Treatment of Serious Gram-Negative Infections with Aztreonam

MATERIALS AND METHODSPatients. The study population consisted of 30 patients, 16 males and 14 females, with a mean age of 4.2 years (range, 0.03 to 15.4 years). Underlying urological abnormalities (12 cases of hydronephrosis, 9 of grade III to IV vesico-ureteral reflux, 3 of uretero-pelvic junction obstruction, 2 of spastic neurogenic bladder, and 5 cases of other multiple abnormalities of the urinary tract) were present in 21 patients of whom 10 had surgical treatment for their urological abnormalities in the previous 2 weeks. One patient had renal calculosis. According to the normal values for age given by Goldsmith (7), 13 patients had renal failure, mild in 6, moderate in 5, and severe in 2 (creatinine clearance, 50 to 80, 30 to 50, and <30 ml/min per 1.73 m2, respectively). In patients <13 years old, glomerular filtration rate was estimated from plasma creatinine concentration and body length by using two different formulas for patients who were <1 year and >1 year old (24,25). Seven patients had been previously treated for the same infection in another hospital with appropriate doses (one case each) of co-trimoxazole, ampicillin, cefotaxime, piperacillin, gentamicin, amikacin, and netilmicin. These antibiotics were reported to be initially active in vitro against the infecting organisms. We discontinued them after at least 6 days because of microbiological failure (bacteriuria > 105 CFU/ml and the development in 6 of 7 cases of in vitro resistance to the drug as determined by Kirby-Bauer criteria). Before aztreonam treatment, seven other patients received co-trimoxazole and six received ampicillin as prophylactic antibiotics; in these cases, also, the pathogens were 310

Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 81%

See 1 more Smart Citation

Aztreonam in the treatment of severe urinary tract infections in pediatric patients

Rusconi¹,

Assael²,

Boccazzi³

et al. 1986

“…This difference is not statistically significant (P >0.10), but because of the limited number of patients, the power of the study (1-beta) was such that a 25% or greater better response rate among the aztreonam-treated patients would have been needed to disprove the null hypothesis. Microbiologic and clinical cure rates for both groups were similar to those found by other investigators (2,3,10,11,13,15 glycosides have poor penetration and may be inactivated by respiratory secretions, and levels in sputum or even serum may barely exceed MICs for some respiratory pathogens. For this reason the optimum dosing of drugs such as tobramycin may be critical in determining the outcome of patients with nosocomial pneumonia (6).…”

Section: Discussionsupporting

confidence: 87%

Randomized clinical trial of aztreonam and aminoglycoside antibiotics in the treatment of serious infections caused by gram-negative bacilli

DeMaria

Treadwell

Saunders

et al. 1989

“…The clinical efficacy of aztreonam in aerobic gram-negative infections has been shown by many investigators (7,24). The impact of antibiotics on fecal flora is well-known, and the effects of some antibiotics on fecal flora have been reported (5,22,25).…”

mentioning

confidence: 99%

Effects of aztreonam on fecal flora and on vitamin K metabolism

Sakata

Kakehashi

Fujita

et al. 1990

The effects of aztreonam on fecal flora and on descarboxy prothrombin (PIVKA-H) in plasma and -y-carboxyglutamic acid (Gla) in urine as an index of vitamin K metabolism were studied in seven children (age range, 2 months to 2 years) with urinary tract infections. Daily doses of aztreonam were 60 to 80 mg/kg. Stool specimens were obtained before the treatment, on days 3 to 5 of aztreonam use, and from 3 to 5 days after the cessation of treatment. The counts of enterobacteria decreased (P < 0.01) and those of streptococci increased (P < 0.05) during aztreonam treatment. The anaerobic organisms, especially bifidobacteria and bacteroides, showed no marked change. PIVKA-IH and Gla were investigated before and during the treatment with aztreonam. PIVKA-II was not detected in seven patients before or during aztreonam use. There were no significant differences in the levels of Gla in urine before or during the treatment.Aztreonam is a monobactam antibiotic which has high activity against many aerobic gram-negative bacilli, but it has low activity against gram-positive cocci and anaerobic bacteria (4, 9). The clinical efficacy of aztreonam in aerobic gram-negative infections has been shown by many investigators (7,24). The impact of antibiotics on fecal flora is well-known, and the effects of some antibiotics on fecal flora have been reported (5,22,25). Although aztreonam might be expected to have little influence on fecal flora because of the features of activity of this agent against bacteria, there are few reports about the effect of aztreonam on fecal flora (6).The hypoprothrombinemia caused by vitamin K deficiency is also one of the important adverse effects induced by antibiotics, especially the broad-spectrum cephalosporins which have the N-methylthiotetrazole side chain, such as moxalactam, cefoperazone, and cefmetazole (12,18,20,21). In this study, we set out to evaluate the effects of aztreonam on fecal flora. We also measured descarboxy prothrombin (PIVKA-II) in plasma and y-carboxyglutamic acid (Gla) in urine in order to discover the effect of this antibiotic on vitamin K metabolism. MATERIALS AND METHODSSeven children (age range, 2 months to 2 years) hospitalized in the Asahikawa Medical College Hospital for the treatment of urinary tract infections were used as subjects for this study. No antibiotics were administered before the study. They received aztreonam intravenously in a 20-mg/kg dose every 6 or 8 h during 3 to 14 days.Stool specimens were obtained before treatment, from days 3 to 5 of antibiotic use, and from 3 to 5 days after the cessation of drug administration. Plasma and urine were taken from patients before treatment and from days 3 to 5 of antibiotic use. Quantitative aerobic and anaerobic cultures were undertaken by a method described previously (22). Stool specimens were immediately put into a sterile transport medium filled with CO2 gas and stored at 4°C until they were cultured. The specimens were homogenized and serially diluted 10-fold in a buffer solution which was prereduced under an...