Ceftriaxone Therapy Research Articles

Factors Associated With Primary Care Physician Knowledge of the Recommended Regimen for Treating Gonorrhea.

The recommended regimen for treating uncomplicated gonorrhea has changed over time, due to the emergence of antimicrobial resistance. We assessed physician knowledge of the recommendation for treating uncomplicated urogenital gonorrhea in adolescents and adults using ceftriaxone and azithromycin dual therapy. We analyzed DocStyles 2015 survey data from 1357 primary care physicians practicing for at least 3 years who provided screening, diagnosis, or treatment for sexually transmitted diseases to one or more patients in an average month. Logistic regression and χ analyses were used to identify factors associated with knowledge of dual therapy. Among the options of treatment with ceftriaxone alone, azithromycin alone, both of these, or spectinomycin plus levofloxacin, 64% of physicians correctly preferred ceftriaxone plus azithromycin. Knowledge of the recommended dual therapy decreased with increasing years of practice, ranging from 74% among physicians with 3-9 years of practice to 57% among those practicing for ≥24 years (adjusted odds ratio, ORa, for ≥24 vs 3-9 years of practice, 0.50; 95% confidence interval [CI], 0.35-0.70). Knowledge of dual therapy decreased with higher socioeconomic status of patients (ORa for high income vs poor/lower middle income patients, 0.47; 95% CI, 0.32-0.69). Physicians who pursued continuing medical education using journals, podcasts, and government health agencies were more likely to report dual therapy than those who did not use these sources (ORa, 2.09; 95% CI, 1.31-3.33). Knowledge of the recommended regimen for treating gonorrhea decreased with increasing years of practice and with higher socioeconomic status of patients.

Evaluating the Impact of Long-Term Outpatient Ertapenem (ETP) vs. Ceftriaxone (CTX) on Clinical Success and Development of Resistance for Documented Enterobacteriaceae Infections

BackgroundCeftriaxone and ertapenem are two commonly prescribed outpatient once-daily parenteral antimicrobials with activity against Enterobacteriaceae. However, there is minimal data evaluating the impact of long-term CTX and ETP therapy on development of resistance. Therefore, the goals of this study were to compare the development of resistance, incidence of Clostridium difficile colitis and clinical outcomes.MethodsWe conducted a single center, retrospective, case cohort study of all adult patients who completed at least 2 weeks of outpatient therapy. A list of adult patients receiving home ETP or CTX between 2011 and 2014 were screened for inclusion. The primary outcome was development of resistance during therapy or within 6 months of completing therapy, and secondary outcomes were mortality, readmission, clinical failure, C. difficileinfection and antibiotic cost.Results1,989 patients were screened and 188 were included: 115 patients in the ETP group and 73 in the CTX group. The most common reason for exclusion was lack of documented Enterobacteriaceae infection. Resistance developed in 13 (6.9%) of all patients, but there was no difference in the development of resistance between groups (ETP 7/115 (6.1%) vs. 6/73 (8.2%), P = 0.57). Similar rates of C. difficile colitis occurred between groups: 7 (6.1%) patients receiving ETP and 4 patients receiving CTX. There was no difference in mortality, clinical failure or readmission.The total cost per treatment course per patient was significantly more expensive in the ETP group ($3,604 vs $221, P = <0.001).ConclusionETP and CTX demonstrated similar rates of mortality, clinical failure, readmission, and the development of resistance or C. difficile colitis. However, ETP therapy was significantly more expensive, and could be a target for stewardship intervention in select patients receiving home antibiotic therapy.Disclosures All authors: No reported disclosures.

Risk Factors associated with Paraurethral Duct Dilatation following Gonococcal Paraurethral Duct Infection in Men

No studies have explored the risk factors for paraurethral duct dilatation following paraurethral duct infection by Neisseria gonorrhoeae in men undergoing ceftriaxone therapy. The present study was performed to explore the risk factors for paraurethral duct dilatation following paraurethral duct infection by N. gonorrhoeae in men undergoing ceftriaxone therapy and thus guide clinical interventions. We compared the demographic, behavioral, and clinical data of men with paraurethral duct infection by N. gonorrhoeae with and without dilatation of the paraurethral duct. Univariate analysis showed significant differences in age, disease course of the infected paraurethral duct, Chlamydia trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae between the patient and control groups (P<0.05). Multivariate logistic regression analysis showed consistent results (P<0.05). This study that shows delayed treatment may be a major risk factor for paraurethral duct dilatation secondary to paraurethral duct infection by N. gonorrhoeae in men. Age, C. trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae are also risk factors. Thus, educating patients to undergo timely therapy and treating the C. trachomatis infection may be effective interventions.

