Prospective comparison of prophylactic antibiotic use between intravenous moxifloxacin and ceftriaxone for high-risk patients with post-ERCP cholangitis

BACKGROUND: The use of prophylactic antibiotics before endoscopic retrograde cholangiopancreatography(ERCP) is recommended by all major international gastroenterological societies, especially in the presence of an obstructed biliary system. This study compared the occurrence rate of post-procedural complications, including cholangitis and septicemia between prophylactic intravenous moxifloxacin and ceftriaxone in patients with bile duct obstruction scheduled for therapeutic ERCP.METHODS: From November 2013 to July 2015, 86 consecutive patients with biliary obstruction with one or more factors predicting benefits of antibiotic prophylaxis prior to ERCP were included in the current randomized open-label non-inferiority trial(Clinical Trial.gov identifier NCT02098486). Intravenous moxifloxacin(400 mg/day) or ceftriaxone(2 g/day)were given 90 minutes before ERCP, and were administered for more than 3 days if the patient developed symptoms and signs of cholangitis or septicemia. Recalcitrant cholangitis was defined as persistence of cholangitis for more than 5 days after ERCP or recurrence of cholangitis within 30 days after ERCP.RESULTS: Recalcitrant cholangitis occurred in 1(2.3%) and 2(4.8%) patients receiving intravenous moxifloxacin and ceftriaxone group, respectively(P=0.612). Septicemia was noted in1(2.3%) and 1(2.4%) patient in intravenous moxifloxacin and ceftriaxone group, respectively(P=1.0). The mean hospital stay was also not significantly different between the moxifloxacin and ceftriaxone groups(8.8±7.2 vs 9.1±9.4 days, P=0.867). Antibiotic resistance of the isolated pathogens by in vitro activity assay was noted in 1(2.3%) and 2(4.8%) patients in the moxifloxacin and ceftriaxone group, respectively(P=0.612). CONCLUSION: Intravenous moxifloxacin is not inferior to intravenous ceftriaxone for the prophylactic treatment of post-ERCP cholangitis and cholangitis-associated morbidity.

Comparative efficacy of levofloxacin and ceftriaxone in the treatment of community acquired pneumonia in children

Pneumonia is a common cause of mortality and morbidity in under-5 children throughout the world. Globally an estimated 156 million new episodes of pneumonia occur each year in children and 2 million children die from pneumonia each year which is 20 percent of all deaths of children under five years old. Ceftriaxone is a commonly used drug for empiric treatment of community acquired pneumonia (CAP) in children. Levofloxacin may be an adequate option for empiric therapy in treatment of CAP in children because it gives the broad spectrum activity against both bacterial and atypical pathogens causing CAP and studies suggest that it can be safely used in children. This open labeled, randomized, comparative clinical trial was carried out in the Department of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Bangladesh during January, 2011 & December, 2012 to compare the efficacy of levofloxacin and ceftriaxone in the treatment CAP in children. A total 70 cases of CAP were enrolled. 35 cases were allocated to levofloxacin group and another 35 cases to ceftriaxone group. At first the study cases were selected by systematic random sampling. Group allocation to either levofloxacin or ceftriaxone group was done by lottery method. Total duration for receiving study drugs was seven days. Dose of levofloxacin was 10 mg/kg/day children ≥5 years, where as it was 10 mg/kg 12 hourly in 6 months to <5 years age groups. Dose of ceftriaxone was 75 mg/kg/day. Response to treatment was assessed initially after 3 days and also after 7 days by clinical symptoms and signs. Clinical cure rate was determined by disappearance of the clinical signs and symptoms of pneumonia and resolution of radiological findings reported at admission. Clinical responses were categorized as cured and treatment failure. 91.43% cases were cured in levofloxacin group, whereas cure rate of ceftriaxone group was 68.57% which was statistically significant (p = 0.0168). Adverse effects of levofloxacin were found as skin rash in 1 case and vomiting in 2 cases whereas skin rash was found in 1 case in ceftriaxone group. So it can be concluded that levofloxacin is more effective than ceftriaxone in the treatment of CAP in children.

