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Medical research on suprax
A patient with paratyphoid A fever: an emerging problem in Asia and not always a benign disease.
J Travel Med. 2008 Sep-Oct; 15(5): 364-5
Pandit A, Arjyal A, Paudyal B, Campbell JC, Day JN, Farrar JJ, Basnyat B
A 15-year-old Nepalese boy with fever was thought to have enteric fever and started on cefixime. His blood culture grew Salmonella paratyphoid A. On the sixth day, he developed gastrointestinal bleeding, disseminated intravascular coagulation, and later, acute respiratory distress syndrome. He succumbed to his illness despite treatment in the intensive care unit with ceftriaxone, intravenous fluids, and mechanical ventilation. Salmonella paratyphoid A, for which there is no commercial vaccine, may not be a benign disease as perceived, and cefixime that is recommended for enteric fever may be an ineffective choice.
Paediatr Drugs. 2008; 10(6): 391-7
Pichichero ME, Doern GV, Kuti JL, Nicolau DP
OBJECTIVE: To define contemporary levels of resistance of Haemophilus influenzae to antibacterials commonly used to treat children for bacterial respiratory infections, and to assess the probability of achieving the requisite pharmacodynamic exposures for regimens against recent respiratory H. influenzae isolates using Monte Carlo simulation. METHODS: 233 H. influenzae isolates obtained from pediatric outpatients with acute otitis media (n = 55), sinusitis (n = 58), or lower respiratory tract infections ( n = 120) from 1 November 2004 to 30 April 2005 were characterized for beta-lactamase production and susceptibility to a panel of 10 beta-lactam antimicrobials. 5000 concentration-time profiles were simulated for US FDA-approved doses of oral amoxicillin, amoxicillin/clavulanic acid, cefpodoxime, cefprozil, ceftibuten, and cefuroxime using pharmacokinetics and weights of 5-year old male children. The probability of attaining free drug concentrations above the minimum inhibitory concentration (MIC) for 50% of the dosing interval (50% fT>MIC) was assessed for each regimen against this population of H. influenzae. RESULTS: beta-Lactamase production was demonstrated in 67 (28.8%) of the H. influenzae isolates and varied by isolation site (38% acute otitis media, 36% sinusitis, and 21% lower respiratory tract infections). Regarding susceptibility, the rank order of the tested antimicrobials was ceftriaxone = cefixime (100%) > cefpodoxime (99.6%) > ceftibuten = amoxicillin/clavulanic acid (99.1%) > cefdinir (98.7%) > cefuroxime (97.4%) > cefprozil (93.1%) > cefaclor (92.3%) > amoxicillin (63.1%). The most active agents based on pharmacodynamic assessment (50% fT>MIC) were cefpodoxime (98.9%), ceftibuten (95.3%), and high-dose amoxicillin/clavulanic acid (90.4%). Several amoxicillin regimens also achieved a high likelihood of pharmacodynamic target attainment (91.8- 98.6%) when beta-lactamase-positive strains were excluded from the analysis. CONCLUSION: Against H. influenzae, the antibacterials most likely to achieve optimal in vivo exposures in children are cefpodoxime, ceftibuten, and amoxicillin/clavulanic acid.
