ro13-9904 and Pneumonia

Tanreqing injection (TRQ) is a traditional Chinese medicine injection. The goal of this study was to assess the clinical efficacy and safety of TRQ injection in combination with azithromycin or ceftriaxone, as well as azithromycin or ceftriaxone alone, in treating Streptococcus pneumoniae pneumonia (SPP).. The randomized controlled trial (RCT) of TRQ injection combined with antibiotics versus antibiotics alone in the treatment of SPP was retrieved from Chinese and English databases (the control group was treated with antibiotics alone, while the experimental group received TRQ injection combined with antibiotics). The retrieval period was from the database's inception through February 2022. The data was extracted using the Cochrane Collaboration Network Quality Evaluation Standards, the methodological quality of the included literature was assessed, and the outcome indicators were calculated using RevMan5.4.1 software.. A total of 25 RCTs were collected, including 2057 patients. TRQ injection combined with antibiotics significantly improved clinical efficacy and reduced defervescence time, lung rale disappearance time, cough disappearance time, disappearance time of chest pain, and average hospitalization time when compared to control group, according to meta-analysis results (p < 0.05).. In the treatment of SPP, TRQ injection combination with antibiotics can significantly improve the total effect rate when compared to standard western medicine. Due to the low quality of the randomized controlled trials included in this investigation, more high-quality, multi-center, large-sample, prospective, randomized, double-blind clinical studies are needed to confirm the aforementioned conclusions.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Drugs, Chinese Herbal; Humans; Pneumonia; Randomized Controlled Trials as Topic; Streptococcus pneumoniae

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

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

Topics: Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Dose-Response Relationship, Drug; Humans; Pneumonia; Randomized Controlled Trials as Topic; Treatment Outcome

Ertapenem has been demonstrated to be highly effective for the treatment of complicated infections. The aim of this study was to compare the efficacy and safety of ertapenem with ceftriaxone.. We searched the PubMed, EMBASE, and the Cochrane Library for published randomized controlled trials (RCTs) that compared the efficacy and safety of ertapenem with ceftriaxone for the treatment of complicated infections including community-acquired pneumonia (CAP), complicated urinary tract infections (cUTIs), and complicated intra-abdominal infections (cIAIs). Meta-analysis was performed by RevMan 5.0.. Eight RCTs, involving 2 883 patients, were included in our meta-analysis. Ertapenem was associated with similar clinical treatment success with ceftriaxone for complicated infections (1 326 patients, fixed-effect model, OR: 1.13, 95% CI: 0.75-1.71). There was no difference between the compared treatment groups with regard to the microbiological treatment success, and no difference was found with regard to the incidence of clinical and laboratory drug-related adverse events between ertapenem and ceftriaxone groups. As to local tolerability, overall, there was no difference between the compared groups; however, in the subgroup analysis, local reaction was significantly less in the ertapenem subgroup than the ceftriaxone plus ceftriaxone subgroup.. Ertapenem can be used as effectively and safely as ceftriaxone for the treatment of complicated infections. It is an appealing option for the treatment of these complicated infections.

Topics: Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Ertapenem; Humans; Intraabdominal Infections; Pneumonia; Randomized Controlled Trials as Topic; Urinary Tract Infections

Ceftriaxone is an effective prophylactic antibiotic. However, there is no consensus about whether ceftriaxone should be used as a first-line antibiotic for the prevention of incisional surgical site infection (SSI). Its role in preventing urinary tract infection (UTI) and pneumonia also is controversial.. A meta-analysis of randomized, controlled trials assessing the prophylactic use of ceftriaxone between 1983 and 2005 was performed. Medline, Embase, and Cochrane registers were reviewed. Additional references, review papers, and proceedings from meetings were searched. The Jadad score was used to assess study quality. A meta-analysis with sensitivity analyses was performed for SSI, UTI, and pneumonia.. Of 231 reviewed papers, 90 were included. Ceftriaxone prophylaxis was superior to other antibiotics in each category. Sixty-one studies assessed the prevention of SSI (odds ratio (OR), 0.68; 95% confidence interval (CI), 0.53-0.7, p < 0.001; Cochran's Q statistic, p = 0.93). The difference was greatest for abdominal surgery. There was no difference for cardiac surgery. Thirty-five studies assessed the prevention of UTI (OR 0.53; 95% CI 0.43-0.63, p = 0; Cochran's Q statistic, p = 0.97). The difference was greatest in obstetric and gynecological and colorectal surgery. Thirty-seven studies assessed the prevention of pneumonia (OR 0.66; 95% CI 0.54-0.81, p = 0; Cochran's Q statistic, p = 0.65). The difference was greatest in upper abdominal surgery.. The meta-analysis confirms that prophylactic ceftriaxone is more effective than most other prophylactic antibiotics. This reduces SSI, UTI, and pneumonia in procedures where there is an increased risk of these infections. In such procedures, the data support using ceftriaxone as a first-line prophylactic antibiotic.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Humans; Pneumonia; Randomized Controlled Trials as Topic; Surgical Wound Infection; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Humans; Pneumonia; Randomized Controlled Trials as Topic; Surgical Wound Infection; Urinary Tract Infections

Stomatococcus mucilaginosus, a normal inhabitant of the human oral cavity and upper respiratory tract, can cause fatal sepsis and meningitis in neutropenic patients. We identified eight cases of bacteremia due to S. mucilaginosus in children with cancer, of whom five developed complications despite receiving appropriate antibiotics. At the time cultures were positive, seven patients had profound neutropenia (< 100 neutrophils and band forms/mm3) and four had mucositis; five had central venous catheters. In two cases, there was unequivocal evidence of catheter-related sepsis. Bacteremia was eradicated in all patients within 48 hours after initiation of antibiotics. Despite prompt instigation of effective antibiotic therapy, the complication rates in this series were high: septic shock (50%), pneumonia (50%), dermatologic manifestations (38%), altered neurological status (25%), meningitis (13%), and adult respiratory distress syndrome (13%). No fatalities were attributable to S. mucilaginosus infection. These cases illustrate the virulence of S. mucilaginosus organisms in neutropenic children and suggest a substantial risk of sequelae even when adequate antibiotic therapy is given.

Topics: Adolescent; Bacteremia; Ceftazidime; Ceftriaxone; Child; Child, Preschool; Female; Gram-Positive Bacterial Infections; Humans; Male; Meningitis, Bacterial; Micrococcaceae; Neoplasms; Neutropenia; Pneumonia; Respiratory Distress Syndrome; Shock, Septic; Skin Diseases; Vancomycin

One gram once daily of ceftriaxone is as effective as 2 gm for the common causative organisms of community-acquired and nosocomial pneumonias. It should not be used alone against L. pneumophila, the TWAR pneumoniae, and possibly anaerobic pathogens. Preliminary study suggests that a regimen of 500 mg a day may be effective in selected patients with simple pneumonias caused by sensitive pathogens. Ceftriaxone is safe, well tolerated, and cost-effective, which means it can play a significant therapeutic role in nursing homes and other long-term care facilities as well as in outpatient therapy.

Topics: Bacterial Infections; Ceftriaxone; Drug Administration Schedule; Humans; Pneumonia; Respiratory Tract Infections

The clinical efficacy and tolerability of ceftriaxone in the treatment of pneumonia and other lower respiratory tract infections were evaluated in 827 patients (515 pneumonia, 312 other lower respiratory tract infections) reported in the international literature (daily dose: 1 of 2 g.i.v. or i.m. in most patients). Therapeutic success was achieved in 738 patients (89.2%). Microbiological results were evaluated in 295 patients. Eradication of the most common respiratory pathogens was achieved in 100% of cases and of Enterobacteriaceae in 85.7%-100%. Adverse effects occurred in 4.9% of patients. A large multicenter trial was carried out in Italy using a single daily dose of 1-2 g by i.v. or i.m. Six hundred ninety-six patients were admitted to the study (370 pneumonia, and 326 other lower respiratory tract infections). Therapeutic success was achieved in 668 cases (96%). Pathogens were eradicated in 88% of cases (184 pts evaluated). Side effects were observed in 4.6% of cases.

Topics: Bacteria; Ceftriaxone; Clinical Trials as Topic; Humans; Pneumonia; Respiratory Tract Infections

Pneumonia is the most common infection after out-of-hospital cardiac arrest (OHCA) occurring in up to 65% of patients who remain comatose after return of spontaneous circulation. Preventing infection after OHCA may (1) reduce exposure to broad-spectrum antibiotics, (2) prevent hemodynamic derangements due to local and systemic inflammation, and (3) prevent infection-associated morbidity and mortality.. The ceftriaxone to PRevent pneumOnia and inflammaTion aftEr Cardiac arrest (PROTECT) trial is a randomized, placebo-controlled, single-center, quadruple-blind (patient, treatment team, research team, outcome assessors), non-commercial, superiority trial to be conducted at Maine Medical Center in Portland, Maine, USA. Ceftriaxone 2 g intravenously every 12 h for 3 days will be compared with matching placebo. The primary efficacy outcome is incidence of early-onset pneumonia occurring < 4 days after mechanical ventilation initiation. Concurrently, T cell-mediated inflammation bacterial resistomes will be examined. Safety outcomes include incidence of type-one immediate-type hypersensitivity reactions, gallbladder injury, and Clostridioides difficile-associated diarrhea. The trial will enroll 120 subjects over approximately 3 to 4 years.. The PROTECT trial is novel in its (1) inclusion of OHCA survivors regardless of initial heart rhythm, (2) use of a low-risk antibiotic available in the USA that has not previously been tested after OHCA, (3) inclusion of anti-inflammatory effects of ceftriaxone as a novel mechanism for improved clinical outcomes, and (4) complete metagenomic assessment of bacterial resistomes pre- and post-ceftriaxone prophylaxis. The long-term goal is to develop a definitive phase III trial powered for mortality or functional outcome.. ClinicalTrials.gov NCT04999592 . Registered on August 10, 2021.

Topics: Ceftriaxone; Double-Blind Method; Humans; Inflammation; Out-of-Hospital Cardiac Arrest; Pneumonia; Randomized Controlled Trials as Topic; Treatment Outcome

Pneumonia is a leading cause of mortality in children <5 years globally. Early identification of hospitalized children with pneumonia who may fail antibiotics could improve outcomes. We conducted a secondary analysis from the Malawi CPAP IMPACT trial evaluating risk factors for antibiotic failure among children hospitalized with pneumonia.. Participants were 1-59 months old with World Health Organization-defined severe pneumonia and hypoxemia, severe malnutrition, and/or HIV exposure/infection. All participants received intravenous antibiotics per standard care. First-line antibiotics were benzylpenicillin and gentamicin for five days. Study staff assessed patients for first-line antibiotic failure daily between days 3-6. When identified, patients failing antibiotics were switched to second-line ceftriaxone. Analyses excluded children receiving ceftriaxone and/or deceased by hospital day two. We compared characteristics between patients with and without treatment failure and fit multivariable logistic regression models to evaluate associations between treatment failure and admission characteristics.. From June 2015-March 2018, 644 children were enrolled and 538 analyzed. Antibiotic failure was identified in 251 (46.7%) participants, and 19/251 (7.6%) died. Treatment failure occurred more frequently with severe malnutrition (50.2% (126/251) vs 28.2% (81/287), p<0.001) and amongst those dwelling ≥10km from a health facility (22.3% (56/251) vs 15.3% (44/287), p = 0.026). Severe malnutrition occurred more frequently among children living ≥10km from a health facility than those living <10km (49.0% (49/100) vs 35.7% (275/428), p = 0.014). Children with severe malnutrition (adjusted odds ratio (aOR) 2.2 (95% CI 1.52, 3.24), p<0.001) and pre-hospital antibiotics ((aOR 1.47, 95% CI 1.01, 2.14), p = 0.043) had an elevated aOR for antibiotic treatment failure.. Severe malnutrition and pre-hospital antibiotic use predicted antibiotic treatment failure in this high-risk severe pneumonia pediatric population in Malawi. Our findings suggest addressing complex sociomedical conditions like severe malnutrition and improving pneumonia etiology diagnostics will be key for better targeting interventions to improve childhood pneumonia outcomes.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Malawi; Malnutrition; Pneumonia; Treatment Failure; World Health Organization

Infections complicate the acute phase of stroke in one third of patients and especially pneumonia is associated with increased risk of death or dependency. In randomized trials of stroke patients, preventive antibiotics reduced overall infections, but did not reduce pneumonia or improve outcome. This may be explained by broad selection criteria, including many patients with a low risk of pneumonia. To assess the potential of selection of patients at high risk of pneumonia, we performed a post-hoc analysis in the Preventive Antibiotics in Stroke Study (PASS).. PASS was a multicentre phase 3 trial in acute stroke patients who were randomized to preventive ceftriaxone for four days within 24 hours or standard care. For this analysis patients were divided based on the ISAN risk score for pneumonia as follows: low (0-6), medium (7-14) and high (15-21). Primary outcomes were pneumonia rate during admission as judged by the treating physician, and by an independent committee; secondary outcomes were overall infections and unfavorable outcome (modified Rankin Scale ≥3). We adjusted with multivariable regression for possible confounders: age, stroke subtype and severity, pre-stroke dependency and diabetes.. Pneumonia occurred more frequently in higher risk groups (25.7% (high), 9.0% (medium) 1.5%, (low)). The absolute difference in pneumonia rate between patients treated with ceftriaxone or standard care increased with the ISAN score (low: 0.5%, medium: 1.2%, high: 10.1%). After adjustment ceftriaxone reduced overall infections in the low and medium groups, not in the high-risk group. There was a trend towards reduction of pneumonia as judged by the committee (3.7% vs 13.6%, aOR = 0.164, p = 0.063) in the high-risk group.. This post-hoc analysis of PASS confirmed higher rates of pneumonia with higher ISAN scores, and suggests that in acute stroke patients with an ISAN score of ≥15, preventive ceftriaxone for four days may reduce pneumonia rate.

Topics: Anti-Bacterial Agents; Ceftriaxone; Humans; Pneumonia; Stroke; Treatment Outcome

Ceftriaxone (CTRX) and ampicillin/sulbactam (ABPC/SBT) are recommended by various guidelines as the first-line antibiotics for community-acquired pneumonia (CAP). However, which of these antibiotics is more effective for treating non-aspiration CAP remains unclear.. This study was a prospective, single-center, open-label, quasi-randomized controlled trial. Patients with adult CAP without risk for aspiration were allocated to either a CTRX or ABPC/SBT group based on the date of hospital admission. Macrolide was added to patients in each group. The primary outcome was the clinical response in the validated per-protocol (VPP) population at end of treatment (EOT). The secondary outcomes were clinical response during treatment and at end of study (EOS) in the VPP population, and mortality rate at day 30 in the modified intention-to-treat (MITT) population.. Of 696 screened patients, 433 patients were excluded and 263 patients were allocated to receive either of the treatments. Males comprised 54% of patients and mean age and PSI were 62.1 ± 19.8 years and 69.3 ± 30.0, respectively, with 124 patients allocated to the CTRX group and 138 patients allocated to the ABPC/SBT group. The clinical effectiveness rate for the VPP population at EOT was 90% in the CTRX and 96% in the ABPC/SBT group (p = 0.072, 95% confidence interval [CI] of risk difference [RD]: - 12.6-0.8%). No significant difference in effectiveness at day 4 was observed between the CTRX and ABPC/SBT groups (p = 0.079, 95%CI of RD: - 12.1-0.4%), but at day 7, ABPC/SBT was significantly more effective than CTRX in the VPP population (p = 0.047, 95%CI of RD: - 13.3--0.4%). No significant difference in late response at EOS was seen between CTRX and ABPC/SBT groups: cure (89 [86%] and 102 [94%]), relapse (5 [5%] and 1 [1%]) and failure (10 [10%] and 5 [5%]; p = 0.053). Deaths within 30 days in MITT population was higher in CTRX group (4 [3%]) than in ABPC/SBT group (0 [0%]) (p = 0.048, 95%CI of RD: 0.1-6.3%).. No significant difference in effectiveness was found between ABPC/SBT and CTRX at EOT. However, ABPC/SBT might be more effective in the early phase of treatment.. UMIN-CTR, UMIN000037464. Registered 25 July 2019 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042262.

Topics: Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Japan; Macrolides; Male; Middle Aged; Pneumonia; Prospective Studies; Risk Factors; Sulbactam

Patients with pneumonia who are elderly or severely ill are at a particularly high risk of mortality. This post hoc retrospective analysis of data from two Phase III studies evaluated early improvement outcomes in subgroups of high-risk patients with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP, excluding ventilator-associated pneumonia [VAP]).. One study included hospitalised CAP patients randomised to ceftobiprole or ceftriaxone ± linezolid treatment. The other study included HAP patients, who were randomised to ceftobiprole or ceftazidime plus linezolid treatment. The primary outcome was rate of early clinical response (Day 3 in CAP and Day 4 in HAP patients). Additional outcome measures included clinical cure at a test-of-cure visit, 30-day all-cause mortality and safety.. The overall high-risk group comprised 398 CAP patients and 307 HAP patients with risk factors present at baseline. The rate of early response was numerically higher in ceftobiprole-treated patients vs comparator-treated patients in the following high-risk groups: CAP patients aged ≥75 years (16.3% difference, 95% confidence interval [CI]: 1.8, 30.8); CAP patients with COPD (20.1% difference, 95% CI: 8.8, 31.1); all high-risk HAP patients (12.5% difference, 95% CI: 3.5, 21.4); HAP patients with >10 baseline comorbidities (15.3% difference, 95% CI: 0.3, 30.4).. Previous studies show that ceftobiprole is an efficacious therapy for patients with pneumonia who are at high risk of poor outcomes. This post hoc analysis provides preliminary evidence that ceftobiprole treatment may have advantages over other antibiotics in terms of achieving early improvement in high-risk patients with HAP (excluding VAP) and in some subgroups of high-risk CAP patients.. NCT00210964 : registered September 21, 2005; NCT00229008 : registered September 29, 2005; NCT00326287 : registered May 16, 2006.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftazidime; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Cross Infection; Female; Humans; Linezolid; Male; Middle Aged; Pneumonia; Retrospective Studies; Severity of Illness Index; Treatment Outcome

In Asia, an estimated one million deaths are caused by communityacquired pneumonia (CAP) each year. Despite the high mortality in elderly people, a large number of CAP patients have been treated and survived with optimal life expectancy. A few studies have been done on adult CAP therapeutic approaches in Asia. Moreover, differences have been noted between these studies and European data. We aimed to investigate the efficacy of oral Levofloxacin (TAVANEX), 750 mg, once daily for five days versus parenteral Ceftriaxone 1gr BD, plus oral Azithromycin (250 mg, once daily) for seven to ten days (standard regimen) in CAP treatment.. We conducted a prospective randomized trial among 150 patients with CAP in Qaem Hospital of Alborz city from December 2016 to June 2017. A group of CAP patients were randomized in two treatment groups. One group was treated with oral Levofloxacin (TAVANEX), 750 mg, once daily for five days and the other group with parenteral Ceftriaxone 1gr BD plus oral Azithromycin (250 mg, once daily) for seven to ten days (standard regimen). The efficacy and side effects of the assigned drugs were compared between two groups. The probability level for statistical significance was set at P ≤ 0.05.. The body temperature (P value=0.09), WBC count (P value=0.15), respiratory sounds (P value=0.18) and admission duration (P value=0.15) showed no significant differences after treatment between two groups. There was no report of hospital mortality, clinical deterioration and antibiotic escalation during hospital admission in both groups of study. In standard regimen group, only two (2.7%) patients had skin rash while in Levofloxacin group one case (1.3%) had skin rash, two patients (2.7%) had gastrointestinal problems and three (4%) patients showed central nervous system (CNS) complications. In both groups, the reticulonodular pattern was more frequently observed in Chest X-ray. Although standard regimen group (n=27, 36%) showed more consolidation than patients in Levofloxacin group (n=22, 29.3%), and the ground glass pattern was observed more in Levofloxacin group.. We concluded that monotherapy with oral Levofloxacin was as effective as treatment with Ceftriaxone plus Azithromycin combination in patients with CAP who required hospitalization.

