ro13-9904 and Pneumonia--Bacterial

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

Carnobacterium species are lactic acid-producing Gram-positive bacteria that have been approved by the US Food and Drug Administration and Health Canada for use as a food bio-preservative. The use of live bacteria as a food additive and its potential risk of infections in immunocompromised patients are not well understood.. An 81-year-old male with a history of metastatic prostate cancer on androgen deprivation therapy and chronic steroids presented to our hospital with a 2-week history of productive cough, dyspnea, altered mentation, and fever. Extensive computed tomography imaging revealed multifocal pneumonia without other foci of infection. He was diagnosed with pneumonia and empirically treated with ceftriaxone and vancomycin. Blood cultures from admission later returned positive for Carnobacterium inhibens. He achieved clinical recovery with step-down to oral amoxicillin/clavulanic acid for a total 7-day course of antibiotics.. This is the fourth reported case of bacteremia with Carnobacterium spp. isolated from humans. This case highlights the need to better understand the pathogenicity and disease spectrum of bacteria used in the food industry for bio-preservation, especially in immunocompromised patients.

Topics: Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Androgen Antagonists; Anti-Bacterial Agents; Bacteremia; Blood Culture; Canada; Carnobacterium; Ceftriaxone; Food Microbiology; Gram-Positive Bacterial Infections; Humans; Immunocompromised Host; Male; Pneumonia, Bacterial; Prostatic Neoplasms; Vancomycin

The goal of this study was to investigate whether ceftriaxone combination therapy is associated with better clinical outcomes than respiratory fluoroquinolone monotherapy for adults with community-acquired pneumonia (CAP). We conducted a meta-analysis of published studies.. Using the PubMed, EMBASE, and Cochrane Library databases, we performed a literature search of available randomized controlled trials (RCTs) published as original articles before September 2017.. Nine RCTs, involving 1520 patients, were included in the meta-analysis. The pooled relative risks (RRs) for the efficacy of ceftriaxone combination therapy versus respiratory fluoroquinolones monotherapy were 0.96 (95% CI: 0.92-1.01), based on clinically evaluable populations, and 0.93 (95% CI: 0.88-0.99) based on intention-to-treat (ITT) populations. No statistically significant differences were observed in microbiological treatment success (pooled RR=0.99, 95% CI: 0.90-1.09), although drug-related adverse events were significantly lower with ceftriaxone combination therapy than with respiratory fluoroquinolones monotherapy (pooled RR=1.27, 95% CI: 1.04-1.55).. Current evidence showed that the efficacy of ceftriaxone combination therapy was similar to respiratory fluoroquinolone monotherapy for hospitalized CAP patients, and was associated with lower drug-related adverse events.

Topics: Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Fluoroquinolones; Humans; Pneumonia, Bacterial; Randomized Controlled Trials as Topic; Treatment Outcome

Few cases of bacteremic pneumonia by Neisseria meningitidis (NM) have been described worldwide; mostly in elderly patients or those with comorbidities. They appear clinically indistinguishable from other acute infectious pneumoniae, that do not develope the syndrome of meningococcemia. We report a 17-years-old male, without prior medical history, consulting in the emergency department with a 7-day history of productive cough, right pleural pain, fever and dyspnea. He was admitted to the ICU due to septic shock and respiratory distress. He was managed with vasoactive drugs and prone positioning ventilation for 48 hours. Chest radiography showed a right superior lobe condensation. The electrocardiogram and echocardiogram suggested septic myocarditis. Blood cultures demonstrated the presence of serogroup W135-NM. A lumbar puncture ruled out meningitis, and a 10-day ceftriaxone therapy was completed favorably.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Chile; Humans; Male; Neisseria meningitidis; Pneumonia, Bacterial

We conducted a meta-analysis of clinical trials of adults hospitalized with pneumonia outcomes research team (PORT) risk class 3-4 community-acquired pneumonia (CAP) receiving ceftaroline fosamil versus ceftriaxone.. Three Phase III trials (clinicaltrials.gov registration numbers NCT00621504, NCT00509106 and NCT01371838) including 1916 hospitalized patients with CAP randomized 1:1 to empirical ceftaroline fosamil (600 mg every 12 h) or ceftriaxone (1-2 g every 24 h) for 5-7 days were included in the meta-analysis. Primary outcome was clinical response at the test-of-cure visit (8-15 days after end of treatment) in the PORT risk class 3-4 modified ITT (MITT) and clinically evaluable (CE) populations. Data were tested for heterogeneity (χ(2) test) and, if not significant, results were pooled and OR and 95% CI constructed. A logistic regression analysis assessed factors impacting cure rate and treatment interactions.. Clinical cure rates in each trial consistently favoured ceftaroline fosamil versus ceftriaxone, with no evidence of heterogeneity. In the meta-analysis, ceftaroline fosamil was superior to ceftriaxone in the MITT (OR: 1.66; 95% CI 1.34, 2.06; P < 0.001) and CE (OR: 1.65; 95% CI 1.26, 2.16; P < 0.001) populations. Results were consistent across various patient- and disease-related factors including patients' age and PORT score. Prior antimicrobial use within 96 h of starting study treatment was associated with diminished differences in cure rates between treatments.. Ceftaroline fosamil was superior to ceftriaxone for empirical treatment of adults hospitalized with CAP. Receipt of prior antimicrobial therapy appeared to diminish the observed treatment effect.

Topics: Anti-Bacterial Agents; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Humans; Pneumonia, Bacterial; Randomized Controlled Trials as Topic

In this case report we described a Bahraini male patient of twenty years of age, a smoker and diagnosed with stage IV B Hodgkin lymphoma. He presented with fever, nonproductive cough, upper back pain and shortness of breath due to right upper lobe pneumonia with right encysted pleural effusion. Salmonella enterica serotype Enteritidis was isolated from the sputum. He was successfully treated with 2 weeks of ceftriaxone followed by 2 weeks of oral cefixime. This was the first case of encysted empyema caused by Salmonella enterica serotype Enteritidis reported in the Kingdom of Bahrain. The different aspects of pulmonary Salmonella infections were discussed and the literature was reviewed.

Topics: Anti-Bacterial Agents; Bahrain; Cefixime; Ceftriaxone; Empyema; Hodgkin Disease; Humans; Male; Pneumonia, Bacterial; Salmonella enteritidis; Salmonella Infections; Sputum; Young Adult

The data on the effectiveness of new cephalosporin, ceftaroline, for the treatment of patients with extramural pneumonia in need of hospitalization. They show that the use of ceftaroline for 5-7 days for the treatment of hospitalized patients with extramural pneumococcal pneumonia exceeding standard therapy with ceftriaxone in terms of efficacy. Therapeutic effect of ceftaroline did not depend on S. pneumoniae serotype and persisted in severe cases complicated by bacteriemia. Another advantage of ceftaroline over ceftriaxone is it ensured an adequate response on day 4 of therapy. Evidently, properly designed prospective studies are needed to better understand the role of ceftaroline in the treatment of hospitalized patients with extramural pneumonia, estimate cost and effect ratio, and elucidate the frequency and character of adverse reactions related to the long stay of the patient in a clinic.

Topics: Anti-Bacterial Agents; Ceftaroline; Ceftriaxone; Cephalosporins; Hospitalization; Humans; Pneumonia, Bacterial; Severity of Illness Index

The development of evidence-based clinical practice guidelines has gained wide acceptance in high-income countries and reputable international organizations. Whereas this approach may be a desirable standard, challenges remain in low-income settings with limited capacity and resources for evidence synthesis and guideline development. We present our experience using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for the recent revision of the Kenyan pediatric clinical guidelines focusing on antibiotic treatment of pneumonia.. A team of health professionals, many with minimal prior experience conducting systematic reviews, carried out evidence synthesis for structured clinical questions. Summaries were compiled and distributed to a panel of clinicians, academicians and policy-makers to generate recommendations based on best available research evidence and locally-relevant contextual factors.. We reviewed six eligible articles on non-severe and 13 on severe/very severe pneumonia. Moderate quality evidence suggesting similar clinical outcomes comparing amoxicillin and cotrimoxazole for non-severe pneumonia received a strong recommendation against adopting amoxicillin. The panel voted strongly against amoxicillin for severe pneumonia over benzyl penicillin despite moderate quality evidence suggesting clinical equivalence between the two and additional factors favoring amoxicillin. Very low quality evidence suggesting ceftriaxone was as effective as the standard benzyl penicillin plus gentamicin for very severe pneumonia received a strong recommendation supporting the standard treatment.. Although this exercise may have fallen short of the rigorous requirements recommended by the developers of GRADE, it was arguably an improvement on previous attempts at guideline development in low-income countries and offers valuable lessons for future similar exercises where resources and locally-generated evidence are scarce.

Topics: Amoxicillin; Ceftriaxone; Child; Developing Countries; Evidence-Based Medicine; Gentamicins; Humans; Kenya; Penicillin G; Pneumonia, Bacterial; Practice Guidelines as Topic; Reference Standards; Trimethoprim, Sulfamethoxazole Drug Combination

To review the laboratory diagnosis of extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase-producing bacteria and evaluate potential treatment options.. A PubMed search, restricted to English-language articles, was conducted (1966-May 2007) using the search terms ESBL, AmpC, diagnosis, detection, carbapenem, ertapenem, fluoroquinolone, cephalosporin, cefepime, tigecycline, and colistin. Additional references were identified through review of bibliographies of identified articles.. All studies that evaluated laboratory methods for the detection of ESBLs and AmpC beta-lactamases and/or the treatment of these organisms were reviewed. All articles that were deemed to be clinically pertinent were included and critically evaluated.. Numerous laboratory techniques are available for the detection of ESBLs. In contrast, laboratory techniques for detection of AmpC beta-lactamases are limited, particularly for plasmid-mediated AmpC beta-lactamases. Routine microbiologic testing may not detect ESBLs or AmpC beta-lactamases. Optimal antibiotic treatment options are derived from limited observational studies and case reports. Randomized clinical trials evaluating appropriate antibiotic treatment options are lacking. In vitro susceptibility does not always correlate with clinical outcomes. The use of imipenem was associated with the lowest incidence of mortality in patients with bacteremia due to ESBL-producing organisms.. Laboratory detection of ESBLs for most organisms is possible with Clinical and Laboratory Standards Institute-recommended testing. However, these tests can be associated with both false negative and false positive results, particularly with organisms that harbor both ESBL- and plasmid-mediated AmpC beta-lactamases. No established guidelines exist for the detection of AmpC beta-lactamases. Imipenem and meropenem are superior to other antibiotics for the treatment of serious infections due to ESBL and AmpC beta-lactamase-producing gram-negative bacteria. While in vitro data demonstrate that tigecycline, ertapenem, and colistin might be potential choices, clinical experience is lacking.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Humans; Imipenem; Klebsiella Infections; Klebsiella pneumoniae; Male; Meropenem; Microbial Sensitivity Tests; Pneumonia, Bacterial; Thienamycins

A retrospective analysis was conducted to assess the cost-effectiveness of four intravenous antibiotic treatment regimens in the treatment of severe community-acquired pneumonia (CAP) in adults in a private hospital setting. The study compared some third-generation cephalosporin regimens with a second-generation cephalosporin and an amoxicillin/clavulanic acid (co-amoxiclav) regimen to investigate published South African treatment guidelines from a pharmaco-economic point of view.. A pharmaco-economic model of local costs, from a payer perspective, was based on the results of a meta-analysis of clinical papers from peer-reviewed journals. The study compared intravenous (i.v.) ceftriaxone (2 g once daily), cefotaxime (i.v. 2 g 3 times a day), cefuroxime (i.v. 750 mg 3 times a day, followed by 500 mg orally 3 times a day) and amoxicillin/clavulanic acid (1.2 g intravenously 3 times a day, followed by 625 mg orally 3 times a day) [corrected].. An analysis of the odds ratios (ORs) of all two-way comparisons indicated that ceftriaxone ensured significantly higher probabilities of successful outcomes than the other antibiotic treatment regimens (ORs in the order of two were indicated). The pharmaco-economic results suggested that the ceftriaxone treatment regimen was the most cost-effective in the hospital treatment of CAP in adult patients. These results proved to be robust across sensitivity analyses for success rates and treatment days. A sensitivity analysis testing the assumption that patients could be discharged once the oral treatment was initiated indicated that the amoxicillin/clavulanic acid and cefuroxime treatment arms were more cost-effective. The clinical validity of such an assumption is questionable.. Despite the conservative approach followed in terms of ceftriaxone data, both the clinical results and cost-effectiveness supported the use of ceftriaxone in the treatment of CAP in adults in the hospital setting.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Cefotaxime; Ceftriaxone; Cefuroxime; Cephalosporins; Community-Acquired Infections; Cost-Benefit Analysis; Drug Administration Schedule; Drug Therapy, Combination; Hospital Costs; Humans; Infant; Length of Stay; Odds Ratio; Pneumonia, Bacterial; Retrospective Studies; South Africa; Treatment Outcome

A 65-year-old diabetic (requiring insulin during the last year) was admitted as an emergency because of a septic temperature rising to 40 degrees C with rigor, tachycardia (up to 120/min) and dyspnoea. On examination there was local reddening and swelling of the skin over the right thenar eminence and along the lower arm. Two days before admission a bad scratch had been inflicted on his right hand by a cat. He had first noticed the reddening and swelling 10 hours after the incident; 1 1/2 days after the scratch and 9-10 hours before hospitalization the first bouts of fever had occurred.. The chest radiogram showed interstitial pneumonia. The clinical findings, the laboratory tests (white cell count 21 750/microliters, platelets 140,000/microliters, C-reactive protein 35 mg/l and positive blood cultures pointed to early septicaemia. The germ was identified as Pasteurella multocida two days after blood had been taken for culturing. HbA1c was 11.38%.. From the time of hospitalization the patient had been treated with ceftriaxon, 2 g daily intravenously, and also with erythromycin because atypical pneumonia had been the suspected diagnosis at first and acute chlamydia infection had at first not been excluded. The patient's general condition quickly improved and the fever started to go down a few hours after onset of treatment. Blood cultures became negative after the first administration of antibiotics. He was discharged in a good state on optimal insulin dosage.. Pasteurella multocida is present in a high percentage of domestic animals and can be the cause of systemic infections in immunocompromised patients (e. g. poorly controlled diabetes mellitus).

Topics: Aged; Animals; Bites and Stings; Cats; Ceftriaxone; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Emergencies; Erythromycin; Humans; Lung Diseases, Interstitial; Male; Pasteurella Infections; Pasteurella multocida; Pneumonia, Bacterial; Sepsis

To evaluate if treatment with ceftriaxone and a macrolide, improved patient outcome when compared with monotherapy with ceftriaxone, in hospitalized patients with human immunodeficiency virus/acquired immunodeficient syndrome (HIV/AIDS) with community-acquired pneumonia (CAP).. Adult patients with HIV hospitalized due to suspected CAP were randomized to receive one of two regimens, ceftriaxone plus macrolide or ceftriaxone plus placebo, at a 1:1 proportion (Brazilian Clinical Trials Registry: RBR-8wtq2b). The primary outcome was in-hospital mortality and the secondary outcomes were mortality within 14 days, need for vasoactive drugs, need for mechanical ventilation, time to clinical stability and length of hospitalization.. A total of 227 patients were randomized, two were excluded after randomization; 225 patients were analysed (112 receiving ceftriaxone plus placebo and 113 receiving ceftriaxone plus macrolide). The frequency of the primary outcome, in-hospital mortality, was not statistically different between the regimens: 12/112 (11%) patients who received ceftriaxone plus placebo and 17/113 (15%) who received ceftriaxone plus macrolide died during hospitalization (hazard ratio 1.22, 95% CI 0.57-2.59). We did not find differences between the regimens for any of the secondary outcomes, including mortality within 14 days, which occurred in 5/112 (4%) patients with ceftriaxone plus placebo and in 12/113 (11%) patients with ceftriaxone plus macrolide (relative risk 2.38, 95% CI 0.87-6.53).. Among hospitalized patients with HIV/AIDS with CAP, treatment with ceftriaxone and a macrolide did not improve patient outcomes, when compared with ceftriaxone monotherapy.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Female; HIV Infections; Hospitalization; Humans; Macrolides; Male; Pneumonia, Bacterial

The broad-spectrum cephalosporin ceftaroline, a metabolite of the prodrug ceftaroline fosamil, has shown in vitro activity against clinical isolates from pediatric patients.. This multicenter, randomized, observer-blinded, active-controlled study (NCT01669980) assessed the safety and effectiveness of ceftaroline fosamil compared with ceftriaxone plus vancomycin in patients between 2 months and 17 years of age with complicated community-acquired bacterial pneumonia. Patients were randomized 3:1 (stratified by age cohort) to receive either ceftaroline fosamil or ceftriaxone plus vancomycin (comparator) as intravenous therapy for ≥3 days. Patients who met specific study criteria on or after Study Day 4 were permitted to switch to an oral study drug. Safety assessments were treatment-emergent adverse events, and the effectiveness of treatment was assessed by clinical and microbiologic outcomes.. The median duration of intravenous treatment was 9.0 (range, 3.0-19.0) days in the ceftaroline fosamil group (N=30) and 7.5 (5.0-13.0) days in the comparator group (N=10). At least one treatment-emergent adverse event was experienced by 12/30 patients (40%) in the ceftaroline fosamil group and 8/10 (80%) in the comparator group; most treatment-emergent adverse events in both groups were mild to moderate in intensity. Clinical response rates in the modified intent-to-treat population were 52% (15/29 patients) in the ceftaroline fosamil group and 67% in the comparator group (6/9); clinical stability at Study Day 4 was 21% (6/29) and 22% (2/9), respectively.. Ceftaroline fosamil was well tolerated and showed similar clinical response rates to ceftriaxone plus vancomycin in pediatric patients with complicated community-acquired bacterial pneumonia.

Topics: Adolescent; Anti-Bacterial Agents; Ceftaroline; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Community-Acquired Infections; Female; Humans; Infant; Infusions, Intravenous; Male; Pneumonia, Bacterial; Treatment Outcome; Vancomycin

Community-acquired bacterial pneumonia (CABP) remains a major infection among children, despite the use of pneumococcal vaccination. Ceftaroline fosamil is a broad-spectrum cephalosporin antibiotic with activity against many bacteria, including Streptococcus pneumoniae (both penicillin-nonsusceptible and multidrug-resistant strains) and Staphylococcus aureus (including methicillin-resistant S. aureus). This article describes the safety, tolerability, and effectiveness of ceftaroline fosamil in the treatment of pediatric patients hospitalized with CABP, from a randomized, active-controlled, observer-blinded clinical study (registration number NCT01530763).. Pediatric patients were stratified into 4 age cohorts and randomized (3:1) to receive either intravenous ceftaroline fosamil or ceftriaxone, with optional oral switch for a total treatment duration of 5-14 days. Enrollment was planned for 160 patients. Data collected included demographics, infection characteristics and pathogens. Treatment-emergent adverse events, clinical outcomes, and microbiologic responses were assessed.. Ceftaroline fosamil was well tolerated. Similar percentages of patients in the ceftaroline fosamil (55/121; 45%) and ceftriaxone (18/39; 46%) groups reported treatment-emergent adverse events. Coombs seroconversion was observed in 17% of patients in the ceftaroline fosamil group; however, no evidence of hemolytic anemia or hemolysis was found. No deaths were reported during the study. Ceftaroline fosamil had similar effectiveness to ceftriaxone, with high clinical cure rates at test-of-cure in the modified intent-to-treat population (94/107; 88% and 32/36; 89%, respectively). Three documented S. aureus infections were successfully treated in the ceftaroline group, including one caused by methicillin-resistant S. aureus.. The results of this study suggest that ceftaroline fosamil may be an important treatment option for pediatric patients hospitalized with CABP.

