[Clinical evaluation of cefteram pivoxil in the pediatric field].
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Keywords:
Streptococcus Pyogenes
Cephem
Cefaclor
Bacterial pneumonia
Acute Otitis Media
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The orally administered cephalosporin antibiotic, cefaclor, has been available for clinical use in many countries since 1979. Because widespread antibiotic use is often cited as a factor in the emergence of bacterial resistance to antibiotics, we sought to determine the degrees of resistance to cefaclor expressed by key pathogens recently isolated in 10 countries widely distributed around the world. Using the E-test ®, minimal inhibitory concentrations (MIC) were determined for cefaclor and several comparator antibiotics against approximately 700 fresh clinical isolates of each of six bacterial species. The results demonstrated that > 90% of Haemophilus influenzae (β-lactamase producing and non-producing), Haemophilus parainfluenzae (β-lactamase producing and non-producing), Moraxella catarrhalis (> 90% β-lactamase producing), and methicillin-susceptible Staphylococcus aureus, and 85% of Escherichia coli were susceptible to cefaclor at the NCCLS interpretive breakpoints. MIC distributions showed that there has been no change in the activity of cefaclor against penicillin-susceptible strains of Streptococcus pneumoniae since 1977.
Cefaclor
Haemophilus parainfluenzae
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Streptococcus Pyogenes
Cephem
Cefaclor
Bacterial pneumonia
Acute Otitis Media
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Changes in nasopharyngeal flora were investigated in children with acute otitis media and with acute exacerbations of chronic sinusitis in whom antibiotic therapy of relatively long duration was required until substantial improvement in clinical findings was achieved.1. The antibiotics used were two cephalosporins, i.e., cefaclor (CCL) and cefixime (CFIX), administered to 18 patients each for 1 week and to 26 and 20 patients, respectively, for 2 weeks. Bacteriologic examination of the nasopharyngeal mucosa was performed at the first visit and at 1 week in those who underwent antibiotic therapy for 1 week, and at the first visit and at 1 and 2 weeks in those treated with antibiotics for 2 weeks.2. The elimination rates for the infecting microorganisms in the patients in the CCL-treated group were 30% for Haemophilus influenzae. 83% for Staphylococcus aureus, 100% for Streptcoccus pyogenes and 100% for Streptcoccus pneumoniae at 1 week, and 18% for H. influenzae, 100% for S. aureus and 100% for S. pyogenes at 2 weeks of antibiotic therapy. Replacement of S. aureus and S. pyogenes by H. influenzae was observed.3. The elimination rates for infecting bacteria in the patients in the CFIX-treated groups were 61% for H. influenzae. 50% for S. aureus, 75% for S. pyogenes, 80% for S. pneumoniae and 100% for Moraxella catarrhalis at 1 week, and 72% for H. influenzae, 0% for S. aureus, 100% for S. pyogenes, and 0% for S. pneumoniae at 2 weeks of antibiotic therapy. The elimination rate for H. influenzae at 2 weeks was significantly higher than the corresponding value for the CCL-treated group. Replacement of H. influenzae by S. aureus and S. pneumoniae and of S. pyogenes by S. aureus was detected.4. There was one patient with acute otitis media in the CFIX-treated group in whom a clinical relapse occurred due to H. influenzae persisters in the nasopharynx. Thus the diagnosis in this patient was so-called "recurrent otitis media".5. H. influenzae tended to persist after exposure to therapeutically adequate concentrations of CCL, as did S. aureus and S. pneumoniae following treatment with CFIX. Thus, it would seem that ample heed must be given to persistence, particularly of H. influenzae and S. pneumoniae, the most common causative agents of acute otitis media in childhood.6. A significant rise in the MICs of the cephalosporins was observed in 4 of 43 patients in whom the same type of organism was isolated from the nasopharynx at weekly intervals during antibiotic therapy. Since cephalosporin therapy brought about a substantial improvement in clinical symptoms in all 4 of these patients with a definite reduction in the infecting bacterial population, the development of drug resistance was considered to be due to selection of a small number of resistant strain among the drug susceptible majority of the microbial population against which the cephallosporins were destructive.
Cefixime
Cefaclor
Streptococcus Pyogenes
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The aim of this study was to carry out a nationwide survey to assess the susceptibility of clinical isolates of four respiratory pathogens against nine antibiotics. Eight Spanish centers participated in the study, collecting a total of 977 isolates of Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis. The susceptibility of S. pneumoniae to penicillin was 37.46% susceptible, 30.43% intermediate and 32.11% resistant. MIC(90) of all antibiotics against this microorganism were 48 mg/l, except cefaclor, cefixime and azithromycin. For S. pyogenes, all the strains were susceptible to penicillins and cephalosporins, and azithromycin was the least active with a rate of resistance of 11.43%. A total of 95 isolates of H. influenzae were betalactamase positive (26.32%). With regard to M. catarrhalis, only penicillin and amoxicillin showed MICs(90) >=8 mg/l.
