Clinical experience of cefotaxime in infections caused by gram-positive pathogens

Cefotaxime in the treatment of staphylococcal infections. Comparison of in vitro and in vivo studies

Staphylococcus aureus strains are well-established pathogens that may cause mild to serious life-threatening disease. Coagulase-negative staphylococci, particularly Staphylococcus epidermidis, also have a pathogenic role in humans and cause infections primarily associated with prosthetic devices and indwelling catheters, whereas Staphylococcus saprophyticus usually causes urinary tract infections. Cefotaxime is a "third-generation" cephalosporin that is stable to the staphylococcal beta-lactamases. In vitro studies over the last 15 years have shown that this parenteral cephalosporin has remained highly active (MIC90 ranges of < or = 2-8 micrograms/ml) against oxacillin-susceptible staphylococci. Cefotaxime therapy of staphylococcal infections has resulted in clinical cure/improvement rates ranging from 78%-100% and bacteriologic eradication rates ranging from 85%-100% in a wide variety of infections. Contrary to contemporary dogma, this "third-generation" cephalosporin appears to be efficacious against staphylococcal infections from a review of 15 years of clinical experience.

Retrospective analysis of the clinical and economic outcomes of twice-daily dosing of cefotaxime in a Canadian tertiary care institution

A retrospective analysis of the clinical and economic outcome of a regimen of cefotaxime 1 g given every 12 h was conducted following the introduction of an institutional policy recommending this new dosing strategy. Patients were identified from a log order entry in the pharmacy, and the medical records were reviewed using a standardized data collection form. Explicit criteria were applied for the indications for antimicrobial therapy, presence of infection, and outcome parameters. A total of 60 patients with a mean (+/- SD) age of 56.2 (+/- 17.8) years and a mean (+/- SD) length of stay of 20.75 (+/- 18.1) days were identified. Of these, 48 (80%) were found to have a clinically or microbiologically documented infection, and of the 42 patients who could be assessed accordingly to the criteria chosen, 37 (88%) had a favorable clinical response; 21 patients (35%) received cefotaxime alone. The costs for administration of cefotaxime have decreased by approximately 30% since the introduction of this new dosing regimen.