Topics: Adolescent; Anti-Bacterial Agents; Ceftaroline; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Community-Acquired Infections; Female; Hospitalization; Humans; Infant; Infusions, Intravenous; Male; Methicillin-Resistant Staphylococcus aureus; Pneumonia, Bacterial; Prospective Studies; Staphylococcus aureus; Treatment Outcome

Stroke-associated infections occur frequently and are associated with unfavorable outcome. Previous cohort studies suggest a protective effect of beta-blockers (BBs) against infections. A sympathetic drive may increase immune suppression and infections.. This study is aimed at investigating the association between BB treatment at baseline and post-stroke infection in the Preventive Antibiotics in Stroke Study (PASS), a prospective clinical trial.. We performed an exploratory analysis in PASS, 2,538 patients with acute phase of stroke (24 h after onset) were randomized to ceftriaxone (intravenous, 2 g per day for 4 days) in addition to stroke unit care, or standard stroke unit care without preventive antibiotic treatment. All clinical data, including use of BBs, was prospectively collected. Infection was diagnosed by the treating physician, and independently by an expert panel blinded for all other data. Multivariable analysis was performed to investigate the relation between BB treatment and infection rate.. Infection, as defined by the physician, occurred in 348 of 2,538 patients (14%). Multivariable analysis showed that the use of BBs at baseline was associated with the development of infection during clinical course (adjusted OR (aOR) 1.61, 95% CI 1.19-2.18; p < 0.01). BB use at baseline was also associated with the development of pneumonia (aOR 1.56, 95% CI 1.05-2.30; p = 0.03). Baseline BB use was not associated with mortality (aOR 1.14, 95% CI 0.84-1.53; p = 0.41) or unfavorable outcome at 3 months (aOR 1.10, 95% CI 0.89-1.35; p = 0.39).. Patients treated with BBs prior to stroke have a higher rate of infection and pneumonia.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Drug Administration Schedule; Female; Humans; Immunocompromised Host; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Opportunistic Infections; Pneumonia, Bacterial; Prospective Studies; Risk Factors; Stroke; Time Factors; Treatment Outcome; Urinary Tract Infections

The primary driver of health care costs for patients with community-acquired pneumonia (CAP) is the hospital length of stay (LOS). Unfortunately, hospital LOS comparisons are difficult to make from phase III CAP trials because of their structured designs and prespecified treatment durations. However, an opportunity still exists to draw inferences about potential LOS differences between treatments through the use of surrogates for hospital discharge. The intent of this study was to quantify the time to a clinical response, a proxy for the time to discharge readiness, among hospitalized CAP patients who received either ceftaroline or ceftriaxone in two phase III CAP FOCUS clinical trials. On the basis of the Infectious Diseases Society of America and American Thoracic Society CAP management guidelines and recent FDA guidance documents for community-acquired bacterial pneumonia, a post hoc adjudication algorithm was constructed a priori to compare the time to a clinical response, a proxy for the time to discharge readiness, between patients who received ceftaroline or ceftriaxone. Overall, 1,116 patients (ceftaroline, n=562; ceftriaxone, n=554) from the pooled FOCUS trials met the selection criteria for this analysis. Kaplan-Meier analyses showed that ceftaroline was associated with a shorter time, measured in days, to meeting the clinical response criteria (P=0.03). Of the patients on ceftaroline, 61.0, 76.1, and 83.6% achieved a clinical response by days 3, 4, and 5, compared to 54.3, 69.8, and 79.3% of the ceftriaxone-treated patients. In the Cox regression, ceftaroline was associated with a shorter time to a clinical response (HR, 1.16, P=0.02). The methodology employed here provides a framework to draw comparative effectiveness inferences from phase III CAP efficacy trials. (The FOCUS trials whose data were analyzed in this study have been registered at ClinicalTrials.gov under registration no. NCT00621504 and NCT00509106.).

Topics: Adult; Aged; Anti-Bacterial Agents; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Treatment Outcome

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Male; Pneumonia, Bacterial; Prednisone; Switzerland

Few publications of prospective studies have described patient outcomes in community-acquired bacterial pneumonia (CABP)-associated bacteremia. Our objective, in performing this subgroup analysis, was to assess outcomes in subjects with CABP-associated bacteremia in 2 randomized, double-blind clinical studies comparing treatment with ceftaroline fosamil versus ceftriaxone.. Our analysis summarizes baseline subject demographics, distribution of baseline pathogens isolated from blood cultures, clinical response rates at Day 4, and clinical cure rates at end of therapy and test of cure (8 to 15 days after end of therapy) in subjects with bacteremic CABP in the ceFtarOline Community-acquired pneUmonia trial vS ceftriaxone in hospitalized patients (FOCUS) studies.. In the FOCUS studies, 23 of 614 patients in the ceftaroline fosamil-treated group and 22 of 614 patients in the ceftriaxone-treated group had CABP-associated bacteremia. Baseline demographics were similar between groups. Streptococcus pneumoniae was the most common baseline bloodstream isolate. For subjects with CABP-associated bacteremia, clinical response/cure rates were similar at Day 4 (60.9% vs 59.1%), end of therapy (69.6% vs 72.7%), and test of cure (69.6% vs 68.2%) for ceftaroline fosamil and ceftriaxone, respectively.. In subjects with CABP-associated bacteremia, ceftaroline fosamil demonstrated similar clinical outcomes at Day 4, end of therapy, and test of cure compared with ceftriaxone.

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Treatment Outcome

Community-acquired pneumonia (CAP) is a serious infection requiring hospitalisation in 20% of cases. The novel cephalosporin ceftobiprole has microbiological activity against the major bacterial pathogens causing CAP, including Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae, as well as against Staphylococcus aureus, including meticillin-resistant S. aureus (MRSA). This was a multicentre, double-blind study in which 706 patients with CAP severe enough to require hospitalisation were randomised to ceftobiprole or to an expert-recommended course of ceftriaxone ± linezolid (comparator group). Clinical and microbiological outcomes were determined 7-14 days after completion of therapy (test-of-cure visit). For the 469 clinically evaluable patients, cure rates were 86.6% vs. 87.4% for ceftobiprole and comparator, respectively [95% confidence interval (CI) of the difference, -6.9% to 5.3%]; in the intention-to-treat (ITT) analysis of 638 CAP patients, these cure rates were 76.4% vs. 79.3%, respectively (95% CI of the difference, -9.3% to 3.6%). A typical bacterial pathogen was identified in 29% of the ITT population. Microbiological eradication rates in the 144 microbiologically evaluable patients were 88.2% and 90.8% for the respective treatment groups (95% CI of the difference, -12.6% to 7.5%). Both study drugs were well tolerated, with but a minority of patients requiring premature discontinuation due to an adverse event (6% in the ceftobiprole group and 4% in the comparator group). The overall incidence of treatment-related adverse events was higher in the ceftobiprole group, primarily owing to differences in rates of self-limited nausea (7% vs. 2%) and vomiting (5% vs. 2%). In summary, ceftobiprole was non-inferior to the comparator (ceftriaxone ± linezolid) in all clinical and microbiological analyses conducted, suggesting that ceftobiprole has a potential role in treating hospitalised patients with CAP. [ClinicalTrials.gov identifier: NCT00326287].

Topics: Acetamides; Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Disease Eradication; Double-Blind Method; Drug Therapy, Combination; Female; Hospitalization; Humans; Linezolid; Male; Middle Aged; Oxazolidinones; Pneumonia, Bacterial; Treatment Outcome; Young Adult

Ceftaroline (active form of the prodrug ceftaroline fosamil) is a novel cephalosporin with activity against pathogens commonly associated with community-acquired pneumonia (CAP), including Streptococcus pneumoniae and Gram-negative pathogens. This randomized, double-blind, Phase III study evaluated the efficacy and safety of ceftaroline fosamil in treating patients with CAP. The primary objective was to determine non-inferiority [lower limit of 95% confidence interval (CI) ≥ -10%] of clinical cure rates achieved with ceftaroline fosamil compared with those achieved with ceftriaxone in the clinically evaluable (CE) and modified intent-to-treat efficacy (MITTE) populations.. Patients hospitalized in a non-intensive care unit setting with CAP of Pneumonia Outcomes Research Team (PORT) risk class III or IV requiring intravenous (iv) therapy were randomized (1:1) to receive 600 mg of ceftaroline fosamil iv every 12 h or 1 g of ceftriaxone iv every 24 h. Clinical cure, microbiological response, adverse events (AEs) and laboratory tests were assessed. FOCUS 2 registration number NCT00509106 (http://clinicaltrials.gov/ct2/show/NCT00509106).. The study enrolled 627 patients, 315 of whom received ceftaroline fosamil and 307 of whom received ceftriaxone. Patients in both treatment groups had comparable baseline characteristics. Clinical cure rates were as follows: CE population, 82.1% (193/235) for ceftaroline fosamil and 77.2% (166/215) for ceftriaxone [difference (95% CI), 4.9% (-2.5, 12.5)]; and MITTE population, 81.3% (235/289) for ceftaroline fosamil and 75.5% (206/273) for ceftriaxone [difference (95% CI), 5.9% (-1.0, 12.7)]. Clinical cure rates for CAP caused by S. pneumoniae in the microbiological MITTE (mMITTE) population were 83.3% (35/42) and 70.0% (28/40) for ceftaroline fosamil and ceftriaxone, respectively. Ceftaroline fosamil and ceftriaxone were well tolerated, with similar rates of AEs, serious AEs, deaths and discontinuations due to an AE. The most common AEs for ceftaroline fosamil-treated patients were diarrhoea, headache, hypokalaemia, insomnia and phlebitis, and the most common AEs for ceftriaxone-treated patients were diarrhoea, insomnia, phlebitis and hypertension.. Ceftaroline fosamil achieved high clinical cure and microbiological response rates in patients hospitalized with CAP of PORT risk class III or IV. Ceftaroline fosamil was well tolerated, with a safety profile that is similar to that of ceftriaxone and other cephalosporins. Ceftaroline fosamil is a promising agent for the treatment of CAP.

Topics: Aged; Aged, 80 and over; Bacteria; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pneumonia, Bacterial; Treatment Outcome

Ceftaroline, the active form of the prodrug ceftaroline fosamil, is a novel cephalosporin with bactericidal activity against important pathogens associated with community-acquired pneumonia (CAP), including Streptococcus pneumoniae and common Gram-negative pathogens. FOCUS 1 is a randomized, double-blinded, Phase III study that was conducted to evaluate the efficacy and safety of ceftaroline fosamil in treating patients with CAP. The primary objective was to determine non-inferiority [lower limit of 95% confidence interval (CI) ≥ -10%] in clinical cure rates achieved with ceftaroline fosamil compared with those achieved with ceftriaxone in the clinically evaluable (CE) and modified intent-to-treat efficacy (MITTE) populations.. Patients hospitalized in a non-intensive care unit setting with CAP of Pneumonia Outcomes Research Team (PORT) risk class III or IV requiring intravenous (iv) therapy were randomized (1:1) to receive 600 mg of ceftaroline fosamil iv every 12 h or 1 g of ceftriaxone iv every 24 h. Patients also received two 500 mg doses of oral clarithromycin every 12 h administered on day 1. Clinical cure, microbiological response, adverse events (AEs) and laboratory tests were assessed. FOCUS 1 registration number NCT00621504 (http://clinicaltrials.gov/ct2/show/NCT00621504).. Of 613 enrolled patients, 298 received ceftaroline fosamil and 308 received ceftriaxone. Baseline characteristics between treatment groups were comparable. Clinical cure rates were as follows: CE population, 86.6% (194/224) for ceftaroline fosamil and 78.2% (183/234) for ceftriaxone [difference (95% CI), 8.4% (1.4, 15.4)]; and MITTE population, 83.8% (244/291) for ceftaroline fosamil and 77.7% (233/300) for ceftriaxone [difference (95% CI), 6.2% (-0.2, 12.6)]. Clinical cure rates for CAP caused by S. pneumoniae in the microbiological MITTE population were 88.9% (24/27) and 66.7% (20/30) for ceftaroline fosamil and ceftriaxone, respectively. Both agents were well tolerated, with similar rates of AEs, serious AEs, deaths and discontinuations because of an AE. The most common AEs for ceftaroline fosamil-treated patients were diarrhoea, headache, insomnia and nausea, and the most common AEs for ceftriaxone-treated patients were hypokalaemia, hypertension, nausea and diarrhoea.. Ceftaroline fosamil demonstrated high clinical cure and microbiological response rates in hospitalized patients with CAP of PORT risk class III or IV. Ceftaroline fosamil was well tolerated, with a safety profile similar to that of ceftriaxone and consistent with the cephalosporin class. In this study, ceftaroline fosamil was an effective and well-tolerated treatment option for CAP.

Topics: Aged; Aged, 80 and over; Bacteria; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pneumonia, Bacterial; Treatment Outcome

Ceftaroline fosamil, the prodrug of the active metabolite ceftaroline, is a broad-spectrum, parenteral cephalosporin approved for treatment of moderate to severe bacterial infections, including community-acquired pneumonia (CAP). This report provides an integrated safety summary of the ceFtarOline Community-acquired pneUmonia trial versuS ceftriaxone (FOCUS) 1 and 2 trials (registration numbers: NCT00621504 and NCT00509106).. Patients hospitalized with CAP requiring intravenous therapy and having Pneumonia Outcomes Research Team (PORT) risk class scores of III or IV were randomized (1:1) to receive 600 mg of ceftaroline fosamil administered intravenously every 12 h or 1 g of ceftriaxone administered intravenously every 24 h for 5-7 days. All patients were followed for treatment-emergent adverse events (TEAEs) occurring from the start of the initial study drug infusion up to the test-of-cure visit; serious adverse events (SAEs) including deaths occurring up to the late follow-up visit or within 30 days after the last dose were additionally recorded. Scheduled laboratory testing was conducted up to the test-of-cure visit; unscheduled testing continued up to the late follow-up visit.. A total of 1228 patients (613 in the ceftaroline fosamil group and 615 in the ceftriaxone group) received any amount of drug and were included in the safety analysis. The incidences of TEAEs (47.0% versus 45.7%), SAEs (11.3% versus 11.7%), discontinuations (4.4% versus 4.1%) and deaths (2.4% versus 2.0%) were similar between the ceftaroline fosamil and the ceftriaxone groups, respectively. Diarrhoea (4.2%), headache (3.4%) and insomnia (3.1%) were the most commonly reported TEAEs in patients treated with ceftaroline fosamil. The distribution of TEAEs based on severity was also similar between groups, and the majority of patients in both treatment groups (∼75%) had either no TEAEs or only mild TEAEs.. The data from the FOCUS 1 and FOCUS 2 trials presented in this integrated safety summary demonstrate that ceftaroline fosamil is well tolerated, with a tolerability profile similar to ceftriaxone and the cephalosporin class overall, with no unexpected safety concerns being identified.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pneumonia, Bacterial

Cephalosporins have been widely used over the last few decades (often as first-line antibiotic therapy) for numerous infections, owing primarily to their broad spectrum of microbiologic activity and favorable safety profile. Current Infectious Diseases Society of America guidelines identify a third-generation cephalosporin in combination with a macrolide antibiotic as an option for treatment of hospitalized adult patients with community-acquired pneumonia (CAP) outside the intensive care unit setting. Although ceftriaxone is a frequently used agent for CAP, increasing incidence of multidrug-resistant Streptococcus pneumoniae and concerns regarding poor outcomes associated with ineffective therapy have prompted the search for a well-tolerated treatment alternative that is effective against bacteria that can cause CAP. Ceftaroline fosamil, the prodrug of ceftaroline, is a new extended-spectrum cephalosporin that exhibits time-dependant bactericidal activity against numerous Gram-negative and Gram-positive organisms, including methicillin-resistant Staphylococcus aureus and penicillin-resistant S. pneumoniae. Notable exceptions include Pseudomonas spp. and Gram-negative organisms that produce extended-spectrum β-lactamases or carbapenemases. Two large Phase III clinical trials (FOCUS 1 and 2) reported that ceftaroline fosamil was well tolerated, with a clinical cure rate of CAP that was noninferior to that with ceftriaxone in nonintensive care unit adult inpatients with moderately severe (Pneumonia Outcomes Research Team score of III or IV) community-acquired pneumonia.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Europe; Female; Humans; Infusions, Intravenous; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Treatment Outcome; United States

To compare clinical response to initial empiric treatment with oxacillin plus ceftriaxone and amoxicillin plus clavulanic acid in hospitalized children diagnosed with very severe community-acquired pneumonia (CAP).. A prospective randomized clinical study was conducted among children 2 months to 5 years old with a diagnosis of very severe CAP in the pediatric ward of São Paulo State University Hospital in Botucatu, São Paulo, Brazil, from April 2007 to May 2008. Patients were randomly divided into two groups by type of treatment: an oxacillin/ceftriaxone group (OCG, n = 48) and an amoxicillin/clavulanic acid group (ACG, n = 56). Analyzed outcomes were: time to clinical improvement (fever and tachypnea), time on oxygen therapy, length of stay in hospital, need to widen antimicrobial spectrum, and complications (including pleural effusion).. The two groups did not differ statistically for age, sex, symptom duration before admission, or previous antibiotic treatment. Time to improve tachypnea was less among ACG patients than OCG patients (4.8 ± 2.2 versus 5.8 ± 2.4 days respectively; P = 0.028), as was length of hospital stay (11.0 ± 6.2 versus 14.4 ± 4.5 days respectively; P = 0.002). There were no statistically significant differences between the two groups for fever improvement time, time on oxygen therapy, need to widen antimicrobial spectrum, or frequency of pleural effusion.. Both treatment plans are effective in treating very severe CAP in 2-month-to 5-year-old hospitalized children. The only analyzed outcome that favored amoxicillin/clavulanic acid treatment was time required to improve tachypnea.. ClinicalTrials.gov ID: NCT01166932.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Combined Modality Therapy; Community-Acquired Infections; Female; Hospitals, Pediatric; Humans; Infant; Inpatients; Male; Oxacillin; Oxygen Inhalation Therapy; Pneumonia, Bacterial; Prospective Studies; Tachypnea; Time Factors; Treatment Outcome

Ceftaroline, the active form of ceftaroline fosamil, is a broad-spectrum cephalosporin with bactericidal activity against pathogens causing community-acquired pneumonia (CAP), including Streptococcus pneumoniae. Ceftaroline was evaluated for the treatment of CAP in 2 randomized, double-blind, multicenter trials: Ceftaroline Community Acquired Pneumonia Trial versus Ceftriaxone in Hospitalized Patients (FOCUS) 1 and FOCUS 2.. Patients hospitalized (but not admitted to an intensive care unit) with Pneumonia Outcomes Research Team risk class III or IV CAP requiring intravenous therapy were randomized to ceftaroline 600 mg every 12 h or ceftriaxone 1 g every 24 h for 5-7 days. Patients in FOCUS 1 received 2 doses of oral clarithromycin 500 mg every 12 h on day 1.. In the individual trials, clinical cure rates in the clinically evaluable (CE) population for ceftaroline versus ceftriaxone were as follows: FOCUS 1, 86.6% vs 78.2% (difference, 8.4%; 95% confidence interval [CI], 1.4%-15.4%); FOCUS 2, 82.1% vs 77.2% (difference, 4.9%; 95% CI, -2.5% to 12.5%). In the integrated analysis, 614 patients received ceftaroline and 614 received ceftriaxone. Of the CE patients treated with ceftaroline, 84.3% achieved clinical cure, compared with 77.7% of ceftriaxone-treated patients (difference, 6.7%; 95% CI, 1.6%-11.8%). Clinical cure rates in the modified intent-to-treat efficacy population were 82.6% versus 76.6% for ceftaroline and ceftriaxone (difference, 6.0%; 95% CI, 1.4%-10.7%). Ceftaroline and ceftriaxone were well tolerated; rates of adverse events, serious adverse events, deaths, and premature discontinuations caused by an adverse event were similar in both treatment arms.. Ceftaroline was noninferior to ceftriaxone in the individual trials. In this integrated analysis, clinical cure rates for the ceftaroline group were numerically higher than those for the ceftriaxone group. Ceftaroline was well tolerated, with a safety profile similar to that of ceftriaxone.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Pneumonia, Bacterial; Treatment Outcome

The carbapenem antibiotic ertapenem has been shown to be safe, well tolerated and effective in treating adults with complicated urinary tract infection, skin and soft-tissue infection and community-acquired pneumonia. In this study, we evaluated ertapenem for treating these infections in children in a randomised, double-blind, active-controlled clinical trial. The primary outcome was the incidence of clinical and laboratory drug-related serious adverse events (AEs). Children were randomised in a 3:1 ratio (ertapenem:ceftriaxone) stratified by index infection and age to receive ertapenem or ceftriaxone; 303 children received ertapenem and 100 children received ceftriaxone. The median duration of parenteral therapy was 4 days for both treatments. The most commonly reported drug-related clinical AEs during parenteral therapy were diarrhoea (5.9% ertapenem, 10% ceftriaxone), infusion site erythema (3% ertapenem, 2% ceftriaxone) and infusion site pain (5% ertapenem, 1% ceftriaxone). One child in each group reported a serious drug-related clinical AE. No serious drug-related laboratory AEs were reported. In children aged 3 months to 17 years, ertapenem was well tolerated and had a comparable safety profile to that of ceftriaxone.

