ro13-9904 and Skin-Diseases--Infectious

Ceftriaxone is generally recognized to be safe and effective when administered either intravenously or intramuscularly to both adults and children as a single drug for skin and skin structure infections. An advantage of ceftriaxone over the other third-generation cephalosporins is its long serum half-life, which allows it to be given every 12 hours in children and every 24 hours in most adults. There is no question that ceftriaxone is effective for skin and soft tissue infections, particularly those caused by staphylococci and streptococci. The drug's sales to home infusion companies around the country attest to its widespread use for such infections. The fact remains, however, that the data required to substantiate efficacy and safety for ceftriaxone or for any of the other third-generation cephalosporins are just not available in large numbers.

Topics: Adult; Bacterial Infections; Ceftriaxone; Cellulitis; Child; Humans; Infant; Skin Diseases, Infectious; Skin Ulcer

Ertapenem is a new, structurally unique, parenteral beta-lactam antimicrobial agent that can be administered once daily.. This study compared the local tolerability of ertapenem 1 g once a day administered intramuscularly (IM) versus IM ceftriaxone, with both drugs reconstituted in lidocaine.. In this prospective, double-blind, multicenter study, adult patients with lower respiratory tract infection, skin infection, or urinary tract infection requiring initial parenteral therapy were randomly assigned in a 3:1 ratio to treatment with IM ertapenem 1 g once daily or IM ceftriaxone 1 g once daily. Although study drugs were administered by unmasked personnel, the patients, investigators, and the sponsor medical reviewer were blinded. Patients who improved clinically could be switched to oral amoxicillin-clavulanate after at least 2 days of IM therapy. Tolerability and safety analyses were carried out for the treated population, and efficacy analyses were performed for the modified intent-to-treat population.. A total of 117 patients were randomized. The 87 patients in the ertapenem group and 30 in the ceftriaxone group received IM therapy for a mean duration of 4.1 and 3.8 days, respectively. During treatment, 35.6% (31/87) of patients treated with ertapenem and 43.3% (13/30) of those treated with ceftriaxone experienced > or =1 symptom at the local injection site; the most common symptom was tenderness, followed by pain. Symptoms were moderate to severe in only 1 patient (1.1%) in the ertapenem group and 3 patients (10.0%) in the ceftriaxone group. Clinical drug-related adverse events were reported during IM therapy in 14 patients (16.1%) in the ertapenem group and 5 patients (16.7%) in the ceftriaxone group. Mean +/- SD creatine kinase concentrations, measured in all patients, were 204.8+/-234.8 U/L at the end of IM ertapenem therapy and 382.9+/-721.1 U/L at the end of IM ceftriaxone therapy; at follow-up, values had returned to normal or had decreased in all cases.. Ertapenem 1 g (reconstituted in lidocaine) administered once daily IM was generally well tolerated. The tolerability and safety profiles of IM ertapenem therapy in this study were comparable to those of IM ceftriaxone therapy.

Topics: Aged; Anesthetics, Local; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Cephalosporins; Double-Blind Method; Ertapenem; Female; Humans; Injections, Intramuscular; Lactams; Lidocaine; Male; Middle Aged; Prospective Studies; Respiratory Tract Infections; Skin Diseases, Infectious

We prospectively compared once-daily administration of ceftriaxone with cefazolin given every 8 h for the treatment of skin and soft tissue infections. Thirty-one patients received cefazolin for a mean of 4.5 days, and 26 patients received ceftriaxone for a mean of 4.0 days. All patients had a satisfactory response. Adverse reactions were few and reversible. Ceftriaxone given as a single daily intramuscular injection is effective therapy for skin and soft tissue infections.

Topics: Adult; Aged; Cefazolin; Cefotaxime; Ceftriaxone; Humans; Middle Aged; Skin Diseases, Infectious

A randomized trial to compare the efficacy and safety of 1 g of ceftriaxone daily and 3 to 4 g of cefazolin daily was conducted in 84 hospitalized adults with skin and soft tissue infections. A variety of infections including bacteriologically proven cellulitis, suppurative diabetic foot ulcer, soft tissue abscess, and other miscellaneous infections were treated. Side effects were minimal. Colonization with various microorganisms was observed during therapy with both agents. Clinical cure with or without surgery was achieved in 81 percent (34) of 42 patients treated with ceftriaxone and 77 percent (32) of 42 patients treated with cefazolin. The major difference between antibiotics was the rate of failure in infections caused by multiple organisms: five failures among 13 patients treated with cefazolin compared with no failures among 12 patients treated with ceftriaxone. Ceftriaxone appears to be an effective agent when given once daily as therapy for many serious skin and soft tissue infections.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefazolin; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Skin Diseases, Infectious

