Cefuroxime Treatment Research Articles

Cefuroxime induced agranulocytosis during heart transplant period: A case report

Rationale: Cefuroxime is a commonly prescribed antibiotic known for its overall safety profile. However, in rare instances, it can lead to a life-threatening condition known as idiosyncratic drug-induced agranulocytosis (IDIA). While there have been few documented cases linking cefuroxime to this severe adverse reaction, a recent study sheds light on a critical case involving a patient awaiting a heart transplant. Patient concern: In this study, the patient developed agranulocytosis after 16 days and 72 grams of cefuroxime treatment. Agranulocytosis is characterized by a drastic reduction in neutrophil count, in this case dropping to 0/mm3. Diagnosis: IDIA is characterized by a drastic reduction in neutrophil count, in this case dropping to 0/mm3. Intervention: This IDIA coincided with the availability of a donor heart, prompting the medical team to proceed with an immediate heart transplant despite the patient’s compromised immune status. Ceasing cefuroxime administration and initiating treatment with G-CSF for 3 days played a pivotal role in normalizing neutrophil levels. A meticulously planned immunosuppressant regimen was also initiated. Outcomes: Precise management of immunosuppressants contributed to the patient’s successful recovery, leading to discharge. Lessons: The rationale for studying cases like these lies in the need for heightened awareness among healthcare providers. By documenting and analyzing such cases, medical professionals can better understand the risk factors, clinical presentation, and optimal management strategies for this uncommon yet serious adverse reaction. Furthermore, the study underscores the significance of individualized patient care, especially in complex scenarios such as organ transplantation. Precise adjustments to immunosuppressant therapy are crucial to balance the risks of rejection and infection, particularly in patients with compromised immune systems due to drug-induced agranulocytosis. In conclusion, this case serves as a reminder of the unpredictable nature of drug reactions and the importance of vigilant monitoring and rapid intervention in managing potentially life-threatening complications.

The impact of cefuroxime prophylaxis on human intestinal microbiota in surgical oncological patients

IntroductionThe intestinal microbiota is vital to human health, and has a profound influence on several biological processes including inflammation and pathogen resistance. Antibiotic intake greatly impacts bacterial diversity, can increase antibiotic resistance and impair the equilibrium between bacterial species. The key to grasping post-antibiotic effects on the gut microbiota rests on the implementation of a suitable procedure to isolate microbial DNA and a meticulous consideration of experimental sequencing artefacts.MethodsWe herein report the bacterial community dynamics of a cohort of 128 surgical oncology patients before and after the intravenous administration of cefuroxime, an antibiotic routinely used in surgical antibioprophylaxis with proven efficiency against both gram-positive and gram-negative bacteria. In our study, we analyzed patient fecal samples collected through rectal examination before and 7 days post cefuroxime treatment by employing a high-throughput sequencing assay which targets the V3–V4 region of the 16S rRNA gene. A first challenge in applying the study design was to extract an appropriate amount of DNA characteristic to the sampled microbiota, which implied the use of both mechanical (ceramic beads) and chemical (proteinase K, lysozyme and lysostaphin) lysis.ResultsGut microbiota richness and composition was significantly different between the two groups, but most differences were determined by additional perioperative procedures, rather than antibioprophylaxis. Intestinal microbiota composition was not significantly changed one week post cefuroxime treatment when compared to pre-treatment condition for patients without mechanical bowel preparation, but some loss in taxonomic variety could be observed.DiscussionTaken together, cefuroxime does not promote short-term dysbiosis in surgical patients without any additional perioperative procedures.

Clinical and microbiological characterization of Aerococcus urinae bacteraemias at Helsinki metropolitan area, Finland

