Cefuroxime Therapy Research Articles

2239. Evaluating the Use of Cefuroxime for the Treatment of Outpatient Pyelonephritis at an Indian Health Service Hospital

Abstract Background In 2015, a rural Indian Health Service Hospital found itself unable to use SMX/TMP due to high E. coli resistance rates. The stewardship team decided to include cefuroxime as a first line agent for outpatient pyelonephritis to have a fluoroquinolone sparing agent. Oral B-lactams are not typically recommended over SMX/TMP or fluoroquinolones for pyelonephritis, however there is sparse literature on the use of cefuroxime. This retrospective review aims to evaluate the efficacy of cefuroxime therapy for acute uncomplicated pyelonephritis over a five-year period. Methods 528 patients with a diagnosis of pyelonephritis from January 1st, 2015 to December 31st, 2019 were screened. Data collection included 30-day reinfection rates, emergence of ESBL isolates, duration of therapy, one time IV antibiotic administration, urine culture and susceptibility, increased risk (genitourinary abnormalities and diabetes), white blood cell count, and symptoms. Pediatric patients and patients requiring hospital admission were excluded. Results 264 patients were included and 188 patients received cefuroxime therapy. Baseline characteristics included 94.5% female patients, median age of 44 years, and average duration of therapy of 11.6 days. 95% of the isolates were E. coli. 31 patients had treatment failure defined as a return to the ED with 30 days for UTI. 25 of those patients received cefuroxime and of those, 20 had a one-time IV antibiotic dose. 10 patients with treatment failure had a history of ESBL after the encounter and of those 3 patients had cefuroxime therapy. 5 patients who had treatment failure with cefuroxime had diabetes and genitourinary abnormality. Conclusion This review suggests a lower rate of bacteriological cure of acute uncomplicated pyelonephritis with cefuroxime therapy with or without a one-time IV antibiotic dose with a cephalosporin or aminoglycoside. Disclosures All Authors: No reported disclosures.

Potential in vivo transfer of a blaCTX-M14-harbouring plasmid established by combining long- and short-read sequencing

Horizontal transfer of plasmid-mediated antibiotic resistance has rarely been documented in vivo. Utilizing long-read (Oxford Nanopore) and short-read (Illumina) sequencing, we confirmed that a gut-colonizing Escherichia coli and a hypervirulent Klebsiella pneumoniae ST23, isolated from a surgical site culture of a patient receiving cefuroxime therapy, harboured a 100% identical blaCTX-M-14-harbouring plasmid, indicative of a potential transfer in vivo.

Prevalence and antimicrobial susceptibility patterns of Neisseria gonorrhea among the Symptomatic Patients attending Outpatient Department in Lyatonde District Hospital Southwestern Uganda

<p class="abstract"><strong>Background:</strong> Neisseria gonorrhea is one of the neglected diseases of public health importance causing symptomatic, suppurative discharge in males and being asymptomatic in females. This cross-sectional study was aimed at determining the prevalence and susceptibility pattern of <em>Neisseria gonorrhea</em> to the commonly used antibiotics among symptomatic patients attending outpatient department in Lyatonde district hospital.</p><p class="abstract"><strong>Methods:</strong> Urethral and endocervical swabs were collected by the attending medical laboratory technologists. The presence of gonorrhea was confirmed by culture, Gram staining and biochemical tests. Antimicrobial sensitivity test was performed using the disc diffusion method and the result was interpreted using the National Committee for Clinical Laboratory Standards guidelines. </p><p class="abstract"><strong>Results:</strong> Overall prevalence of <em>N. gonorrhea</em> was 4.9% with high prevalence rates of 7.7% among the young age group of 15-25 years. Low level of antimicrobial susceptibility to cefuroxime (50%) followed by erythromycin and gentamycin both at 25% was observed. An alarming resistance to ceftriaxone and ciprofloxacin at 100% followed by penicillin 75% was exhibited by the colonies.</p><p class="abstract"><strong>Conclusions:</strong> The high resistant rate to ceftriaxone and ciprofloxacin obviates their use as the first line of syndromic treatment of gonorrhea in Southwestern Uganda. The use of laboratory culture for diagnosis and management of N. gonorrhea, especially with cefuroxime therapy is highly recommended.</p>

