Anaphylaxis caused by beta-lactam antibiotics usually develops following the systemic administration of the drug, although it can also occur with trivial contact of the drug on the skin in extraordinarily sensitive individuals. Cefotiam is a second-generation cephalosporin developed in Japan, and cefotiam-induced contact urticaria and systemic symptoms (contact urticaria syndrome) have been reported in several nurses from Japan and Korea. Considering the serious nature of the systemic manifestations, such as hypotension, contact anaphylaxis is a more appropriate name for severe forms of the disease than contact urticaria syndrome. No previous study has reported a case involving contact urticaria syndrome to multiple drugs. We describe a case of cefotiam-induced contact anaphylactic shock combined with cefoperazone/sulbactam-induced contact urticaria syndrome in a 24-year-old nurse. She exhibited positive skin prick test responses to both cefotiam and cefoperazone/sulbactam.
Anaphylaxis ; Anti-Bacterial Agents ; Cefoperazone ; Cefotiam ; Humans ; Hypotension ; Japan ; Korea ; Skin ; Sulbactam ; Urticaria ; Young Adult

We recently noticed four cases of Vibrio(V.) vulnificus infection from July, 1985 to September, 1985. The V. vulnificus was isolated by culture from the necrotizirig skin bullae in three cases, blood culture in two cases, and cerebrospinal fluid(CSF) in one case. The clinical characteristics of V. vulnificus infection in our cases was as follows: 1)All patients were men with their age over forties and the outbreak of the disease was during the summer season. 2) It was suspected that all patients had the previous hepatic problems. 3) The skin lesions showing bullae in three patients and subcutaneous nodules in one patient were noticed. 4) Two patients were showed positive in blood culture and one of thern also showed positive in lesional skin, urine and CSF. Lesional skin culture showed positive in three patients. 5) The isolated v. ulnificus was sensitive to chloramphenicol, erythromycin, gentamycin, kanamycin and cefobid. 6) Two patients died due to sepsis within 48 hours after liospitalization and one patient died due to hepatic failure.
Cefoperazone ; Chloramphenicol ; Erythromycin ; Gentamicins ; Humans ; Kanamycin ; Liver Failure ; Male ; Seasons ; Sepsis ; Skin ; Vibrio vulnificus* ; Vibrio*

Polymicrobial nature of diabetic foot infection has been well documented in the literature. Initial antibiotic therapy of diabetic foot infection is usually empiric until reliable culture data is shown. This study was carried out to determine the common bacteriological flora of diabetic foot infection and antimicrobial sensitivity pattern in order to enhance possible empiric treatment. The specimens were obtained from wounds of 207 cases of diabetic foot ulcer, and the bacteriological isolation, and antimicrobial susceptibility tests of the isolates were carried out by standard microbiological methods. Staphylococcus aureus was the most common isolate, with 46.2% of recover rate among total bacterial isolated cases. Among gram-negative organisms, Pseudomonas aeruginosa was most common. Gram-positive organisms showed significant susceptibility to clindamycin, trimethoprim/sulfamethoxazole, and levofloxacin, besides vancomycin. Cefoperazone, piperacillin/tazobactam, and amikacin in addition to imipenem were most effective agents compared to gram-negative organisms. Diabetic foot infection requires use of combined antimicrobial therapy for initial management. Our results indicate that the most effective antibiotic combination for diabetic foot infection of Korean patients is clindamycin plus cefoperazone.
Amikacin ; Bacteriology* ; Cefoperazone ; Clindamycin ; Diabetic Foot* ; Humans ; Imipenem ; Levofloxacin ; Pseudomonas aeruginosa ; Staphylococcus aureus ; Ulcer* ; Vancomycin ; Wounds and Injuries

Because of increasing resistance of circulating N. gonorrhoeae and frequent failures in the treatment of gonorrhoea, intensive work on gonorrhoea has become of paramount importance. During January 1980-April 1984, at the Choong-Ku VD Clinic in Seoul, 3,340 male patients with uncomplicated gonococcal urethritis were treated with various treatment regimens. Diagnosis of gonorrhoea and declaration of a treatment failure were made on the basis of positive urethral culture. In 1984, the prevalence of Penicillinase Producing N. gonorrhoeae (PPNG) was about 30%, The pretreatment minimun inhibitory concentration of various antibiotics were quite high. Even for non-PPNG urethritis standard penicillin regimens gave unsatisfactory results. For PPNG urethritis, only spectinomycin, cefoperazone and cefotaxim-probenecid regimens gave satisfactory results. No spectmomycin resistant strain of N. gonorrhoeae has been found since 1982 at the Choong-Ku VD Clinic. As an agent of single drug therapy, spectinomycin seems to be one of the most cost effective drugs in the treatment of uncomplicated gonorrhoea in men.
Anti-Bacterial Agents ; Cefoperazone ; Diagnosis ; Drug Therapy ; Humans ; Male ; Penicillinase ; Penicillins ; Prevalence ; Seoul ; Spectinomycin ; Treatment Failure ; Urethritis

