Ninety infants and children were prospectively randomized to receive cefepime (n = 43) or cefotaxime (n = 47) for therapy of bacterial meningitis. The two treatment groups were comparable in terms of age, duration of illness before enrollment, history of seizures, clinical status on admission, and etiology. Six (7%) patients died--two treated with cefepime and four treated with cefotaxime. Clinical response, cerebrospinal fluid sterilization, development of complications, antibiotic toxicity, and hospital stay were similar for the two treatment regimens. Concentrations of cefepime in cerebrospinal fluid varied from 55 to 95 times greater than the maximal MIC required by the causative pathogens. Audiologic and/or neurologic sequelae were found in 16% of the cefepime-treated patients and 15% of the cefotaxime-treated patients examined 2 to 6 months after discharge. We conclude that cefepime is safe and therapeutically equivalent to cefotaxime for management of bacterial meningitis in infants and children.

No abstract

The interaction between tazobactam and several chromosome- and plasmid-encoded (TEM, SHV, PSE types) class A and C beta-lactamases was studied by spectrophotometry. Tazobactam behaved as a competitive inhibitor or inactivator able to restore in several cases the efficiency of piperacillin as a partner beta-lactam. A detailed kinetic analysis permitted measurement of the acylation efficiency for some cephalosporinases and broad-spectrum beta-lactamases; the presence of a turn-over of acyl-enzyme complex was also evaluated.

The in vitro activities of six commonly used antibiotics and six newer β-lactam agents were determined in 50 consecutive clinical isolates of β-lactamase-negative Neisseria gonorrhoeae . The gonococci isolated were notably resistant to penicillin, ampicillin, erythromycin, and tetracycline, whereas all of the strains were susceptible to the newer β-lactam agents cefoxitin and spectinomycin.

suMMxRY Efficacy of single-dose spectinomycin (TRO: 2 g intramuscularly) was compared with that ofaqueous procaine penicillin G (APPG: 4.8 x 106 units) plus 1 g ofprobenecid for treatment of gonococcal urethritis and cervicitis. Cure rates ofthe 210 patients who received TRO and 190 patients who received APPG were 97-6% and 91 1%, respectively. MICs of antibiotics were determined using the agar dilution method. Those isolates with MICs of APPG of < 1.0 ug/ml had low failure rates (2.9%), while strains with increased resistance to APPG (MICs > 1.0 pg/ml) had higher failure rates (24%). Treatment failures seen with TRO were not correlated to isolates with the higher MICs. Clinical results suggest TRO could be given for treatment ofgenital gonorrhoea in Puerto Rico due to the high prevalence of both chromosomally-mediated penicillin-resistant Neisseria gonorrhoeae (20%) and penicillinase-producing Neisseria gonorrhoeae (7.5%) strains and the high rate of failure seen with the use of APPG. The failure ofpenicillin and spectinomycin regimens in the clinical setting are known to vary according to geographic location.'`3 The reports of significant spatial and prevalence variation in the distribution of penicillinase-producing Neisseria gonorrhoeae (PPNG),' chromosomally mediated penicillin-resistant Neisseria gonorrhoeae (CMRNG) strains,9" and spectinomycin-resistant isolates'2-'5 are causes for concern among health-care practitioners world-wide.