Cefuroxime-Induced Hepatocellular-Cholestatic Hepatitis with Pancytopenia

Drug-induced liver injury is a rare event. We report on a 15-year old girl de-veloping jaundice and a maculopapular rash with pruritus after oral cefuroxime therapy. Liver enzymes as well as total bilirubin and direct bilirubin were elevated. After eliminating other causes of hepatitis, cefuroxime-induced hepatocellular-cholestatic hepatitis with pancytopenia was diagnosed and cefuroxime therapy was stopped. The patient recovered quickly and was discharged without complications. The prognosis of this side-effect of cefuroxime is generally favourable; lethal courses are rare.

Potential toxicity of cefuroxime therapy on rats' ovary

Potential toxicity of cefuroxime therapy on rats' ovary

Sequential therapy with cefuroxime and cefuroxime-axetil for community-acquired lower respiratory tract infection in the oldest old

Community acquired lower respiratory tract infection (CALRTI) is the most common infection requiring hospitalization in the elderly. Sequential antibiotic therapy offers the potential for earlier functional rehabilitation, shorter length of hospital stay and lower costs. We studied the efficacy and safety of an empiric sequential antibiotic therapy with cefuroxime-cefuroxime axetil in elderly patients hospitalized with a CALRTI. A prospective, randomized, open-label, in-hospital study of cefuroxime IV 750 mg tid for 10 days (IV group) vs cefuroxime 750 mg IV tid for 3 days, followed by cefuroxime-axetil PO 500 mg bid for 7 days (sequence group), when clinical (symptoms improved and fever disappeared) and/or laboratory response [decrease in C-reactive protein (CRP)] occurred. A total of 142 patients, 71 (mean age: 83.3 (+/-6 SD), M/F ratio: 1.1) in the IV group, and 71 (mean age: 81.5 (+/-7 SD), M/F ratio: 1.5) in the sequence group, were included in the study. Eighty-three (58.4%) presented with radiologically confirmed pneumonia (CAP) and 59 (41.6%) with non-pneumonic LRTI (NPLRTI) (p=ns between study groups). Treatment was considered effective in 84.5% (60/71) of patients in the IV group and 80.3% (57/71) in the sequence group (p=ns). Therapy failed in 15% (21/142) of the study population (p=ns between study groups) and, after day 3 of therapy, 8.45% (6/71) failed in both study groups. By the end of treatment, two patients had died in each study group, and total in-hospital mortality was 8.5% (12/142, p=ns between study groups). The length of hospital stay (LOS) did not differ between the two study groups. When a favorable clinical or biochemical response occurs on day 3 of IV cefuroxime therapy, further therapy with oral cefuroxime-axetil is as effective and safe as a full course of cefuroxime IV in elderly patients hospitalized with CALRTI. However, LOS was not reduced after sequential antibiotic therapy in this population.

Lyme-Borreliose im Kindes- und Jugendalter

In Europe, Lyme borreliosis is the most common disease communicated by ticks and especially affects the skin, nervous system, joints, and heart. It is caused by at least four species of the spirochete Borrelia burgdorferi. The various pathologies are classified as early forms (erythema migrans, borrelia lymphocytom, early neuroborreliosis, carditis) or late forms (arthritis, acrodermatitis chronica atrophicans, chronic neuroborreliosis). The accuracy of serodiagnosis is 20-50% with erythema migrans, 70-90% with early neuroborreliosis, and nearly 100% with Lyme arthritis. Following special indications, the agent is confirmed by skin biopsy or spinal or joint puncture. Oral therapy is performed with amoxicillin, doxycycline, and cefuroxime, and intravenous therapy uses ceftriaxone, cefotaxime, or penicillin G. All in all, the prognosis of treated Lyme borreliosis is good. In childhood permanent defects are extremely rare, even following long-term manifestation at an early age.

