This was an open-labelled, randomized, parallel-group study of seventy-three (73) radiologically and bacteriologically confirmed adult cases of community-acquired pneumonia, between July 1 and September 31, 2011 at two health care facilities in Ibadan, Nigeria. All of these patients had severity index (CURB 65) scores of either 1 or 2. They were treated with either Cefixime, 400mg twice daily or Ciprofloxacin 500mg twice daily for 14 days. They were evaluated four times during the course of their treatment for clinical responses, radiological and bacteriological clearances and safety of therapy.
Genomic methods might aid efforts to slow the spread of antibiotic-resistant N gonorrhoeae through augmentation of gonococcal outbreak surveillance and identification of populations that could benefit from increased screening for asymptomatic infections.
Twenty-six studies, involving 3033 patients, are included in this review.Fluoroquinolones versus older antibiotics (chloramphenicol, co-trimoxazole, amoxicillin and ampicillin)In one study from Pakistan in 2003-04, high clinical failure rates were seen with both chloramphenicol and co-trimoxazole, although resistance was not confirmed microbiologically. A seven-day course of either ciprofloxacin or ofloxacin were found to be superior. Older studies of these comparisons failed to show a difference (six trials, 361 participants).In small studies conducted almost two decades ago, the fluoroquinolones were demonstrated to have fewer clinical failures than ampicillin and amoxicillin (two trials, 90 participants, RR 0.11, 95% CI 0.02 to 0.57).Fluoroquinolones versus current second-line options (ceftriaxone, cefalexin, and azithromycin)The two studies comparing a seven day course of oral fluoroquinolones with three days of intravenous ceftriaxone were too small to detect important differences between antibiotics should they exist (two trials, 89 participants).In Pakistan in 2003-04, no clinical or microbiological failures were seen with seven days of either ciprofloxacin, ofloxacin or cefixime (one trial, 139 participants). In Nepal in 2005, gatifloxacin reduced clinical failure and relapse compared to cefixime, despite a high prevalence of NaR in the study population (one trial, 158 participants, RR 0.04, 95% CI 0.01 to 0.31).Compared to a seven day course of azithromycin, a seven day course of ofloxacin had a higher rate of clinical failures in populations with both multi-drug resistance (MDR) and nalidixic acid resistance (NaR) enteric fever in Vietnam in 1998-2002 (two trials, 213 participants, RR 2.20, 95% CI 1.23 to 3.94). However, a more recent study from Vietnam in 2004-05, detected no difference between gatifloxacin and azithromycin with both drugs performing well (one trial, 287 participants).
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Shiga toxin-producing Escherichia coli (STEC) and enteropathogenic E. coli (EPEC) cells were isolated from 191 fecal samples from cattle with gastrointestinal infections (diagnostic samples) collected in New South Wales, Australia. By using a multiplex PCR, E. coli cells possessing combinations of stx1, stx2, eae, and ehxA were detected by a combination of direct culture and enrichment in E. coli (EC) (modified) broth followed by plating on vancomycin-cefixime-cefsulodin blood (BVCC) agar for the presence of enterohemolytic colonies and on sorbitol MacConkey agar for the presence of non-sorbitol-fermenting colonies. The high prevalence of the intimin gene eae was a feature of the STEC (35 [29.2%] of 120 isolates) and contrasted with the low prevalence (9 [0.5%] of 1,692 fecal samples possessed STEC with eae) of this gene among STEC recovered during extensive sampling of feces from healthy slaughter-age cattle in Australia (M. Hornitzky, B. A. Vanselow, K. Walker, K. A. Bettelheim, B. Corney, P. Gill, G. Bailey, and S. P. Djordjevic, Appl. Environ. Microbiol. 68:6439-6445, 2002). Forty-seven STEC serotypes were identified, including O5:H-, O8:H19, O26:H-, O26:H11, O113:H21, O157:H7, O157:H- and Ont:H- which are known to cause severe disease in humans and 23 previously unreported STEC serotypes. Serotypes Ont:H- and O113:H21 represented the two most frequently isolated STEC isolates and were cultured from nine (4.7%) and seven (3.7%) animals, respectively. Fifteen eae-positive E. coli serotypes, considered to represent atypical EPEC, were identified, with O111:H- representing the most prevalent. Using both techniques, STEC cells were cultured from 69 (36.1%) samples and EPEC cells were cultured from 30 (15.7%) samples, including 9 (4.7%) samples which yielded both STEC and EPEC. Culture on BVCC agar following enrichment in EC (modified) broth was the most successful method for the isolation of STEC (24.1% of samples), and direct culture on BVCC agar was the most successful method for the isolation of EPEC (14.1% samples). These studies show that diarrheagenic calves and cattle represent important reservoirs of eae-positive E. coli.
