Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A single-blind therapeutic trial, using randomly either cefotaxime or a benzyl-penicillin-gentamicin combination, was carried out in 68 hospitalised paediatric patients with 72 episodes of severe infection, which were, in the main, septicaemia, pneumonia, neonatal meningitis and a few other miscellaneous infections. The cefotaxime group showed a cure rate of 94.4% compared with 72.2% in the other group. One patient with bacterial meningitis treated initially with cefotaxime died a month later; however, penicillin and chloramphenicol had been added due to clinical deterioration. In the penicillin-gentamicin group there were five deaths, all from suspected neonatal septicaemia, and three cases required a change in antibiotic regimen before a cure could be effected. The results indicate that cefotaxime should be considered a drug of choice in many neonates with life-threatening sepsis.
J Antimicrob Chemother 1984 Sep
PMID:A therapeutic trial of cefotaxime versus penicillin-gentamicin for severe infections in children. 609 34

Seventy-five children with bacterial meningitis were included in a multicentre trial for evaluation of cerebrospinal fluid (CSF) pharmacokinetics and clinical efficacy of cefotaxime. Mean age of patients was 4 years. Causative pathogens were Haemophilus influenzae in 28 patients (37%), Neisseria meningitidis in 27 patients (36%), Streptococcus pneumoniae in 10 patients (13%), group B streptococcus in 2 patients (2%) and unknown in 8 patients. All isolated pathogens were susceptible to cefotaxime. Seven ampicillin-resistant H. influenzae (9.4%) were found. Cefotaxime was 50 mg/kg intravenously, 4 times daily. The duration of treatment ranged from 5 to 22 days (mean: 13.8). Blood and CSF concentrations of cefotaxime were performed in 50 patients 3 h after infusion at day one and seven cefotaxime levels were determinated both by microbiological assay procedure and high pressure liquid chromatography. On day 1, CSF levels ranged from 0.39 to 2.0 mg/l by microbiological assay procedure (median 3.6) and from 0.0 to 17.4 mg/l (median 2.2) for cefotaxime and from 0.0 to 11.5 mg/l (median 2.2) for desacetyl-cefotaxime by HPLC. We observed a decrease in CSF levels of cefotaxime on day 7. They ranged from 0.3 to 7.0 mg/l (median 1.1) by microbiological assay and from 0.0 to 3.3 mg/l (median 0.8) for cefotaxime and from 0.0 to 6.0 mg/l (median 1.0) for desacetyl-cefotaxime by HPLC. On day 1 and day 7, CSF levels determined by microbiological assay and HPLC were correlated as follows: day 1:r = 0.59 (P less than 0.001). All children (100%) were cured and efficacy of cefotaxime was excellent in 72 cases (96%).(ABSTRACT TRUNCATED AT 250 WORDS)
J Antimicrob Chemother 1984 Sep
PMID:Pharmacokinetics and clinical evaluation of cefotaxime in children suffering with purulent meningitis. 609 36

Ampicillin-cefotaxime was tested as initial therapy of presumptive bacterial meningitis in 55 children greater than or equal to 2 months of age at our hospital. During the first year of this ongoing trial, 11 patients, 10 whose CSF yielded ampicillin-resistant Haemophilus influenzae type b (MIC greater than 16 mg/l, beta-lactamase +) and one, indole-negative proteus (MIC 4 mg/l), were begun on ampicillin-cefotaxime and then continued on cefotaxime alone. All did well clinically except one who convulsed briefly but recovered without sequelae. The cefotaxime MICs/MBCs of the beta-lactamase-positive H. influenzae isolates (less than or equal to 0.007 to 0.03/less than or equal to 0.007 to 0.12) and the proteus isolate (0.03/0.12) were significantly lower than chloramphenicol MICs/MBCs (0.25 to 1.0/0.5 to 1.0 and 8/greater than 16). We followed 44 other children with meningitis due to ampicillin-sensitive organisms who were treated with ampicillin or penicillin after 1 or 2 days of ampicillin-cefotaxime. Aetiological agents included ampicillin-sensitive H. influenzae (25), pneumococci (9), meningococci (8), Strept. MG (1) and Listeria monocytogenes (1). 40/44 recovered uneventfully. There were 4 neurological complications: the streptococcal meningitis sustained a brain abscess and the three others were motor incoordination (sensitive haemophilus), hearing loss and subdural effusion (2 pneumococci). There were no deaths. 18/48 children managed initially with ampicillin-chloramphenicol during the same 12-month period one year earlier had significant neurological complications and/or sequelae and there was one death; aetiological agents included sensitive H. influenzae (30), pneumococci (9), ampicillin-resistant haemophilus (5), meningococci (3) and pneumococci plus strept. MG (1). The two groups were comparable except for the number of resistant haemophilus and meningococcal strains and underlying disease more frequent in the ampicillin-cefotaxime group. A significant reduction of neurological morbidity (5/55 or 9.1% vs. 18/48 or 37.5%:P less than 0.001) was therefore associated with the ampicillin-cefotaxime schedule in the initial treatment of proven bacterial meningitis. A prolonged hospitalization (greater than 15 days) was less frequent (P less than 0.01) in the ampicillin-cefotaxime group (3/55 or 5.5% vs. 13/48 or 27.1%). The results of the trial to date are considered to be very promising.
J Antimicrob Chemother 1984 Sep
PMID:A comparison of ampicillin-cefotaxime and ampicillin-chloramphenicol in childhood bacterial meningitis: an experience in 55 patients. 609 37

