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Chen MF, Zhang JF, Ren XL, Liu Y, Huang L. [Retrospective analysis of perioperative anaphylactic shock induced by cefuroxime]. Zhonghua Nei Ke Za Zhi 2024; 63:406-411. [PMID: 38561287 DOI: 10.3760/cma.j.cn112138-20231103-00293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This study investigated the characteristics and frequency of perioperative anaphylactic shock induced by cefuroxime, so as to provide a reference for the safe and rational use of cefuroxime in the perioperative period. Cases of perioperative anaphylactic shock caused by cefuroxime in our hospital from 2011 to 2021 were extracted from the Adverse Drug Reaction Monitoring System. Literature reporting adverse drug reactions (ADR) including cefuroxime-induced anaphylactic shock in perioperative settings was collected from the CNKI, VIP, Wanfang, PubMed, and Web of Science databases from their respective inception to May 2022. Statistical analysis was performed for all cases of cefuroxime-induced perioperative anaphylactic shock. A total of 31 patients were included [13 men (48.1%) and 14 women (51.9%)], most of whom were over 60 years old (n=16, 59.3%); 9 (29.0%) patients had a history of drug allergy; 5 (16.1%) patients had received skin tests, but with negative results; 28 (90.3%) patients received treatment intravenously; 22 (71.0%) patients were treated after anesthesia. For 20 (64.5%) patients the ADR occurred within 10 minutes after anesthesia. The main manifestations were hypotension, dyspnea, rash, and tachycardia. For all patients, symptoms resolved after withdrawal of the drug and active rescue, and there were no deaths. A history of allergy and skin test findings may have limitations in predicting perioperative anaphylactic shock caused by cefuroxime; greater vigilance should be exercised when using cefuroxime in the perioperative period. Close monitoring is recommended for patients undergoing treatment with cefuroxime. Rescue therapy should be administered for allergic shock, and suitable response measures must be taken in a timely manner to ensure the safety of patients.
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Affiliation(s)
- M F Chen
- Department of Infectious Disease, Peking University People's Hospital, Beijing 100044,China
| | - J F Zhang
- Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China Department of Pharmacy, Tongliao Hospital, Tongliao 028000, China
| | - X L Ren
- Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
| | - Y Liu
- Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
| | - L Huang
- Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
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Zhan M, Yang X, Zhao C, Han Y, Xie P, Mo Z, Xiao J, Cao Y, Xiao H, Song M. Dietary nobiletin regulated cefuroxime- and levofloxacin-associated "gut microbiota-metabolism" imbalance and intestinal barrier dysfunction in mice. Food Funct 2024; 15:1265-1278. [PMID: 38196314 DOI: 10.1039/d3fo04378a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Nobiletin (NOB) exhibits significant biological activities and may be a potential dietary treatment for antibiotic-associated gut dysbiosis. In this study, mice were gavaged with 0.2 mL day-1 of 12.5 g L-1 cefuroxime (LFX) and 10 g L-1 levofloxacin (LVX) for a duration of 10 days, accompanied by 0.05% NOB to investigate the regulatory effect and potential mechanisms of NOB on antibiotic-induced intestinal microbiota disorder and intestinal barrier dysfunction. Our results indicated that dietary NOB improved the pathology of intestinal epithelial cells and the intestinal permeability by upregulating the expression of intestinal tight junction proteins (TJs) and the number of goblet cells. Furthermore, dietary NOB reduced the levels of serum lipopolysaccharide (LPS) and pro-inflammatory factors (TNF-α and IL-1β), thereby facilitating the restoration of the intestinal mucosal barrier. Additionally, dietary NOB increased the abundance of beneficial bacteria f_Lachnospiraceae and regulated the metabolic disorders of short-chain fatty acids (SCFAs) and bile acids (BAs). Notably, NOB supplementation resulted in elevated levels of butyric acid and lithocholic acid (LCA), which contributed to the repair of the intestinal mucosal barrier function and the maintenance of intestinal homeostasis. Collectively, our results propose a healthy dietary strategy for the prevention or mitigation of antibiotic-associated gut dysbiosis by dietary NOB.