Simultaneous drug-induced immune hemolytic anemia (DIIHA) caused by multiple drugs is rare. We report a case of a patient who developed DIIHA caused by 2 drugs. The patient's serum exhibited agglutination of ceftizoxime- or sulbactam-coated red blood cells (RBCs; via a drug-adsorption mechanism) and of uncoated RBCs in the presence of sulbactam (via an immune-complex mechanism). Although ceftizoxime is known to exhibit a positive reaction by an immune-complex method with or without reactivity with drug-coated RBCs, this patient's antibodies were reactive only against drug-coated RBCs. On the other hand, sulbactam, which is known to cause hemolytic anemia by nonimmunologic protein adsorption, exhibited positive reactions in tests with both drug-coated RBCs and in the presence of sulbactam. This is the first report of DIIHA due to a sulbactam-cefoperazone combination and the fourth report of DIIHA due to ceftizoxime. Owing to the patient's complicated laboratory results, DIIHA was suspected only at a late stage. We propose that for the prompt diagnosis of DIIHA, tests for all possible causative drugs should be conducted by 2 methods.
Anemia, Hemolytic/chemically induced/*diagnosis/immunology ; Anti-Bacterial Agents/*adverse effects ; Cefoperazone/*adverse effects ; Ceftizoxime/*adverse effects ; Erythrocytes/chemistry/metabolism ; Female ; Humans ; Middle Aged ; Sulbactam/*adverse effects

It is well known that renal cell carcinoma shows poor responses upon chemotherapy, and a multidrug-resistance has been suggested as one of the possible mechanisms of these resistances to chemotherapeutics of renal cell carcinoma as well as other malignancies. We tried to measure the expressions of the multidrug resistance gene and p-glycoprotein in human renal cell carcinoma cell lines, and to evaluate whether various multidrug resistance modulators could enhance the cytotoxicity of adriamycin. Four human renal cell carcinoma cell lines, A-498, A-704, Caki-1, Caki -2, were used and verapamil, cyclosporin A, cefoperazone, quinidine were used as the multidrug resistance modulating agents. Polymerase chain reaction was used to detect the expression of MDR1 mRNA, and measurement of p-glycoprotein was done by FACScan using JSB-1 monoclonal antibody. Cytotoxicity of adriamycin was measured by MTT colorimetric assay. Expression of MDR1 mRNA was observed in A-704, and A-498, but was not detected in Caki-1 and Caki-2. Expression of p-glycoprotein was found in A-498 and A-704, but not in Caki-1 and Caki-2. The relative expression rates of MDR1 and p-glycoprotein in A-498, A-704, Caki-1 and Caki-2 comparing to KB-3-1, the negative control cell line were 1.75, 2.44, 0.98, 0.97 and 1.31, 1.12, 1.08, 0.78 respectively. From these observations, A-498 was selected as MDR positive cell line and Caki-2 as MDR negative cell line, and then a study was performed to evaluate the effect of multidrug resistance modulators on the cytotoxicity of adriamycin upon these cell lines. Verapamil, in concentration of 0.1/microM, did not enhance the anticancer effect of adriamycin on A -498 cells, but with the concentration of 1 microM and 10microM, it decreased IC(50) of adriamycin from 0.43 microgram/ml when only adriamycin was used to 0.21 and 0.16, showing the dose modification effect of 2. 05 and 2.68 respectively (p<0.05, by Mann Whitney test). Cyclosporin A, in all the concentration of 0.3, 1, 3 microM, also decreased IC(50) of adriamycin on A-498 cells to 0.17, 0.14, 0.15 microgram/ml respectively, showing the dose modification effect of 2.53 to 3.07 (p<0.05, by Mann Whitney test). But the cytotoxicity of adriamycin was not influenced by cefoperazone and quinidine. In Caki-2 cells, in which MDR1 and p-glycoprotein expression were barely detected, verapamil and cyclosporin A as well as cefoperazone and quinidine did not show any effect upon the cytotoxicity of adriamycin. Considering above results, verapamil and cyclosporin A seem to be an effective multidrug resistance modulating agents to enhance the cytotoxicity of adriamycin in renal cell carcinoma showing MDR1 and p-glycoprotein expression, and further studies including in vivo study are needed before clinical trials to improve chemotherapeutic effect upon renal cell carcinoma.
Carcinoma, Renal Cell* ; Cefoperazone ; Cell Line* ; Cyclosporine ; Doxorubicin* ; Drug Resistance, Multiple* ; Drug Therapy ; Genes, MDR ; Humans* ; P-Glycoprotein ; Polymerase Chain Reaction ; Quinidine ; RNA, Messenger ; Verapamil

