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Data on resistance from ambulatory care are rarely available, since surveillance systems cover mostly isolates come from inpatient care. The outpatient setting is of interest, however, since it is where hospitalized patients with resistant pathogens are also treated as outpatients, and where patients are seen who have resistant pathogens from other sources, such as food. In addition, 85% of the antibiotics used in human medicine, are used in ambulatory care. Using data from the Antibiotic Resistance Surveillance System (ARS), we show the development of resistance of Staphylococcus aureus to oxacillin and of Escherichia coli and Klebsiella pneumoniae to cefotaxime in outpatient care between 2008 and 2012 and corresponding socio-demographic differences in the resistance rate. According to our analyses, the proportion of MRSA in S. aureus since 2009 in the outpatient sector decreased (all materials: 2009 11.5%, 2012 9.8%), which is similar to inpatient care, while the proportion of ESBL in E. coli (2008 2.7%, 2012 5.6%), and K. pneumoniae (2008 2.7%, 2012 6.6%) increased over the total period. At the same time resistance for the three pathogens in both sexes over the age groups continuously increased, women still hold a lower proportion of resistance than men. The resistance levels of S. aureus and K. pneumoniae in ambulatory care are reflected at a lower level than in hospital care. In contrast, the high proportion of resistant E. coli in children suggests another source in ambulatory care.

While infections with salmonella typhi may frequently result in encephalopathy, this complication is rare in infections with salmonella enteritidis and has been rarely reported. We report about a 21 months old girl which developed encephalopathy with convulsion, ataxia and cortical blindness following salmonella infection. Moreover, we show a summary of ten previous case reports.

A twelve and a half year old girl of foreign nationality was been found in her domestic environment in unwakeable condition. The emergency was alarmed, and she was transferred to the children's hospital. Her condition at this time: she was unconscious and suffering from cold sweat but her circulation was stable and her respiration sufficient. Because of language barriers it was difficult to find out the antecedence of her state, but an empty box of pills (Amitryptilin) lying next to the patient may serve as a first hint to a intoxication. The father denied that his daughter might have consumed drugs or alcohol and meant that any abuse of medicine was out of the question. First urinary measurements to check if any drugs might be involved remain inconspicuous; in a control measurement of the blood 12 hours later only an elevation of the CPK is noticed as an unusual detail. The CPK-MB remains being according to normal. The native CT of the skull remains inconspicuous as well as the control with contrastation after 12 hours and a MRT-examination after 36 hours. The liquor punction does not give hints to any pathological facts. The EEG shows a high degree of continuous irregular slowe waves over both hemispheres in the delta and theta activity range. This gives reason to assume an encephalitis. The result of an electrocardiogram reveals a sinus bradycardia. The therapy was symptomatically, virustatically with aciclovir, antibiotically with cefotaxim and prophylactically against edema of brain with dexamethason. After 24 hours the patient abruptly awakes from coma and after 36 hours the reason for the coma can be stated: The toxicological examinations of the blood lead to the result: Intoxication with Baclofen. Explantation for the origin of the tablets: The family lives together with an aunt, who, after a cerebrovascular accident, was treated with Baclofen, Amitryptilin and ASA.

Pain is one of the presenting symptoms in acute neuroborreliosis. Classically, acute neuroborreliosis--also known in Europe as Bannwarth's syndrome--is a combination of radicular pain, cranial neuritis and peripheral radiculitis and inflammatory changes of the CSF. The prognosis following antibiotic therapy is favorable. At least in its early stages, however, the diagnosis neuroborreliosis might be missed or mistaken. Thus, targeted assessment of typical signs is needed to expedite examination of the CSF which then permits definitive diagnosis.

A 59-year-old female patient with a history of malignant lymphoma presented with symptoms of septicaemia. The skin of the extremities showed bullous, necrotizing plaques. Blood culture revealed Vibrio vulnificus as the causative organism. The infection was most likely acquired while swimming in the unusually warm Baltic Sea through inadvertent swallowing of sea water. The disease is rare in Europe. It is discussed in view of its typical clinical and histological picture.

