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AmpC, Extended-Spectrum β-Lactamase and Carbapenemase Producers
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Many Aeromonas spp. express AmpC enzymes as well as a class D penicillinase and class B metallo-β-lactamase (MBL). More than 90% of isolates are susceptible to third-generation cephalosporins; however, treatment failure with cefotaxime has rarely been described. Piperacillin/tazobactam is also usually active, although rates of resistance of 10%–50% have been reported.
Infections in Cirrhosis in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
John M. Horne, Laurel C. Preheim
Clinical trials directly comparing antimicrobial regimens for the treatment of SBP are limited, and no single agent or combination of antibiotics has been proven superior. Most SBP is caused by enteric gram-negatives. However, bacterial SBP also may also be due to other pathogens, including gram-positive streptococci or staphylococci. Thus, initial broad-spectrum therapy using a third-generation cephalosporin is recommended. Cefotaxime, which achieves high serum and ascitic fluid concentrations, has proven efficacy. The recommended dose is 2 g intravenously every 8 hours for 5 days. Ceftriaxone, dosed 1 g every 12 hours, is an alternative. Parenteral fluoroquinolones, such as levofloxacin and ciprofloxacin, may be effective alternatives as well. However, due to the increased likelihood of a fluoroquinolone-resistant pathogen, these agents should be avoided as the empiric therapy in patients who have received a fluoroquinolone for SBP prophylaxis.
Cefotaxime
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Baek-Nam Kim, David L. Paterson
Cefotaxime is a potentially appropriate antibiotic for therapy of complicated intraabdominal infections for which the usual causative organisms are the Enterobacteriaceae and anaerobic organisms, particularly B. fragilis. Because cefotaxime lacks antianaerobic activity it should be used in combination with an antibiotic with antianaerobic activity (e.g. metronidazole) in this setting. Guidelines of the Surgical Infection Society and the IDSA include cefotaxime plus metronidazole as an appropriate regimen for mild to moderate community-acquired (complicated) intraabdominal infections in adults (Solomkin et al., 2010). A third-generation cephalosporin plus metronidazole is also mentioned for the treatment of community-acquired intraabdominal infections with mild to moderate severity in the Canadian (Chow et al., 2010) and proposed Asian guidelines (Hsueh and Hawkey, 2007).
Treatment options for neonatal infections in the post-cefotaxime era
Published in Expert Review of Anti-infective Therapy, 2022
Susannah Franco, Daniel Rampersad, Daniel Mesa, Margaret R. Hammerschlag
Ceftazidime lacks Gram-positive coverage and cannot replace cefotaxime for presumptive management of neonatal sepsis or meningitis [9,11]. Data including extremely preterm neonates show comparable safety profiles between ceftazidime and cefepime despite cefepime’s lack of FDA approval in neonates [9]. Cefepime should be considered for use over ceftazidime in neonates within institutions without access to cefotaxime, but additional studies are needed to adequately assess the therapeutic potential of cefepime in preterm and VLBW neonates. Ceftaroline cannot currently be recommended due to poor CSF penetration data and a lack of neonatal data overall. More data are needed to optimize neonatal dosing and guide appropriate use of all cephalosporins for neonatal infections. When cefotaxime ultimately becomes permanently unavailable in the U.S., every neonatal provider will need to be prepared to consider the differences in spectrum, resistance, and CSF penetration of these agents for each neonate with suspected sepsis or meningitis.
Off-label use of pentazocine and the associated adverse events among pediatric surgical patients in a tertiary hospital in Northern Nigeria: a retrospective chart review
Published in Current Medical Research and Opinion, 2019
Kazeem A. Oshikoya, Ibrahim Abayomi Ogunyinka, Brian Godman
Potential confounders for the primary outcome were determined a priori and collected through manual review of the case files. These variables included demographic data (age and gender), clinical data (weight and type of surgery) and drug exposure data (total daily dose, frequency of exposure and duration of drug use). Routinely, cefuroxime and metronidazole were used prophylactically for pediatric surgical patients. These are often commenced in emergency patients before surgery and continued after surgery with an open duration of use, while for elective patients antibiotics are commenced on the day of the surgery or immediately after the surgery for at least five days, although we are aware that others have recommended antibiotics prior to surgery for certain situations or no prophylactic antibiotics at all39. However, cefotaxime or ceftriaxone are occasionally used in place of cefuroxime in emergency patients presenting with severe sepsis or surgical complications. Consequently, concomitant medications (principally prophylactic antibiotics) were excluded from this study since they were not considered confounders because they have been rarely associated with similar AEs to pentazocine40.
Early Buckle Migration and Restrictive Strabismus after Successful Medical Management of Scleral Buckle Infection
Published in Journal of Binocular Vision and Ocular Motility, 2019
V G Madanagopalan, Fredrick Mouttapa, Jivitesh Singh
On the second post-operative day, the patient presented with pain, chemosis, restricted ocular movements, diplopia, and purulent discharge at the sites of conjunctival suturing (Figure 1a). There was no exposure of the SB or sutures. There was no intraocular inflammation and the retina was attached. Microbial analysis of the purulent discharge showed the presence of methicillin resistant Staphyloccus aureus (MRSA). The isolate was susceptible to cephalosporins. Intense systemic therapy with intravenous cefotaxime (1000 mg/day) and topical therapy with fortified cefazolin (every two hours) was instituted for 5 days. Prompt reduction in lid edema, chemosis and discharge was seen at two days. The retina remained attached, as inferior support provided by the SB was not removed. Oral cefixime (400 mg/day) was continued for 7 days. Clinical improvement evidenced by reduction of conjunctival congestion and discharge was well marked at day 7 (Figure 1b) and complete resolution of SB infection was seen by 1 month (Figure 1c).