Gram-positive superinfections: A consequence of modern β-lactam chemotheraphy

Cephalosporin Antibiotics

The last three decades have seen the emergence of a cornucopia of antimicrobials in the cephalosporin class. This becomes even more apparent when one realizes that over 60 pages of the 1993 AHFS drug information text is dedicated to the cephalosporin class.1 Due to similarities in nomenclature and the proliferation of available agents, the clinician is constantly challenged by this confusing array of antimicrobials. The intent of this manuscript will be to distill the volumes of information available on cephalosporins into a more manageable format and close with a summary of the most clinically important cephalosporin antimicrobials.

Comparison of the efficacy and adverse effect profile of cefotaxime and ceftriaxone in ICU patients with susceptible infections

In a prospective randomized double-blind trial, the efficacy and safety of cefotaxime and ceftriaxone were compared in intensive care unit (ICU) patients with serious infections requiring systemic antimicrobial therapy. Patients were randomly assigned to receive either cefotaxime 1 g i.v. t.i.d. or ceftriaxone 2 g every 24 hr. Clinical and bacteriologic assessments were made before treatment, at 48 hr and 5 days during treatment, and 48 hr after treatment. At the time of reporting, a total of 34 patients had been entered into the trial, 27 of whom were evaluable; 23 patients (85%) completed a minimum of 5 days antibiotic treatment. At the end of treatment, using current statistics 67% of cefotaxime and ceftriaxone patients demonstrated clinical cure or improvement. Bacteriologic responses appeared greater in the cefotaxime group (55% vs 42%). The incidence of adverse effects, which were usually minor, was similar in each group. From these preliminary results, it would appear that at the doses used in this study, cefotaxime and ceftriaxone are equally effective in the treatment of infections in the ICU.

Susceptibility of enterococci and epidemiology of enterococcal infection in the 1980s

Enterococcisensu strictoform part of the normal gut flora (1) and may be found in the mouth, vagina and anterior urethra (2). They are opportunist pathogens which can cause serious infection including endocarditis. Nosocomial enterococcal infection appears to be increasing both in the UK (Public Health Laboratory Service [PHLS] Communicable Disease Surveillance Centre [CDSC], unpublished) and the USA (3) and to correspond to usage of broad spectrum β-lactam antimicrobial agents (4−7) and invasive surgical devices (8, 9). At the same time, the incidence of enterococci resistant or tolerant to previously commonly employed antimicrobial agents or their synergistic combinations is increasing and is compromising therapy of serious enterococcal infection. Strains of enterococci with high-level resistance to streptomycin and kanamycin (minimal inhibitory concentrations [MICs] > 2000 mg/L) were first reported in 1970 (10, 11) and rapidly became widespread (8, 12−14).