Ceftriaxone, a broad-spectrum cephalosporin with a markedly extended half-life, was administered to 100 patients with 56 bone and 44 soft tissue infections. Sixty-eight received 1 g twice daily, and 32 received 2 g once daily intravenously. Overall, 91% had a satisfactory clinical response, with similar efficacies in both treatment regimens. In six patients, failure to achieve a cure correlated well with the development of resistance to ceftriaxone during therapy in Enterobacter and Pseudomonas species (two cases) and with superinfection with Bacteroides fragilis (four cases). In 41 patients, intravenous drug therapy was continued after discharge from the hospital. In this group, 1,093 patient-days of hospitalization were saved, amounting to $150,020 in cost savings. The prolonged half-life facilitated the administration of ceftriaxone in this setting.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bone Diseases; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Costs and Cost Analysis; Cross Infection; Female; Humans; Male; Middle Aged; Skin Diseases, Infectious

Treatment of community acquired skin and soft tissue infections (SSTIs) is a common indication for \ outpatient parenteral antibiotic therapy (OPAT) in USA, UK and Australasia, however data from Asia are lacking. OPAT is well established within the Singapore healthcare since 2002, however, systematic use of OPAT for the treatment of SSTIs remains infrequent. In this report, we describe the treatment and outcome of patients with SSTIs referred directly from Emergency Department (ED) to OPAT for continuation of intravenous (IV) antibiotics in Singapore, thus avoiding potential hospital admission.. This is a single center university hospital retrospective study of patients with SSTIs presenting to ED who\ were assessed to require IV antibiotics and accepted to the OPAT clinic for continuation of IV treatment. Exclusion criteria were: haemodynamic instability, uncontrolled or serious underlying co-morbidities, necessity for inpatient surgical drainage, facial cellulitis and cephalosporin allergy. Patients returned daily to the hospital’s OPAT clinic for administration of IV antibiotics and review, then switched to oral antibiotics on improvement.. From 7 February 2012 to 31 July 2015, 120 patients with SSTIs were treated in OPAT. Median age was\ 56 years and 63% were male. Lower limbs were affected in 91%. Diabetes was present in 20%. Sixty-seven (56%) had been treated with oral antibiotics for a median duration of 3 days prior to OPAT treatment. Common\ symptoms were erythema (100%), swelling (96%), pain (88%) and fever (55%). Antibiotics administered were IV cefazolin with oral probenecid (71%) or IV ceftriaxone (29%) for median 3 days then oral cloxacillin (85%) for\ median 7 days. Clinical improvement occurred in 90%. Twelve patients (10%) were hospitalized for worsening\ cellulitis, with 4 patients requiring surgical drainage of abscess. Microbiological cultures from 2 patients with\ drained abscess grew methicillin sensitive Staphylococcus aureus (MSSA) and Klebsiella pneumoniae, both of which were susceptible to cefazolin and ceftriaxone. Hospital bed days saved was 318 days.. OPAT treatment of community acquired SSTIs in a selected patient population has good outcomes in\ Singapore. Treatment with IV cefazolin or IV ceftriaxone was successful in the majority with low hospital\ readmission rate.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Cloxacillin; Community-Acquired Infections; Female; Humans; Infusions, Intravenous; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Outpatient Clinics, Hospital; Outpatients; Retrospective Studies; Singapore; Skin Diseases, Infectious; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Treatment Outcome

Rouget du porc, or swine erysipelas, usually occurs in man as Rosenbach's erysipeloid. Septicemic forms are more uncommon and can be associated with dermal involvement far from the site of inoculation. We report a case in a patient given corticosteroid therapy for systematic lupus.. A 50-year-old farmer was seen with fever, infiltrative erythema of the long finger and dorsal lesions on the ring finger which developed after a skin lesions caused by a duck. The diagnosis of septicemic rouget du porc was made after isolating the germ from blood cultures. There was no associated endocarditis. Fever and skin lesions totally regressed after treatment with ceftriaxone.. The diagnosis of erysipeloid was supported by epidemiologic arguments and characteristic clinical features. The corticosteroid therapy was probably a favoring factor for development of septicemia. Positive diagnosis is usually obtained from blood culture but the germ can be isolated from skin biopsies at the site of inoculation. Our patient was free of endocarditis which should always be suspected. Endocarditis is frequent and often fatal. Intravenous high-dose penicillin G is recommanded treatment.

