Introductory remarks

Article Abstract:

The use of the term 'third-generation' implies a marked distinct in antibacterial activity over the older cephalosporins, and this term is appropriate. However, the term also implies a close relationship among the antibacterials of the third-generation, which is not the case. Members of these third-generation drugs include antibiotics such as cefotaxime, which was introduced first, ceftazidime, moxalactam, and ceftriaxone. These compounds are quite different from each other in a variety of ways. They have different spectra of activity, pharmacokinetics, metabolism, and susceptibility to resistance development; they also have different clinical uses. Cefotaxime is effective against streptococci, Staphylococcus aureus, and pneumococci. In synergistic combination with its metabolite desacetylcefotaxime, it also acts against anaerobic bacteria such as Bacteroides fragilis. The combination is also effective against meningeal bacteria, such as Hemophilus and Neisseria strains. Most enterobacteria are susceptible to the third-generation cephalosporins, but a few are resistant to the entire class of drugs. When fighting infections with Enterobacter, Citrobacter, Serratia, Pseudomonas aeruginosa, or Acinebacter, protection against resistant strains is important, and antibiotic combinations should be used. To disseminate new information about this class of antibiotics, and to permit discussion among prominent researchers, a symposium was held at the 16th International Congress of Chemotherapy where the current uses and future advances of cephalosporins were reviewed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Ceftriaxone, Ceftazidime, Moxalactam

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Cefotaxime and prophylaxis: new approaches with a proven agent

Article Abstract:

Nosocomial infection, infection acquired in the hospital, is an important cause of illness with potentially serious complications. In the United States, it is estimated that over three percent of hospital patients become infected during their stay. Urinary tract infections are by far the most common nosocomial infections accounting for about 40 percent, followed by lower respiratory and surgical wound infections at 18 and 17 percent, respectively. Numerous studies have shown that the third-generation cephalosporins may effectively be used to prevent infection in a variety of surgical patients. A review of the published studies suggests that a single one- or two-gram dose of cefotaxime delivered just prior to surgery is an effective prophylaxis (preventative treatment). Although cefotaxime is more expensive on a per-dose basis than some other cephalosporins, the overall cost is less due to the decreased likelihood of a hospital stay complicated by infection. In some institutions, an infection can increase the average length of stay by 10 days, making prophylactic use of antibiotics quite economical. The recognition of the effectiveness of the third-generation cephalosporins has resulted in increased use. Unfortunately, this increased use has caused the emergence of strains of bacteria and fungi resistant to the drugs. Although cephalosporin resistance has been demonstrated in the laboratory, the full clinical implications are not yet clear. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Drug therapy, Preventive medicine, Nosocomial infections, Cross infection, Medicine, Preventive, Cefazolin

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Serious pediatric infections

Article Abstract:

Bacterial meningitis is one of the most serious infections among children. Although meningitis may be caused by a number of different organisms, the three most common causes of meningitis are Hemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis. All three are susceptible to third-generation cephalosporins. Strains of H. influenzae that have become resistant to ampicillin and chloramphenicol are still susceptible to the cephalosporins cefotaxime and ceftriaxone. Likewise, penicillin-resistant strains of S. pneumoniae are also susceptible to cephalosporins. Gram-negative bacteria like Escherichia coli, Klebsiella pneumoniae, and species of Enterobacter, Citrobacter diversus, and Salmonella, may also cause meningitis in children, and are killed by low levels of cephalosporins. Unfortunately, cephalosporins are ineffective against Listeria monocytogenes. Cefotaxime and ceftriaxone are the agents of choice in the empiric treatment of suspected bacterial meningitis in children over the age of three months. Of the third-generation cephalosporins, the greatest amount of experience treating neonates has been accumulated using cefotaxime, and this drug is preferred for treating gram-negative meningitis in newborns. For older children treated as outpatients, the once-a-day dosage that is possible with ceftriaxone makes it a good treatment choice. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pediatric diseases, Meningitis, Infection in children

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