Safety Profile and Efficacy of Cefotaxime for the Treatment of Hospitalized Children

Abstract

Cefotaxime has been used to treat serious bacterial infections in children since 1982. With the predominant use of cephalosporins in pediatrics, reports of adverse effects of certain compounds have increased. A retrospective review is presented of 2,243 cases of children receiving therapy with cefotaxime in order to evaluate the safety profile and efficacy of cefotaxime in the treatment of serious infections in hospitalized children. Overall, 57 (2.5%) children experienced adverse reactions. These included local reactions in 6 (0.3%), rash in 28 (1.2%), diarrhea in 15 (0.97%), vomiting in 10 (0.7%), abdominal pain in 1 (0.1%), headache in 3 (0.4%), and drug fever in 1 (0.1%). No cases of hemolytic anemia, bleeding, or hyperbilirubinemia were found. Efficacy of treatment for different disease categories ranged from 90.5% to 100%. The percentage of children in any treatment group with a particular laboratory abnormality following initiation of cefotaxime therapy ranged from 0% to 2.6%, and rates of superinfection with bacteria or Candida were 0.4% to 1.7%. Cefotaxime has the distinct advantage of high rates of efficacy and low rates of complications and superinfection among children hospitalized for serious infections.

Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials?

“…Most of the trials failed to detect statistically significant differences between the two groups, thus providing little understanding about the relative effectiveness of various regimens for treating osteomyelitis. Another limitation of the available literature is that trials involving 'bone and joint infections' include a heterogeneous spectrum of diseases, with different 61 Cefotaxime iv GPC 2 NA 23/24 (96) Mader 62 Ceftizoxime iv GPC and GNR 6 1-12 13/14 4 Gomis 63 Cefotaxime iv E. coli 4 6 40/50 (80) Dutoy 64 Ceftazidime iv P. aeruginosa 4 6 7/7 a 11/14 c Eron 65 Ceftazidime iv P. aeruginosa 6 NA 4/8 1 leukopenia Bach 66 Ceftazidime iv P. aeruginosa 4 6 a 9/11 a 12 c 7/15 c De Bastiani 67 prognoses. For example, the cure rate with antibiotics alone of pediatric hematogenous osteomyelitis is much higher than that of a prosthetic joint infection.…”

Renal Transporters in Drug Development

“…In addition, a disproportional increase in organic anion secretion relative to kidney mass has been reported in human subjects, suggesting a specific maturation of the organic anion transport system during development (43). Interestingly, cephalosporin-related nephrotoxicity occurs more frequently in adults than in children (48,49). The reasons for this are largely unknown, although differences in transporter expression could, in part, explain these observations.…”

Chromosomal and plasmid encoded drug resistances of a Klebsiella pneumoniae UTI 2 strain isolated from urine of a post-operative patient

“…Klebsiella pneumoniae UTI 2 is resistant to 36 antibiotics and this organism is only susceptible to cefotaxime and imipenem. Cefotaxime [b-lactam antibiotic (Tateda et al 1999)] is a semi-synthetic cephalosporin of group 4 cephalosporins which exhibit more activity than other compounds of this group (Jacobs et al 1992). In most cases, the resistance of clinical isolates is due to the production of a bacterial enzyme, b-lactamase, that opens the blactam ring causing inactivation of the antibiotic.…”