Topics: Administration, Intravenous; Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Asia; Azithromycin; Ceftriaxone; Community-Acquired Infections; Drug Administration Schedule; Drug Therapy, Combination; Female; Hospitalization; Humans; Levofloxacin; Male; Middle Aged; Pneumonia; Prospective Studies; Treatment Outcome

Ceftriaxone with or without a macrolide antibiotic is a recommended treatment for patients with community-acquired pneumonia requiring hospital admission and intravenous antibiotic treatment. We aimed to assess the efficacy and safety of ceftaroline fosamil compared with ceftriaxone in the treatment of Asian patients admitted to hospital with community-acquired pneumonia.. In this international, randomised, controlled, double-blind, phase 3, non-inferiority with nested superiority trial, adult Asian patients with Pneumonia Outcomes Research Team (PORT) risk class III-IV acute community-acquired pneumonia were randomly assigned (1:1) to receive intravenous ceftaroline fosamil (600 mg every 12 h) or ceftriaxone (2 g every 24 h) for 5-7 days. Patients were randomly assigned via centralised telephone and web-based system; patients and treating clinicians were masked to treatment allocation. Investigators who did study assessments remained masked to treatment allocation until completion of the study. The primary endpoint was clinical cure at the test-of-cure visit (8-15 days after last dose of study drug) in the clinically evaluable population. Non-inferiority of ceftaroline fosamil was defined as a lower limit of the two-sided 95% CI for the difference in the proportion of patients clinically cured of -10% or higher; if non-inferiority was achieved, superiority was to be concluded if the lower limit of the 95% CI was greater than 0%. This trial is registered with ClinicalTrials.gov, number NCT01371838.. Between Dec 13, 2011, and April 26, 2013, 847 patients were enrolled at 64 centres in China, India, South Korea, Taiwan, and Vietnam, of whom 771 were randomly assigned and 764 received study treatment. In the clinically evaluable population (n=498) 217 (84%) of 258 patients in the ceftaroline fosamil group and 178 (74%) of 240 patients in the ceftriaxone group were clinically cured at the test-of-cure visit (difference 9·9%, 95% CI 2·8-17·1). The superiority of ceftaroline fosamil was consistent across all preplanned patient subgroup analyses (split by age 65 years, age 75 years, sex, PORT risk class, and previous antibiotic use) apart from patients younger than 65 years. The frequency of adverse events was similar between treatment groups and the safety results for ceftaroline fosamil were consistent with the cephalosporin class and previous clinical trial data.. Ceftaroline fosamil 600 mg given every 12 h was superior to ceftriaxone 2 g given every 24 h for the treatment of Asian patients with PORT III-IV community-acquired pneumonia. These data suggest that ceftaroline fosamil should be regarded as an alternative to ceftriaxone in empirical treatment regimens for this patient population.. AstraZeneca.

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

In adults with acute stroke, infections occur commonly and are associated with an unfavourable functional outcome. In the Preventive Antibiotics in Stroke Study (PASS) we aimed to establish whether or not preventive antimicrobial therapy with a third-generation cephalosporin, ceftriaxone, improves functional outcome in patients with acute stroke.. In this multicentre, randomised, open-label trial with masked endpoint assessment, patients with acute stroke were randomly assigned to intravenous ceftriaxone at a dose of 2 g, given every 24 h intravenously for 4 days, in addition to stroke unit care, or standard stroke unit care without preventive antimicrobial therapy; assignments were made within 24 h after symptom onset. The primary endpoint was functional outcome at 3 months, defined according to the modified Rankin Scale and analysed by intention to treat. The primary analysis was by ordinal regression of the primary outcome. Secondary outcomes included death, infection rates, antimicrobial use, and length of hospital stay. Participants and caregivers were aware of treatment allocation but assessors of outcome were masked to group assignment. This trial is registered with controlled-trials.com, number ISRCTN66140176.. Between July 6, 2010, and March 23, 2014, a total of 2550 patients from 30 sites in the Netherlands, including academic and non-academic medical centres, were randomly assigned to the two treatment groups: 1275 patients to ceftriaxone and 1275 patients to standard treatment (control group). 12 patients (seven in the ceftriaxone group and five in the control group) withdrew consent immediately after randomisation, leaving 2538 patients available for the intention-to-treat-analysis (1268 in the ceftriaxone group and 1270 in the control group). 2514 (99%) of 2538 patients (1257 in each group) completed 3-month follow-up. Preventive ceftriaxone did not affect the distribution of functional outcome scores on the modified Rankin Scale at 3 months (adjusted common odds ratio 0·95 [95% CI 0·82-1·09], p=0·46). Preventive ceftriaxone did not result in an increased occurrence of adverse events. Overgrowth infection with Clostridium difficile occurred in two patients (<1%) in the ceftriaxone group and none in the control group.. Preventive ceftriaxone does not improve functional outcome at 3 months in adults with acute stroke. The results of our trial do not support the use of preventive antibiotics in adults with acute stroke.. Netherlands Organization for Health Research and Development, Netherlands Heart Foundation, and the European Research Council.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Female; Follow-Up Studies; Humans; Intention to Treat Analysis; Length of Stay; Male; Middle Aged; Netherlands; Pneumonia; Prospective Studies; Quality-Adjusted Life Years; Recovery of Function; Stroke; Treatment Outcome; Urinary Tract Infections

A randomized controlled trial compared day care versus hospital care management of pneumonia.. Children 2 to 59 months of age with severe pneumonia received either day care, with antibiotic treatment, feeding, and supportive care from 8:00 am to 5:00 pm, or hospital care, with similar 24-hour treatment.. In 2006-2008, 360 children were assigned randomly to receive either day care or hospital care; 189 (53%) had hypoxemia, with a mean±SD oxygen saturation of 93±4%, which increased to 99±1% after oxygen therapy. The mean±SD durations of day care and hospital care were 7.1±2.3 and 6.5±2.8 days, respectively. Successful management was possible for 156 (87.7% [95% confidence interval [CI]: 80.9%-90.9%]) of 180 children in the day care group and 173 (96.1% [95% CI: 92.2%-98.1%]) of 180 children in the hospital care group (P=.001). Twenty-three children in the day care group (12.8% [95% CI: 8.7%-18.4%] and 4 children in the hospital care group (2.2% [95% CI: 0.9%-5.6%] required referral to hospitals (P<.001). During the follow-up period, 22 children in the day care group (14.1% [95% CI: 9.5%-20.4%]) and 11 children in the hospital care group (6.4% [95% CI: 3.6%-11%]) required readmission to hospitals (P=.01). The estimated costs per child treated successfully at the clinic and the hospital were US$114 and US$178, respectively.. Severe childhood pneumonia without severe malnutrition can be successfully managed at day care clinics, except for children with hypoxemia who require prolonged oxygen therapy.

Topics: Anti-Bacterial Agents; Bangladesh; Ceftriaxone; Child, Preschool; Day Care, Medical; Female; Hospital Costs; Hospitalization; Humans; Infant; Male; Oxygen; Pneumonia; Treatment Outcome

In this randomized, single-blind, case-controlled, prospective study, the incidence and outcome of ceftriaxone-associated biliary pseudolithiasis in Chinese children was evaluated via ultrasonography. A total of 108 children diagnosed with hepatobiliary infection or pneumonia were randomized to receive ceftriaxone or ceftazidime. Serial gallbladder sonograms were obtained on days 1, 5 - 7 and 10 - 14 of therapy. Gallstones were detected in 43.10% of patients in the ceftriaxone-treated group and in 2.00% of the ceftazidime-treated group. The incidence of pseudolithiasis was significantly higher in the ceftriaxone-treated than the ceftazidime-treated group. Biliary precipitation abnormalities appeared after 2 - 7 days of treatment. After gallstones were found, the drug was stopped and symptoms resolved within 1 - 2 days. This study suggests that the risk of ceftriaxone-associated biliary pseudolithiasis should be considered when treating Chinese children.

Topics: Adolescent; Anti-Bacterial Agents; Asian People; Biliary Tract Diseases; Ceftazidime; Ceftriaxone; Child; Child, Preschool; China; Female; Gallbladder; Humans; Infant; Male; Pneumonia; Ultrasonography

We studied the cost-effectiveness of oral gemifloxacin with intravenous ceftriaxone followed by oral cefuroxime with or without a macrolide to treat patients hospitalized with community-acquired pneumonia. Data were prospectively collected as part of a randomized multicenter study. The costs evaluated included antimicrobial acquisition (1st level); plus preparation, dispensing, and administration costs, and treatment of antimicrobial-related adverse events and clinical failures (2nd level); plus per diem costs for hospital stay related to study drug administration (3rd level). At follow-up, clinical success was similar between gemifloxacin (76.9%)- and ceftriaxone (79.1%)-treated patients. The median 1st-level costs for gemifloxacin and ceftriaxone were $136 and $470 (P<0.001), respectively. For the 2nd level, these costs were $158 and $542 (P<0.001), and for the 3rd level, these were $5052 and $5789 (P=0.025), respectively. The median cost per expected success was $6568 for gemifloxacin and $7321 for ceftriaxone (P=0.29). Oral gemifloxacin is clinically effective and has an economic advantage over ceftriaxone, followed by oral cefuroxime with or without a macrolide.

Topics: Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Cefuroxime; Community-Acquired Infections; Cost-Benefit Analysis; Female; Fluoroquinolones; Gemifloxacin; Humans; Macrolides; Male; Middle Aged; Naphthyridines; Pneumonia

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

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

This study compared patients with moderate-to-severe community-acquired pneumonia (CAP) requiring hospitalisation, who received initial therapy with either intravenous ceftriaxone plus intravenous azithromycin, followed by step-down to oral azithromycin (n = 135), with patients who received intravenous ceftriaxone combined with either intravenous clarithromycin or erythromycin, followed by step-down to either oral clarithromycin or erythromycin (n = 143). Clinical and bacteriological outcomes were evaluated at the end of therapy (EOT; day 12-16) or at the end of study (EOS; day 28-35). At baseline, mean APACHE II scores were 13.3 and 12.6, respectively, with >50% of patients classified as Fine Pneumonia Severity Index (PSI) category IV or V. Clinical success rates (cure or improvement) in the modified intent-to-treat (MITT) population at EOT were 84.3% in the ceftriaxone/azithromycin group and 82.7% in the ceftriaxone/clarithromycin or erythromycin group. At EOS, MITT success rates (cure only) were 81.7% and 75.0%, respectively. Equivalent success rates in the clinically evaluable population were 83% and 87%, respectively, at EOT, and 79% and 78%, respectively, at EOS. MITT bacteriological eradication rates were 73.2% and 67.4%, respectively, at EOT, and 68.3% vs. 60.9%, respectively, at EOS. Mean length of hospital stay (LOS) was 10.7 and 12.6 days, and the mean duration of therapy was 9.5 and 10.5 days, respectively. The incidence of infusion-related adverse events was 16.3% and 25.2% (p 0.04), respectively. An intravenous-to-oral regimen of ceftriaxone/azithromycin was at least equivalent in efficacy and safety to the comparator regimen and appeared to be a suitable treatment option for hospitalised patients with CAP.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Clarithromycin; Community-Acquired Infections; Drug Therapy, Combination; Erythromycin; Female; Hospitalization; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia; Prospective Studies; Random Allocation; Treatment Outcome

Levofloxacin has established efficacy and safety in the treatment of community-acquired pneumonia (CAP) in adults, and its use as an alternative therapy for children with CAP has been proposed.. Assess the clinical efficacy and safety of levofloxacin compared with standard of care antibiotic therapy in the treatment of CAP in children aged 6 months to 16 years.. In an open-label, multicenter, noninferiority trial, children with CAP were randomized 3:1 to receive levofloxacin or comparator antimicrobial therapy (0.5 to <5 years: amoxicillin/clavulanate or ceftriaxone; > or =5 years: clarithromycin or ceftriaxone with clarithromycin or erythromycin lactobinate) for 10 days. The primary outcome was cure rates at the test-of-cure visit (10-17 days after completing treatment) as determined by symptoms, physical examination, and chest radiography.. Seven hundred and thirty-eight children were enrolled and 539 (405 levofloxacin-treated, 134 comparator-treated) were clinically evaluable at test-of-cure visit. Clinical cure rates were 94.3% (382 of 405) in levofloxacin-treated and 94.0% (126 of 134) in comparator-treated children. Cure rates were also similar for levofloxacin and comparator for each age group (<5 years, 92.2% versus 90.8%; > or =5 years, 96.5% versus 97.1%; respectively) and for children categorized as being at higher risk for severe disease. Mycoplasma pneumoniae was the most frequently identified cause of pneumonia (230 children). Levofloxacin was as well tolerated as comparators, with similar type and incidence of adverse events.. Levofloxacin was as well tolerated and effective as standard-of-care antibiotics for the treatment of CAP in infants and children.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Clarithromycin; Community-Acquired Infections; Drug Therapy, Combination; Erythromycin; Female; Humans; Infant; Infant, Newborn; Levofloxacin; Male; Ofloxacin; Pneumonia; Treatment Outcome

Empiric therapy for community-acquired pneumonia (CAP) requires the use of antibiotics with activity against a broad spectrum of respiratory pathogens and suitable pharmacokinetic properties to simplify IV-to-oral step-down therapy switches.. The aim of this study was to compare the efficacy and tolerability of IV gatifloxacin with the option for oral stepdown gatifloxacin with a standard regimen of IV ceftriaxone (with or without erythromycin or clarithromycin) with the option for oral stepdown clarithromycin in patients with mild to moderate CAP requiring hospitalization.. In a randomized, open-label, parallel-group, multicenter study, adults with CAP received 7 to 14 days of treatment with either IV gatifloxacin 400 mg QD with the stepdown option or IV ceftriaxone 1 or 2 g QD (with or without erythromycin 0.5 or 1 g QID or clarithromycin 500 mg BID) with the stepdown option.. One hundred seventy adults with CAP were included in the study. IV gatifloxacin was stepped down to oral gatifloxacin in 90.6% (7785) of patients; IV ceftriaxone was stepped down to oral clarithromycin in 87.1% (7485) of patients. Among clinically evaluable patients (n = 153), cure rates at 1 to 3 days after treatment were 97.4% in the gatifloxacin group (7476) and 90.9% in the ceftriaxone group (7077), with a 95% CI for the difference (-3.7% to 19.1%) indicating statistical equivalence. In patients in whom pathogens were isolated from pretreatment sputum cultures, bacteriologic eradication rates were 100.0% (2929) and 90.9% (3033), respectively. Both regimens were well tolerated; treatment-related adverse events occurred in 27.1% (2385) and 21.2% (1885) of patients, respectively.. In the population studied, treatment with IV gatifloxacin with an option for oral stepdown gatifloxacin was as effective for achieving clinical cure as IV ceftriaxone (with or without concomitant IV erythromycin or clarithromycin) with an option for oral stepdown clarithromycin. Both regimens were well tolerated.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Clarithromycin; Community-Acquired Infections; Erythromycin; Female; Fluoroquinolones; Gatifloxacin; Hospitalization; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia

Changing etiologic patterns and the growing problem of antimicrobial resistance, particularly an increase in macrolide-resistant pneumococcal bacteremia, are causing physicians to adopt new approaches to the treatment of community-acquired pneumonia (CAP).. The relative efficacy and tolerability of levofloxacin monotherapy and azithromycin and ceftriaxone combination therapy were assessed in hospitalized adults with moderate to severe CAP.. This Phase IV, multicenter, open-label, randomized trial compared 2 treatment regimens: (1) levofloxacin 500 mg PO or IV q24h, and (2) azithromycin 500 mg IV q24h for > or = 2 days plus ceftriaxone 1 g IV q24h for 2 days, followed by an optional transition to azithromycin 500 mg PO q24h at the investigator's discretion. The total duration of therapy was to be a minimum of 10 days in both treatment groups. Ceftriaxone was included in the initial azithromycin regimen to ensure coverage against pneumococcal bacteremia.. Of 236 patients in the intent-to-treat population, completion or withdrawal information was available for 110 patients in the levofloxacin group and 114 in the azithromycin group. Baseline demographic and disease characteristics were comparable between groups. At the end of treatment, the clinical success rate (cured + improved) in clinically evaluable patients was 94.1% in the levofloxacin group and 92.3% in the azithromycin group. The respective posttherapy microbiologic eradication rates were 89.5% and 92.3%. Levofloxacin was as well tolerated as azithromycin, with an incidence of drug-related adverse events (AEs) for all body systems of 5.3% and 9.3%, respectively. None of the drug-related AEs were considered serious [corrected].. In this study in hospitalized patients with moderate to severe CAP, levofloxacin monotherapy was at least as effective as a combination regimen of azithromycin and ceftriaxone in providing coverage against the current causative pathogens in CAP. In addition, levofloxacin was as well tolerated as the combination of azithromycin and ceftriaxone.