Background: Endophthalmitis subsequent to Klebsiella sepsis leads to functional blindness in most cases and is very difficult to treat. Every successful therapeutic modality can therefore help in creating an optimal therapeutic plan., Case Report: A 69-year old diabetic patient exhibited bilateral Klebsiella endophthalmitis with sepsis after a pneumonia. Two intravenous antibiotics were used: aminoglycosides (Gentamycin) and cephalosporins (Cefotaxim or Cefuroxim) with local parabulbar injections of Prednisolon. The long-term follow-up of four years provided some overview of morphological aspects of the development of endophthalmitis. Characteristic greyish hypopyon was seen in both eyes, which was more pronounced in the left eye than in the right. The left eye became phthisic. After resorption of the hypopyon in the right eye and prolonged resorption of the subretinal abscess for 9 months a useful visual acuity at 0.2 was achieved. Two years after the endophthalmitis a cataract surgery with implantation of a posterior chamber silicon lens was performed and good visual acuity (0.6) was achieved. After four years, the subretinal abscess left an extremely large, sharp bordered, unpigmented scar up to the sclera., Conclusion: An early diagnosis and adequate long-time antibiotic therapy under the co-operative supervision of an ophthalmologist with internist appears to be most important for the therapeutic success in Klebsiella endophthalmitis.

Background: Infectious endophthalmitis is a serious complication following cataract surgery, since it often induces a substantial reduction of visual acuity., Patients and Methods: We retrospectively evaluated the clinical data of 53 patients with endophthalmitis following cataract surgery who were treated at the department of ophthalmology of the University Hospital in Ulm between 1995 and May 2001. Of these patients, 50 had been referred. Clinical presentation, infecting organism, treatment and visual outcome were analysed with a followup ranging from 2 weeks up to 42 months (median: 6 months)., Results: In 52 patients endophthalmitis was preceeded by cataract extraction and IOL implantation, in one case by secondary IOL implantation. Confirmed microbiologic growth was demonstrated from intraocular specimens in 26 out of 41 operated eyes (63%), the most frequent causative organisms were coagulase-negative Staphylococci (50%). All isolated bacteria were sensitive to a combination of the antibiotics vancomycin and amikacin or vancomycin and ceftazidime. 13 patients were treated with intravenous antibiotic therapy alone. In 46% of patients, who were initially treated with intraocular antibiotic injections alone, required further therapeutic intervention for recurrent infection. Only 7.7% of the patients who initially underwent intraocular antibiotic injections combined with IOL removal or pars plana vitrectomy with or without IOL removal, required further surgical intervention. Initial visual acuity was hand movements (median) only but improved during follow-up to 0.2 (median)., Conclusions: In this series all tested bacteria were susceptible to the combination of vancomycin with either amikacin or ceftazidime. Aggressive initial treatment including IOL removal may be associated with a lower frequency of recurrent disease.

The aim of this study was to examine the effect of decontamination as compared to placebo medication on post-gastrectomy treatment costs. The results of a prospective double-blind placebo-controlled multicenter trial indicate that perioperative i.v. prophylaxis with cefotaxim and topical decontamination with polymyxin B, tobramycin, vancomycin and amphotericin B from the day before surgery until the 7th postoperative day is most effective in the prevention of esophagojejunal anastomotic leakage following total gastrectomy. For the cost analysis, only patients who had been decontaminated according to the study protocol (n = 90) were compared to the non-decontaminated patients (n = 103). The esophagojejunal leakage rate was 10.6% in placebo patients (n = 103) and could be reduced significantly to 1.1% in decontaminated patients (n = 90, P = 0.0061; two-tailed Fisher's exact test). There was only one asymptomatic leakage detected on Gastrografin swallow. The pulmonary infection (P = 0.0173) and overall complication rates (p = 0.0238) were significantly reduced in the decontamination group as well. During the observation period, 9 (8.7%) patients in the placebo group and 3 (3.3%) in the decontaminated group died (P = n.s.). Patients were followed up for the initial 42 postoperative days and treatment costs were calculated for this time period only. The parameters compiled in the study pertaining to use of medical resources formed the basis for the determination of the postoperative treatment costs. These were the costs for decontaminating drugs, intravenous antibiotics, reoperations and non-surgical reinterventions as well as daily treatment costs of the general ward, the intensive care unit (ICU) and rehabilitation. The average costs per patient in the placebo group amounted to DM 20,000 while the costs for decontaminated patients were only DM 16,200, which was due to a significantly lower number of patients requiring treatment in the ICU (P = 0.0082), significantly fewer patients requiring i.v. antibiotics (P = 0.0232) and fewer patients with reoperations (P = 0.0909). The prophylaxis employing decontaminating drugs in the amount of DM 400 lowered post-gastrectomy treatment costs by DM 3800 or 19%. The prophylaxis can be recommended, because it lowers morbidity, mortality and the costs of total gastrectomy.