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Cefixime
Streptococcus Pyogenes
Ketolide
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<em>Background and aims.</em> <em>Streptococcus pneumoniae,</em> <em>Haemophilus influenzae</em> and <em>Moraxella</em> <em>catarrhalis</em> are the most common causative agents of acute respiratory tract infections (RTIs). The objective of this study was to assess their susceptibility to several antibiotics.<br /><em>Materials and methods</em>. A total of 58 strains (16 <em>S. pneumoniae</em>, 19 <em>H. influenzae</em> and 23 <em>M. catarrhalis</em>) were isolated from samples collected in two paediatric centres, and their susceptibility to commonly used antibiotics tested by E-test. <br /><em>Results</em>. Among <em>H. influenzae</em> isolates, 10.5% were resistant to ampicillin (all β-lactamase-positive), and 88.9% were susceptible to cefaclor. High β-lactam resistance rates (penicillin: 31.3% and cephalosporins: 18.7 to 31.3%) had been observed among <em>S</em>. <em>pneumonia</em> strains. Only 50% of isolates were susceptible to azithromycine. 91.3% of <em>M</em>. <em>catarrhalis</em> isolates β-lactamases producers were resistant to ampicillin while susceptible to the most tested antibiotics. <br /><em>Conclusions</em>. Except <em>M. catarrhalis</em> β-lactamases producing strains, frequency of antibiotic resistance was mainly observed among <em>S. pneumoniae,</em> and to a lesser extent among <em>H</em>. <em>influenzae</em> clinical isolates, suggesting the need for continuous surveillance of antimicrobial resistance patterns in the management of RTIs.
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Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, and Streptococcus pneumoniae are the most common causative agents of respiratory tract infections (RTIs). The increase in resistance to current antibacterial agents highlights the need to monitor the resistance pattern of these bacterial pathogens.In this study, we assessed the antibacterial susceptibility of these pathogens causing respiratory tract infections in Dakar, Senegal, during 2007-2008. A total of 290 bacterial isolates (75 H. influenzae, 10 M. catarrhalis, 105 S. pneumoniae, and 100 S. pyogenes) were collected.All H. influenzae isolates were susceptible to amoxicillin/clavulanic acid, ofloxacin, clarithromycin, cephalosporins, and macrolides. Overall, 26.7% of H. influenzae isolates were completely resistant to ampicillin. Among the M. catarrhalis isolates, 30% were resistant to ampicillin. All the isolates of H. influenzae and M. catarrhalis that were resistant to ampicillin were beta-lactamase producing strains. Among the S. pneumoniae isolates, 33.3% isolates exhibited intermediate susceptibility to penicillin G, and one isolate was completely resistant. All five isolates that were resistant to erythromycin expressed the M phenotype. S. pyogenes exhibited high susceptibility to all other antibiotics, except tetracycline. Our study suggests that except for M. catarrhalis, all other bacterial isolates are susceptible to cephalosporins, macrolides, and fluroquinolones.
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Amp resistance
Moraxella (Branhamella) catarrhalis
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The time-kill method was used to determine the bactericidal activity of cefditoren compared with oral cephalosporins, amoxicillin, amoxicillin/clavulanate and levofloxacin against a randomly selected group of strains isolated from community-acquired respiratory tract infections (CARTIs). Cefditoren was the only agent showing significant bactericidal activity (≥3 log10 reduction of viable cells) within 4 h against all Streptococcus pneumoniae strains, both penicillin-susceptible (PEN S) or -resistant (PEN R), as well as against Streptococcus pyogenes, and Moraxella catarrhalis. Against? β-lactamase positive strains of Haemophilus influenzae, cefditoren was comparable to the quinolone and more active than other cephalosporins at 24 h. Cefditoren showed the best killing kinetic profiles and this observation may be important when choosing an oral third-generation cephalosporin as initial or sequential therapy.
