ro13-9904 and Nausea

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

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

To compare the efficacy of sequential i.v. to p.o. moxifloxacin with ceftriaxone +/- azithromycin +/- metronidazole for the treatment of patients with community acquired pneumonia (CAP), a multi-centered, prospective, randomized, open label study was performed. CAP patients were randomized to moxifloxacin (400 mg/d-at least one i.v. dose) or ceftriaxone (at least one dose of 2 g i.v. q.d. followed by cefuroxime 500 mg p.o. b.i.d.) +/- azithromycin, +/- metronidazole (cephalosporin/macrolide control: CMC). The primary endpoint was clinical response at test-of-cure (TOC) visit. Bacteriological response at TOC was the secondary endpoint. Clinical cure was found in 83.3% (90/108) of moxifloxacin patients and 79.6% (90/113) of control patients. Microbiological responses were 81.8% (18/22) for moxifloxacin and 60.7% (17/28) for CMC patients. Drug-related adverse events occurred in 18.0% of moxifloxacin and 16% of CMC patients. It is concluded that i.v. to p.o. moxifloxacin is as effective as CMC for treatment of CAP and is a reliable alternative antimicrobial therapy.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Aza Compounds; Azithromycin; Ceftriaxone; Community-Acquired Infections; Constipation; Drug Therapy, Combination; Emergency Medical Services; Female; Fluoroquinolones; Humans; Male; Metronidazole; Middle Aged; Moxifloxacin; Nausea; Pneumonia, Bacterial; Prospective Studies; Quinolines; Safety; Time Factors; Treatment Outcome

Efficacy and safety of ceftriaxone (Oframax, Ranbaxy, India) in the treatment of 25 patients with Staphylococcus endocarditis (SE) were studied. The drug was administered intravenously in a dose of 2-4 g a day for 4 weeks and simultaneously gentamicin was used intramuscularly in a dose of 2-3 mg/kg body weight a day every 8 hours for 2 weeks. The treatment was followed by observation of the patients for up to 2 years under the hospital or dyspensary conditions. The disease was due to S. epidermidis (17 patients) or S.aureus (8 patients). The efficacy was controlled in the dynamics. The criteria of the therapy efficacy were disappearance of the disease clinical signs, normalization of the blood count and urinalysis and the pathogen eradication by the results of the control bacteriological blood analysis. The cure without any surgical correction was observed in 68 per cent of the patients and that with the valve replacement was stated in 24 per cent of the patients. The lethal outcome due to bacteriotoxic shock was recorded in 8 per cent of the patients. The SE relapsing was stated in 28 per cent of the patients 3 or more months after the ceftriaxone therapy completion. 10 patients (40 per cent) with evident clinicolaboratory improvement were discharged from the hospital 2 (4 patients) and 3 (6 patients) weeks after the therapy start for the treatment with ceftriaxone as outpatients. In 2 patients nausea as the adverse reaction was observed. Therefore, the complex clinicolaboratory investigation showed that the combined use of ceftriaxone and gentamicin was efficient and safe in the treatment of SE. Ceftriaxone may be considered as a basic drug for the therapy of SE. In some patients with SE the treatment with ceftriaxone may be completed under outpatient conditions.

Topics: Adolescent; Adult; Ceftriaxone; Cephalosporins; Colony Count, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Injections, Intravenous; Male; Middle Aged; Nausea; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

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

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

Topics: Abdominal Pain; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Liver Abscess; Male; Metronidazole; Middle Aged; Nausea; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sepsis; Treatment Outcome; Vomiting

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

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

Topics: Adult; Anti-Bacterial Agents; Antibodies; Ataxia; Borrelia burgdorferi; Brain; Ceftriaxone; Female; Humans; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Nausea; Neck Pain; Norway; Opsoclonus-Myoclonus Syndrome; Time; Tomography, X-Ray Computed; Treatment Outcome

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