Patients and Methods: In a prospective protocol 25 consecutive patients with diffuse peritonitis were treated in the Surgical Clinic of the RWT-University in Aachen, Germany, from January to December 1995. According to the "Mannheim Peritonitis Score" three different stages were treated with different surgical procedures and a selective antibiotic regimen. Group-A patients with prognostically favorable peritonitis (MPS 0-20) were treated with the so-called standard procedure, group-B patients (MPS: 21-29) with closed postoperative lavage. The antibiotic regimen was cefotaxime (2 x 2 g) and metronidazole (2 x 500 mg) for both group-A and group-B patients. Severe group-C cases (MPS > 29) were treated with the so-called Etappenlavage (multiple reexplorations and intra-operative lavage) and received a combination of three antibiotics (2 x 2 g cefotaxime; 2 x 500 mg metronidazole and 2 x 200 mg ofloxacin)., Results: Eight patients belonged to group A, 10 to group B, and 7 to group C. The mortality was 0% (group A), 20% (group B), and 29% (group C), respectively. The actual overall mortality of the whole group was 16% (4/25). The statistically expected mortality was 36%, according to the APACHE-II-Score (P = 0.0982).

160 children aged 1 to 12 years with clinical diagnosis of bacterial pharyngitis and/or tonsillitis were treated either with cefixime ready-to-use-suspension or penicillin V in an open, controlled and randomized multicenter study. Before treatment a rapid antigen detection test was accomplished and throat swabs were taken. After randomization, the children were either treated for 5 days with 8 mg cefixime/kg bodyweight ready-to-use suspension once daily or with 20,000 I.U. penicillin V/kg bodyweight t.i.d. also administered as suspension. The data of 151 children could be evaluated for clinically efficacy. In the cefixime-group 86.7% of the children were cured and 9.3% significantly improved. After initial improvement, in one child (1.3%) a relapse occurred and in the two remaining children (2.7%) therapy failed. 90.8% of the patients treated with penicillin V were cured, 6.6% improved and in one child each a relapse was registered resp. therapy failed. Complete microbiological data were available in 137 patients. In the cefixime-group in 82.6% of the patients the pathogens were eradicated. The elimination rate in the penicillin-group was 88.2%. At the follow-up 3-4 weeks after end of treatment 6 relapses were seen in the cefixime-group, and 8 in the patients treated with penicillin. Both regimes were safe. Mild to moderate adverse events at least possibly related to the study medication were seen in only 4 children treated with cefixime and in 5 treated with penicillin. A 5 day treatment of bacterial pharyngitis and tonsillitis with cefixime was as effective as a ten day treatment with penicillin V.

Method: In this open, randomized and controlled multicenter study involving a total of 100 hospitalized patients with infections of the lower respiratory tract, including pneumonia, the efficacy and tolerability of sequential treatment with cefotaxime i.v./cefixime oral were compared with those of exclusively parenteral treatment with cefotaxime. The patients received either 2 x 2 g cefotaxime i.v. over a period of 7 to 10 days, or 2 x 2 g cefotaxime over a period of 48 to 72 hours followed by oral cefixime treatment (1 x 400 mg/day) for a further 5 to 8 days., Results: A total of 94 patients were evaluated for efficacy; in 93.6% of the evaluable patients in each treatment group, either a cure or improvement was obtained. In four patients in the cefotaxime group and five patients treated first with cefotaxime and then with cefixime, adverse reactions were observed. For three of these adverse reactions (diarrhea, nausea, aggravation of an pre-existing genital mycosis) an association with the respective test substance was considered to be at least possible.