Topics: Adolescent; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Double-Blind Method; Ertapenem; Female; Humans; Infant; Male; Molecular Sequence Data; Pneumonia, Bacterial; Skin Diseases, Bacterial; Soft Tissue Infections; Urinary Tract Infections

We monitored the serum concentration of ceftriaxone (CTRX) in order to clarify its pharmacokinetics in pediatric patients. Subjects were 21 patients undergoing CTRX therapy (50 mg/kg/d) for pneumonia from January to September 2007. To determine the serum concentration of CTRX and to obtain other laboratory data, blood samples were drawn just before and after drug administration. To clarify the relationship between protein concentration and the protein binding ratio of CTRX in vitro and in vivo, the effect of human albumin on the binding ratio was investigated. Thereafter, the relationship between the protein binding ratio and the concentration of CTRX in pediatric patients was analyzed. There was no significant correlation between age and the elimination half-life of CTRX. Moreover, no significant differences were observed in the distribution volume and the clearance between pediatric patients and adults. The binding ratios increased with increased CTRX and albumin concentrations in both in vitro and in vivo studies. It was suggested that the CTRX concentration just before administration (i.e., C(trough)) was sufficiently maintained above the mean inhibitory concentration against Streptococcus pneumoniae and Haemophilus influenzae. Therefore, CTRX administration once daily to pediatric patients with pneumonia was shown to be bacteriologically and pharmacokinetically superior in terms of efficacy.

Topics: Age Factors; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Half-Life; Humans; Infant; Pneumonia, Bacterial; Regression Analysis

Community-Acquired Pneumonia (CAP) is a major public health problem. In Brazil it has been estimated that 2,000,000 people are affected by CAP every year. Of those, 780,000 are admitted to hospital, and 30,000 have death as the outcome. This is an open-label, non-comparative study with the purpose of evaluating efficacy, safety, and tolerability levels of IV azithromycin (IVA) and IV ceftriaxone (IVC), followed by oral azithromycin (OA) for the treatment of inpatients with mild to severe CAP. Eighty-six patients (mean age 56.6 +/- 19.8) were administered IVA (500 mg/day) and IVC (1g/day) for 2 to 5 days, followed by AO (500 mg/day) to complete a total of 10 days. At the end of treatment (EOT) and after 30 days (End of Study--EOS) the medication was evaluated clinically, microbiologically and for tolerability levels. Out of the total 86-patient population, 62 (72.1%) completed the study. At the end of treatment, 95.2% (CI95: 88.9% - 100%) reported cure or clinical improvement; at the end of the study, that figure was 88.9% (CI95: 74.1% - 91.7%). Out of the 86 patients enrolled in the study, 15 were microbiologically evaluable for bacteriological response. Of those, 6 reported pathogen eradication at the end of therapy (40%), and 8 reported presumed eradication (53.3%). At end of study evaluation, 9 patients showed pathogen eradication (50%), and 7 showed presumed eradication (38.89%). Therefore, negative cultures were obtained from 93.3% of the patients at EOT, and from 88.9% at the end of the study. One patient (6.67% of patient population) reported presumed microbiological resistance. At study end, 2 patients (11.11%) still reported undetermined culture. Uncontrollable vomiting and worsening pneumonia condition were reported by 2.3% of patients. Discussion and Conclusion Treatment based on the administration of IV azithromycin associated to ceftriaxone and followed by oral azithromycin proved to be efficacious and well-tolerated in the treatment of Brazilian inpatients with CAP.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Follow-Up Studies; Humans; Middle Aged; Pneumonia, Bacterial; Severity of Illness Index; Treatment Outcome; Young Adult

This study presents a cost-minimisation analysis of moxifloxacin compared to combination treatment with levofloxacin and ceftriaxone in patients hospitalised with community-acquired pneumonia (CAP) in Germany.. In the MOTIV study, 738 adult patients with CAP requiring hospitalisation and initial parenteral antibiotic therapy were randomised to sequential IV/oral therapy with either moxifloxacin (n = 368), or levofloxacin and ceftriaxone (n = 365). The primary effectiveness endpoint was the proportion of patients demonstrating clinical improvement 5-7 days after the completion of study treatment. Subgroup analysis considered patients with severe CAP according to pneumonia severity index (PSI) risk class IV and V, microbiologically proven infection, a history of chronic obstructive pulmonary disease, and a history of cardiovascular disease. The analysis included the cost of study medication, hospital stay, readmission and inpatient procedures and diagnostics. Event frequency in the study was multiplied by German unit costs to estimate per-patient expenditure. The analysis was conducted from a hospital perspective. Sensitivity analysis investigated the effect of costing from an insurer perspective.. No significant difference was found in the percentage of successfully treated patients. Average per patient cost was euro 2190 for the moxifloxacin group, and euro 2619 for the levofloxacin + ceftriaxone group (difference -euro 430, 95% CI: -euro 138, -euro 740; p < 0.05). Variability in total costs was wide, with some patients accruing up to euro 18,000. Medication cost was significantly lower with moxifloxacin than levofloxacin + ceftriaxone (-euro 470, 95% CI: -euro 522, -euro 421), and accounted for between 15 and 30% of total costs.. In this analysis of patients hospitalised with CAP in Germany, treatment with moxifloxacin was significantly less costly than treatment with levofloxacin and ceftriaxone.

Topics: Administration, Oral; Aza Compounds; Ceftriaxone; Community-Acquired Infections; Cost of Illness; Cost-Benefit Analysis; Cross-Over Studies; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluoroquinolones; Follow-Up Studies; Hospitalization; Humans; Infusions, Intravenous; Length of Stay; Levofloxacin; Male; Moxifloxacin; Ofloxacin; Pneumonia, Bacterial; Prospective Studies; Quinolines; Severity of Illness Index; Treatment Outcome

The aim of this study was to show that sequential intravenous and oral moxifloxacin monotherapy (400 mg once per day) is as efficacious and safe as a combination regimen (intravenous ceftriaxone, 2 g once per day, plus sequential intravenous and oral levofloxacin, 500 mg twice per day) in patients hospitalized with community-acquired pneumonia.. We conducted a prospective, multicenter, randomized, double-blind noninferiority trial. Patients with a Pneumonia Severity Index (PSI) of III-V were stratified on the basis of PSI risk class before randomization. The primary efficacy end point was clinical response at test of cure (4-14 days after the completion of treatment). Secondary efficacy end points were clinical and bacteriological response at end of treatment (days 7-14) and at follow-up assessment (21-28 days after the end of treatment), overall mortality, and mortality attributable to pneumonia.. Seven hundred thirty-three patients were enrolled in the study (368 in the moxifloxacin arm and 365 in the comparator arm); 49% had a PSI of IV, and 10% had a PSI of V. Of 569 patients (291 in the moxifloxacin arm and 278 in the comparator arm) valid for per-protocol analysis, the overall clinical cure rates at test of cure were 86.9% for moxifloxacin and 89.9% for the comparator regimen (95% confidence interval, -8.1% to 2.2%). Bacteriological success at test of cure was 83.3% for moxifloxacin and 85.1% for the comparator regimen (95% confidence interval, -15.4% to 11.8%). There were no significant differences between moxifloxacin and comparator treatments in the incidence of treatment-emergent adverse events or in mortality.. Monotherapy with sequential intravenous/oral moxifloxacin was noninferior to treatment with ceftriaxone plus levofloxacin combination therapy in patients with community-acquired pneumonia who required hospitalization.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Aza Compounds; Bacteria; Ceftriaxone; Community-Acquired Infections; Double-Blind Method; Drug Therapy, Combination; Female; Fluoroquinolones; Humans; Levofloxacin; Male; Middle Aged; Moxifloxacin; Ofloxacin; Pneumonia, Bacterial; Prospective Studies; Quinolines; Severity of Illness Index; Treatment Outcome

To compare once-daily intramuscular cefepime with ceftriaxone controls.. Double-blind study.. Six skilled nursing facilities.. Residents aged 60 and older with nursing home-acquired pneumonia.. Cultures were obtained, and patients were randomized to cefepime or ceftriaxone 1 g intramuscularly every 24 hours.. Clinical success: cure or improvement. Cure was defined as complete resolution of all symptoms and signs of pneumonia or a return to the patient's baseline state. Improvement was defined as clear improvement but incomplete resolution of all pretherapy symptoms or signs or incomplete return to the patient's usual baseline status. Safety and pharmacoeconomics were also assessed.. Sixty-nine patients were randomized; 61 were evaluable: (32 to cefepime, 29 ceftriaxone). Patients were predominately female (76%). They had a mean age+/-standard deviation of 85+/-6, with a mean 5.8+/-1.9 comorbidities; they had age-appropriate renal dysfunction, with a mean estimated creatinine clearance of 35+/-7 mL/min. Clinical success occurred in 78% of cefepime- and 66% of ceftriaxone-treated patients (P=.39). Fifty-seven patients (93%) were switched to oral antibiotics after 3 days. Antibiotic-related adverse events occurred in 5% of patients. Seven patients (11.5%) were hospitalized. The overall mortality rate was 8%. Mean antibiotic costs were 117+/-40 dollars for cefepime- and 215+/-68 dollars for ceftriaxone-treated patients (P<.001). Cost-effectiveness analysis of total costs showed that cefepime would cost 597 dollars and ceftriaxone 1,709 dollars per expected successfully treated patient. One- and two-way sensitivity analyses using a generic price for ceftriaxone and improving its comparative efficacy revealed that the results were robust.. Once-daily cefepime was a cost-effective alternative to ceftriaxone for the treatment of elderly nursing home residents who developed pneumonia and did not require hospitalization.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefepime; Ceftriaxone; Cephalosporins; Cross Infection; Double-Blind Method; Drug Administration Schedule; Drug Costs; Female; Humans; Injections, Intramuscular; Male; Nursing Homes; Pneumonia, Bacterial

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

Empiric treatment of hospital-acquired pneumonia (HAP) should be focused on the suspected pathogens. We evaluated the efficacy and safety of moxifloxacin vs ceftriaxone in patients with HAP without risk of infections with Pseudomonas aeruginosa and other non-fermentative Gram-negative bacteria.. We performed a prospective, randomized, non-blind, multicentric and multinational study to compare the efficacy and safety of moxifloxacin 400 mg IV once daily followed by oral moxifloxacin 400 mg once daily to ceftriaxone 2 g IV once daily followed by oral cefuroxime axetil 500 mg twice daily to treat mild-to-moderate HAP in adult patients requiring initial parenteral therapy. The primary efficacy variable was clinical response 7-10 days after the end of a 7-14-day treatment period, secondary endpoints included clinical and bacteriologic response at different intervals for up to 31 days after treatment. The trial was terminated prematurely due to slow patient recruitment.. A total of 161 subjects (87 men, 74 women) between 18 and 95 years of age were enrolled, 120 of whom were eligible for per protocol efficacy analyses (60 each in the moxifloxacin and the comparator groups). Clinical success rates were 87% for moxifloxacin and 83% for the comparator [95% CI (-9.77 to 15.96%)]. The results for secondary endpoints were comparable between groups. Both treatments were safe and well tolerated.. Moxifloxacin IV/oral can be considered as a possible alternative for the antibiotic treatment of patients with mild-to-moderate nosocomial pneumonia without risk factors for highly resistant microorganisms.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Aza Compounds; Bacteria; Ceftriaxone; Cefuroxime; Cross Infection; Drug Therapy, Combination; Endpoint Determination; Female; Fluoroquinolones; Humans; Injections, Intravenous; Male; Middle Aged; Moxifloxacin; Pneumonia, Bacterial; Quinolines; Treatment Outcome

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

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

In looking for outcome differences beyond rates of cure, we prospectively compared the symptom resolution, side effects, and processes of care between the use of clarithromycin and gatifloxacin for the treatment of radiographically confirmed community-acquired pneumonia. We conducted a multicenter, randomized, open-label study comparing gatifloxacin monotherapy to clarithromycin alone or combined with ceftriaxone for patients with multiple risk factors. We measured the return to usual activities and symptoms over seven interviews ending 42 days after randomization. Admission and hospital discharge decision support were provided to treating physicians. We enrolled 266 patients over the age of 18 years between September 2000 and June 2003. The groups were similar in age and gender, with a mean age of 53.5+/-19.4 years, and were 54% female. Patient severity as determined by the number of risk factors and the Pneumonia Severity Index was similar between groups; 95% of the patients were low risk. A total of 91% of patients completed at least five of seven symptom interviews. In the clarithromycin study arm, 64% received concomitant therapy with ceftriaxone. We found no significant difference in return to usual activities, pneumonia-specific symptom scores, and 12-item short-form health survey scores. Individual symptom scores were similar except for bad taste and injection site soreness, which were higher in clarithromycin patients. The rates of hospital admission and length of stay were similar. The cost of antibiotic was higher in the clarithromycin group: $257 versus $110 for gatifloxacin. We found that gatifloxacin monotherapy is similar to clarithromycin given with or without ceftriaxone for the treatment of community-acquired pneumonia, except that antibiotic cost, bad taste, and injection site soreness favor the use of gatifloxacin.

Topics: Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Clarithromycin; Community-Acquired Infections; Drug Therapy, Combination; Fluoroquinolones; Gatifloxacin; Humans; Length of Stay; Middle Aged; Pneumonia, Bacterial; Prospective Studies

Consecutive adult patients admitted to the hospital with community-acquired pneumonia from January 2000 to September 2003 were included in this prospective observational cohort study. A total of 459 patients, 259 treated with levofloxacin in single drug therapy at a dose of 500 mg once a day and 209 with the combination of ceftriaxone plus clarithromycin at a dose of 2 g once a day and 500 mg every 12 h, respectively, were included. The hospital admission decision was made using a clinical guideline based on the Pneumonia Severity Index (PSI). Fifteen (6%) patients died in the group treated with levofloxacin in single drug therapy and 25 (12%) in the group treated with ceftriaxone plus clarithromycin (P = 0.024). The mortality differences between both treatment groups, adjusted by the PSI score, show an OR of 0.39 (95% CI 0.17-0.87). There were no statistically significant differences between the duration of treatments or hospital stay. These data suggest that levofloxacin as single drug therapy is more effective than the combination of ceftriaxone plus clarithromycin in the treatment of moderate to severe pneumonia that requires hospitalization.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Clarithromycin; Cohort Studies; Community-Acquired Infections; Drug Therapy, Combination; Female; Hospitalization; Humans; Levofloxacin; Male; Ofloxacin; Pneumonia, Bacterial; Prospective Studies; Treatment Outcome

To assess the effectiveness and safety of implementing an inpatient management and discharge strategy based on empiric antibiotic therapy with ceftriaxone sodium and a guideline to promote timely discharge for clinically stable patients hospitalized with community-acquired pneumonia.. A cluster randomized controlled clinical trial with 30 days of patient follow-up at 8 teaching hospitals and 17 nonteaching hospitals nationwide.. Participants included 240 intervention patients and 209 control patients admitted by 85 physician groups between December 1998 and December 1999. Within each hospital, defined physician practice groups were randomized to the intervention arm (physician notification coupled with ceftriaxone sodium as empiric therapy) or control arm (neither component). Physicians in the intervention arm were notified when their patients met guideline criteria for clinical stability; physicians in the control arm were not contacted.. The median length of stay was 4 days in both study arms. The observed reduction in costs associated with the intervention was not statistically significant when cost outliers were excluded. Mortality, serious adverse event, and rehospitalization rates did not differ significantly across study arms.. Implementation of an inpatient management strategy based on physician reminders coupled with empiric use of ceftriaxone sodium did not reduce length of stay or associated medical care costs for patients hospitalized with community-acquired pneumonia. These negative findings are most likely due to insufficient potency of the intervention, inadequate guideline implementation, or imbalances in baseline patient characteristics.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Disease Management; Female; Guidelines as Topic; Humans; Inpatients; Male; Middle Aged; Patient Discharge; Pneumonia, Bacterial; United States

Although third-generation cephalosporins, such as ceftriaxone (CTRX), and pneumococcal fluoroquinolones, such as moxifloxacin (MXF), are currently recommended first-line antibiotics for empirical treatment of inpatients with community-acquired pneumonia, CTRX and MXF have never undergone a head-to-head comparison. We therefore compared the efficacy, safety, and speed and quality of defervescence of sequential intravenous or oral MXF and high-dose CTRX with or without erythromycin (CTRX+/-ERY) for patients with community-acquired pneumonia requiring parenteral therapy.. In this prospective, multicenter, randomized, controlled, nonblinded study, 397 patients were randomly assigned to receive either MXF (400 mg once daily intravenously, possibly followed by oral tablets) or CTRX (2 g intravenously once daily) with or without ERY (1 g intravenously every 6-8 h) for 7-14 days.. Among 317 patients evaluable for efficacy and safety, 138 (85.7%) of 161 MXF-treated patients and 135 (86.5%) of 156 CTRX+/-ERY-treated patients (59 [37.8%] of whom received CTRX and ERY) achieved continued clinical resolution. Defervescence and relief of symptoms, such as chest pain, occurred significantly earlier in the MXF-treated group than in the CTRX+/-ERY-treated group. Both regimens were generally well tolerated.. For adult patients hospitalized with community-acquired pneumonia, sequential MXF therapy was clinically equivalent to high-dose CTRX+/-ERY therapy but led to a faster clinical improvement.

Topics: Administration, Oral; Aged; Anti-Bacterial Agents; Aza Compounds; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Erythromycin; Female; Fluoroquinolones; Hospitalization; Humans; Injections, Intravenous; Male; Moxifloxacin; Parenteral Nutrition; Pneumonia, Bacterial; Prospective Studies; Quinolines; Remission Induction; Time Factors

A randomized trial was performed comparing azithromycin and levofloxacin for treating moderately to severely ill patients hospitalized with community-acquired pneumonia. This is a cost-minimization analysis comparing those regimens.. The cost-minimization analysis compares 81 patients receiving sequential therapy with IV azithromycin plus IV ceftriaxone followed by oral azithromycin with 82 patients receiving IV levofloxacin followed by oral levofloxacin, all with complete economic data over approximately 30 days, including information about hospitalization, study medications, home care, postdischarge utilization, and lost productivity. Units of utilization were multiplied by unit prices in order to estimate cost per patient. These total costs were compared using a two-sample t test.. Direct medical costs of the azithromycin group were 2,481 US dollars less than the corresponding costs in the levofloxacin group (p = 0.03; 95% confidence interval, 238 US dollars to 4,724 US dollars). Most of the cost difference (2,300 US dollars) is attributable to hospital days, with the majority of these days being spent on the general medicine wards. The precise magnitude of the cost advantage attributable to azithromycin, if any, depends on both the reduction in length of hospital stay and its associated daily cost.. Azithromycin was no more costly than levofloxacin, and perhaps less so. Cost is but one of many factors that should be considered by clinicians in decisions involving any individual patient.