Topics: Adult; Aged; Aged, 80 and over; Azithromycin; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Female; Humans; Levofloxacin; Male; Middle Aged; Ofloxacin; Pneumonia; Severity of Illness Index

The aim of this study was to determine the pharmacokinetic profile of the normal recommended dose of ceftriaxone in critically ill patients and to establish whether the current daily dosing recommendation maintains plasma concentrations adequate for antibacterial efficacy. Ceftriaxone at a recommended dose of 2 g iv was administered od to 12 critically ill patients with severe sepsis and normal serum creatinine concentrations. Blood samples were taken at pre-determined intervals over the first 24 h and on day 3 for measurement of ceftriaxone concentrations. There was wide variability in drug disposition, explained by the presence of variable renal function and identified by the measurement of creatinine clearance. In nine patients with normal renal function, there was a high level of creatinine clearance (mean +/- S.D., 41 +/- 12 mL/min) and volume of distribution (20 +/- 3.3 L), which resulted in an elimination half-life of 6.4 +/- 1.1 h. In comparison with normal subjects, ceftriaxone clearance was increased 100%, volume of distribution increased 90% and the elimination half-life was similar. Three patients had substantially suboptimal plasma ceftriaxone concentrations. We confirm previous findings that ceftriaxone clearance in critically ill patients correlates with renal clearance by glomerular filtration. The elimination half-life is prolonged (21.4 +/- 9.8 h) in critically ill patients with renal failure when compared with previously published data in non-critically ill patients with renal failure. We conclude that in critically ill patients with normal renal function, inadequate plasma concentrations may result following od bolus dosing of ceftriaxone. Drug accumulation may occur in critically ill patients with renal failure.

Topics: Adolescent; Adult; Aged; Ceftriaxone; Cephalosporins; Critical Illness; Female; Half-Life; Humans; Kidney; Male; Middle Aged; Pneumonia; Renal Insufficiency; Sepsis

Many hospitalized patients with community acquired pneumoniae can be switched early in the course of therapy from intravenous to oral antibiotics, when there are subjective and objective indicators of improvement. This modality of treatment is called "switch therapy".. To compare sequential therapy using an oral third generation cephalosporin, with conventional therapy using intravenous ceftriaxone in community acquired pneumonia.. Forty patients admitted due to community acquired pneumonia, initially treated with ceftriaxone 1 g/day i.v. and that showed clinical improvement after three days of therapy, were studied. They were randomly assigned to continue intravenous therapy with ceftriaxone for a total of 10 days or switched to ceftibuten 400 mg od for seven days.. Twenty one patients continued i.v. treatment and 19 were switched to ceftibuten. There were no differences between both groups in terms of clinical cure, radiological improvement or normalisation of white blood cell count.. Patients with community acquired pneumonia that have a good initial response to intravenous antimicrobials, can be safely switched to oral therapy. This therapy will shorten hospital stay and thereby treatment costs.

Topics: Administration, Oral; Aged; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Female; Humans; Injections, Intravenous; Male; Pneumonia; Prospective Studies; Treatment Outcome

Levofloxacin, an antibiotic from the quinolone family, which is used with success in the ambulatory treatment of patients with community-acquired pneumonia, has been recently introduced to the pharmaceutical market. The purpose of this study was to compare the effectiveness and tolerance of oral (v.o.) levofloxacin (LVF) versus intravenous (i.v.) amoxicillin/clavulanate (AMX/CL) and ceftriaxone (CTX) in the treatment of the community-acquired pneumonia that require hospitalization (CAPH).. In this prospective and randomized study 84 patients were included, 28 per group, from both sex with CAPH. The patients were assigned randomly to receive one of the next treatments: AMX/CL, 1.02 g i.v. every 8 h, CTX, 1 g i.v. every 12 h or LVF, 500 mg v.o. every 24 h. At the beginning clinical, biochemical and radiological characteristics were recorded from each case and at the 72 h the effect of treatment was evaluated using the evolution of the thermal curve and radiological images. The quantitative variables were analyzed with ANOVA, the qualitatives parameters with *2 test and Yates correction. The level of signification was * = 0.05.. Age, sex, clinical presentation, biochemical measurements and radiological images in the 3 groups were similar and no adverse effects were recorded in any of them. Number of patients with favorable outcome in the groups AMX/CL, CTX and LVF was 25 (89%), 25 (89%) and 26 (93%); p = 0,870.. Levofloxacin can be a simple, effective and safe therapeutic option for patients with CAPH.

Topics: Administration, Oral; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Analysis of Variance; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Levofloxacin; Male; Middle Aged; Ofloxacin; Pneumonia; Prospective Studies

In this study the efficacy and cost-effectiveness of i.v. ceftriaxone 1 g once daily (CTX) was compared with standard i.v. antibiotic treatment (STD) for lower respiratory tract infections (LRTI). STD was given according to the guidelines of the American Thoracic Society and consisted of either cefuroxime 1500 mg three times daily (q8h), amoxicillin/clavulanic acid 1200 mg q8h or ceftriaxone 2 g once daily; each with or without a macrolide. After a minimum of 5 days i.v. therapy, patients could be switched to oral therapy. One hundred patients were enrolled in the study; 52 patients received CTX and 48 STD. Groups were comparable with respect to demographic and baseline characteristics. Seventy patients had a confirmed diagnosis of pneumonia. Twenty-nine patients had a severe type I exacerbation of chronic bronchitis. In one patient the diagnosis of LRTI could not be confirmed. In approximately 50% of the patients a microbiological diagnosis could be made. The most important isolated pathogens from sputum and blood were (positive blood cultures in brackets): Streptococcus pneumoniae 14 (9) and Haemophilus influenzae 16. Mean duration of i.v. therapy was 7.4 days in both groups. Average duration of hospitalisation was 15.0 days for CTX patients and 15.9 days for STD patients. Overall cure and improvement rate at the end of treatment was 47 (90%) for patients receiving ceftriaxone 1 g compared to 37 (77%) for patients receiving standard therapy. Pathogens were eradicated or presumed to be eradicated in 84% of the CTX patients and in 76% of the STD patients. Mean total costs per treatment were lower for CTX than for STD treatment: NLG 169 versus 458. These results show, that i.v. ceftriaxone 1 g once daily is as effective as standard therapy in the treatment of LRTI and that its use reduces treatment costs, in view of the multiple daily dosing regimens of most standard therapies.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bronchitis; Ceftriaxone; Cephalosporins; Chronic Disease; Drug Administration Schedule; Drug Costs; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pneumonia

The aim of this study was to determine the efficacy of antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG).. An open prospective, randomised, multicenter study was conducted in 141 patients; 72 received ceftriaxone 1 g i.v. 30 min preintervention, and 69 received no study medication. A standardized protocol was followed for PEG preparation, insertion, and aftercare; all patients received a 15-Fr gastrostomy tube. Follow-up of local and systemic infection and clinical course was continued to postintervention day 10. An aggregate erythema and exudation score >3 or the presence of pus was taken as indicative of peristomal infection. The pharmacoeconomics of antibiotic use were also examined.. In no-prophylaxis patients, wound infection rates were 25% on day 4 and 26.4% on day 10, versus 10.1% (p = 0.03) and 14.5% (p = 0.10), respectively, in prophylaxis patients. Results were disproportionally better in tumor patients: systemic infection rates were 16.7% versus 5.8% in no-prophylaxis versus prophylaxis patients (p = 0.045), and overall infection rates 38.9% versus 17.4%, respectively (p = 0.046). Pneumonia was more frequent in patients with underlying neurological disease. Antibiotic costs were the same in both groups (p = 0.792).. Single dose ceftriaxone 1 g is an effective prophylaxis against local and systemic infection after PEG.

Topics: Aged; Antibiotic Prophylaxis; Bacteremia; Ceftriaxone; Cephalosporins; Drug Costs; Economics, Pharmaceutical; Enteral Nutrition; Erythema; Exudates and Transudates; Female; Follow-Up Studies; Gastroscopy; Gastrostomy; Humans; Male; Neoplasms; Nervous System Diseases; Pneumonia; Prospective Studies; Sepsis; Suppuration; Surgical Wound Infection

Effective empiric treatment of pneumonia requires antibiotic coverage against gram-negative and gram-positive pathogens, including drug-resistant isolates. We compared the safety and efficacy of intravenous (i.v.) cefepime (2 g administered every 12 h) to those of i.v. ceftriaxone (1 g administered every 12 h) for the empiric treatment of hospitalized patients with community-acquired pneumonia. Of the 115 patients randomized to the study, 86 (cefepime recipients, n = 40; ceftriaxone recipients, n = 46) were evaluated for clinical efficacy (clinically evaluated patients). Favorable clinical outcomes (cure or improvement) were comparable among clinically evaluated patients in the cefepime and ceftriaxone treatment arms (95.0 versus 97.8%, respectively; 95% confidence interval for treatment difference [data for ceftriaxone group minus data for cefepime group], -5.1 to +10.8%). The most common bacteria isolated from patients in both treatment groups were Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. In clinically evaluated patients with a microbiologic response, all (100%) of the 32 pathogens from cefepime-treated patients and 97.4% (38 of 39) of the pathogens from ceftriaxone-treated patients were eradicated (documented or presumed eradication). The one persistent infection in the ceftriaxone group was caused by Pseudomonas fluorescens. Both treatments were well tolerated. Our data thus suggest that cefepime and ceftriaxone have comparable safety and efficacy for the treatment of pneumonia in hospitalized patients.

Topics: Cefepime; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Female; Humans; Male; Middle Aged; Pneumonia

The objective of this multicentre, randomized, prospective and comparative study was to evaluate and compare the efficacy and safety of 1 g intravenous ceftriaxone (active ingredient of Rocephin), 3 g intravenous cefoiaxime (active ingredient of clafron), and 2.25 g intavenous cefuroxime (active ingredient of Zinacef).. In this multicentre, randomized, prospective and comparative study, patients received 1 g of ceftriaxone intravenously once a day (group A), or 1 g of cefotaxime intravenously three times a day (group B), or 0.75 g of cefuroxime intravenously three time a day (group C). 197 patients were enrolled in the study, and in 142 (48 in group A, 46 in group B and 48 in group C) we were able to make an evaluation.. The overall efficacy (bacteriological eradication plus clinical cure or clear improvement) of ceftriaxone, cefotaxime and cefuroxime were 81%, 83%, 79% respectively (P > 0.05). The eradication rate for three groups were 80%, 78%, 75% (P > 0.05). No adverse events occured.. Data obtained in our study indicate that for the majority of patients with lower respiratory tract infections, 1 g ceftriaxone, 3 g cefotaxime and 2.25 g cefuroxime are effective and safe, and 7 days therapy is enough, but the use of 1 g ceftriaxone is more convenient.

Topics: Adolescent; Adult; Aged; Bronchitis; Cefotaxime; Ceftriaxone; Cefuroxime; Cephalosporins; Female; Gram-Negative Bacterial Infections; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia; Prospective Studies

To evaluate the economic benefit associated with the early conversion of therapy from intravenous ceftiaxone to the comparable oral third-generation cephalosporin, cefpodoxime proxetil.. Open-label, unblind, nonrandomized clinical trial.. A 360-bed Veterans Affairs Medical Center.. Forty patients who began receiving intravenous ceftriaxone for either a community-acquired pneumonia or a complicated urinary tract infection.. twenty patients were selected, based on clinical assessment, to be converted from intravenous ceftriaxone to oral cefpodoxime proxetil. Twenty other comparable patients who would have been appropriate for step-down therapy, did not receive pharmacy intervention and were used as a control group.. Both groups were assessed and compared for length of ceftiaxone therapy, length of oral follow-up therapy (if any), length of hospitalization, results of culture and sensitivity testing, treatment success and readmissions, and cost of respective therapeutic regimens.. In the cefpodoxime study group, the average time receiving intravenous and oral antibiotics was 9.1 days at a total cost of $3040.26 for the 20 patients. In the control group, the average time receiving intravenous and oral antibiotics was 11.9 days at a total cost of $3961.26. A savings of $46.05 per patient was achieved. Patients receiving step-down therapy averaged 1 fewer day of hospitalization.. Pharmacist intervention and cefpodoxime step-down therapy were associated with decreased overall antibiotic costs in our intravenous-to-oral program.

Topics: Administration, Oral; Aged; Bacterial Infections; Cefpodoxime Proxetil; Ceftizoxime; Ceftriaxone; Colorado; Community-Acquired Infections; Costs and Cost Analysis; Drug Costs; Female; Hospital Bed Capacity, 300 to 499; Hospitals, Veterans; Humans; Injections, Intravenous; Male; Middle Aged; Pharmacy Service, Hospital; Pneumonia; Prodrugs; Urinary Tract Infections

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

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

To compare the efficacy and safety of intramuscular cefoperazone and intramuscular ceftriaxone in the treatment of nursing home-acquired pneumonia in the nursing home setting.. A randomized clinical trial.. Skilled nursing wards at the Veterans Home of California.. 104 residents of skilled nursing wards, aged 65 years or older.. Intramuscular administration of either cefoperazone or ceftriaxone.. The variables analyzed for baseline comparability were demographics (age, sex), clinical variables (duration in nursing home; presence of sputum, fever, cough, or leukocyte count), and clinical symptoms and signs. Efficacy was assessed by days of therapy, final maximum temperature, and clinical and bacteriological response.. Fifty residents received cefoperazone, 1 gm every 12 hours, intramuscularly. Fifty-four residents received ceftriaxone, 1 gm every 24 hours, intramuscularly. The total duration of treatment was scheduled for 10 days. Clinical cure was seen in 45 (90%) of the cefoperazone treatment group and 51 (94%) of the ceftriaxone treatment group, with a mean duration of therapy of 10.30 and 9.90 days, respectively. Satisfactory sputum specimens were collected in 71% of the treated residents; the most common isolate was Streptococcus pneumoniae, followed by Haemophilus influenzae and Staphylococcus aureus, respectively. The overall mortality was 4.5% at long-term follow-up. Both agents were well tolerated and no therapy was discontinued due to intramuscular pain or abnormal laboratory values.. Intramuscular cefoperazone and intramuscular ceftriaxone are safe and effective in the treatment of nursing home-acquired pneumonia. The clinical outcomes in both treatment groups support their use within this select population without the need for transferring the patient to an acute care hospital. Clinical studies are needed to evaluate the impact of such therapy on the control of health care expenditures within the nursing home facility.

Topics: Aged; Aged, 80 and over; Bacterial Infections; Cefoperazone; Ceftriaxone; Cross Infection; Female; Humans; Injections, Intramuscular; Male; Nursing Homes; Pneumonia

Ceftriaxone and cefoperazone monotherapy was compared in a multicentered, randomized, nonblinded, prospective study of patients with nosocomial pneumonia. These antibiotics were equally effective, with an overall successful treatment rate of 48 (80%) of 60 for the cefoperazone-treated patients and 35 (70%) of 50 for the ceftriaxone-treated patients. Patients with nursing-home-acquired pneumonia had similar bacterial pathogens and an almost identical cure rate to those patients with hospital-acquired infection. There was no statistical difference in the incidence of side effects of superinfections. The development of secondary pneumonia with resistant bacteria was low, 3% with cefoperazone and 4% with ceftriaxone. When antibiotic, administrative, and laboratory costs were calculated, cefoperazone was slightly less expensive than ceftriaxone. Both cefoperazone and ceftriaxone are effective therapy for the treatment of nosocomial pneumonia.

Topics: Adult; Aged; Aged, 80 and over; Cefoperazone; Ceftriaxone; Costs and Cost Analysis; Cross Infection; Female; Humans; Male; Middle Aged; Pneumonia; Prospective Studies; Sputum; Superinfection

A multicenter Canadian study enrolled 74 persons to compare low-dose cefotaxime at 1 g every 8 hr to ceftriaxone 1 g every 12 hr in patients with nosocomial pneumonia. Of 57 evaluable patients (30 cefotaxime and 27 ceftriaxone) in this preliminary report, 93% responded to therapy in both groups. Ceftriaxone patients tended to have more side effects (14.2%). This study is continuing to accrue patients to achieve 100 evaluable patients. Interim data, however, support the continued use of low-dose cefotaxime as an appropriate alternative for clinically effective and cost-effective management of nosocomially acquired pneumonia.

Topics: Adult; Aged; Aged, 80 and over; Cefotaxime; Ceftriaxone; Cross Infection; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia

Seventy-two hospitalized patients with pneumonia or bacteremia were randomly allocated to receive ceftriaxone 2 g once daily i.v. or ceftazidime 2 g twice a day i.v. At the end of the study 60 patients were evaluable, 31 in the ceftazidime group and 29 in the ceftriaxone group. Thirty-four patients (ceftazidime = 15, ceftriaxone = 19) yielded one or more pathogens, of which 64% were gram-negative bacilli. Clinical cure or improvement was observed in 90% of patients in both groups. All 3 cases of bacteremia were cured. Three patients in each group failed to respond to the administered drug. Eradication of the pathogen(s) was observed in 82% of the ceftazidime group and in 86% of the ceftriaxone group. Two episodes of superinfection due to Pseudomonas aeruginosa were recorded in the ceftriaxone group, while Candida spp. was isolated from the sputum in 2 patients in the ceftazidime group. Three strains of P. aeruginosa (2 in the ceftazidime group, 1 in the ceftriaxone group) persisted despite the treatment. No side effects were seen except for skin rash in 2 patients receiving ceftazidime. Compliance was good in both groups, particularly with the once daily administration of ceftriaxone. Overall ceftriaxone and ceftazidime appear to be equally effective in the treatment of nosocomial pneumonia, with the exception of P. aeruginosa infection.

