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Franco S, Rampersad D, Mesa D, Hammerschlag MR. Treatment options for neonatal infections in the post-cefotaxime era. Expert Rev Anti Infect Ther 2022; 20:1253-1259. [PMID: 35924433 DOI: 10.1080/14787210.2022.2110069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Cefotaxime has been used for the management of neonatal infections since the 1990s for suspected meningitis and to mitigate gentamicin-associated renal injury. Its shortage in 2015 and subsequent removal from the U.S. pharmaceutical market forced providers to consider alternatives. Ceftriaxone, a cephalosporin with an identical antibacterial spectrum of activity to cefotaxime, is contraindicated in neonates due to its risk of biliary pseudolithiasis. Ceftazidime was recommended as an alternative by the American Academy of Pediatrics but is inequivalent. AREAS COVERED : This article addresses indications for cephalosporin use and considerations when selecting an alternative to cefotaxime. Differences among cefotaxime, ceftriaxone, ceftazidime, and cefepime are discussed and compared to the standard-of-care presumptive regimen, ampicillin and gentamicin. The authors consider the data behind the neonatal contraindication to ceftriaxone and provide recommendations for their application to practice. EXPERT OPINION : The data against ceftriaxone use in neonates remain poor, particularly in the context of the cefotaxime shortage and lack of an equivalent alternative. Ceftriaxone could be considered in low-risk neonates without hyperbilirubinemia or exposure to calcium-containing fluids on a case-by-case basis. Ceftazidime monotherapy for presumptive management of neonatal infections is inappropriate; cefepime should be more frequently utilized in neonates who are poor candidates for ceftriaxone.
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Affiliation(s)
| | | | | | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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Arnold CJ, Ericson J, Cho N, Tian J, Wilson S, Chu VH, Hornik CP, Clark RH, Benjamin DK, Smith PB. Cefepime and Ceftazidime Safety in Hospitalized Infants. Pediatr Infect Dis J 2015; 34:964-8. [PMID: 26376308 PMCID: PMC4573537 DOI: 10.1097/inf.0000000000000778] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cefepime and ceftazidime are cephalosporins used for the treatment of serious Gram-negative infections. These cephalosporins are used off-label in the setting of minimal safety data for young infants. METHODS We identified all infants discharged from 348 neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2012 who were exposed to either cefepime or ceftazidime in the first 120 days of life. We reported clinical and laboratory adverse events occurring in infants exposed to cefepime or ceftazidime and used multivariable logistic regression to compare the odds of seizures and death between the 2 groups. RESULTS A total of 1761 infants received 13,293 days of ceftazidime, and 594 infants received 4628 days of cefepime. Laboratory adverse events occurred more frequently on days of therapy with ceftazidime than with cefepime (373 vs. 341 per 1000 infant days, P < 0.001). Seizure was the most commonly observed clinical adverse event, occurring in 3% of ceftazidime-treated infants and 4% of cefepime-treated infants (P = 0.52). Mortality was similar between the ceftazidime and cefepime groups (5% vs. 3%, P = 0.07). There was no difference in the adjusted odds of seizure [odds ratio (OR) = 0.96 (95% confidence interval: 0.89-1.03)] or the combined outcome of mortality or seizures [OR = 1.00 (0.96-1.04)] in infants exposed to ceftazidime versus those exposed to cefepime. CONCLUSIONS In this cohort of infants, cefepime was associated with fewer laboratory adverse events than ceftazidime, although this may have been due to a significant difference in clinical exposures and severity of illness between the 2 groups. There was no difference in seizure risk or mortality between the 2 drugs.
