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[Clinical evaluation of cefmenoxime in infections of neonates]
T Haruta1, K Okura, H Yamamoto
1Department of Pediatrics, Kobe Central Municipal Hospital.
Insights
Cefmenoxime (CMX) demonstrates dose-dependent serum concentrations and variable half-lives in neonates and premature infants. The antibiotic proved effective in treating serious bacterial infections, including meningitis, septicemia, and UTIs in this vulnerable population.
Area of Science:
- Pharmacokinetics and pharmacodynamics in pediatric populations.
- Antibiotic efficacy and safety in neonates and premature infants.
- Clinical pharmacology of third-generation cephalosporins.
Context:
- Neonates and premature infants represent a unique population with altered drug metabolism and excretion.
- Bacterial infections in this age group require careful consideration of antibiotic choice and dosing.
- Limited data exists on the pharmacokinetic profile and therapeutic effectiveness of certain antibiotics in neonates.
Purpose:
- To evaluate the absorption, excretion, and therapeutic effectiveness of Cefmenoxime (CMX) in neonates and premature infants.
- To determine the relationship between CMX dosage and serum concentrations.
- To assess the efficacy of CMX in treating various bacterial infections in the neonatal population.
Summary:
- Cefmenoxime (CMX) administration resulted in dose-dependent serum concentrations and varied elimination half-lives across different age groups and dosages in premature infants and neonates.
- Urinary recovery rates of CMX varied, with lower rates observed in low birth weight premature infants.
- CMX demonstrated excellent therapeutic efficacy against meningitis, septicemia, and urinary tract infections, and good efficacy for purulent parotitis and pneumonia in neonates.
Impact:
- Provides crucial pharmacokinetic data for Cefmenoxime (CMX) in a vulnerable pediatric population.
- Supports the use of Cefmenoxime (CMX) as an effective treatment option for serious bacterial infections in neonates and premature infants.
- Informs optimal dosing strategies and clinical management of Cefmenoxime (CMX) in neonatal care.
Abstract:
Cefmenoxime (CMX) was evaluated for its absorption and excretion as well as for therapeutic effectiveness in neonates and premature infants. The following results were obtained. 1. Serum concentrations of the drug were examined in 3 premature infants 1 to 11 days old upon intravenous administration of about 10 mg/kg body weight (1st group), in 2 premature infants 18 and 32 days old and 1 neonate 17 days old upon intravenous administration of about 20 mg/kg (2nd group), and in 1 neonate 15 days old with meningitis upon intravenous administration of 45.2 mg/kg. Concentrations of CMX at 30 minutes after administration were 43, 29 and 27 micrograms/ml, respectively, in the 1st group, 46, 37 and 44 micrograms/ml, respectively, in the 2nd group and 208 micrograms/ml in the other neonate, and appeared to be dose-dependent. Concentrations of CMX at 6 hours after administration were 18.2, 6.6 and 8.1 micrograms/ml, respectively, in the 1st group, 9.6, 11 and 1.35 micrograms/ml, respectively, in the 2nd group and 5.2 micrograms/ml in the other subject. Serum half-lives were, respectively, 4.59, 2.85 and 3.48 hours in the 1st group, 2.52, 2.73 and 1.14 hours in the 2nd group and 1.0 hour in the other subject. Urinary recovery rates during the first 6 hours after administration were 45.8, 87.0, 50.2 and more than 100% in 4 cases examined. Two of these cases, in which recovery rates were 45.8 and 50.2%, were premature infants of low birth weight. Spinal fluid concentrations of the drug at 80 to 90 minutes after dosing to 1 neonate with purulent meningitis (causative organism presumed: Escherichia coli) given 48.3 mg/kg tended to decline gradually with the recovery of the disease, 3.8, 1.72 and 1.32 micrograms/ml on the 2nd, 6th and 8th day, respectively. 2. The drug was given to 9 neonates 0 to 24 days old. The therapeutic effectiveness on bacterial infections was evaluated in 7 cases (10 diseases) including 1 disease of purulent meningitis presumably caused by E. coli, 4 of septicemia caused by E. coli, Staphylococcus aureus and Streptococcus agalactiae (1, 2 and 1, respectively), 3 of urinary tract infection caused by E. coli, Serratia and Enterococcus faecalis (1 each), 1 of purulent parotitis caused by S. aureus and 1 of pneumonia (causative organism was unknown). Therapeutic efficacies were assessed as "Excellent" in all of meningitis, septicemia and urinary tract infection cases, and "Good" in 1 each of purulent parotitis and pneumonia cases.(ABSTRACT TRUNCATED AT 400 WORDS)