Topics: Adolescent; Adult; Aged; Bacteremia; Ceftazidime; Ceftriaxone; Child; Child, Preschool; Cross Infection; Humans; Infant; Injections, Intravenous; Middle Aged; Pneumonia; Prospective Studies; Risk Factors

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

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

Three hundred and twenty patients were enrolled in a prospective randomized trial comparing cefoperazone, ceftizoxime and ceftriaxone for initial therapy of infectious episodes in cancer patients. Patients with neutropenia were excluded. In 286 evaluable episodes, the response rates associated with the three agents were 77% for cefoperazone, 70% for ceftizoxime and 72% for ceftriaxone, with no statistically significant differences between the three treatment groups. The overall response rate for all episodes of pneumonia (64%) was significantly lower than the response rate for all other infections (81%; p = 0.002), and the mortality associated with pneumonia (9%) was higher than that associated with all other episodes (2%; p = 0.01). Patients with infections due to gram-negative organisms responded well to all three agents, whereas patients with gram-positive infections responded more favorably to cefoperazone. Two different schedules of ceftriaxone were used. The clinical response did not differ significantly between patients receiving ceftriaxone once daily and those receiving it twice daily. The incidence of superinfection and relapse was extremely low and all three agents were well tolerated. It is concluded that extended spectrum cephalosporins are effective as single agents for the treatment of infections in cancer patients with adequate neutrophil counts.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoperazone; Ceftizoxime; Ceftriaxone; Costs and Cost Analysis; Drug Administration Schedule; Female; Half-Life; Humans; Male; Metabolic Clearance Rate; Middle Aged; Neoplasms; Pneumonia; Prospective Studies; Remission Induction

The clinical efficacy and tolerability of ceftriaxone in the treatment of pneumonia and other lower respiratory tract infections were evaluated in 827 patients (515 pneumonia, 312 other lower respiratory tract infections) reported in the international literature (daily dose: 1 of 2 g.i.v. or i.m. in most patients). Therapeutic success was achieved in 738 patients (89.2%). Microbiological results were evaluated in 295 patients. Eradication of the most common respiratory pathogens was achieved in 100% of cases and of Enterobacteriaceae in 85.7%-100%. Adverse effects occurred in 4.9% of patients. A large multicenter trial was carried out in Italy using a single daily dose of 1-2 g by i.v. or i.m. Six hundred ninety-six patients were admitted to the study (370 pneumonia, and 326 other lower respiratory tract infections). Therapeutic success was achieved in 668 cases (96%). Pathogens were eradicated in 88% of cases (184 pts evaluated). Side effects were observed in 4.6% of cases.

Topics: Bacteria; Ceftriaxone; Clinical Trials as Topic; Humans; Pneumonia; Respiratory Tract Infections

Pediatric patients with serious infections are usually hospitalized for parenteral antibiotic treatment. We studied prospectively 74 pediatric patients with community-acquired serious infections and used once daily intramuscular ceftriaxone. Seventeen patients (23%) were initially hospitalized and 57 (77%) patients were treated entirely as outpatients. An initial intramuscular dose of 75 mg/kg was followed by daily doses of 50 mg/kg (maximum, 1.5 g). Infections treated included periorbital/buccal cellulitis, other cellulitis, urinary tract infections, pneumonia, osteomyelitis, mastoiditis, suppurative arthritis and orbital cellulitis. Organisms were recovered from cultures of 37 (50%) patients and 6 (8%) patients were bacteremic. Bacteria included Gram-positive (mostly Staphylococcus aureus) and Gram-negative (mostly enteric bacilli and Haemophilus influenzae organisms). No serious side effects were observed. Of 74 patients 72 (97%) were cured and improvement was usually observed within 24 hours. Two patients did not improve: one with chronic Pseudomonas mastoiditis; and one with lung abscess. Based on previous experience it is estimated that 376 hospitalization days were saved. All 72 successfully treated patients and their parents resumed normal activity within 72 hours of starting therapy. Our data suggest that ceftriaxone can be used for outpatient treatment of some infectious diseases.

Topics: Adolescent; Ambulatory Care; Bacterial Infections; Ceftriaxone; Cellulitis; Child; Child, Preschool; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Male; Mastoiditis; Pneumonia; Prospective Studies; Urinary Tract Infections

Patients with pneumonia or bronchitis were randomized to receive ceftriaxone or cefamandole. A total of 30 of 38 patients were evaluable, 16 in the ceftriaxone group (average age 66.3 years) and 14 in the cefamandole group (average age 69.4 years). All but one had underlying diseases. Patients usually received 1 g of ceftriaxone intravenously every 12 h (mean duration 8.7 days) or 1.5 g of cefamandole intravenously every 6 h (mean duration 8.2 days). Adverse experiences attributable to the drugs were confined to one episode of discomfort at the infusion site in each group. Bacteriological results with ceftriaxone were 83% cured, 11% superinfected after eradication of pretherapy isolate, and 6% failed. Bacteriological results with cefamandole were 76% cured, 24% failed. Clinical results with ceftriaxone were 38% cured, 56% improved, 6% failed. Clinical results with cefamandole were 57% cured, 21% improved, 21% failed. Emergence of a resistant Serratia marcescens was seen in a ceftriaxone-treated patient. Disc diffusion susceptibility testing identified six of the seven pretherapy nonfastidious Gram-negative isolates as susceptible; however, two of the six could not be eradicated with the assigned drug and another two were eradicated with ensuing super-infection with susceptible isolates of Pseudomonas aeruginosa. In contrast, MBCs were an accurate guide to clinical outcome with nonfastidious Gram-negative bacilli.

Topics: Adult; Aged; Aged, 80 and over; Bronchitis; Cefamandole; Ceftriaxone; Female; Humans; Male; Middle Aged; Pneumonia; Random Allocation; Sepsis

To evaluate the clinical and microbiological efficacy and safety of ceftriaxone in comparison with cefotaxime in treating acute lower respiratory tract infections two open randomized trials were performed. Sixty-two adult hospital in-patients were entered and 58 completed the study. The patients suffered from either acute (broncho-)pneumonia (19pts) or severe exacerbation of chronic bronchopneumonia (39 pts). Forty-one of the patients had severe underlying or concurrent diseases. Diagnoses were in all cases confirmed by isolation of the causative pathogen(s) from bronchial brushing or washing under fiberoptic bronchoscopy. Twenty-eight patients were administered at random with either a single 2g daily dose of ceftriaxone or 2g twice daily dose of cefotaxime (1st trial). Successively (2nd trial) ceftriaxone was administered at a dose of 1g once daily either i.v. or i.m. The duration of treatment ranged from 7 to 12 days. A satisfactory response was observed in all patients suffering from acute pneumonia or bronchopneumonia; the eradication rate of the causative pathogen was 73% and 62% for ceftriaxone and cefotaxime, respectively. Concerning the exacerbation of chronic bronchopneumonia (39 patients) an overall satisfactory response to both treatments was registered in about 80% of cases. No significant differences between the 1g and 2g single daily dosing regimens of ceftriaxone appeared. Both ceftriaxone and cefotaxime were well tolerated: no or minimal changes in laboratory values were noticed. It is concluded that a 1g or 2g single daily dose of ceftriaxone were at least as effective as a 2g twice daily dose of cefotaxime in treating acute lower respiratory tract infections due to susceptible pathogens.

Topics: Adult; Bronchopneumonia; Ceftriaxone; Female; Humans; Male; Middle Aged; Pneumonia; Respiratory Tract Infections

Topics: Adult; Aged; Bacterial Infections; Cefoperazone; Ceftriaxone; Female; Hospitalization; Humans; Male; Middle Aged; Pneumonia; Sepsis; Urinary Tract Infections

In 512 patients undergoing major cardiovascular surgery, this prospective, randomized study compared the effectiveness of perioperative prophylaxis with either ceftriaxone or cefuroxime. In the ceftriaxone group, 254 patients received a single 2 g dose given intravenously at the start of anesthesia followed by a 1 g dose 24 hours later. In the cefuroxime group, 258 patients received 1.5 g at the start of anesthesia, followed by 1.5 g given intravenously every 12 hours for 2 days postoperatively. Postoperative infectious complications developed in only 12 patients in each group (4.7 percent). In 53 patients the mean serum concentration of ceftriaxone 24 hours after administration of the 2 g dose was 37.4 micrograms/ml, a level far in excess of the minimal inhibitory concentrations of usual cardiovascular pathogens with the exception of Bacteroides species and Pseudomonas species. We conclude that a single 2 g dose of ceftriaxone given at the time of cardiovascular surgery should provide adequate prophylaxis.

Topics: Bacterial Infections; Cardiac Surgical Procedures; Cefotaxime; Ceftriaxone; Cefuroxime; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Male; Pneumonia; Postoperative Complications; Random Allocation; Sepsis; Surgical Wound Infection; Time Factors; Urinary Tract Infections; Vascular Surgical Procedures

The safety of ceftriaxone was compared with that of amoxicillin in a randomized study of 91 patients with community-acquired pneumonia. The origin of infection was similar in the two groups. It was proven or probable Streptococcus pneumoniae in 50 percent of the patients and remained uncertain in 40 percent. Ninety percent of the patients who received ceftriaxone were clinically cured compared with 69 percent of those given amoxicillin (p less than 0.05). However, this difference was not apparent among the patients with proven or probable pneumococcal pneumonia. No severe clinical side effects were observed. Cutaneous reactions were more prevalent in the amoxicillin group, whereas mild diarrhea and mucosal candidiasis were more frequent in the ceftriaxone group. Reversible neutropenia was observed in two patients treated with ceftriaxone and none of those treated with amoxicillin.

Topics: Adult; Aged; Amoxicillin; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged; Neutropenia; Penicillins; Pneumococcal Infections; Pneumonia

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Cellulitis; Clinical Trials as Topic; Humans; Osteomyelitis; Pneumonia

Ceftriaxone is recommended as first-line antibiotic treatment (with the addition of macrolide) for hospitalised adults with community acquired pneumonia (CAP). Narrower-spectrum β-lactam as ampicillin, may be associated with comparable clinical outcomes, with less emergence of resistant pathogens or Clostridioides difficile infection (CDI). We aimed to examine whether ampicillin and ceftriaxone (with the addition of macrolides for both arms) are comparable for the treatment of hospitalized adults due to CAP.. This was a single center, observational cohort study. We included adult patients who were hospitalized in internal medicine wards due to CAP and were treated with either ceftriaxone or ampicillin with the addition of macrolide. A propensity-score model was used. The primary outcome was 30-day all-cause mortality. A multivariable logistic regression analysis and Kaplan-Meier survival analysis was performed. We performed subgroup analyses for the main outcome based on CURB-65 score and age.. A total of 1586 patients fulfilled the inclusion criteria. There was no difference in 30-day mortality rate in the total cohort (28/233 vs. 208/1353 in ampicillin and ceftriaxone arm, respectively; p = 0.184). In the propensity matched cohort (197 in ampicillin and 394 in ceftriaxone arm), there was no significant difference in 30-day all-cause mortality between treatment groups in multivariable analysis of the main model (OR 0.67, 95% CI, 0.37-1.2; p = 0.189) and Kaplan-Meier survival analysis (p = 0.108). Thirty-day mortality rate was (19/197 vs. 57/394, in ampicillin and ceftriaxone arms, respectively; p = 0.108) Patients who were treated with ampicillin experienced significantly lower rates of CDI (0/197, 0% vs. 8/394, 2%; p = 0.044).. Ampicillin was associated with comparable clinical outcomes in comparison to ceftriaxone for patients who were hospitalized due to CAP. Ampicillin was associated with significantly lower rate of CDI. Results need to be confirmed by more robust study designs.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Community-Acquired Infections; Humans; Macrolides; Pneumonia

Ceftriaxone is widely used in children with community-acquired pneumonia. Currently, there are no available data regarding epithelial lining fluid (ELF) concentrations of ceftriaxone in children. Thus, blood and bronchoalveolar lavage fluids samples were collected by using an opportunistic sampling design, then we determined plasma and ELF concentrations in 22 children (0.5-11.7 years), with a total of 36 plasma and 22 ELF samples available for analysis. Ceftriaxone plasma and ELF concentrations ranged from 1.07 to 138.71 mg/L and from 0.61 to 26.69 mg/L, respectively. Ceftriaxone concentration in ELF was 12.18 ± 5.15 (mean ± standard deviation) times higher than that in plasma, ranging from 1.29 to 20.44.

Topics: Anti-Bacterial Agents; Bronchoalveolar Lavage Fluid; Ceftriaxone; Child; Humans; Pneumonia

Topics: Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Doxycycline; Drug Therapy, Combination; Humans; Pneumonia

Guidelines recommend intravenous (IV) ceftriaxone at a dose of 1-2 g/d as empirical treatment in adults hospitalized with community acquired pneumonia (CAP), with the addition of macrolide. We examined whether 1 g/d of IV ceftriaxone is associated with similar clinical outcomes to those of 2 g/d. This is a single-center, retrospective, cohort study of all adult patients hospitalized at Rabin Medical Center between 2015 and 2018 with CAP. The primary outcome was 30-day all-cause mortality. Risk factors for 30-day all-cause mortality were identified by univariable and multivariable analyses, using logistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. A total of 2045 patients were treated with IV ceftriaxone 1 g/d and were and compared to 1944 patients who were treated with 2 g/d. The groups were comparable in their baseline characteristics and their clinical presentation. The 30-day all-cause mortality rate was similar between the groups (301/2045 (14.7%) for 1 g/d vs. 312/1944 (16.0%) for 2 g/d, p = 0.24). The rate of C. difficile infection (CDI) was significantly decreased with 1 g/d compared to 2 g/d (4/2045 (0.2%) vs. 12/1944 (0.6%), p = 0.03) and the length of stay was significantly shorter (median 4 days interquartile range (IQR) 3-7 vs. 5 days IQR 3-8, p = 0.02). None of the blood isolates of Streptococcus pneumoniae were penicillin or ceftriaxone resistant. For hospitalized patients with CAP, IV ceftriaxone 1 g/d was associated with similar mortality rates as IV ceftriaxone 2 g/d, with a decreased rate of CDI and shorter length of stay. Ceftriaxone 1 g/d may be sufficient to treat patients with CAP in countries with low prevalence of drug resistant Streptococcus pneumoniae.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Clostridioides difficile; Cohort Studies; Community-Acquired Infections; Humans; Pneumonia; Retrospective Studies; Treatment Outcome

It is well documented that inappropriate use of antimicrobials is the major driver of antimicrobial resistance. To combat this, antibiotic stewardship has been demonstrated to reduce antibiotic usage, decrease the prevalence of resistance, lead to significant economic gains and better patients' outcomes. In Nigeria, antimicrobial guidelines for critically ill patients in intensive care units (ICUs), with infections are scarce. We set out to develop antimicrobial guidelines for this category of patients.. A committee of 12 experts, consisting of Clinical Microbiologists, Intensivists, Infectious Disease Physicians, Surgeons, and Anesthesiologists, collaborated to develop guidelines for managing infections in critically ill patients in Nigerian ICUs. The guidelines were based on evidence from published data and local prospective antibiograms from three ICUs in Lagos, Nigeria. The committee considered the availability of appropriate antimicrobial drugs in hospital formularies. Proposed recommendations were approved by consensus agreement among committee members.. Candida albicans and Pseudomonas aeruginosa were the most common microorganisms isolated from the 3 ICUs, followed by Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. Targeted therapy is recognized as the best approach in patient management. Based on various antibiograms and publications from different hospitals across the country, amikacin is recommended as the most effective empiric antibiotic against Enterobacterales and A. baumannii, while colistin and polymixin B showed high efficacy against all bacteria. Amoxicillin-clavulanate or ceftriaxone was recommended as the first-choice drug for community-acquired (CA) CA-pneumonia while piperacillin-tazobactam + amikacin was recommended as first choice for the treatment of healthcare-associated (HA) HA-pneumonia. For ventilatorassociated pneumonia (VAP), the consensus for the drug of first choice was agreed as meropenem. Amoxycillin-clavulanate +clindamycin was the consensus choice for CAskin and soft tissue infection (SSIS) and piperacillin-tazobactam + metronidazole ±vancomycin for HA-SSIS. Ceftriaxone-tazobactam or piperacillin-tazobactam + gentamicin was consensus for CA-blood stream infections (BSI) with first choice+regimen for HA-BSI being meropenem/piperacillin-tazobactam +amikacin +fluconazole. For community-acquired urinary tract infection (UTI), first choice antibiotic was ciprofloxacin or ceftriaxone with a catheter-associated UTI (CAUTI) regimen of first choice being meropenem + fluconazole.. Data from a multicenter three ICU surveillance and antibiograms and publications from different hospitals in the country was used to produce this evidence-based Nigerian-specific antimicrobial treatment guidelines of critically ill patients in ICUs by a group of experts from different specialties in Nigeria. The implementation of this guideline will facilitate learning, continuous improvement of stewardship activities and provide a baseline for updating of guidelines to reflect evolving antibiotic needs.. Il est bien établi que l’utilisation inappropriée des antimicrobiens est le principal moteur de la résistance aux antimicrobiens. Pour lutter contre ce phénomène, il a été démontré que la bonne gestion des antibiotiques permettait de réduire l’utilisation des antibiotiques, de diminuer la prévalence de la résistance, de réaliser des gains économiques significatifs et d’améliorer les résultats pour les patients. Au Nigéria, les directives antimicrobiennes pour les patients gravement malades dans les unités de soins intensifs (USI), souffrant d’infections, sont rares. Nous avons entrepris d’élaborer des lignes directrices sur les antimicrobiens pour cette catégorie de patients.. Un comité de 12 experts, composé de microbiologistes cliniques, d’intensivistes, de médecins spécialistes des maladies infectieuses, de chirurgiens et d’anesthésistes, a collaboré à l’élaboration de lignes directrices pour la prise en charge des infections chez les patients gravement malades dans les unités de soins intensifs nigérianes. Les lignes directrices sont basées sur des données publiées et des antibiogrammes prospectifs locaux provenant de trois unités de soins intensifs de Lagos, au Nigeria. Le comité a pris en compte la disponibilité des médicaments antimicrobiens appropriés dans les formulaires des hôpitaux. Les recommandations proposées ont été approuvées par consensus entre les membres du comité.. Candida albicans et Pseudomonas aeruginosa étaient les microorganismes les plus fréquemment isolés dans les trois unités de soins intensifs, suivis par Klebsiella pneumoniae, Acinetobacter baumannii et Escherichia coli. La thérapie ciblée est reconnue comme la meilleure approche pour la prise en charge des patients. Sur la base de divers antibiogrammes et publications provenant de différents hôpitaux du pays, l'amikacine est recommandée comme l'antibiotique empirique le plus efficace contre les entérobactéries et A. baumannii, tandis que la colistine et la polymixine B se sont révélées très efficaces contre toutes les bactéries. L'amoxicilline-clavulanate ou la ceftriaxone ont été recommandées comme médicaments de premier choix pour les pneumonies communautaires, tandis que la pipéracilline-tazobactam + amikacine ont été recommandées comme médicaments de premier choix pour le traitement des pneumonies associées aux soins. Pour les pneumonies acquises sous ventilation mécanique (PAV), le consensus sur le médicament de premier choix est le méropénem. L'amoxycilline-clavulanate +clindamycine était le choix consensuel pour les infections de la peau et des tissus mous et la pipéracilline-tazobactam + métronidazole ±vancomycine pour les infections de la peau et des tissus mous. HA-SSIS. Ceftriaxone-tazobactam ou pipéracilline-tazobactam + gentamicine a fait l'objet d'un consensus pour les infections de la circulation sanguine de l'AC (BSI), le premier choix de régime pour les HA-BSI étant le méropénem/pipéracilline-tazobactam +amikacine +fluconazole. Pour les infections urinaires communautaires, l'antibiotique de premier choix était la ciprofloxacine ou la ceftriaxone, le régime de premier choix pour les infections urinaires associées à un cathéter étant le meropenem +fluconazole.. Les données issues d’une surveillance multicentrique de trois unités de soins intensifs, d’antibiogrammes et de publications de différents hôpitaux du pays ont été utilisées par un groupe d’experts de différentes spécialités nigérianes pour élaborer ces lignes directrices sur le traitement antimicrobien des patients gravement malades dans les unités de soins intensifs, fondées sur des données probantes et spécifiques au Nigeria. La mise en œuvre de ces lignes directrices facilitera l’apprentissage, l’amélioration continue des activités de gestion et fournira une base de référence pour la mise à jour des lignes directrices afin de refléter l’évolution des besoins en antibiotiques.. Antimicrobiens, Résistance aux antimicrobiens, Gestion des antibiotiques, Lignes directrices, Soins intensifs, Unité de soins intensifs, Infections associées aux soins de santé.