Topics: Aged; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Community-Acquired Infections; Costs and Cost Analysis; Drug Therapy, Combination; Female; Home Care Services; Hospitalization; Humans; Length of Stay; Levofloxacin; Male; Ofloxacin; Pneumonia, Bacterial; United States

The efficacy and safety of ertapenem, 1 g once a day, for the treatment of community-acquired pneumonia (CAP) requiring parenteral therapy were compared with those of ceftriaxone, 1 g once a day, in 866 hospitalized adults randomized in two prospective, double-blind, multicentre studies. Patients were stratified according to Pneumonia Severity Index (< or = 3 or >3) or age (< or = 65 or >65 years). After > or = 3 days of parenteral antimicrobial therapy, patients who had clinically improved could be switched to oral co-amoxiclav. The median durations of parenteral, oral and total therapy in the 658 clinically evaluable patients, of whom 88% were switched to oral therapy, were 4, 7 and 12 days, respectively, in both treatment groups. The most common pathogen was Streptococcus pneumoniae, of which 79% (143/181) were penicillin susceptible and 3.3% (6/181; three in each treatment group) were penicillin resistant. Cure rates for the two treatments were equivalent: 91.9% for ertapenem and 92.0% for ceftriaxone (95% confidence interval for the difference, adjusted for strata: -4.5 to 4.4). Cure rates in the different severity and age strata and bacterial eradication rates for both treatment groups were also similar. The most common drug-related adverse events in both treatment groups were diarrhoea and mild-to-moderate elevations in aminotransferase levels. The results of these studies demonstrate that ertapenem, 1 g once a day, was highly effective therapy for CAP in hospitalized adults with moderate-to-severe disease.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Double-Blind Method; Ertapenem; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Lactams; Male; Middle Aged; Pneumonia, Bacterial; Treatment Outcome

Community-acquired pneumonia is very common, but some of the cases do require hospitalization for treatment, particularly when older patients and/or co-morbidities are involved; both "typical" and "atypical" respiratory pathogens take part etiologically, and there is increasing concern about the emergence of resistance. There is interest in therapeutic options that can: a) comprehend such a spectrum of bacteria and resistance; b) allow parenteral to oral sequential treatment. We made a multicenter, prospective and randomized trial to compare the "standard" treatment of ceftriaxone IV alone or in combination with erythromycin IV, followed by clarithromycin PO (ceftriaxone treatment arm), with gatifloxacin IV, followed by oral administration (gatifloxacin treatment arm). The need for hospitalization was based on clinical criteria as judged by the investigators. Standardized criteria for diagnosis and follow-up were employed. Fifty-six patients were enrolled, with 48% over 65 years old, and there were frequent co-morbidities. Of these, 51 were clinically evaluable, 26 in the gatifloxacin and 25 in the ceftriaxone arm, with comparable success rates, 92% and 88%, respectively, even when major prognostic factors were considered. There were no serious adverse events or significant laboratory value changes attributable to the study drugs. Gatifloxacin as monotherapy (initially IV then orally until completion of treatment) was shown to be effective and safe, comparable to ceftriaxone IV alone or in combination with a macrolide (initially IV then orally until completion of treatment), in empirical therapy for community-acquired pneumonias, for patients that, at the physician s discretion, require initial treatment as inpatients.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Female; Fluoroquinolones; Gatifloxacin; Humans; Macrolides; Middle Aged; Pneumonia, Bacterial; Prospective Studies

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

The diagnosis and the treatment of community-acquired severe pneumonia is still a serious child health problem in developing countries. The aim of this study is to evaluate the effectiveness of two different antibiotic regimens in the empirical treatment of severe childhood pneumonia.. We enrolled 97 infants (aged 2-24 months) with severe community-acquired pneumonia in a randomized-controlled trial of 10 days of treatment with penicillin G+chloramphenicol (n:46) or ceftriaxone (n:51). We evaluated the effectiveness of treatments with symptoms and some laboratory tests during and at the end of the study.. The cure rates were similar in both groups and the antibiotic regimens in all patients were found effective (P< 0.001). The number of nurse rounds was much more in penicillin plus chloramphenicol group than ceftriaxone group.. Both penicillin G plus chloramphenicol and ceftriaxone are effective in the empirical treatment of severe community pneumonia of young children. In spite of more nurse visits for antibiotic treatment, penicillin G+ chloramphenicol combination may be a cheaper alternative to ceftriaxone in the treatment of childhood pneumonia.

Topics: Ceftriaxone; Child, Hospitalized; Child, Preschool; Chloramphenicol; Community-Acquired Infections; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Hospitals, Urban; Humans; Infant; Male; Penicillin G; Pneumonia, Bacterial; Probability; Prospective Studies; Severity of Illness Index; Survival Rate; Treatment Outcome; Turkey

To compare the efficacy and tolerability of ceftriaxone plus azithromycin with those of levofloxacin in the treatment of hospitalized patients with moderate to severe community-acquired pneumonia (CAP).. Randomized, open-label multicenter trial with 1 : 1 treatment allocation in an inpatient setting.. 212 male or female inpatients with a clinical diagnosis of CAP were included in the study. In each treatment group >50% of patients had a pneumonia severity index of IV or V.. Open-label treatment with either intravenous (IV) ceftriaxone 1g and IV azithromycin 500 mg daily or IV levofloxacin 500 mg daily. Patients who improved clinically were switched to oral follow-on therapy with either azithromycin 500 mg/day or levofloxacin 500 mg/day. At the clinician's discretion, oral cefuroxime axetil was added to the treatment regimen of patients who received oral azithromycin if a macrolide resistant pneumococcal isolate was documented.. Overall, both study treatments were well tolerated. Favorable clinical outcomes in clinically evaluable patients were demonstrated in 91.5% of patients treated with ceftriaxone plus azithromycin and 89.3% (95% CI -7.1%, 11.4%) of patients treated with levofloxacin at the end of therapy visit and in 89.2% and 85.1% (95% CI -6.7%, 14.8%) patients, respectively, at the end of study visit. Bacteriological eradication rates for both treatments were equivalent with the exception of Streptococcus pneumoniae; 44% of isolates were eradicated with levofloxacin compared with 100% of isolates with ceftriaxone plus azithromycin.. As acknowledged by international CAP treatment guidelines, the combination of a third-generation cephalosporin and a macrolide is at least as efficacious as monotherapy with a fluoroquinolone with enhanced anti-pneumococcal activity, for hospitalized patients with moderate to severe CAP. Combined medication with a macrolide and third-generation cephalosporin may be preferred over fluoroquinolones as first-line therapy of hospitalized patients with CAP to minimize the development of multiresistant nosocomial Gram-negative bacilli.

Topics: Administration, Oral; Aged; Anti-Bacterial Agents; Azithromycin; Canada; Ceftriaxone; Community-Acquired Infections; Drug Administration Schedule; Female; Germany; Humans; Infusions, Intravenous; Levofloxacin; Male; Ofloxacin; Pneumonia, Bacterial; Severity of Illness Index; Treatment Outcome; United States

This monocentric prospective randomized study was designed to determine the efficacy of single-shot perioperative antibiotic prophylaxis with 1 g ceftriaxone i.v. in transperitoneal tumor nephrectomy. Eighty-three patients were randomized either into a prophylaxis or a control group: 39 patients received 1 g ceftriaxone i.v. 30 min preoperatively and 44 no study medication. Characteristics of the two groups showed no statistical differences. Postoperative overall infection rates were 7.7% and 27.3% (p=0.007), respectively. Postoperative assessment revealed overall 0 (0%)/7 (15.9%) wound infections, 0 (0%)/2 (4.5%) deep wound infections, 1 (2.6%)/2 (4.5%) pneumoniae, and 2 (5.2%)/3 (6.8%) significant urinary tract infections. In 4 (10.3%)/4 (9.1%) patients, postoperative antibiosis was started without detection of an infectious focus. Overall antibiotic treatment was carried out in 7 (17.9%)/12 (27.3%) patients postoperatively. Costs of antibiotic prophylaxis and/or treatment resulted in 23.60/30.10ZZZ;EUR per patient. Perioperative prophylaxis with 1 g ceftriaxone i.v. decreases postoperative infection rates. Although not all infections have to be treated with antibiotics, there are pharmacoeconomic advantages of such prophylaxis.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Comorbidity; Cross Infection; Cross-Sectional Studies; Female; Humans; Incidence; Infusions, Intravenous; Kidney Neoplasms; Male; Middle Aged; Nephrectomy; Pneumonia, Bacterial; Prospective Studies; Risk Factors; Sepsis; Surgical Wound Infection; Treatment Outcome; Urinary Tract Infections

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

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

In this open, prospective, study were enrolled 204 hospitalized elderly patients with severe (88 males, 116 females, age range 70-94). Patients were randomized to receive one of the following antibiotic treatment regimens: meropenem 500 mg i.v. t.i.d. (52); imipenem/cilastatin 500 mg i.v. t.i.d. (51), clarithromycin 500 mg + ceftriaxone 1 g i.v. b.i.d. (52), clarithromycin 500 mg + amikacin 250 mg i.v. b.i.d. (49). In 99 cases causative germs were isolated (24 meropenem, 26 imipenem, 23 clarithromycin + ceftriaxone, 26 ceftriaxone + amikacin). A satisfactory clinical, bacteriological response was achieved respectively in 86.5% 77% in meropenem; 86.3% 71% in imipenem/cilastatin; 69% 61% in ceftriaxone + clarithromycin and in 85.7% 77% in clarithromycin + amikacin. The mean total cost for each patient was $1,560; $1,620; $1,760 and $1,792 in meropenem, imipenem/cilastatin, clarithromycin + ceftriaxone and clarithromycin + amikacin respectively. This study shows that treatment with either meropenem or imipenem is as efficacious as conventional therapy in the treatment of community acquired pneumonia (CAP), and that meropenem is the most cost-effective.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Carbapenems; Ceftriaxone; Cilastatin; Cilastatin, Imipenem Drug Combination; Clarithromycin; Community-Acquired Infections; Costs and Cost Analysis; Drug Combinations; Drug Costs; Drug Therapy, Combination; Female; Hospitalization; Humans; Imipenem; Male; Meropenem; Pneumonia, Bacterial; Prospective Studies; Thienamycins; Treatment Outcome

In a double-blind, multicenter trial, 502 patients hospitalized with community-acquired pneumonia were randomized to receive therapy with either ertapenem or ceftriaxone (for each, 1 g given intravenously once daily). After a minimum of 3 days, therapy could be switched to oral amoxicillin-clavulanate. The median duration of intravenously administered therapy for the 383 clinically evaluable patients was 4 days for both treatment groups; 345 patients (90.1%) had their treatment switched to orally administered therapy. Of the clinically evaluable patients, 168 (92.3%) in the ertapenem group and 183 (91.0%) in the ceftriaxone group had a favorable clinical response. Streptococcus pneumoniae was the most commonly isolated pathogen, and high cure rates were observed both for penicillin-susceptible and -nonsusceptible infections in the ertapenem group (28 [87.5%] of 32 patients versus 17 [100%] of 17 patients, respectively). Both treatment regimens were generally well tolerated; the most common drug-related adverse events reported were diarrhea (2.9% versus 2.7%) and nausea (0.8% versus 2.0%) in the ertapenem and ceftriaxone groups, respectively. These results suggest that ertapenem and ceftriaxone therapy have similar efficacy and safety in hospitalized patients with community-acquired pneumonia.

Topics: Adult; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Drug Tolerance; Ertapenem; Female; Humans; Lactams; Male; Middle Aged; Pneumonia, Bacterial; Prospective Studies; Treatment Outcome

Empirical antibiotic therapy of community-acquired pneumonia (CAP) has been complicated by the worldwide emergence of penicillin resistance among Streptococcus pneumoniae. The impact of this resistance on the outcome of patients hospitalized for CAP, empirically treated with betalactams, has not been evaluated in a randomized study. We conducted a prospective, randomized trial to assess the efficacy of amoxicillin-clavulanate (2 g/200 mg/8 hr) and ceftriaxone (1 g/24 hr) in a cohort of patients hospitalized for moderate-to-severe CAP. Three-hundred seventy-eight patients were randomized to receive amoxicillin-clavulanate (184 patients) or ceftriaxone (194 patients). Efficacy was assessed on Day 2, after completion of therapy and at long term follow-up. There were no significant differences in outcomes between treatment groups, both in intention-to-treat and per-protocol analysis. Overall mortality was 10.3% for amoxicillin-clavulanate and 8.8% for ceftriaxone (NS). There were 116 evaluable patients with proven pneumococcal pneumonia. Rates of high-level penicillin resistance (MIC of penicillin > or = 2 microg/mL) were similar in the two groups (8.2 and 10.2%). Clinical efficacy at the end of therapy was 90.6% for amoxicillin-clavulanate and 88.9% for ceftriaxone (95% C.I. of the difference: -9.3 to +12.7%). No differences in outcomes were attributable to differences in penicillin susceptibility of pneumococcal strains. Sequential i.v./oral amoxicillin-clavulanate and parenteral ceftriaxone were equally safe and effective for the empirical treatment of acute bacterial pneumonia, including penicillin and cephalosporin-resistant pneumococcal pneumonia. The use of appropriate betalactams in patients with penumococcal pneumonia and in the overall CAP population, is reliable at the current level of resistance.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactam Resistance; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin G; Penicillins; Pneumonia, Bacterial; Streptococcus pneumoniae

To determine the cost-effectiveness of sequential IV to oral gatifloxacin therapy vs IV ceftriaxone with or without IV erythromycin to oral clarithromycin therapy to treat community-acquired pneumonia (CAP) patients requiring hospitalization.. Two hundred eighty-three patients enrolled in a randomized, double-blind, clinical trial were eligible for inclusion in the cost-effectiveness analysis.. Data collected included patient demographics, clinical and microbiological outcomes, length of stay (LOS), and antibiotic-related LOS (LOSAR). Costs evaluated include drug acquisition (level 1); plus costs of preparation, dispensing, and administration, treating adverse events, and clinical failures (level 2); plus hospital per diem costs (level 3). Robustness of economic findings was tested using sensitivity analyses.. Two hundred three patients were clinically and economically evaluable (98 receiving gatifloxacin and 105 receiving ceftriaxone). IV erythromycin was administered to 35 patients in the ceftriaxone-treated group. Oral conversion was achieved in 98% of patients in each group. Clinical cure and microbiological eradication rates did not differ statistically (98% and 97% with gatifloxacin vs 92% and 92% with ceftriaxone, respectively). Overall, neither geometric mean LOS nor LOSAR differed significantly (4.2 days and 4.1 days with gatifloxacin vs 4.9 days and 4.9 days with ceftriaxone, respectively). Treatment failures in the ceftriaxone group contributed to a mean incremental increase in LOSAR of 1.09 days and increased mean cost per patient. The geometric mean costs per patient (level 3) were $5,109 for gatifloxacin and $6,164 for ceftriaxone (p = 0.011). The cost-effectiveness ratios (mean cost per expected success) were $5,236:1 and $7,047:1 for gatifloxacin and ceftriaxone, respectively.. Gatifloxacin monotherapy for CAP patients requiring hospitalization is clinically effective and provides an economic advantage compared to the regimen of ceftriaxone with or without erythromycin IV with a switch to oral clarithromycin.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Cost-Benefit Analysis; Decision Trees; Double-Blind Method; Female; Fluoroquinolones; Gatifloxacin; Humans; Macrolides; Male; Middle Aged; Pneumonia, Bacterial; Prospective Studies

The purpose of this study was to assess the value of tracheal aspirate as a predictor of pneumonia after coronary artery bypass grafting and to evaluate the efficacy of prolonged perioperative antibiotic prophylaxis.. Tracheal aspirates of 500 patients undergoing coronary artery bypass grafting were taken immediately after intubation and analyzed for microorganisms by Gram stain and semiquantitative microbiologic cultures. All patients received 2 g ceftriaxone as a single-dose perioperative antibiotic prophylaxis before operation. Results of Gram stains were available before the patients were transferred to the intensive care unit. After the results were known, both groups of patients (positive Gram stain, group 1; negative Gram stain, group 2) were randomly assigned to either conventional antibiotic prophylaxis (A), consisting of ceftriaxone 2 g on postoperative day 1, or prolonged antibiotic prophylaxis (B), with ticarcillin + clavulanic acid 3 x 5.2 g during 72 hours.. From 500 patients, 91 had a positive Gram stain whereas 409 had a negative one. The incidence of pneumonia was significantly higher in patients with preoperative positive tracheal aspirates (15.3%) than in patients with a negative one (3.6%; p < 0.01). However, prolonged prophylaxis did not reduce the rate of postoperative pneumonia, which was as high as 13% in untreated positive patients versus 17% in treated positive patients, and 2% in untreated negative patients versus 4% in treated patients. In patients who had pneumonia, there was a high correlation between the microorganisms found in preoperative aspirates and those observed when aspirates were repeated (100% correlation in patients with conventional antibiotic prophylaxis and 87% in those with prolonged prophylaxis).. Early postoperative pneumonia (<7 days) is most likely caused by microorganisms that colonize the respiratory tract before operation. The risk of pulmonary infection after coronary artery bypass grafting can be predicted from the preoperative tracheal aspirates. Prolonged perioperative antibiotic prophylaxis has no efficacy in reducing the incidence of pulmonary infections.

Topics: Aged; Antibiotic Prophylaxis; Bacteriological Techniques; Ceftriaxone; Clavulanic Acids; Coronary Artery Bypass; Double-Blind Method; Drug Administration Schedule; Female; Humans; Intubation, Intratracheal; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Postoperative Complications; Prospective Studies; Ticarcillin; Trachea

In an open-label, phase 3, randomized, multicenter study, clinafloxacin (200 mg/d) was compared to ceftriaxone (2 g/d; with or without erythromycin) in 527 patients with acute community-acquired bacterial pneumonia (CAP). Primary efficacy parameters were clinical cure rate and microbiologic eradication rates (by pathogen and by patient) determined 5-9 d post-therapy (test of cure; TOC). Clinical cure rates at TOC for the 2 treatment groups were equivalent in the intention-to-treat (clinafloxacin 79.3, ceftriaxone 78.6%), clinically evaluable (clinafloxacin 88.1, ceftriaxone 85.0%), modified intention-to-treat (clinafloxacin 82.6, ceftriaxone 86.9%) and microbiologically evaluable populations (clinafloxacin 86.2, ceftriaxone 86.2%). Microbiologic eradication rates were similar in the 2 treatment groups. Both drugs were tolerated. Treatment of hospitalized CAP patients with clinafloxacin is a reasonable choice, especially when a resistant pathogen is anticipated.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Cross Infection; Drug Therapy, Combination; Erythromycin; Female; Fluoroquinolones; Humans; Male; Middle Aged; Pneumonia, Bacterial; Prospective Studies; Treatment Outcome

In a prospective, multicentre double-blind trial, 151 patients over the age of 65 years were randomly assigned to receive either cefepime 2 g every 12 h for a minimum of 3 days and up to 14 days or ceftriaxone 1 g every 12 h for a minimum of 3 days and up to 14 days. Antibiotics were maintained until 48 h after fever had resolved; no other antibiotics were permitted. The average age in each group exceeded 77 years and significant co-morbidity was found in the majority of patients. The mean total duration of therapy was 5.8+/-2.4 days for the cefepime group and 6.7+/-2.7 days for the ceftriaxone group (P = 0.06). The clinical success rate at the end of therapy was 79.1% with cefepime and 75.4% with ceftriaxone (P = 0.62). At the end of follow-up, 91.7% of the cefepime-treated patients and 86.5% of the ceftriaxone patients had a satisfactory clinical response (P = 0.38). In 35 bacteriological evaluable patients, potential pathogens were eradicated in all but one patient receiving cefepime. Seven patients in each group died during the study period but in each case the death was unrelated to study drug. The commonest side-effect was diarrhoea (cefepime, five patients; ceftriaxone, two patients). The clinical and microbiological efficacy of cefepime is similar to that of ceftriaxone in elderly patients with community-acquired pneumonia requiring hospitalization. Cefepime is an appropriate choice for the treatment of community-acquired respiratory tract infections in the elderly.

