Related Experiment Videos
[The third generation cephems for surgical infections]
Abstract:
The third generation cephems, Cefotaxime, Ceftizoxime, Cefmenoxime and Latamoxef, have been developed to aim opportunistic Gram negative pathogens and applied for surgical infections since 1980. Although they have excellent antibacterial activities in vitro against Enterobacter spp., indole positive Proteus spp., Pseudomonas spp. and Bacteroides spp., they show lower activities against Gram positive bacteria. Their pharmacokinetic characteristics are longer serum half-life, lower urinary excretion and higher biliary transmission without any metabolic inactivation in human body. Clinical trials of the third generation cephems to surgical infections in Japan revealed the average efficacy rate of 84% which might be better than that of the second generation cephems. It may be a discrepancy between their antibacterial spectrum and clinical results that responses in cases caused by Gram negatives did not exceed those by Gram positives. Clinical application of the third generation cephems should be limited to the surgical infections caused by Gram negatives in immunocompromised host to avoid the emergence of resistant strains.
Insights
Third-generation cephalosporins (cephems) show excellent activity against Gram-negative pathogens but lower efficacy against Gram-positive bacteria. Clinical use should focus on Gram-negative surgical infections in immunocompromised patients to prevent resistance.
Area of Science:
- Pharmacology
- Microbiology
- Clinical Medicine
Context:
- Third-generation cephalosporins, including Cefotaxime, Ceftizoxime, Cefmenoxime, and Latamoxef, were developed for opportunistic Gram-negative pathogens and surgical infections.
- These antibiotics exhibit potent in vitro activity against Enterobacter spp., indole-positive Proteus spp., Pseudomonas spp., and Bacteroides spp.
Purpose:
- To evaluate the efficacy and pharmacokinetic properties of third-generation cephalosporins in surgical infections.
- To compare their clinical performance against second-generation cephalosporins.
Summary:
- Third-generation cephalosporins possess longer serum half-lives, reduced urinary excretion, and higher biliary transmission without metabolic inactivation.
- Clinical trials in Japan demonstrated an average efficacy rate of 84% for surgical infections.
- A discrepancy exists between their broad-spectrum activity and clinical results, with Gram-negative infections not showing superior response rates compared to Gram-positive infections.
Impact:
- Clinical application should be judiciously limited to Gram-negative surgical infections in immunocompromised hosts.
- This targeted approach aims to mitigate the emergence of antibiotic-resistant strains.
- Findings suggest a need for careful consideration of the antibacterial spectrum versus clinical outcomes in treatment strategies.