Leukocytoclastic Vasculitis Following Ceftriaxone Exposure

Leukocytoclastic vasculitis (LCV) is an immune-complex mediated inflammation of dermal capillaries and venules that can occur after infections, drugs, autoimmune disorders, neoplasms, or idiopathically. We present the case of a 59-year-old male who was treated with ceftriaxone for an abscess, S. aureus cellulitis, and osteomyelitis of his right second toe. Biopsy confirmed the diagnosis of LCV and symptoms resolved after ceftriaxone was discontinued and systemic corticosteroids were introduced.

Evaluation of Prophylaxis with Norfloxacin and Ceftriaxone versus Ciprofloxacin during the Period of Neutropenia after Haematopoietic Stem Cell Transplantation:Retrospective Analysis of Two Sequencial Cohorts

Background: The aim of this study was to evaluate the occurrence of febrile neutropenia (FN) during aplasia after haematopoietic stem cell transplantation (HSCT) in patients who received anti-bacterial prophylaxis with norfloxacin/ceftriaxone or ciprofloxacin, between September 2006 and May 2009. Methods: We retrospectively examined all patients undergoing HSCT at S?o Paulo Hospital during the study period. Results: Of the 107 studied patients, 71 (66.3%) were included in the analysis. The exclusion criteria were as follows: occurrence of fever or infection before the transplantation (17), prophylactic use of norfloxacin (6), fever of probable non-infectious aetiology (2), and absence of prophylaxis during the aplasia period (11). Thirty-eight patients received norfloxacin and ceftriaxone as prophylaxis (Group I) and 33 received ciprofloxacin (Group II). The groups were comparable with respect to age, underlying diseases, comorbidities, and status of the underlying disease. Patients in Group II used antibiotics in a significantly higher frequency than those in Group I (66.7% vs 33.8%, p = 0.017), for 30 days before transplantation. The number of previous hospitalisations, length of hospitalisation until transplantation, type of transplant, progenitor cells used, number of CD34 cells infused, type of conditioning, and graft-versus-host disease prophylaxis were similar in both groups. After the transplantation, 28.9% and 39.4% of the patients in Groups I and II, respectively, presented Grade III and IV mucositis (p = 0.448). Neutropenia of <500 neutrophils/mm3 lasted an average of 9.5 and 9.3 days in Groups I and II, whereas neutropenia of <100 neutrophils/mm3 lasted between 6.6 and 5.7 days. FN occurred in 78.9% of patients in Group I and 81.8% in Group II, with no significant difference in the classification of these episodes. Six patients (15.8%) in Group I and five (15.2%) in Group II had bacteraemia. All patients who did not receive prophylaxis developed FN. Conclusions: The high incidence and classification of FN episodes were similar between groups;however, the frequency was lower than in those patients who did not receive prophylaxis.

Global Transmission of the penA Allele 60.001–Containing High-Level Ceftriaxone-Resistant Gonococcal FC428 Clone and Antimicrobial Therapy of Associated Cases:A Review

Neisseria gonorrhoeae is a multidrug-resistant bacterial pathogen for which ceftriaxone is the only remaining recommended first-line therapy.However,ceftriaxone susceptibility has been waning in a number of countries over the last decade and ceftriaxone treatment failures have been reported,commonly as a result of sporadic high-level ceftriaxone-resistant strains.In recent years,N.gonorrhoeae strains associated with the high-level ceftriaxone-resistant FC428 clone or strains that acquired its main ceftriaxone resistance determinant,penA allele 60.001,have shown global transmission,resulting in ceftriaxone treatment failure in a number of cases.The FC428 clone was first encountered in Japan in 2015 and subsequently in China,Europe,Australia,North America and Southeast Asia afterward.Strains associated with the FC428 clone commonly display a ceftriaxone minimum inhibitory concentration of 0.5-1 mg/L.However,where penA alleles encountered in sporadic high-level ceftriaxone-resistant isolates induce an in vitro growth defect,penA allele 60.001 does not seem to affect in vitro growth.The limited impact of penA allele 60.001 on biological fitness might be associated with its successful global transmission.Although the FC428 clone displays high-level ceftriaxone resistance,most gonorrhea cases associatedwith this clone were still successfully curedwith ceftriaxonewhen intramuscular or intravenous doses of 500mg to 2 g were used.A successful alternative therapy seems to be ertapenem given at 1-g doses,although further clinical studies are required to validate ertapenemefficacy.This review summarizes the global transmission of strains associated with the FC428 clone and antimicrobial treatment of associated cases.