Topics: Aged; Aged, 80 and over; Cefepime; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Female; Humans; Male; Pneumonia, Bacterial; Prospective Studies; Treatment Outcome

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

We evaluated the effect of selective decontamination of the digestive tract (SDD) on the incidence of ventilator-associated pneumonia (VAP) and its associated morbidity and cost in a mixed population of intubated patients. Two hundred seventy-one consecutive patients admitted to the intensive care units (ICUs) of five teaching hospitals and who had an expected need for intubation exceeding 48 h were enrolled and received topical antibiotics or placebo. Uninfected patients additionally received ceftriaxone or placebo for 3 d. VAP occurred in 11.4% of SDD-treated and 29.3% of control-group patients (p < 0.001; 95% confidence interval [CI]: 7.8 to 27.9). The incidence of nonrespiratory infections in the two groups was 19.1% and 30.7%, respectively (p = 0.04; 95% CI: 0.7 to 22.7). Among survivors, the median length of ICU stay was 11 d (interquartile range: 7 to 21.5 d) for the SDD-treated group and 16. 5 d (10 to 30 d) for the control group (p = 0.006). Mean cost per survivor was $11,926 for treated and $16,296 for control-group patients. Mortality was 38.9% and 47.1%, respectively (p = 0.57). In decontaminated patients, the prevalence of gram-negative bacilli fell within 7 d from 47.4% to 13.0% (p < 0.001), whereas colonization with resistant gram-positive strains was higher (p < 0. 05) than in the placebo group. In a mixed population of intubated patients, SDD was associated with a significant reduction of morbidity at a reduced cost. Our findings support the use of SDD in this high-risk group.

Topics: Bacteria; Bacterial Infections; Cause of Death; Ceftriaxone; Cephalosporins; Colony Count, Microbial; Confidence Intervals; Critical Care; Critical Illness; Digestive System; Double-Blind Method; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Health Care Costs; Humans; Incidence; Intubation, Intratracheal; Length of Stay; Male; Middle Aged; Oropharynx; Placebos; Pneumonia, Bacterial; Respiration, Artificial; Survival Rate

Among community-acquired infections, pneumonia is still a large health problem which is of great interest mainly due its high mortality and morbidity. From 1991 to 1997, 409 patients who had been diagnosed with community-acquired pneumonia and had been admitted to the internal medicine service of a university hospital were prospectively studied. The patients were classified into three groups according to the random antibiotic treatment they had received (ceftriaxone, cefuroxime or amoxicillin-clavulanic acid). The initial characteristics of the patients with regard to epidemiology, clinical description and critical situation were similar in all the groups studied. A total of 36.9% of the cases were documented microbiologically, with the most frequently isolated pathogens being Streptococcus pneumoniae and Haemophilus influenzae. The recovery rate was 92.2% and three patients had a recurrence of pneumonia. Global mortality was 5.8%. No statistically significant differences were found in the evolution of patients treated with cefuroxime, ceftriaxone or amoxicillin-clavulanic acid, with the latter representing an empirical treatment of choice for community-acquired pneumonia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Ceftriaxone; Cefuroxime; Cephalosporins; Child; Community-Acquired Infections; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Prospective Studies

A multinational, multicentre, open, randomised study in hospitalised patients with pneumonia compared levofloxacin 500 mg twice daily with ceftriaxone 4 g i.v. once daily. Levofloxacin patients started on i.v. treatment and switched to oral on d 3-5 of therapy if signs and symptoms had improved. The minimum treatment duration was 5 d, except for treatment failure, and the median 8 d. The primary efficacy analysis was based on the per-protocol assessment of the clinical cure rate determined 2-5 d after the end of treatment in the per-protocol (PP) population (levofloxacin 127, ceftriaxone 139). Of 625 patients enrolled and randomized, 6 received no treatment, giving an intention-to-treat (ITT) population of 619 (levofloxacin 314, ceftriaxone 305). At the clinical endpoint, 2-5 d after the end of treatment, the cure rates for levofloxacin and ceftriaxone were similar in both the ITT (76% and 75%, respectively) and PP (87% and 86%, respectively) populations. Both drugs were well tolerated. Twice-daily levofloxacin 500 mg, either i.v. or as sequential i.v./oral therapy, was as effective as i.v. once-daily ceftriaxone 4 g in the treatment of hospitalized patients with pneumonia and offers the advantage of sequential therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Hospitalization; Humans; International Cooperation; Levofloxacin; Male; Middle Aged; Ofloxacin; Pneumonia, Bacterial; Treatment Outcome

Five hundred ninety patients were enrolled in a prospective, multicenter, randomized trial comparing the efficacy and safety of 7 to 14 days of levofloxacin treatment with that of ceftriaxone and/or cefuroxime axetil in the management of community-acquired pneumonia in adults. Patients received either intravenous and/or oral levofloxacin (500 mg once daily) or the comparative agents, parenteral ceftriaxone (1 to 2 g once to twice daily) and/or oral cefuroxime axetil (500 mg twice daily). Erythromycin or doxycycline could be added to the comparator arm at the investigator's discretion. The decision to use an intravenous or oral antimicrobial agent for initial therapy was made by the investigator. Clinical and microbiological evaluations were completed at the baseline, during treatment, 5 to 7 days posttherapy, and 3 to 4 weeks posttherapy. Four hundred fifty-six patients (226 given levofloxacin and 230 administered ceftriaxone and/or cefuroxime axetil) were evaluable for clinical efficacy. Streptococcus pneumoniae and Haemophilus influenzae were isolated in 15 and 12%, respectively, of clinically evaluable patients. One hundred fifty atypical pathogens were identified: 101 were Chlamydia pneumoniae, 41 were Mycoplasma pneumoniae, and 8 were Legionella pneumophila. Clinical success at 5 to 7 days posttherapy was superior for the levofloxacin group (96%) compared with the ceftriaxone and/or cefuroxime axetil group (90%) (95% confidence interval [CI] of -10.7 to -1.3). Among patients with typical respiratory pathogens who were evaluable for microbiological efficacy, the overall bacteriologic eradication rates were superior for levofloxacin (98%) compared with the ceftriaxone and/or cefuroxime axetil group (85%) (95% CI of -21.6 to -4.8). Levofloxacin eradicated 100% of the most frequently reported respiratory pathogens (i.e., H. influenzae and S. pneumoniae) and provided a >98% clinical success rate in patients with atypical pathogens. Both levofloxacin and ceftriaxone-cefuroxime axetil eradicated 100% of the S. pneumoniae cells detected in blood culture. Drug-related adverse events were reported in 5.8% of patients receiving levofloxacin and in 8.5% of patients administered ceftriaxone and/or cefuroxime axetil. Gastrointestinal and central and peripheral nervous system adverse events were the most common events reported in each treatment group. In conclusion, these results demonstrate that treatment with levofloxacin is superior to ceftriaxone and/or cefurox

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Ceftriaxone; Cefuroxime; Cephalosporins; Community-Acquired Infections; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Levofloxacin; Male; Middle Aged; Ofloxacin; Pneumonia, Bacterial; Prodrugs; Prospective Studies; Treatment Outcome

The serum bactericidal activities of ceftizoxime and ceftriaxone against organisms commonly implicated in community-acquired and nosocomial pneumonias were studied. Ceftizoxime 1 g (as the sodium salt) every 12 hours for two doses and ceftriaxone 1 g (as the sodium salt) every 24 hours for two doses were administered to 20 healthy volunteers in a crossover fashion. Blood samples were drawn immediately before and 2,4,6,8,10, and 12 hours after the second ceftizoxime dose and immediately before and 8,12,16,18,20, and 24 hours after the second ceftriaxone dose. Serum drug concentrations were determined by validated high-performance liquid chromatography. Serum bactericidal titers were determined in duplicate for each serum sample against four clinical isolates of each of the following organisms: Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, and Serratia marcescens. The median duration of serum bactericidal activity during the dosage interval was significantly different between antimicrobial regimens only for S. pneumoniae (92% of the dosage interval for ceftizoxime, versus 100% for ceftriaxone). This difference does not appear to be clinically important since ceftizoxime provides adequate serum bactericidal activity for more than 50% of the dosage interval and its effectiveness against pneumococcal pneumonia has been supported in clinical trials. The ceftriaxone and ceftizoxime regimens did not differ significantly in their duration of serum bactericidal activity against six of the seven organisms tested.

Topics: Adolescent; Adult; Ceftizoxime; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Cross Infection; Cross-Over Studies; Female; Humans; Male; Pneumonia, Bacterial; Prospective Studies; Serum Bactericidal Test

Much remains unknown about the impact of initial antibiotic adequacy on mortality in community onset bacterial pneumonia (COBP). Therefore, we performed a study to determine how the adequacy of initial antibiotic therapy affects in-hospital mortality for patients with COBP.We carried out a retrospective cohort study among the 11 BJC Healthcare community and academic hospitals in Missouri and Illinois. The electronic medical records for BJC Healthcare were queried to obtain a set of patient admissions with culture positive (respiratory or blood) COBP admitted from January 1, 2016 through December 31, 2019. Patients with COBP required an International Classification of Diseases (ICD)-10 diagnostic code for pneumonia, admission to the hospital through an emergency department, a chest radiograph with an infiltrate, an abnormal white blood cell count or temperature, an order for 1 or more new antibiotics, and a positive respiratory or blood culture. Antibiotic selection was deemed adequate if the patient had organisms susceptible to at least one of the antibiotics received according to in vitro testing using standard laboratory breakpoints.Among 36,645 screened pneumonia admissions, 1843 met criteria for culture positive COBP. Eight hundred nineteen (44.4%) had ceftriaxone-resistant (CTX-R) organisms and 1024 had ceftriaxone-sensitive (CTX-S) organisms. The most common CTX-R pathogens were methicillin resistant Staphylococcus aureus (46.9%), Pseudomonas species (38.4%), and Escherichia coli (4.5%). On the day of admission 71% of all patients were given adequate antibiotic treatment (62.2% of CTX-R and 77.9% of CTX-S). Unnecessarily broad initial treatment was administered to 57.1% of CTX-S patients. In a logistic regression model accounting for comorbidities and severity of illness, inadequate therapy on the day of admission was associated with higher in-hospital mortality (P = .005). Among CTX-S patients who were adequately treated, initial use of unnecessarily broad antibiotics was associated with increased in-hospital mortality (P = .003).Ceftriaxone resistance was common in this cohort of culture positive COBP patients. Inappropriate coverage on day of admission was associated with greater likelihood of in-hospital mortality.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Pneumonia, Bacterial; Retrospective Studies

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Female; Gallstones; Humans; Kidney; Kidney Transplantation; Pneumonia, Bacterial; Risk Assessment; Stents

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bacteremia; Biomarkers; Ceftriaxone; Diagnosis, Differential; Drug Therapy, Combination; Enzyme Inhibitors; Humans; Male; Oseltamivir; Pneumonia, Bacterial; Streptococcal Infections; Streptococcus

The infection by Nocardia spp is not common in immunocompetent patients. The empirical antimicrobial treatment directed by anatomical regions does not contemplate the particularities of the germ and the microbiological analysis is necessary for the specific treatment.\ We present the case of a previously healthy and immunocompetent patient, without known risk factors for Nocardia spp. infection, with evidence of involvement of the pulmonary parenchyma and the skin and subsequent development of multiple brain abscesses.. La infección por Nocardia spp. no es común en pacientes inmunocompetentes. El tratamiento antimicrobiano empírico dirigido según las regiones anatómicas, no contempla las particularidades del germen y el análisis microbiológico se hace necesario para el tratamiento específico. A continuación, se presenta el caso de una paciente previamente sana, inmunocompetente y sin factores de riesgo conocidos para la infección por Nocardia spp., con evidencia de compromiso en el parénquima pulmonar y la piel, que posteriormente desarrolló varios abscesos cerebrales.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Female; Headache; Humans; Immunocompetence; Magnetic Resonance Imaging; Middle Aged; Neuroimaging; Nocardia Infections; Pneumonia, Bacterial; Pulmonary Atelectasis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

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

Topics: Adult; Azithromycin; Ceftriaxone; Chlamydophila Infections; Chlamydophila pneumoniae; Community-Acquired Infections; Dexamethasone; Female; Humans; Pneumonia, Bacterial; Stomatitis

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

Extra-intestinal complications of Salmonella Typhi (S. Typhi) infections usually occur in endemic countries and in patients with underlying risk conditions. A 14-year-old immunocompetent girl was admitted with respiratory distress owing to S. Typhi pneumonia and pleural empyema. She was a native of Ivory Coast but had lived in France for 4 years and had not travelled abroad for several years. There were no gastro-intestinal symptoms and no S. Typhi carriage was detected in her family. She recovered completely with ceftriaxone and ciprofloxacin and pleural drainage was not required. An atypical presentation of S. Typhi should be considered even in settings where there are no risk factors.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drainage; Empyema, Pleural; Female; France; Humans; Pneumonia, Bacterial; Salmonella typhi; Treatment Outcome; Typhoid Fever

Gram-negative bacilli are the causative organisms in a significant proportion of patients with severe community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU). Clinical guidelines recommend broad-spectrum antimicrobials for empirical treatment despite alarming global trends in antimicrobial resistance. In this study, we aimed to assess the safety and efficacy of gentamicin, an aminoglycoside with potent bactericidal activity, for empirical Gram-negative coverage of severe CAP in patients admitted to the ICU. A retrospective cohort study was performed at a university teaching hospital where the severe CAP guideline recommends penicillin, azithromycin and gentamicin as empirical cover. Ceftriaxone plus azithromycin is used as an alternative. Adults with radiologically-confirmed severe CAP were included, comparing those who received gentamicin in the first 72 h of admission with those who did not. Participants were identified using ICD-10 codes for bacterial pneumonia and data manually extracted from electronic medical records. Of 148 patients admitted with severe pneumonia, 117 were given at least one dose of gentamicin whereas the remaining 31 were not. The two groups were well matched in terms of demographics, co-morbidities and disease severity. There were no significant differences between the gentamicin and no-gentamicin groups in the incidence of acute kidney injury [60/117 (51%) vs. 16/31 (52%), respectively], hospital mortality [20/117 (17%) vs. 7/31 (23%)] and secondary outcomes including relapse and length of hospital stay. In conclusion, gentamicin is safe and has similar outcomes to alternative Gram-negative antimicrobial regimens for empirical coverage in severe CAP patients admitted to the ICU.

Topics: Acute Kidney Injury; Aged; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Community-Acquired Infections; Female; Gentamicins; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Pneumonia, Bacterial; Retrospective Studies

Topics: Acute Disease; Adolescent; Anaphylaxis; Antigens, CD; Ceftriaxone; Fatal Outcome; Female; Gene Expression; Heart Failure; Hematologic Neoplasms; Humans; Leukemia, Mast-Cell; Mast Cells; Pneumonia, Bacterial; Respiratory Distress Syndrome

Results of a study evaluating the impact of an antimicrobial stewardship program (ASP) on clinical outcomes in patients hospitalized for community-acquired pneumonia (CAP) are reported.. A retrospective records review was conducted at a 400-bed hospital to identify patients admitted over 3 years with CAP documented as a primary or secondary diagnosis. Clinical and medication-use outcomes during a 1-year baseline period and in the first and second years after ASP implementation (post-ASP years 1 and 2) were analyzed. A local CAP guideline was implemented around the beginning of post-ASP year 2.. The mean hospital length of stay declined from 7.24 days in the baseline period to 5.71 days in post-ASP year 1 (. ASP implementation was associated with specific clinical benefits in patients with CAP, including decreased length of stay, decreased durations of antimicrobial therapy, and a shift in utilization to a primary regimen shown to produce superior clinical outcomes.

Topics: Aged; Anti-Bacterial Agents; Antimicrobial Stewardship; Azithromycin; Ceftriaxone; Community-Acquired Infections; Female; Hospitals, Community; Humans; Length of Stay; Levofloxacin; Male; Pneumonia, Bacterial; Retrospective Studies; Tertiary Care Centers; Treatment Outcome

Therapy directed against atypical pathogens in patients with community-acquired pneumonia (CAP) is often recommended. This post-hoc analysis evaluated the effect of addition of a macrolide to ceftaroline fosamil or ceftriaxone treatment in atypical CAP.. Two phase 3, double-blind, comparative safety and efficacy studies of ceftaroline fosamil vs. ceftriaxone, FOCUS 1 and FOCUS 2, enrolled adults with CAP. Only FOCUS 1 included 24-h adjunctive clarithromycin therapy for all patients on day 1. Day 4 and test-of-cure (TOC) outcomes were compared for adjunctive vs. no adjunctive therapy.. Of 1240 enrolled patients, 130 patients with CAP due to atypical pathogens alone were included (FOCUS 1, n = 64; FOCUS 2, n = 66). Among patients infected with Mycoplasma pneumoniae and/or Chlamydophila pneumoniae alone, a higher clinical response rate was observed with clarithromycin plus ceftaroline fosamil or ceftriaxone compared with treatment without additional clarithromycin at day 4 [38/49 (77.6%; FOCUS 1) vs. 24/43 (55.8%; FOCUS 2)], but not at the TOC assessment [42/49 (85.7%; FOCUS 1) vs. 41/43 (95.3%; FOCUS 2)]. In patients infected with Legionella pneumophila alone, a higher clinical response rate with adjunctive clarithromycin therapy was observed at the TOC assessment alone [12/12 (100%; FOCUS 1) vs. 14/19 (73.7%; FOCUS 2)]. The unadjusted odds ratio of a favourable clinical response at day 4 with adjunctive clarithromycin vs. no adjunctive clarithromycin was 2.4 (95% confidence interval 1.1-5.1; P = 0.0299) for all pathogens combined.. These results suggest that empirical antibiotic therapy against atypical pathogens may improve early clinical response rate. This hypothesis is best evaluated in a prospective trial.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftaroline; Ceftriaxone; Cephalosporins; Chlamydial Pneumonia; Chlamydophila pneumoniae; Clinical Trials, Phase III as Topic; Community-Acquired Infections; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Legionella pneumophila; Macrolides; Male; Middle Aged; Mycoplasma pneumoniae; Pneumonia, Bacterial; Pneumonia, Mycoplasma; Randomized Controlled Trials as Topic; Time Factors; Treatment Outcome

The current treatment options for patients with community-acquired pneumonia (CAP) often present a trade-off between the potential for treatment failure and safety concerns. We set out to investigate real-world outcomes associated with the use of currently available antimicrobial treatment options for CAP in both the outpatient and inpatient (non-intensive care unit [ICU]) settings.. This claims-based retrospective study included adult patients diagnosed with CAP and treated with antibiotic therapies, including any oral fluoroquinolone, macrolide, or beta-lactam monotherapy in the outpatient setting, and intravenous (IV) levofloxacin or IV azithromycin/ceftriaxone in the inpatient setting. Generalized linear model (GLM) regression was used to determine total charges for inpatient stay, the length of stay, and days of inpatient therapy. For outpatients, rates of adverse events (AEs), treatment failure, and hospitalization were compared by type of initial antibiotic therapy using logistic regression multivariate models that controlled for baseline characteristics.. A total of 441,820 outpatients and 33,287 inpatients treated for CAP between 2007 and 2012 were included in this analysis. In the outpatient setting, fluoroquinolone therapy led to a higher rate of documented AEs (adjusted odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.20-1.25; p < 0.0001) but a lower rate of retreatment (adjusted OR: 0.9; 95% CI: 0.87-0.94; p < 0.0001) compared with macrolides. Both AEs and retreatment in these patients were associated with increased costs. For patients treated with the IV macrolide/beta-lactam combination compared with IV fluoroquinolone in the inpatient setting, a significantly longer length of stay in hospital (4.71 vs. 4.38 days; p < 0.0001) and greater overall costs ($3,535 more per stay; p < 0.0001) were observed.. In both the inpatient and outpatient settings, the development of additional efficacious treatment options that have a reduced AE burden for patients with CAP may be warranted.