Our objective was to assess the incidence of bacteraemic Aerococcus urinae cases at Helsinki metropolitan area, Finland, from a 6-year study period (2013 to 2018) and to further characterize available cases. The study evaluates the outcome of commonly used cefuroxime treatment and determinate a set of A. urinae in vitro antimicrobial susceptibilities for benzylpenicillin, cefuroxime, and ceftriaxone. Clinical records of A. urinae bacteraemic patients were reviewed retrospectively. Antimicrobial susceptibility testing was performed by disk diffusion, gradient test, and broth microdilution for 139–141 clinical A. urinae isolates. Clinical data of 72/77 patients were combined with the in vitro susceptibilities. We found an increasing number of bacteraemic A. urinae cases within 6-year study period (p = 0.01). The patients were mainly elderly males, and all suffered from underlying conditions. A total of 27.3% of cases (21/77) showed polymicrobial blood cultures. Thirty-day mortality was 22.1%. Cefuroxime was the initial empiric antimicrobial agent given for 66/76 of the patients and treatment outcome was favorable for 20/22 patients who received cefuroxime at least up to day 5. All isolates were susceptible to benzylpenicillin and cefuroxime interpreted by EUCAST breakpoints for Aerococci and PK-PD breakpoints, respectively. MIC determinations gave variable results for ceftriaxone, 2.1–2.9% of the isolates were resistant. To conclude, it seems that the number of bacteraemic Aerococcus urinae cases is increasing at Helsinki metropolitan area, Finland, reflecting the growing blood culture sampling. Clinical A. urinae isolates were susceptible to cefuroxime in vitro. Treatment data indicate that empirical cefuroxime started for possibly urinary tract -derived community-acquired bacteraemia covers A. urinae.

DOP73 Antibiotic use differentially affects the risk of antidrug antibody formation during anti-TNFα therapy in Inflammatory Bowel Disease

Abstract Background Anti-drug antibodies (ADA) to anti-TNF therapy drive loss of response to treatment. Links between intestinal microbial composition and response to anti-TNF therapy were demonstrated, and antibiotic use during anti-TNF therapy reduced the risk of ADA formation. Here, we aimed to assess the possible implications of specific antibiotic treatments on ADA formation in patients with inflammatory bowel disease (IBD) patients. Methods We performed a retrospective analysis of data from three health maintenance organizations, covering 89% of the Israeli population. All patients with IBD and available ADA levels were included. Survival analysis using Kaplan-Meier and multivariate Cox proportional hazards regression with drug use as time varying covariates methods were used to assess the association between specific antibiotic use and ADA development. C57BL and germ free mice were treated with respective antibiotics followed by immunization with infliximab. ADA were assessed after 14 days. Results We analyzed 1,946 patients treated with anti-TNF. Positive ADAs were detected in 363 patients (18.6%). Age, gender and concomitant use of immunomodulators where comparable in patients who eventually developed ADAs or not. However, infliximab and not adalimumab therapy, previous anti-TNF therapy and higher baseline C-reactive protein levels were significantly associated with ADA development in univariate analysis. Kaplan-Meier curves of prior antibiotic use demonstrated significant hazard of ADA development in patients who used cephalosporins or penicillins with beta-lactamase inhibitors (BLI) and reduced risk with prior use of fluoroquinolones, macrolides or metronidazole (Figure 1) with early risk divergence for most classes. Multivariable Cox proportional hazards model adjusted for multiple factors associated with ADA development was overall consistent with Kaplan-Meier estimates (Figure 2). In mice exposed to infliximab, increased ADA production by cefuroxime treatment and a non-significant reduction following azithromycin treatment was noticed (Figure 3). Germ free mice produced no ADA. Figure 1: Kaplan-Meier curves of cumulative risk of ADA development for prior use of specific antibiotics. P value for the log rank test is presented in each plot. Figure 2: Multivariable-adjusted HR with 95% CI of ADA for use of various antibiotic classes during anti-TNF therapy. Figure 3: Mean ADA levels in mice treated with anti-TNF and prior cefuroxime, azithromycin, or no antibiotic Conclusion ADA production is microbial dependent. The risk of ADA development during anti-TNF therapy can possibly be reduced by avoidance of cephalosporins and penicillins with BLI, or possibly reduced by treatment with fluoroquinolones or macrolides.

An Improved 2-Aminoimidazole Based Anti-Biofilm Coating for Orthopedic Implants: Activity, Stability, and in vivo Biocompatibility.

Orthopedic device-related infections remain a serious challenge to treat. Central to these infections are bacterial biofilms that form on the orthopedic implant itself. These biofilms shield the bacteria from the host immune system and most common antibiotic drugs, which renders them essentially antibiotic-tolerant. There is an urgent clinical need for novel strategies to prevent these serious infections that do not involve conventional antibiotics. Recently, a novel antibiofilm coating for titanium surfaces was developed based on 5-(4-bromophenyl)-N-cyclopentyl-1-octyl-1H-imidazol-2-amine as an active biofilm inhibitor. In the current study we present an optimized coating protocol that allowed for a 5-fold higher load of this active compound, whilst shortening the manufacturing process. When applied to titanium disks, the newly optimized coating was resilient to the most common sterilization procedures and it induced a 1 log reduction in biofilm cells of a clinical Staphylococcus aureus isolate (JAR060131) in vitro, without affecting the planktonic phase. Moreover, the antibiofilm effect of the coating in combination with the antibiotic cefuroxime was higher than cefuroxime treatment alone. Furthermore, the coating was successfully applied to a human-scale fracture fixation device resulting in a loading that was comparable to the titanium disk model. Finally, an in vivo biocompatibility and healing study in a rabbit osteotomy model indicated that these coated implants did not negatively affect fracture healing or osteointegration. These findings put our technology one step closer to clinical trials, confirming its potential in fighting orthopedic infections without compromising healing.

Cefuroxime compared to piperacillin/tazobactam as empirical treatment of Escherichia coli bacteremia in a low Extended-spectrum beta-lactamase (ESBL) prevalence cohort.

Objectives: On January 18, 2010, a part of the capital region of Denmark shifted the empirical treatment of febrile conditions from cefuroxime to piperacillin/tazobactam. We compare empirical treatment with piperacillin/tazobactam versus cefuroxime for Escherichia coli bacteremia with regard to 14 days mortality, in a low prevalence cohort of Extended-spectrum beta-lactamase-producing E. coli.Methods: From January 18, 2010 to December 31, 2012, we conducted a retrospective cohort study including patients with E. coli bacteremia from six university hospitals in Copenhagen, Denmark. Clinical and laboratory information was obtained from a bacteremia research database, including information on comorbidity, and we used Cox proportional hazard analysis to asses all-cause 14 days mortality.Results: A total of 568 patients receiving either cefuroxime (n=377) or piperacillin/tazobactam (n=191) as empirical therapy were included. In the Cox proportional hazard model, cefuroxime treatment was significantly associated with death (mortality rate ratio 3.95, CI 1.12–13.90). Other variables associated with death were health care related infection (MRR 3.20, CI 1.67–6.15), hospital-acquired infection (MRR 2,17, CI 1.02–4.62), admission at intensive care unit (MRR 20.45, 5.31–78.82), and combination therapy with ciprofloxacin (MRR 2.14, CI 0.98–4.68).Conclusion: Empiric cefuroxime treatment of E. coli bacteremia was significantly associated with higher 14 days mortality in comparison with piperacillin/tazobactam.

Effectiveness of penicillin, dicloxacillin and cefuroxime for penicillin-susceptible Staphylococcus aureus bacteraemia: a retrospective, propensity-score-adjusted case–control and cohort analysis

Penicillin-susceptible Staphylococcus aureus isolates account for a fifth of cases of S. aureus bacteraemia (SAB) in Denmark, but little is known about treatment outcomes with penicillins or other antimicrobials. Here we compare penicillin, dicloxacillin and cefuroxime as definitive treatments in relation to 30 day mortality. A retrospective chart review of 588 penicillin-susceptible S. aureus cases at five centres from January 1995 to December 2010. Data on demographics, antimicrobial treatment, clinical signs and symptoms, and mortality at day 30 were collected. Hazard ratios (HRs) with 95% CIs associated with mortality were modelled using propensity-score-adjusted Cox proportional hazards regression analysis. Propensity-score-matched case-control studies were carried out. Definitive therapy with cefuroxime was associated with an increased risk of 30 day mortality compared with penicillin (adjusted HR 2.54, 95% CI 1.49-4.32). Other variables that were statistically significantly associated with 30 day mortality included increasing age, disease severity and a primary respiratory focus. Osteomyelitis/arthritis was associated with a lower risk of death than were other secondary manifestations. Propensity-score-matched case-control studies confirmed an increased risk of 30 day mortality: cefuroxime treatment (39%) versus penicillin treatment (20%), P = 0.037; and cefuroxime treatment (38%) versus dicloxacillin treatment (10%), P = 0.004. Definitive therapy for penicillin-susceptible SAB with cefuroxime was associated with a significantly higher mortality than was seen with therapy with penicillin or dicloxacillin.

United Kingdom survey of antibiotic prophylaxis practice after publication of the ESCRS Endophthalmitis Study

The European Society of Cataract & Refractive Surgeons Endophthalmitis Study published preliminary results in 2006 showing a near 5-fold decrease in the rates of postoperative endophthalmitis with the use of intracameral cefuroxime. The study findings have generated considerable controversy, and 1 year later its recommendations had been heeded by only 6% of American Society of Cataract and Refractive Surgery (ASCRS) members. This poll sought to gauge the uptake among surgeons in the United Kingdom and survey their response to its findings. Fifty-five percent of respondents were using intracameral cefuroxime; 48% had switched after publication of the ESCRS study. Of those remaining, 68% reported their main concern was the risk for dilution errors in the absence of a commercially preformulated preparation, with 67% stating they would switch if such a product became available. Sixty-eight percent considered the lack of a subconjunctival cefuroxime treatment arm within the study a major methodology flaw. Sixty-seven percent said they do not consider penicillin allergy a contraindication to intracameral cefuroxime use, with the remaining 33% opting for alternative antibiotic prophylaxis. The majority of United Kingdom and Ireland Society of Cataract and Refractive Surgeons members have switched to intracameral cefuroxime, despite the absence of previously preferred practice in the study design. The major barrier to its further use appears to be the lack of a commercially available preformulated preparation.

Randomized, Comparative Efficacy Trial of Oral Penicillin Versus Cefuroxime for Perianal Streptococcal Dermatitis in Children

To investigate the efficacy of penicillin compared with cefuroxime for group A beta-hemolytic Streptococcus pyogenes (GABHS) perianal dermatitis. Children 1 to 16 years of age with signs and symptoms of perianal dermatitis and a positive anal swab were randomized to penicillin or cefuroxime treatment and were clinically re-evaluated on day 3 and at the end of treatment (cefuroxime, day 7; penicillin, day 10). An anal swab was obtained to document eradication of GABHS at the end of treatment. Severity of disease was assessed with a clinical score (perianal erythema, 5 points; perianal itch, 3 points; painful defecation, 3 points; constipation, 2 points). Patients were enrolled and randomly assigned to penicillin (n = 18) or cefuroxime (n = 17) treatment. Treatment with penicillin was inferior to cefuroxime, which led to premature study termination after consultation with the ethics committee. Clinical improvement was more rapid in the cefuroxime group (P = .028) and GAHBS was not isolated from the anus the last day of therapy in 13 of 14 patients treated with cefuroxime compared with 7 of 15 patients treated with penicillin (P < .01). Cefuroxime was more effective than penicillin and therefore should be considered as the treatment of choice for perianal dermatitis due to GABHS.

Perspectives on antibiotics for postoperative endophthalmitis prophylaxis: Potential role of moxifloxacin

To aid the cataract surgeon's understanding of rational approaches to antimicrobial prophylaxis and place the European Society of Cataract & Refractive Surgeons (ESCRS) postoperative endophthalmitis study in perspective, a review was conducted of published and unpublished data on intracameral antibiotic use during cataract surgery and the antimicrobial efficacy, pharmacodynamics, ocular penetration, and safety of moxifloxacin. The ESCRS-sponsored study of postoperative endophthalmitis prophylaxis reported rates of presumed infectious postoperative endophthalmitis of 0.07% with intracameral cefuroxime treatment and 0.34% in control groups. Postoperative endophthalmitis after cefuroxime use was mostly due to cefuroxime-resistant gram-positive bacteria. Intracameral cefuroxime also requires extemporaneous compounding, has short-term stability, and carries a risk for hypersensitivity. Moxifloxacin, a fourth-generation fluoroquinolone, has potent and rapid bactericidal activity against the most common gram-positive postoperative endophthalmitis pathogens, has excellent ocular penetration after topical administration, and is available in a self-preserved ophthalmic formulation that has been shown safe and effective in preventing endophthalmitis when administered intracamerally in an animal model. Available data suggest that the optimum antibiotic regimen and route of delivery for cataract surgery antimicrobial prophylaxis require further study. Moxifloxacin offers many theoretical advantages that make it an attractive first-line choice for topical use and of interest for intracameral administration.

Staphylococcus aureus Meningitis: Experience with Cefuroxime Treatment During a 16 Year Period in a Danish Region

Staphylococcus aureus is a rare cause of bacterial meningitis and there is no consensus on antibiotic treatment. Nafcillin is a common choice in countries where it is approved and marketed. High-dose cefuroxime has been the systemic treatment used in the study region, and a retrospective record review was conducted to determine its clinical efficacy. Cases of bacterial meningitis during 1984-1999 in the County of North Jutland, Denmark (approx. 490000 inhabitants), were identified in a regional bacteriology register. Inclusion of a case required either growth of S. aureus from > or = 2 specimens of cerebrospinal fluid (CSF), 1 positive CSF specimen with a CSF leucocyte count > 10(8)/l or 1 positive CSF specimen with a concurrent positive blood culture. A diagnosis of brain abscess required growth of S. aureus from aspirated pus. Staphylococcus aureus meningitis was confirmed in 45 patients, and 5 additional patients had a brain abscess. 44 cases were nosocomial (mortality 16%) and 6 were community acquired (mortality 83%). None of the isolates was methicillin resistant and 6 were penicillin susceptible. Intraventricular antibiotic treatment was given to 28 patients, systemic therapy included cefuroxime in 32 patients (64%) as either a primary or secondary choice, 6 (12%) were treated with penicillin G, 10 (20%) with penicillinase-resistant penicillin and 2 (4%) with cephalothin. Among 31 nosocomial cases treated systemically with cefuroxime the mortality was 10% (95% exact confidence limits 2-26%). In conclusion, cefuroxime seems to be a valid choice for S. aureus meningitis in the nosocomial setting.

Facial swelling and eosinophilia in a 44-year-old woman

CHIEF COMPLAINT A 44-year-old woman was referred to our institution for evaluation of facial swelling and progressively increasing eosinophilia, which began 2 months before she was seen. The patient first noticed right-sided temple and periorbital angioedema 2 days after completing a 10-day course of cefuroxime (Ceftin, GlaxoSmithKline, Research Triangle Park, NC) for a presumed upper respiratory infection/flulike illness. A complete blood count done 4 days after cefuroxime treatment was completed revealed an eosinophil count of 1,384 cells/mm3. The patient was then evaluated by an otolaryngologist and treated with a methylprednisolone acetate (Medrol Dose Pak Pharmacia, Peapack, NJ) and cetirizine hydrochloride (Zyrtec, Pfizer, New York, NY), which resulted in complete resolution of swelling. Angioedema recurred 2 days after she completed the methylprednisolone course (GlaxoSmithKline, Research Triangle Park, NC). Because of recurrent symptoms, she was started on zafirlukast (Accolate, AstraZeneca, Wilmington, DE) 20 mg twice a day and ranitidine (Zantac, GlaxoSmithKline) 75 mg twice a day. Angioedema persisted. Two weeks before the patient was seen in our institution, her eosinophil count increased to 5,742 cells/mm3. At that time, she was given a second methylprednisolone course. The angioedema again resolved completely and then recurred several days after methylprednisolone was completed. Two days before we saw her, her eosinophil count increased further to 13,050 cells/mm3. The patient was seen at our institution complaining of facial and upper extremity swelling, a 16-pound weight gain over the past 2 months, fatigue, and a nonpruritic rash on bilateral antecubital fossae for the past 2 to 3 days. She denied any headaches, shortness of breath, chest tightness, abdominal pain, bloody stools, lower extremity edema, or numbness/tingling in any extremities. MEDICAL HISTORY The patient had a history of osteoarthritis and mild mitral regurgitation. Surgical history was significant for breast biopsy of a benign tumor 6 years before and a total abdominal hysterectomy and bilateral oopherectomy 3 months before she was seen. She experienced allergy to penicillin 1.5 years earlier, which manifested as self-limited hives. There was no history of asthma, urticaria, food allergy, or recurrent respiratory infection.

An Unusual Complication of Cefuroxime Treatment

An Unusual Complication of Cefuroxime Treatment

Comparison of the effects of cefuroxime axetil and cefaclor on the fecal flora in pediatric patients

An open, randomized clinical trial was performed to evaluate the effects of cefuroxime axetil, compared with those of cefaclor, on the fecal flora of children with acute infectious diseases. Thirty-two children were randomized to receive either cefuroxime axetil or cefaclor. Fecal samples were collected 24 hours before treatment, 3 and 6 to 7 days after the start of treatment, and 7 days after the completion of treatment. Cefuroxime axetil induced few changes in aerobic fecal flora, causing only a slight increase in Aerococcus viridans and a slight decrease in Enterobacter cloacae ( P < 0.05), and no changes in anaerobic flora. Cefaclor induced more marked changes in bacterial flora; it decreased the aerobes lactobacilli ( P < 0.05) and Escherichia coli ( P < 0.001) and increased Citrobacter freundii ( P < 0.001) and Proteus mirabilis ( P < 0.01), while its effects on anaerobic microorganisms produced a reduction in Fusobacterium varium and Bacteroides ureolyticus ( P < 0.05). Clostridium difficile, absent during cefuroxime treatment, was observed in three children during or soon after cefaclor therapy. We conclude that cefuroxime axetil does not induce any clinically significant changes in the intestinal microflora.

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.

Ceftriaxone vs Cefotaxime for Treatment of Haemophilus influenzae Meningitis

In Reply.— The issues raised by Madson and Grose do not relate directly to our report, which describes a case of cefuroxime treatment failure in Haemophilus influenzae meningitis and reviews the literature.1 However, since the issues they raised are important we offer this response. The decision to choose which of the newer cephalosporins to use for treatment of bacterial meningitis must be based on available experience which includes efficacy data, safety and toxicity record, and relative coast analysis.

Ceftriaxone vs Cefotaxime for Treatment of Haemophilus influenzae Meningitis

To the Editor.— In a case report, Arditi et al1 d cefuroxime treatment failure in a child with Haemophilus influenzae meningitis. They substituted ceftriaxone for cefuroxime, but they did not mention that ceftniaxone treatment regimens have been associated with two problems. The first is the basis of a case report which described delayed sterilization of H influenzae type B meningitis under management with ceftriaxone.2 The infant had a positive cerebrospinal fluid culture after 3 days (six doses) of ceftriaxone.

Antibiotic Prophylaxis in Open-Heart Surgery Patients: Comparison of Cefamandole and Cefuroxime

The efficacy of cefamandole and cefuroxime in preventing postoperative wound infections was compared in 3037 patients undergoing open-heart surgery. Antibiotic prophylaxis in 1467 patients having coronary artery bypass and valve replacement surgery was cefamandole 2 g iv preoperatively followed by 2 g q6h for five days postoperatively; 1570 patients received cefuroxime 1.5 g iv preoperatively then 1.5 g iv q 12h for three days postoperatively. Postoperative wound infections (sternal and leg wounds) were studied in each treatment group. In the cefamandole study group, 27 patients (1.8 percent) developed postoperative wound infections (9 sternal and 18 leg wounds). In the cefuroxime treatment group, 19 patients (1.2 percent) developed postoperative wound infections (9 sternal and 10 leg wounds). Overall, no statistical difference was found between the two antibiotics in preventing postoperative wound infections. However, in patients having valve replacement surgery, cefuroxime was found statistically more effective than cefamandole prophylaxis in preventing sternal wound infections (no infections in 284 patients compared with five infections in 205 patients, respectively, p = 0.01). The most common organism isolated from infected wounds with cefamandole was Staphylococcus aureus followed by S. epidermidis compared with cefuroxime which had S. epidermidis followed by S. aureus. Cefuroxime was found to be as effective as cefamandole and considerably less expensive in preventing postoperative wound infections in patients undergoing open-heart surgery.

Cefuroxime Treatment of Bacterial Meningitis in Infants and Children

Cefuroxime Treatment of Bacterial Meningitis in Infants and Children

Cefuroxime treatment of bacterial meningitis in infants and children.

Recently, ampicillin- and chloramphenicol-resistant strains of Haemophilus influenzae type b and multiply-resistant Salmonella strains have appeared in some areas of the world. Therefore, alternative drug therapy for infections caused by these organisms is being sought. We used cefuroxime to successfully treat five children with H. influenzae type b meningitis and two children with Salmonella meningitis. Four H. influenzae type b isolates and one Salmonella isolate were resistant to ampicillin, chloramphenicol, and cotrimoxazole. Each of the patients received 200 to 250 mg of cefuroxime per kg per day in four divided doses for 14 to 21 days. The concentrations of cefuroxime in cerebrospinal fluid at 2 h after intravenous 50-mg/kg doses were 6.4 +/- 1.7 (mean +/- standard deviation) and 3.6 +/- 2.2 micrograms/ml on days 2 and 14 of treatment, respectively. The level of drug in cerebrospinal fluid was 1.34 +/- 1.3 micrograms/ml in children without meningitis. The mean cefuroxime concentration in subdural fluid samples from each of three patients was 12.6, 15, and 25.2 micrograms/ml. Cefuroxime is recommended as an alternative drug for the treatment of H. influenzae type b meningitis, but additional information is necessary before cefuroxime can be recommended for therapy of Salmonella meningitis.