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Affiliation(s)
- Minmin Zhan
- Guangdong Provincial Key Laboratory of Nutraceuticals and Functional Foods, College of Food Sciences, South China Agricultural University, Guangzhou, China.
- Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
| | - Xiaoshuang Yang
- Guangdong Provincial Key Laboratory of Nutraceuticals and Functional Foods, College of Food Sciences, South China Agricultural University, Guangzhou, China.
| | - Chenxi Zhao
- Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
| | - Yanhui Han
- College of Food Engineering and Nutritional Science, Shaanxi Normal University, Xi'an, Shanxi 710062, P.R. China
| | - Peichun Xie
- Guangdong Provincial Key Laboratory of Nutraceuticals and Functional Foods, College of Food Sciences, South China Agricultural University, Guangzhou, China.
| | - Zheqi Mo
- Guangdong Provincial Key Laboratory of Nutraceuticals and Functional Foods, College of Food Sciences, South China Agricultural University, Guangzhou, China.
| | - Jie Xiao
- Guangdong Provincial Key Laboratory of Nutraceuticals and Functional Foods, College of Food Sciences, South China Agricultural University, Guangzhou, China.
| | - Yong Cao
- Guangdong Provincial Key Laboratory of Nutraceuticals and Functional Foods, College of Food Sciences, South China Agricultural University, Guangzhou, China.
| | - Hang Xiao
- Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
- Department of Food Science, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - Mingyue Song
- Guangdong Provincial Key Laboratory of Nutraceuticals and Functional Foods, College of Food Sciences, South China Agricultural University, Guangzhou, China.
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Sun J, Wei Y, Li H, Zheng S, Wu X. Macular Toxicity of Low-Concentration Cefuroxime during Cataract Surgery in Vitrectomized Eyes. Ophthalmic Res 2022; 66:116-123. [PMID: 35970172 DOI: 10.1159/000526449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/04/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of this study was to determine the toxic effect and clinical characteristics of 1 mg/mL cefuroxime sodium on retinas after phacoemulsification in vitrectomized eyes. METHODS Cataract patients with vitrectomized eyes were studied retrospectively. Phacoemulsification combined with intraocular lens implantation was performed uneventfully. Best-corrected visual acuity, intraocular pressure, fundus photography, macular central thickness, and angiography were collected and analyzed. They were studied in patients with macular edema to evaluate macular toxicity. RESULTS Ninety two cases (92 eyes) were enrolled, including 44 eyes of males and 48 eyes of females with an average age of 55.35 ± 12.32 years. Univariate analysis showed that the intraoperative use of balanced salt solution containing 1 mg/mL cefuroxime sodium compound electrolyte and macular involvement in primary vitrectomy were important risk factors for macular edema on the first day after cataract surgery (p < 0.05). In addition, the characteristics of this kind of macular edema were studied; the thickness of macular fovea was significantly high at 1-day follow-up (p < 0.05), but there was no difference between pre-operation and 1-week post-operation (p > 0.05). CONCLUSION Low-concentration cefuroxime sodium can cause acute macular edema in vitrectomized eyes, which can heal within 1 week after surgery.
