The pharmacokinetics and dosage regimen of cefotaxime following its single subcutaneous administration (10 mg/ kg) were investigated in buffalo calves. Plasma and urine samples were collected over 10 and 24 h post administration, respectively. Cefotaxime in plasma and urine was estimated by microbiological assay technique using E. coli as test organism. The pharmacokinetic profiles fitted one-compartment open model. The peak plasma levels of cefotaxime were 6.48 +/- 0.52 microgram/ml at 30 min and the drug was detected upto 10 h. The absorption half-life and elimination halflife were 0.173 +/- 0.033 h and 1.77 +/- 0.02 h, respectively. The apparent volume of distribution and total body clearance were 1.17 +/- 0.10 l/kg and 0.45 +/- 0.03 l/kg/h, respectively. The urinary excretion of cefotaxime in 24 h, was 5.36 +/- 1.19 percent of total administrated dose. A satisfactory subcutaneous dosage regimen for cefotaxime in buffalo calves would be 13 mg/kg repeated at 12 h intervals.
Animals ; Anti-Bacterial Agents/*administration&dosage/blood/*pharmacokinetics/urine ; Area Under Curve ; *Buffaloes ; Cefotaxime/*administration&dosage/blood/*pharmacokinetics/urine ; Drug Administration Schedule ; Half-Life ; Male ; Tissue Distribution

Haemophilus aphrophilus is an aerobic, gram-negative oropharyngeal bacterium, commonly isolated from cases of HACEK endocarditis. In addition, H. aphrophilus has also been shown to cause invasive bone and joint infections. Although multiple cases of H. aphrophilus endocarditis have been described, no cases of invasive bone and joint infections caused by H. aphrophilus have been reported in Korea. Here we report the case of a 69-year old woman with a diagnosis of vertebral osteomyelitis and spinal epidural abscess with compressive myelopathy caused by H. aphrophilus, in which there was no objective evidence of infective endocarditis. She was successfully treated with intravenous administration of cefotaxime and drainage of the epidural abscess by laminectomy of the T3-7 vertebrae.
Administration, Intravenous ; Aged ; Aggregatibacter aphrophilus* ; Cefotaxime ; Diagnosis ; Drainage ; Endocarditis ; Epidural Abscess* ; Female ; Haemophilus Infections ; Haemophilus* ; Humans ; Joints ; Korea ; Laminectomy ; Osteomyelitis* ; Spinal Cord Compression ; Spine ; Spondylitis

PURPOSE: This study examined the clinical effectiveness of parenteral cefuroxime and cefotaxime as empirical antibiotics for treating hospitalized women with uncomplicated acute pyelonephritis (APN). MATERIALS AND METHODS: This study was based on the clinical and microbiologic data of 255 hospitalized women with APN. Of these 255 women, 144 patients received cefuroxime and 111 received cefotaxime. RESULTS: There were no marked differences in the demographic features, clinical characteristics, and treatment duration between the populations of the cefuroxime and cefotaxime groups. The rates of defervescence showed no significant differences in the two groups at 48, 72, 96, and 120 hours. The clinical cure rates observed at the follow-up visit 4 to 14 days after the completion of antimicrobial therapy were not statistically different between the cefuroxime and cefotaxime groups [94.9% (129 of 136) versus 98.0% (100 of 102), respectively; p=0.307], and the microbiological cure rates were also not significantly different [88.3% (91 of 103) versus 95.0% (76 of 80), respectively; p=0.186]. The median hospitalization periods in the cefuroxime and cefotaxime groups were 7 (6-8) and 7 (6-8) days (p=0.157), respectively. Microbiological success rates after 72-96 hours of initial antimicrobial therapy were also not statistically different in the cefuroxime and cefotaxime groups, 89.4% (110 of 123) versus 94.9% (93 of 98; p=0.140). CONCLUSION: Cefuroxime, a second-generation cephalosporin, is an appropriate antibiotic option for the initial treatment of uncomplicated APN and its efficacy does not differ from cefotaxime, a third-generation cephalosporin, in the initial parenteral therapy for community-onset APN.
Administration, Intravenous ; Adult ; Aged ; Anti-Bacterial Agents/administration & dosage/*therapeutic use ; Cefotaxime/administration & dosage/*therapeutic use ; Cefuroxime/administration & dosage/*therapeutic use ; Community-Acquired Infections/*drug therapy ; Escherichia coli/drug effects ; Female ; Humans ; Infusions, Parenteral ; Length of Stay ; Male ; Middle Aged ; Pyelonephritis/*drug therapy/microbiology ; Retrospective Studies ; Treatment Outcome