Thirty children with bacterial meningitis were randomized to receive either ampicillin and chloramphenicol in standard doses or cefotaxime (50 mg/kg/dose every 6 h) for 10 to 14 days. Eighteen patients received ampicillin and chloramphenicol and 12 patients received cefotaxime. Cerebrospinal fluid isolated included: Haemophilus influenzae (20), Streptococcus pneumoniae (4), Neisseria meningitidis (3), Group B streptococcus (2), and Salmonella enteritidis (1). Five of the H. influenzae isolates were ampicillin resistant but no isolates were resistant to cefotaxime. The minimum inhibitory concentrations of cefotaxime for 30 isolates ranged from 0.0004 to 0.06 mg/l, while the minimum bactericidal concentrations ranged from 0.007 to 0.12 mg/l. The cerebrospinal fluid bactericidal titres for the cefotaxime-treated group ranged from 1:64 to 1:1024. On the second day of therapy the mean cefotaxime serum concentrations were 56.9 +/- 28.7 mg/l at 1 h and 3.66 +/- 5.65 mg/l at 6 h after administration of the drug whilst mean desacetyl-cefotaxime serum concentrations were 12.31 +/- 7.56 mg/l at one hour and 7.96 +/- 8.26 mg/l at 6 h respectively. Cerebrospinal fluid concentrations of cefotaxime and desacetylcefotaxime measured one hour after drug administration were 3.72 +/- 5.57 mg/l and 4.35 +/- 7.12 mg/l, respectively. No adverse drug reactions were noted in either treatment group. Cefotaxime proved to be both as safe and as efficacious as standard therapy for the treatment of bacterial meningitis in children.
J Antimicrob Chemother 1984 Sep
PMID:Cefotaxime therapy of bacterial meningitis in children. 609 38

One hundred and sixty cases of acute bacterial meningitis were treated with cefotaxime. Patients were between 9 days and 79 years old: 7 new borns, 37 infants, 43 children, 19 adolescents and 54 adults. Fifty-eight patients (36%) were in coma when admitted. Aetiology was determined in 110 patients (68.8%): Neisseria meningitidis in 42, Streptococcus pneumoniae in 36, Haemophilus influenzae in 16, Salmonella spp. in 7, Staphylococcus aureus in 2, Enterobacter spp. in 2 and Haemophilus parainfluenzae, pseudomonas aeruginosa, Escherichia coli, Citrobacter freundii and Klebsiella pneumoniae in one patient each. All isolates were sensitive to cefotaxime, with MIC's for 26 strains ranging from 0.01 to 0.50 mg/l. One hundred and fifty-six of the 160 patients were treated with cefotaxime alone and the four others with cefotaxime in association with an aminoglycoside in three and rifampicin in one. Cefotaxime was administered by intravenous infusion, in a daily dose 100 to 300 mg/kg. Duration of treatment ranged from 8 days to 6 weeks, with a mean of 15 days. One hundred and forty-nine patients (93.1%) were cured, two after a relapse. Three patients had sequelae. Most (88.5%) had sterile CSF within 72 h after starting treatment. Eleven patients (6.9%) died, eight within the first 48 h. The only side-effects observed were mild transient eosinophilia in some patients and rash and leukopenia in 2 each. The study demonstrates that cefotaxime is effective in the treatment of acute bacterial meningitis.
J Antimicrob Chemother 1984 Sep
PMID:Treatment of 160 cases of acute bacterial meningitis with cefotaxime. 609 40