VLBW-infants below 1500 g of birth weight have a quite high risk to acquire a nosocomial sepsis. 20-40% of all infants exhibit signs of nosocomial infection once during neonatal intensive care. The rate of infection is related to technique and amount of used invasive devices as to gestational age. Coagulase-negative staphylococci (CONS) and gram-negative organisms contribute most to these cases of sepsis. In a three phase study we tried to demonstrate the efficacy of different mechanisms to change the rate of nosocomial sepsis. During the first phase a strict hygienical protocol was enforced as isolation, care with sterile gloves and aseptic techniques in introducing and maintaining i.v. lines. In a second phase we started a randomized controlled study of prophylactic vancomycin (10 mg/kg/day in two doses). In a third phase we added an oral antibiotic regime with cefixime for all patients with positive cultures for gramnegative organisms under the hypothesis of translocation from the gut as the way of infection. During the first phase 23.7% of 76 patients enrolled acquired CONS-sepsis, 0.52% gramnegative sepsis. During the second phase (41 patients) 6 patients in the control group acquired CONS-sepsis, none in the vancomycin-group. The rate of gramnegative infections was not different (4 and 3 cases). During the third phase (vancomycin plus cefixime eventually in cases of positive stool cultures) no case of nosocomial sepsis occurred (35 patients, 11 positive cultures). The management used in phase 3 reduced the rate of nosocomial infections in VLBW-infants drastically.

Orthopedic deformations of the feet play an important role in the etiology of the foot ulcers of diabetic patients, together with neuropathy and vascular impairment. The employment of new techniques in the treatment of diabetic foot has considerably improved its prognosis. These are the transient circulatory blockade (TCB) and the regional intravenous antibiotic administration (RAA). This paper reports on the usage of these techniques in the treatment of 24 diabetic patients, 8 women with ages between 41 and 75 (mean 54.7) years, and 16 men with ages between 41 and 75 (mean 59.3) years who were operated on 29 opportunities because of foot ulcer. Most of the patients had different grades of foot infection. Neuropathy was present in all cases and a distal type of arterial occlusion was diagnosed in 8 cases. Foot surgery was performed under regional i.v. anesthesia associated with regional i.v. injection of 1 g Cefotaxine (Calaforan) in 250 ml saline solution which was administered through the same butterfly needle used for the regional anesthesia. The drainage of the foot infection was performed simultaneously with the orthopedic correction of the foot deformities. All patients healed without complications attributable to the bone surgery. Patients operated upon while complicated with foot phlegmons remained longer (31 days) in the hospital than those without infection (18 days). After a follow-up period of 4.7 (1 to 8) years there were 2 recurrencies and 3 patients developed new foot ulcers. All patients were using a normal, soft shoe. We conclude that the TCB and the RAA facilitate orthopedic surgery in diabetic patients with foot ulcers improving their life quality and prognosis.

In patients with peripheral arterial occlusive disease, it is difficult to attain an adequate antibiotic concentration in poorly perfused infected lesions. The antibiotic concentrations prevailing in the ulcer secretion with the different routes of administration were investigated in 7 patients. The patients received 1 g of cefotaxim on consecutive days: intravenously on the first day, intraarterially on the second day and by retrograde venous injection on the third day. Significantly higher concentrations in the secretion were found after retrograde venous antibiotic administration than after intravenous or intraarterial injection. Clinical experience up to now indicates that far better results of treatment can be attained if the antibiotic is administered by retrograde venous injection (in addition to the surgical measures required).

Background: In-vitro and clinical efficacy of a combination therapy consisting of 3 antibiotic agents was to be assessed in neonatal septicemia., Methods: From 1980 to 1987, 152 newborns with septicemia as proven by blood culture were treated with an initial antibiotic regimen consisting of azlocillin (150 mg/kg bw), cefotaxime (100 mg/kg bw), and tobramycin (5 mg/kg bw)., Results: According to the microbiologic testing, antimicrobic therapy was effective in each of the 152 organisms: 101/152 bacteria were susceptible to all 3 agents; resistance to 1 or 2 of the antibiotics was evident in 33/152 and in 18/152 organisms, respectively. Mortality due to septicemia was 7.2%., Conclusion: As no difference was observed in the frequency in which one of the three antibiotic substances was the only effective drug, each of the 3 agents seemed to be necessary for clinical effectiveness of this antibiotic combination.

We saw two cases of infectious sacroiliitis in young patients. The multi-various clinical symptoms, the predispositions, as well as the alteration of laboratory analyses are described. Further, we discuss problems of early diagnosis, diagnostic measures like x-ray, sonography, bone-scan, computerized tomography scan, magnetic resonance imaging, and their particular significance. Computerized tomography scan of iliosacral joints determined the further therapeutic procedure. In both cases, we prescribed cephalosporin-antibiotic cefotaxime-sodium.