ANTI-DEPRESSANT EFFECT OF CEFTRIAXONE IN FORCED SWIMMING TEST AND IN TAIL SUSPENSION TEST IN MICE

Objective: Depression is a major psychiatric disorder affecting nearly 350 million people worldwide and imposes a substantial health burden on the society. Ceftriaxone has demonstrated neuroprotective effects in animals. It has also undergone trials as a treatment option for amyotrophic lateral sclerosis. This study was therefore undertaken to evaluate the antidepressant-like effect of ceftriaxone in mice.Methods: Ceftriaxone was administered at three different doses (0.130, 0.195 and 0.260g/kg) to Swiss albino mice of either sex by intra peritoneal (i. p.) route. The period of immobility in control and drug-treated mice were recorded in forced swimming test (FST) and tail suspension test (TST). The antidepressant effect of ceftriaxone indicated by the decrease in duration of immobility was compared to that of fluoxetine (0.020 g/kg, i. p.).Results: Ceftriaxone decreased the duration of immobility in mice. It showed a significant dose-dependent antidepressant effect. The antidepressant effect of 0.260g/kg of ceftriaxone was comparable to that of fluoxetine in the TST but not in the FST.Conclusion: The results of the present study indicate antidepressant activity of Ceftriaxone. The study shows that ceftriaxone has additional action on the central nervous system other than neuroprotection. Ceftriaxone therapy in cases of encephalomeningitis and in various cases of hemorrhages in the brain can, therefore, prevent the development of depression in future

Comparative evaluation of ceftriaxone- and cefotaxime-induced biliary pseudolithiasis or nephrolithiasis: A prospective study in 154 children

Biliary lithiasis, or sludge, and nephrolithiasis have been reported as a possible complication of ceftriaxone therapy. However, no study related to cefotaxime-induced biliary pseudolithiasis or nephrolithiasis was observed in the literature. Therefore, we investigated the comparative formation of biliary pseudolithiasis and nephrolithiasis after cefotaxime and ceftriaxone therapies. The patients treated with ceftriaxone or cefotaxime were enrolled during the study period. Ultrasound imaging of the biliary and urinary tract was performed in all patients before and after the treatment. The patients with a positive sonographic finding at the end of treatment were followed up with monthly ultrasonography for 3 months. The present study showed that abnormal biliary sonographic findings were demonstrated in 18 children (20.9%) treated with ceftriaxone, 13 (15.1%) had biliary lithiasis, 5 (5.8%) had biliary sludge and 1 (1.2%) had nephrolithiasis. Abnormal biliary sonographic findings were demonstrated in only four (5.9%) children treated with cefotaxime who had biliary sludge and only one (1.5%) had nephrolithiasis. It was observed that older age was at significantly higher risk of developing biliary sludge or stone formation. Receiver operating characteristic analysis was performed to determine the residual risk and analysis found that 4.5 years was the cut-off value for age. The present study is unique in the literature for reporting for the first time gall bladder sludge and nephrolithiasis associated with cefotaxime use. Therefore, patients treated with cefotaxime should be monitored for serious complications like patients treated with ceftriaxone. Nevertheless, if third-generation cephalosporin is used, cefotaxime is recommended to be used rather than ceftriaxone.