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Affiliation(s)
- Jiajun Sun
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Yufen Wei
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Honglei Li
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Simeng Zheng
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Xiaoming Wu
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
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Davila JR, Mishra K, Leung LS. Macular Edema and Serous Macular Detachment after a Standard Dose of Intracameral Cefuroxime. Ophthalmic Surg Lasers Imaging Retina 2021; 52:615-618. [PMID: 34766852 DOI: 10.3928/23258160-20211027-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Intracameral cefuroxime has been associated with postoperative macular edema and sub-retinal fluid. To date, nearly all published cases are attributed to errors in antibiotic dilution, leading to administration of supratherapeutic doses. We report three cases of postoperative macular edema and subretinal fluid following a standard dose of 1 mg/0.1 mL of cefuroxime at the end of cataract surgery. Distinguishing features of these cases were intraoperative zonular instability and history of vitrectomy. We hypothesize that certain factors may increase the risk of cefuroxime-associated retinal toxicity, including history of vitrectomy, zonular compromise, posterior capsular break, surgery for a secondary intraocular lens, and unicameral state. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:615-618.].
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Díez-Álvarez L, Salvá-Palomeque T, Jaumandreu L, Gómez-Mariscal M, Muñoz-Negrete FJ, Rebolleda G. Ocular toxicity after inadvertent overdose of intracameral cefuroxime during cataract surgery. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:571-577. [PMID: 34756278 DOI: 10.1016/j.oftale.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. METHODS Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5 mg/0.1 ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. RESULTS All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P = .038), being <1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. CONCLUSIONS Although 1 mg/0.1 ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments.
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Affiliation(s)
- L Díez-Álvarez
- Departamento de Oftalmología, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain.
| | - T Salvá-Palomeque
- Departamento de Oftalmología, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - L Jaumandreu
- Departamento de Oftalmología, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - M Gómez-Mariscal
- Departamento de Oftalmología, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - F J Muñoz-Negrete
- Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - G Rebolleda
- Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
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Affiliation(s)
- David F Chang
- University of California, San Francisco, San Francisco, California
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Zuo C, Mi L, Ye D, Guo X, Xiao H, Wu M, Liu X. Toxic retinopathy after phacoemulsification when the cefuroxime dilution is correct. J Cataract Refract Surg 2019; 44:28-33. [PMID: 29502614 DOI: 10.1016/j.jcrs.2017.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine the clinical characteristics and outcomes of patients with toxic retinopathy after phacoemulsification and intraocular lens implantation when the correct cefuroxime dilution is administered. SETTING State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. DESIGN Prospective case series. METHODS Patients developing toxic retinopathy after phacoemulsification between January 2016 and April 2017 were observed. All patients received an anterior chamber injection of correctly diluted cefuroxime at the end of the surgery. RESULTS The study evaluated 20 patients (20 eyes). At the 1-day follow-up, the mean logarithm of the minimum angle of resolution (logMAR) corrected distance visual acuity (CDVA) decreased to 0.78 logMAR ± 0.31 (SD) with no significant difference compared with the preoperative CDVA of 0.71 ± 0.34 logMAR (P = .535). Spectral-domain optical coherence tomography (SD-OCT) showed cystoid macular edema (CME) with extensive serous neurosensory retinal detachment (RD) at the posterior pole. At the 1-week follow-up, the mean CDVA improved to 0.13 ± 0.80 logMAR and the improvement was significant compared with the preoperative and 1-day postoperative logMAR CDVA (P < .001). The SD-OCT showed regression of CME and recovery of RD. CONCLUSIONS When the drug dilution is correct, there is still a possibility of sporadic cefuroxime toxic maculopathy after intracameral injection of cefuroxime. This toxicity might be related to transient retinal pigment epithelium sodium-potassium pump dysfunction resulting from a large injection volume of a standard dose concentration or individual differences in conventional drug dose tolerance.