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Affiliation(s)
- Christopher J. Arnold
- Duke Clinical Research Institute, Durham, NC
- Division of Infectious Diseases, Duke University, Durham, NC
| | - Jessica Ericson
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - Nathan Cho
- Duke Clinical Research Institute, Durham, NC
| | - James Tian
- Duke Clinical Research Institute, Durham, NC
| | | | - Vivian H. Chu
- Duke Clinical Research Institute, Durham, NC
- Division of Infectious Diseases, Duke University, Durham, NC
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | | | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - P. Brian Smith
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
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Grossi P, Dalla Gasperina D. Treatment ofPseudomonas aeruginosainfection in critically ill patients. Expert Rev Anti Infect Ther 2014; 4:639-62. [PMID: 17009943 DOI: 10.1586/14787210.4.4.639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Critically ill patients are on the increase in the present clinical setting. Aging of our population and increasingly aggressive medical and therapeutic interventions, including implanted foreign bodies, organ transplantation and advances in the chemotherapy of malignant diseases, have created a cohort of particularly vulnerable patients. Pseudomonas aeruginosa is one of the leading gram-negative organisms associated with nosocomial infections. This organism is frequently feared because it causes severe hospital-acquired infections, especially in immunocompromised hosts, and is often antibiotic resistant, complicating the choice of therapy. The epidemiology, microbiology, mechanisms of resistance and currently available and future treatment options for the most relevant infections caused by P. aeruginosa are reviewed.
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Affiliation(s)
- Paolo Grossi
- University of Insubria, Infectious Diseases Department, viale Borri 57, 21100 Varese, Italy.
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Richard GC, Lepe M. Meningitis in Children: Diagnosis and Treatment for the Emergency Clinician. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2013. [DOI: 10.1016/j.cpem.2013.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
INTRODUCTION The introduction of protein conjugate vaccines for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (S. pneumoniae) and Neisseria meningitidis (N. menigitidis) has changed the epidemiology of bacterial meningitis. Bacterial meningitis continues to be an important cause of mortality and morbidity, and our incomplete knowledge of its pathogenesis and emergence of antimicrobial resistant bacteria contribute to such mortality and morbidity. An early empiric antibiotic treatment is critical for the management of patients with bacterial meningitis. AREAS COVERED This article gives an overview on optimal treatment strategies of bacterial meningitis, along with considerations of new insights on epidemiology, clinical and laboratory findings supportive of bacterial meningitis, chemoprophylaxis, selection of initial antimicrobial agents for suspected bacterial meningitis, antimicrobial resistance and utility of new antibiotics, status on anti-inflammatory agents and adjunctive therapy, and pathogenesis of bacterial meningitis. EXPERT OPINION Prompt treatment of bacterial meningitis with an appropriate antibiotic is essential. Optimal antimicrobial treatment of bacterial meningitis requires bactericidal agents able to penetrate the blood-brain barrier (BBB), with efficacy in cerebrospinal fluid (CSF). Several new antibiotics have been introduced for the treatment of meningitis caused by resistant bacteria, but their use in human studies has been limited. More complete understanding of the microbial and host interactions that are involved in the pathogenesis of bacterial meningitis and associated neurologic sequelae is likely to help in developing new strategies for the prevention and therapy of bacterial meningitis.
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Affiliation(s)
- Seon Hee Shin
- Johns Hopkins University School of Medicine, 200 North Wolfe Street, Room 3157, Baltimore, MD 21287, USA
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6
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Clinical Practice Guidelines for the Management of Bacterial Meningitis in Adults in Korea. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.3.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
The approach to therapy in patients with pneumococcal meningitis has changed considerably over the past 20 years. Given the emergence of pneumococcal strains that are intermediately susceptible or highly resistant to penicillin, penicillin is not recommended as empiric therapy for presumed pneumococcal meningitis; the combination of vancomycin and a third-generation cephalosporin (either cefotaxime or ceftriaxone) should be used, pending isolation of the organism and in vitro susceptibility testing. For patients with pneumococcal meningitis caused by highly penicillin- or cephalosporin-resistant strains, the addition of rifampin can be considered if the organism is susceptible in vitro, the expected clinical or bacteriologic response is delayed, or the pneumococcal isolate has a cefotaxime or ceftriaxone minimal inhibitory concentration greater than 4 μg/mL. Meropenem is not a good option for monotherapy of highly penicillin- or cephalosporin-resistant strains, but use of a fluoroquinolone with in vitro activity against Streptococcus pneumoniae (specifically moxifloxacin) is an option in patients failing standard therapy; if used, however, it should be combined with a third-generation cephalosporin or vancomycin. Newer glycopeptides, daptomycin, and linezolid require further study to determine their efficacy in patients with pneumococcal meningitis.