Ertapenem versus ceftriaxone for the treatment of complicatedinfections： a meta-analysis of randomized controlled trials

Background Ertapenem has been demonstrated to be highly effective for the treatment of complicated infections. Theaim of this study was to compare the efficacy and safety of ertapenem with ceftriaxone.

Granulicatella adiacens Infective Endocarditis Treated With Teicoplanin and Ceftriaxone:A Case Report

We describe a case of infective endocarditis(IE)caused by Granulicatella adiacens in a patient who had fever for 4months before admission.He had a complex medical history of active hyperthyroidism and schizophrenia,which might have misled the clinician in ignoring the existence of a serious infection like IE.A history of splenectomy and the likelihood of congenital cardiac valve deficiency were the possible underlying risk factors.His persistent leukocytosis perplexed our judgement in terms of resolution of infection and treatment efficacy,which was probably due to his splenectomy.C-reactive protein was the alternative laboratory indicator.Clinical and Laboratory Standards Institute criteria have not been established for the fastidious G.adiacens.Therefore,we referred to the viridans group streptococci and literature to evaluate antimicrobial susceptibility testing.We suggest that teicoplanin combined with ceftriaxone could serve as an effective therapy for IE caused by G.adiacens.

In vitro activity of allicin combined with two antibiotics on intestinal Shigella

Objective: We aimed to evaluate the combined antibacterial effects of allicin in combination with levofloxacin and ceftriaxone on Shigella isolated from the intestinal tract in vitro. Materials and Methods: Using a checkerboard design, broth microdilution assay was used to test the effects of the compounds on the organism. We also determined the MIC of the two groups of antibacterial drugs against 30 strains of Shigella and calculated the fractional inhibitory concentration(FIC) index, to judge the combination effect. Result: After the combined application of allicin and ceftriaxone the MIC decreased significantly. Distribution of the FIC index was as follows: FIC ≤0.5, accounting for 10%; 0.5< FIC ≤1.0, accounting for 60%; 1 < FIC ≤2, accounting for 30%; FIC >2, percentage is zero. After combined application of allicin and levofloxacin, distribution of FIC index was as follows: FIC≤0.5, ratio is zero; 0.5< FIC ≤1, accounting for 56.7%; 1 < FIC ≤2, accounting for 43.3%; FIC >2, ratio is zero. Conclusion: After the combined use of ceftriaxone, levofloxacin, and allicin, most of the tests showed synergistic effects and additive effects on Shigella, while some of them showed no correlation and no antagonistic effect.

Nano-Coupling of Cephalosporin Antibiotics with Fe<SUB>3</SUB>O<SUB>4</SUB>Nanoparticles: Trojan Horse Approach in Antimicrobial Chemotherapy of Infections Caused by <i>Klebsiella spp</i>.

In the present study we had an aim to develop the methods of functionalizing the surface of magnetite nanoparticles with cefotaxime and ceftriaxone antibiotics. The quantitative analysis of the nanostructured cephalosporins was determined by Atom Absorbance Spectroscopy (AAS) and based on the Lambert-Beer law. The engineered nanostructures were tested on gram-negative microorganisms Klebsiella spp., of Enterobacteriaceae, and gram-positive bacteria Staphylococcus aureus, each having multi-drug resistance properties.

Stenotrophomonas maltophilia,an emerging pathogen in newborns:Three case reports and a review of the literature

BACKGROUND Stenotrophomonas maltophilia(S.maltophilia)is a rare cause of neonatal sepsis with significant morbidity and mortality and has extensive resistance to several antibiotics leaving few options for antimicrobial therapy.Only a few cases have been reported in neonates from developing countries.We report three cases of critically ill,extramural babies with neonatal S.maltophilia sepsis.All three babies recovered and were discharged.CASE SUMMARY All three cases were term extramural babies,who were critically ill at the time of presentation at our neonatal intensive care unit.They had features of multiorgan dysfunction at admission.Blood culture was positive for S.maltophilia in two babies and one had a positive tracheal aspirate culture.The babies were treated according to the antibiogram available.They recovered and were subsequently discharged.CONCLUSION Although various authors have reported S.maltophilia in pediatric and adult populations,only a few cases have been reported in the newborn period and this infection is even rarer in developing countries.Although S.maltophilia infection has a grave outcome,our three babies were successfully treated and subsequently discharged.

