Shorter Course Antibiotic Therapy (SCAT): Principles, Current Data, and Caveats
Robert C. Owens, Lautenbach Ebbing in Antimicrobial Resistance, 2007
Because fluoroquinolones are no longer recommended, the options for treating gonococcal infections in the United States are limited (104). For the treatment of uncomplicated urogenital and anorectal gonorrhea, the CDC now recommends a single intramuscular dose of ceftriaxone 125 mg or a single oral dose of cefixime 400 mg. However, 400 mg tablets of cefixime are not available; cefixime is only available in a suspension formulation. Some evidence suggests that a single oral dose of cefpodoxime 400 mg or cefuroxime axetil 1 g might be additional oral alternatives for the treatment of urogenital and anorectal gonorrhea (104).
Cefixime
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 in Kucers’ The Use of Antibiotics, 2017
Cefixime is an orally administered cephalosporin with a broader antimicrobial spectrum than those of earlier oral cephalosporins, such as cephalexin and cefaclor. It is referred to as a third-generation oral cephalosporin, but its spectrum of activity is not quite as wide as those of other oral third-generation cephalosporins (e.g. cefpodoxime) or parenteral third-generation cephalosporins (e.g. cefotaxime) (Anonymous, 1989). Its molecular weight is 453. Its chemical structure is shown in Figure 29.1.
Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence
Published in Paediatrics and International Child Health, 2018
Phoebe C. M. Williams, James A. Berkley
Cefixime is an oral third-generation cephalosporin which inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs), inhibiting cell wall synthesis. It is widely distributed throughout the body and reaches therapeutic concentration levels in most tissues and body fluids, with a time to peak serum concentration of 2–6 h and a half-life of 3–4 h [25]. Cefixime has been demonstrated to be effective (at 8 mg/kg/day in two divided doses) for shigellosis in adults and paediatric patients [26–29], although one study documented inferior efficacy to that of azithromycin [27]. Short (2-day) courses have been found to be as effective as 5-day courses [27,29]. Cefixime may be useful for paediatric patients when cephalosporin is necessary owing to high resistance to fluoroquinolones and β-lactams, and it can be taken orally. Cefixime is affordable and the suspension can be stored at room temperature [28]. Updated clinical trials to investigate this therapy as an alternative treatment option are urgently needed because previous randomised controlled trials investigating its efficacy are over a decade old.
Breakthrough pneumonia, meningitis and bloodstream infection due to Streptococcus pneumoniae during cefixime therapy
Published in Journal of Chemotherapy, 2019
Novella Carannante, Carlo Pallotto, Mariano Bernardo, Enza Mallardo, Giovanni Di Caprio, Giulia Palmiero, Vittorio Attanasio, Carlo Tascini
A 20 year-old female was admitted for community-acquired pneumonia. The patient suffered from shaking chills, fever and cough for 5 days. The patient was treated with cefixime (400 mg per day) according to her general practitioner’s prescription. Despite this antibiotic therapy, fever and cough persisted. A chest CT scan was performed and revealed a bilateral lobar pneumonia so that the patient was admitted to our hospital. At admission SOFA score was 4 with FiO2 90%, platelets count 140,000/ml, Glasgow coma scale (GCS) 15, Bilirubin 0.8 mg/dl, blood pressure 90/60 mmHg, creatinine 1.7 mg/dl, C-reactive protein (CRP) was 36.6 mg/dl, procalcitonin (PCT) was 18.7 ng/ml, leucocytes count was 10700/mm3, blood cultures were positive for S. pneumoniae. Treatment with ceftriaxone 2 g/day and rifampin 600 mg/day was started with resolution of symptoms in 3 days. Also, blood cultures turned negative in 3 days of treatment. S. pneumoniae antibiogram showed intermediate susceptibility to penicillin (MIC 0.38 mg/L), susceptibility but with increased MIC to ceftriaxone (0.25 mg/L) and MIC for cefixime equal to 4 mg/L. S. pneumoniae was characterized as serotype 14.
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).
Related Knowledge Centers
- Antibiotic
- Ceftriaxone
- Otitis Media
- Pneumonia
- Streptococcal Pharyngitis
- Urinary Tract Infection
- Lyme Disease
- Diarrhea
- Pathogenic Bacteria
- Gonorrhea