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Affiliation(s)
- Chengguo Zuo
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lan Mi
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dan Ye
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xinxing Guo
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hui Xiao
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingxing Wu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xing Liu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Kamal-Salah R, Osoba O, Doyle E. OCULAR TOXICITY AFTER INADVERTENT INTRACAMERAL INJECTION OF HIGH DOSE OF CEFUROXIME DURING CATARACT SURGERY: A CASE SERIES. Retin Cases Brief Rep 2019; 13:269-272. [PMID: 28301414 DOI: 10.1097/icb.0000000000000577] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To report ocular side effects after inadvertent intracameral injection of a high dose of cefuroxime. METHODS Nineteen eyes of 19 patients were seen in our eye department 1 week after the referring surgeon had injected an erroneous dose of intracameral cefuroxime (12.5 mg/0.1 mL in 14 patients, Group A, and 10 mg/0.1 mL in 5 patients, Group B) at the end of a cataract surgery. A complete ophthalmic examination was performed postoperatively. RESULTS Eight patients (42.10%) exhibited ocular side effects. One patient (Group A) developed a noninfectious panuveitis. One case (Group B) had a serous macular detachment. Five patients (4 from Group A and 1 from Group B) showed a disruption of the ellipsoid layer with temporary/permanent drop in visual acuity. One patient presented with color alteration (Group A), but electrodiagnostic studies did not reveal any significant alterations. CONCLUSION Anterior and posterior inflammation has been described after intracameral injection of high dose of cefuroxime. In this study, 10 mg to 12.5 mg of intracameral cefuroxime is shown to be, principally, toxic to the retina with transient or permanent retinal changes on optical coherence tomography which correlate with visual outcomes postoperatively. Protocols to avoid dilution errors should be available in theaters during cataract surgery where such commercial preparations are not available.
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Affiliation(s)
- Radua Kamal-Salah
- Torbay Hospital-South Devon Healthcare NHS Foundation Trust, Torquay, United Kingdom
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Bathini L, Jandoc R, Kuwornu P, McArthur E, Weir MA, Sood MM, Battistella M, Muanda FT, Liu A, Jain AK, Garg AX. Clinical Outcomes of Failing to Dose-Reduce Cephalosporin Antibiotics in Older Adults with CKD. Clin J Am Soc Nephrol 2019; 14:197-205. [PMID: 30630861 PMCID: PMC6390923 DOI: 10.2215/cjn.10710918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/19/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Current dosing recommendations for cephalosporin antibiotics are on the basis of pharmacokinetic studies and are frequently ignored in practice. This study was undertaken to investigate the clinical outcomes of failing to dose-reduce cephalosporin antibiotics in CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Retrospective cohort study conducted in Ontario, Canada using linked population-based health care databases. Nine thousand three hundred forty-seven outpatients (median age 83; interquartile range, 77-88 years; 57% women) with an eGFR<30 ml/min per 1.73 m2 and no prior history of dialysis were dispensed oral cephalexin, cefuroxime, or cefprozil between April of 2007 and March of 2016. Two thirds of the patients (6253 of 9347) received a higher than recommended daily dose of cephalexin (>1000 mg), cefuroxime (>500 mg), or cefprozil (>500 mg). The primary outcome was a hospital encounter (emergency room visit or hospital admission) with a condition listed as a possible side-effect of cephalosporins. Secondary outcomes were antibiotic treatment failure and all-cause mortality. All measures were assessed in the 30 days after cephalosporin initiation. RESULTS Patients who received a higher than recommended dose of a cephalosporin antibiotic were similar in multiple indicators of baseline health to patients who received a reduced dose. Overall, 6% of patients presented to hospital with a possible cephalosporin side-effect, 13% failed antibiotic treatment, and 3% died. Compared with a reduced dose, receiving a higher dose of antibiotic was not associated with a different rate of side-effects (adjusted odds ratio, 1.00; 95% confidence interval, 0.84 to 1.20), treatment failure (1.01; 0.88 to 1.15), or death (0.99; 0.76 to 1.29). CONCLUSIONS In this study we failed to demonstrate any association between the dose of cephalosporin antibiotic administered to elderly patients with CKD and the risk of side-effects leading to hospitalization, treatment failure, or mortality.
