Thirty-five trials involving 7125 patients were included in the meta-analysis. The overall summary odds ratio (OR) for the bacteriologic cure rate significantly favored cephalosporins compared with penicillin (OR: 3.02; 95% confidence interval [CI]: 2.49-3.67, with the individual cephalosporins [cephalexin, cefadroxil, cefuroxime, cefpodoxime, cefprozil, cefixime, ceftibuten, and cefdinir] showing superior bacteriologic cure rates). The overall summary OR for clinical cure rate was 2.33 (95% CI: 1.84-2.97), significantly favoring the same individual cephalosporins. There was a trend for diminishing bacterial cure with penicillin over time, comparing the trials published in the 1970s, 1980s, and 1990s. Sensitivity analyses for bacterial cure significantly favored cephalosporin treatment over penicillin treatment when trials were grouped as double-blind (OR: 2.31; 95% CI: 1.39-3.85), high-quality (OR: 2.50; 95% CI: 1.85-3.36) trials with well-defined clinical status (OR: 2.12; 95% CI: 1.54-2.90), with detailed compliance monitoring (OR: 2.85; 95% CI: 2.33-3.47), with GABHS serotyping (OR: 3.10; 95% CI: 2.42-3.98), with carriers eliminated (OR: 2.51; 95% CI: 1.55-4.08), and with test of cure 3 to 14 days posttreatment (OR: 3.53; 95% CI: 2.75-4.54). Analysis of comparative bacteriologic cure rates for the 3 generations of cephalosporins did not show a difference.
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We conducted an anonymous electronic survey of US PEM fellows in April-June 2009.
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A multicenter, collaborative study was performed over a three-year period (1992-1994) to determine the antimicrobial susceptibilities of isolates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae from community-acquired lower respiratory tract infections. Isolates were collected from five geographically separated medical centers in the United States and sent to a central laboratory for antimicrobial susceptibility testing. Of 350, 536, and 372 isolates of H. influenzae collected from the five centers in 1992, 1993, and 1994, 26.3%, 28.2%, and 30.1%, respectively, were beta-lactamase-positive. All isolates of H. influenzae remained susceptible to ceftriaxone, doxycycline, ciprofloxacin, and ofloxacin over the three-year period. Between 95 and 100% of isolates of H. influenzae remained susceptible to amoxicillin-clavulanic acid cefixime, clarithromycin, and chloramphenicol over this same period. The prevalence of beta-lactamase-positive isolates of M. catarrhalis increased from 92.1% in 1992 to 93.8% in 1993 and to 96.5% in 1994; however, isolates of this species were highly susceptible to amoxicillin-clavulanic acid, the cephalosporins, the macrolides, the fluoroquinolones, chloramphenicol, doxycycline, and trimethoprim-sulfamethoxazole. The prevalence of penicillin-intermediate isolates of S. pneumoniae decreased from 16% in 1992 to 8.2% in 1994, whereas that of penicillin-resistant isolates increased from 5.6% to 10.9% in the same period. Ceftriaxone susceptibility declined from 95.2% to 88.4% over the three years, whereas chloramphenicol susceptibility declined from 98.4% to 90.5% and that of trimethoprim-sulfamethoxazole declined from 85.6% to 68.7%. Macrolide activity remained unchanged.
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Adult patients with chronic periodontitis (n = 90) underwent non-surgical periodontal treatment (zero-day) and then randomly divided into three groups. The group I served as a control, the group II was additionally treated with the combination of amoxicillin and metronidazole (for 7 days), while the group III was treated with cefixime (also for 7 days). To assess the condition of periodontium before and seven days after the therapy, four clinical parameters were used: gingival index (GI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL).
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Emergence of multi-resistant strains of Salmonella typhi is a major problem in treatment of typhoid fever and requires an excessive hospitalization period. Therefore, the present study was carried out to estimate the degree of the resistance of S. typhi strains to various antibiotics such as cefixime. Fifty two strains of Salmonella typhi isolated from patients with typhoid fever and their sensitivity to various antibiotics was determined. MICs of cefixime and chloramphenicol were also determined according to comitee de l'antibiogramme français. Results indicated that 41.9%, 33.9%, 38.7%, 58.1% and 1.6% of isolated strains were resistant to chloramphenicol, co-trimoxazole, ampicillin, tetracycline and gentamycin respectively. About one third (33.9%) of strains showed multiple resistance to the first four mentioned antibiotics. All strains were susceptible to ceftizoxime and cefixime (MICs 1 and less than 1 mcg/ml). It could be concluded that cefixime due to its effectiveness, oral administration and shorter courses of treatment could be the therapy of choice in cases of typhoid fever caused by multiple resistant strains especially when we have a shortage of hospital beds.