In vivo selection of OmpK35-deficient mutant after cefuroxime therapy for primary liver abscess caused by Klebsiella pneumoniae

The aim of the study was to characterize the genetic basis of beta-lactam resistance developed in clinical isolates of Klebsiella pneumoniae after exposure to cefuroxime. Clinical features of two episodes of liver abscess caused by K. pneumoniae in a diabetic patient were reported. Four isolates (KP(1)/KP(2) and KP(3)/KP(4)) of K. pneumoniae were recovered from cultures of blood/pus in the first and second episodes, respectively. Laboratory investigation of the K. pneumoniae isolates included genotyping by PFGE, resistance gene analysis by PCR amplification and DNA sequencing, and outer membrane protein analysis by SDS-PAGE. KP(3) and KP(4) were recovered after a 21 day cefuroxime therapy and demonstrated identical genotypes to that of KP(1) and KP(2). However, compared with KP(1) and KP(2), emerging resistance to piperacillin, cefalotin, cefuroxime and cefoxitin was observed. The other antibiotics tested, except ampicillin, retained the same effectiveness against the four isolates, although increases (4- to 8-fold) in the MICs of cefotaxime, ceftriaxone, ceftazidime, cefepime, flomoxef and aztreonam were observed in KP(3) and KP(4). None of the isolates produced extended-spectrum beta-lactamases or plasmid-mediated AmpC beta-lactamases. Deficiency in the expression of an outer membrane protein (OmpK35) was observed in the cefuroxime-resistant isolates, KP(3) and KP(4). The increased resistance to cephalosporins in these clinical isolates of K. pneumoniae after exposure to cefuroxime might be related to the loss of OmpK35.

A Rare but Serious Side Effect of Levofloxacin

Drugs should always be considered in the differential diagnosis of hypoglycemia. Fluoroquinolones have rarely been associated with hypoglycemia (1,2). Levofloxacine, which belongs to the fluoroquinolone group of antibiotics, has previously been reported to cause hypoglycemia in only one patient who was also receiving oral antidiabetic drugs (2). Herein, we describe an elderly patient with hypoglycemia associated with levofloxacine therapy who did use oral antidiabetic drugs or insulin. A 64-year-old female with type 2 diabetes treated only by diet was interned for urinary infection and pneumonia. She had no history of malabsorbtion or oral intolerance. The patient’s weight was 84 kg, and she was 157 cm tall (corresponding to a BMI of 34.1 kg/m2). Her current medications included coraspin, omeprazole, and atorvastatin. Cefuroxime 3 × 750 mg/day i.v. was started. During cefuroxime therapy, her blood glucose levels were within normal limits with diet. …

Clinical Efficacy and Safety of a Short Regimen of Azithromycin Sequential Therapy vs Standard Cefuroxime Sequential Therapy in the Treatment of Community-Acquired Pneumonia: An International, Randomized, Open-Label Study

An international, randomized, open-label, comparative study was undertaken in order to assess the efficacy and safety of azithromycin and cefuroxime, short sequential vs standard sequential therapy, respectively, in the treatment of patients with community-acquired pneumonia (CAP). 180 adult patients were included in the study. 89 patients received azithromycin 500 mg intravenously (i.v.) once daily for 1-4 days followed by azithromycin 500 mg orally once daily for 3 days. 91 patients received cefuroxime 1.5 g i.v. three times daily for 1-4 days followed by cefuroxime axetil 500 mg orally twice daily for 7 days. Clinical efficacy was achieved in 67/82 (81.7%) patients treated with azithromycin, and in 73/89 (82.0%) patients treated with cefuroxime. The mean duration of total (i.v. and oral) therapy was significantly shorter for the azithromycin group than for the cefuroxime group (6.2 days vs 10.1 days). Adverse events were recorded in 38.2% of patients treated with azithromycin, and in 29.7% of patients treated with cefuroxime (p = 0.20). Shorter sequential i.v.-to-oral azithromycin therapy of patients with CAP was as effective as standard sequential i.v.-to-oral cefuroxime therapy.

Clinical use of cefuroxime in paediatric community-acquired pneumonia.