Topics: Adult; Aged; Ambulatory Care; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Community-Acquired Infections; Female; Humans; Male; Middle Aged; Ofloxacin; Pneumonia, Bacterial; Retrospective Studies; Risk Assessment

Ceftriaxone is one of the most commonly used antibiotics due to its high antibacterial potency, wide spectrum of activity and low potential for toxicity. However, the global trend shows misuse of this drug. The aim of this study was to evaluate prospectively the appropriateness of ceftriaxone use in medical and emergency wards of Tikur Anbessa Specialized Hospital.. A prospective cross-sectional study was conducted by reviewing medication records of patients receiving ceftriaxone during hospitalization at Tikur Anbessa Specialized Hospital between February 1 and June 30, 2014. Drug use evaluation was conducted to determine whether ceftriaxone was being used appropriately based on six criteria namely indication for use, dose, frequency of administration, duration of treatment, drug-drug interaction, culture and sensitivity test. The evaluation was made as per the protocol developed from current treatment guidelines.. The total of 314 records of patients receiving ceftriaxone was reviewed. The prescribing rate of ceftriaxone was found to be very high (58 % point prevalence). Ceftriaxone use was empiric in 274 (87.3 %) cases. The most common indication for ceftriaxone use was pneumonia; observed in 110 (35.0 %) cases. The most common daily dosage, frequency of administration and duration of treatment with ceftriaxone were 2 g (88.9 %), twice-daily (98.4 %) and 8-14 days (46.2 %), respectively. Inappropriate use of ceftriaxone was observed in most of cases (87.9 %), the greatest proportion of which was attributed to inappropriate frequency of administration (80.3 %), followed by absence of culture and sensitivity test (53.2 %).. This study revealed that the inappropriate use of ceftriaxone was very high in the medical and emergency wards of Tikur Anbessa Specialized Hospital. This may lead to emergence of resistant pathogens which in turn lead to treatment failure and increased cost of therapy. Therefore, adherence to current evidence-based guidelines is recommended.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Cross-Sectional Studies; Diagnostic Errors; Drug Administration Schedule; Emergency Service, Hospital; Ethiopia; Female; Hospitals, Special; Hospitals, Teaching; Humans; Inappropriate Prescribing; Male; Middle Aged; Pneumonia, Bacterial; Practice Patterns, Physicians'; Prospective Studies; Tertiary Care Centers; Young Adult

Infection is a major determinant of clinical outcome among patients in the intensive care unit. However, these data are lacking in most developing countries; hence, we set out to describe the profile of nosocomial infection in one of the major tertiary hospitals in northern Nigeria.. Case records of patients who were admitted into the intensive care unit over a 4-year period were retrospectively reviewed. A preformed questionnaire was administered, and data on clinical and microbiological profile of patients with documented infection were obtained.. Eighty-our episodes of nosocomial infections were identified in 76 patients. Road traffic accident (29/76, 38.2%) was the leading cause of admission. The most common infections were skin and soft tissue infections (30/84, 35.7%) followed by urinary tract infection (23/84, 27.4%). The most frequent isolates were Staphylococcus aureus (35/84, 41.7%), Klebsiella pneumoniae (18/84, 21.4%), and Escherichia coli (13/84, 15.5%). High rate of resistance to cloxacillin (19/35, 54.3%) and cotrimoxazole (17/26, 65.4%) was noted among the S aureus isolates. All the Enterobacteriaceae isolates were susceptible to meropenem, whereas resistance rate to ceftriaxone was high (E coli, 55.6%; K pneumoniae, 71.4%; Proteus spp, 50%).. Infection control practice and measures to curtail the emergence of antimicrobial resistance need to be improved.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Catheter-Related Infections; Ceftriaxone; Cloxacillin; Cross Infection; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Nigeria; Pneumonia, Bacterial; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Tertiary Care Centers; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Bacteremic pneumonia is usually associated with greater mortality. However, risk factors associated with hospital mortality in bacteremic pneumonia are inadequately described.The study was a retrospective cohort study, conducted in Barnes-Jewish Hospital (2008-2015). For purposes of this investigation, antibiotic susceptibility was determined according to ceftriaxone susceptibility, as ceftriaxone represents the antimicrobial agent most frequently recommended for hospitalized patients with community-acquired pneumonia as opposed to nosocomial pneumonia. Two multivariable analyses were planned: the first model included resistance to ceftriaxone as a variable, whereas the second model included the various antibiotic-resistant species (methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae).In all, 1031 consecutive patients with bacteremic pneumonia (mortality 37.1%) were included. The most common pathogens associated with infection were S aureus (34.1%; methicillin resistance 54.0%), Enterobacteriaceae (28.0%), P aeruginosa (10.6%), anaerobic bacteria (7.3%), and Streptococcus pneumoniae (5.6%). Compared with ceftriaxone-susceptible pathogens (46.8%), ceftriaxone-resistant pathogens (53.2%) were significantly more likely to receive inappropriate initial antibiotic treatment (IIAT) (27.9% vs 7.1%; P < 0.001) and to die during hospitalization (41.5% vs 32.0%; P = 0.001). The first logistic regression analysis identified IIAT with the greatest odds ratio (OR) for mortality (OR 2.2, 95% confidence interval [CI] 1.5-3.2, P < 0.001). Other independent predictors of mortality included age, mechanical ventilation, immune suppression, prior hospitalization, prior antibiotic administration, septic shock, comorbid conditions, and severity of illness. In the second multivariable analysis that included the antibiotic-resistant species, IIAT was still associated with excess mortality, and P aeruginosa infection was identified as an independent predictor of mortality (OR 1.6, 95% CI 1.1-2.2, P = 0.047), whereas infection with ceftriaxone-resistant Enterobacteriaceae (OR 0.6, 95% CI 0.4-1.0, P = 0.050) was associated with lower mortality.More than one-third of our patients hospitalized with bacteremic pneumonia died. IIAT was identified as the most important risk factor for hospital mortality and the only risk factor amenable to potential intervention. Specific antibiotic-resistant pathogen species were also associated with mortality.

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Drug Resistance, Bacterial; Enterobacteriaceae; Female; Hospital Mortality; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Pneumonia, Bacterial; Pseudomonas aeruginosa; Retrospective Studies

We describe the laboratory-confirmed etiologies of illness among participants in a hospital-based febrile illness cohort study in northern Tanzania who retrospectively met Integrated Management of Adolescent and Adult Illness District Clinician Manual (IMAI) criteria for septic shock, severe respiratory distress without shock, and severe pneumonia, and compare these etiologies against commonly used antimicrobials, including IMAI recommendations for emergency antibacterials (ceftriaxone or ampicillin plus gentamicin) and IMAI first-line recommendations for severe pneumonia (ceftriaxone and a macrolide). Among 423 participants hospitalized with febrile illness, there were 25 septic shock, 37 severe respiratory distress without shock, and 109 severe pneumonia cases. Ceftriaxone had the highest potential utility of all antimicrobials assessed, with responsive etiologies in 12 (48%) septic shock, 5 (14%) severe respiratory distress without shock, and 19 (17%) severe pneumonia illnesses. For each syndrome 17-27% of participants had etiologic diagnoses that would be non-responsive to ceftriaxone, but responsive to other available antimicrobial regimens including amphotericin for cryptococcosis and histoplasmosis; anti-tuberculosis therapy for bacteremic disseminated tuberculosis; or tetracycline therapy for rickettsioses and Q fever. We conclude that although empiric ceftriaxone is appropriate in our setting, etiologies not explicitly addressed in IMAI guidance for these syndromes, such as cryptococcosis, histoplasmosis, and tetracycline-responsive bacterial infections, were common.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Ampicillin; Anti-Infective Agents; Bacterial Infections; Ceftriaxone; Child; Cohort Studies; Cryptococcosis; Emergencies; Female; Gentamicins; Histoplasmosis; Humans; Infections; Macrolides; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Respiratory Distress Syndrome; Shock, Septic; Tanzania; Tetracycline; Young Adult

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

Guidelines for management of community-acquired pneumonia recommend empiric therapy with a macrolide and beta-lactam when infection with Mycoplasma pneumoniae is a significant consideration. Evidence to support this recommendation is limited. We sought to determine the effectiveness of ceftriaxone alone compared with ceftriaxone combined with a macrolide with respect to length of stay and total hospital costs.. We conducted a retrospective cohort study of children 1-17 years with pneumonia, using Poisson regression and propensity score analyses to assess associations between antibiotic and length of stay. Multivariable linear regression and propensity score analyses were used to assess log-treatment costs, adjusting for patient and hospital characteristics and initial tests and therapies.. A total of 4701 children received combination therapy and 8892 received ceftriaxone alone. Among children 1-4 years of age, adjusted models revealed no significant difference in length of stay, with significantly higher costs in the combination therapy group [cost ratio: 1.08 (95% confidence interval: 1.05-1.11)]. Among children 5-17 years of age, children receiving combination therapy had a shorter length of stay [relative risk: 0.95 (95% confidence interval: 0.92-0.98)], with no significant difference in costs [cost ratio: 1.01 (95% confidence interval: 0.98-1.04)].. Combination therapy did not appear to benefit preschool children but was associated with higher costs. Among school-aged children, combination therapy was associated with a shorter length of stay without a significant impact on cost. Development of sensitive point-of-care diagnostic tests to identify children with M. pneumoniae infection may allow for more focused prescription of macrolides and enable comparative effectiveness studies of targeted provision of combination therapy.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Drug Therapy, Combination; Hospital Costs; Humans; Infant; Length of Stay; Macrolides; Pneumonia, Bacterial; Retrospective Studies; United States

A retrospective cohort study was performed on 175 adult patients treated for community-acquired pneumonia with moxifloxacin or ceftriaxone/azithromycin in a nonintensive care unit. Both cohorts were very similar with regard to a wide range of characteristics including age, severity of disease, comorbidities, length of stay, and mortality. Multidrug-resistant organisms were subsequently isolated from 6 (15%) moxifloxacin-treated patients and 5 (4%) ceftriaxone/azithromycin-treated patients within 90 days after beginning of therapy (P = .026 on logistic regression analysis).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Bacteria; Ceftriaxone; Cohort Studies; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Female; Fluoroquinolones; Humans; Male; Middle Aged; Moxifloxacin; Pneumonia, Bacterial; Retrospective Studies; Risk Assessment; Young Adult

Topics: Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Cross Infection; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Methicillin-Resistant Staphylococcus aureus; Pneumonia, Bacterial; Randomized Controlled Trials as Topic; Staphylococcal Infections

Nosocomial pneumonia remains an important cause of mortality and morbidity worldwide. Surveillance programs play an important role in the identification of common etiologic agents and local patterns of antimicrobial resistance.. In this study we determined the frequency and antimicrobial susceptibility of pathogens isolated from patients with nosocomial pneumonia during 2009 to 2011.. A total of 642 bacteria were isolated from 516 suspected samples. Acinetobacter baumannii (21.1%, n = 136), was the commonest isolated pathogen followed by Pseudomonas aeruginosa (17.4%, n = 112), Staphylococcus aureus (15.8%, n = 102) and enterococci (8.4% n = 54). The most effective therapeutic agents against A. baumannii were polymyxin B (95.5% susceptible), ceftriaxone/tazobactam (72% susceptible) and levofloxacin (52.9% susceptible). Polymixin B (89.2% susceptible), ceftriaxone/tazobactam (89.2% susceptible) and piperacillin-tazobactam (80.3% susceptible) were found to be the most active agents against P. aeruginosa. Extended-spectrum beta-lactamases were detected among isolates of K. pneumoniae (45.4%) and E. coli (20.3%). Overall, the prevalence of methicillin-resistant S. aureus and vancomycin resistant enterococci were 80.4% and 40.7% respectively. Linezolid was found to be the most active antibiotic against these pathogens. The etiology of 50% of the nosocomial infection cases was polymicrobial.. The combination of ceftriaxone/tazobactam seems to be beneficial agent against multidrug-resistant Gram-negative bacilli isolated form respiratory tract infections. The results of our study can be used for guiding appropriate empiric therapy in this geographic region.

Topics: Acinetobacter baumannii; Anti-Bacterial Agents; Ceftriaxone; Cross Infection; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Hospitals; Humans; Iran; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia, Bacterial; Polymyxin B; Prevalence; Pseudomonas aeruginosa; Respiratory Tract Infections; Sputum; Staphylococcus aureus

The case is presented of a 38 year-old patient who was admitted in the Emergency Department due to a severe acute respiratory failure and who was transferred to the Critical Care Unit with a suspected initial diagnosis of community acquired pneumonia caused by an atypical microorganism, which was complicated with an acute respiratory distress syndrome. This was able to be treated with non-invasive mechanical ventilation. At 48 hours after admission, the growth of Gram negative bacilli in the blood culture was reported, which was subsequently identified as Salmonella enteritidis. This information, along with the lymphopenia suffered by the patient, suggested an immunodepressed state, thus serological tests were performed which showed positive for HIV. Antibiotic treatment was started based on the microbiological findings, with a favourable clinical outcome for the patient.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Bacteremia; Bronchoalveolar Lavage Fluid; Ceftriaxone; Cocaine-Related Disorders; Community-Acquired Infections; Diagnosis, Differential; Female; Humans; Lymphopenia; Pneumonia, Bacterial; Pneumonia, Pneumocystis; Respiratory Distress Syndrome; Salmonella enteritidis; Salmonella Infections; Trimethoprim, Sulfamethoxazole Drug Combination

We report an immunocompetent 24-year-old man who presented with a severe, invasive non-typhoidal salmonella (iNTS) infection. He presented with lumbar back pain associated with fever and rigours, which had been preceded by diarrhoea. Blood cultures grew Salmonella enteritidis. An MRI scan of his pelvis and spine showed that he had a small gluteal abscess and sacroiliitis. His condition subsequently deteriorated due to the development of a secondary pneumonia and respiratory failure. He was managed conservatively with 2 weeks of intravenous ceftriaxone, followed by 6 weeks of oral ciprofloxacin. Detailed investigations did not reveal any predisposing factors or evidence of an underlying immunodeficiency. Follow-up showed complete resolution of symptoms with no long-term sequelae.

Topics: Abscess; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Communicable Diseases, Emerging; Diagnosis, Differential; Humans; Immunocompromised Host; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Pneumonia, Bacterial; Sacroiliitis; Salmonella enteritidis; Salmonella Infections; Young Adult

The administration of ceftriaxone is known to be associated with biliary pseudolithiasis, although the development of urolithiasis has only rarely been reported. We treated a young male with bacterial meningitis complicated by urinary precipitates composed of ceftriaxone-calcium salt, which prompted us to study whether ceftriaxone administration predisposes children to the formation of urinary precipitates. The case-control study reported here included 83 children with bacterial pneumonia aged from 3 months to 8.9 years. The children were divided into one group of 43 children who received ceftriaxone (group A) and a second group of 40 children who received amoxicillin (group B). Paired samples of serum and urine before and after treatment were obtained from the patients in each group. There were no significant differences in demographic characteristics and blood biochemistry between the groups. However, the mean urinary calcium to creatinine ratio (uCa/Cr; mg/mg) was significantly higher in group A patients than in group B patients after treatment (0.19 vs. 0.09, respectively; p < 0.001), and analysis of the paired urine samples revealed that the uCa/Cr significantly increased after treatment only in group A patients(p < 0.001). There was a weak but non-significant relationship between the dose of ceftriaxone and the uCa/Cr in group A (p = 0.10, r = 0.24). Our results are the first to demonstrate that ceftriaxone has the potential to significantly increase urinary excretion of calcium, which may be linked to ceftriaxone-related urolithiasis or sludge. We therefore suggest that it is worthwhile monitoring the uCa/Cr levels in patients on ceftriaxone as they may be at greater risk for developing large stones and renal damage.

Topics: Anti-Bacterial Agents; Calcium; Case-Control Studies; Ceftriaxone; Child; Child, Preschool; Creatinine; Female; Humans; Infant; Male; Pneumonia, Bacterial; Retrospective Studies; Urolithiasis

Leptospirosis is a zoonotic disease with protean manifestations. A 35-year-old male presented with pneumonia after the Typhoon Morakot. Skin rash, conjunctival suffusion, and subconjunctival hemorrhage led us to the diagnosis of leptospirosis and the microscopic agglutination test confirmed the diagnosis. This patient well demonstrated the picture of conjunctival suffusion and reminded us of the alertness of leptospirosis after a typhoon.

Topics: Adult; Ceftriaxone; Cyclonic Storms; Humans; Leptospirosis; Male; Penicillins; Pneumonia, Bacterial; Taiwan; Treatment Outcome

Topics: Adult; Animals; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Ciprofloxacin; Female; Fusobacterium Infections; Humans; Hypoxia; Meningitis, Bacterial; Penicillanic Acid; Pets; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia, Bacterial; Rats; Respiratory Distress Syndrome; Streptobacillus; Thrombocytopenia

Shewanella putrefaciens is a gram-negative, non-fermentative, oxidase positive, motile bacillus that produces hydrogen sulphide. It is found widely in the nature especially in marine environments. Although it is accepted as saprophytic, different clinical syndromes, most commonly skin or soft tissue infections, have been associated with S.putrefaciens, mainly in immunocompromised cases and patients with underlying diseases. However, pneumonia cases due to S.putrefaciens are quite limited in the literature. In this report, a case of pneumonia caused by S.putrefaciens was presented. A 43-year-old female patient was admitted to our hospital with the complaints of fever, cough, sputum and weakness. The patient has had brochiectasis since childhood and has used periodical antibiotic therapies due to pneumoniae episodes. She was diagnosed to have pneumonia based on the clinical, radiological and laboratory findings, and empirical antibiotic treatment with ciprofloxacin and ceftazidime combination was initiated. Gram-stained smear of sputum yielded abundant leucocytes and gram-negative bacteria, and the isolate grown in the sputum culture was identified as S.putrefaciens by conventional methods and API 20 NE (BioMerieux, France) system. The isolate was found susceptible to ceftriaxone, ceftazidime, cefepime, ciprofloxacin, piperacillin-tazobactam, cephoperazon-sulbactam, imipenem, amikacin, gentamicin and trimethoprime-sulphametoxazole; whereas resistant to ampicillin, amoxycillin-clavulanate, cefazolin and cefuroxime, by Kirby-Bauer disk diffusion method. According to the antibiogram results, the therapy was changed to ceftriaxone (1 x 2 g, intravenous). The patient was discharged with complete cure after 14 days of therapy. In conclusion, S.putrefaciens should be considered in patients with predisposing factors as an unusual cause of pneumonia and the characteristics such as H2S production and sensitivity to third generation cephalosporins and penicillins should be used to differentiate it from Pseudomonas aeruginosa and prevent the unnecessary use of antipseudomonal antibiotics.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Bronchiectasis; Ceftazidime; Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Female; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Pneumonia, Bacterial; Shewanella putrefaciens; Sputum

To assess the effectiveness of guidelines and education on empirical therapy for community-acquired pneumonia.. Administrative records for children with a primary diagnosis of pneumonia from January 2007 to September 2009 were reviewed. Antimicrobial use was measured monthly over 3 periods: (1) before creation of an antimicrobial stewardship task force (ASTF), (2) after ASTF formation but before release of guidelines for antimicrobial use, and (3) after guideline release. Antimicrobial use over time was assessed by using quasi-binomial logistic regression models that incorporated interrupted events, seasonality, and autocorrelation. Allowing calculation of immediate changes due to specific interventions and trends in use over each time period. The primary outcome was use of ampicillin as recommended in the guidelines versus ceftriaxone, the historical standard. Secondary outcomes included other antimicrobial use, length of stay, mortality, and readmission.. One thousand two hundred forty-six children met study criteria. Ampicillin use increased from 2% at baseline to 6% after ASTF formation and 44% after guideline release. Ceftriaxone use increased slightly (from 56% to 59%) after ASTF formation but decreased to 28% after guideline release. An immediate change in prescription occurred in the month after guideline publication and remained stable over the following year.. Guidelines and education can have an impact on antimicrobial use in the pediatric setting. Although the optimal strategies for pediatric antimicrobial stewardship programs still are being determined, we believe that our approach offers an inexpensive and low-risk step in the right direction.

Topics: Ampicillin; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Child; Child, Preschool; Clindamycin; Community-Acquired Infections; Consensus; Drug Substitution; Drug Utilization; Evidence-Based Medicine; Female; Guideline Adherence; Hospitals, Pediatric; Humans; Infant; Inservice Training; Kentucky; Length of Stay; Logistic Models; Male; Patient Readmission; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Practice Patterns, Physicians'; Survival Analysis; Treatment Outcome; Vancomycin

We read with interestingly the paper named "A Rare Cause of Pneumonia: Shewanella putrefaciens" presented by Durdu et al. published in Mikrobiyol Bul 2012; 46(1): 117-21. S.putrefaciens is a gram-negative, facultative anaerobic and non-fermentative rod that rarely causes infections in humans. First, the authors reported that antibotic sensitivity tests of S.putrefaciens in the presented case were performed by Kirby-Bauer disc diffusion method. However, there is no recommendation about the antibiotic susceptibility testing by disc diffusion test for this bacteria in Clinical and Laboratory Standards Institute (CLSI), European Committee on Antimicrobial Susceptibility Testing (EUCAST), and British Society for Antimicrobial Chemotherapy (BSAC) guidelines. According to CLSI criteria, antibiotic susceptibility tests for S.putrefaciens should be done by a method which detects minimal inhibitory concentration. Second, this paper reported that S.putrefaciens was sensitive to third generation cephalosporins and penicillins. Besides, the authors suggested that susceptibility of these bacteria to these antibiotics was helpful for the differential diagnosis of Pseudomonas aeruginosa and S.putrefaciens. However, in the literature, S.putrefaciens had been reported as resistant to penicillin. We thought that these additional information would be helpful in the future studies related to S.putrefaciens.