[Evolution of Escherichia coli antibiotic resistances in urine samples from the community]
Arch Esp Urol. 2008 Sep; 61(7): 776-80
Sánchez Merino JM, Guillán Maquieira C, Fuster Foz C, López Medrono R, González Pérez M, Raya Fernández C, García Alonso J
OBJECTIVES: The objectives of this work are two: first, to evaluate the resistance of Escherichia coli to several antibiotics and their trends over a six-year period in strands isolated in urine samples from patients receiving health-care in general practitioner offices in our environment; and second, to evaluate if empirical treatment regimens commonly accepted in our country would be applicable in our environment depending on the results of this study. METHODS: We analyzed the urine cultures positive for Escherichia coli obtained from samples collected at the 10 primary health care centers of the health-care area of El Bierzo and Laciana (Leon, Spain) between the years 2002 and 2007. In vitro resistances of these germs to several common use antibiotics were determined: fosfomycin, nitrofurantoin, tobramycin, cefuroxime, cefixime, amoxicillin-clavulanic acid, cotrimoxazole, ciprofloxacin, norfloxacin, and ampicillin. The existence of statistically significant (p < 0.05) differences in sensitivity comparing the years 2002 and 2007, including all antimicrobials except cefixime, was analyzed by the chi-square test. For cefixime we compared the results between 2002 and 2005. RESULTS: An increase of the resistance of Escherichia coli isolated in urine to all antimicrobials under study has occurred, except for nitrofurantoin, being the differences statistically significant in most cases. Nevertheless, resistances to fosfomycin and nitrofurantoin have remained below 6% throughout the study period. Resistances to tobramycin and cefuroxime were slightly over 10% and cefixime below 3.4%, although in the last one we only have data until 2005. Resistances to amoxicillin-clavulanic acid, initially low, have progressively increase reaching 20.6% in 2007. The same has happened for cotrimoxazole, ciprofloxacin, norfloxacin and ampicillin, passing 32% in 2007 in the first three cases and 62% in the last one. CONCLUSIONS: Variations in bacterial resistance patterns for Escherichia coli obliges to have an updated knowledge of them to adapt general empirical treatment uses to each specific health-care area.
Talanta. 2005 Oct 15; 67(4): 703-12
Golcu A, Dogan B, Ozkan SA
The voltammetric behavior of cefixime was studied using cyclic, linear sweep, differential pulse and square wave voltammetric techniques. The oxidation of cefixime was irreversible and exhibited diffusion controlled process depending on pH. The oxidation mechanism was proposed and discussed. Different parameters were tested to optimize the conditions for the determination of cefixime. The dependence of current intensities and potentials on pH, concentration, scan rate, nature of the buffer was investigated. According to the linear relationship between the peak current and the concentration, differential pulse (DPV) and square wave (SWV) voltammetric methods for cefixime assay in pharmaceutical dosage forms and biological fluids were developed. For the determination of cefixime were proposed in acetate buffer at pH 4.5, which allows quantitation over the 6x10(-6)-2x10(-4)M range in supporting electrolyte and spiked serum sample; 8x10(-6)-2x10(-4)M range in urine sample; 6x10(-6)-1x10(-4)M range in breast milk samples for both techniques. The repeatability, reproducibility, precision and accuracy of the methods in all media were investigated. No electroactive interferences from the excipients and endogenous substances were found in the pharmaceutical dosage forms and in the biological samples, respectively.
Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever).
Cochrane Database Syst Rev. 2008; CD004530
Thaver D, Zaidi AK, Critchley JA, Azmatullah A, Madni SA, Bhutta ZA
BACKGROUND: Fluoroquinolones are recommended as first-line therapy for typhoid and paratyphoid fever (enteric fever), but how they compare with other antibiotics and different fluoroquinolones is unclear. OBJECTIVES: To evaluate fluoroquinolone antibiotics for treating enteric fever in children and adults compared with other antibiotics, different fluoroquinolones, and different durations of fluoroquinolone treatment. SEARCH STRATEGY: In November 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE, EMBASE, LILACS, mRCT, conference proceedings, and reference lists. SELECTION CRITERIA: Randomized controlled trials of fluoroquinolones in people with blood or bone marrow culture-confirmed enteric fever. DATA COLLECTION AND ANALYSIS: Two authors independently assessed the trials' methodological quality and extracted data. We calculated odds ratios (OR) for dichotomous data with 95% confidence intervals (CI). We analysed trials with greater than 60% children separately