Cefuroxime has been recommended as a component of treatment for community-acquired pneumonia (CAP) in guidelines produced by several groups, including the US and British Thoracic Societies. It is effective in vitro against the major bacterial pathogens in CAP but it needs to be given with an agent that is active against Mycoplasma, Chlamydia or Legionella spp. if the presence of any of these organisms is suspected. Cefuroxime penetrates respiratory tissue effectively after either parenteral or oral administration, and it has a pharmacodynamic profile which suggests that adequate cover can be achieved with oral therapy for respiratory pathogens susceptible to cefuroxime concentrations of 4 mg/L or less. This break-point is applicable to oral monotherapy and to sequential therapy regimens for the treatment of pneumonia. Cefuroxime can be used either orally or parenterally and it is approved in many countries for the treatment of adult pneumonia by either route. The oral form, cefuroxime axetil, has been used extensively in the treatment of children aged over 3 months but its use in paediatric pneumonia has not been reviewed. The present review summarises clinical experience in the treatment of bacterial pneumonia, of varying severity, in children. The data show that children with severe pneumonia, including those with pleural effusion or complications, can be treated with a full course of intravenous cefuroxime therapy, whereas hospitalised children whose pneumonia stabilises rapidly after initial intravenous therapy can change to oral cefuroxime axetil after 24 to 72 hours and may be able to return home. Oral cefuroxime axetil was appropriate for patients with milder pneumonia managed either in hospital or at home.

CONTINUOUS VS. INTERMITTENT INFUSION OF CEFUROXIME FOR THE TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIA

There is increasing interest in the clinical utility and pharmacoeconomic benefits of continuous infusion (CI) therapy with β-lactam antibiotics because this form of therapy may be as efficacious as and less costly than intermittenl infusion (II) therapy. We investigated the efficacy, pharmacokinetics, and pharmacocconomics of CI cefuroxime therapy in adult patients with a primary diagnosis of community-acquired pneumonia (CAP) who were admitted to a 800-bed community teaching hospital. Twenty-five patients with CAP who received 750 or l500 mg of cefuroxime per day by CI were compared with 25 patients given 750 mg of cefuroxime three times daily by II. Clinical cure or improvement at the end of the course of intravenous therapy and 30 clays later occurred in 23/24 and 21/22 evaluable patients in the II and CI groups, respectively. Steady-slate serum cefuroxime concentrations in CI patients were 13.25 ± 6.29 μg/mL. These concentrations are more; than two to lour limes the MIC90 values of the bacterial pathogens typically associated with CAP. The mean (± SD) total amount of intravenous drug used (II group, 8021 ± 3444 mg; CI group, 5953 ± 3210 mg; P = .04) and cost of the drug, labor, and supplies (II group, $83.85 ± $34.82; CI group, $63.64 ± $30.95; P = .04) were less in the CI group. Duration of inpalienl antimicrobial therapy and length of hospital stay tended to be shorter in the CI group, by 14.7 and 11.6 hours, respectively (P = not significant). The duration of outpatient oral therapy was longer in the CI group (P = .05). Consequently, there was a tendency toward shorter duration of inpalienl therapy and longer duration of outpatient therapy in the CI group. These data support CI celuroxime therapy as a pharmacody-namically sound and pharmacoeconomically beneficial alternative to II therapy in the treatment of CAP. However, randomized controlled trials may be warranted to verify the equivalence of efficacy between treatment regimens.

Cefuroxime Treatment Failure of Nontypable Haemophilus influenme Meningitis Associated with Alteration of Penicillin-Binding Proteins

A 10-year-old boy presented with nuchal rigidity and cerebrospinal fluid (CSF) leukocytosis initially and again on day 6 of intravenous cefuroxime therapy (200 mg/kg/day). Both CSF specimens yielded nontypable beta-lactamase-negative Haemophilus influenzae that were susceptible by disk tests but relatively resistant to cefuroxime (MIC, 8- to 16-fold greater than that of control isolates). To define the mechanism of resistance, the cefuroxime resistance marker was transformed to a susceptible H. influenzae recipient; inactivation and permeability of beta-lactam substrate were tested and the penicillin-binding protein (PBP) profiles were examined. Inactivation of beta-lactam substrate was not detected and reduced permeability was not found. However, reduced beta-lactam binding to PBPs 4 and 5 was observed; 18- to 27-fold more penicillin and 2.5-to 4-fold more cefuroxime was required to saturate or block 50% of the binding sites of these PBPs, respectively. Thus, reduced affinity of PBPs 4 and 5 for beta-lactam substrate appears to be the mechanism of cefuroxime resistance in this strain. The reduced affinity of these targets appears to have contributed to the bacteriologic and clinical failure in this patient.