Infection with Borrelia burgdorferi can induce various skin manifestations. The type of skin manifestation and the histopathological picture depend on the stage of infection and vary from local inflammatory infiltrates to chronic atrophic skin disease. Involvement of subcutaneous tissue has been observed only very rarely. We report on two patients suffering from nodular panniculitis (Pfeifer-Weber-Christian) and present evidence that the disease was caused by Borrelia burgdorferi. In one of the cases Borrelia burgdorferi was repeatedly isolated from skin and subcutaneous tissue biopsies in spite of repeated high-dose therapy with ceftriaxone, Doxycycline and cefotaxime.

The effectiveness of a single prophylactic dose of two broad spectrum antibiotics, during Caesarean section, was compared and evaluated. In 119 consecutive cases at the Cantonal Hospital in Winterthur, Switzerland, either 1 g i.v. cefotaxime or 1,2 g amoxicillin plus clavulanic acid were administered after clamping the umbilical cord during Caesarean section. The study shows that single dose prophylaxis of either regimen provides adequate cover in preventing morbidity in Caesarean section, in both high-risk and low-risk groups.

An open multicenter study on inpatients of 12 german hospitals was performed to investigate efficacy and safety of sulbactam in combination with mezlocillin, piperacillin or cefotaxim in severe bacterial infections. In total 155 patients were enrolled. The following infections were diagnosed: 48 lower respiratory tract infections, 66 intraabdominal infections, 34 skin/soft tissue infections including post operative wound infections and 5 complicated urinary tract infections. 55 patients received 3 daily doses of 4 g mezlocillin + 1 g sulbactam, 52 patients received 3 daily doses of 4 g piperacillin + 1 g sulbactam and 48 patients received 3 daily doses of 2 g cefotaxim + 1 g sulbactam. Antibiotics and sulbactam were administered concomitantly via intravenous short infusion. Mean duration of therapy was 8 days. Endpoints for assessment of therapeutic efficacy were cure (complete resolution of pretreatment signs and symptoms of the infection) or improvement (marked reduction or partial disappearance or pretreatment signs and symptoms, no further antibiotic therapy required) as well as eradication of pretreatment pathogens. 141 (92%) of 153 evaluable patients were successfully treated (98 cures and 43 improvements), therapy failed in 12 patients (7.8%). Success rates of the 3 sulbactam combinations were almost identical: 91% for mezlocillin/sulbactam, 92% for piperacillin/sulbactam and 93% for cefotaxim/sulbactam. 106 patients (68.4%) were also bacteriologically evaluable. In these patients 192 bacterial pathogens were isolated prior to study therapy, 55 patients had mixed infections. In 96 patients (90%) pretreatment pathogens were eradicated (180 strains = 94%).(ABSTRACT TRUNCATED AT 250 WORDS)

A 60-year old man developed a subacute psychoorganic syndrome over four weeks. CCT was normal, except a slight atrophy of the cerebellar superior vermiform process. In the CSF we found 1696/3 cells, suggesting a lesion of the hemato-encephalic barrier, an autochthonous IgG production and an increased specific antibody-titre (10.3) for Borrelia burgdorferi. Based on these data a Lyme-Neuroborreliosis being diagnosed. Treatment with Cefotaxim and Gentamycin was successful, a complete remission of the psychopathological symptoms had been obtained. This case is an uncommon manifestation of a Borrelia-burgdorferi-infection of the CNS with psychopathological symptoms but no neurological deficit. We conclude that an affection of the CNS with Borrelia burgdorferi must always be taken into consideration in patients presenting a subacute psychoorganic syndrome of unknown etiology.