This multi-center study was performed prospectively to evaluate the causative organisms and antibiotic sensitivity of isolates in bacterial keratitis from April 1995 to December 1998. Total number of infectious keratitis was 1002 cases. Among them,279 cases were confirmed with bacterial keratitis and 314 strains were identified. Major causative organisms of bacterial keratitis were Pseudomonas aeruginosa 121 strains (38.54%), coagulase negative staphylococcus (CNS) 34 strains (10.83%), Streptococcus pneumoniae 19 strains (6.81%), Staphylococcus aureus 18 strains (5.73%), and Serratia marscence 16 strains (5.10%). P.aeruginosa was highly sensitive to ciprofloxacin, ceftazidime, piperacillin, cefoperazone, imipenem,tobramicin,and gentamycin. Coagulase negative streptococcus showed high sensitivity to vancomycin, teicoplanin, clindamycin, and ciplofloxacin, but low sensitivity to penicillin and gentamycin. In conclusion, the choice of the effective antibiotics in the treatment of bacterial keratitis were essential to decrease resistant bacterial strains.
Anti-Bacterial Agents ; Cefoperazone ; Ceftazidime ; Ciprofloxacin ; Clindamycin ; Coagulase ; Gentamicins ; Humans ; Keratitis ; Penicillins ; Piperacillin ; Prospective Studies ; Pseudomonas aeruginosa ; Serratia ; Staphylococcus ; Staphylococcus aureus ; Streptococcus ; Streptococcus pneumoniae ; Teicoplanin ; Vancomycin

BACKGROUND AND OBJECTIVES: The chondritis of the auricle is a relatively common and severe complication of ear burns and frequently leads to the destruction of unburned cartilage, thus destroying the shape of the ear. The purpose of this study is to document the clinical nature of the injury, the results of various methods of treatment and to recommend the management protocol for chondritis of the burned ear. MATERIALS AND METHODS: A retrospective study of 69 patients who suffered the chondritis of the burned ear were carried out. These patients had been admitted to the Burn center at the Hangang Sacred Heart Hospital, Hallym University from January, 1993 through December, 1998. RESULTS: 1) The most common causative agent was flame burns (91.3%). 2) A mean interval of onset was 29.36 days. 3) Pseudomonas aeruginosa was noted on 68.5% of the cultures taken. 4) The sensitivity studics showed that Cefoperazone is the most sensitive antibiotics to P. aeruginosa. 5) The methods of treatment were dressing with cerettage (36%), incision and drainage with antibiotics soaking (22%), chondrectomy (35%), and chondrectomy with through and through drain (7%). 6) The final results of treatment were affected by the initial degree of burn. CONCLUSION: The most important preventive measures were strict avoidance of pressure on the injured ear and effective topical chemotherapy to control microbial proliferation. Early detection and early surgical intervention of chondritis were essential to limit progression of infection and necrosis, and to minimize the deformity of the auricle.
Anti-Bacterial Agents ; Bandages ; Burn Units ; Burns* ; Cartilage ; Cefoperazone ; Congenital Abnormalities ; Drainage ; Drug Therapy ; Ear* ; Heart ; Humans ; Necrosis ; Pseudomonas aeruginosa ; Retrospective Studies

OBJECTIVETo observe the changes in plasma levels of lipopolysaccharide (LPS), tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) in burn patients with severe infection treated with Imipenem or Cefoperazone.

METHODSThirteen severe burn patients infected with gram negative bacilli were enrolled in the study in which 7 were treated with IPM and 6 with CPZ. Venous blood samples were harvested before and 2, 12, 24, 48 and 72 hours after the use of antibiotic for the determination of the plasma levels of LPS, TNF-alpha and IL-6, and correlative analysis was carried out among all the factors in regard to their changes.

RESULTSThe plasma levels of LPS in both groups were elevated 2 hours after the injection of either antibiotic, but it was more obvious in patients with CPZ when compared with that before treatment (13.95 +/- 5.44 pg/ml), and the levels were much higher than that after IPM (P < 0.05). The plasma LPS level declined thereafter. The plasma TNF-alpha level in CPZ group was 0.86 +/- 0.16 ng/ml at 2 hours after the use of antibiotic, and it was much higher than that before the use of the drug, and it was higher compared with IPM group. (P < 0.01). But there was no change in the plasma IL-6 level in all the patients at all the time points before and after the use of either drug. The plasma TNF-alpha levels in the two groups were positively correlated with the plasma levels of LPS and IL-6.

CONCLUSIONThe release of LPS and TNF-alpha from bacteria could be induced by the administration of different kinds of antibiotics in the management of burn patients infected by gram negative bacilli in different releasing amounts. And the TNF-alpha production was correlated with the release of LPS and IL-6.

Burns ; blood ; Cefoperazone ; therapeutic use ; Female ; Gram-Negative Bacterial Infections ; blood ; drug therapy ; Humans ; Imipenem ; therapeutic use ; Interleukin-6 ; blood ; Lipopolysaccharides ; blood ; Male ; Tumor Necrosis Factor-alpha ; analysis

Administration, Cutaneous ; Bronchopneumonia ; drug therapy ; Cefoperazone ; therapeutic use ; Child, Preschool ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Infant ; Infusions, Intravenous ; Male