Cefuroxime Treatment of Bacterial Meningitis in Infants and Children

Sirinavin, Sayomporn; Chiemchanya, Surang; Visudhipan, Pongsakdi; Lolekha, Somsak

doi:10.1128/aac.25.5.672

Cited by 2 publications

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“…Sin embargo, aunque in vitro sean más efectivas, in vivo tardan más en esterilizar el LCR y no mejoran las tasas de fatalidad (102,103). La cefuroxima no se utiliza en el tratamiento de meningitis por H. influenzae tipo b, ya que tarda hasta el doble de tiempo que los otros agentes en esterilizar el LCR (104). Independientemente del manejo, el tratamiento debe prolongarse hasta que el paciente esté afebril y sin signos clinicos o de laboratorio durante 3 a 5 dias.…”

Section: Tratamientounclassified

Ensayo cuantitativo para la determinación de la actividad hidrolítica de la enzima biotinidasa

González¹,

Diaz²,

Frómeta³

et al. 2001

biomedica

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.aoorniorio ac I P~ 7aje k~o n a l a . i e o i i o le irill.. I( e~.sü/(> . a r I Z <~. <~O ; I .:.."a nsi ii.10 ni. t.; en-i-is YIISICJS : Pre? I~. . c~s / C I O~~J (it C. i~~i C t~i f i a r n e o~~ ae inm..no og a a Habana, Cuba.El presente trabajo describe la estandarización de un ensayo diseñado para cuantificar la actividad hidrolitica de la enzima biotinidasa en muestras de suero humano, el cual se basa en el método de Wolf y colaboradores, que emplea el N-biotinil-p-aminobenzoico (BPABA) como sustrato. Con la adición de detergentes a la solución de nitrito de sodio, se eliminan las burbujas de nitrógeno formadas durante la reacción de diazotación y se mejora la precisión del ensayo. Se observó que la congelación-descongelación de las muestras de suero no afecta la actividad hidrolitica de la enzima biotinidasa. La evaluación de la interferencia de fármacos en el ensayo mostró que con el sulfametoxasolltrimetoprim y la procainal benzilpenicilina hay desarrollo de color en ausencia del sustrato BPABA. Los valores promedio de actividad hidrolitica de la biotinidasa, obtenidos en un grupo de 205 niños sanos, fue de 7,04 i-2,2 nmol/min/ml. No se encontraron diferencias estadisticamente significativas al evaluar la actividad de la enzima por sexo, raza y grupos de edad. Este ensayo se puede emplear en la determinación de la actividad hidrolitica de la enzima biotinidasa en muestras de suero humano y, específicamente, en la confirmación de los casos detectados por los programas de tamizaje neonatal para la deficiencia de biotinidasa.Palabras clave: deficiencia de biotinidasa, ensayo colorimétrico, tamizaje neonatal.Quantitative assay to determine the hydrolytic activity of biotinidase A quantitative assay was standardized to determine the hydrolytic activity of biotinidase in human serum samples. The current Wolf et al. assay uses N-biotinyl-p-aminobenzoic acid as substrate. The assay's precision was improved by the addition of detergents to the sodium nitrite solution. This eliminated the formation of nitrogen bubbles during the diazotation reaction. Freezing and thawing of the serum samples did not affect the hydrolytic activity Farmaco's interference test showed positive results with sulfametoxasoi/trimetoprima and procainel benzylpenicilline. The hydrolytic activity of biotinidase averaged 7.04 ' 2.2 nmol/min/ml in a group of 205 healthy children. No statistically significant differences in enzymatic activity was observed between variables of sex, races and age group. The standardize assay can determine the hydrolytic activity of biotinidase human serum samples and can confirm the positive cases detected by neonatal screening programs for biotinidase deficiency.Key words: Biotinidase deficiency, colorimetric assay, neonatal screening.Uno de los errores innatos del metabolismo de la biotinidasa. Descrita en la década de los 50, la biotina lo constituye la deficiencia de la enzima biotinidasa e s la enzima encargada del reciclaje Correspondencia: d e la biocitina obtenida de la degradación de las ~~~~~t~ C. ~~...