Attention has recently been focused on bacterial proteases with the capacity to cleave immunoglobulin A (IgA proteases) as possible pathogenic factors in bacterial meningitis, gonorrhoea, and destructive periodontal disease. Here, we describe a method for the rapid purification of a specific IgA1 protease from Bacteroides melaninogenicus. The IgA1 protease was purified 6,172-fold with a yield of 9% by ammonium sulfate precipitation, DEAE-ion exchange chromatography, and separation on a preparative TSK-G 3000SWG high-pressure gel permeation chromatography column. The enzyme was specific for human IgA1 and cleaved a prolyl-seryl peptide bond in the hinge region of the alpha 1 chain between residues 223 and 224. The molecular weight of the enzyme was 62,000, the isoelectric point was 5.0, and the Km was 3.4 X 10(-6). The enzyme was active over a broad pH range and had maximal activity at pH 5.0. B. melaninogenicus IgA1 protease was classified as a thiol protease on the basis of its inhibition by traditional protease inhibitors and the fact that it was active only under reducing conditions.
Infect Immun 1984 Sep
PMID:Purification and characterization of an immunoglobulin A1 protease from Bacteroides melaninogenicus. 614 9

Cefotaxime sodium was evaluated in the treatment of ten patients with bacterial meningitis. Seven of the patients were infected with unusual and difficult to eradicate pathogens. Eight of the ten patients had a favorable clinical response and rapid sterilization of their CSF. Trough CSF levels of cefotaxime (range, 5.6 to 44.3 micrograms/mL) and desacetylcefotaxime (3.7 to 44.0 micrograms/mL) were manyfold greater than the minimal bactericidal concentrations of the causative pathogens with the exception of the one Pseudomonas aeruginosa isolate. Trough CSF bactericidal titers ranged from 1:16 to 1:4,096 or more (median, 1:256) in the nine patients with susceptible pathogens. Trough cefotaxime and desacetylcefotaxime levels and bactericidal titers were maintained or actually increased over the course of therapy. Cefotaxime appears to be a promising new agent for the treatment of bacterial meningitis.
Arch Intern Med 1983 Sep
PMID:Cefotaxime therapy. Evaluation of its effect on bacterial meningitis, CSF drug levels, and bactericidal activity. 631 Nov 28

An inhibition enzyme-linked immunosorbent assay (ELISA) for the detection of herpes simplex virus antigens in cerebrospinal fluid (CSF) has been developed. A Triton X-100 extract of herpes simplex virus type 1 (HSV-1) infected HEp-2 cells was used to coat wells of polyvinyl chloride plates. Rabbit anti-HSV-1 globulin served as the reference antibody and the CSF specimens were tested at a final dilution of 1:4. Positive results were obtained in CSF specimens from 11/18 (61%) neonates with HSV infection, 15/23 (65%) older individuals with HSV culture positive brain biopsies, and in 4/29 (14%) patients with culture negative brain biopsies. The assay was negative with CSF from 14 infants without HSV infections, from 30 patients with bacterial meningitis and 10 with cryptococcal meningitis. The test was positive in 10/21 patients within 10 days of onset, 11/14 within 11-20 days, and in 5/6 more than 20 days after onset of the herpetic infection. The overall sensitivity of the assay was 63% and the specificity was 95%.
J Virol Methods 1983 Sep
PMID:ELISA for the detection of herpes simplex virus antigens in the cerebrospinal fluid of patients with encephalitis. 631 49

Neonatal bacterial meningitis continues to cause substantial mortality and morbidity despite the advent of new antimicrobial agents and of modern intensive care facilities. In Dallas, the case-fatality rate for bacterial meningitis in newborn and young infants is 17% (40 of 231 patients). Three pathogens, Group B streptococcus, Escherichia coli and Listeria monocytogenes, accounted for 84% of the causative agents. Although new beta-lactam antibiotics have been extensively evaluated in experimental meningitis due to these pathogens, there is limited clinical experience from which to judge efficacy and safety. Currently, conventional therapy with ampicillin and an amino-glycoside should be used as initial empirical therapy for neonatal meningitis. Once the pathogen has been identified and the susceptibilities determined, the most appropriate antibiotic or combination of antibiotics can be selected. Latamoxef (moxalactam) and cefotaxime are highly active agents in vitro against Gram-negative enteric bacilli and may prove useful for therapy of meningitis due to those organisms. Additional experience with these compounds is required before they can be recommended for routine use.
J Antimicrob Chemother 1984 Sep
PMID:Management of neonatal meningitis, 1984. 643 45

Within the framework of a more extensive study of the epidemiology of bacterial meningitis in The Netherlands (1976-1982), 280 cases of neonatal meningitis were investigated retrospectively. Escherichia coli (132 cases, 47%), Streptococcus agalactiae (68 cases, 24%), Listeria monocytogenes (12 cases, 4%) were the organisms most commonly isolated. The mortality rate for these 280 cases was 27%. The male-female ratio was 1.33:1. The minimum incidence for The Netherlands was calculated to be 23 per 100 000 live births.
J Infect 1984 Sep
PMID:A study of 280 cases of neonatal meningitis in The Netherlands. 643 42


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