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Adderson EE, Flynn PM, Hoffman JM. Efficacy and safety of cefepime in pediatric patients: a systematic review and meta-analysis. J Pediatr 2010; 157:490-5, 495.e1. [PMID: 20434167 DOI: 10.1016/j.jpeds.2010.03.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 02/24/2010] [Accepted: 03/17/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We systematically reviewed clinical trials on the safety and efficacy of cefepime in pediatric patients in view of recent reports, which suggested that cefepime is associated with increased 30-day all-cause mortality rates. STUDY DESIGN We searched the Cochrane Central Registry of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and other published and unpublished sources. Randomized clinical trials of cefepime in patients<19 years of age were selected. RESULTS Sixteen clinical trials were included. All-cause mortality rates did not differ between cefepime and comparator groups (risk difference, 0.00; 95% CI, -0.01-0.02). The risks of overall clinical failure (relative risk, 0.93; 95% CI, 0.82-1.04; P>.05) and failure in microbiologically confirmed infections (relative risk, 0.91; 95% CI, 0.68-1.22; P>.05) were not greater in subjects treated with cefepime. Rates of adverse events were similar in each group in all trials except 1. All studies had significant methodological flaws. CONCLUSIONS Comparisons of the safety and efficacy of cefepime relative with other antimicrobial agents in pediatric patients are limited by small numbers of trials and enrolled subjects and poor study methodology. This review, however, suggests that cefepime therapy in pediatric patients is not associated with an increased risk of adverse outcomes.
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Affiliation(s)
- Elisabeth E Adderson
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis TN 38105, USA.
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Abstract
Bacterial meningitis continues to be an important disease throughout the world and can be a life-threatening emergency if not suspected, appropriately diagnosed and managed expeditiously. The epidemiology of bacterial meningitis has changed dramatically over the last 20 years, primarily as a result of the introduction of conjugate vaccines against the common meningeal pathogens, such that in the developed world where vaccination is routinely utilized, bacterial meningitis has become a disease of adults rather than of infants and children. The management approach to patients with suspected or proven bacterial meningitis includes emergent cerebrospinal fluid analysis and initiation of appropriate antimicrobial and adjunctive therapies. The choice of empirical antimicrobial therapy is based on the patient's age and underlying disease status; once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment. Many patients with suspected or proven bacterial meningitis should also receive adjunctive dexamethasone therapy. This is based on experimental animal model data which demonstrated that the subarachnoid space inflammatory response that results from antimicrobial-induced bacterial lysis can contribute to morbidity and mortality. Clinical studies have demonstrated the benefit of adjunctive dexamethasone in infants and children with Haemophilus influenzae type B meningitis, and adults with pneumococcal meningitis, in which mortality and adverse outcome are reduced. Use of adjunctive dexamethasone in adults with meningitis caused by other bacteria, and in infants and children with pneumococcal meningitis, is controversial. To be effective, adjunctive dexamethasone should be administered concomitant with or just prior to the first antimicrobial dose for maximal effect on the subarachnoid space inflammatory response.
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Affiliation(s)
- Yuliya Nudelman
- Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey 07740, USA
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Miranda J, Tunkel AR. Strategies and new developments in the management of bacterial meningitis. Infect Dis Clin North Am 2010; 23:925-43, viii-ix. [PMID: 19909891 DOI: 10.1016/j.idc.2009.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The principles of antimicrobial therapy for acute bacterial meningitis include use of agents that penetrate well into cerebrospinal fluid and attain appropriate cerebrospinal fluid concentrations, are active in purulent cerebrospinal fluid, and are bactericidal against the infecting pathogen. Recommendations for treatment of bacterial meningitis have undergone significant evolution in recent years, given the emergence of pneumococcal strains that are resistant to penicillin. Clinical experience with use of newer agents is limited to case reports, but these agents may be necessary to consider in patients who are failing standard therapy.