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In this study, we determined the in vitro activity of various combinations of antimicrobial agents against 54 Neisseria gonorrhoeae isolates. The combined activity of ceftriaxone (CRO) and azithromycin (AZM), CRO and doxycycline (DOX), CRO and spectinomycin (SPT), cefixime (CFX) and AZM, CFX and DOX, and CFX and SPT was determined using a checkerboard method. The fractional inhibitory concentration index (FICI) values for all combinations were either additive or indifferent, and no synergistic or antagonistic effects were found. The FICI comparison in each combination did not show any difference according to the N.gonorrhoeae-resistant phenotypes and genotypic characteristics, including penicillinase-producing N. gonorrhoeae, tetracycline-resistant N. gonorrhoeae, stratified MIC of all antibiotics, and N. gonorrhoeae multiantigen sequence typing. MIC50 and MIC90 of tigecycline by agar dilution were 0.5 mg/L and 0.5 mg/L, respectively, which were lower than that of tetracycline and DOX. Additive/indifference results could suggest that combinations that include CRO may be used safely without a significant likelihood of generating resistance.
Enteric fever is a serious public health problem in Pakistan, where multidrug-resistant salmonellosis causes enteric fever with increased morbidity and mortality. Costly parenteral therapy and lack of an established safety profile for the use of quinolones in children necessitate evaluation of an oral treatment option. This study is meant to assess the efficacy, safety, and cost effectiveness of an oral third-generation cephalosporin (cefixime) in the treatment of multidrug-resistant enteric fever.
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Currently, there is no imminent risk of untreatable gonorrhea in Austria. However, continuing the use of gonococcal cultures as a diagnostic tool for establishing resistance profiles is essential in order to monitor trends in the development of Neisseria (N.) gonorrhoeae resistance.
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Tonsillopharyngitis is very common in children, with Group A Streptococci being the most common bacterial etiology. Effective antibacterial treatment is imperative due to risk of rheumatic fever. Cephalosporins have been used successfully for the treatment of Group A beta-hemolytic Streptococcal (GABHS) tonsillopharyngitis. Cefprozil is a novel broad-spectrum oral cephalosporin. Cefprozil is rapidly absorbed from the gastrointestinal tract with high bioavailability. The excellent penetration of cefprozil into tonsillar and adenoidal tissue corresponds well with the clinical outcome. The drug provides excellent coverage against both gram-negative and -positive bacteria that may cause pharyngitis/tonsillitis. The beta-lactamase stability of cefprozil appears to exceed that of other oral cephalosporins for important gram negative pathogens. In clinical trials, cefprozil appears to be at least as effective as commonly used comparison agents such as cefaclor and cefixime. Additionally, cefprozil is better tolerated than the latter, especially with regard to gastrointestinal adverse effects. Thus cefprozil can be considered a safe and reliable drug for the treatment of Streptococcal tonsillopharyngitis in children.
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Ophthalmologists are still facing difficulties in managing bacterial eye infections. The study was designed for the isolation and identification of bacteria from infected eyes and observation of the sensitivity and resistant pattern. This cross sectional study was performed among 160 patients of suspected bacterial eye infection at Dr. K. Zaman BNSB Eye Hospital, Mymensingh and Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh from March, 2010 to June, 2014. After collection of the samples from suspected infected eyes, it was nourished into nutrient broth in shaking incubator for three hours and then cultured into nutrient agar media followed by Mannitol salt agar, MacConkey's agar and blood agar. Bacteria were categorized by colony characteristics and Gram staining. Antibiogram was performed by disc diffusion method on Mueller Hinton agar media. McFarland Equivalence Turbidity Standard was maintained. The efficacy of the drug was evaluated by measuring the diameter of the zone of inhibition surrounding the disc. Ten percent Staphylococcus species isolates was resistant to Gatifloxacin, Gentamicin, Tobramycin and Cloxacillin, 26.0% to Ciprofloxacin, 40.0% to Azythromycin and Moxifloxacin, 58.0% to Cefixime and 64.0% to Cephalexin. Methicillin resistant Staphylococcus aureus was 62.8%. About 24.0% Streptococcus species isolates was resistant to Gatifloxacin, 33.3% to Azythromycin, Ciprofloxacin, Gentamycin, Moxifloxacin and Tobramycin, 52.4% to Cefixime and 71.4% to Cephalexin. About 9.0% of Pseudomonas species was resistant to Gatifloxacin and Tobramycin, 14.7% to Ciprofloxacin, 26.5% to Cefixime, 29.4% to Gentamicin and Moxifloxacin, 44.1% to Azythromycin and 82.3% to Cephalexin and Cloxacillin. Rational use of antibiotics and proper attentions of concerned authorities are necessary to overcome the emergent ocular situation leaded by antibiotic resistant.
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In contrast to West-European countries, in our region, resistance to azithromycin has increased up to 30 % in the last 5 years, so the recommendation of the European Guideline -500 mg of ceftriaxone combined with 2 g of azithromycin as first choice therapy against N. gonorrhoeae- should be seriously considered in case of Hungary.