Lipid peroxidation in the pathogenesis of neuroborreliosis

This study analyzed the onset of lipid peroxidation (LPO) in neuroborreliosis and the effects of ceftriaxone therapy on LPO. Twenty-two patients with early neuroborreliosis and 22 healthy subjects were studied. LPO in the cerebrospinal fluid (CSF), as well as the plasma and urine was estimated by the levels of reactive aldehydes: 4-hydroxynonenal (4-HNE), 4-hydroxyhexenal, malondialdehyde, and 4-oxononenal, F2-isoprostanes and A4/J4-neuroprostanes (NPs). The plasma level of 4-HNE-protein adducts arachidonic acid (AA), docosahexaenoic acid (DHA) and vitamin E was determined. Additionally, enzymatic activities of phospholipase A2 (PLA2), platelet-activating factor acetylhydrolase (PAF-AH) and glutathione peroxidase (GSH-Px) were determined. A decrease of AA, DHA levels and GSH-Px activity in plasma was associated with a significant increase of aldehydes in the CSF, plasma and urine. Similarly, the increase of F2-isoprostanes and NPs in the CSF and plasma was associated with the decreased activity of PLA2 and PAF-AH. Ceftriaxone therapy cured patients and reduced the levels of F2-isoprostanes, NPs and reactive aldehydes. However, the activities of PLA2 and PAF-AH increased. Pathophysiological association of neuroborreliosis with systemic LPO was revealed. Effective antibiotic therapy attenuated LPO. Biomarkers of LPO could be useful to monitor the onset of neuroborreliosis and show the effectiveness of pharmacotherapy.

Prospective study of nephrolithiasis occurrence in children receiving cefotriaxone.

Ceftriaxone is a commonly used antibiotic among the paediatric population. Various reports have associated high doses of Ceftriaxone with the development of nephrolithiasis; our aim was to test this association with a 5 day course of treatment. Our study group consisted of 120 patients divided into two groups. The first group included 60 patients who underwent treatment with Ceftriaxone therapy that was started empirically and continued for 5 days at the dose of 80 mg/kg per day. The second group (60 patients) who received treatment with other antibiotics (other than Ceftriaxone), as recommended by hospital protocols. Patients with urinary tract infections (UTI) were excluded as UTI may be a predisposing cause for nephrolithiasis. Baseline and follow up after 5 days were done with; abdominal ultrasound, serum urea, creatinine, serum calcium, 24 h urinary calcium and urinary calcium/ creatinine ratio. Extended metabolic tests were done for cases that developed nephrolithiasis. Five cases out of the 60 patients treated with Ceftriaxone developed calculi; that were small and were eliminated spontaneously in four cases at mean duration of 3 weeks. In these cases renal ultrasonography examinations were normal prior to treatment; and none of them had metabolic disturbances or risk factors leading to stone formation. By multiple regression analysis, only age was related to nephrolithiasis formation being higher in the group that has developed stones. Only patients who underwent Ceftriaxone therapy have developed renal stones, even with a short course of therapy (5 days), and in the absence of a known predisposing cause for nephrolithiasis. We have thus concluded that Ceftriaxone by itself maybe a predisposing factor for nephrolithiasis.

Open Label Observational Comparative Efficacy Study of Ceftriaxone and Levofloxacin in COPD Exacerbations

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common preventable and treatable disease. Part of the natural history of the disease is an exacerbation characterized by severity of dyspnoea, increased sputum volume, and purulence. Antibiotics are given to most patients with Acute Exacerbation Chronic Obstructive Pulmonary Disease (AECOPD). Objectives: This study examines the clinical efficacy of ceftriaxone and levofloxacin in patients with AECOPD. It is an open label, observational comparative study. The study compares the efficacy of 1gm ceftriaxone intravenous infusion BD and oral 500 mg levofloxacin OD for 5 days based on clinical parameters, investigates the healthcare utilization of the study population during hospitalization and looks into the cost comparison between the treatment groups. Methods: The clinical improvement and resolution was measured using the Borg scale for dyspnoea to quantify its severity. The sputum volume and sputum purulence were also quantified by scales. The measurements were done on day 1, 3 and 5. Results: Improvement and resolution of dyspnoea, sputum purulence, and oxygen saturation were similar with empirical intravenous ceftriaxone and oral levofloxacin therapy. Intravenous Ceftriaxone was significantly beneficial with p value of 0.009 in resolving sputum volume compared to levofloxacin. Treatment failure was observed in 23.5% ceftriaxone and 4.5% levofloxacin treatment groups; both were associated with low rate of relapse requiring hospitalization. Among these patients, the time to next exacerbation was within 3 weeks. Conclusion: This study has shown comparable clinical efficacy between ceftriaxone and levofloxacin in AECOPD. The ceftriaxone regimen is certainly costlier than the levofloxacin regimen due to higher acquisition, nursing, and infusion fee. Key words: Acute Exacerbation Chronic Obstructive Pulmonary Disease, Ceftriaxone, Levofloxacin, Borg scale, Anthonisen criteria.

