A reassessment of the activity of the third-generation cephalosporins against anaerobes and Staphylococcus aureus

No significant difference between ceftriaxone and cefotaxime in the emergence of antibiotic resistance in the gut microbiota of hospitalized patients: A pilot study

BACKGROUND

Ceftriaxone and cefotaxime share a similar antibacterial spectrum and similar indications but have different pharmacokinetic characteristics. Ceftriaxone is administered once daily and 40% of its clearance is by biliary elimination, whereas cefotaxime requires three administrations per day and shows less than 10% biliary elimination. The high biliary elimination of ceftriaxone suggests a greater impact of this antibiotic on the gut microbiota than cefotaxime. The objective of this study was to compare the impact of ceftriaxone and cefotaxime on the gut microbiota.

METHODS

A prospective clinical trial was performed that included 55 patients treated with intravenous ceftriaxone (1 g/24 h) or cefotaxime (1 g/8 h) for at least 3 days. Three fresh stool samples were collected from each patient (days 0, 3, and 7 or at the end of intravenous treatment) to assess the emergence of third-generation cephalosporin (3GC)-resistant Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, Pseudomonas aeruginosa, toxigenic Clostridioides difficile, and vancomycin-resistant enterococci.

RESULTS

The emergence of 3GC-resistant gram-negative enteric bacilli (Enterobacteriaceae) (5.9% vs 4.7%, p > 0.99), Enterococcus spp, and non-commensal microorganisms did not differ significantly between the groups. Both antibiotics reduced the counts of total gram-negative enteric bacilli and decreased the cultivable diversity of the microbiota, but the differences between the groups were not significant.

CONCLUSION

No significant difference was observed between ceftriaxone and cefotaxime in terms of the emergence of resistance.

A comparison of the prophylactic efficacy of ceftriaxone and cefotaxime in abdominal surgery

BACKGROUND

Although ceftriaxone (R) and cefotaxime (C) are highly effective antibiotics, few studies have directly compared their prophylactic efficacy.

METHODS

In a prospective, randomized, double blind study of 1,013 patients undergoing abdominal surgery, the prophylactic use of ceftriaxone and cefotaxime were compared. Intravenous cephalosporin, 1 g, was given at induction of anesthesia, with intravenous metronidazole, 500 mg, also being given for colorectal surgery.

RESULTS

The difference in wound infection (R 8%, C 12%, P <0.05) was due to appendicectomies not receiving metronidazole, (R 6%, C 18%, P <0.03) and was no longer present when these cases were excluded from analysis (R 8%, C 10%). Of note chest and urinary tract infection (R 6%, C 11%, P <0.02) and "any" infection (R 20%, C 27%, P <0.05) were reduced with ceftriaxone.

CONCLUSIONS

Both antibiotics provide comparable wound prophylaxis as long as metronidazole is added for colorectal and appendiceal surgery. Ceftriaxone may be more versatile having the additional apparent benefits of reducing other postoperative infections, being less dependent on metronidazole as an adjunct and providing a more effective prophylactic cover against Staphylococcus aureus.

Cefotaxime. A reappraisal of its antibacterial activity and pharmacokinetic properties, and a review of its therapeutic efficacy when administered twice daily for the treatment of mild to moderate infections

Cefotaxime is well established as an effective and well tolerated antibacterial drug for 3 times daily parenteral treatment of a variety of moderate to severe infections in hospitalised patients. Its frequency of administration has recently been reassessed with a 12-hourly regimen. Comparative studies in hospitalised patients with nosocomial or community-acquired lower respiratory tract infections, demonstrate the similar clinical and bacteriological efficacy of twice daily cefotaxime 1 or 2 g and the same daily dose of ceftriaxone, usually administered once daily. Cefotaxime 2 g twice daily was also similar in efficacy to ceftriaxone 2 g once daily. Retrospective and post-marketing studies also reveal the similar efficacy of cefotaxime administered twice and 3 times daily, and pharmacoeconomic studies suggest that total direct costs of treatment with cefotaxime compared is similar to that with other third generation cephalosporins in currently used dosage regimens. When administered twice daily, cefotaxime is, thus, an effective antibacterial agent for the treatment of hospitalised patients outside the intensive care unit with a variety of mild to moderate non-CNS infections caused by susceptible organisms. When appropriately administered twice daily there is potential to lower the cost of antibacterial treatment without compromising efficacy.

Risk of diarrhoea, Clostridium difficile and cefotaxime in the elderly

Clostridium difficile diarrhoea is an increasingly important nosocomial infection. Clostridium difficile infection is associated with antibiotic use. The elderly are at greatest risk. We reported an outbreak associated with the use of cefotaxime, a third-generation cephalosporin. We review the extent of this association, putative causal mechanisms and suggest an integrated approach to the control of C difficile infection which focuses on both limiting environmental contamination and reducing patient susceptibility. Future developments are also considered, especially the potential for vaccination.

Cefotaxime and desacetylcefotaxime antimicrobial interactions. The clinical relevance of enhanced activity: a review

This presentation reviews 15 years of in vitro, pharmacokinetic, and clinical data concerning the active metabolite of cefotaxime sodium, desacetylcefotaxime. This principle metabolite maintains an antimicrobial activity and spectrum superior to so-called "second-generation" cephalosporins, plus it has an extended serum elimination half-life. Furthermore, it penetrates well into various important body compartments. The metabolite enhances cefotaxime potency by additive or synergistic antimicrobial interactions that can significantly reduce cefotaxime minimum inhibitory concentrations (MICs) among oxacillin-susceptible staphylococci, Streptococcus species including pneumococci resistant to penicillin, anaerobes, enteric bacilli, Pseudomonas aeruginosa, and when tested in human serum, some enterococci. The high activity of cefotaxime alone and the contributions of desacetylcefotaxime to the drug's total antimicrobial value must be considered in reestablishing correct dosing of this "third-generation" cephalosporin. Physicians should use cefotaxime susceptibility tests to direct appropriate, cost-effective dosing and the selection of co-drugs when needed. Moreover, empiric cefotaxime regimen doses should also be reduced for some infections at sites where expected pathogen MICs remain low (< or = 2 micrograms/ml).