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Gram-Negative Bacterial Infections; Humans; Pneumonia, Bacterial; Shewanella putrefaciens

Pulmonary nocardiosis is a serious, most often considered an opportunistic infection affecting the respiratory tract. Even though it is more common in immunocompromised hosts, it is not infrequently seen in immunocompetent patients as well. The aerosol route is the main portal of entry in to the body. Molecular techniques have revolutionised the identification of Nocardia species. However such tests are limited to referral laboratories. The radiographic appearances of Nocardia infection vary from a small nodule to bilateral infiltrates with cavitation. Traditionally sulphonamides have been considered the treatment of choice. However, resistance to sulphonamides is increasingly recognised. Carbapenems and linezolid have been found to be uniformly active against all the pathogenic species of Nocardia that affect human beings. The authors report a case of pulmonary nocardiosis in an immunocompetent patient, in whom the infection relentlessly progressed to florid sepsis despite prompt institution of right antibiotics. Florid sepsis relating to pulmonary nocardiosis is rare.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Diagnosis, Differential; Drug Therapy, Combination; Fatal Outcome; Humans; Male; Middle Aged; Nocardia; Nocardia Infections; Pneumonia, Bacterial

In June 2004 an 8-year-old boy was admitted to a hospital in Thessaloniki, Greece, because of high fever, tachypnea, hypotonia, diarrhea, and tonoclonic convulsions. Phlebovirus infection was diagnosed by IgG seroconversion to Toscana virus. As IgM antibodies were not detected, it is suggested that this was an acute infection caused by a phlebovirus virus distinct from Toscana virus. Complication by a hospital-acquired Pseudomonas aeruginosa pneumonia resulted in 2 months of hospitalization. Slight ataxia was still present on discharge.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Bunyaviridae Infections; Ceftriaxone; Child; Colistin; Cross Infection; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Greece; Humans; Immunoglobulin G; Male; Meningoencephalitis; Phlebovirus; Pneumonia, Bacterial; Pseudomonas aeruginosa; Pseudomonas Infections; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Ertapenem; Humans; Ofloxacin; Pneumonia, Bacterial

Neurological symptoms of patients suffering from neurodegenerative diseases such as Alzheimer's dementia (AD), Parkinson's disease (PD), or amyotrophic lateral sclerosis (ALS) often worsen during infections. We assessed the disease-modulating effects of recurrent systemic infections with the most frequent respiratory pathogen, Streptococcus pneumoniae, on the course of AD, PD, and ALS in mouse models of these neurodegenerative diseases [transgenic Tg2576 mice, (Thy1)-[A30P]alpha SYN mice, and Tg(SOD1-G93A) mice]. Mice were repeatedly challenged intraperitoneally with live S. pneumoniae type 3 and treated with ceftriaxone for 3 days. Infection caused an increase of interleukin-6 concentrations in brain homogenates. The clinical status of (Thy1)-[A30P]alpha SYN mice and Tg(SOD1-G93A) mice was monitored by repeated assessment with a clinical score. Motor performance was controlled by the tightrope test and the rotarod test. In Tg2576 mice, spatial memory and learning deficits were assessed in the Morris water maze. In none of the three mouse models onset or course of the disease as evaluated by the clinical tests was affected by the recurrent systemic infections performed. Levels of alpha-synuclein in brains of (Thy1)-[A30P]alpha SYN mice did not differ between infected animals and control animals. Plaque sizes and concentrations of A beta 1-40 and A beta 1-42 were not significantly different in brains of infected and uninfected Tg2576 mice. In conclusion, onset and course of disease in mouse models of three common neurodegenerative disorders were not influenced by repeated systemic infections with S. pneumoniae, indicating that the effect of moderately severe acute infections on the course of neurodegenerative diseases may be less pronounced than suspected.

Topics: Acute Disease; alpha-Synuclein; Alzheimer Disease; Amyloid beta-Peptides; Amyotrophic Lateral Sclerosis; Animals; Anti-Bacterial Agents; Ceftriaxone; Disease Models, Animal; Disease Progression; Interleukin-6; Maze Learning; Memory Disorders; Mice; Mice, Transgenic; Neurodegenerative Diseases; Neuropsychological Tests; Parkinson Disease; Plaque, Amyloid; Pneumonia, Bacterial; Recurrence; Streptococcal Infections; Streptococcus pneumoniae; Up-Regulation

We report the case of a 39-year old patient with septicemia treated for pharyngitis with antibiotics since a few days. She wasn't able to swallow her antibiotics anymore because of dysphagia. Radiologic examination revealed pulmonary infiltrates and Vena iugularis interna-thrombosis. These findings and anamnesis led to the diagnosis of Lemierre syndrome inspite of lacking detection of bacteria. After changing the antibiotic therapy and start of anticoagulation further course of illness was favorable. The long duration of hospitalization was indepted to high morbidity typically seen in Lemierre syndrome.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anticoagulants; Ceftriaxone; Clindamycin; Deglutition Disorders; Diagnosis, Differential; Drug Therapy, Combination; Female; Fever of Unknown Origin; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Jugular Veins; Pneumonia, Bacterial; Sepsis; Syndrome; Thrombosis; Tomography, X-Ray Computed; Tonsillitis; Ultrasonography

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Cholelithiasis; Community-Acquired Infections; Female; Humans; Infant; Infusions, Intravenous; Injections, Intravenous; Male; Meningitis, Bacterial; Pneumonia, Bacterial; Urinary Tract Infections

An 87-year-old man was admitted to hospital because of fever, productive cough, dyspnea and altered consciousness. His medical history was significant for chronic obstructive pulmonary disease. He owned several pets. Physical examination and a chest radiograph revealed right upper lobe pneumonia. Blood cultures taken on admission yielded Pasteurella multocida and antimicrobial susceptibility testing showed susceptibility to beta-lactams. The fever subsided four days after treatment with intravenous ceftriaxone and the patient was discharged in a very good clinical condition after two weeks of treatment. Although no history of bites or scratches was documented, it is likely that our patient was exposed to the secretions of his many pets through inhalation of contaminated aerosols. This resulted in tracheobronchial tree colonization by P. multocida, which later developed into pneumonia. Close animal contact should be avoided by frail, elderly patients with chronic pulmonary diseases, as it is a risk factor for pneumonia due to Pasteurella spp.

Topics: Aged, 80 and over; Animals; Animals, Domestic; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Community-Acquired Infections; Humans; Infusions, Intravenous; Male; Pasteurella Infections; Pasteurella multocida; Pneumonia, Bacterial

The aim of the study was to evaluate therapeutic efficiency of ceftriabol (Russia) and claforan (both 3d generation cefalosporins) used to manage severe extrahospital pneumonia. Ceftriabol (2 g) was administered one or twice daily, claforan intravenously (2 g b.i.d. or t.i.d). Results of the treatment were assessed from a combination of anamnestic and physical examination data, results of X-ray and laboratory studies. Normalization of major clinical, laboratory, and instrumental parameters in patients treated with ceftriabol and claforan was achieved roughly within the same time period. It means that ceftriabol is at least as efficacious as claforan when applied to the treatment of severe extrahospital pneumonia.

Topics: Adult; Aged; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Community-Acquired Infections; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Young Adult

A case of colchicine-induced rhabdomyolysis is reported. A 48 year old African-American male with history of hypertension and chronic gout on colchicine 0.6 mg daily presented with symptoms of a community acquired pneumonia. The patient was started on 500 mg of clarithromycin orally twice daily and represented to the emergency room after 3 days complaining of severe muscle pain. His liver panel showed elevations in the serum aminotransferases; AST 513 mU/ml (nl 15-41) and ALT 182 mU/ml (nl 17-63). His complete blood count showed an elevated white blood cell count of 18,800/ml (nl 4,000-10,000/ml). Urine analysis was positive for myoglobin with no red cells present. Serum creatine kinase (CK) was 22,996 mU/ml (nl 31-221) with a normal troponin I 0.18 (nl <0.4).Investigations confirmed the presence of rhabdomyolysis and discontinuation of colchicine and clarithromycin resulted in resolution of clinical and biochemical features of rhabdomyolysis. By hospital day four, his muscle soreness had improved markedly. His serum CK improved to 3,389 mU/ml (nl 31-221 mU/ml) and serum creatinine improved to 1.5 mg/dl (nl 0.8-1.2). On hospital day five, the patient was discharged on oral anti-hypertensive medication and a ten-day course of doxycycline. Metabolism of colchicine by the cytochrome P450 3A4 system has been previously described, but this is the first published report of colchicine associated rhabdomyolysis secondary to drug metabolism interactions with an antibiotic. A review of medications that are metabolized via the cytochrome 3A4 and A-SLAVED-LIVER (Amiodarone, Simvastatin, Lovastatin, Atorvastatin, Verapamil, Erythromycin, Diltiazem, cLarithromycin, Itraconazole, Voriconazole, colchicinE, Ritonavir) pneumonic was established.

Topics: Anti-Bacterial Agents; Ceftriaxone; Clarithromycin; Colchicine; Community-Acquired Infections; Doxycycline; Drug Interactions; Gout; Gout Suppressants; Humans; Male; Middle Aged; Pneumonia, Bacterial; Rhabdomyolysis; Treatment Outcome

Topics: Adult; Aged; Ambulatory Care; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Male; Middle Aged; Patient Admission; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Pneumonia, Viral; Risk Factors; Systemic Inflammatory Response Syndrome

A case of Salmonella paratyphi A infection was diagnosed late in a patient treated for febrile pneumonia after his returning from India. This case was remarkable in two aspects: first, it illustrated the reemergence of S.paratyphi A infections in people having traveled to India, with increasing fluoroquinolone resistance, and second the difficulty of diagnosing this disease, since the patient was initially treated for pneumonia and flu-like syndrome. Salmonella typhi or paratyphi infections should be evoked in case of persistent fever in patients having traveled to endemic areas, even if digestive signs are absent. Furthermore, choosing an empiric antibiotic treatment with fluoroquinolones could lead to treatment failure if the patient traveled in a country where fluoroquinolone resistance is high, as in Asia and especially in India.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Bangladesh; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Endemic Diseases; Fluoroquinolones; Humans; India; Ketolides; Male; Paratyphoid Fever; Pneumonia, Bacterial; Salmonella paratyphi A; Travel

Pneumonia remains a concern for persons with long-standing HIV infection. We present a case of a 43-year-old HIV-infected woman with bilateral pneumonia whose presentation suggested the cause was a bacterial pathogen. A chest of radiograph and CT scan of the chest revealed infiltrates and adenopathies, but this did not help in the differential diagnosis. A Gram stain of a sputum specimen revealed gram-positive filamentous rods, and infection with Nocardia asteroides was diagnosed. The patient was started on a regimen of ceftriaxone and trimethoprim/sulfamethoxazole and experienced significant improvement within a few days.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Female; HIV Infections; Humans; Nocardia asteroides; Nocardia Infections; Pneumonia, Bacterial; Radiography; Sputum; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Risk of death may influence the efficacy of anti-inflammatory agents in sepsis. "Physiologic" dose corticosteroids, while improving survival in earlier trials with higher control mortality rates (>50%), were not beneficial in the recent CORTICUS trial with lower control mortality (31%). We investigated whether risk of death altered the effects of hydrocortisone in a mouse pneumonia model.. Mice (n=637) challenged with high, medium or low intratracheal E. coli doses were randomized to receive one of three hydrocortisone doses (5, 25 or 125 mg/kg) or normal saline (NS) only (control) for 4 days. All animals were treated with similar volumes of ceftriaxone and NS support following E. coli and were observed for 168 h.. Decreasing E. coli doses reduced control mortality rates (from 94 to 12%). In similar patterns (not significant) each hydrocortisone dose increased the odds ratio (OR) of survival (95% confidence interval) with each E. coli dose (ORs ranging from 1.2 [0.4, 3.7] to 6.1 [0.6, 61.0]). The effect of hydrocortisone on the OR was not related to control mortality rate (r=-0.13, p=0.29) and overall was highly significant (2.04 [1.37, 3.03], p=0.0004). In randomly selected animals 48 h after the highest E. coli dose, compared with the control, hydrocortisone (125 mg/kg) significantly decreased IL-6, INFgamma, and nitric oxide levels.. In this mouse model the beneficial effects of hydrocortisone were independent of risk of death. These findings suggest that factors other than risk of death may underlie the differing effects of corticosteroids in recent sepsis trials.

Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Bacteremia; Ceftriaxone; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Therapy, Combination; Escherichia coli; Hydrocortisone; Intubation, Intratracheal; Lung; Male; Mice; Mice, Inbred C57BL; Pneumonia, Bacterial; Severity of Illness Index; Treatment Outcome

Available data on the etiology of community-acquired pneumonia (CAP) in Australia are very limited. Local treatment guidelines promote the use of combination therapy with agents such as penicillin or amoxycillin combined with either doxycycline or a macrolide.. The Australian CAP Study (ACAPS) was a prospective, multicenter study of 885 episodes of CAP in which all patients underwent detailed assessment for bacterial and viral pathogens (cultures, urinary antigen testing, serological methods, and polymerase chain reaction). Antibiotic agents and relevant clinical outcomes were recorded.. The etiology was identified in 404 (45.6%) of 885 episodes, with the most frequent causes being Streptococcus pneumoniae (14%), Mycoplasma pneumoniae (9%), and respiratory viruses (15%; influenza, picornavirus, respiratory syncytial virus, parainfluenza virus, and adenovirus). Antibiotic-resistant pathogens were rare: only 5.4% of patients had an infection for which therapy with penicillin plus doxycycline would potentially fail. Concordance with local antibiotic recommendations was high (82.4%), with the most commonly prescribed regimens being a penicillin plus either doxycycline or a macrolide (55.8%) or ceftriaxone plus either doxycycline or a macrolide (36.8%). The 30-day mortality rate was 5.6% (50 of 885 episodes), and mechanical ventilation or vasopressor support were required in 94 episodes (10.6%). Outcomes were not compromised by receipt of narrower-spectrum beta-lactams, and they did not differ on the basis of whether a pathogen was identified.. The vast majority of patients with CAP can be treated successfully with narrow-spectrum beta-lactam treatment, such as penicillin combined with doxycycline or a macrolide. Greater use of such therapy could potentially reduce the emergence of antibiotic resistance among common bacterial pathogens.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Australia; Bacteria; Ceftriaxone; Community-Acquired Infections; Doxycycline; Female; Guideline Adherence; Humans; Macrolides; Male; Microbial Sensitivity Tests; Middle Aged; Penicillins; Pneumonia, Bacterial; Pneumonia, Viral; Prospective Studies; Treatment Outcome; Viruses

Topics: Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Cloxacillin; Diaphragm; Digestive System Fistula; Humans; Male; Pneumonia, Bacterial; Psoas Abscess; Radiography; Staphylococcal Infections

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Bronchoscopy; Ceftriaxone; Drug Therapy, Combination; Floxacillin; Hemorrhage; Humans; Leptospira; Leptospirosis; Lung Diseases; Male; Pneumonia, Bacterial; Radiography, Thoracic

Topics: Administration, Oral; Aged; Anti-Bacterial Agents; Cefepime; Ceftriaxone; Cephalosporins; Cross Infection; Drug Therapy, Combination; Drug Utilization; Homes for the Aged; Hospital Mortality; Hospitalization; Humans; Injections, Intramuscular; Nursing Homes; Pneumonia, Aspiration; Pneumonia, Bacterial; Survival Rate; Treatment Failure

Corynebacterium pseudodiphteriticum has been considered a very infrequent respiratory pathogen. We report three cases of pneumonia due to C. pseudodiphteriticum, describing their clinical and microbiological features. There were two patients with pre-existing chronic respiratory disease, one of their with steroidal therapy, and other associated with endotracheal intubation. The diagnostic was made by Gram stain and quantitative cultures from respiratory tract specimens. All patients were cured after treatment with amoxicillin-clavulanate, ceftriaxone and vancomycin respectively. C. pseudodiphteriticum must be consider as a possible causal agent of pneumonia in patients with underlying respiratory disease or endotracheal intubation. Antimicrobial susceptibility testing of C. pseudodiphteriticum may be useful for correct treatment of infected patients, but beta-lactam antibiotics are an appropriate therapeutic option against this bacteria.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Corynebacterium; Corynebacterium Infections; Diabetes Mellitus, Type 1; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Intubation, Intratracheal; Male; Multiple Trauma; Ofloxacin; Pneumonia, Bacterial; Prednisone; Pulmonary Disease, Chronic Obstructive; Sjogren's Syndrome; Smoking; Vancomycin

This report presents a case of bacteraemic pneumonia caused by Neisseria lactamica in an adult patient with liver cirrhosis who was successfully treated with ceftriaxone. The isolate was confirmed as N. lactamica by analysis of a partial sequence of the 16S rRNA gene; it had reduced susceptibilities to penicillin (MIC 0.75 microg ml(-1)) and ciprofloxacin (MIC > or =0.5 mg l(-1)).

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Bacteremia; Base Sequence; Ceftriaxone; Ciprofloxacin; Humans; Injections, Intravenous; Liver Cirrhosis; Male; Microbial Sensitivity Tests; Neisseria lactamica; Penicillins; Pneumonia, Bacterial; RNA, Bacterial; RNA, Ribosomal, 16S

Nontyphoidal Salmonella (NTS) is recognized as a common cause of bacteremia in malaria-endemic Africa but its importance as a cause of pneumonia is uncertain. We report a case of pneumonia caused by NTS confirmed by culture of lung aspirate from a consolidated left lung in a 16 month-old HIV-uninfected girl who had been admitted to the hospital 1 month previously with severe malaria. She did not respond to first-line antibiotic therapy for benzylpenicillin and gentamicin but improved with ceftriaxone therapy.

