Cefotaxime in children: efficacy, tolerance and effect on the intestinal bacterial flora

Lambert-Zechovsky, N; Aufrant, C; Bingen, Édouard; Blum, Cori; Proux, M. C.; Mathieu, H

doi:10.1093/jac/6.suppl_a.235

Cited by 12 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another factor that affects the results is the concentration of the drug in the intestine. Among the antibiotics given parenterally, gentamicin, cephalothin, or cefotaxime, which are excreted in the bile at lower concentrations, alter the flora only slightly (1,10). In contrast, cefoperazone or cefpiramide, which are known to be excreted in the bile at high concentrations, usually cause significant changes in the stool flora (7,15).…”

Section: Methicill Inmentioning

confidence: 99%

The effect of antimicrobial agents on fecal flora of children

Sakata¹,

Fujita²,

Yoshioka³

1986

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Influences of antibiotics on the fecal flora in children were studied for oral ampicillin, penicillin V, erythromycin, cefaclor, and gentamicin and for intravenous ainpicillin, methicillin, cefpiramide, and ceftazidime. AU antibiotics affected the normal flora, although the quality and quantity of the changes were variable. No substantial differences were noted between the oral and intravenous use of ampicillin with regard to its effect on the flora. Three penicillins, ampicillin, penicillin V, and niethicillin, caused remarkable changes. The characteristic pattern observed was the considerable suppression of Bifidobacterium, Streptococcus, and Lactobacillus species. Although enterobacteria did not significantly change in number, Klebsiella spp. frequently replaced Escherichia coli. In patients given erythromycin and cefaclor, the reduction in the number of Bifidobacterium spp. was 1 logio and that of members of the family Enterobacteriaceae was 3 log1o.Gentamicin administered orally caused a drastic change, including a remarkable decline, of E. coli to less than 2 loglo/g of feces. Cefpiramide, a parenteral expanded-spectrum cephalosporin, suppressed normal flora so markedly that almost all species of organisms were eradicated, and the active growth of yeasts was promoted (2.6 loglo increase). Ceftlzidime caused similar changes as cefpiramide, but the changes were less extensive.

show abstract

Section: Methicill Inmentioning

confidence: 99%

The effect of antimicrobial agents on fecal flora of children

Sakata¹,

Fujita²,

Yoshioka³

1986

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…It suppresses endogenous intestinal members of the Enterobacteriaceae (8,18). However, strains of Enterobacteriaceae resistant to cefotaxime (CTX-R) have been described with increasing frequency (2,3,6,12,14,18).…”

mentioning

confidence: 99%

Epidemiology of intestinal colonization by members of the family Enterobacteriaceae resistant to cefotaxime in a hematology-oncology unit

