration.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Cefotaxime; Ceftriaxone; Dose-Response Relationship, Drug; Haemophilus Infections; Metabolic Clearance Rate; Mice; Microbial Sensitivity Tests; Salmonella Infections; Streptococcal Infections

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Cephamycins; Chloramphenicol; Haemophilus Infections; Haemophilus influenzae; Microbial Sensitivity Tests; Moxalactam; Rats