Detection and Identification of Gonococci Resistance to Cephalosporin and Determination the Most Effective Empirical Treatment for Gonococcal Urethritis in Male Human in Egypt

Introduction: Gonorrhoeae and antimicrobial resistance AMR of gonococci is a major health problem today, because emerged resistance to last line empirical treatment for gonorrhoeae cephalosporins in many countries is predictable to be untreatable disease in near future. WHO GASP, WHO GLASS and WHO’s global action plan on AMR recommends to expand nationally and internationally to collect data to monitor AMR of gonococci for public health policies. Objective: Our aim is to detect resistance of gonococci to Cepha- losporins and determine the most effective empirical treatment for un-com- plicated gonococcal urethritis in males in Egypt. Methods: We depended in our methodology on selected gonococci from male urethral discharge specimens on Thyer Martien medium;collected 33 isolates during three years from 2017 to 2020;used antibiotics with MIC according to international standards and measuring IZD according to antimicrobial susceptibility testing reference ranges in international standards. Results: By statistical studies, resistance to cephalosporins was as follows: Cephradine 97%, Cefaclor 87.9%, Cefoxitin 97%, Ceftriaxone 90.9% and 42.4% to Cefepime, that shows hetero-genecity in resistance inside cephalosporin group;while resistance to Macrolides group represented by Azithromycin and Tetracyclins group represented by Doxycycline was as follows: Azithromycin 39.4%, Doxycycilne 27.3%;finally fluoroquinolones, the most effective group, resistance, was as: Levofloxacin 15.2%, Ciprofloxacin 15.2% and Ofloxacin 24.2%. Conclusion: The most effective empirical treatment for uncomplicated gonococcal urethritis in males in EGYPT is Fluoroquinolone;especially Levofloxacin ranks first susceptibility as 78.8% and 15.2% resistance followed by Ciprofloxacin susceptibility as 69.7% and 15.2% resistance, finally Ofloxacin susceptibility as 66.7% and 24.2% resistance;for Ceftriaxone not more recommended in EGYPT as empirical treatment for uncomplicated gonococcal urethritis, it is susceptibility as 6.1% and 90.9% resistance;in addition, we can use combination therapy of Fluoroquinolones with Azithromycin or Doxycycline, whose susceptibility is 30.3% for Azithromycin and 42.4% for Doxycycycline, while resistance is 39.4% for Azithromycin and 27.3% for Doxycycline. It is worth noting that only Cefepime in Cephalosporins group represents 42.4% susceptibility and 42.4% resistance;in addition to the Carbapenems group, it represents as 42.4% susceptibility for Imipenem and 45.5% resistance, then 42.2% susceptibility for Meropenem and 48.5% resistance, which can play role in combination therapy.

Antibiotic Resistance and Treatment Options for Multidrug-Resistant Gonorrhea

Gonorrhea is a sexually transmitted disease with a high global incidence.Its causative agent,Neisseria gonorrhoeae,has shown a remarkable flexibility to adapt and become resistant to all antimicrobials introduced over the past century for gonococcal therapy.The currently last available first-line therapy that is recommended in most countries is ceftriaxone.However,resistance levels against ceftriaxone are rising globally and incidences of confirmed treatment failure are increasingly encountered,particularly with the global spreading of the ceftriaxone-resistant FC428 clone in recent years.Resistance against most antimicrobials has been the result of adaptive genomic mutations that reduce affinity of the antimicrobial to its target protein or rRNA,although most multidrug-resistant strains also appear to have an upregulated multidrug efflux pump.To ensure gonococcal treatment remains available in the future,alternative therapies are urgently needed.Therefore,both alternative clinically approved antimicrobials and novel antimicrobials have been intensely studied both in gonococcal susceptibility analyses and clinical efficacy trials.Although there have been some limited successes,all studied alternative therapies that reached clinical trials have displayed some shortcomings in their efficacy against pharyngeal infections and/or overlapping resistance determinants with previously or currently used antimicrobials.This review summarizes the development of gonococcal antimicrobial resistance over the past century,describes the mechanisms involved in antimicrobial resistance,and provides an overview of the alternative therapies that have been under investigation this past decade.