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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Broad spectrum cephalosporins have been studied extensively in animal models of experimental infections. There is generally good correlation between the results of therapy of experimental infections and clinical trials in humans. However, the results of animal model studies are better predictors of the failure than of the success of a chemotherapeutic regimen. Cefotaxime and the new 'fourth' generation agent, cefpirome, were comparable in the treatment of experimental meningitis caused by Streptococcus pneumoniae. Cefpirome was the most effective cephalosporin as therapy for methicillin-susceptible Staphylococcus aureus experimental endocarditis. The most effective broad spectrum cephalosporins for the treatment of Gram-negative experimental pneumonia were cefpirome, cefotaxime and cefodizime. Cefpirome was equivalent to ceftazidime or cefazolin as treatment for Pseudomonas aeruginosa or methicillin-susceptible S. aureus experimental osteomyelitis. Because of its potent activity in vitro and in animal models of experimental infections caused by methicillin-susceptible S. aureus and Gram-negative bacilli, cefpirome may offer a therapeutic advantage over currently available broad spectrum cephalosporins.
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PMID:Animal models as predictors of outcome of therapy with broad spectrum cephalosporins. 160 55

Cefotaxime, a third generation cephalosporin, is used throughout the world over a wide range of doses. The purpose of this paper is to discuss the rationale for determination of the optimal dosage and of adequate modes of administration. Among the factors determining in vivo activity, the most important are: (1) the time dependence of the antibacterial effect of cephalosporins, (2) the limited effect of increasing the drug concentration in contact with the bacteria and (3) the absence of a significant post-antibiotic effect. Combined with the rather short elimination half-life of cefotaxime, these factors argue for the use of a unitary dose of 1g in adult patients and for a 6- or 8-hour interval between doses. Information obtained from various animal models of infection are discussed. Clinical and bacteriological studies published in the international literature report a high rate of cure (between 80 and 100%) according to the type of infection and to the criteria of efficacy, with daily doses ranging from 2 to 4g bid or qid. The results obtained with the lowest doses are detailed, particularly for infections permitting the use of a low dosage. The necessity for increasing the dose is discussed in the following situations: (1) in specific infections requiring high local drug concentrations such as meningitis and endocarditis, (2) against micro-organisms exhibiting moderate susceptibility to cefotaxime (MIC greater than or equal to 1 mg/L) and (3) in immunocompromised patients. It is now well established that third generation cephalosporins have to be combined with other antimicrobial agents (e.g. aminoglycosides) for the treatment of patients with infections caused by bacteria able to become resistant. For susceptible strains, it has not been established that a synergistic effect of cefotaxime with another agent allows a reduction of the dosage of each member of the combination.
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PMID:Cefotaxime optimal dosage in adult patients. A reappraisal. 329 77

We studied the activity of cefotaxime both microbiologically and clinically. 138 blood cultures positive for gram-positive cocci were evaluated (90 strains of Staphylococcus aureus, 25 of Streptococcus faecalis, 13 of Streptococcus alpha and ten of Streptococcus mutans). Cefotaxime showed good activity against all strains with the exception of S. mutans, of which only 30% were sensitive. Ten cases of gram-positive infections were studied clinically: six sepsis cases and one endocarditis case due to S. aureus, two sepsis cases caused by Streptococcus alpha and one Enterococcus endocarditis case. Therapy was successful in nine; the S. aureus endocarditis failed. The local and general tolerance of cefotaxime was good.
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PMID:Clinical experience of cefotaxime in infections caused by gram-positive pathogens. 405 40

Twenty-nine adult patients undergoing open-heart surgery were given 2 g cefotaxime as 5 min intravenous bolus injection preoperatively. Within 6 h cefotaxime serum concentrations declined from 81.0 to 6.3 mg/l. Subcutaneous tissue and muscle concentrations varied between 0.3 and 8.7 micrograms/g, heart valve concentrations varied between 2.2 and 13.0 micrograms/g. Cefotaxime concentrations in heart valves are high enough to inhibit most Gram-negative organisms causing postoperative wound infections and endocarditis.
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PMID:Penetration of cefotaxime into heart valves, subcutaneous and muscle tissue of patients undergoing open-heart surgery. 609 25