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Cefuroxime axetil is a beta-lactamase-stable, second-generation, oral cephalosporin that penetrates sinus tissue in concentrations exceeding the MIC90 values (the minimum concentration of drug needed to inhibit the growth of 90% of an isolate of a particular microorganism) for pathogens most commonly associated with acute sinusitis, including Streptococcus pneumoniae and Haemophilus influenzae. A review of all clinical data published to date demonstrates that cefuroxime axetil has been evaluated in the treatment of acute sinusitis and acute exacerbations of chronic sinusitis ("acute-on-chronic sinusitis") in 18 clinical trials involving 1516 assessable patients. In 12 randomized, comparative trials, the rates of satisfactory clinical outcomes (cure or improvement, 79% to 100%) and bacteriologic eradication (84% to 100%) reported with the use of 250 mg of cefuroxime axetil twice daily were similar to those observed with the use of amoxicillin, amoxicillin/clavulanate potassium, cefaclor, cefadroxil, cefixime, clarithromycin, and doxycycline. In these comparisons, no antibiotic demonstrated any therapeutic advantages over cefuroxime axetil regarding time to symptom abatement. Cefuroxime axetil was at least as well tolerated as the other antibiotics. Overall, the role of cefuroxime axetil in the treatment of sinusitis appears to be as one of the broad-spectrum antibiotics that can be used for infections due to the most commonly implicated sinus pathogens, especially those due to the increasing number of relatively penicillin-resistant strains of S pneumoniae and beta-lactamase-producing strains of H influenzae and Moraxella catarrhalis.
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This study determined the in vitro activities of oral antibiotics among 1501 pathogens from outpatients with CA-UTI and CA-URTI in medical centers during 2012 and 2013 from Argentina, Mexico, Venezuela, Russia, and the Philippines. Minimal inhibitory concentrations (MICs) were determined using broth microdilution and susceptibility defined by Clinical Laboratory Standards Institute (CLSI) and European Committee for Antimicrobial Susceptibility Testing (EUCAST) criteria.
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Microdilution MIC assays were performed using CLSI-approved methods. S. pneumoniae 19A strains were identified by quellung reaction.
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A heterologous gene expression system, Xenopus laevis oocytes, was used to prove the intestinal absorption of various beta-lactam antibiotics mediated by an H(+)-dipeptide cotransport system in rat, rabbit and human small intestines. The microinjection of mRNA (messenger RNA) from rat intestine into Xenopus laevis oocytes led to significantly higher uptakes of p.o. active cephalosporins including zwitter-ionic derivatives (cephalexin, cephradine and cefadroxil) and dianionic derivatives (cefixime and ceftibuten) in comparison with oocytes injected with water, whereas the uptake of cefazolin, a parenterally administered derivative, was negligible in both mRNA- and water-injected oocytes. The uptake of cefadroxil was reduced significantly in the presence of dipeptide and various beta-lactam antibiotics, but not in the presence of an amino acid. After sucrose density gradient centrifugation of mRNA, the highest expression of transport activities of both cefadroxil and ceftibuten was observed in the same mRNA fraction with a size of 2.20 to 3.75 kilobases. mRNA-injected oocytes showed a marked pH-dependency in the uptakes of cefadroxil and ceftibuten, whereas water-injected oocytes exhibited only modes uptakes. The most stimulated uptakes of cefadroxil and ceftibuten were observed at an external pH of 5.5 and 5.0, respectively. Furthermore, injection of mRNA isolated from either rat rabbit or human small intestine into oocytes produced significantly higher uptake of cefadroxil and ceftibuten compared with those by oocytes injected with water. Thus, intestinal absorption of p.o. active beta-lactam antibiotics was confirmed to be mediated by an H+ gradient-dependent transport system across the brush-border membrane of rats, rabbits and humans. The carrier-protein for this process is likely a dipeptide transport system.