In a prospective randomised study, the effects of two different colonisation prophylaxis techniques on colonisation and pulmonary infection were investigated in 40 critically ill patients with long-term ventilatory support (greater than or equal to 4 days). 20 patients were selectively decontaminated with 4 x 100 g polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and with an antimicrobial sticky paste in the oropharynx (group I). 20 patients received 50 mg of polymyxin B and 80 mg of gentamicin dissolved in 10 ml of 0.9% saline at 6 h intervals into nose, oropharynx and stomach as well as 300 mg of amphotericin B in the oropharynx only (group II). All patients received cefotaxime systemically in the first 3 days. In group I gram-negative aerobic bacteria in the pharynx decreased from 35% to 0%, in group II from 40% to 10% and in the rectum from 80% to 61% (10% in the second week) in Group I and from 100% to 73% (33% in the second week) in group II. The decrease in gram-negative microorganisms was accompanied by an increase in the frequency of Staphylococcus epidermidis. In group I, two patients developed pneumonia and two patients urinary tract infections, in group II two patients suffered from pneumonia and 3 patients urinary tract infections. Both regimes are effective methods of prophylaxis for lowering colonisation with gram-negative aerobic bacteria and the frequency of pneumonia in patients requiring long-term mechanical ventilation. A possible selection of gram-positive bacteria must be appropriately monitored.

We investigated the penetration of beta-lactam antibiotics into parotid saliva after intravenous administration. Neither mezlocillin nor oxacillin could be detected in parotid saliva, but cefotaxime (CTX) and cefotiam (CTM) penetrated parotid saliva very well. While salivary CTM concentrations reached peak values (9.52 +/- 3.4 mg/l) within 30 min of the end of infusion, the highest CTX concentrations in parotid saliva (5.84 +/- 2.6 mg/l) were observed after 90 min. After 300 min the salivary CTM levels were below the limit of detection, while the mean CTX concentration even 360 min after the end of infusion was 2.27 +/- 1.23 mg/l. Both CTX and CTM achieve salivary concentrations that are inhibitory against the prevailing pathogens causing suppurative parotitis, and thus promise to be effective for the treatment of this disease. Furthermore, the excretion of comparatively high concentrations of both drugs into the mouth achieves a selective decontamination of the mucosal surfaces of the upper aerodigestive tract so that they are suitable for perioperative prophylaxis in head and neck surgery.

The pharmacokinetics of cefotaxime were investigated in 14 patients suffering from multiple-organ failure requiring pump-assisted, continuous volume-constant hemofiltration (CVHF) for blood purification, whereby the filtration rate was 20 ml/min. Samples of blood and ultrafiltrate were evaluated by high-pressure liquid chromatography. For dose adjustment, three different algorithms of Dettli and Kroh were used. As compared with values obtained for anuric patients during the dialysis-free period, the mean serum half-life was nearly doubled (2.75 vs 4.48 h). This reduced elimination depended mainly on a diminished non-renal elimination ratio ranging from 0.085 to 0.366. The volume of distribution remained unchanged within a wide interindividual range (Vz, 0.35 l/kg, from 0.22 to 0.56 l/kg); the sieving coefficient increased to 0.89 as compared with 0.62 in healthy volunteers. Dose adjustment by algorithms showed varied degrees of over-dosage. The estimate closest to an optimal dose was reached by the application of a new algorithm of Kroh (mean dose deviation +19%; SD, +/- 27%) using an individual non-renal elimination ratio (QIND). QIND correlated significantly with the severity of disease according to the sepsis score of Elebute and Stoner (r = 0.763, P less than 0.005). Thus, it is possible to adjust reliably individual dosage in multiple-organ failure and to reduce the frequency of drug monitoring required.

In a clinical study, 40 patients suffering from acute, recurrent or chronic sinusitis were treated with cefixime. The duration of therapy ranged from seven to 15 days. The dosage was 200 mg bid. In all patients cure or a marked improvement of clinical symptoms was noticed. Ten patients suffered gastrointestinal side effects which were classified as mild to moderate; however, all the patients received a full treatment course.

The pharmacokinetic parameters of cefixime were determined in healthy volunteers following oral administration of 200 mg cefixime as tablet, syrup and dry suspension, respectively. All three galenic formulations showed reliable absorption. Mean peak plasma concentrations amounted to 2.4-3.4 mg/l and were reached after 3.3-3.5 h. Mean terminal half-lives were 2.9-3.1 h. The mean areas under the plasma concentration-time curves ranged between 18 and 26 mg/l.h; 18-24% of the dose administered were recovered unchanged in the urine. The best bioavailability was obtained with the dry suspension followed by the tablet and the syrup. With respect to the ester pro-drug cephalosporins, cefuroxime axetil, cefetamet pivoxyl and cefotiam hexetil, cefixime exhibits higher plasma half-life and area under the curve as well as, comparable absolute bioavailability but consistently lower urinary recovery which indicates higher non-renal clearance.