Topics: Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Clavulanic Acid; Community-Acquired Infections; Critical Illness; Cross Infection; Fluconazole; Humans; Meropenem; Microbial Sensitivity Tests; Nigeria; Piperacillin, Tazobactam Drug Combination; Pneumonia; Prospective Studies; Urinary Tract Infections

PTA of protein-unbound ceftriaxone may be compromised in critically ill patients with community-acquired pneumonia (CAP) with augmented renal clearance (ARC). We aimed to determine an optimized ceftriaxone dosage regimen based on the probability of developing ARC on the next day (PARC,d+1; www.arcpredictor.com).. Thirty-three patients enrolled in a prospective cohort study were admitted to the ICU with severe CAP and treated with ceftriaxone 2 g once daily. Patients contributed 259 total ceftriaxone concentrations, collected during 1 or 2 days (±7 samples/day). Unbound fractions of ceftriaxone were determined in all peak and trough samples (n = 76). Population pharmacokinetic modelling and simulation were performed using NONMEM7.4. Target attainment was defined as an unbound ceftriaxone concentration >4 mg/L throughout the dosing interval.. A two-compartment population pharmacokinetic model described the data well. The maximal protein-bound ceftriaxone concentration decreased with lower serum albumin. Ceftriaxone clearance increased with body weight and PARC,d+1 determined on the previous day. A high PARC,d+1 was identified as a clinically relevant predictor for underexposure on the next day (area under the receiver operating characteristics curve 0.77). Body weight had a weak predictive value and was therefore considered clinically irrelevant. Serum albumin had no predictive value. An optimal PARC,d+1 threshold of 5.7% was identified (sensitivity 73%, specificity 69%). Stratified once- or twice-daily 2 g dosing when below or above the 5.7% PARC,d+1 cut-off, respectively, was predicted to result in 81% PTA compared with 47% PTA under population-level once-daily 2 g dosing.. Critically ill patients with CAP with a high PARC,d+1 may benefit from twice-daily 2 g ceftriaxone dosing for achieving adequate exposure on the next day.

Topics: Anti-Bacterial Agents; Body Weight; Ceftriaxone; Critical Illness; Humans; Pneumonia; Probability; Prospective Studies; Renal Insufficiency; Serum Albumin

Ceftriaxone (CRO) is a long-acting third-generation cephalosporin antibiotic. We present a case of CRO-induced encephalopathy in an 84-year-old male patient with a solitary right kidney, admitted with bilateral pneumonia and right pyelonephritis. Intravenous CRO (2 g, every 24 hours) was started for the infection, but tonic-clonic seizures of the left face and left upper extremity appeared on the eighth day. To examine the relationship between CRO administration and the seizures, we measured CRO concentrations in the patients' plasma/serum and cerebrospinal fluid. The CRO concentration in blood at the onset of encephalopathy was estimated to have been approximately 60 μg/ml based on a simulation curve. We also calculated the pharmacokinetic parameters after CRO administration. The patient had about one-tenth of the total body clearance and one-third of the volume of distribution compared with healthy adults, and the elimination half-life was about three times longer.

Topics: Administration, Intravenous; Adult; Aged, 80 and over; Brain Diseases; Ceftriaxone; Humans; Male; Pneumonia; Solitary Kidney

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Conservative Treatment; Female; Humans; Hydropneumothorax; Length of Stay; Pneumonia; Radiography; Thorax; Treatment Outcome

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Conservative Treatment; Female; Humans; Hydropneumothorax; Lung; Pneumonia; Radiography, Thoracic

Topics: Anti-Bacterial Agents; Ceftriaxone; Child Abuse; Diagnosis, Differential; Female; Humans; Infant; Liver Failure, Acute; Lung; Pleural Effusion; Pneumonia; Radiography; Rib Fractures; Streptococcal Infections

Topics: Ceftriaxone; Community-Acquired Infections; Extracorporeal Membrane Oxygenation; Female; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia; Protein Binding

Topics: Aged; Anti-Bacterial Agents; Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Humans; Pneumonia

Topics: Acetaminophen; Adult; Ampicillin; Anti-Bacterial Agents; Azithromycin; Cefpodoxime; Ceftizoxime; Ceftriaxone; Dexamethasone; Drug Therapy, Combination; Fatigue; Female; Headache; Humans; Meningitis, Aseptic; Pneumonia; Tomography, X-Ray Computed; Treatment Outcome; Vancomycin; Young Adult

To assess ceftriaxone population pharmacokinetics in a large pediatric population and describe the proper dose for establishing an optimized antibiotic regimen.. From pediatric patients using ceftriaxone, blood samples were obtained and the concentration was measured using high-performance liquid chromatography ultraviolet detection. The NONMEM software program was used for population pharmacokinetic analysis, for which data from 99 pediatric patients (2 to 12 years old) was collected and 175 blood concentrations were obtained.. The best fit with the data was shown by the one-compartment model with first-order elimination. According to covariate analysis, weight had a significant impact on the clearance of ceftriaxone. Using Monte Carlo simulation, in a pediatric population with community-acquired pneumonia, a dose regimen of 100 mg/kg every 24 h produced satisfactory target attainment rates while remaining within the required minimum inhibitory concentration (2 mg/L).. Population pharmacokinetics of ceftriaxone was evaluated in children and an optimum dosing regimen was constructed on the basis of the pharmacokinetics-pharmacodynamics model-based approach.

Topics: Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Humans; Models, Biological; Monte Carlo Method; Pneumonia

Typhoid fever is usually a mild clinical disease, but it can have potentially serious complications. Here, we describe a case of an adolescent male who presented with severe illness and multi-organ involvement from typhoid fever. He required follow-up after discharge but eventually recovered. Clinicians should be aware of the spectrum of clinical manifestations as early recognition will improve monitoring and management of typhoid disease.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Confusion; Humans; Hypotension; Male; Meningism; Pancytopenia; Paratyphoid Fever; Pneumonia; Salmonella typhi; Typhoid Fever

Community-onset pneumonia (COP) is a combined concept of community acquired pneumonia and the previous classification of healthcare-associated pneumonia. Although ceftriaxone (CRO) is one of the treatment choices for COP, it is unclear whether 1 or 2 g CRO daily has better efficacy. We compared the effectiveness of 1 g with 2 g of CRO for COP treatment. We hypothesized that 1 g CRO would show non-inferiority over 2 g CRO.. This study was an analysis of prospectively registered data of the patients with COP from four Japanese hospitals (the Adult Pneumonia Study Group-Japan: APSG-J). We included subjects who were initially treated solely with 1 or 2 g of CRO. The propensity score was estimated from the 33 pre-treatment variables, including age, sex, weight, pre-existing comorbidities, prescribed drugs, risk factors for aspiration pneumonia, vital signs, laboratory data, and a finding from chest xrays. The primary endpoint was the cure rate, for which a non-inferiority analysis was performed with a margin of 0.05. In addition, we performed three sensitivity analyses; using data limited to the group in which CRO solely was used until the completion of treatment, using data limited to inpatient cases, and performing a generalized linear mixed-effect logistic regression analysis to assess the primary outcome after adjusting for random hospital effects.. Of the 3817 adult subjects with pneumonia who were registered in the APSG-J study, 290 and 216 were initially treated solely with 1 or 2 g of CRO, respectively. Propensity score matching was used to extract 175 subjects in each group. The cure rate was 94.6 and 93.1% in the 1 and 2 g CRO groups, respectively (risk difference 1.5%; 95% confidence interval - 3.1 to 6.0; p = 0.009 for non-inferiority). The results of the sensitivity analyses were consistent with the primary result.. The propensity score-matched analysis of multicenter cohort data from Japan revealed that the cure rate for COP patients treated with 1 g daily CRO was non-inferior to that of patients treated with 2 g daily CRO.

Topics: Administration, Intravenous; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Community-Acquired Infections; Female; Humans; Japan; Kaplan-Meier Estimate; Logistic Models; Male; Pneumonia; Propensity Score; Registries

Topics: Aged; Anti-Bacterial Agents; Antibody Specificity; Antifungal Agents; Autoantibodies; Autoimmune Diseases; Ceftriaxone; Cephalosporins; Ciprofloxacin; Drug Substitution; Drug Therapy, Combination; Factor V; Factor V Deficiency; Fluoroquinolones; Humans; Levofloxacin; Male; Meropenem; Micafungin; Partial Thromboplastin Time; Pneumonia; Prothrombin Time

Children with conversion disorder experience neurological symptoms without a definable organic cause. Clinical presentation of conversion disorders is uncommon in the emergency department (ED).. An 11-year-old previously healthy girl presented to the ED for management of lobar pneumonia. She developed acute visual loss subsequent to accidental placement of an intra-arterial cannula in her arm. Clinical assessments by the emergency physician, neurology, ophthalmology, and psychiatry services, and negative neuroimaging studies established the diagnosis of functional visual loss as a manifestation of conversion disorder. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Conversion disorder symptoms are often without any specific markers and do not fit standard clinical guidelines. A comprehensive and step-wise evaluation of unusual clinical presentation by multiple specialties and ancillary test results should be considered to rule out organic causes and establish the diagnosis of conversion disorder, as seen in our patient.

Topics: Anti-Bacterial Agents; Blindness; Ceftriaxone; Child; Conversion Disorder; Emergency Service, Hospital; Female; Humans; Pneumonia

Supported by years of clinical use in some countries and more recently by literature on experimental models, as well as its compassionate use in Europe and in the United States, bacteriophage (phage) therapy is providing a solution for difficult-to-treat bacterial infections. However, studies of the impact of such treatments on the host remain scarce. Murine acute pneumonia initiated by intranasal instillation of two pathogenic strains of

Topics: Administration, Intranasal; Animals; Anti-Bacterial Agents; Bacteremia; Bacterial Load; Blood Cell Count; Ceftriaxone; Cytokines; Edema; Escherichia coli Infections; Lung Diseases; Male; Mice, Inbred BALB C; Myoviridae; Phage Therapy; Pneumonia; Podoviridae; Treatment Outcome

Topics: Anti-Bacterial Agents; Antifungal Agents; Candida; Candidiasis, Oral; Ceftriaxone; Female; Humans; Pigmentation Disorders; Pneumonia; Tongue; Tongue Diseases; Young Adult

Antibiotics are commonly administered to hospitalized patients with infiltrates for possible bacterial pneumonia, often leading to unnecessary treatment and increasing the risk for resistance emergence. Therefore, we performed a study to determine if an enhanced antibiotic de-escalation practice could improve antibiotic utilization in mechanically ventilated patients with suspected pneumonia cared for in an academic closed intensive care unit (ICU).. This was a prospective cross-over trial comparing routine antibiotic management (RAM) and enhanced antimicrobial de-escalation (EAD) performed within two medical ICUs (total 34 beds) at Barnes-Jewish Hospital, an academic referral center. Patients in the EAD group had their antibiotic orders and microbiology results reviewed daily by a dedicated team comprised of a second-year critical care fellow, an ICU attending physician and an ICU pharmacist. Antibiotic de-escalation recommendations were made when appropriate based on microbiologic test results and clinical response to therapy.. There were 283 patients evaluable, with suspected pneumonia requiring mechanical ventilation: 139 (49.1%) patients in the RAM group and 144 (50.9%) in the EAD group. Early treatment failure based on clinical deterioration occurred in 33 (23.7%) and 40 (27.8%) patients, respectively (P = 0.438). In the remaining patients, antimicrobial de-escalation occurred in 70 (66.0%) and 70 (67.3%), respectively (P = 0.845). There was no difference between groups in total antibiotic days ((median (interquartile range)) 7.0 days (4.0, 9.0) versus 7.0 days (4.0, 8.8) (P = 0.616)); hospital mortality (25.2% versus 35.4% (P = 0.061)); or hospital duration (12.0 days (6.0, 20.0) versus 11.0 days (6.0, 22.0) (P = 0.918).. The addition of an EAD program to a high-intensity daytime staffing model already practicing a high-level of antibiotic stewardship in an academic ICU was not associated with greater antibiotic de-escalation or a reduction in the overall duration of antibiotic therapy.. ClinicalTrials.gov, NCT02685930 . Registered on 26 January 2016.

Topics: Academic Medical Centers; Aged; Anti-Bacterial Agents; Carbapenems; Cefepime; Ceftriaxone; Cephalosporins; Cross-Over Studies; Female; Hospital Mortality; Humans; Intensive Care Units; Male; Middle Aged; Monobactams; Pneumonia; Pneumonia, Ventilator-Associated; Prospective Studies; Quinolones; Respiration, Artificial; Statistics, Nonparametric

This paper describes an elderly male patient, living in the Veneto Region, Italy, who developed Vibrio cholerae bacteraemia and pneumonia. Some days previously, while on holiday in the Lagoon of Venice, he had been collecting clams in seawater, during which he suffered small abrasions of the skin. On admission to hospital, he was confused, had fever and a cough, but neither diarrhoea nor signs of gastroenteritis were found. Both blood and stool cultures grew V. cholerae of non-O1 non-O-139 type, and the patient recovered after prompt administration of intravenous ceftriaxone for 2 weeks. This clinical case emphasises the role of global warming and climate changes in causing increasing numbers of water-borne infections.

Topics: Administration, Intravenous; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Blood; Ceftriaxone; Feces; Humans; Italy; Male; Pneumonia; Vibrio cholerae non-O1; Vibrio Infections

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening, drug-induced hypersensitivity reaction that includes skin eruption, haematological abnormalities, lymphadenopathy, and internal organ involvement.. Presenting a rare condition in children, to facilitate a rapid diagnostic suspicion and recognition by doctors.. An 9 months old infant admitted due to a severe viral pneumonia, managed with non-invasive ventilation and ceftriaxone. Five days after stopping antibiotics, a confluent maculopapular rash appeared, which was predominantly in the trunk, face and upper extremities, combined with a fever, eosinophilia, and elevated serum levels of transaminase. She received treatment with oral prednisone and topical corticosteroids for 6 weeks, with a good outcome after 3 months.. The diagnosis of DRESS syndrome is made using clinical criteria, laboratory values, and histopathology, if there is any query. Although it is classically caused by anticonvulsants and sulphonamides, many other drugs have been implicated. The offending drug should be immediately discontinued and the patient given supportive treatment, and systemic corticosteroids for long periods of treatment.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Hypersensitivity Syndrome; Female; Follow-Up Studies; Glucocorticoids; Humans; Infant; Pneumonia; Prednisone

While ceftriaxone 1 g q24h is commonly used for hospitalized patients with community-acquired pneumonia (CAP), the prescribing information recommends 2-4 g a day to treat methicillin-susceptible Staphylococcus aureus (MSSA). Similarly, recent pharmacodynamic analyses suggest shortcomings of 1 g q24h against the bulk of the MSSA. We evaluated the outcomes of empiric ceftriaxone 1 g q24h ± azithromycin in patients with MSSA pneumonia, as compared with Streptococcus pneumoniae. Adult patients admitted to Hartford Hospital from 1/2005 to 12/2014 with respiratory culture for MSSA or S. pneumoniae were considered for inclusion. Non-ICU, CAP patients were included. Early clinical failure (ECF) was defined as persistent signs/symptoms or change of antibiotic due to poor response at 72-96 h. A multivariate analysis was performed to evaluate predictors of ECF. Over the study period, 403 MSSA and 227 S. pneumoniae positive respiratory cultures were identified. The majority of patients were excluded due to the following: no signs/symptoms of pneumonia, hospital-acquired pneumonia, alternative antibiotics, and polymicrobial infection. Thirty-nine patients met inclusion/exclusion criteria. All but three patients in the S. pneumoniae group received ceftriaxone + azithromycin. ECF was greater in the MSSA group (53 vs. 4 %, P = 0.003), as was length of stay (7.5 ± 5.4 vs. 4.6 ± 3.3 days, P = 0.006). When controlling for disease severity and macrolide non-susceptibility in a multivariate analysis, MSSA was significantly correlated with ECF (OR 12.3, 95 % CI 0.8-188.8). Poor clinical outcomes were observed in patients empirically treated with ceftriaxone ± azithromycin for MSSA CAP. Despite the popularity of ceftriaxone 1 g q24h, these data suggest this dose or compound may be inadequate for CAP caused by MSSA.

