Cefotaxime and desacetylcefotaxime in neonates and children: a review of microbiologic, pharmacokinetic, and clinical experience

Diagn Microbiol Infect Dis. 1989 Jan-Feb;12(1):93-9. doi: 10.1016/0732-8893(89)90052-7.

Abstract

Over the past 5 yr, we have conducted two clinical and two pharmacokinetic investigations of cefotaxime (CTX) and desacetylcefotaxime (dCTX) in neonates, infants, and children. A total of 50 children with culture-proven bacterial meningitis were randomized to receive either 200 mg/kg/day of CTX (n = 23, mean age 24.4 mo) or standard doses of ampicillin (AMP) and chloramphenicol succinate (CAPS; n = 27, mean age 16.6 mo). Results were similar between the CTX and Amp/CAPS groups for clinical/microbiological cures (100% versus 96%, respectively) and for survival without sequelae (78% vs. 77%, respectively). All bacterial isolates were sensitive to CTX, and the comparison of the MIC/MBC values for CTX to the CSF bactericidal titers suggested antimicrobial activity for dCTX. In a second clinical trial, 20 infants (1 wk-3 mo) were treated with 200 mg/kg/day of CTX for Gram-negative enteric bacillary meningitis. Cultures of CSF obtained 24 hr after the initiation of treatment were sterile in all subjects. Survival and complication rates of 95% and 21%, respectively, were observed. This compared favorably to previously published experiences with alternate treatment regimens for Gram-negative meningitis in the newborn. In both meningitis studies, the safety profile for CTX was excellent.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Review

MeSH terms

  • Adolescent
  • Ampicillin / therapeutic use
  • Cefotaxime / analogs & derivatives*
  • Cefotaxime / pharmacokinetics
  • Cefotaxime / pharmacology
  • Cefotaxime / therapeutic use*
  • Child
  • Child, Preschool
  • Chloramphenicol / therapeutic use
  • Clinical Trials as Topic
  • Drug Therapy, Combination / pharmacokinetics
  • Drug Therapy, Combination / pharmacology
  • Drug Therapy, Combination / therapeutic use
  • Gram-Negative Bacteria / drug effects
  • Haemophilus influenzae / drug effects
  • Humans
  • Infant
  • Infant, Newborn
  • Meningitis / drug therapy*
  • Meningitis / metabolism
  • Random Allocation

Substances

  • Chloramphenicol
  • desacetylcefotaxime
  • Ampicillin
  • Cefotaxime