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Affiliation(s)
- Justine Miranda
- Department of Internal Medicine, Division of Infectious Diseases, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA
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Haas H. Antibiothérapie d’une méningite présumée bactérienne de l’enfant (rationnel, modalités, durée, suivi). Med Mal Infect 2009; 39:647-58. [DOI: 10.1016/j.medmal.2009.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Cefepime is a fourth-generation cephalosporin usually reserved for treating severe nosocomial pneumonia, as well as empirical treatment of febrile neutropenia, uncomplicated and complicated urinary tract infections, uncomplicated skin and skin structure infections, and complicated intra-abdominal infections. OBJECTIVE Since reports of neurotoxic effects and of an all-cause mortality higher with cefepime than with comparators have created some concerns regarding its safety, this paper reviews data available in the PubMed database up to December 2007 on cefepime safety. METHODS Literature data from PubMed obtained by combining cefepime and safety, or cefepime and clinical trials, were examined. RESULTS/CONCLUSIONS Caution in the use of cefepime should be adopted until new evidence on cefepime safety is available.
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Affiliation(s)
- Lorenzo Drago
- University of Milan, Laboratory of Clinical Microbiology, Department of Preclinical Science, LITA Vialba, Via GB Grassi 74, 20157 Milan, Italy.
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Lodise TP, Nau R, Kinzig M, Jones RN, Drusano GL, Sörgel F. Comparison of the probability of target attainment between ceftriaxone and cefepime in the cerebrospinal fluid and serum against Streptococcus pneumoniae. Diagn Microbiol Infect Dis 2007; 58:445-52. [PMID: 17512154 DOI: 10.1016/j.diagmicrobio.2007.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 03/16/2007] [Indexed: 11/29/2022]
Abstract
Although the disposition of ceftriaxone and cefepime in the cerebrospinal fluid (CSF) has been described, the ability of these agents to achieve critical pharmacodynamic targets against Streptococcus pneumoniae in CSF has not been reported. Plasma and CSF pharmacokinetic data were obtained from hospital patients with external ventricular drains and receiving ceftriaxone or cefepime. Concentration-time profiles in plasma and CSF were modeled using a 3-compartment model with 0-order infusion and 1st-order elimination and transfer. The model parameters were identified with population pharmacokinetic analysis (Big Non-Parametric Adaptive Grid with adaptive gamma). A Monte Carlo Simulation (9999 subjects) estimated the probability of target attainment (PTA) for total drug CSF concentrations at 50% and 100% T>MIC for ceftriaxone 2G IV Q12H and cefepime 2G IV Q8H. The S. pneumoniae bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (USA) provided the distribution of contemporary (2003-2004) MICs. Post-Bayesian measures of bias and precision, observed-predicted plots, and R2 values were highly acceptable for both drugs. The probabilities of achieving 50% and 100% T>MIC in the CSF for ceftriaxone were 76% and 65%, respectively. For cefepime, the PTA at 50% and 100% T>MIC in the CSF were 91.8% and 82%, respectively. The CSF pharmacodynamics against S. pneumoniae for cefepime were superior to that of ceftriaxone. The implications of these findings need to be reexamined in the clinical setting.
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Affiliation(s)
- Thomas P Lodise
- Institute for Biomedical and Pharmaceutical Research, Nürnberg-Heroldsberg, 90562 Germany
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Jones RN, Sader HS, Fritsche TR, Pottumarthy S. Comparisons of parenteral broad-spectrum cephalosporins tested against bacterial isolates from pediatric patients: report from the SENTRY Antimicrobial Surveillance Program (1998–2004). Diagn Microbiol Infect Dis 2007; 57:109-16. [PMID: 16930923 DOI: 10.1016/j.diagmicrobio.2006.