Topics: Aged; Azithromycin; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Female; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Pneumonia; Staphylococcus aureus; Streptococcus pneumoniae; Treatment Outcome

Pneumococcal pneumonia is a leading cause of mortality worldwide. The inflammatory response to bacteria is necessary to control infection, but it may also contribute to tissue damage. Phosphodiesterase-4 inhibitors, such as rolipram (ROL), effectively reduce inflammation. Here, we examined the impact of ROL in a pneumococcal pneumonia murine model. Mice were infected intranasally with 10(5)-10(6) CFU of Streptococcus pneumoniae, treated with ROL in a prophylactic or therapeutic schedule in combination, or not, with the antibiotic ceftriaxone. Inflammation and bacteria counts were assessed, and ex vivo phagocytosis assays were performed. ROL treatment during S. pneumoniae infection decreased neutrophil recruitment into lungs and airways and reduced lung injury. Prophylactic ROL treatment also decreased cytokine levels in the airways. Although modulation of inflammation by ROL ameliorated pneumonia, bacteria burden was not reduced. On the other hand, antibiotic therapy reduced bacteria without reducing neutrophil infiltration, cytokine level, or lung injury. Combined ROL and ceftriaxone treatment decreased lethality rates and was more efficient in reducing inflammation, by increasing proresolving protein annexin A1 (AnxA1) expression, and bacterial burden by enhancing phagocytosis. Lack of AnxA1 increased inflammation and lethality induced by pneumococcal infection. These data show that immunomodulatory effects of phosphodiesterase-4 inhibitors are useful during severe pneumococcal pneumonia and suggest their potential benefit as adjunctive therapy during infectious diseases.

Topics: Animals; Annexin A1; Anti-Bacterial Agents; Ceftriaxone; Cyclic Nucleotide Phosphodiesterases, Type 4; Lung; Lung Injury; Macrophages; Male; Mice, Inbred BALB C; Phagocytosis; Phosphodiesterase 4 Inhibitors; Pneumonia; Pneumonia, Pneumococcal; Respiratory Function Tests; Rolipram; Streptococcus pneumoniae

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Male; Pneumonia; Stroke; Urinary Tract Infections

Edwardsiella tarda is an Enterobacteriaceae found in aquatic environments. Extraintestinal infections caused by Edwardsiella tarda in humans are rare and occur in the presence of some risk factors. As far as we know, this is the first case of near-drowning-associated pneumonia with bacteremia caused by coinfection with methicillin-susceptible Staphylococcus aureus and Edwardsiella tarda in a healthy patient.. A 27-year-old previously healthy white man had an episode of fresh water drowning after acute alcohol consumption. Edwardsiella tarda and methicillin-sensitive Staphylococcus aureus were isolated in both tracheal aspirate cultures and blood cultures.. This case shows that Edwardsiella tarda is an important pathogen in near drowning even in healthy individuals, and not only in the presence of risk factors, as previously known.

Topics: Adult; Bacteremia; Ceftriaxone; Ciprofloxacin; Clindamycin; Coinfection; Edwardsiella tarda; Enterobacteriaceae Infections; Humans; Male; Methicillin; Near Drowning; Oxacillin; Pneumonia; Staphylococcal Infections; Staphylococcus aureus

An 84-year-old man was admitted to our hospital with bloody sputum. He was found to have a right lower lobe wedge-shaped nodular lesion with chest X-ray and computed tomography of the chest. Ceftriaxone and minocycline were started empirically based on a working diagnosis of community-acquired pneumonia. Streptococcus parasanguinis was isolated with sputum cultures obtained on three consecutive days and was identified based on its biochemical properties. S. parasanguinis is a member of the sanguinis group of viridans Streptococci. It is known as a causative pathogen for endocarditis. There are very few reports of S. parasanguinis associated with pulmonary infections. The present report describes the association of S. parasanguinis with a wedge-shaped nodular lesion in the lungs.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Humans; Male; Pneumonia; Streptococcal Infections; Streptococcus

Clostridium difficile infection (CDI) is one of the most common gastrointestinal complication after antimicrobial treatment. It is estimated that CDI after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. The aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia CDI. We addressed the issue by examining retrospectively the records of 217 patients who met the diagnostic criteria of CDI. Ninety four of those patients (43.3 %) came down with CDI infection after pneumonia treatment. Fifty of the 94 patients went through severe or severe and complicated CDI. The distribution of antecedent antibiotic treatment of pneumonia in these 50 patients was as follows: ceftriaxone in 14 (28 %) cases, amoxicillin with clavulanate in 9 (18 %), ciprofloxacin in 8 (16.0 %), clarithromycin in 7 (14 %), and cefuroxime and imipenem in 6 (12 %) each. The findings revealed a borderline enhancement in the proportion of deaths due to CDI in the ceftriaxone group compared with the ciprofloxacin, cefuroxime, and imipenem groups. The corollary is that ceftriaxone should be shunned in pneumonia treatment. The study demonstrates an association between the use of a specific antibiotic for pneumonia treatment and post-pneumonia mortality in patients who developed CDI.

Topics: Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Cefuroxime; Ciprofloxacin; Clarithromycin; Clavulanic Acid; Clostridioides difficile; Clostridium Infections; Cross Infection; Female; Hospitalization; Host-Pathogen Interactions; Humans; Imipenem; Male; Pneumonia; Retrospective Studies; Treatment Outcome

We describe a case of pneumonia and empyema thoracis caused by trimethoprim-sulfamethoxazole-susceptible, but imipenem-resistant Nocardia abscessus in a cancer patient. The isolate was confirmed to the species level by 16S rRNA sequencing analysis. The patient did not respond to antibiotic therapy, including ceftriaxone and imipenem, and died of progressing pneumonia and multiple organ failure.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Empyema, Pleural; Hemangiosarcoma; Humans; Imipenem; Immunocompromised Host; Male; Middle Aged; Multiple Organ Failure; Nocardia; Nocardia Infections; Pneumonia; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Female; Humans; Male; Pneumonia

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Male; Pneumonia; Stroke; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Female; Humans; Male; Pneumonia

Topics: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Female; Humans; Male; Pneumonia

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Male; Pneumonia; Stroke; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Male; Pneumonia; Stroke; Urinary Tract Infections

Topics: Adult; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Cesarean Section; Female; Fetal Monitoring; Humans; Lung; Oseltamivir; Oxygen Inhalation Therapy; Pneumonia; Pregnancy; Pregnancy Complications; Radiography; Respiratory Distress Syndrome

Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis.. This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement.. Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as < 2 months), with an overall mean ± SD duration of symptoms of 33.9 ± 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 ± 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients.. Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bronchitis; Brucellosis; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pleural Effusion; Pneumonia; Prognosis; Retrospective Studies; Rifampin; Streptomycin; Turkey; Young Adult

Recent Food and Drug Administration (FDA) guidance endorses the use of an early clinical response endpoint as the primary outcome for community-acquired bacterial pneumonia (CABP) trials. While antibiotics will now be approved for CABP, in practice they will primarily be used to treat patients with community-acquired pneumonia (CAP). More importantly, it is unclear how achievement of the new FDA CABP early response endpoint translates into clinically applicable real-world outcomes for patients with CAP. To address this, a retrospective cohort study was conducted among adult patients who received ceftriaxone and azithromycin for CAP of Pneumonia Outcomes Research Team (PORT) risk class III and IV at an academic medical center. The clinical response was defined as clinical stability for 24 h with improvement in at least one pneumonia symptom and with no symptom worsening. A classification and regression tree (CART) was used to determine the delay in response time, measured in days, associated with the greatest risk of a prolonged hospital length of stay (LOS) and adverse outcomes (in-hospital mortality or 30-day CAP-related readmission). A total of 250 patients were included. On average, patients were discharged 2 days following the achievement of a clinical response. In the CART analysis, adverse clinical outcomes were higher among day 5 nonresponders than those who responded by day 5 (22.4% versus 6.9%, P = 0.001). The findings from this study indicate that time to clinical response, as defined by the recent FDA guidance, is a reasonable prognostic indicator of real-world effectiveness outcomes among hospitalized PORT risk class III and IV patients with CAP who received ceftriaxone and azithromycin.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Cohort Studies; Community-Acquired Infections; Endpoint Determination; Female; Hospital Mortality; Humans; Male; Middle Aged; New York; Patient Readmission; Pneumonia; Retrospective Studies; Risk Assessment; Time Factors; Treatment Outcome

Community-acquired pneumonia (CAP) is a major cause of death and morbidity worldwide. Treatment is centred on antibiotics with ceftriaxone and amoxicillin-clavulanate being some of the most commonly prescribed agents.. To compare treatment outcomes and costs in patients receiving either of these two antibiotics at Witbank Hospital (WH).. A total of 200 randomly selected adult patient files (100 receiving ceftriaxone and 100 amoxicillin-clavulanate) recording a diagnosis of CAP were studied to determine the length of hospital stay, comorbid conditions and treatment outcomes. A descriptive and comparable analysis was performed.. Male gender, higher CURB-65 scores and death were associated with the use of ceftriaxone. Severity of disease and previous antibiotic exposure influenced the duration of hospital admission.. Gender and severity of disease (based on the CURB-65 score) were the determinants of antibiotic choice at WH. Male gender increased the likelihood of being treated with ceftriaxone, as did a CURB-65 score of > 2. There were no differences in the outcomes of CAP patients treated with ceftriaxone compared with those treated with amoxicillin-clavulanate. Irrespective of antibiotic used, gender and severity of disease influenced treatment outcomes. Male gender was associated with a higher mortality and longer hospital stay. The average duration of stay for both antibiotics was not significantly different. Thus, only level 1 and 2 costs need to be considered when comparing the two regimens. On this basis, ceftriaxone was cheaper than amoxicillin-clavulanate.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aminopyridines; Ceftriaxone; Clavulanic Acid; Community-Acquired Infections; Drug Combinations; Female; Humans; Length of Stay; Male; Middle Aged; Pneumonia; Sex Factors; Treatment Outcome

In this study, our objective was to determine whether a synergistic antimicrobial combination in vitro would be beneficial in the downregulation of pneumococcal virulence genes and whether the associated inflammation of the lung tissue induced by multidrug-resistant Streptococcus pneumoniae infection in vivo needs to be elucidated in order to consider this mode of therapy in case of severe pneumococcal infection. We investigated in vivo changes in the expression of these virulence determinants using an efficacious combination determined in previous studies. BALB/c mice were infected with 10(6) CFU of bacteria. Intravenous levofloxacin at 150 mg/kg and/or ceftriaxone at 50 mg/kg were initiated 18 h postinfection; the animals were sacrificed 0 to 24 h after the initiation of treatment. The levels of cytokines, chemokines, and C-reactive protein (CRP) in the serum and lungs, along with the levels of myeloperoxidase and nitric oxide the inflammatory cell count in bronchoalveolar lavage fluid (BALF), changes in pneumolysin and autolysin gene expression and COX-2 and inducible nitric oxide synthase (iNOS) protein expression in the lungs were estimated. Combination therapy downregulated inflammation and promoted bacterial clearance. Pneumolysin and autolysin expression was downregulated, with a concomitant decrease in the expression of COX-2 and iNOS in lung tissue. Thus, the combination of levofloxacin and ceftriaxone can be considered for therapeutic use even in cases of pneumonia caused by drug-resistant isolates.

Topics: Animals; Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; Bronchoalveolar Lavage Fluid; Ceftriaxone; Disease Models, Animal; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Levofloxacin; Male; Mice; Mice, Inbred BALB C; N-Acetylmuramoyl-L-alanine Amidase; Pneumococcal Infections; Pneumonia; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Streptolysins; Virulence; Virulence Factors

To explore the perceptions of ED doctors regarding the use of ceftriaxone in patients with community-acquired pneumonia (CAP).. Face-to-face interviews were conducted with ED doctors in an Australian tertiary public hospital. A semi-structured interview method was used for collecting data and a framework analysis approach utilised to identify emerging themes regarding the influences on ED prescribers when using ceftriaxone for CAP.. Eight interviews were performed (two consultants, four registrars and two residents). Five main themes emerged as influencing decisions regarding the selection of ceftriaxone for patients with CAP: (i) clinical intuition versus structured evaluation of severity; (ii) clinical uncertainty; (iii) prior experience; (iv) source of guidance; and (v) prescribing etiquette.. As most cases of CAP are initially diagnosed and treated empirically in the ED, any interventions that aim to decrease inappropriate use of ceftriaxone for CAP should address the factors identified here that influence ED doctors' prescribing decisions.

Topics: Adult; Anti-Bacterial Agents; Attitude of Health Personnel; Australia; Ceftriaxone; Community-Acquired Infections; Emergency Medicine; Emergency Service, Hospital; Female; Humans; Male; Pneumonia; Practice Patterns, Physicians'

Antibiotic prophylaxis with norfloxacin, intravenous ciprofloxacin, or ceftriaxone has been recommended for cirrhotic patients with gastrointestinal hemorrhage but little is known about intravenous cefazolin. This study aimed to compare the outcome of intravenous cefazolin and ceftriaxone as prophylactic antibiotics among cirrhotic patients at different clinical stages, and to identify the associated risk factors. The medical records of 713 patients with acute variceal bleeding who had received endoscopic procedures from were reviewed. Three hundred and eleven patients were entered for age-matched adjustment after strict exclusion criteria. After the adjustment, a total of 102 patients were enrolled and sorted into 2 groups according to the severity of cirrhosis: group A (Child's A patients, n = 51) and group B (Child's B and C patients, n = 51). The outcomes were prevention of infection, time of rebleeding, and death. Our subgroup analysis results failed to show a significant difference in infection prevention between patients who received prophylactic cefazolin and those who received ceftriaxone among Child's A patients (93.1% vs. 90.9%, p = 0.641); however, a trend of significance in favor of ceftriaxone prophylaxis (77.8% vs. 87.5%, p = 0.072) was seen among Child's B and C patients. More rebleeding cases were observed in patients who received cefazolin than in those who received ceftriaxone among Child's B and C patients (66.7% vs. 25.0%, p = 0.011) but not in Child's A patients (32% vs. 40.9%, p = 0.376). The risk factors associated with rebleeding were history of bleeding and use of prophylactic cefazolin among Child's B and C patients. In conclusion, this study suggests that prophylactic intravenous cefazolin may not be inferior to ceftriaxone in preventing infections and reducing rebleeding among Child's A cirrhotic patients after endoscopic interventions for acute variceal bleeding. Prophylactic intravenous ceftriaxone yields better outcome among Child's B and C patients.

Topics: Acute Disease; Administration, Intravenous; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefazolin; Ceftriaxone; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Gram-Negative Bacterial Infections; Humans; Kaplan-Meier Estimate; Liver Cirrhosis; Male; Middle Aged; Multivariate Analysis; Pneumonia; Retrospective Studies; Sepsis; Treatment Outcome

The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America community-acquired pneumonia (CAP) guideline recommends narrow-spectrum antimicrobial therapy for most children hospitalized with CAP. However, few studies have assessed the effectiveness of this strategy.. Using data from 43 children's hospitals, we conducted a retrospective cohort study to compare outcomes and resource utilization among children hospitalized with CAP between 2005 and 2011 receiving either parenteral ampicillin/penicillin (narrow spectrum) or ceftriaxone/cefotaxime (broad spectrum). Children with complex chronic conditions, interhospital transfers, recent hospitalization, or the occurrence of any of the following during the first 2 calendar days of hospitalization were excluded: pleural drainage procedure, admission to intensive care, mechanical ventilation, death, or hospital discharge.. Overall, 13,954 children received broad-spectrum therapy (89.7%) and 1610 received narrow-spectrum therapy (10.3%). The median length of stay was 3 days (interquartile range 3-4) in the broad- and narrow-spectrum therapy groups (adjusted difference 0.12 days, 95% confidence interval [CI]: -0.02 to 0.26). One hundred fifty-six children (1.1%) receiving broad-spectrum therapy and 13 children (0.8%) receiving narrow-spectrum therapy were admitted to intensive care (adjusted odds ratio 0.85, 95% CI: 0.27 to 2.73). Readmission occurred for 321 children (2.3%) receiving broad-spectrum therapy and 39 children (2.4%) receiving narrow-spectrum therapy (adjusted odds ratio 0.85, 95% CI: 0.45 to 1.63). Median costs for the hospitalization were $3992 and $4375 (adjusted difference -$14.4, 95% CI: -177.1 to 148.3).. Clinical outcomes and costs for children hospitalized with CAP are not different when treatment is with narrow- compared with broad-spectrum therapy.

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child, Preschool; Cohort Studies; Drug Therapy, Combination; Female; Hospitalization; Humans; Infant; Male; Penicillins; Pneumonia; Retrospective Studies

To evaluate modifications of gut microbiota after antibiotic therapy in breast-fed infants.. Twenty-six exclusively breast-fed infants younger than 5 months hospitalized for pneumonia treated with ceftriaxone (50 mg per kilo per day administered intramuscularly) were recruited. Intestinal microbiota at day 0 - before starting antibiotic administration - at the end of the therapy (5 days after) and after 15 days after the stop was analysed. Stool samples were collected and immediately diluted and cultured on selective media to detect total bacteria, Enterobacteriaceae, enterococci and lactobacilli. Statistical analysis was performed by using Wilcoxon test.. After 5 days of antibiotic therapy, we observed a significant reduction in total faecal bacterial count (p = 0.003) in Enterobacteriaceae (p = 0.001) and enterococci (p < 0.001), in comparison with day 0. After 5 days of therapy, lactobacilli are no longer detected. Conversely, bacterial count values for all bacteria detected after 15 days from the end of therapy are significantly increased and similar to day 0..   Our findings showed that gut microbiota was significantly modified after 5 days of antibiotic therapy; exclusively, breast-feeding may be relevant in promoting the re-establishment of gut microbiota composition in early infancy.