In a prospective study, 50 women patients were given 2 g Ceftriaxon (Rocephin) as a short infusion before performing hysterectomy. A control group of 50 patients remained without any antibiotic treatment. In 31 patients, the concentration of Ceftriaxon in the serum and tissue was determined at the time the uterus was removed. Due to the long half-life of Ceftriaxon (8 hours), high serum and tissue levels were found for a period of many hours. After 4-5 hours, the serum level was still 100 micrograms/ml, whereas the concentration in the endometrium, myometrium and in the salpinges were 21 micrograms/g, 24 micrograms/g and 31 micrograms/g, respectively. Due to these long-lasting serum and tissue levels, the protective effect against infections was also very high. 15 infections in the control group are contrasted by one infection only in the treated group. The efficacy of the prophylaxis is objectively assessed by measuring the temperature curve and by determining the number and the spectrum of the postoperatively isolated germs. The germs isolated in the treated group are exclusively such germs which are resistant to Ceftriaxon (enterococci) or which are only moderately sensitive to Ceftriaxon, such as Bacteroides.

In a prospective study on infectious morbidity after vaginal hysterectomy we examined the clinical symptoms of an infection and partly also the microbial conditions of the vaginal wound. With a group of 49 patients without antibiotic prophylaxis we tried to find out if the type of vaginal occlusion might have any influence on the microbial situation and the healing process. The results of this first group were compared to those of a second group consisting of 31 patients, who had received antibiotic prophylaxis before the operation with a cephalosporin. Though it was not possible to make any microbial analyses in the second group, the clinical evaluation showed distinctly that antibiotic prophylaxis is an important contribution to the prevention of infections after vaginal hysterectomy. The careful consideration of septic-surgical precautions, however, and this was proved by the first part of the study, contributes as well to the prevention of infections.

In 11 patients in whom an antibiotic (Cefotaxim) had been applied preoperatively, the tissue concentration was determined in the vaginal mucosa where postoperative infections after gynaecological operations are most common. The tissue concentration is compared with the minimum inhibition concentration of the pathogens identified directly before the operation in the cervicovaginal flora. In the case of the aerobic pathogens--with the exception of Pseudomonas aeruginosa--the concentration is far in excess of the necessary MIC, whereas with the anaerobic pathogens the concentration is only partly greater than the MIC. Resistance exists against Bacteroides fragilis.

Colonization of the oropharynx with potentially pathogenic microorganisms (PPM) is a highly significant factor in the pathogenesis of bacterial pneumonia in intensive care patients. Via colonization of the oropharynx, bacteria pass into the tracheobronchial tree, where they can give rise to pneumonia after overcoming pulmonary resistance mechanisms. By a new, prophylactic antibiotic treatment schedule consisting in selective decontamination of the digestive tract (SDD) with locally applied nonabsorbable antibiotics, Stoutenbeek achieved drastic lowering of the colonization and infection rate in trauma patients. In the present study, we wanted to check whether this new prophylactic antibiotic schedule can be applied on a surgical intensive care ward in all patients with long-term ventilation, irrespective of the diagnosis, and whether it affords advantages over a conventional antibiotic schedule. MATERIALS AND METHODS. All patients on a surgical intensive care ward in whom it was expected that mechanical ventilation would be necessary for more than 4 days were included in the study. During the first 6 months 83 patients were investigated, in whom antibiotics were only administered when the presence of infection had been confirmed, in accordance with generally accepted guidelines (control group). In the second 6-month period, 82 patients were selectively decontaminated with 4 x 100 mg polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and in an antimicrobial paste in the oropharynx (SDD group). The SDD schedule entailed systemic administration of cefotaxime in the first 3-4 days. RESULTS. In the control group, enterobacteria/Pseudomonas spp. were isolated significantly more frequently than in the SDD group (P less than 0.001): in the pharyngeal smear in up to 53%, in the tracheal secretion up to 36%, and in the rectal smear in up to 93% of the patients In the SDD group in the 1 week the frequency of gram-negative aerobic bacteria in the pharynx decreased from 33% to 5%, in the tracheal secretion from 23% to 14% and in the rectum from 86% to 52% (24% in the second week). However, the decrease in gram-negative microorganisms was accompanied by significant increase in the frequency of Staphylococcus epidermidis and enterococci. The SDD schedule proved to be effective with regard to the rate of infection. In the control group, 35 patients developed pneumonia (42%) as against 5 patients receiving SDD prophylaxis (6%). The duration of mechanical ventilation in the patients with pneumonia was 5 days longer than in patients without pneumonia.(ABSTRACT TRUNCATED AT 400 WORDS)

