Summary
Fifty-five patients with gram-positive bacteremias were treated with cefotaxime after enrollment in comparative and non-comparative study protocols. Forty-nine of these 55 patients were evaluable and followed for their response to therapy and adverse effects. Most patients were white males 50 years of age or older (69%); 45% had two or more serious underlying diseases. Pneumonias caused 59% of these bacteremias, which were etiologically due toStreptococcus pneumoniae (22 episodes),Staphylococcus aureus (15), coagulase-negative staphylococci (3) and other streptococci (12). Overall, 90% of bacteremias were cured with cefotaxime therapy. Among five treatment failures were included three deaths, one due to cefotaxime-associated pseudomembranous colitis, one caused by a bacteremic superinfection due toPseudomonas aeruginosa and one due to a progressive pneumonia despite therapy. Adverse effects of therapy were infrequent and noteworthy for only one patient with questionable nephrotoxicity and a lack of cefotaxime-associated coagulopathy.
Zusammenfassung
55 Patienten mit grampositiven Bakteriämien wurden nach Zuordnung zu Studienprotokollen, die entweder für Vergleichsstudien konzipiert waren oder für nicht vergleichende Studien, mit Cefotaxim behandelt. Von diesen 55 Patienten standen 49 für eine Auswertung bezüglich Therapie-Erfolg und Nebenwirkungen zur Verfügung. Die meisten Patienten waren Kaukasier im Alter von 50 Jahren oder darüber (69%). 45% hatten zwei oder mehr ernsthafte Grundkrankheiten. 59% der Bakteriämien gingen von Pneumonien aus, die durchStreptococcus pneumoniae (22 Fälle),Staphylococcus aureus (15), koagulasenegative Staphylokokken (3) und andere Streptokokken (12) verursacht waren. Insgesamt wurden 90% der Bakteriämien unter Cefotaximtherapie geheilt. Unter den fünf Therapieversagern waren drei Todesfälle, von denen einer auf eine mit der Cefotaximbehandlung assoziierte pseudomembranöse Colitis zurückzuführen war, einer durchPseudomonas aeruginosa und einer durch die trotz Therapie fortschreitende Pneumonie bedingt war. Nebenwirkungen traten nur selten auf und sind nur bei einem Patienten mit fraglicher Nephrotoxizität erwähnenswert; eine Koagulopathie trat im Zusammenhang mit Cefotaximtherapie nicht auf.
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Schleupner, C.J. Clinical experience with cefotaxime for the therapy of bacteremias due to gram-positive organisms. Infection 13 (Suppl 1), S28–S33 (1985). https://doi.org/10.1007/BF01644214
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DOI: https://doi.org/10.1007/BF01644214