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Gentamicins; HIV Infections; Hospitalization; Humans; Infant; Lung; Malaria; Malawi; Penicillin G; Pneumonia, Bacterial; Salmonella; Salmonella Infections

Parapneumonic effusion and empyema are recognized complications of bacterial pneumonia. Optimal management in children, especially the duration of parenteral antibiotics and the role of surgery, is controversial. This study analyzed the clinical characteristics, management, outcome, and bacterial etiology of 59 patients with complicated parapneumonic effusion and empyema treated at a single medical center in Kaohsiung from January 1995 to March 2004.. The diagnosis of complicated parapneumonic effusion was based on the specific characteristics of pleural fluid, computed tomography or ultrasound findings, or direct visualization of loculations during the surgical procedure.. Causative agents were culture-confirmed in 42% of the cases. Streptococcus pneumoniae was the leading pathogen in this series (20% of cases). None of the S. pneumoniae isolates were susceptible to penicillin. Mycoplasma pneumoniae accounted for 19% of cases based on immunoglobulin M assay.. An initial combination therapy regimen consisting of cefotaxime or ceftriaxone plus macrolide provided reasonable activity against 80% of the pathogens isolated in this series. This study also revealed that prolonged parenteral antibiotic treatment resulted in longer length of hospital stay.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Drug Therapy, Combination; Empyema, Pleural; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin M; Infant; Infant, Newborn; Macrolides; Male; Mycoplasma pneumoniae; Penicillin Resistance; Penicillins; Pleural Effusion; Pneumonia, Bacterial; Pneumonia, Mycoplasma; Retrospective Studies; Seasons; Streptococcus pneumoniae; Taiwan; Treatment Outcome

A cohort of 1,391 patients with community-acquired pneumonia of unknown etiology, atypical pneumonia, Legionella pneumophila pneumonia, viral pneumonia, or pneumococcal pneumonia was studied according to a standard protocol to analyse whether the addition of a macrolide to beta-lactam empirical treatment decreases mortality rates. Patients admitted to the intensive care unit were excluded. Severity was assessed using the PORT score. An etiological diagnosis was achieved in 498 (35.8%) patients (292 infections due to Streptococcus pneumoniae). Treatment was chosen by the attending physician according to his/her own criteria: beta-lactam agent in 270 and beta-lactam agent plus a macrolide in 918 cases. The mortality rate was 13.3% in the group treated with a beta-lactam agent alone and 6.9% in the group treated with a beta-lactam agent plus a macrolide (p=0.001). The percentage of PORT-group V patients was 32.6% in the group treated with a beta-lactam agent alone compared to 25.7% in the group who received a beta-lactam agent plus a macrolide (p=0.02). After controlling for PORT score, the odds of fatal outcome was two times higher in patients treated with a beta-lactam agent alone than in those treated with a beta-lactam agent plus a macrolide (adjusted OR = 2, 95%CI 1.24-3.23). The results suggest that the addition of a macrolide to an initial beta-lactam-based antibiotic regimen is associated with lower mortality in patients with community-acquired pneumonia, independent of severity of infection, thus supporting the recommendation of a beta-lactam-agent plus a macrolide as empirical therapy.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Azithromycin; Cefotaxime; Ceftriaxone; Clarithromycin; Community-Acquired Infections; Drug Therapy, Combination; Erythromycin; Humans; Pneumonia, Bacterial

To study the influence of duration of hospitalization on etiologic agent and antibiotic-resistance of hospital-acquired pneumonia (HAP).. Cases of HAP were patients hospitalized in Fudan University Zhongshan Hospital, Ruijin Hospital, Beijing Hospital, Zhongshan University Affiliated Third Hospital, Guangzhou Medical College Affiliated Hospital and Guangdong People's Hospital. These patients were hospitalized from January 2001 to December 2003, and the diagnosis of HAP was made based on positive respiratory specimen cultures. Clinical data including time of HAP onset, severity of illness, risk factors, isolated bacteria and antimicrobial susceptibility were collected and analyzed. Statistical analysis was performed with the SPSS 12.0 software.. A total of 562 cases of HAP were recruited, including 136 cases of early-onset pneumonia (time of onset < or = 5 d), 326 cases of middle-onset pneumonia (time of onset 6 - 14 d) and 100 cases of late-onset pneumonia (time of onset > or = 15 d). The rate of prior antibiotic use increased from 68.4% in the early-onset group to 88.0% in the late-onset group (P = 0.002); ICU admission increased from 29.4% to 46.0% (P = 0.03), and immunosuppression increased from 1.5% to 15% (P = 0.001). A total of 918 strains of bacteria were isolated, the most common pathogens being Pseudomonas aeruginosa (18.6%), Staphylococcus aureus (16.1%), Acinetobacter spp (16.1%), Klebsiella spp (14.4%) and Enterobacter spp (8.8%). Early-onset HAP were more commonly caused by Klebstella (18.3%), while the main etiologic agents for late-onset HAP were Pseudomonas aeruginosa (24.2%) and Methicillin-resistant Staphylococcus aureus (19.3%). The rates of pneumonia caused by Haemophilus and Streptococcus were 4.3% and 2.4% respectively in the early-onset cases, but none was found in late-onset cases. The antibacterial activity of ceftriaxone was influenced by duration of hospitalization, risk factors and severity of the disease. In less severe early-onset cases without risk factors, the sensitivity of ceftriaxone was 80%. But in severe late-onset cases, it was only 50%.. There was significant difference in the pathogen constitution and antibiotic-resistance among early-onset, middle-onset and late-onset cases of HAP. The sensitivity of ceftriaxone was high in less severe early-onset cases without risk factors.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Cross Infection; Drug Resistance, Bacterial; Female; Humans; Klebsiella; Length of Stay; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Pseudomonas aeruginosa; Retrospective Studies; Staphylococcus aureus

Deliberate induction of hypercapnic acidosis protects against lung injury after ischemia-reperfusion, endotoxin-induced, and ventilation-induced lung injury. The efficacy of hypercapnic acidosis in bacterial lung infection, a common cause of acute respiratory distress syndrome, is not known. Furthermore, its effect may differ depending on the presence or absence of antibiotic therapy. We investigated whether hypercapnic acidosis-induced by adding CO2 to inspired gas-would protect against acute lung injury induced by pulmonary Escherichia coli instillation in an in vivo model in the presence and absence of effective antibiotic therapy.. Prospective randomized animal study.. University research laboratory.. Adult male Wistar-Kyoto rats.. The animals were anesthetized and ventilated. In series 1, rats were administered intravenous ceftriaxone (100 mg x kg) and randomized to normocapnia (Normocapnia-ABx; Fico2 0.00, n = 10) or hypercapnia (Hypercapnia-ABx; Fico2 0.05, n = 10) groups. E. coli (8.4 x 10 colony forming units) was instilled intratracheally. Series 2 animals did not receive antibiotics. They were randomized to normocapnia (Normocapnia, n = 10) or hypercapnia (Hypercapnia, n = 10) groups, and intratracheal E. coli was administered. All animals were ventilated for 6 hrs.. In series 1, there were no differences between Hypercapnia-ABx and Normocapnia-ABx groups with regard to: (a-a)o2 gradient (mean +/- sem; 215 +/- 13 vs. 252 +/- 22 mm Hg), Pao2, bronchoalveolar lavage neutrophil count, static lung compliance, or histologic injury. Lung bacterial yield was not different between the groups. In series 2, in the absence of antibiotic therapy, there were no differences between Hypercapnia and Normocapnia groups in: (a-a)o2 gradient (mean +/- sem, 345 +/- 25 vs. 332 +/- 23 mm Hg), systemic Pao2, bronchoalveolar lavage neutrophil count, or static lung compliance. Lung bacterial yield was not altered by hypercapnia in either series 1 or 2.. We conclude that hypercapnic acidosis did not alter the magnitude of the lung injury induced by intratracheal E. coli instillation in the presence or absence of antibiotics.

Topics: Acidosis, Respiratory; Animals; Ceftriaxone; Escherichia coli Infections; Hypercapnia; Male; Pneumonia, Bacterial; Rats; Rats, Inbred WKY; Respiratory Distress Syndrome; Severity of Illness Index

Topics: Anti-Bacterial Agents; Bronchoscopy; Ceftriaxone; Diagnosis, Differential; Discitis; Follow-Up Studies; Humans; Liver Abscess; Lung Abscess; Male; Middle Aged; Pneumonia, Bacterial; Radiography, Thoracic; Streptococcal Infections; Streptococcus intermedius; Time Factors; Tomography, X-Ray Computed

Klebsiella pneumoniae is a common cause of nosocomially acquired pneumonia in immunocompromised patients. Previously, we established a pneumonia model using Klebsiella pneumoniae in B6D2F1/J mice sublethally irradiated with 7-Gy 60Co gamma-radiation and inoculated intratracheally. In the study reported here, we investigated survival of mice following 10 days of antimicrobial therapy with ceftriaxone, gentamicin, gatifloxacin, and a ceftriaxone-gentamicin combination given once daily. Survival was significantly prolonged in response to all therapies. However, survival of mice was 95% when treated with the ceftriaxone-gentamicin combination followed by ceftriaxone alone (75%), and gatifloxacin (80%), whereas survival for controls was 0%. In addition, resistance to any of the treatments did not develop during the study. We conclude that an immunocompromised status does not alter the Infectious Disease Society of America's primary recommendation for treating community-acquired K. pneumoniae pneumonia using a third-generation cephalosporin, with or without an aminoglycoside.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Drug Combinations; Female; Fluoroquinolones; Gatifloxacin; Gentamicins; Humans; Immunocompromised Host; Klebsiella Infections; Klebsiella pneumoniae; Mice; Mice, Inbred Strains; Pneumonia, Bacterial; Survival Rate; Whole-Body Irradiation

This report describes a post-hoc analysis of two large studies of typical community-acquired pneumonia (CAP) in hospitalized patients, focusing on demographics, disease characteristics, and outcome in patients with and without chronic obstructive pulmonary disease (COPD). In both studies, ertapenem 1 g IV daily was compared with ceftriaxone 1 g IV daily as initial antimicrobial therapy. Clinically improving patients could be switched to oral antibiotic therapy after 3 days. Of the 857 patients treated in both studies, 264 (31%) had COPD. The proportions of patients who were male, were >/=65 years of age, had a Pneumonia Severity Index of IV/V, or had Haemophilus influenzae isolated in a baseline culture were higher in patients with COPD. Streptococcus pneumoniae was the most common pathogen both in patients with and without COPD. Clinical response rates in assessable patients 7-14 days after completion of therapy for the combined treatment groups were 90% (187/208) for patients with COPD and 93% (424/456) for those without COPD (odds ratio 0.7 [95% CI, 0.4-1.2], P = 0.17). Of assessable COPD patients, 109/121 (90%) treated with ertapenem and 78/87 (90%) treated with ceftriaxone achieved a favorable clinical response (odds ratio 1.0 [95% CI, 0.6-1.8], P = 0.94). The outcome in patients with or without COPD was similar regardless of therapy. In patients with COPD as well as in the overall study population, the efficacy of ertapenem as initial antimicrobial monotherapy for patients with serious typical community-acquired pneumonia was comparable to that of ceftriaxone.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Enterobacteriaceae; Ertapenem; Female; Haemophilus influenzae; Hospitalization; Humans; Injections, Intravenous; Lactams; Male; Middle Aged; Pneumonia, Bacterial; Pulmonary Disease, Chronic Obstructive; Randomized Controlled Trials as Topic; Streptococcus pneumoniae; Treatment Outcome

An immune complex mechanism for ceftriaxone sodium- induced severe autoimmune hemolytic anemia has previously been demonstrated using routine blood bank techniques. We describe herein a patient with severe hemolysis that subsided once the drug was discontinued. Serologic techniques demonstrated immune complex-mediated ceftriaxone-dependent red cell antibodies. These findings were further supported by the results of flow cytometry, in which a change in basal red cell autofluorescence was seen in the presence of the antibody and the drug. Our case illustrates the adjunctive value of flow cytometry in the diagnosis of ceftriaxone-dependent red cell antibody.

Topics: Anemia, Hemolytic, Autoimmune; Anemia, Sickle Cell; Antigen-Antibody Complex; Blood Transfusion; Ceftriaxone; Child; Drug Hypersensitivity; Epilepsy, Generalized; Erythrocytes; Flow Cytometry; Fluorescence; Humans; Male; Oxidative Stress; Pneumonia, Bacterial; Respiratory Insufficiency

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

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

Topics: Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Dysentery, Bacillary; Glycogen Storage Disease Type I; Humans; Infant; Infusions, Intravenous; Male; Pneumonia, Bacterial; Radiography; Shigella sonnei

Nocardiasis is an uncommon bacterial disease often observed in immunodepressed patients. Its interactions with the immune system remain poorly known. We report a case of Nocardia asteroides thoracic nocaridiasis in an African subject who also had macrophage activation syndrome. We recall the classic data on nocardiasis in Africa and emphasize the importance of emergence in HIV-infected subjects. The association between nocardiasis and macrophage activation syndrome suggest a possible pathogenic mechanism involving the immune system (lymphocytes and macrophages) and Nocardia asteroides.

Topics: AIDS-Related Opportunistic Infections; Amikacin; Arthritis, Infectious; Biopsy; Bone Marrow; Ceftriaxone; Diagnosis, Differential; Drug Resistance, Multiple; Drug Therapy, Combination; Histiocytosis, Non-Langerhans-Cell; Humans; Lung; Macrophage Activation; Male; Microbial Sensitivity Tests; Middle Aged; Nocardia asteroides; Nocardia Infections; Pneumonia, Bacterial; Recurrence; Synovial Membrane; Systemic Inflammatory Response Syndrome; Tomography, X-Ray Computed

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

This study was explore the distribution of the bacteria and their sensibility to antibiotics in hospital-acquired pneumonia.. One hundred and ninety-six bacterium species were collected in patients with the hospital-acquired pneumonia to make sputum culture. The sensibility of the bacteria to antibiotics were examined by KB paper method and the minimal-inhibitory-concentration by gel double multiple dilute method.. Most of the G- bacteria were pseudomonas aeruginosa (30%) and klebsiella bacillus (22%). Most of the G+ bacteria were staphylococcus epidermidis (14%) and staphylococcus aureus (12%). G- bacteria were sensitive to impienem(98%), cefoperazone(90%), ceftriaxone(90%), leftazidime(92%), ciprofloxacin(90%), and amikacin(89%). The sensibility of vancomycin to G+ bacteria was 100%.. The pseudomonas aeruginosa, klebsiella bacillus, staphylococcus epidermidis, and staphylococcus aureus are the most important bacteria in patients with hospital-acquired pneumonia. Imipenem, cefoperazone, ceftriazone, leftazidime, ciprofloxacin, amikacin, and vancomycin are effective antibiotics for treating hospital-acquired pneumonia.

Topics: Adult; Aged; Aged, 80 and over; Cefoperazone; Ceftriaxone; Cross Infection; Female; Humans; Imipenem; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Pneumonia, Bacterial; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Staphylococcus epidermidis

Central venous catheterization is commonly performed in the critically ill. The femoral vein is widely accepted as an insertion site with complications thought to be comparable to other central access sites. We used serial ultrasound examinations with Doppler to examine the evolution of a heretofore undescribed complication of femoral vein catheterization, phlegmasia cerulea dolens with compartment syndrome.. Serial ultrasounds were performed in patients before the insertion of femoral venous catheters and sequentially every 48 hrs while the catheters were in place. The noncatheterized leg served as a control.. A trauma and life support center of a tertiary multidisciplinary critical care unit.. A 32-yr-old man with respiratory failure as a consequence of a severe community-acquired pneumonia that required central venous access for antibiotics because no peripheral sites could be obtained.. None.. The initial ultrasound examination of both legs before femoral catheter insertion revealed no sign of venous thrombosis. Ultrasound of the catheterized leg at 48 hrs revealed a small nonocclusive thrombosis, whereas the opposite leg remained normal. At 72 hrs, the catheterized leg had clinical and ultrasonographic evidence of a massive thrombosis. A compartment syndrome defined by pressure measurements soon ensued and required emergent surgical release.. This case report and a review of the available literature suggest that thrombosis associated with femoral vein catheterization should be considered when clinicians decide where to obtain central venous access when multiple sites are available. This report also suggests the utility of serial ultrasound examinations to define clinically nonapparent thrombosis as an early indicator of a potentially catastrophic complication.

Topics: Adult; Catheterization, Central Venous; Ceftriaxone; Compartment Syndromes; Critical Care; Drug Therapy, Combination; Erythromycin; Femoral Vein; Humans; Male; Pneumonia, Bacterial; Respiratory Insufficiency; Thrombophlebitis; Ultrasonography

Pasteurella multocida is a normal oral commensal in animals. Animal bites are often complicated by severe wound infection due to P. multocida, but systemic infection is rare. We report a patient with bacteremic pneumonia successfully treated with ceftriaxone and ciprofloxacin. We also review the clinical isolates of P. multocida reported by a major teaching hospital laboratory over a 10-year period. There were 23 patients, comprising the present case, 17 patients with wound infections following animal bites, one case of neonatal meningitis and associated maternal vaginal carriage of P. multocida, and three sputum isolates of doubtful significance.

Topics: Aged; Animals; Ceftriaxone; Cephalosporins; Ciprofloxacin; Dogs; Humans; Male; Pasteurella Infections; Pasteurella multocida; Pneumonia, Bacterial; Zoonoses

A time-series prospective study of patients admitted to the hospital for treatment of community-acquired pneumonia was undertaken to determine vancomycin-resistant enterococcal perianal colonization rates among patients who received ceftriaxone with or without erythromycin versus those who received levofloxacin. A colonization rate of 16% (8/51) was found in the ceftriaxone-erythromycin group versus 0% (0/52) in the levofloxacin group .

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Drug Therapy, Combination; Enterococcus; Erythromycin; Female; Gram-Positive Bacterial Infections; Humans; Levofloxacin; Male; Middle Aged; Ofloxacin; Pneumonia, Bacterial; Prospective Studies; Risk Factors; Vancomycin Resistance

Topics: Bacteremia; Ceftriaxone; Cephalosporins; Female; Humans; Infant; Moraxella catarrhalis; Pneumonia, Bacterial

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacteria; Humans; Infant, Newborn; Macrolides; Meningitis, Bacterial; Neutropenia; Penicillin Resistance; Penicillins; Pneumonia, Bacterial; Sepsis; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Topics: Adult; Cefotaxime; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Cost-Benefit Analysis; Humans; Pneumonia, Bacterial; Treatment Outcome

Topics: Adult; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Cost-Benefit Analysis; Humans; Pneumonia, Bacterial; Treatment Outcome

Legionella jordanis has seldom been reported as a cause of infection in humans. We describe a case of pneumonia due to L. jordanis that occurred in a non-immunocompromised 74-year-old patient and failed to respond to a combination of ceftriaxone and ofloxacin. Cure was achieved only after an erythromycin-rifampin combination was started.

Topics: Aged; Anti-Infective Agents; Ceftriaxone; Drug Therapy, Combination; Erythromycin; Humans; Immunocompetence; Legionella; Legionellosis; Male; Ofloxacin; Pneumonia, Bacterial; Rifampin

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

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

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

Of 342 patients with community-acquired pneumonia, 100 were diagnosed etiologically. In these patients, disease epidemiology, prognostic factors, and influence of antibiotic treatment were analyzed prospectively. Fifty-two patients were treated with a broad-spectrum antibiotic (ceftriaxone), and 48 received a medium-spectrum antibiotic (cefuroxime); some patients in each group also received erythromycin. Streptococcus pneumoniae was the most frequently isolated microorganism (43%), followed by Chlamydia pneumoniae (21%), Haemophilus influenzae (19%), and Mycoplasma pneumoniae (11%). Factors significantly associated with increased mortality were initially critical or poor clinical condition, involvement of two or more lobules, and complications. Prior administration of antibiotics was predictive of penicillin and erythromycin resistance in Streptococcus pneumoniae, but had no effect on the course of the disease. Eight patients died, 89 were cured, and three had recurrences; there was no significant difference in outcome between treatment groups, regardless of whether patients also received erythromycin. Increased knowledge of epidemiological, predictive, and prognostic factors can significantly improve early diagnosis of community-acquired pneumonia and facilitate the choice of appropriate antibiotic treatment, thereby helping to reduce morbidity and mortality.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Cefuroxime; Cephalosporins; Chlamydophila pneumoniae; Community-Acquired Infections; Drug Resistance, Microbial; Erythromycin; Female; Haemophilus influenzae; Humans; Male; Middle Aged; Mycoplasma pneumoniae; Penicillin Resistance; Pneumonia, Bacterial; Prognosis; Prospective Studies; Streptococcus pneumoniae

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; CD4 Lymphocyte Count; Ceftriaxone; Cephalosporins; Female; Gentamicins; Gram-Negative Bacterial Infections; HIV Infections; Humans; Microbial Sensitivity Tests; Netilmicin; Pneumonia, Bacterial; Rhizobium; Stavudine

Pulmonary involvement is an uncommon extraintestinal manifestation of salmonellosis. We describe a 30 year old man with mental retardation, presenting with salmonella gastroenteritis and bacteremia. An early pneumonia evolving in the clinical setting of severe kyphoscoliosis, suggests that hematogenous spread to the lungs may occur as a result of abnormalities of the chest wall.

Topics: Adult; Ceftriaxone; Cephalosporins; Humans; Intellectual Disability; Kyphosis; Male; Pneumonia, Bacterial; Salmonella Infections; Scoliosis

A case of community acquired pneumonia with Acinetobacter calcoaceticus is presented. Acinetobacter must be considered in the differential diagnosis of Gram negative coccobacillary pneumonia.

Topics: Acinetobacter calcoaceticus; Acinetobacter Infections; Adult; Amikacin; Ceftriaxone; Community-Acquired Infections; Diagnosis, Differential; Humans; Male; Pneumonia, Bacterial