Effects of herbal extract of Ocimum sanctum as supportive therapy with intravenous ceftriaxone in experimentally induced staphylococcal chronic mastitis in goat

The protective effects of Ocimum sanctum leaf juice as supportive therapy in induced chronic staphylococcal mastitis were evaluated with intravenous ceftriaxone injection in lactating goats. Chronic mastitis was induced after 30days of intracisternal inoculation of 2000 c.f.u. of Staphylococcus aureus (J 638) into the left teat of the udder in two Groups of goats (Group I and Group II). Group I mastitic goats received only ceftriaxone injection i.v. at 20mg/kg at 4days intervals two times, whereas Group II mastitic goats were given fresh undiluted O. sanctum leaf juice at 5ml/kg orally for consecutive 14days with intravenous ceftriaxone injection at 20mg/kg at 7days intervals two times. In the animals receiving O. sanctum leaf juice, the plasma concentration of ceftriaxone increased to 0.11±0.03μg/ml, 33.93±1.54μg/ml, 1.62±0.17μg/ml, 0.70±0.09μg/ml and 0.19±0.03μg/ml vs control at 48, 216, 240, 264 and 288h with an increased concentration of ceftizoxime i.e., 0.26±0.03μg/ml,0.58±0.05μg/ml, 0.85±0.02μg/ml,1.26±0.04μg/ml, 2.82±0.04μg/ml, 1.96±0.04μg/ml, 0.67±0.02μg/ml vs below detectable level in control Group at 72, 216, 240, 264, 288, 312 and 336h, respectively. Further, the concentration of its metabolite i.e., ceftizoxime increased to 4.08±0.18μg/ml and 0.80±0.18μg/ml at day 4 and 6, respectively in milk from a below detectable level and milk concentration of both ceftriaxone and ceftizoxime increased in both halves of the udder at different time in Group II goats. No S. aureus colony was seen in milk at 96h post treatment in Group II goats. O. sanctum leaf juice (0.05ml) decreased the minimum inhibitory concentration of ceftriaxone (3μg/ml) and ceftizoxime (1μg/ml) to 0.5μg/ml for both the drugs against inoculated S. aureus. O. sanctum treatment significantly reduced the alkaline phosphatase activity along with an increase in lactoperoxidase activity maintaining normal reduced glutathione level with intravenous ceftriaxone therapy. The findings proved that O. sanctum leaf juice has significant bioenhancing and antioxidant activities which can be used as supportive therapy in staphylococcal chronic mastitis in goat.

Gallbladder sludge associated with ceftriaxone therapy for typhoid fever in Nigerian children: A case series

Ceftriaxone is a third-generation cephalosporin with a wide spectrum of activity against both gram-negative and gram-positive organisms. Ceftriaxone has proven efficacy against severe and difficult-to-treat community-acquired infections including typhoid fever and other sepsis syndromes caused by multi-drug resistant organisms. Several studies including prospective studies exist in the literature that described the accumulation of sonographically demonstrable sludge (or precipitates) in the gallbladder and sometimes in the urinary tract. The accumulation of sludge occurs during therapy for severe infections in some children identified with certain predisposing factors. The condition is often asymptomatic but might be associated with clinical features that could mimic disease progression in patients with intra-abdominal manifestations of infection such as typhoid fever. Five Nigerian children aged between 4 and 11 years developed demonstrable gallbladder sludge (precipitate) while on treatment for typhoid fever with ceftriaxone. Three of the children manifested clinical features suggestive of gallbladder precipitate accumulation following commencement of the antibiotic, while the other two did not. Ceftriaxone therapy was continued to completion in all the cases along with conservative management. Four of the children recovered and had resolution of the sludge, while the fifth died of multi-organ failure after surgery for intestinal perforation. Although several studies exist in the literature regarding this condition, our search using Medline and Google Scholar did not identify such reports from children in Nigeria or sub-Saharan Africa. The cases are presented to create awareness on the possibility of occurrence of a drug-induced biliary precipitate formation in children.

