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Query: UMLS:C0519030 (Klebsiella)
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Cefuroxime is a new semisynthetic cephalosporin for parenteral administration. It is resistant to destruction by beta-lactamases produced by staphylococci and most Gram-negative aerobic bacteria and is active against many bacteria resistant to cephalothin. Cefuroxime is the most active of the cephalosporins against gonococci and Haemophilus influenzae particularly against beta-lactamase producing strains. Given by intramuscular or intravenous injection cefuroxime is effective against a wide variety of infections caused by Gram-positive or Gram-negative aerobes, but has no effect against infections caused by Pseudomonas aeruginosa or B. fragilis. Cefuroxime is of value in the treatment of respiratory infections due to Haemophilus influenzae and Streptocococcus pneumoniae and is useful against cephalosporin-resistant Klebsiella and Enterobacter infections. Cefuroxime is an alternative to spectinomycin for the treatment of beta-lactamase producing Neisseria gonorrhoeae infections. It is generally well tolerated and appears not to be nephrotoxic when given alone at usual dosages.
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PMID:Cefuroxime: a review of its antibacterial activity, pharmacological properties and therapeutic use. 3 64

Strains with the same number of resistances were arranged in so-called resistance classes. Nine classes of resistance (0 to greater to or equal to 8) were formed by means of ten standard chemotherapeutics; the four new cephalosporins were excluded. For every resistance class frequency of cephalosporinresistance was described as coefficient ranging from 0 to 1 (Fig. 1). In Cephalothin the coefficients were markedly rising only in 6 (7)-fold resistant strains of the species examined. Similar but somewhat reduced rising of coefficients was also observed in Cefaclor and Cefamandole. In Cefaclor this is particularly evident for E. coli, whereas in Cefamandole, it concerns Klebsiella spec. In the other species rising of coefficients of Cefaclor and Cefamandole are less marked. The probability of restance in multiresistant strains are therefore distinguished more clearly from that of Cephalothin. Cefuroxime and Cefoxitin take a special position because the probability of resistance does not rise in multiresistant strains. The coefficients of Cefoxitin do not show any recognizable dependance on multiresistance. For clinical purpose the following conclusions can be derived: Because of their effectiveness in multiresistant strains Cefoxitin and Cefuroxime are suitable for empiric use in intensive care units where many multiresistant Klebsiella-strains are to be expected. Cefamandole on the other hand is characterized by a rising probability of resistance in multiresistant strains. Therefore it should only be given after antibiotic testing. Cefaclor, a new oral cephalosporin, will be introduced specially for outpatients where multiresistant strains are rarely found.
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PMID:[Comparison of four recently introduced cephalosporins with respect to probability of resistance in multiresistant strains of Escherichia coli, Proteus mirabilis and Klebsiella spec. (author's transl)]. 4 85

Strains of a species were divided into two groups according to the number of resistances (less than or equal to 4, greater than or equal to 5) using 10 standard chemotherapeutics regularly examined, the new cephalosporins not being among them. These groups of less than or equal to 4- and greater than or equal to 5-fold resistant strains were compared for each cephalosporin tested (Fig. 1). The most different distributions of zone diameters (of both groups) were seen in Cephalothin, whereas in Cefoxitin and - with little limitations - also in Cefuroxime in the main these distributions did not differ; they covered the same field. The distributions of Cefaclor and Cefamandole took an intermediate position. With respect to the two groups similar observations were made for E. coli, proteus mirabilis and Klebsiella spec. The differences between the two groups were most marked in Klebsiella strains. E. coli exhibited the smallest differences (Fig 1). On the assumption that the distribution of zone diameters reflect that of MIC's it can be concluded that nearly all of the Cefaclor- and Cefamandole-sensitive multiresistant strains have more elevated MIC's than those with only less than or equal to 4 resistances. On the other hand it must not be expected that MIC'S OF Cefoxitin and Cefuroxim are rising in multiresistant strains. It could be demonstrated that the different qualities of the recently introduced cephalosporins revealed in multiresistant strains can be explained by different dependences on mechanisms of Cephalothin-resistance (Fig. 2). This resistance is much more frequent in greater than or equal to 5-fold resistant strains. Recommendations for clinical use derived from these results are discussed.
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PMID:[The distribution of minimal inhibitory concentrations of recently introduced cephalosporins in multiresistant strains of Escherichia coli, Proteus mirabilis and Klebsiella spec. as revealed by zone sizes of a standardized agar diffusion test (author's transl)]. 4 86

The in vitro activity of cefuroxime, a cephalosporin antibiotic, was investigated against 604 isolates and compared with the activity of other beta-lactam compounds. Cefuroxime had activity comparable to that of other cephalosporins, including cefamandole and cefoxitin, against streptococcal and staphylococcal species; most streptococci were inhibited by 0.1 mug or less per ml, and staphylococci were inhibited by 1.6 mug or less per ml. Enterococci were relatively resistant. Cefuroxime inhibited beta-lactamase-producing Neisseria gonorrhoeae and Haemophilus influenzae. Cefuroxime had excellent activity against members of the Enterobacteriaceae; 83% of beta-lactamase-producing Escherichea coli, 100% of Salmonella, 100% of Klebsiella, 90% of Proteus mirabilis, 95% of Citrobacter, 56% of Enterobacter, and 58% of Shigella were inhibited by 12.5 mug/ml. Cefuroxime had activity comparable to that of cefamandole and cefoxitin; it inhibited isolates of E. coli and Klebsiella resistant to cefamandole and inhibited Enterobacter and Citrobacter resistant to cefoxitin. Many isolates of Serratia, some indole-positive strains of Proteus, and Bacteroides fragilis were resistant to cefuroxime. Resistance of cefuroxime to hydrolysis by beta-lactamases played a major role in its activity against both gram-positive and gram-negative organisms.
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PMID:Cefuroxime, a beta-lactamase-resistant cephalosporin with a broad spectrum of gram-positive and -negative activity. 24 68