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The application of pharmacokinetic (PK) and pharmacodynamic (PD) data in conjunction with minimum inhibitory concentrations (MICs) of antibacterial agents has been shown to allow for improved selection and appropriate dosing of antimicrobial agents for specific infections, increasing the likelihood of bacteriologic cure and, through this, reducing the risk for the development of resistant organisms.
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All 56 isolates of S. typhi were sensitive to amoxycillin+clavulanate, gentamicin, cefixime, cefotaxime and ceftazidime. Multidrug resistance (MDR, resistance to three drugs) was seen in 22 cases (39%) and resistance to five drugs was seen in 12 cases (21%). Only two isolates were resistant to chloramphenicol (3%). MIC 90 for ampicillin, chloramphenicol, ciprofloxacin and cefotaxime were 1.0 microg/ml, 4.0 microg/ml, 64 microg/ml and 0.125 microg/ml respectively. All S. paratyphi A isolates were sensitive to ampicillin and chloramphenicol and resistant to nalidixic acid. MIC distribution data for chloramphenicol revealed elevated MIC but still in susceptible range.
Gonorrhoea is currently the second most common bacterial sexually transmitted infection in England and Wales (Public Health Laboratory Service, 2002). Early initiation of treatment is important in the reduction of the onward transmission of infection and contributes to the overall control of the spread of gonorrhoea. A central tenet of this is the use of effective antimicrobial treatment. Both global and local surveillance programmes have successfully generated robust data, identifying the prevalence of antimicrobial resistance when using fluoroquinolones, formerly a first-line treatment for genital infection with Neisseria gonorrhoeae. As a result of this evidence base, the first-line treatment recommendations in England and Wales were changed. It is now recommended that anogenital gonorrhoea is treated with third generation cephalosporins, with either a 400 mg single oral dose of cefixime, or a single intramuscular dose of ceftriaxone 250 mg. This change in 2004 in first-line treatment exemplifies the application and delivery of evidence-based treatment and care.
Potassium tellurite was assessed for the selection of verocytotoxigenic (VT+) Escherichia coli O157. MICs were higher for VT+ E. coli O157 than for other strains of E. coli and for Aeromonas spp. MacConkey medium containing sorbitol, tellurite and cefixime (TC-SMAC) permitted the growth of VT+ E. coli O157 and Shigella sonnei but partially or completely inhibited the growth of 67% of other strains of E. coli and all or most strains of other sorbitol-non-fermenting species tested. Of 391 rectal swabs from cattle screened on TC-SMAC medium, 26 yielded isolates of VT+ E. coli O157 whereas sorbitol-MacConkey medium with cefixime and rhamnose yielded only nine isolates. Inclusion of potassium tellurite in sorbitol-MacConkey agar markedly increased the rate of isolation of VT+ E. coli O157 from cattle rectal swabs and may do so for other types of specimen.
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MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints.