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Affiliation(s)
- Lavanya Bathini
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Division of Nephrology, Department of Medicine, and
| | - Racquel Jandoc
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Paul Kuwornu
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Matthew A. Weir
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Division of Nephrology, Department of Medicine, and
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Manish M. Sood
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada; and
| | | | - Flory T. Muanda
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Division of Nephrology, Department of Medicine, and
| | - Aiden Liu
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Arsh K. Jain
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Division of Nephrology, Department of Medicine, and
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Amit X. Garg
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Division of Nephrology, Department of Medicine, and
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Tucker A, Hegarty P, Magill PJ, Blaney J, Armstrong LV, McCaffrey JE, Beverland DE. Acute Kidney Injury After Prophylactic Cefuroxime and Gentamicin in Patients Undergoing Primary Hip and Knee Arthroplasty-A Propensity Score-Matched Study. J Arthroplasty 2018; 33:3009-3015. [PMID: 29807788 DOI: 10.1016/j.arth.2018.04.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Perioperative acute kidney injury (AKI) can be associated with lower limb arthroplasty and increases morbidity, length of stay, and mortality. AKI is more prevalent in some antibiotic regimes compared with others. The aim of the present study is to assess the impact of cefuroxime (CEF), with or without gentamicin (±G), on AKI rates. METHODS A prospective cohort study involving patients undergoing hip or knee arthroplasty was performed, between September 1, 2015 and November 30, 2016. Prophylactic intravenous antibiotics were administered according to local policy. AKI was graded according to the validated Acute Kidney Injury Network criteria based on the changes from baseline serum creatinine values. Propensity score matching was performed to identify risk factors. The local audit department approved the study. Appropriate statistical analyses were performed. RESULTS A total of 2560 met the inclusion criteria, with a female preponderance (1447/2560; 56.5%). The mean age was 67.5 ± 10.7 years, with males being significantly younger (65.9 ± 10.9 vs 68.7 ± 10.4 years). AKI developed in 32 cases (1.25%). There was no difference in AKI rates between CEF alone and CEF in combination with gentamicin (1.07% vs 1.36%; P = .524). Overall 31/32 cases were Acute Kidney Injury Network stage I. AKI did not affect the length of stay. Postoperative infection rate was 7/2560 (0.27%). There were no incidences of Clostridium difficile-associated diarrhea. Multivariate analysis demonstrated an increased AKI risk with the use of intravenous gentamicin. CONCLUSION C ± G yields low rates of infection and AKI compared with high-dose penicillin-based regimes. It is a safe and effective choice for lower limb arthroplasty.
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Affiliation(s)
- Adam Tucker
- Outcomes Department, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - Paul Hegarty
- Department of Orthopaedics, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - Paul J Magill
- Department of Orthopaedics, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - Janine Blaney
- Outcomes Department, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - Lynne V Armstrong
- Department of Orthopaedics, Withers Ward 1A, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - John E McCaffrey
- Department of Anaesthetics, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
| | - David E Beverland
- Department of Orthopaedics, Musgrave Park Hospital, Belfast, County Antrim, United Kingdom
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Merget R, Sander I, Fartasch M, van Kampen V, Röseler S, Merk H, Wurpts G, Raulf M, Brüning T. Occupational generalized urticaria and anaphylaxis after inhalation of cefuroxime in a nurse. Am J Ind Med 2018; 61:261-266. [PMID: 29114903 DOI: 10.1002/ajim.22788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 12/21/2022]
Abstract
We present the case of a 53 years old nonatopic female nurse who experienced repeated anaphylactic reactions at work without involvement in drug-specific tasks such as crushing of tablets or preparation of injections. The causal allergen was not identified until a further severe anaphylactic reaction occurred after oral use of cefuroxime during a respiratory infection. Sensitization to cefuroxime was demonstrated by specific IgE, basophil activation test and skin prick test. An inhalation challenge with a dosimeter induced generalized urticaria after a cumulative dose of about 10 μg of the drug, but no asthmatic reaction. Complete exposure cessation was initiated and a 1-year follow-up was without further allergic reactions. We conclude that work-related systemic allergic reactions to β-lactam antibiotics may occur in nurses after inhalation of low doses and without perceived association with drug-specific tasks like handling of antibiotics.