from trials of mostly adults. MAIN RESULTS: Of 38 included trials, 22 had unclear allocation concealment and 34 did not use blinding. Four trials included exclusively children, seven had both adults and children, and three studied outpatients. ADULTS: Among primary outcomes (clinical failure, microbiological failure, and relapse), compared with chloramphenicol, fluoroquinolones were not statistically significantly different for clinical failure (594 participants) or microbiological failure (378 participants), but they reduced clinical relapse (OR 0.14, 95% CI 0.04 to 0.50; 467 participants, 6 trials). We detected no statistically significant difference versus co-trimoxazole (82 participants, 2 trials) or azithromycin (152 participants, 2 trials). Fluoroquinolones reduced clinical failure compared with ceftriaxone (OR 0.08, 95% CI 0.01 to 0.45; 120 participants, 3 trials), but not microbiological failure or relapse. Versus cefixime, fluoroquinolones reduced clinical failure (OR 0.05, 95% CI 0.01 to 0.24; 238 participants; 2 trials) and relapse (OR 0.18, 95% CI 0.03 to 0.91; 218 participants, 2 trials). CHILDREN: In children with high proportions of nalidixic acid-resistant strains, older fluoroquinolones increased clinical failures compared with azithromycin (OR 2.67, 95% CI 1.16 to 6.11; 125 participants, 1 trial), with no differences using newer fluoroquinolones (285 participants, 1 trial). Fluoroquinolones and cefixime were not statistically significantly different (82 participants, 1 trial). Trials comparing different durations of fluoroquinolone treatment were not statistically significantly different (889 participants, 9 trials). Norfloxacin had more clinical failures than other fluoroquinolones (417 participants, 5 trials). AUTHORS' CONCLUSIONS: Trials were small and methodological quality varied. In adults, fluoroquinolones may be better for reducing clinical relapse rates compared to chloramphenicol. Data are limited for other comparisons, particularly in children.
J Clin Microbiol. 2008 Oct 8;
Wong WW, Huang CT, Li LH, Chiang CC, Chen BD, Li SY
From April 2006 to August 2007, a total of 146 Neisseria gonorrhoeae isolates collected from 139 male patients in Taipei, Taiwan were analyzed by N. gonorrhoeae multiantigen sequence typing (NG-MAST) and antibiotic susceptibility testing. The resistant rates of all isolates to ciprofloxacin, cefpodoxime and cefixime were 76.7% (112/146), 21.2% (31/146) and 16.4% (24/146), respectively. NG-MAST identified 71 sequence types (STs), of which 21 STs contained 2 to 21 isolates. The isolates that belonged to the three major ST clusters were typically from patients who had specific epidemiological characteristics (such as sexual orientation and HIV status). The major ST clones exhibited distinct resistant profiles and are associated with specific high-risk groups.
Foodborne Pathog Dis. 2008 Jun; 5(3): 227-44
Hussein HS, Bollinger LM
Shiga toxin-producing Escherichia coli (STEC) strains have caused a large number of human illness outbreaks worldwide. In most cases, the infection was traced to consumption of meats or vegetables contaminated with cattle feces. To combat this public health problem, pre- and post-harvest control strategies are continuously implemented to assure food safety. Thus, rapid, reliable, and sensitive methods for STEC detection must be available to provide confidence not only in the meats or vegetables entering the food chain but also in testing humans with illnesses. As a result, enrichment for STEC has been a critical step in any successful protocol for their detection. The base media commonly used for STEC enrichment include sorbitol MacConkey agar, tryptic soy broth (TSB), E. coli broth, enterohemorrhagic E. coli broth, buffered peptone water (BPW), and brain heart infusion broth. In addition to bile salts, antibiotics (e.g., tellurite, cefixime, novobiocin, vancomycin, cefsulodin, and acriflavin) are used at different concentrations to enrich for STEC. In most published reports, however, the reasons for choosing the selective medium were not provided. Thus, this review was intended to evaluate the base media and antibiotics commonly used for STEC detection. The efficacy of a detection method will certainly depend on the choice of the base medium, selective agents, and their concentrations. The interactions among these factors are also expected to affect sensitivity of the detection method, especially when the test sample contains a small number of STEC cells. Because sensitivity of detection is expected to decline when testing for stressed or injured STEC cells, as is the case in environmental samples, a pre-enrichment step in TSB or BPW without antibiotics may be necessary. Future research should focus on identifying possible antibiotic combinations that effectively inhibit most background bacteria without affecting pathogenic STEC strains in the test sample.
