Cefuroxime therapy for urinary tract infections caused by a multi-resistant, epidemic Klebsiella aerogenes

Influence of Antibiotic Administration on the Urinary Bladder Cancer Early Recurrence Rate

Bladder cancer tends to recur, making treatment one of the most expensive in oncology. The limited efficacy and high cost of adjuvant therapies in the treatment of bladder cancer prompt research on new drugs which could replace them. In vitro studies have established that antibiotics can have a cytostatic and cytotoxic effect on urinary bladder cancer cells. The objective of the study was to investigate the influence of antibiotics on the recurrence rate of bladder cancer. In a retrospective study, we analyzed a group of 199 patients with urinary bladder cancer from four urological centers. The study groups consisted of 40 patients who received ciprofloxacin and 83 patients who received beta-lactams as perioperative antimicrobial prophylaxis. The control group included 76 patients who did not get perioperative antimicrobial prophylaxis. The groups were analyzed for risk stratification, degree of malignancy, and size of the primary tumor. The average follow-up time was 24 months. The main focus of the study was to investigate the early recurrence rate of bladder cancer among studied groups, which could correlate with the effectiveness of currently used intravesical instillations. Additionally, cancer’s early progression was examined. Regardless of the division used, the highest recurrence rate was found in the ciprofloxacin group. There were no statistical differences in the recurrence rate between patients who received beta-lactams and patients who did not receive any antibiotics. In addition, there were no differences due to the progression rate between the groups. Perioperative antibiotic administration does not influence the early recurrence rate in patients with nonmuscle invasive urothelial bladder cancer.

Cephalosporin-induced nephrotoxicity: does it exist?

The literature has been reviewed to determine whether cephalosporins have been implicated in causing nephrotoxicity and to assess the influence of concomitant aminoglycoside therapy. Animal and human data have implicated cephaloridine and cephalothin in causing nephrotoxicity, both alone and in combination with aminoglycosides. There are few data implicating other cephalosporins in causing nephrotoxicity. Cefazolin, which is nephrotoxic in animals, has not been reported to produce nephrotoxicity in humans. Two studies have documented nephrotoxicity due to ceftazidime, especially in patients with preexisting renal impairment. Such patients should have their dosage adjusted to minimize ceftazidime-induced renal impairment. Finally, cephalosporins other than cephaloridine and cephalothin have not been documented to increase the risk of nephrotoxicity when used in combination with aminoglycosides compared with aminoglycosides alone.

Review of the new second-generation cephalosporins: cefonicid, ceforanide, and cefuroxime

The new second-generation cephalosporins, cefonicid, ceforanide, and cefuroxime, have recently become available. These agents are generally less active against gram-positive cocci than first-generation cephalosporins and, at best, equal to cefoxitin and cefamandole against many gram-negative bacteria. Cefuroxime, however, is the most active cephalosporin for beta-lactamase-producing Haemophilus influenzae. These newer agents have superior pharmacokinetic characteristics over cefoxitin and cefamandole. Smaller doses, longer dosing intervals and, potentially, a reduction in total drug cost may be the real advantage of these agents. Open trials and a limited number of comparative studies have documented the effectiveness of cefonicid, ceforanide, and cefuroxime in the treatment of most mild-to-serious infectious diseases, although failures with cefonicid in the treatment of staphylococcal infections have been reported. Notably, cefuroxime has received approval for the treatment of common pediatric bacterial meningitis infections. Replacement of cefamandole or cefoxitin with one of these "longer-acting" agents may be cost-beneficial; however, clinicians must be on alert for the development of bacterial resistance or decreased efficacy.

Antibacterial activity of five cephalosporins

The in vitro susceptibilities of 7 commonly isolated species of bacteria to cephalothin, cefoxitin, and 3 new cephalosporins--cephamandole, cefuroxime, and cefoperazone--were studied using an agar dilution method. Cephalothin and cephamandole were the most active agents against staphylococci. Against members of the Enterobacteriaceae all the newer agents were more active than cephalothin; however, important individual differences emerged. Only cefoperazone had significant activity against Pseudomonas aeruginosa.

A survey of the sensitivity of fresh clinical isolates to cefuroxime and other antibiotics

The sensitivities to cefuroxime and cephradine of potentially pathogenic bacteria isolated in two British general hospitals comprising 900 beds have been assessed. In a three-month period 2537 strains were studied; 30 microgram cefuroxime discs were used with 2511 strains, and cephradine discs of the same strength were used with 2525 strains. The organisms were also examined routinely for sensitivity to other antibiotics. Overall, 91.7% of the isolates were sensitive to cefuroxime and 85.8% were inhibited by cephradine, the differences in percentage strain susceptibility to cefuroxime and cephradine being mainly a result of the greater activity of cefuroxime against the Gram-negative bacteria. The wide antibacterial effectiveness of cefuroxime should make it a useful antibiotic for the treatment of serious infections including those conditions in which the causative organism has not been identified.