Summary
66 patients with predominantly community-acquired pneumonia were treated with cefotaxime. The group consisted of 45 males and 21 females, aged 56 to 90 years, 43 of the patients belonging to the age groups 65–80 years.Streptococcus pneumoniae was isolated in 21 of the 34 patients with gram-positive pneumonia,Staphylococcus aureus in six,Staphylococcus epidermidis in five andStreptococcus faecalis in two.Klebsiella pneumoniae was the predominant pathogen in gram-negative pneumonia (eight patients), followed byEnterobacter (n=6),Pseudomonas aeruginosa (n=5),Haemophilus influenzae (n=4),Escherichia coli (n=3),Serratia marcescens andCitrobacter (two cases each). Thein vitro activity of cefotaxime against the isolates was compared to the activity of other β-lactam antibiotics. Characteristically, the classical signs and symptoms of pneumonia were absent or discrete in some of the elderly patients. There was a delayed clearance of pulmonary infiltrates. 55 of 66 patients responded to cefotaxime within four weeks of treatment; the symptoms were aggravated or remained unchanged in seven patients. Patients with a delayed clinical response displayed decreased peripheral lymphocyte counts and T cell functions in PHA stimulation tests, as well as low immunoglobulin levels. A combination of cefotaxime and gamma-venin cleared the symptoms in some of these patients.
Zusammenfassung
66 Patienten mit vorwiegend außerhalb des Krankenhauses erworbener Pneumonie wurden mit Cefotaxim behandelt. 45 Patienten waren Männer, 21 Frauen im Alter von 56 bis 90 Jahren. 43 der Patienten waren in den Altersgruppen zwischen 65 und 80 Jahren. Bei 21 der 34 Patienten mit grampositiver Pneumonie wurdeStreptococcus pneumoniae isoliert, bei sechsStaphylococcus aureus, bei fünfStaphylococcus epidermidis und bei zweiStreptococcus faecalis. Bei den gramnegativen Pneumonien warKlebsiella pneumoniae der häufigste Erreger, es folgteEnterobacter (n=6),Pseudomonas aeruginosa (n=5),Haemophilus influenzae (n=4),Escherichia coli (n=3),Serratia marcescens undCitrobacter (je zwei). DieIn vitro-Aktivität von Cefotaxim gegen die isolierten Erreger wurde mit der von anderen ß-Lactamantibiotika verglichen. Typischerweise waren die klassischen Symptome der Pneumonie bei einigen älteren Patienten nicht vorhanden oder nur diskret ausgeprägt. Die pulmonalen Infiltrate bildeten sich verzögert zurück. Bei 55 der 66 Patienten verschwanden die Symptome innerhalb einer vierwöchigen Therapie mit Cefotaxim. Bei sieben Patienten verschlechterte sich die Symptomatik oder blieb unverändert. Bei Patienten mit verzögertem klinischen Ansprechen fanden sich verminderte periphere Lymphozytenzahlen und eine reduzierte T-Zell-Stimulierbarkeit sowie niedrige Immunglobulinspiegel. Bei einigen dieser Patienten konnte eine Rückbildung der Symptome durch kombinierte Anwendung von Cefotaxim und Gammavenin erreicht werden.
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Katsunuma, H. Clinical evaluation of the effect of cefotaxime in senile pneumonia caused by gram-positive and gram-negative bacteria. Infection 13 (Suppl 1), S18–S24 (1985). https://doi.org/10.1007/BF01644212
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DOI: https://doi.org/10.1007/BF01644212