15 patients with severe diabetic gangrene were treated with a combined intra-arterial PGE1/Cefotaxime infusion therapy. There was no indication for vascular reconstructive surgery. The average treatment took 24.7 days. 11 of the 15 patients were responsive to the therapy. Nevertheless 5 of these 11 patients had to be amputated below-knee in the further course of treatment. In 6 cases we succeeded in preserving the affected extremity in a state of acceptable use. One patient died during the study. No complications due to the therapy were seen. Considering that all patients were near to amputation when entering the study the result to have saved the extremities in 40% of the cases must be regarded as a success.

In 43 ICU patients undergoing continuous volume constant hemofiltration (CVHF), the pharmacokinetics of 12 drugs were investigated to ensure correct dosage adjustments. Under conditions of CVHF, maximum doses were defined for cefotaxime, ceftazidime, digoxin, digitoxin, imipenem, metronidazole++, netilmicin, phenobarbital, phenytoin, theophylline, tobramycin, and vancomycin. For the estimation of sufficient doses without blood level measurements, sieving coefficients (S) were calculated by a new method. In addition, S was integrated as a CVHF-specific factor into a common equation for drug dose adjustment in patients with renal insufficiency. The regression of dosage received from kinetics on blood-level-independent equation adjustment was r = 0.9923. Since the volumes of distribution in ICU patients are variable, it is suggested that further drug monitoring is necessary for toxic drugs.

In a randomized trial in 60 patients undergoing elective colorectal surgery the efficiency of intravenous antibiotic short time prophylaxis was determined. We compared single dose application with multiple dose prophylaxis for 24 h. The substance used was cefotaxime. The rate of wound infections was comparable in both groups (16.6 vs. 13.3%) as well as postoperative infections of the urinary tract (33.3 vs. 23.3%). The results of the study suggest that single dose prophylaxis is as efficient as multiple dose application to reduce postoperative infections in elective colorectal surgery.

In continuation of our clinical observations on perioperative prophylaxis by application of Halospor and Gentamicin the dosage of Halospor has been reduced to 2 grams once only. According to our experiences in 98 cases of cesarean section we can recommend these advance: fever in 12.2% (21.2% without prophylaxis), secondary wound-healing in 2% (6.7%) and therapeutical antibiotics in 13.3%, Metronidazol as often as not (36.6%).

The corresponding levels of cefotaxime in serum and synovial fluid were investigated in patients undergoing surgery under perioperative antibiotic medication. By investigating 32 samples a concentration band over 4 hours could be established. Clinically relevant levels of the drug could be found from 10 minutes after start of the intravenous dose with an increase up to 30 minutes. Between 30 and 90 minutes the average concentration was about 40 micrograms/ml. After 90 minutes a decrease of the concentration was found and the median lines for synovial and serum concentrations crossed at about 105 minutes. Even after 4 hours we found synovial titers of 10 to 20 micrograms/ml having therapeutical relevance. From the results we can conclude, that cefotaxime infusion of 2 g produced over hours therapeutical synovial levels being significantly over the break point of 16 micrograms/ml for bacteria susceptible to this antibiotic agent. On the other hand we strongly recommend not to wait too long with surgical intervention when a joint infection does not improve significantly in 48 hours under systemic antibiotic treatment.

55 intensive care patients with an internal underlying disease were treated with cefotaxime, and 12 patients with bronchopulmonary infections were treated with the combination cefotaxime/ticarcillin. The following aspects were evaluated: clinical success, antimicrobial activity of bacteria in evidence before and after therapy, persistence of pathogens, and resistance. Renal function was monitored continuously in 21 patients over a period of 20 days in order to demonstrate nephrotoxic side-effects of cefotaxime when administered simultaneously with furosemide (in doses of mre than 1 g/day). In view of the clinical results and of the fact that the cefotaxime/ticarcillin combination is well tolerated by the kidneys, the possibility of efficient chemotherapy without aminoglycosides is being discussed for treatment of bronchopulmonary infections in patients under intensive care.