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During the past decade there has been an increase in the percentage of resistant bacteria isolated from middle-ear effusions aspirated from infants and children who have had acute otitis media. At least nine oral antibiotics or combination agents are available for this indication. Cefixime, a third generation cephalosporin, has excellent in vitro activity against both beta-lactamase-negative and beta-lactamase-positive Haemophilus influenzae and Moraxella catarrhalis, good activity against Streptococcus pneumoniae and Streptococcus pyogenes but relatively poor activity against Staphylococcus aureus. In children cefixime is similar in effectiveness to amoxicillin and cefaclor, but diarrhea and stool changes are more common with cefixime. Amoxicillin is still preferred for initial empiric treatment of uncomplicated acute otitis media. Its major drawback is limited efficacy when beta-lactamase-producing bacteria are the causative organisms. Cefixime is a viable alternative to amoxicillin for infants and children with acute otitis media when: (1) a beta-lactamase-producing H. influenzae or M. catarrhalis is isolated from otorrhea or tympanocentesis; (2) the child has a history of delayed hypersensitivity to the penicillins but no history of hypersensitivity to the cephalosporins; (3) there is a high incidence of resistant bacteria in the community; (4) there is not clinical improvement with amoxicillin; or (5) once daily administration is more convenient.
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Little information is available about the effect of antibiotic treatment on the prevalence and MIC of the subsequently isolated pathogens in cases of acute otitis media (AOM) failing a course of antibiotic therapy. This information is important, particularly regarding the effectiveness of the oral antibiotics used in children failing initial therapy.One hundred eighty-one children with culture-positive AOM were prospectively studied between October, 1995, and July, 1996. Sixty-three (35%) patients received various antibiotics for variable periods during the 14 days preceding enrollment.A total of 94 Streptococcus pneumoniae (Pnc) and 113 Haemophilus influenzae (Hi) were isolated. Thirty-eight Pnc and 35 Hi were isolated in the 63 patients with recently treated AOM. Pnc as a single isolate was more prevalent in patients recently treated with antibiotics (27 of 63, 43%) than among those not recently treated (32 of 118, 27%, P = 0.047). The MIC50 values of penicillin, cefaclor and cefuroxime axetil for Pnc were significantly higher in the pneumococci isolated from patients recently treated than among those isolated from patients not recently treated with antibiotics (0.38, 3 and 0.75 microg/ml vs. 0.094, 0.38 and 0.12 microg/ml, respectively). Seventy-nine percent of Pnc isolates in the recently treated group had MIC for penicillin of >0.1 microg/ml vs. only 47% in those not recently treated (P < 0.05). The respective figures for MIC >0.5 microg/ml of cefaclor were 79% vs. 41% for the recently treated and not recently treated groups (P < 0.001); cefuroxime MIC >0.5 microg/ml was found in 61 and 25%, respectively (P = 0.001).Pneumococcus is more prevalent in AOM after a recent antibiotic treatment, and the MIC of the commonly used beta-lactam drugs for Pnc is considerably higher in this setting. In view of our data, the use of oral cephalosporins like cefaclor or cefuroxime as second line drugs in the treatment of unresponsive AOM, particularly in regions where resistant PNC is prevalent, should be reconsidered.
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Acute Otitis Media
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Clinical isolates of Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes, and Moraxella catarrhalis were gathered from 19 different clinical laboratories throughout the continental United States. The in vitro activities of 12 orally administered antimicrobial agents were compared by broth microdilution tests with 3,151 bacterial isolates. Among 890 H. influenzae isolates, 30% were capable of producing beta-lactamase enzymes (12 to 41% in different medical centers). Most of the 619 beta-lactamase-negative H. influenzae strains were susceptible to ampicillicin (MIC, < or = 1.0 micrograms/ml): 5 strains were intermediate in susceptibility (MIC, 2.0 micrograms/ml) and 1 strain was ampilicillin resistant (MIC, 4.0 micrograms/ml). Ninety-two percent of 698 M. catarrhalis strains were beta-lactamase positive. Of 799 S. pneumoniae isolates, 15% were intermediate in susceptibility to penicillin and 7% were resistant to penicillin. The prevalence of penicillin-susceptible pneumococci in different institutions ranged from 63 to 95%. Only 1% of 764 S. pyogenes isolates were resistant to the macrolides, but 5% of S. pneumoniae isolates were macrolide resistant. Only 71% of 58 penicillin-resistant S. pneumoniae isolates were erythromycin susceptible, whereas 97% of the 622 penicillin-susceptible strains were erythromycin susceptible. Penicillin-resistant pneumococci were also relatively resistant to the cephalosporins and amoxicillin. Penicillin-susceptible pneumococci were susceptible to amoxicillin-clavulanic acid (MIC for 90% of isolates tested [MIC90], < or = 0.12/0.06 microgram/ml), cefixime (MIC90, 0.25 microgram/ml), cefuroxime axetil (MIC90, < or = 0.5 microgram/ml), cefprozil (MIC90, < or = 0.5 micrograms/ml), cefaclor (MIC90, 0.5 microgram/ml), and loracarbef (MIC90, 1.0 microgram/ml). Most strains of the other species remained susceptible to the study drugs other than amoxicillin.
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Broth microdilution
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