A case report of asystole after a test dose of ceftriaxone in an adult man

Ceftriaxone is a commonly used antibiotic for various infections such as respiratory tract infection, urinary tract infection, and enteric fever, as well as in surgical prophylaxis. Hypersensitivity reactions after ceftriaxone therapy are uncommon but are potentially life-threatening, and they may lead to cardiac arrest. Here we report a 44-year-old man who presented with bradycardia, bronchospasm, hypotension, and cardiac arrest (asystole) after a single injected dose of ceftriaxone introduced for surgical prophylaxis. Epinephrine was given intravenously, and cardiopulmonary resuscitation was performed successfully. The patient regained his conscious level 2 h later and became hemodynamically stable within 4 h; next, he was extubated and closely observed for 24 h and then discharged. Physicians should be aware of the risk of anaphylaxis and asystole that may occur after the first dose of ceftriaxone and be ready for managing it properly.

Isolated thrombocytopenia a rare presenting feature of enteric fever

Leucopenia and anemia are generally seen as a presenting hematological feature in typhoid fever. However, our case presented with thrombocytopenia as a presenting sign on admission. A 50-year-old female with complaint of bleeding from gums four day prior to admission. There was no complaints of diarrhoea, rash on any part of the body. Isolated thrombocytopenia encountered on routine complete blood count examination. The diagnosis of typhoid fever was established when Salmonella typhi was isolated from the blood cultures. The platelet count returned to normal level within the first week of ceftriaxone therapy. We report this case of enteric fever with atypical presentation of fever, bleeding gums and thrombocytopenia.

When it can be useful look to gallbladder: 2 clinical cases

D.A.N. 6 years old, comes to our attention for vomiting and fever. The laboratory investigations show neutrophilic leukocytosis and increased inflammatory markers. She starts intravenous rehydration and antibiotic (Ceftriaxone) therapy with resolution of symptoms after 2 days when diarrhea appears. The third day ultrasound abdomen shows gallbladder contracted with content characterized by biliary sludge collected in a shadow back. She starts UDCA therapy. The new control after about a month of therapy shows complete resolution. Diagnosis: pharmacological pseudogallstones (Ceftriaxone therapy). D.S.F. 5 years old, comes to our observation for uncontrollable vomiting, fever and diarrhea. The laboratory investigations show neutrophilic leukocytosis, elevated lever-associated enzymes and inflammatory markers. Ultrasound abdomen shows cholecystitis with accumulation of biliary sludge in the sloping with acute adenomesenteritis. Diagnosis: acute cholecystitis in adenomesenteritis. Antibiotic and UDCA therapy led to complete remission of symptoms. Gallstones in children is rare (incidence between 0.15% and 0.22%), and often begins with acute cholecystitis. The biliary sludge does not necessarily comes before a calcoluos disease. The treatment with UDCA, however, is useful in resolution of symptoms and it can prevent the formation of calculous. The pseudogallstones has an incidence of 25–40% of patients with antibiotic therapy. It has a spontaneous resolution after discontinuation of therapy, which usually it can be seen from two weeks to five months from interruption.

Autosomal recessive polycystic kidney disease: Hepatic manifestations in relation to kidney failure

D.A.N. 6 years old, comes to our attention for vomiting and fever. The laboratory investigations show neutrophilic leukocytosis and increased inflammatory markers. She starts intravenous rehydration and antibiotic (Ceftriaxone) therapy with resolution of symptoms after 2 days when diarrhea appears. The third day ultrasound abdomen shows gallbladder contracted with content characterized by biliary sludge collected in a shadow back. She starts UDCA therapy. The new control after about a month of therapy shows complete resolution. Diagnosis: pharmacological pseudogallstones (Ceftriaxone therapy). D.S.F. 5 years old, comes to our observation for uncontrollable vomiting, fever and diarrhea. The laboratory investigations showneutrophilic leukocytosis, elevated lever-associated enzymes and inflammatory markers. Ultrasound abdomen shows cholecystitis with accumulation of biliary sludge in the slopingwith acute adenomesenteritis. Diagnosis: acute cholecystitis in adenomesenteritis. Antibiotic andUDCA therapy led to complete remission of symptoms. Gallstones in children is rare (incidence between 0.15% and 0.22%), and often begins with acute cholecystitis. The biliary sludge does not necessarily comes before a calcoluos disease. The treatment with UDCA, however, is useful in resolution of symptoms and it can prevent the formation of calculous. The pseudogallstones has an incidence of 25–40% of patients with antibiotic therapy. It has a spontaneous resolution after discontinuation of therapy, which usually it can be seen from two weeks to five months from interruption.