Pharmacist intervention in prescribing of cefuroxime for pediatric patients

A targeted drug review of cefuroxime use in pediatric patients is described. Because of a 65% increase in cefuroxime costs over one year, pharmacists assessed the appropriateness of cefuroxime therapy from October 13 to December 20, 1987. This assessment was done within 48 hours after the prescription was written and again after 72 hours of cefuroxime therapy, when bacteriology and susceptibility data were available. When a drug order was inappropriate, a pharmacist intervened with the prescribing physician. For comparison, data collection forms were completed for patients who had received cefuroxime before and after the study period. Before the study period, 42% of the cefuroxime orders were inappropriate with respect to dosage or indication at the time of the initial order; this rate fell to 26% during the study period and increased to 33% after the study period. After 72 hours of therapy, the rates of inappropriate prescribing were 48% (before study period), 32% (during study period), and 40% (after study period). During the study period, pharmacists intervened in only half of the 51 cefuroxime orders initially deemed to be inappropriate, and only 26% of these interventions resulted in an order change. Although pharmacists met with some success in increasing the appropriateness of cefuroxime prescribing, both pharmacists and physicians resumed their previous monitoring and prescribing habits after the study period had ended.

Emergence of cross-resistance to beta-lactam antibiotics in fecal Escherichia coli and Klebsiella strains from neonates treated with ampicillin or cefuroxime

Both ampicillin and cefuroxime therapy of neonates selected drug- and species-dependent beta-lactam resistance patterns in fecal strains of Escherichia coli and Klebsiella spp. This was in contrast to our previous findings that ampicillin, but not cefuroxime, contributed to the emergence of beta-lactam resistance also by the promotion of nosocomial spread of resistant strains.

Influence of antibiotic therapy on faecal carriage of P-fimbriated Escherichia coli and other gram-negative bacteria in neonates.

The influence of previous antibiotic therapy on the aerobic faecal flora, including P-fimbriated Escherichia coli, was studied in 953 neonates at discharge from 22 neonatal wards in Sweden. Antibiotics, mainly ampicillin (with or without gentamicin) or cefuroxime, had been received by 37% of the infants. Treatment with ampicillin (with or without gentamicin) increased Klebsiella/Enterobacter and reduced Esch. coli colonization. Cephalosporin therapy (71% cefuroxime) reduced the frequency of colonization with both Esch. coli and Klebsiella/Enterobacter spp. but doubled the isolation rate of other Gram-negative bacteria (Citrobacter, Pseudomonas, Proteus and Acinetobacter spp.) and tripled the incidence of specimens yielding no aerobic Gram-negative growth. Gentamicin showed no significant ecological impact. The selection of Klebsiella/Enterobacter and P-negative Esch. coli strains by ampicillin was correlated with their resistance to this agent, while the association between P-fimbriated Esch. coli and cefuroxime therapy was not related to cefuroxime resistance.