Topics: Anti-Bacterial Agents; Bacterial Load; Breast Feeding; Ceftriaxone; Enterobacteriaceae; Enterococcus; Feces; Female; Humans; Infant; Intestines; Lactobacillus; Male; Metagenome; Pneumonia; Time Factors; Treatment Outcome

Acute phlegmonous gastritis is an uncommon disease, often fatal condition characterized by suppurative bacterial infection of the gastric wall. It has a high mortality rate mainly because the diagnosis is usually made late. Until recently, gastrectomy in combination with antibiotics was recommended. We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. At upper gastrointestinal endoscopy, the gastric lumen was narrow, and the mucosa was severely inflamed, which was erythematous, swelled, and showed necrotic areas covered with purulent exudate. Klebsiella oxytoca and Acinetobacter lwoffii were isolated in the gastric tissue culture. Contrast-enhanced computerized tomography scan of abdomen demonstrated diffuse gastric wall thickening and an intramural abscess in the gastric antral wall. Although delayed gastric emptying by gastroparesis prolonged the in-hospital period, the only medical treatment with antibiotics alone successfully cured the patient without gastrectomy.

Topics: Acinetobacter; Acute Disease; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Gastritis; Gastroparesis; Gastroscopy; Humans; Imipenem; Klebsiella oxytoca; Male; Ofloxacin; Pneumonia; Tomography, X-Ray Computed

We report a possible and rare case of drug-induced organizing pneumonia in a patient receiving daptomycin. A 75-year-old man with acute infective aorta valve endocarditis due to Enterococcus faecalis developed organizing pneumonia following treatment with intravenous daptomycin and ceftriaxone. The patient could have acquired an infectious agent which was resistant to ceftriaxone, such as Legionella, and he was thus treated with ciprofloxacin and rifampicin. However, no antigen was found in the urine, and the patient's symptoms subsided after daptomycin was discontinued.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Daptomycin; Endocarditis, Bacterial; Enterococcus faecalis; Eosinophilia; Humans; Male; Pneumonia

The 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend that community-acquired pneumonia (CAP) patients admitted to hospital wards initially receive respiratory fluoroquinolone monotherapy or beta-lactam plus macrolide combination therapy. There is little evidence as to which regimen is preferred, or if differences in medical resource utilization exist between therapies. Thus, the authors compared length of hospital stay (LOS) and length of intravenous antibiotic therapy (LOIV) for patients who received initial levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily ('combination therapy').. Adult hospital CAP cases from January 2005 to December 2007 were identified by principal discharge diagnosis code. Patients with a chest infiltrate and medical notes indicative of CAP were included. Direct intensive care unit admits and healthcare-associated cases were excluded. A propensity score technique was used to balance characteristics associated with initial antimicrobial therapy using multivariable regression to derive the scores. Propensity score categories, defined as propensity score quintiles, rather than propensity scores themselves, were used in the least squares regression model to assess the impact of LOS and LOIV.. A total of 495 patients from six hospitals met study criteria. Of these, 313 (63%) received levofloxacin and 182 (37%) received combination therapy. Groups were similar with respect to age, sex, most comorbidities, presenting signs and symptoms, and Pneumonia Severity Index (PSI) risk class. Patients on combination therapy were more likely to have heart failure and receive pre-admission antibiotics. Adjusted least squares mean (+/-SE) LOS and LOIV were shorter with levofloxacin versus combination therapy: LOS, 4.6 +/- 0.17 vs. 5.4 +/- 0.22 days, p < 0.01; and LOIV, 3.6 +/- 0.17 vs. 4.8 +/- 0.21 days, p < 0.01. Results for PSI risk class III or IV patients were: LOS, 5.0 +/- 0.30 vs. 5.9 +/- 0.37 days, p = 0.07; and LOIV, 3.7 +/- 0.33 vs. 5.2 +/- 0.39 days, p < 0.01. Due to the retrospective study design, limited sample size, and scope (single health-network), the authors encourage replication of this study in other data sources.. Given the LOS and LOIV reductions of 0.8 and 1.2 days, respectively, utilization of levofloxacin 750 mg daily for CAP patients admitted to the medical floor has the potential to result in substantial cost savings for US hospitals.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Female; Health Resources; Humans; Least-Squares Analysis; Levofloxacin; Male; Middle Aged; Ofloxacin; Pneumonia; Practice Guidelines as Topic; Societies, Medical; United States

The United States labeling for gatifloxacin has been updated to include contradictions related to its reported association with dysglycemia. However, adequately controlled studies in acute care settings assessing the magnitude and clinical determinants of dysglycemia are lacking.. To compare the hypoglycemic and hyperglycemic effects of gatifloxacin with ceftriaxone in hospitalized patients.. A retrospective cohort study of hospitalized adult (> or =18 years) patients admitted with Community Acquired Pneumonia (CAP) or Acute Exacerbation of Chronic Bronchitis (AECB) in a US tertiary care hospital between 7/1/01 and 12/31/04 treated with gatifloxacin or ceftriaxone during hospital admission. Outcomes of interests were incidence of hypoglycemia (blood glucose levels <46 mg/dL) or hyperglycemia (>200 mg/dL) during up to 5 days of drug exposure. Risks for gatifloxacin and ceftriaxone were compared adjusting for variables previously reported to be independent predictors of hypoglycemia or hyperglycemia.. 1504 patients met the study inclusion criteria. Compared to ceftriaxone, gatifloxacin was associated with an increased risk of hypoglycemia: (adjusted odds ratio (OR) 2.34, 95% confidence interval (CI) 1.4-4.0). The increased risk of hypoglycemia during exposure to gatifloxacin was similar in patients with and without a diagnosis of diabetes mellitus. Gatifloxacin was not associated with an increased risk for hyperglycemia (adjusted OR: 1.06 95% CI 0.8-1.4) considering the whole study cohort. However, stratification by diagnosis of diabetes, gatifloxacin treated patients appeared to have a reduced risk of hyperglycemia (adjusted OR: 0.4 95% CI 0.2-0.4) while non-diabetic gatifloxacin treated patients appeared to have an increased risk of hyperglycemia (adjusted OR: 1.64 95% CI 1.1-2.4).. The risk of dysglycemia with gatifloxacin in this population of hospitalized patients was not as high as previously reported in ambulatory patients. Although these results suggest gatifloxacin use is safer in acute care settings, we recommend that clinicians monitor blood glucose levels carefully or consider alternatives to gatifloxacin therapy whenever possible.

Topics: Adult; Aged; Anti-Bacterial Agents; Blood Glucose; Bronchitis; Ceftriaxone; Cohort Studies; Community-Acquired Infections; Diabetes Mellitus; Female; Fluoroquinolones; Gatifloxacin; Homeostasis; Hospitalization; Humans; Hyperglycemia; Hypoglycemia; Male; Middle Aged; Pneumonia; Retrospective Studies; Risk Factors; United States

Topics: Administration, Oral; Aza Compounds; Ceftriaxone; Cefuroxime; Cross Infection; Fluoroquinolones; Humans; Moxifloxacin; Pneumonia; Quinolines

A 5-year-old girl with no underlying immune deficiency or hematologic disease was treated with a combination of ceftriaxone and ampicilline-sulbactam for pneumonia. On the ninth day of the therapy, she developed oliguria, paleness, malaise, immune hemolytic anemia (IHA) and acute renal failure (ARF). Laboratory studies showed the presence of antibodies against ceftriaxone. Acute interstitial nephritis (AIN) was diagnosed by renal biopsy. The patient's renal insufficiency was successfully treated with peritoneal dialysis without any complications. The patient recovered without any treatment using steroids or other immunosuppressive agents.

Topics: Acute Disease; Acute Kidney Injury; Ampicillin; Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Coombs Test; Female; Humans; Immunoglobulin G; Nephritis, Interstitial; Peritoneal Dialysis; Pneumonia; Sulbactam; Treatment Outcome

Limited data exist on the effectiveness of ceftriaxone plus doxycycline in the treatment of patients hospitalized with community-acquired pneumonia (CAP).. We performed a retrospective cohort study of all adults hospitalized for pneumonia between January 1999 and July 2001 at an academic medical center. Outcomes were compared for patients with CAP treated with ceftriaxone plus doxycycline versus other appropriate initial empiric antibiotic therapies. Outcomes were adjusted with the use of a propensity score to account for differences in patient characteristics and illness severity between groups.. A total of 216 patients were treated with ceftriaxone plus doxycycline and 125 received other appropriate initial empiric antibiotic therapies. After adjustment, use of ceftriaxone plus doxycycline was associated with reduced inpatient mortality (OR = 0.26, 95% CI: 0.08-0.81) and 30-day mortality (OR = 0.37, 95% CI: 0.17-0.81), but not with length of stay or readmission rates. Analysis of a subset of the sample that excluded patients admitted from nursing homes, patients admitted to the ICU, and patients diagnosed with aspiration also showed reduced inpatient mortality with the use of ceftriaxone plus doxycycline.. The use of ceftriaxone plus doxycycline as an initial empiric therapy for patients hospitalized with CAP appears safe and effective, and its potential superiority should be evaluated prospectively.

Topics: Adult; California; Ceftriaxone; Community-Acquired Infections; Doxycycline; Drug Therapy, Combination; Hospitalization; Humans; Length of Stay; Pneumonia; Retrospective Studies; Treatment Outcome

On December 26, 2004, a tsunami from the Indian Ocean struck the coastal city of Banda Aceh, Sumatra, Indonesia. This case report describes a 24-year-old woman who presented to the Dr. Zainoel Abidin Hospital in Banda Aceh on January 8, 2005, with a tsunami-related illness. The patient was initially treated for tetanus and aspiration pneumonia with a guarded prognosis. Her recovery was complicated by malaria and recurrent pneumonia. Treatment was hampered by a shortage of medication and equipment, damage to the hospital, and a filthy environment. Morphine, diazepam, and ketamine infusions were used to good effect. This case highlights some of the logistical problems of treating multiple tetanus patients in an austere environment.

Topics: Adult; Ceftriaxone; Diazepam; Disasters; Female; Humans; Indonesia; Malaria; Metronidazole; Pneumonia; Prognosis; Tetanus

Though the pathogenic significance and the reservoir of Ewingella americana have not been clarified, this organism has caused several pathogenic infections, especially in immunocompromised patients. We report a pneumonia in a patient with chronic renal failure, who had chronic rejection of transplanted kidney. E. americana was identified to be the pathogen of pneumonia with clinical symptoms and signs and radiological examination. As soon as he was treated with ceftriaxone and isepamicin, clinical improvement was followed with no further growth of E. americana or other pathogenic isolates from sputum culture. This suggests to be the case of pneumonia caused by E. americana for the first time in the Korean literature.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Enterobacteriaceae; Enterobacteriaceae Infections; Gentamicins; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Pneumonia; Sputum; Time Factors

To determine the frequency of aspiration pneumonitis in nursing home residents with an initial diagnosis of pneumonia and to compare the clinical characteristics, management, and outcome of aspiration pneumonitis with those of pneumonia.. Retrospective chart review.. Hospital geriatric unit for nursing home residents.. Nursing home residents admitted to the inpatient geriatric unit with suspected pneumonia between May 1999 and April 2001 (n = 195 episodes).. Aspiration events were defined as definite (witnessed or unwitnessed) or suspected. Aspiration pneumonitis was defined as symptoms/signs of lower respiratory tract infection plus a history of an aspiration event plus a lower lobe infiltrate on chest radiograph. Pneumonia was defined as symptoms/signs of lower respiratory tract infection plus an infiltrate on chest radiograph plus no history of an aspiration event.. The 195 episodes were stratified into three clinical groups: aspiration pneumonitis (n = 86; aspiration history/infiltrate), pneumonia (n = 43; no aspiration history/infiltrate), and an aspiration event (n = 66; aspiration history/no infiltrate). In general, symptoms, signs, and laboratory tests were not useful in distinguishing between the three groups. Survivors with aspiration pneumonitis (13/75 (17%)) or with an aspiration event (20/60 (33%)) were significantly more likely not to be treated with an antibiotic or to be treated for 1 day or less than those with pneumonia (0/41; P <.001). Excluding those not treated, significantly more patients with pneumonia (33/40 (83%)) were discharged on antibiotic treatment than those with aspiration pneumonitis (35/70 (50%)) or an aspiration event (21/51 (41%); P <.001). There was no significant difference in hospital mortality between the three clinical groups.. The findings of this study have implications for the diagnosis and management of suspected pneumonia in nursing home residents but require prospective validation.

Topics: Aged; Aged, 80 and over; Algorithms; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Female; Geriatric Assessment; Hospital Mortality; Hospital Units; Humans; Length of Stay; Male; Nursing Homes; Pneumonia; Pneumonia, Aspiration; Retrospective Studies; Severity of Illness Index

Topics: Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Humans; Macrolides; Pneumonia

Much controversy exists regarding the initial choice of antibiotics and selected outcomes for patients with community-acquired pneumonia (CAP).. The investigators analyzed a hospital claims-made database to assess the impact of initial antibiotic choice on 30-day mortality, total hospital costs, and hospital length of stay (LOS). Fine risk groups allowed for stratification for variations in the severity of illness. Patients were divided into five monotherapy groups (ie, ceftriaxone, "other" cephalosporins, fluoroquinolones, macrolides, or penicillins) and four groups that received dual therapy (ie, the agents listed above, except macrolides) plus macrolides. Patients also were stratified by age (ie, > 65 years of age and < 65 years of age). Severely ill patients were excluded.. Overall, 44,814 persons met the criteria for inclusion. Among monotherapy patients, those who received macrolides had the least mortality but were the least ill. Patients who received dual therapy generally had shorter LOSs, lower total hospital charges, and decreased mortality compared with those who received monotherapy. Differences among dual-therapy regimens regarding outcomes studies were noted. Patients who were < 65 years of age had lower mortality rates, shorter LOSs, and lower hospital charges than did the more elderly patients. Within this group, those who received dual therapy had better outcomes than those who received monotherapy.. We confirmed the value of dual therapy employing macrolides as a second agent in decreasing mortality from CAP, and we provided similar data regarding shorter LOSs and lower hospital charges. This appears to hold for a younger population. Differences among dual-therapy regimens (all employing macrolides) appear to exist and may be clinically relevant.

Topics: 4-Quinolones; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Drug Therapy, Combination; Fluoroquinolones; Hospital Costs; Humans; Length of Stay; Macrolides; Middle Aged; Outcome Assessment, Health Care; Penicillins; Pneumonia

Topics: Adult; Anti-Bacterial Agents; Antigens, Bacterial; Bioterrorism; Cefotaxime; Ceftriaxone; Chlamydophila pneumoniae; Community-Acquired Infections; Humans; Legionnaires' Disease; Macrolides; Microbial Sensitivity Tests; Pneumonia; Pneumonia, Pneumococcal; Severe Acute Respiratory Syndrome; Streptococcus pneumoniae

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

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Cefuroxime; Cephalosporins; Gram-Negative Anaerobic Bacteria; Gram-Negative Bacterial Infections; Humans; Infant; Male; Pneumonia

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Drug Therapy, Combination; Feces; Female; Hospitalization; Humans; Infusions, Intravenous; Intestines; Male; Middle Aged; Pneumonia; Treatment Outcome

Topics: Amoxicillin; Australia; Azithromycin; Ceftriaxone; Clinical Trials as Topic; Community-Acquired Infections; Drug Therapy, Combination; Drug Utilization; Humans; Pneumonia; Sensitivity and Specificity

Topics: Aged; Ceftriaxone; Cephalosporins; Cross Infection; Drug Therapy, Combination; Frail Elderly; Humans; Injections, Subcutaneous; Nursing Homes; Pneumonia; Practice Guidelines as Topic

Topics: Cefepime; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Humans; Outcome Assessment, Health Care; Pneumonia

Topics: Amoxicillin; Bacterial Infections; Ceftriaxone; Cephalosporins; Child, Preschool; Dysentery; Humans; Infant; Meningitis; Penicillins; Pneumonia; Practice Patterns, Physicians'; Primary Health Care; Sepsis

Topics: Adult; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Drug Resistance, Microbial; Humans; Pneumonia

A 39-year-old HIV positive patient developed myalgia, headache and cough 4 weeks after a tick bite. His temperature was 37.4 degrees C and a circular pale erythema was noted over the left lower leg.. C-reactive protein was raised to 120 mg/l, white blood cell count was 5860/microliter, CD4-lymphocyte count 250/microliter. The chest radiogram showed pneumonitic infiltration in the left lower lobe. There were IgM antibodies against Borrelia burgdorferi.. Left lower lobe pneumonia and chronic erythema migrans were diagnosed and he was given oral azithromycin (500 mg on the first day and 250 mg for 4 days). The pneumonia cleared up, but 2 weeks later he developed symptoms of meningitis (496 cells per microliter, 87% lymphocytes, positive Borrelia burgdorferi antibody titer), which quickly and lastingly responded to ceftriaxon (2 g daily by brief infusion for 14 days).. This immune-compromised HIV-infected patient developed disseminated borreliosis with CNS involvement 2 weeks after the occurrence of chronic erythema migrans. The initial treatment of the latter with azithromycin was unable to prevent the meningitis. It is unlikely that there was a causal connection between the borreliosis and the pneumonia.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Borrelia burgdorferi Group; Ceftriaxone; Cephalosporins; HIV Seropositivity; Humans; Immunocompromised Host; Immunoglobulin M; Insect Bites and Stings; Lyme Disease; Male; Meningitis, Bacterial; Pneumonia; Ticks

In order to evaluate antimicrobial activity of ceftriaxone (CTRX), minimum inhibitory concentrations (MICs) of CTRX and control drugs were determined against clinically isolated strains including those from purulent meningitis and liver and biliary tract infections in 1995. The results are summarized as follows; 1. MIC90 of CTRX was 0.05 micrograms/ml against benzylpenicillin (PCG)-insensitive Streptococcus pneumoniae or PCG-resistant S. pneumoniae and it was < or = 0.025 micrograms/ml against beta-lactamase producing strains of Haemophilus influenzae. Antimicrobial activities of CTRX against these strains were stronger than control drugs. 2. MIC distribution of CTRX was in a lower concentration range than those of ceftazidime and flomoxef against extend broad-spectrum beta-lactamase (EBLA)-producing Escherichia coli and Klebsiella pneumoniae subsp. pneumoniae. 3. These results suggested that CTRX will be effective against community-acquired pneumonia, purulent meningitis and liver & biliary tract infections.