Fasting and bed rest, even for a relatively short period, are risk factors for ceftriaxone‐associated pseudolitiasis

Cholelithiasis is one of the side-effects of ceftriaxone (CTRX). Reportedly, the cholelithiasis resolves relatively soon after cessation of CTRX, hence, it is called pseudolithiasis. Previous reports have suggested that biliary pseudolithiasis can cause not only gallstone attacks, but also severe adverse events, such as cholecystitis and pancreatitis. The purpose of this study was to prospectively elucidate the risk factors and clinical features of CTRX-associated pseudolithiasis in pediatric patients. We prospectively examined the incidence and clinical outcome of CTRX-associated biliary pseudolithiasis. Subjects included infants and children who were admitted to hospital with acute disease. Ultrasonography was used to confirm the absence of stones and sludge in the gallbladder before CTRX therapy, and in assessment of pseudolithiasis on days 3, 5, 7 and 10 after initiation of CTRX in all subjects. The pseudolithiasis group was then compared with the non-pseudolithiasis group in terms of age, sex, CTRX dose, CTRX duration, duration of fever, fasting period, period of bed rest, and blood test results. Sixty patients were enrolled in the study. Eleven of them had biliary pseudolithiasis on ultrasonography (18.3%). Formation of biliary pseudolithiasis was prevalent in the fasting and bed rest groups, appearing relatively early in these groups. Special attention should be paid to the degree of oral intake and patient activity when CTRX is prescribed. We recommend regular ultrasonographic follow up of patients receiving CTRX, to evaluate the formation of biliary pseudolithiasis.

Evaluation of posttraumatic recurrent bacterial meningitis in adults.

Acute bacterial meningitis may develop as a complication after head trauma. The aim of this study was to present the demographic, clinical, microbiological and radiological characteristics of adult patients who presented with recurrent bacterial meningitis attacks after trauma. Using a retrospective approach, the medical records of patients with acute recurrent bacterial meningitis (RBM) were reviewed, and those who had a history of trauma were included into the study. RBM was diagnosed based on clinical, bacteriologic and laboratory results. Demographic characteristics, clinical course, laboratory test results including cerebrospinal fluid analysis (CSF), radiological images, and the applied treatments were evaluated. A total of two hundred and twelve patients with acute bacterial meningitis were included into the study. RBM was diagnosed in twenty-five patients (11.8%), and in 18 of these patients (8.5%), the attacks had occurred subsequent to a trauma. In the CSF cultures of four patients, S. pneumoniae growth was observed. CT cisternography indicated CSF leaks in eleven patients. Moreover, bone fractures were observed in the CT images of ten patients. Ceftriaxone therapy was prescribed to 83% of the patients. Eight patients had a history of a fall in childhood, and five were involved in traffic accidents before acute bacterial meningitis. Four of the patients developed epilepsy and one developed deafness as sequelae. Since RBM attacks are frequently observed following trauma, in patients with a history of trauma who present with meningitis, the risk of recurrence should be considered.

A clinical trial of treatment of uncomplicated typhoid fever: efficacy of ceftriaxone-azithromycin combination

Background: Typhoid fever is a systemic infection caused by Gram-negative bacterium Salmonella enterica serovar typhi ( S. typhi ). It is a major health problem in India. It carries significant morbidity and mortality. Antimicrobial therapy is critical for the management of typhoid fever. Emergence of multidrug-resistant (MDR) and nalidixic acid-resistant (NAR) strains of S. typhi has complicated therapy by limiting treatment options. Hence, this study was conducted to evaluate the efficacy and safety profile of ceftriaxone and azithromycin combination therapy in uncomplicated typhoid fever. Methods: Adults patients of blood culture proven uncomplicated typhoid fever admitted in the medicine ward of Teerthanker Mahaveer Medical College and Research Centre were treated with ceftriaxone intravenously (2 g daily for 14 days) and azithromycin orally (500 mg daily for 7 days). Patients were clinically and bacteriologically evaluated during the study period and follow-up. Results: 96% cure rate was observed. No relapse was recorded. Conclusion: Ceftriaxone-azithromycin combination may be considered as an empirical therapy for treatment of uncomplicated typhoid fever in view of the emergence of MDR and NAR strains of S. typhi .