Cefotaxime was administered as sole treatment (49 cases) or after failure of another previous antibiotic (17 cases) to 66 patients suffering from infectious diseases. The 78 infections thus treated included urinary tract infections (35), septicaemia or endocarditis (25), respiratory tract infections (7), osteitis (5), meningitis (4), biliary infection (1), and skin infection (1). The pathogens identified were more often enterobacteria: Serratia: 23, E. coli: 15, Klebsiella: 7, Proteus: 7, Enterobacter: 1, Providentia: 1, Pseudomonas: 5, Staphylococcus: 7, Pneumococcus: 4, Streptococcus: 2, Branhamella: 1. Cefotaxime was given either intravenously (2/3 of cases) or intramuscularly, at an average daily dose of 3.75 g (mean: 1.5-8 g). It was administered alone to 49 patients suffering from septicaemia and urinary tract infections caused by E. coli, Klebsiella and especially Serratia, and it was combined in 17 cases, particularly in meningitis and bone infections. The overall results of cefotaxime given in serious diseases were especially favourable in debilitated patients (88% therapeutic success). The local tolerance was good and side effects were not observed in any patient. Cefotaxime seems to be an active antibiotic, indicated in many severe septicemic or not septicemic infections, more particularly in diseases with multiresistant Gram negative pathogens.
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PMID:[The use of cefotaxime against infections (author's transl)]. 625

Seventy-six strains of various species of streptococci isolated from patients with infective endocarditis were tested for their susceptibility to 13 antibiotics by an agar dilution method. The antibiotics tested were: benzyl-penicillin, ampicillin, cefotaxime, vancomycin, erythromycin, rifampicin, pristinamycin, gentamicin, netilmicin, tobramycin, amikacin, dibekacin and streptomycin. Excluding enterococci, 91% of strains were sensitive to benzylpenicillin. Resistance to benzylpenicillin was only found in some strains of S. sanguis I, S. sanguis II and S. mitis. Enterococci were more sensitive to ampicillin. Cefotaxime was highly active against all strains, except enterococci. Vancomycin was active against all strains. Resistance to erythromycin was found in 16% of isolates. Rifampicin and pristinamycin were highly active against all strains, except some enterococci. Gentamicin and netilmicin were the most active of the six aminoglycosides tested. High level resistance to streptomycin was seen in six strains. Overall, S. agalactiae was more resistant to the aminoglycosides than the other species. Among the non-groupable streptococci, strains of S. mitis, S. sanguis I and S. sanguis II were the least sensitive to many antibiotics. Benzylpenicillin remains the antibiotic of choice for the treatment of IE caused by streptococci. If the MIC exceeds 0.1 mg l-1, an aminoglycoside (netilmicin or gentamicin) should be added and the duration of treatment increased from 4 to 6 weeks.
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PMID:Antibiotic susceptibility of streptococcal strains associated with infective endocarditis. 639 32

Severe infectious diseases treatment often needs a frequent antimicrobial agent blood levels control. These controls are still performed by microbiological assay procedure. High performance liquid chromatography (HPLC) is now allowing a new kind of assay procedure and improves on speed, specificity and sensitivity. We developed a procedure allowing us to monitor every day by routine, five beta-lactam antibiotics with only one analytical column: benzylpenicillin, ampicillin, cloxacillin, mezlocillin and cefotaxime. A single extraction procedure suitable to the five beta-lactam antibiotics and to various body fluids and the use of three mobile phases, permit us to give a quick answer to the clinicians and thus to consider a rapid adaptation of the doses being administered. In consideration of the specificity, it is possible to control blood levels of each beta-lactam antibiotic even by associated antimicrobial treatment, what is sometimes impossible using the microbiological assay procedure. Cefotaxime is well separated from its active metabolite desacetyl-cefotaxime. The disparity of the levels obtained, for the same posology, essentially by prematures and new-borns, but also in case of massive infusions for endocarditis justify the use of a rapid and specific procedure like high performance liquid chromatography (HPLC).
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PMID:[Focus and value of the assay of 5 beta-lactams using high-performance liquid chromatography]. 641 37

A clinical case of streptococcal endocarditis in which the isolate proved susceptible to third- but not first-generation cephalosporins prompted us to examine the susceptibility of 44 alpha-haemolytic streptococci from cases of endocarditis to ten cephalosporins and benzylpenicillin. Twenty per cent of strains were resistant to penicillin, and 20% were tolerant. Cefazolin, cefuroxime and cefpirome were the most active first-, second- and third-generation cephalosporins tested. Other first-generation cephalosporins tested compared poorly to cefazolin. Cefotaxime and cefpirome were moderately active against some penicillin-resistant strains. Penicillin tolerance was common in Streptococcus gordonii, but a correlation between tolerance and dextran production could not be confirmed.
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PMID:Susceptibility of alpha-haemolytic streptococci causing endocarditis to benzylpenicillin and ten cephalosporins. 822 18