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Section: Tratamientounclassified

Ensayo cuantitativo para la determinación de la actividad hidrolítica de la enzima biotinidasa

González¹,

Diaz²,

Frómeta³

et al. 2001

biomedica

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“…Cefuroxime penetrates inflamed meninges efficiently (7,9), but decline in penetration is observed during the course of treatment of meningitis. Sirinavin et al (13) noted a decline from a mean of 6.4 to 3.6 ,ug/ml on days 2 and 14 of treatment, and Pfenninger et al (11) reported a decline in the mean from 7.0 to 1.6 p.g/ml between the beginning and end of therapy in children with meningitis.…”

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“…Degree of underlying brain damage may also influence penetration. Sirinavin et al (13) noted that two patients who were severely brain damaged had CSF cefuroxime concentrations averaging 16.1 ,ug/ml on day 2 and 9.2 pg/ml on day 14 of therapy.…”

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Penetration of cefuroxime into ventricular fluid in cerebrospinal fluid shunt infections

Edwards

Baker

Butler

et al. 1989

Antimicrob Agents Chemother

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The penetration of intravenously administered cefuroxime into ventricular fluid was assessed in five pediatric patients with ventriculoperitoneal shunt infections and in one with a ventriculostomy infection. Patients received a total dose of 200 to 230 mg of cefuroxime per kg of body weight per day administered at 8-h intervals. Levels of cefuroxime in ventricular fluid ranged from 1.6 to 22.5 ,ug/ml and were associated with cerebrospinal fluid bactericidal titers ranging from less than 1:2 to 1:16 against infecting staphylococcal isolates. Five infections were cured with cefuroxime monotherapy. On the basis of MIC data, one patient had vancomycin substituted for cefuroxime and the infection was cured.The extent to which cefuroxime penetrates the bloodcerebrospinal fluid (CSF) barrier has been shown to depend on the degree of meningeal inflammation (7, 9). The penetration after a single 1.5-g intravenous bolus injection of cefuroxime in patients with severely inflamed meninges ranged from 1.5 to 3.7 ,ug/ml, while patients with mildto-moderate inflammation had cefuroxime concentrations ranging from less than 1 to 2 ,ug/ml (7). With repeated injections, mean cefuroxime levels in CSF of 6.0 and 3.2 ,ug/ml have been documented for severely and mildly inflamed meninges, respectively (9). While cefuroxime is considered an alternative antibiotic for the treatment of acute bacterial meningitis due to susceptible organisms (4, 11), there is a paucity of data regarding the penetration of intravenously administered cefuroxime into ventricular CSF in cases of minimal meningeal inflammation. The current study was designed to determine the ventricular penetration of cefuroxime in patients with CSF shunt or ventriculostomy infections and to assess cefuroxime monotherapy as an alternative for the treatment of these infections when caused by susceptible isolates.Shunt infection was defined as the recovery of the same organism on two or more occasions from the CSF or surgically removed shunt apparatus. Ventriculitis was diagnosed when culture obtained directly from the ventricle after shunt removal yielded a pathogen.Isolates were considered susceptible to cefuroxime by the Kirby-Bauer disk-diffusion method (1) if the zone of inhibition around a 30-,ug disk was 18 mm or more. The MIC and MBC of cefuroxime were determined by standard tube broth macrodilution techniques and subculture onto sheep blood agar plates at 24 h (6). Isolates for which the MIC was lower than 16 ,ug/ml were considered susceptible. To test the CSF titer of cefuroxime in relationship to an intravenous dose, a sample of fluid was removed from the ventricle directly or * Corresponding author. t Present address: Pediatric Branch, National Cancer Institute, Bethesda, MD 20892. from the proximal portion of the ventricular drain and analyzed by bioassay, with Bacillus subtilis as the indicator organism (2). The lower limit of sensitivity of the assay was 2.0 p,g/ml. The assay was linear from 2 to 32 ,ug/ml, with an average coefficient of correlation for the curv...

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Cefuroxime Treatment of Bacterial Meningitis in Infants and Children

Cited by 2 publications

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Ensayo cuantitativo para la determinación de la actividad hidrolítica de la enzima biotinidasa

Ensayo cuantitativo para la determinación de la actividad hidrolítica de la enzima biotinidasa

Penetration of cefuroxime into ventricular fluid in cerebrospinal fluid shunt infections

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