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A contemporary collection of 12737 strains from pediatric patients (<18 years) isolated over a 7-year period (1998-2004) from 52 sentinel hospitals in North America was tested to determine the comparative antimicrobial potency of broad-spectrum parenteral cephalosporins and selected comparator agents. Most of the strains (84.1%) were isolated from blood stream or respiratory tract infections. The rank order of the top 10 pediatric pathogens analyzed was Streptococcus pneumoniae (15.5%) >Haemophilus influenzae (14.6%) >Staphylococcus aureus (13.8%) >Moraxella catarrhalis = coagulase-negative staphylococci (8.0%) >Escherichia coli (7.8%) >Pseudomonas aeruginosa (5.2%) >Klebsiella spp. (4.8%) >Enterococcus spp. (4.7%) > beta-hemolytic streptococci (4.4%). Both cefepime and ceftriaxone (MIC(90), 1 microg/mL; 93.9% and 93.7% susceptible, respectively) were highly active against S. pneumoniae. However, the S. pneumoniae strains showed reduced susceptibility to ceftazidime (56.6%), as well as penicillin (56.6%) < trimethoprim-sulfamethoxazole (57.1%) < erythromycin (66.2%) < tetracycline (71.4%). beta-Hemolytic streptococci showed 100.0% susceptibility to penicillin, cefepime, and ceftriaxone. Cefepime and ceftriaxone exhibited high activity against oxacillin (methicillin)-susceptible S. aureus, (MIC(90), 4 microg/mL; 100.0% and 99.8% susceptible, respectively), whereas ceftazidime (MIC(90), 16 microg/mL) was active against only 86.7% of strains. H. influenzae strains showed complete susceptibility to cefepime, ceftriaxone, and levofloxacin (MIC(90), < or =0.5 microg/mL; 100.0%), and 34.0% of H. influenzae and 99.2% of M. catarrhalis strains produced beta-lactamase. Although the 3 cephalosporins tested (cefepime, ceftriaxone, and ceftazidime) were very active (98.6-99.6% susceptible) against E. coli, cefepime (99.0% susceptible) was slightly more active than ceftriaxone and ceftazidime (96.4% and 95.1% susceptible, respectively) against Klebsiella spp. Cefepime was also the most active beta-lactam agent tested against Enterobacter spp. (MIC(90), 2 microg/mL; 99.3% susceptible), whereas the susceptibility rates of other broad-spectrum beta-lactams (ceftriaxone, ceftazidime and piperacillin-tazobactam) were significantly lower (78.4-81.5%). Against P. aeruginosa, imipenem and piperacillin-tazobactam showed the highest susceptibility rates (94.4% and 93.3%, respectively), whereas imipenem and cefepime showed the lowest resistance rates (1.4% and 2.3%, respectively). Our results indicate that cefepime was the most broad-spectrum cephalosporin analyzed and remains a very potent alternative for the treatment of contemporary pediatric infections in North America.
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Affiliation(s)
- Ronald N Jones
- JMI Laboratories, 345 Beaver Kreek Centre, North Liberty, IA 52317, USA.
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Lodise TP, Rhoney DH, Tam VH, McKinnon PS, Drusano GL. Pharmacodynamic profiling of cefepime in plasma and cerebrospinal fluid of hospitalized patients with external ventriculostomies. Diagn Microbiol Infect Dis 2006; 54:223-30. [PMID: 16423490 DOI: 10.1016/j.diagmicrobio.2005.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 09/22/2005] [Indexed: 11/26/2022]
Abstract
Population pharmacokinetic (PK) modeling and Monte Carlo simulation (MCS) were used to describe the pharmacodynamic profile of cefepime in the both plasma and cerebrospinal fluid (CSF). Plasma and CSF cefepime data were obtained from a PK study of 7 hospitalized patients with external ventricular drains. Concentration-time profiles in plasma and CSF were modeled using a 3-compartment model with zero-order infusion and first-order elimination and transfer. Estimates of the PK parameters were identified in the Big Non Parametric Adaptive Grid with adaptive gamma (BigNPAG) program of Leary, Jelliffe, Schumitzky, and Van Guilder. MCS (10,000 subjects) was performed to estimate the probability of attaining the targets of free plasma concentration (20% protein binding) and total drug CSF concentration of 50-100% T>minimal inhibitory concentration (MIC) for MICs 0.06-8 mg/L for cefepime 2 g, iv, every 8 h (0.5-h infusion); cefepime 2 g, iv, every 12 h (0.5-h infusion); and cefepime 2 g (0.5-h infusion) once and 250 mg/h continuous infusion. After the Bayesian step, the observed-predicted regression and r(2) for plasma and CNS were as follows: plasma, observed=0.984 x predicted+2.570, r(2)=0.944; CSF, observed=0.785 x predicted+0.868, r(2)=0.821. The median penetration of cefepime as measured by AUC(CSF)/AUC(plasma) was 7.8%. In the MCS, the target attainment rates in plasma for 60-70% fT>MIC were high at each MIC value between 0.03 and 8 microg/mL for each regimen examined. In CSF, none of the regimens achieved 50-100% T>MIC for>80% of patients for MICs>0.5 mg/L.