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The use of pharmacodynamic properties when formulating antibacterial administration guidelines can maximise the potential for efficacy while minimising the risk of toxicity. Aminoglycosides and quinolones demonstrate concentration-dependent bactericidal killing, which is maximised when their concentrations appreciably exceed their minimum inhibitory concentration (MIC) for an organism. beta-Lactams demonstrate time-dependent or concentration-independent bactericidal killing, which is maximised when the time that concentrations exceed the MIC is prolonged, regardless of the absolute levels attained. Methods of prolonging the time beta-lactam concentrations exceed the MIC include the following: interfering with excretion (e.g. probenecid); decreasing the dosage interval; increasing the dose; infusing continuously rather than by bolus; and choosing an agent with a prolonged elimination half-life. The optimal duration for exceeding the MIC varies with the infecting organism, site of infection, inoculum effect, and the immunocompetence of the host. Integration of the microbiological activity and pharmacokinetic properties enables estimation of the time that serum concentrations of various cephalosporins will exceed the MIC of a given organism, consequently allowing estimation of the relative potential for clinical success. Cefixime, a third generation oral cephalosporin with a long plasma elimination half-life, allowing once-daily administration, achieves serum concentrations that exceed the MIC of Haemophilus influenzae, Moraxella catarrhalis, Escherichia coli, and Group A streptococci for greater than 90% of the dosage interval, and the MIC of Streptococcus pneumoniae for 50 to 90% of the dosage interval.
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Data are reviewed for safety from worldwide clinical trials of 4000 patients and postmarketing studies of 38,000 patients treated with cefixime, a broad-spectrum, bactericidal, beta-lactam stable, third-generation cephalosporin. Adverse experiences were similar in adults and children in all groups, with the most frequent side effects being gastrointestinal in nature. The reported frequency of gastrointestinal adverse experiences was higher in patients in US clinical trials when compared with French, German, or Canadian clinical trials or Canadian or US postmarketing studies. The overall incidence of side effects ranged from 2.7% to 48.2%, and the incidence of gastrointestinal events reported in these studies ranged from 1.4% to 38.6%. Patients infrequently discontinued treatment due to adverse events. The design and methods of data collection in US clinical trials may have resulted in higher frequencies of adverse experiences being reported in US trials when compared with the experiences reported in postmarketing studies and in clinical trials conducted outside of the United States. This is because of the more rigorous methodology used to elicit patient reporting of adverse events in US clinical trials compared with the methodology in postmarketing studies and foreign clinical trials.
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The extended release formulation of amoxicillin/clavulanic acid has potential for empiric use against many respiratory tract infections worldwide due to its activity against species resistant to many agents currently in use.
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We examined gonococci isolated in 2004, in East Java and Papua, Indonesia, to review the suitability of ciprofloxacin-based and other treatment regimens. Gonococci from the two provinces were tested in Sydney for susceptibility to penicillin, tetracycline, spectinomycin, ceftriaxone, ciprofloxacin, gentamicin, azithromycin and rifampicin. Of 163 gonococcal isolates from East Java (91) and Papua (72), 120 (74%) of gonococci, 62 (68%) and 58 (80%) from East Java and Papua, respectively, were penicillinase-producing gonococci and 162 displayed high-level tetracycline resistance. Eighty-seven isolates (53%) were ciprofloxacin resistant, 44 (48%) from East Java and 43 (60%) from Papua. All isolates were sensitive to cefixime/ceftriaxone, spectinomycin and azithromycin. Minimum inhibitory concentrations of gentamicin were in the range 0.05-8 mg/L. Sixty-nine gonococci (42%) showed combined resistance, to penicillin, tetracycline and quinolones. Quinolone resistance has now reached unacceptable levels, and their use for the treatment of gonorrhoea in Indonesia should be reconsidered.
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The National Strategy for Combating Antibiotic-Resistant Bacteria identifies prevention, rapid detection, and control of outbreaks of ceftriaxone-resistant N. gonorrhoeae infection as a priority for U.S.
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The cefixime preparation was most commonly rated as best tasting by children.
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The mainstay of medical therapy for acute and subacute sinusitis is the selection of an antimicrobial agent based on an appreciation of the usual bacterial pathogens that include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Amoxicillin is appropriate therapy for patients with uncomplicated sinusitis in geographic areas in which the prevalence of beta-lactamase-producing pathogens is less than 20%. If a patient does not respond to amoxicillin or in areas in which there is a high prevalence of beta-lactamase-producing bacterial species, alternative antimicrobials include amoxicillin-clavulanate, erythromycin-sulfisoxazole, trimethoprim-sulfamethoxazole, cefaclor, cefuroxime axetil, and cefixime. Cefixime, which is less active against S. pneumoniae than most of these antimicrobials, should be reserved for patients who do not improve with amoxicillin. Amoxicillin-potassium clavulanate, cefuroxime axetil, and erythromycin-sulfisoxazole have the most comprehensive antibacterial spectra.