Cefoxitin, cefuroxime, and cephalothin were added to dense populations of beta-lactamase-producing enterobacteria, and the subsequent turbidity changes were monitored continuously. Viable counts and antibiotic assays were made at intervals after the addition of antibiotic, and the morphological appearances of the organisms were observed. Cephalothin caused lysis of most of the organisms tested, but even at high concentrations, after a few hours the antibiotic was destroyed and the organisms recommenced logarithmic growth. Cefoxitin produced lysis of all the strains of Escherichia coli and Klebsiella species tested, with supression of regrowth. With cephalothin and cefoxitin the viable counts after the addition of antibiotic correlated with the turbidity measurements. Cefuroxime infrequently caused lysis that suppressed multiplication, and the organisms became long and filamentous while the turbidity readings increased; the viable counts did not correlate with the turbidity measurements. Cefuroxime and cefoxitin were not destroyed by the beta-lactamases of any of the strains of enterobacteria that were studied.
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PMID:Lysis if enterobacteria by cefoxitin, cefuroxime, and cephalothin. 31 51

Cefuroxime, a new cephalosporin antibiotic, was inhibitory at low concentrations to several types of gram-negative bacteria. It was considerably more stable than cephaloridine or cephalothin to the beta-lactamases produced by Escherichia coli (RP1), Klebsiella aerogenes K1 and Enterobacter cloacae P99. Concentrations of cefuroxime much greater than the minimum inhibitory concentration (MIC) were usually necessary to induce lysis of beta-lactamase and non-beta-lactamase producers. In contrast, cephaloridine, cephalothin and ampicillin were rapidly bacteriolytic at, or near, the respective MIC against non-beta-lactamase producers, whereas the activity of these three antibiotics was considerably reduced against beta-lactamase-producing strains.
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PMID:Lytic activity of a new cephalosporin, cefuroxime, against gram-negative bacteria. 35 69

The antibacterial activity of cefotaxim and seven cephalosporins was determined in 1,112 fresh isolates using the microdilution technique. All of the cephalosporins tested were ineffective against enterococci. Cefalotin was the most effective agent against Staphylococcus aureus. Cefaclor was superior to cephalexin against Escherichia coli and Proteus mirabilis, and thus inhibited 20% more Enterobacteriaceae. Cefazolin was as effective as cefamandole against E. coli. Cefuroxime and cefoxitin were almost equally effective against E. coli, Klebsiella and P. mirabilis; more than 95% of the strains were sensitive. Cefuroxime and also cefamandole were much more effective than cefoxitin against Citrobacter and Enterobacter. Cefoxitin on the other hand was superior against Serratia and indol-positive Proteus species. Cefotaxim was by far the most active cephalosporin against Enterobacteriaceae, only 2% of the strains being resistant. More than 90% of the strains of E. coli, Klebsiella, P. mirabilis and Serratia were sensitive to 1 mg/l, the lowest degree of activity being displayed against Enterobacter; 82% of the strains were inhibited by 16 mg/l. Cefotaxim was the only cephalosporin which showed appreciable activity against Pseudomonas.
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PMID:[Antibacterial activity of cefotaxim in comparison with seven cephalosporins]. 38 4

810 strains of eight species: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis, Escherichia coli, Klebsiella sp, Enterobacter sp, Proteus mirabilis and Proteus vulgaris, were tested by the disc diffusion method against cephalothin and cefuroxime. The activity of the two drugs was comparable to S aureus and S epidermidis, and a little in favour of cefuroxime regarding S faecalis. Cefuroxime turned out to be superior to cephalothin against the gram negative rods investigated. This pattern was most pronounced when Enterobacter was investigated.
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PMID:A comparison of the in vitro activity of a new cephalosporin, cefuroxime, and cephalothin against 810 clinical isolates. 39 60

Having resistance to beta-lactamase-producing strains and showing resistance to not only cephalosporin resistant strains of E. coli and Klebsiella but also to Citrobacter, Proteus and Enterobacter, Cefuroxime (CXM) was used in pediatric field for both fundamental and clinical studies. CXM was found to be a useful antibiotic in views of high clinical efficacy rate obtained and no side effect noted. As for the dose, the single dose of 25 mg/kg achieved sufficient blood levels. Also in view of good clinical effect, the dose of 25 mg/kg three or four times daily seems appropriate for treatment of children.
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PMID:[Experience with cefuroxime in pediatric field (author's transl)]. 51 98

Cefuroxime is a new broad-spectrum cephalosporin antibiotic with increased stability to beta-lactamases. This stability, although no absolute in all cases, has the effect of widening the antibacterial spectrum of the compound so that many organisms resistant to the established cephalosporins are susceptible to cefuroxime. It is active against gram-positive organisms, including penicillinase-producing staphylococci, but it is less active against methicillin-resistant strains. In addition to its high activity against non-beta-lactamase-producing gram-negative bacteria, cefuroxime effectively inhibits the growth of many beta-lactamase-producing strains, including Enterobacter, Klebsiella, and indole-positive Proteus spp. It is highly active against Neisseria gonorrhoeae, Neisseria meningitidis, and also Haemophilus influenzae, including ampicillin-resistant strains. Cefuroxime is rapidly bactericidal and induces the formation and subsequent lysis of filamentous forms over a small concentration range.
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PMID:Cefuroxime, a new cephalosporin antibiotic: activity in vitro. 125 7


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