M¹,

Andremont²,

Sancho‐Garnier³

et al. 1986

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Intestinal colonization by members of the family Enterobacteriaceae resistant to cefotaxime was surveyed for 3 years in a hematology-oncology unit. Of 416 patients, 66 (15.9%) were colonized, each with a different strain. The incidence of intestinal carriage was not correlated with cefotAxime consumption in the ward but was strongly associated with individual exposure to cefotaxime.Cefotaxime, a broad-spectrum cephalosporin exhibiting high activity against members of the family Enterobacteriaceae (10) and good beta-lactamase stability (13), is often used as first-line empiric therapy in leukemic patients (4,5,9). It suppresses endogenous intestinal members of the Enterobacteriaceae (8, 18). However, strains of Enterobacteriaceae resistant to cefotaxime (CTX-R) have been described with increasing frequency (2,3,6,12,14,18). We previously showed that intestinal colonization is the major harbinger of gram-negative bacteremia in neutropenic patients with hematological malignancies (17). Consequently, intestinal colonization of these patients by CTX-R strains of Enterobacteriaceae might induce bacteremia caused by these resistant bacteria. This is why, in the present work, we analyzed the epidemiology of intestinal colonization by CTX-R strains of Enterobacteriaceae in a hematologyoncology unit using methods that we previously described (1). We also compared the CTX-R strains of Enterobacteriaceae isolated from fecal samples with those isolated from the blood of patients who developed bacteremia.The study started on 1 January 1981, when cefotaxime was first introduced in empirical antibiotic combination therapy in the hematology-oncology unit of our institution, and ended on 31 December 1983. The number of patients discharged was 1,030 (mean hospital stay ± standard deviation, 12.0 + 2.1 days).Fecal samples were usually obtained twice a week from inpatients with fewer than 102 leukocytes per ,ul. In all, 2,009 fecal samples from 416 such patients (34.7 ± 7.6 patients per quarter) were analyzed. Total members of the Enterobacteriaceae (1) and CTX-R strains of Enterobacteriaceae (18) were counted, as previously described. Student's t test was used for comparison of mean log values of bacterial counts. At least three blood specimens were drawn for culture at the onset of all febrile episodes (fever of >38.5°C for 6 h or more). A total of 3,959 blood culture samples were analyzed. Bacteremia was defined as the recovery of a bacterial strain from one or more blood cultures during periods of fever. All the fecal CTX-R strains of Enterobacteriaceae and blood isolates were biotyped by the API 20E system (API, La Balme les Grottes, France), and the MICs of cefotaxime were determined by the method of Steers et al. on Mueller-* Corresponding author.Hinton agar (16). Susceptibility to amikacin, ampicillin, carbenicillin, cefazQlin, chloramphenicol, colistin, gentamicin, kanamycin, minocycline, nalidixic acid, streptomyrin, sulfamethoxazole, tetracycline, tobramycin, and trimethoprim was determined by the disk-diffusion technique...

show abstract

Mechanism of Action, Antimicrobial Activity, Pharmacology, Adverse Effects, and Clinical Efficacy of Cefotaxime

LeFrock¹,

Prince

Left

1982

Pharmacotherapy

View full text Add to dashboard Cite

Cefotaxime sodium, a parenteral cephalosporin antibiotic, exerts its bactericidal action through inhibition of bacterial cell wall synthesis. Chemical structure modifications have enabled this compound to be resistant to the action of Richmond I, III, IV, and V beta-lactamase enzymes. Excellent activity against many gram-negative bacilli, especially Enterobacteriaceae, has been demonstrated. Antipseudomonal activity is generally poor, however. Activity against gram-positive cocci, with the notable exception of Streptococcus fecalis, is adequate. Anaerobic activity is variable, particularly against Clostridia and Bacteroides species. Acute, subacute, and chronic toxicity studies in animals were generally unremarkable. No mutagenic effects or reproductive toxicity have been noted in animals. In man, cefotaxime is desacetylated to a microbiologically active metabolite. Urinary excretion is approximately 50-60% and 15-20% of a dose for the parent compound and desacetyl metabolite, respectively. The elimination half-life of cefotaxime is about one hour, with the total body clearance being approximately twice that of the renal clearance. Severe renal dysfunction causes a prolongation of the elimination half-life of cefotaxime and particularly desacetyl cefotaxime. A relatively low degree of protein binding in part attributes to a wide bodily distribution of cefotaxime. Cefotaxime is effective in a variety of infectious processes caused by susceptible organisms. Local reactions at the injection site and hypersensitivity phenomena are the most common adverse effects. Comparative trials attesting to cefotaxime's clinical utility over other parenteral cephalosporins or amino-glycosides are very limited. Based on the available evidence, cefotaxime should be most useful in combating serious gram-negative infections, because of its excellent activity against most of these organisms and its low toxicity profile.

show abstract

Cefotaxime in children: efficacy, tolerance and effect on the intestinal bacterial flora

Cited by 12 publications

References 0 publications

The effect of antimicrobial agents on fecal flora of children

The effect of antimicrobial agents on fecal flora of children

Epidemiology of intestinal colonization by members of the family Enterobacteriaceae resistant to cefotaxime in a hematology-oncology unit

Mechanism of Action, Antimicrobial Activity, Pharmacology, Adverse Effects, and Clinical Efficacy of Cefotaxime

Contact Info

Product

Resources

About