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Affiliation(s)
- Thomas P Lodise
- Department of Pharmacy Practice, Albany College of Pharmacy, Albany, NY 12208, USA.
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Sinner SW, Tunkel AR. Antimicrobial agents in the treatment of bacterial meningitis. Infect Dis Clin North Am 2004; 18:581-602, ix. [PMID: 15308277 DOI: 10.1016/j.idc.2004.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The use of antimicrobial agents in the treatment of acute bacterial meningitis has undergone significant changes in recent years. There is a wealth of in vitro and animal model data that support the use of the specific antimicrobial agents in the treatment of bacterial meningitis, although not all regimens have been evaluated in clinical trials. Recent investigations have focused on expanding the potential antimicrobial formulary to manage patients with bacterial meningitis effectively in this era of increasing antimicrobial resistance. Despite these advances, the morbidity and mortality of acute bacterial meningitis remain unacceptably high. The use of adjunctive dexamethasone has been shown to improve morbidity and mortality in patients with bacterial meningitis, although concerns have been raised that dexamethasone may reduce penetration of certain antimicrobial agents into cerebrospinal fluid.
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Affiliation(s)
- Scott W Sinner
- Division of Infectious Diseases, Drexel University College of Medicine, 245 North 15th Street, Mail Stop 487, Philadelphia, PA 19102-1101, USA
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Haase MR. Acute Bacterial Meningitis in Children. J Pharm Pract 2004. [DOI: 10.1177/0897190004270422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite advances in recent decades in management, including new and effective antimicrobials, children with bacterial meningitis still incur significant morbidity and mortality. Pathophysiologic processes including colonization and migration of the bacteria to blood, seeding of the meninges, and meningeal and brain inflammation have been largely elucidated, but more specific knowledge could lead to new effective therapies. Outside of the neonatal period, the most common causative organisms have been Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis. However, conjugate vaccines, especially the H influenzae type b preparation, have contributed significantly to steep declines in the incidence of meningitis. Optimal management consists of rapid diagnosis and administration of bactericidal antibiotics with properties allowing adequate penetration of the inflamed blood-brain barrier. Recently, development of microbial resistance has resulted in changes to recommended empiric antibiotic regimens. Novel therapies are under investigation; however, until controlled trials can be conducted, these therapies cannot be recommended.
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Affiliation(s)
- Mark R. Haase
- Texas Tech University, HSC School of Pharmacy, 1300 S. Coulter, Suite 206, Amarillo, TX 79106-1712
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Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267-84. [PMID: 15494903 DOI: 10.1086/425368] [Citation(s) in RCA: 1237] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Accepted: 08/25/2004] [Indexed: 12/11/2022] Open
Affiliation(s)
- Allan R Tunkel
- Drexel University College of Medicine, Philadelphia, PA 19129, USA.
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Abstract
The treatment of pneumococcal meningitis remains a major challenge, as reflected by the continued high morbidity and case fatality of the disease. The worldwide increase of penicillin-resistant pneumococci and more recently cephalosporin- and vancomycin-tolerant pneumococci has jeopardised the efficacy of standard treatments based on extended spectrum cephalosporins alone or in combination with vancomycin. This review provides a summary of newly developed antibiotics tested in the rabbit meningitis model. In particular, newer beta-lactam monotherapies (cefepime, meropenem, ertapenem), recently developed quinolones (garenoxacin, gemifloxacin, gatifloxacin, moxifloxacin) and a lipopeptide antibiotic (daptomycin) are discussed. A special emphasis is placed on the potential role of combination treatments with some of the new compounds, which are of interest based on the background of increasing resistance problems due to their often synergistic activity in the rabbit model of pneumococcal meningitis.
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Affiliation(s)
- P H Cottagnoud
- Department of Internal Medicine, Inselspital, Bern, Switzerland.