Cefuroxime Therapy for Bacteremic Soft-Tissue Infections in Children

Although it is used extensively in Europe, there is a limited amount of published data concerning pediatric clinical experience with cefuroxime in the United States. Thirty-six children, ranging from 3.5 to 57 months of age, received intravenous cefuroxime (75 mg/kg/day in three divided doses) for soft-tissue infections of the face or epiglottis. Infections treated included preseptal (19 patients) and buccal (13 patients) cellulitis and epiglottitis (four patients). Blood cultures were positive in 22 patients, yielding Haemophilus influenzae type b in 17 (four were beta-lactamase-positive), Streptococcus pneumoniae in four; and beta-lactamase-positive, nontypable H influenzae in one. An additional five patients with buccal cellulitis had negative blood cultures but H influenzae type b antigenuria. A satisfactory clinical response was noted in all patients, and repeated blood cultures performed in initially bacteremic patients were sterile. Cefuroxime therapy was well tolerated, and abnormal laboratory results were infrequent, except for absolute granulocytopenia (granulocytes, less than 1,500/cu mm), which occurred in six patients but could not be ascribed to a drug effect because of the uncontrolled design of our study. Treatment with cefuroxime appears to be a safe and effective therapy for pediatric soft-tissue infections due to H influenzae and S pneumoniae.

Cefuroxime in acute septic arthritis.

Cefuroxime was used in 17 patients with clinical, bacteriological and/or laboratory signs of acute septic arthritis in comparison with 10 patients given cloxacillin and ampicillin alone, or in combination. 14 patients in the study group had positive cultures (Staphylococcus aureus, 10, S. epidermidis, 1, Streptococcus pyogenes group G, 2 and Acinetobacter, 1). Three more patients with non-bacterial arthritis were included in an antibiotic penetration study. In 6 patients serum and joint fluid concentrations of cefuroxime were repeatedly determined by an assay using high pressure liquid chromatography. After 1.5 g intravenous cefuroxime the joint fluid concentrations were 16-80 and 5-40 mg/l at 2 and 8 h, respectively, exceeding the serum concentrations during that period of time. From the clinical and pharmacokinetic data a dosage of 1.5 g cefuroxime intravenously t.i.d. is recommended to the adult patient. This high dosage resulted in primary healing in 11 patients with one relapse one year later in a patient with a knee arthroplasty. Half the dosage intramuscularly in 6 patients failed in 2. No side effects were seen during cefuroxime therapy.

Cefuroxime therapy for pneumonia in infants and children.

Because Streptococcus pneumoniae, Haemophilus influenzae b and Staphylococcus aureus are the major causes of bacterial pneumonia in infancy, we customarily have given a beta-lactam antibiotic and chloramphenicol as initial antibiotic therapy. Cefuroxime (75 mg/kg/day divided every 8 hours iv or im) was evaluated as single drug therapy in an open study of 100 infants and children with suspected bacterial pneumonia. The mean serum concentration of cefuroxime 30 minutes after a 15-minute infusion of 25 mg/kg iv was 29.1 micrograms/ml, and the volume of distribution was 695 ml/kg. Pleural fluid concentrations in 3 specimens were 2.2, 8.5 and 11 micrograms/ml. Median age of patients was 15 months. Bacterial etiology was established in 20 patients: H. influenzae b (8 patients); pneumococcus (8 patients); S. aureus (2 patients); Group A streptococcus (1 patient); Neisseria meningitidis B (1 patient). All organisms were susceptible to 1.25-micrograms/ml doses or less of cefuroxime. The mean number of days was 3.1 until patients became afebrile and 5.1 until respiratory symptoms were gone. Eosinophilia occurred in 10 patients. Cefuroxime is safe and effective single drug therapy for pneumonia in infants and children.

Clinical results of cefuroxime (CXM) therapy in pediatric infections (author's transl)

Cefuroxime, a new cephalosporin C antibiotic, was administered to 15 children with respiratory tract infection, urinary tract infection, or subcutaneous tumour. The following results were obtained. 1) CXM 30 approximately 100 mg/kg/day were used in treatment of respiratory tract infection. Eight of the eleven patients treated responded to the therapy. 2) CXM 45 approximately 75 mg/kg/day were given to 3 patients with urinary tract infection. Excellent results were obtained in all these cases. 3) One patient with subcutaneous tumour responded to CXM therapy. 4) Clinical isolates from the foci involved, i.e., Staphylococcus aureus (4 strains), Group A Streptococcus hemolyticus (1 strain), Streptococcus pneumoniae (1 strain), Haemophilus influenzae (1 strain), and Escherichia coli (3 strains) were all eliminated by CXM therapy except 2 unassessable strains. 5) No noteworthy side effect was noted.