BACKGROUND: Acute pyelonephritis in women can be treated with trimethoprim-sulfamethoxazole (SXT), fluoroquinolone, aminoglycosides, second- and third- generation cephalosporins. The purpose of this study is to provide basic informations for the choice of the most effectve and economic first-line antibiotics among several agents to clinicians, who manage community- acquired acute pyelonephritis. METHODS: We investigated antibiotic sensitivities of 130 organisms isolated from urine culture of 165 patients, who admitted to Catholic University St. Vincent's Hospital due to community-acquired acute pyelonephritis from February 2001 to November 2002. All those patients had more than 105 cfu/mL on urine culture and we analyzed the usage of antibiotics and clinical course in those patients. RESULTS: Among 130 isolates, 120 isolates were E. coli, 6 K. pneumoniae, 1 K. oxytoca, 1 Enterobacter aerogenes and 2 Proteus mirabilis. Among 120 E. coli, the rates of resistance were 59.2% to piperacillin, 58.3% to cephalothin, 36.7% to sulfamethoxazole, 19.2 % to gentamicin, and 7.5% to ciprofloxacin in order. For 120 E. coli isolates, 100%, 99.2%, 99.2%, 99.2%, and 97.5% were susceptible to imipenem, cefotaxime, cefuroxime, amikacin, and piperacillin/tazobactam, respectively. Among 165 patients, 130 patients who had positive urine or blood culture, were divided into three groups according to the first-line antibiotics administered on the day of admission. Gentamicin (5 mg/kg q 24h) were infused to 90 patients, and 9 (10%) of 90 patients revealed clinical manifestations of therapeutic failure such as persistent fever and pyuria in group I. Cefuroxime were administered to 36 patients in group II and all 36 patients revealed evidences of clinical success such as defervescence and absence of pyuria. Intravenous antibiotics changed to oral administration of the first-, second-cephalosporin, and trimethoprim- sulfamethoxazole in all patients except one patient, who received oral fluoroquinolone according to the results of antibiotic sensitivities. CONCLUSION: Cefuroxime, amikacin, and the third- generation cephalosporins showed excellent antibacterial activity against isolated organisms from women with acute pyelonephritis in this study, and gentamicin could be used as initial empiric regimen with careful monitoring of clinical response and antibiotic sensitivities of isolated microorganisms. These findings would be useful informations to physicians, who are trying to use low-priced antibiotics with narrow spectrum antibacterial activity, sparing more expensive and broad spectrum antibiotics in managing urinary tract infections.
Administration, Oral ; Amikacin ; Aminoglycosides ; Anti-Bacterial Agents* ; Cefotaxime ; Cefuroxime ; Cephalosporins ; Cephalothin ; Ciprofloxacin ; Enterobacter aerogenes ; Female ; Fever ; Gentamicins ; Humans ; Imipenem ; Piperacillin ; Pneumonia ; Proteus mirabilis ; Pyelonephritis* ; Pyuria ; Sulfamethoxazole ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Tract Infections

BACKGROUND: Acinetobacter baumannii has emerged as a major cause of nosocomial outbreaks. It is particularly associated with nosocomial pneumonia and bloodstream infections in immunocompromised and debilitated patients with serious underlying pathologies. Over the last two decades, a remarkable rise in the rates of multidrug resistance to most antimicrobial agents that are active against A. baumannii has been noted worldwide. We evaluated the rates of antimicrobial resistance and changes in resistance over a 5-year period (2010–2014) in A. baumannii strains isolated from hospitalized patients in a tertiary Greek hospital. MATERIALS AND METHODS: Identification of A. baumannii was performed by standard biochemical methods and the Vitek 2 automated system, which was also used for susceptibility testing against 18 antibiotics: ampicillin/sulbactam, ticarcillin, ticarcillin/clavulanic acid, piperacillin, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, imipenem, meropenem, gentamicin, amikacin, tobramycin, ciprofloxacin, tetracycline, tigecycline, trimethoprim/sulfamethoxazole, and colistin. Interpretation of susceptibility results was based on the Clinical and Laboratory Standards Institute criteria, except for tigecycline, for which the Food and Drug Administration breakpoints were applied. Multidrug resistance was defined as resistance to ≥3 classes of antimicrobial agents. RESULTS: Overall 914 clinical isolates of A. baumannii were recovered from the intensive care unit (ICU) (n = 493), and medical (n = 252) and surgical (n = 169) wards. Only 4.9% of these isolates were fully susceptible to the antimicrobials tested, while 92.89% of them were multidrug resistant (MDR), i.e., resistant to ≥3 classes of antibiotics. ICU isolates were the most resistant followed by isolates from surgical and medical wards. The most effective antimicrobial agents were, in descending order: colistin, amikacin, trimethoprim/sulfamethoxazole, tigecycline, and tobramycin. Nevertheless, with the exception of colistin, no antibiotic was associated with a susceptibility rate >40% for the entire study period. The most common phenotype showed resistance against ampicillin/sulbactam, cephalosporins, carbapenems, aminoglycosides, ciprofloxacin, and tigecycline. An extremely concerning increase in colistin-resistant isolates (7.9%) was noted in 2014, the most recent study year. CONCLUSION: The vast majority of A. baumannii clinical isolates in our hospital are MDR. The remaining therapeutic options for critically ill patients who suffer from MDR A. baumannii infections are severely limited, with A. baumannii beginning to develop resistance even against colistin. Scrupulous application of infection control practices should be implemented in every hospital unit. Lastly, given the lack of available therapeutic options for MDR A. baumannii infections, well-controlled clinical trials of combinations of existing antibiotics are clearly needed.
Acinetobacter baumannii* ; Acinetobacter* ; Amikacin ; Aminoglycosides ; Anti-Bacterial Agents ; Anti-Infective Agents ; Carbapenems ; Cefotaxime ; Ceftazidime ; Cephalosporins ; Ciprofloxacin ; Colistin ; Critical Illness ; Disease Outbreaks ; Drug Resistance, Multiple ; Gentamicins ; Hospital Units ; Humans ; Imipenem ; Infection Control ; Intensive Care Units ; Pathology ; Phenotype ; Piperacillin ; Pneumonia ; Tetracycline ; Ticarcillin ; Tobramycin ; United States Food and Drug Administration