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Abstract
This review comprises aspects of the epidemiology, microbiology, pathophysiology, clinical manifestations, diagnosis, management, prognosis, and prevention of bacterial meningitis, with emphasis on the paediatric population. The beginning of this millennium has witnessed the virtual disappearance of Haemophilus invasive disease in some countries, emergence of pneumococcal strains that are resistant to multiple antibiotics, isolation of pneumococci with tolerance to vancomycin, outbreaks and clusters of meningococcal meningitis in several geographical areas, and intense research in development of effective conjugate pneumococcal and meningococcal vaccines. Bacterial meningitis has become an uncommon disease in the developed world. Unfortunately, because of limited economic resources and poor living conditions, many developing countries are still affected by the devastating consequences of this life-threatening systemic infection. Basic and clinical research is needed to discover new antimicrobial and anti-inflammatory agents to improve outcome from disease. Novel strategies are needed to distribute and implement effective vaccines worldwide to prevent bacterial meningitis.
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Affiliation(s)
- Xavier Sáez-Llorens
- University of Panama School of Medicine, Hospital del Niño, Panama City, Panama.
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Abstract
Brain abscess is a relatively uncommon but life-threatening infection in children. It can originate from contiguous site infections (eg, chronic otitis media, mastoiditis, sinusitis, meningitis), from distant pathologic states (eg, cyanotic congenital heart disease, chronic lung infections), after head trauma or neurosurgical procedures, or from cryptogenic sources. Predominant etiologic microorganisms vary depending on these predisposing factors. Computed tomography and magnetic resonance imaging are essential tools that enable the physician to make an accurate diagnosis of intracranial purulent collections. Proper selection of antimicrobial agents with good penetration of the central nervous system and with adequate coverage of both anaerobic and aerobic bacteria is critical for the medical management of brain abscess. Delay in surgical drainage can be associated with high morbidity and case-fatality rates. In the early phase of cerebritis, however, infection can respond to antibiotic therapy alone. Advances in diagnostic and therapeutic modalities during the last decade have improved the prognosis of this serious disease.
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Affiliation(s)
- Xavier Sáez-Llorens
- University of Panamá School of Medicine, Hospital del Niño, Panama City, Panamá.
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Rhoney DH, Tam VH, Parker D, McKinnon PS, Coplin WM. Disposition of cefepime in the central nervous system of patients with external ventricular drains. Pharmacotherapy 2003; 23:310-4. [PMID: 12627928 DOI: 10.1592/phco.23.3.310.32108] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To assess central nervous system (CNS) penetration of cefepime in adults with external ventricular drains and to compare the achieved cerebrospinal fluid (CSF) concentrations with the usual minimum inhibitory concentrations (MICs) of common pathogens. DESIGN Open-label, prospective study. SETTING University-affiliated medical center. PATIENTS Seven patients with external ventricular drains and normal renal function (documented creatinine clearance > 60 ml/min) who received cefepime 2 g intravenously every 12 hours for treatment of nosocomial pneumonia. INTERVENTION Serial serum and CSF samples were obtained concurrently after the fourth dose during one dosing interval. MEASUREMENTS AND MAIN RESULTS The concentration-time profiles in serum and CSF were comodeled by using a two-compartment model with zero-order infusion to the central compartment. The CSF concentration-time profiles of the individual patients were compared with published MIC90 of common pathogens isolated in nosocomial meningitis. Our model reasonably characterized the disposition of cefepime in serum and CSF. Penetration into the CNS was 4-34% based on area under the curve and was 5-58% based on minimum concentration. CONCLUSION Penetration of cefepime into the CNS was variable among the patients (4-34%) but appeared similar to that reported for other cephalosporins given to treat meningitis. The concentrations attained by most patients in this study were above the MIC90 of many common nosocomial organisms.
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Affiliation(s)
- Denise H Rhoney
- Department of Pharmacy Practice, Wayne State University College of Pharmacy and Allied Health Professions, Detroit, Michigan 48201, USA.
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25
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Garau J, Martínez-Lacasa X. [Betalactam resistant Streptococcus pneumoniae and management of pneumococcal meningitis]. Enferm Infecc Microbiol Clin 2003; 21:3-6. [PMID: 12550037 DOI: 10.1016/s0213-005x(03)72867-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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