Topics: Biliary Tract Diseases; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Escherichia coli; Haemophilus influenzae; Humans; Klebsiella pneumoniae; Meningitis; Penicillin G; Pneumonia; Streptococcus pneumoniae

Topics: Ceftriaxone; Cephalosporins; Drug Delivery Systems; Humans; Male; Medication Errors; Middle Aged; Nursing Care; Pneumonia; Risk Management

Topics: Acute-Phase Reaction; Adult; Anti-Inflammatory Agents; Budesonide; Ceftriaxone; Drug Therapy, Combination; Fires; Humans; Lung Volume Measurements; Male; Paraffin; Pneumonia; Prednisolone; Pregnenediones; Tomography, X-Ray Computed

The aim of the present study was to know the clinical and etiologic features of community-acquired pneumonia (CAP) in elderly patients requiring hospital admission.. A prospective study of 36 consecutive patients aged over 70 years, admitted to a general hospital was performed. Standard analytical determinations, blood cultures, and serologic studies were performed in all patients using invasive techniques: aspirative transthoracic puncture (ATP) with ultrafine needle in 35 (97%) cases, and telescopic catheter (TC) in 1 case.. The mean age was 79 years (range: 71-90). Twenty-two patients had received antibiotic treatment prior to admission (61%) and 17 (47%) presented chronic debilitating diseases. The clinical characteristics of CAP were "typical" with acute presentation in most. Fifteen cases (42%) were etiologically diagnosed and the most frequently isolated agents were Streptococcus pneumoniae (22%) and Haemophilus influenzae (8%). Empiric treatment was changed on the basis of isolations in 7 cases (19%). Eight patients died (22%).. According to our results community-acquired pneumonia in the population studied: 1) generally showed an acute presentation with "typical" characteristics, carrying a high mortality rate (22%), 2) is of bacterial etiology, with S. pneumoniae and H. influenzae being the most frequently isolated microorganisms, 3) the use of ATP in community-acquired pneumonia offers a high diagnostic effectiveness, good tolerance and low risk of complications.

Topics: Aged; Aged, 80 and over; Bacteria; Biopsy, Needle; Ceftriaxone; Community-Acquired Infections; Female; Hospitalization; Humans; Male; Pneumonia; Prospective Studies; Spain

Twenty-four alcoholic patients with community-acquired pneumonia were studied for 2 years in order to define clinical signs and etiology. Blood cultures and serological profiles were done for all patients in addition to standard blood analyses. All had an invasive procedure -transthoracic puncture with an ultrafine 25G needle (20 patients) or telescopic catheter with bacteriologic brush (4 patients). When we were unable to obtain a good sputum sample (5 patients), a culture was grown. The patients' mean age was 48 and 83% had an acute clinical profile (< or = 7 days with symptoms) with "typical" signs. The X-rays showed an alveolar pattern in all patients, with cavitation in 29%. Etiological diagnosis was reached in 17 (71%) cases, with St. Pneumoniae (25%), anaerobic microorganisms (20%) and C. burnetii (12.5%) being the germs found most frequently. The invasive techniques were more useful (54%) than the blood cultures (17%) or sputum cultures (4%), and they were well tolerated and uncomplicated. Empirical antibiotic treatment was modified for 12 patients (50%). Seventeen percent required intensive care treatment and mortality was 12.5%.

Topics: Adult; Alcoholism; Bacteria; Bacterial Infections; Ceftriaxone; Clindamycin; Community-Acquired Infections; Humans; Male; Middle Aged; Pneumonia; Prospective Studies; Spain

A cost-effectiveness analysis was performed for three antibiotic drug therapies in pneumonia and bronchopneumonia: broad spectrum penicillins, III generation cephalosporins and ceftriaxone. The study was based on records from 117 patients in 9 general medical departments in North and Central Italy during 1989. Costs included direct cost of drugs, staff, accommodation, and other hospital costs. Effectiveness was measured radiographically as clinical cure, interruption of therapy or death. The effectiveness and shorter duration of therapy with ceftriaxone in respect to the other treatments, produced a 15.18% savings of hospital resources compared with other III generation cephalosporins, and a 14.76% savings compared with broad spectrum penicillins. This is a provisional conclusion requiring confirmation with a larger number of patients and randomized trials.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Cost-Benefit Analysis; Female; Hospitals; Humans; Male; Middle Aged; Penicillins; Pneumonia

Pulmonary infection complicating intra-abdominal sepsis is a major clinical problem. An experimental model for intra-abdominal sepsis was created with implantation of gelatin capsules, containing 3 x 10(8) cfu E. coli strain no. 2554, in the peritoneal cavity of 20 rats (10 animals received and 10 did not receive antibiotic therapy with ceftriaxone) in order to verify the role of the primary site of infection in the pathogenesis of pneumonia. Ten rats were sacrificed to determine the relative pulmonary weight and 10 were submitted to simple laparotomy and insertion of a germ-free capsule (sham-operated group). In this group of animals there was only one death (10%). All the rats that received antibiotic therapy survived until sacrifice while all the rats that did not receive ceftriaxone died, 7 within the 2nd and 3 on the 6th postoperative day. Pneumonia and peritonitis developed only in the animals that did not receive ceftriaxone. Bacteriological findings of material obtained from peritoneal and pleural cavities revealed the same strain of E. coli used for the experiment, suggesting that bacteria involved in the pleuro-pulmonary infections may originate in the primary site of infection and that antibiotic therapy started at the moment of contamination, can prevent this major complication.

Topics: Abdomen; Abscess; Animals; Ceftriaxone; Colony Count, Microbial; Male; Organ Size; Peritonitis; Pleural Effusion; Pneumonia; Rats; Rats, Sprague-Dawley

Cefotaxime 1 g intramuscularly (i.m.) 12-hourly was compared with ceftriaxone 1 g i.m. 12-hourly in adult patients requiring hospitalization with uncomplicated community-acquired pneumonia. Fifty-two patients were enrolled and two were subsequently withdrawn, leaving 50 patients who completed the study; 23 received cefotaxime and 27 received ceftriaxone. Clinical cure was achieved in 49 of the 50 patients (98%). One treatment failure occurred in a patient who received ceftriaxone. The only significant pathogen isolated from the pretreatment sputum cultures was Streptococcus pneumoniae (50%). All isolates were sensitive to both drugs. Cefotaxime 1 g i.m. 12-hourly was as effective as ceftriaxone in the treatment of patients with uncomplicated community-acquired pneumonia requiring hospital admission.

Topics: Adult; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Humans; Injections, Intramuscular; Male; Middle Aged; Pneumonia

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

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

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Cross Infection; Homes for the Aged; Humans; Nursing Homes; Pneumonia; United States

Ceftriaxone, a broad spectrum third-generation cephalosporin with a half-life of six to eight hours, was evaluated prospectively in 147 children with severe community-acquired bacterial pneumonia during the period 11/15/88-5/15/89. Thirty-nine of the children had been unsuccessfully treated with vanous oral antibiotics prior to admission [corrected]. All the patients were initially hospitalized and started on once a day intramuscular ceftriaxone. Mean duration of ceftriaxone therapy was five days. Pathogens were recovered from blood cultures of 17 (11.6%) patients and included S. pneumoniae (13 patients), H. influenzae (three, all resistant to ampicillin) and S. viridans (1) [corrected]. All isolates were sensitive to ceftriaxone. An additional patient had L. pneumophila diagnosed by serology. Cure was achieved in 142 (96.6%) patients; improvement was usually observed within 24-48 hours. After 48 hours, 121 (82.2%) children could be discharged and continued the therapy on ambulatory basis. Based on previous experience we estimated that 383 hospitalization days were saved. No serious side effects were observed. Five patients were considered therapeutic failures; two of them developed empyema and one of them required repeated drainage procedures. A third patient experienced a relapse of pneumonia shortly after completion of therapy. The other two remained febrile for more than seven days; their subsequent improvement was unrelated to the antibiotic therapy, suggesting a viral or mycoplasmal syndrome. Our data suggest that once daily intramuscular ceftriaxone can be successfully used for the outpatient treatment of most community-acquired severe bacterial pneumonias in children. In our opinion it represents the treatment of choice for patients who failed treatment with other antimicrobials and are clinically stable enough not to require hospitalization.

Topics: Adolescent; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Infant; Injections, Intramuscular; Male; Pneumonia; Radiography

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

Data are reported of the results of clinical trials of the therapeutic efficacy of longaceph--a drug of the new generation of cephalosporins with a long period of half-decay--in acute pneumonia complicating influenza in 42 patients. The sensitivity of 120 microbial strains to longaceph was also studied. It was established that cephalosporin possesses a high efficacy in diseases caused by gram-positive and gram-negative microorganisms. A high degree of sensitivity to longaceph was observed in pneumococci biogenous and Streptococcus viridans, Staphylococcus aureus and epidermidis, klebsiellae and escherichiae. A new property of longaceph was found, namely, its capacity to stimulate the formation of endogenous interferon.

Topics: Adult; Bacterial Infections; Ceftriaxone; Cephalosporins; Delayed-Action Preparations; DNA; DNA Repair; Drug Evaluation; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Interferons; Lymphocytes; Microbial Sensitivity Tests; Middle Aged; Pneumonia

A woman with diabetes mellitus and coronary artery disease developed pneumonia and bacteremia from Branhamella catarrhalis. This is only the fifth reported case of pneumonia with bacteremia due to this organism, which was previously considered normal upper airway flora.

Topics: Aged; Ceftriaxone; Cefuroxime; Cross Infection; Female; Humans; Moraxella catarrhalis; Pneumonia; Sepsis

Sixty-two episodes of bacterial infection were studied in 51 cirrhotic patients. 2 g of ceftriaxone (active ingredient of Rocephin) were given intravenously once daily for 7-10 days. The infections were pneumonia, bacteremia, spontaneous bacterial peritonitis, urinary infection and others. Good responses were seen in 90% of the cases.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Pneumonia; Sepsis; Urinary Tract Infections

Ceftriaxone, a broad-spectrum third-generation cephalosporin with a long half-life, was administered intramuscularly to 23 outpatients who had a variety of infectious diseases. Cure was achieved in 21 of the patients (91%). The results of this study indicate that ceftriaxone is an effective and well-tolerated antimicrobial agent when administered intramuscularly to outpatients with various infections.

Topics: Adult; Aged; Bacterial Infections; Ceftriaxone; Escherichia coli; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Pneumonia; Pyelonephritis; Skin Diseases, Infectious; Staphylococcus aureus; Streptococcus

Topics: Ceftriaxone; Citrates; Citric Acid; Humans; Male; Middle Aged; Osteomyelitis; Pneumonia; Radionuclide Imaging

Topics: Aged; Aged, 80 and over; Ceftriaxone; Enterobacteriaceae Infections; Humans; Male; Pneumonia; Postoperative Complications; Serratia marcescens

Selected patients with community-acquired infections can be discharged from the hospital, when afebrile and stable, with parenteral antibiotic therapy continued on an ambulatory basis. This therapy is currently possible because of the availability of long-acting cephalosporins that can be administered once daily, often with substantial reductions in hospital costs. Cefonicid and ceftriaxone both have sufficiently long half-lives and either may be administered intramuscularly once daily. Their antibacterial spectra encompass many of the pathogens encountered in community-acquired infections of the lower respiratory tract, skin and soft tissue, bone, and urinary tract. Ceftriaxone, a third-generation cephalosporin, has a broader spectrum than the second-generation agent cefonicid. Ceftriaxone should generally be reserved for the treatment of gonococcal disease and of community- or hospital-acquired infections due to organisms resistant to the narrower-spectrum and less expensive long half-life agent cefonicid.

Topics: Ambulatory Care; Cefamandole; Cefonicid; Ceftriaxone; Costs and Cost Analysis; Humans; Osteomyelitis; Pneumonia; Pyelonephritis; Skin Diseases, Infectious

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

The antibacterial efficacy of ceftriaxone (CTRX) against group B Streptococcus and its clinical efficacy in newborns were examined, and the results obtained are summarized as follows. 1. MIC's of CTRX against 55 strains of B group Streptococcus from the pregnant vagina were 0.10 micrograms/ml or lower. 2. Efficacies of CTRX were good to excellent in 8 cases administered for treatment, 3 cases for prophylaxis and 1 for observation of adverse reactions. Observed adverse reactions included diarrhea in 4 cases and vomiting in 2 cases. As abnormal laboratory parameters, eosinophilia and thrombocytosis were observed in 1 case each. 3. An examination of intestinal bacteria in 9 cases revealed that CTRX gave as much influence to the flora as other third-generation cephems. 4. An examination for the vitamin K deficiency in 11 cases found a prolongation of prothrombin time (PT) in 3 cases and protein induced by vitamin K absence (PIVKA) II positive in 2 cases. 5. Testing of platelet aggregation with adenosine diphosphate (ADP) in 7 cases showed little influence of CTRX.

Topics: Ceftriaxone; Humans; Infant, Newborn; Intestines; Pneumonia; Sepsis; Streptococcal Infections; Streptococcus agalactiae

Topics: Bacteria; Bacterial Infections; Ceftriaxone; Humans; Microbial Sensitivity Tests; Peritonitis; Pneumonia; Urinary Tract Infections

Topics: Adult; Aged; Ceftriaxone; Humans; Middle Aged; Pneumonia

20 patients suffering from severe lower respiratory tract infections were included in the study. 10 patients were given ceftriaxone (1-2 g/day) and the other 10 cefotaxime (2-4 g/day) for a week. The results of microbiological findings and both local and systemic tolerance were found to be similar for both drugs. This indicates that 7-14 g of ceftriaxone and 14-28 g of cefotaxime are equivalent quantities in the treatment of severe respiratory tract infections.

Topics: Acute Disease; Adult; Aged; Bronchitis; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Drug Tolerance; Haemophilus influenzae; Humans; Middle Aged; Pneumonia; Respiratory Tract Infections; Staphylococcus aureus; Streptococcus; Streptococcus pneumoniae

Ceftriaxone, a third-generation cephalosporin with a wide spectrum of antimicrobial activity and a long half-life of 8 hours permitting administration every 24 hours, was evaluated in 33 patients with severe lower respiratory tract infections. Twenty-nine patients showed a favourable clinical response and 2 failed to respond to therapy. In 2 patients the clinical response was impossible to assess. In 19 of the 23 patients in whom it was possible to assess bacteriological response, there was a favourable outcome. Serum ceftriaxone levels were well maintained above the minimal inhibitory concentrations of sensitive organisms for the entire dosage interval whether the drug was given by intramuscular or intravenous injection. There were no side-effects that could be attributed to ceftriaxone, which was highly effective in the immediate treatment of both community and nosocomial acquired severe lower respiratory tract infections.

Topics: Adult; Aged; Ceftriaxone; Cross Infection; Drug Evaluation; Humans; Middle Aged; Pneumonia; Time Factors

Topics: Adolescent; Adult; Aged; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged; Peritonitis; Pneumonia; Surgical Wound Infection

12 patients with acute bacterial infections were treated with ceftriaxone, 1.5 g intravenously twice daily for 7-13 days. Pharmacokinetic variables were studied in 11 patients. In older subjects, serum half-lives were longer and serum clearances lower than in younger individuals. After the last dose, a larger increase in AUC compared to the first dose was observed in older patients and a biphasic elimination curve appeared in all patients but 2, with a terminal half-life of 15.6 h and 11.4 in old and young subjects, respectively. Estimated biliary clearances showed large individual variation, with a range of 0-16 ml/min X 1.73 m2. Changes in the colonic microflora were pronounced. Almost total disappearance of staphylococci, streptococci and enterobacteria was found, and there was a marked tendency to overgrowth of yeasts and enterococci. One patient with the highest estimated biliary clearance of ceftriaxone developed diarrhoea after 7 days of therapy. A toxin-producing Clostridium difficile was isolated from the stool.

Topics: Acute Disease; Adult; Aged; Bacteria; Bacterial Infections; Bile; Cefotaxime; Ceftriaxone; Colon; Female; Humans; Kinetics; Male; Middle Aged; Pneumonia; Sepsis; Staphylococcus; Streptococcus; Yeasts

Ceftriaxone is an investigational cephalosporin with a half-life of five to eight hours. In an uncontrolled study, we evaluated its efficacy and safety in 30 pediatric and 12 young adult patients with serious bacterial infections. This agent was administered to children at a dosage of 50 to 75 mg/kg/day intravenously in two divided doses. Those with CNS infections received 100 mg/kg/day. In adults, the dosage was 1 g either once or twice daily. The diseases we treated included pneumonia (17), sepsis (eight), ventriculoperitoneal shunt infections (three), osteomyelitis (three), brain abscess (two), peritonitis (two), and miscellaneous (seven). Clinical cures were achieved in all cases, although one child with cystic fibrosis and Pseudomonas pneumonia had persistent colonization in his sputum. No serious side effects were observed. Although not the agent of choice for many of these pathogens, ceftriaxone appears to represent an important alternative to therapy.

Topics: Bacteria; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Osteomyelitis; Pneumonia

Two pilot comparative trials in 29 patients suffering from severe lower respiratory tract infections are described. 15 patients received 7-10.5 g ceftriaxone as a total dose and 14 received 28 g amoxicillin, both antibiotics being given by intravenous route during 1 week. The local and systemic tolerance of the drugs were satisfactory; no adverse reactions or relevant laboratory changes were noticed. The clinical response was favourable in all patients. The mot relevant pathogens found in the sputum were Streptococcus pneumoniae in 11 cases and Haemophilus influenzae in 15 cases. Less relevant microorganisms such as Klebsiella pneumonia, Serratia, Pseudomonas sp. and Streptococcus viridans were cultivated prior to therapy. The two main pathogens disappeared from the sputum after therapy in 11 of 13 patients treated with ceftriaxone and in 10 of 13 treated with amoxicillin. The results of these pilot studies indicate that 7-10.5 g ceftriaxone are as active as 28 g amoxicillin in the treatment of severe lower respiratory tract infections.

Topics: Adult; Aged; Amoxicillin; Bacterial Infections; Bronchitis; Ceftriaxone; Cephalosporins; Chronic Disease; Drug Tolerance; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pilot Projects; Pneumonia