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We evaluated by means of a bioassay the efficacy of 4 different antibiotics administered in a prophylactic dose to children with vesicoureteral reflux.
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Palatability was determined using a single-blind taste test of 4 flavored antimicrobial agents. The 4 antimicrobial agents used were azithromycin, cefprozil, cefixime, and amoxicillin-clavulanic acid.
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Infection is a rare complication after orthognathic surgery. A rate of 1% to 15% has been reported in the literature. We reviewed our experience.
Invastigation of macrolides in the treatment of drug effects in chronic rhinosinusit.
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Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in children. However, due to their widespread use, we are witnesses to increased development of bacterial resistance to antibiotics. The purpose of this study was to evaluate the necessity of antibiotic treatment in patients with AOM. Our study included 314 children, aged between 2 months and 6 years. Children were divided into two groups: the first group included children with less severe forms of AOM, who received symptomatic therapy and "wait-and-see" approach (237 children); the second group presented with purulent ear infection and received antibiotic treatment from the beginning (77 children). After symptomatic therapy, resolution of the disease, without use of any antibiotics, was established in 61% of patients, compared to the overall sample of children with AOM. None of the children developed complications that would require surgical treatment. In the second group of children, receiving antibiotics, almost the same therapeutic effects (80%) were achieved with the use of amoxicillin, amoxicillin-clavulanate and cefixime, while the worst results were obtained after using azithromycin. The wait-and-see approach is recommended in forms of AOM without serious signs and symptoms, because it significantly reduces the use of antibiotics and their potential adverse effects.
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We compared cefixime with chloramphenicol in a trial for treatment of children with culture positive typhoid fever. Twenty children were given cefixime 10 mg/kg/day orally for 14 days and twenty received chloramphenicol 50 mg/kg/day orally for 14 days. On entry the clinical characteristics of the two groups were comparable. Clinical cure was observed in 18 (90%) patients treated with cefixime and 9 (45%) treated with chloramphenicol. Of 11 patients who did not respond to chloramphenicol, 10 were switched over to cefixime and all were cured. Overall 28 out of 30 cases (93.3%) were cured by cefixime.
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This study compared the efficacy and tolerability of once-daily dosing with either roxithromycin or cefixime in previously healthy adult patients aged between 18 and 60 with markers of uncomplicated community-acquired pneumonia (CAP) in three outpatient clinics in an open, randomized study. Sixty patients were enrolled: 17 males and 13 females received roxithromycin 300 mg once daily for 8-10 days and 22 males and eight females received 400 mg cefixime once daily for the same period. All patients were assessed clinically, radiologically and bacteriologically before inclusion, immediately after the study and approximately 1 month later. The most common pathogen isolated from sputum was Streptococcus pneumoniae (in 26 (43%) of 60 patients), with mixed organisms isolated from the sputum of 18 (30%) of 60 patients. Staphylococcus aureus, Haemophilus influenzae or Moraxella catarrhalis occurred in 11/60 patients, and atypical pathogens were detected by serology in 7/26 cases in the roxithromycin group and 3/23 in the cefixime group. The severity of infection was rated as mild to moderate at the beginning of the trial. At the end of the study treatment period, clinical cure rates were 30/30 (100%) for roxithromycin and 28/30 (94%) for cefixime, with one patient on cefixime being classed as a partial responder and one patient being classed as a failure and withdrawn. However, radiological abnormalities persisted in three patients on roxithromycin and one on cefixime. Of the 59 patients who completed the study, none required further antibiotic therapy. No abnormal laboratory parameters or adverse events were reported in either group. Roxithromycin at a daily dose of 300 mg was an effective and well-tolerated treatment for the empirical treatment of mild to moderate CAP in this group of patients.
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To determine the current sensitivity and resistance profile of Salmonellae (S.) isolates in a laboratory setting.