A Pediatric Case of Cardiobacterium Hominis Endocarditis after Right Ventricular Outflow Tract Reconstruction

Cardiobacterium hominis, a member of the HACEK group of organisms, is a rare cause of endocarditis and is even rarer in pediatric population. In this report, we present a case of infective endocarditis caused by C. hominis in a 16-year-old Tunisian girl who had undergone right ventricular outflow tract reconstruction using a Hancock® heterograft for double outlet right ventricle with pulmonary stenosis. Two weeks before admission, the patient suffered from worsened shortness of breath and fever. Tranthoracic echocardiography revealed right ventricular outflow tract stenosis and vegetation attached to the leaflet conduit. The Subsequent blood cultures grew Cardiobacterium hominis and the patient was treated successfully with 6 weeks of intravenous ceftriaxone therapy. Conduit replacement was performed after appropriate antibiotic therapy with favourable course.

6. Ceftriaxone and nonconvulsive status epilepticus (NCSE)

Purpose Ceftriaxone related nonconvulsive status epilepticus is least suspected and unusual complication especially patients with renal insufficiency (Pre admission Creatinine 140 microMol/L). Methods We reviewed the clinical and electroencephalographic (EEG) characteristics of a patient presented with delirium due to UTI and renal failure in whom developed alteration of consciousness without convulsions associated with continuous epileptiform EEG activity while being treated with ceftriaxone. Results and conclusion Patient was given Ceftriaxone as treatment for UTI and treatment for electrolyte imbalance. Patient started having decreased responsiveness and altered level of consciousness. The EEG showed continuous or intermittent bursts of generalized, high-voltage, 1–2 Hz sharp wave activity or sharp and slow wave activity that resembled triphasic waves but completely differentiated from triphasic waves. It was not possible to obtain EEG few days after ceftriaxone discontinuation and level of consciousness improved and patient transferred to nursing home with continue AED (dilantin). Epoch 1 is EEG after first dose of ceftriaxone and Epoch 2 is 2nd day after discontinuation of ceftriaxone. It is usually not correlated with the use of ceftriaxone and it is hard to speculate. After evaluating all possible common causes, only thing correlated with this patient was ceftriaxone. Also continued epileptiform activity in presence of dilantin and Lorazepam infusion. The temporal relationship between the start of ceftriaxone therapy and the manifestation of NCSE as well as the withdrawal of ceftriaxone and the improved consciousness within 48 h indicated that ceftriaxone was a causative agent. It has been proposed to be mediated by competitive antagonism of γ-aminobutyric acid (GABA) in brain, which is the principal inhibitory neurotransmitter in the brain, could lead to a low neuronal threshold for neuronal excitation. Cephalosporins can cause nonconvulsive status epilepticus in setting of poor renal elimination. The clinical picture is difficult to differentiate from that of metabolic encephalopathy unless an EEG is obtained. Physicians should be aware of this potentially dangerous complication.

Effect of ceftriaxone on the outcome of murine pyelonephritis caused by extended-spectrum-β-lactamase-producing Escherichia coli.

Urinary tract infections (UTIs) due to extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae in children are becoming more frequent, and they are commonly treated initially with a second- or third-generation cephalosporin. We developed a murine model of ascending UTI caused by ESBL-producing Escherichia coli. Using this model, we investigated the renal bacterial burden, interleukin-6 (IL-6) expression, and histopathological alterations caused by ESBL- and non-ESBL-producing bacteria after 1, 2, or 6 days with or without ceftriaxone therapy. The renal bacterial burden, IL-6 concentration, and histological inflammatory lesions were not significantly different between mice infected with ESBL- and non-ESBL-producing bacteria without treatment at any of the time points examined. Following ceftriaxone administration, the bacterial burden was eliminated in the kidneys of mice infected with ESBL- and non-ESBL-producing bacteria on the 6th postinfection day. The histological analysis demonstrated that among mice treated with ceftriaxone, those infected with ESBL-producing bacteria had more profound renal alterations than those infected with non-ESBL-producing bacteria on the 6th day (P < 0.001). In comparison, microbiological outcomes did not differ significantly between mice infected with ESBL- and non-ESBL-producing bacteria at any of the time points examined. The effectiveness of ceftriaxone in mice with UTIs due to ESBL-producing E. coli may have therapeutic implications; it is, however, hampered by limited activity on the histopathological lesions, a finding that needs further investigation.