Topics: Animals; Bacteremia; Bites and Stings; Ceftriaxone; Cephalosporins; Ducks; Erysipeloid; Humans; Male; Middle Aged; Skin Diseases, Infectious

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

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: Adult; Arthritis, Infectious; Ceftriaxone; Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillinase; Pregnancy; Pregnancy Complications, Infectious; Skin Diseases, Infectious; Syndrome

Ceftriaxone CTRX was evaluated about its antibacterial activity against clinical isolates at our department and tried clinically in 10 children of 6 months to 10 years and 6 months of age. The antibacterial activity was equal to cefotaxime or higher while the clinical results were almost satisfactory. Three out of 4 strains were eradicated (75%). As to the adverse reaction, eosinophilia was observed only in 1 case.

Topics: Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Respiratory Tract Infections; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

We evaluated the efficacy and safety of ceftriaxone in 50 adults with serious infections, usually giving 1 g every 12 h. Of the 35 patients who could be evaluated for clinical efficacy, 15 had failed on previous therapy, 15 had nosocomial infections, and all but 1 had underlying diseases. One patient had three sites of infection. Favorable responses were seen in 34 of 37 infections, including 11 of 13 respiratory tract infections, all 7 urinary tract infections, all 12 skin and soft tissue infections, 1 of 2 bone and joint infections, a catheter-related septicemia, a liver abscess, and an otitis media and externa. Favorable bacteriological responses were seen for 48 of 58 organisms. This included 6 of 7 Staphylococcus aureus strains, 14 of 16 other aerobic gram-positive cocci, 18 of 20 Enterobacteriaceae, 6 of 9 Pseudomonas aeruginosa, and 1 of 2 anaerobes. Peak plasma ceftriaxone levels on day 1 were 152 micrograms/ml by bioassay and 78 micrograms/ml by high-pressure liquid chromatography. Four of the 31 initial isolates of aerobic gram-negative rods developed resistance to ceftriaxone on disk diffusion testing. Diarrhea occurred in 3 of 50 patients. All three had received a higher than usual dose. Drug administration was stopped twice, once for a thrombocytopenia and once for a thrombocytopenia with leukopenia. Neither problem could be attributed exclusively to ceftriaxone. Other adverse reactions were eosinophilia, abdominal pain, inguinal candidiasis, and nonsuppurative phlebitis. Even among debilitated adults, ceftriaxone was safe and effective in a twice daily regimen.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Respiratory Tract Infections; Skin Diseases, Infectious; Urinary Tract Infections

Ceftriaxone, a broad spectrum cephalosporin with a markedly extended half-life, was administered to 68 patients with 71 infections in an open trial. Sixty-three infections (89%) had a satisfactory clinical response with eradication of bacteria present at the initiation of therapy in 62 infections (87%). The eight treatment failures correlated well with the development of resistance to ceftriaxone during therapy in Enterobacter and Pseudomonas species (two cases) and with superinfection with Bacteroides fragilis (three cases). Treatment was discontinued in eight patients because of unwanted effects. Serious side effects included leukopenia, rash, fever, and enterocolitis.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Creatinine; Female; Humans; Male; Middle Aged; Osteitis; Respiratory Tract Infections; Skin Diseases, Infectious

Eighteen patients with 21 serious infections were treated with ceftriaxone, 1 g intravenously every 12 h, for a mean duration of 8 days. Eighteen gram-negative and two gram-positive organisms were isolated. Sites of infection included blood (three patients), urinary tract (six patients), respiratory tract (seven patients), biliary tract (three patients), ascitic fluid (one patient), and skin (one patient). Serum, bile, and ascitic fluid concentrations of ceftriaxone were in excess of the minimal bactericidal concentration required for the infecting organism in all cases. A bacteriological response was demonstrated in 94% of the infections. A clinical response occurred in four infections from which no pathogens were recovered. In one patient, ceftriaxone failed to eradicate a peritoneal infection due to Bacteroides fragilis. In two patients, superinfection with enterococci developed both during and after therapy. Systemic tolerance to ceftriaxone was excellent.

Topics: Aged; Bacterial Infections; Biliary Tract Diseases; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Humans; Male; Middle Aged; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections