Cloxacillin Therapy Research Articles

Predictive Factors of Cloxacillin Susceptibility in Primary Bacterial Spinal Infection.

Prognostic study. The objective of this study is to identify predictive factors for cloxacillin susceptibility in spinal infections. A retrospective analysis was conducted using data from January 1, 1997, to December 31, 2021. The study included patients presenting with back pain and either a positive bacterial culture from the spine or radiological evidence of spinal infection (spondylodiscitis and/or epidural abscess) along with positive bacterial blood culture. Among 171 patients (127 males, 44 females), 53.2% had Staphylococcus isolates, with 40.4% showing cloxacillin resistance. Lower globulin levels (<33.5g/L), recent hospitalization within 90days, and residence in an old age home predicted gram-positive bacteria with cloxacillin resistance and gram-negative bacteria as causative organisms (P<.05). The 30-day and 1-year all-cause mortality rates were 0% and 8.2%, respectively. Higher red cell distribution width (RDW >16.1%) and Charlson comorbidity index (CCI) scores predicted 1-year all-cause mortality (P<.05). Intensive care unit admission was required for 9.9% of patients. This study identified predictive factors for spinal infection by gram-positive bacteria with cloxacillin resistance and gram-negative bacteria. Patients with lower globulin levels (<33.5g/L), recent hospitalization within 90days, or residency in an old age home upon admission should avoid standalone cloxacillin therapy and consider antibiotics with gram-negative coverage. Higher RDW (>16.1%) and CCI scores were associated with increased 1-year all-cause mortality. These findings contribute to treatment decision-making and improving patient outcomes in spinal infections.

A probable clinically significant interaction between warfarin and cloxacillin: three case reports

Three patients were admitted to the Imam Hospital, Tehran, Iran with a diagnosis of bacterial endocarditis. The patients had indications for valve replacement surgery and anticoagulant therapy. The administration of cloxacillin reduced the effect of warfarin, and subsequent increases in warfarin doses were unable to overcome this effect. A decrease in warfarin anticoagulation effects was detected in our three patients following cloxacillin therapy for infective endocarditis. Penicillinase-resistant penicillins remain essential antibiotics in the treatment of severe infections caused by Staphylococcus aureus due to their bactericidal activity, safety, and cost. Thus, in situations where anticoagulants are indicated in patients with infective endocarditis, it would be better to replace warfarin with low-molecular-weight or unfractionated heparin.

Enhanced anticoagulant effect of warfarin in a patient treated with cloxacillin

To present the case of warfarin-cloxacillin interaction that resulted in an increased international normalized ratio (INR). A 70-year-old man had been treated with warfarin for atrial fibrillation. He was hospitalized because of superficial thrombophlebitis of the left median cubital vein, which developed after venipuncture. An antibiotic therapy with cloxacillin was initiated immediately after the admission. Two days later, INR value increased from baseline 1.9 to 4.6. Anticoagulation therapy was discontinued and INR value was measured daily. His INR remained high for the entire duration of antibiotic therapy. Three days after the cloxacillin therapy was discontinued, the INR decreased to the baseline value. In the presented case, the temporal relationship between the administration of cloxacillin and increased INR suggests that the cloxacillin was responsible for the enhanced warfarin activity. According to the Drug Interaction Probability Scale, a causal relationship between the warfarin-cloxacillin interaction and increased INR value was rated "probable". Interactions between warfarin and cloxacillin can result in serious adverse reactions. INR value should be closely monitored when patients are prescribed this combination of drugs.

Piomiositis paravertebral infantil en relación con traumatismo cerrado

Pyomyositis is an acute bacterial infection that affects striated muscle and is generally accompanied by the formation of an abscess. In most cases, the microorganism involved is Staphylococcus aureus. Clinical findings are characterized by pain, swelling and muscular edema, together with variable general symptoms. Complications include arthritis, osteomyelitis and even septic shock with a mortality of 1.8%. We report the case of an 8-year-old boy who sustained a closed lumbar injury on banging his shoulder while he was playing on a trampoline and who developed paravertebral pyomyositis complicated by sepsis. S. aureus was isolated in the blood culture. The boy subsequently developed a perivertebral abscess and finally contiguous osteomyelitis in the L3 spinous process. The patient received treatment with vancomycin and metronidazole for 6 weeks followed by cloxacillin therapy for 2 weeks (a total of 8 weeks of intravenous antibiotic therapy). Physical examination 3 months after discharge revealed no abnormalities. The possibility of pyomyositis should be borne in mind, especially in children with fever, localized muscular pain and a history of accidental or sports injuries. Early diagnosis and treatment are important to reduce the risk of possibly fatal complications.

The role of vancomycin in the persistence or recurrence of Staphylococcus aureus bacteraemia

Persistence and recurrence of Staphylococcus aureus bacteraemia (SAB) have been linked primarily with difficult-to-eradicate foci of infection such as endocarditis, osteomyelitis or abscess formation. Although vancomycin therapy has been suggested as a predictor of relapse of SAB, it has never been shown to be associated with persistent SAB. The purpose of this study was to examine the possible association of vancomycin therapy and persistence of SAB. Two groups of patients were retrospectively studied. One group consisted of 124 patients who completed > or =10 d of appropriate anti-staphylococcal therapy (from among a total of 284 patients with SAB during 2 y, 1997-8). In this group, persistence of SAB (methicillin resistant and susceptible combined) for >3 d while on therapy, occurred in 11 (22%) of 55 vancomycin recipients and in none of 52 cloxacillin recipients (p = 0.002). When calculated for methicillin susceptible SAB alone, the numbers were 3 of 13 vs 0 of 52, respectively (p = 0.007). The second study group included all patients with persistence and/or relapse of SAB while on appropriate anti-staphylococcal therapy during 4 y (1997-2000). In this group, the persistence occurred while on vancomycin therapy, in 32 (94%) of 34 patients with >3 d of persistence of SAB. In the majority of these patients a secondary focus of infection serving as the site of persistence was identified in addition to the primary focus (or portal of entry). It was concluded that vancomycin is inferior to cloxacillin therapy in terminating SAB and therefore may predispose to prolonged bacteraemia and secondary seeding of infection during therapy.

Clinical Pharmacokinetics of Continuous Intravenous Administration of Penicillins

Theoretically, continuous intravenous administration of beta-lactam antibiotics has advantages over intermittent administration because of the close relationship between efficacy and the time the plasma concentration remains above the minimal inhibitory concentration that has been found in vitro. The aim of the present study was to establish the pharmacokinetic parameters of benzylpenicillin and cloxacillin administration in patients receiving high-dose benzylpenicillin or cloxacillin therapy by continuous infusion. A major part of the interindividual variation in the plasma concentrations at steady-state was attributable to variation in renal function, as estimated by the creatinine clearance. On the basis of these results, a nomogram was constructed that can be used to determine on an individualized basis the total daily dose of benzylpenicillin or cloxacillin necessary for each patient to obtain therapeutic plasma concentrations.

Acute hematogenous staphylococcal osteomyelitis: evaluation of cloxacillin therapy in an animal model

A reproducible avian model of acute hematogenous staphylococcal osteomyelitis was used to investigate various aspects of antibiotic therapy using a single antibiotic, cloxacillin. The effects of both delaying antibiotic administration and increasing the frequency of antibiotic administration on the outcome of the disease were evaluated. Following bacterial inoculation, a delay in commencing therapy for 4 d in comparison to 1 d significantly reduced the likelihood of a favourable outcome. An increase in the frequency of antibiotic administration from once to 4 times daily resulted in significant improvement in the recovery rate of chickens. Whilst repeated antibiotic administration controlled the systemic effects of the disease and improved the clinical status of chickens, the local bone lesion was not always sterilized. The role of antibiotic therapy in acute hematogenous osteomyelitis is discussed in relation to these findings.

Penicillin (cloxacillin)-tolerantr Staphylococcus aureus from bovine mastitis: identification and lack of correlation between tolerance in vitro and response to therapy in vivo

Twenty-four isolates of Staphylococcus aureus from naturally occurring cases of bovine mastitis were examined in vitro for resistance to cloxacillin. All strains produced penicillinase and none showed intrinsic resistance (methicillin resistance) to cloxacillin. The minimum inhibitory concentration of cloxacillin for all these strains was normal (low) but differences were found between them in their sensitivities to the bactericidal action. Three were considered to be tolerant to cloxacillin and a further five possibly so. In a mouse model of mastitis there was no difference in the response to intramammary therapy with cloxacillin between cloxacillin-sensitive or tolerant strains of S aureus and a known methicillin-resistant strain was similarly sensitive to cloxacillin therapy in vivo. It is concluded that cloxacillin tolerance may have little clinical significance in mastitis therapy.

Acute haematogenous osteomyelitis in infancy and childhood.

Chronic osteomyelitis is recognised as a very old disease, but acute osteomyelitis appears to have been understood only in the last 50 or so years. Until the latter part of the nineteenth century, acute osteomyelitis was only rarely recognised, except as a complication of open fractures or local sepsis. According to Wilensky (1927) the term osteomyelitis was probably coined by Nelaton in 1844. Acute osteomyelitis has always been a serious disease because of the risk to the life of the patient as well as its tendency to chronicity and recurrence. Recent improvements in surgical care and chemotherapy have made it less

Benefits and risks of sequential parenteral--oral cephalosporin therapy for suppurative bone and joint infections.

Seventy-five infants and children with suppurative skeletal infections were managed with a sequential parenteral-oral regimen of cephalosporin antibiotic therapy. Initially, parenteral antibiotics (cefamandole for 48 patients and cefuroxime for 27 patients) were given for a median of 5 days. Oral therapy was with large doses of cefaclor (150 mg/kg/day) or cephalexin (100 mg/kg/day). Eight patients (11%) had inadequate serum bactericidal activity with cefaclor. Six of them were successfully managed with alternative oral antibiotics, and parenteral therapy resumed in one patient. Chronic disease developed in a child who was continued on oral cloxacillin therapy in spite of absent serum bactericidal activity. It is concluded that oral therapy can be successful for the majority of patients but that it is hazardous and not indicated if careful laboratory monitoring of compliance and serum bactericidal activity cannot be performed.

Response to Treatment of Chronic Mastitis Induced in Mice by Strains of Staphylococcus Aureus Isolated from Herds of Different Susceptibility to Cloxacillin Therapy

SUMMARY Strains of staphylococci, derived from field cases of mastitis in two herds that differed in their response to cloxacillin therapy, induced chronic reactions in the mammary glands of lactating mice under experimental conditions. These chronic infections were equally refractory to intramammary therapy with sodium cloxacillin though the strains were susceptible to cloxacillin in vitro . The results indicate that failure to respond to therapy was due to differences in the way the mammary gland responded to invasion rather than to inherent differences between the strains of staphylococcus.

Loss of antibiotic resistance in Staphylococcus aureus in vivo probably resulting from cloxacillin therapy.

Summary Between Dec. 1971 and July 1972, a strain of Staphylococcus aureus was isolated on many occasions from the sputum of a patient suffering from fibrocystic disease. Early isolates of this strain all formed penicillinase and were resistant to fusidic acid, erythromycin, streptomycin and neomycin. On two occasions (31 May 1972 and 27 July 1972) about 30 per cent. of the colonies isolated from the patient were sensitive to one or more but not to all of these antibiotics, although they resembled the fully resistant strain in other properties. Loss of resistance to penicillin and to fusidic acid was always associated, as was loss of resistance to streptomycin and to neomycin; the latter two were often linked with loss either of erythromycin resistance or of δ-haemolysin production. Because the patient was being treated with cloxacillin at the time of these isolations, and treatment of the strain with this antibiotic in vitro resulted in loss of resistance, it is inferred that the loss in vivo was probably due to cloxacillin therapy.