Curr Med Res Opin. 2008 Oct; 24(10): 2853-61
Jansen WT, Verel A, Beitsma M, Verhoef J, Milatovic D
BACKGROUND: Haemophilus influenzae is a major respiratory tract pathogen that is becoming increasingly resistant to beta-lactam antibiotics. MATERIALS AND METHODS: Using a microdilution method performed to Clinical and Laboratory Standards Institute (CLSI) guidelines, we determined the minimal inhibitory concentrations (MICs) of various antibacterial agents against 536 isolates of H. influenzae. The isolates were obtained from patients with respiratory tract infections being treated in 18 European and two Canadian centres between 2006 and 2007. RESULTS: Levofloxacin, moxifloxacin, cefixime and cefpodoxime with MIC(90) values of < or = 0.03, < or = 0.03, 0.03 and 0.06 g/mL, respectively, were the four most active agents tested. Overall, amoxicillin resistance was observed in 25.0% of the strains, but was generally reversed with the addition of clavulanic acid. In 73 strains (13.6%) resistance was due to beta-lactamase (BL) production while the remainder (n = 61; 11.4%) were BL-negative, amoxicillin-resistant (BLNAR) strains. Comparison of penicillin binding protein 3B sequences in BLNAR isolates revealed that only mutations at amino acids 502 (alanine [Ala] --> threonine [Thr]/valine [Val]) and 526 (asparagine [Asn] --> lysine [Lys]) were significantly associated with amoxicillin resistance among European H. influenzae isolates (p < 0.0001 for both). CONCLUSIONS: This surveillance study highlights an increased prevalence of amoxicillin-resistant strains of H. influenzae compared with a previous study that we performed in 2004/2005. The third-generation cephalosporins cefixime and cefpodoxime, as well as amoxicillin plus clavulanic acid, continue to be very active against both BL-positive and BLNAR strains of H. influenzae, and thus remain useful treatment options for patients with respiratory tract infections.
[Antibiotic treatment of pyelonephritis in children. Recent advances]
Recenti Prog Med. 2008 Jul-Aug; 99(7-8): 343-6
Montini G
Urinary tract infection (UTI) is one of the most common bacterial infections in infancy, its prevalence being 5% in febrile infants (2 to 24 months of age). 10 to 20% of febrile UTIs may result in permanent renal damage (scar), whose long-term significance (hypertension or proteinuria) in previously normal kidneys remains unclear. A wide variety of antibiotic agents have been used, generally administered aggressively by intravenous route and for long periods (up to three weeks), to possibly prevent scar formation and/or sepsis complications. Recent studies suggest that children with febrile UTIs can be effectively treated with oral antibiotics such as cefixime or amoxycillin/clavulanic acid for 10 to 14 days.
J AOAC Int. 2008 Jul-Aug; 91(4): 744-9
Khan IU, Sharif S, Ashfaq M, Asghar MN
A simple, precise, and sensitive high-performance liquid chromatographic method was developed and validated for the simultaneous determination of potassium clavulanate and cefixime in synthetic mixture form. The analytes were separated on a C18 column by using 0.03 M disodium hydrogen phosphate buffer (pH 6.5)-methanol (84 + 16, v/v) as the mobile phase with detection at 220 nm. The method exhibited high sensitivity and good linearity in the concentration ranges of 12.5-62.5 and 20-100 microg/mL for potassium clavulanate and cefixime, respectively. The total run time for the 2 components was 101.5% with a relative standard deviation of