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Affiliation(s)
- Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Ingrid Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Manigé Fartasch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Stefani Röseler
- Department of Dermatology and Allergology, University Hospital Aachen, Aachen, Germany
| | - Hans Merk
- Department of Dermatology and Allergology, University Hospital Aachen, Aachen, Germany
| | - Gerda Wurpts
- Department of Dermatology and Allergology, University Hospital Aachen, Aachen, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
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Nag DS, Samaddar DP, Kant S, Mahanty PR. [Perianesthetic refractory anaphylactic shock with cefuroxime in a patient with history of penicillin allergy on multiple antihypertensive medications]. Rev Bras Anestesiol 2017; 67:217-220. [PMID: 25746334 DOI: 10.1016/j.bjan.2014.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/06/2014] [Indexed: 02/05/2023] Open
Abstract
We report a case of perianesthetic refractory anaphylactic shock with cefuroxime in a patient with history of penicillin allergy on regular therapy with atenolol, losartan, prazosin and nicardipine. Severe anaphylactic shock was only transiently responsive to 10mL of (1:10000) epinephrine and needed norepinephrine and dopamine infusion. Supportive therapy with vasopressors and inotropes along with mechanical ventilation for the next 24hours resulted in complete recovery. She was successfully operated upon 2 weeks later with the same anesthetic drugs but intravenous ciprofloxacin as the alternative antibiotic for perioperative prophylaxis.
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Affiliation(s)
- Deb Sanjay Nag
- Tata Main Hospital, Department of Anesthesiology and Critical Care, Jamshedpur, Índia.
| | - Devi Prasad Samaddar
- Tata Main Hospital, Department of Anesthesiology and Critical Care, Jamshedpur, Índia
| | - Shashi Kant
- Tata Main Hospital, Department of Anesthesiology and Critical Care, Jamshedpur, Índia
| | - Pratap Rudra Mahanty
- Tata Main Hospital, Department of Anesthesiology and Critical Care, Jamshedpur, Índia
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van Dam DGHA, Burgers DMT, Foudraine N, Janssen PKC, Neef C, le Noble JLML. Treatment of cefuroxime-induced neurotoxicity with continuous venovenous haemofiltration. Neth J Med 2017; 75:32-34. [PMID: 28124668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 61-year-old woman with decreased consciousness, myoclonus, tremors, nystagmus and bradypnoea, due to cefuroxime-induced neurotoxicity, was admitted to the intensive care unit. Continuous venovenous haemofiltration (CVVH) rapidly reduced plasma cefuroxime concentrations and improved neurological manifestations within the next few hours. Retrospective pharmacokinetic assessment showed a total cefuroxime clearance of 166 ml/min during the CVVH.
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Affiliation(s)
- D G H A van Dam
- Department of Intensive Care, VieCuri Medical Centre, the Netherlands
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14
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Del Villar-Guerra P, Moreno Vicente-Arche B, Castrillo Bustamante S, Santana Rodríguez C. Anaphylactic reaction due to cefuroxime axetil: A rare cause of anaphylaxis. Int J Immunopathol Pharmacol 2016; 29:731-733. [PMID: 27531605 PMCID: PMC5806846 DOI: 10.1177/0394632016664529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022] Open
Abstract
One of the most used cephalosporins in clinical practice is cefuroxime axetil. Anaphylaxis due to the administration of cefuroxime is considered a rare event. We report a case of anaphylactic reaction after the administration of cefuroxime in a child who had tolerated the drug in past exposures. Diagnostic workup is recommended for all patients with at least a moderate anaphylactic reaction (hypotension, tachycardia, bronchial hyperreactivity). This should include a detailed history of the event, previous allergies, and underlying conditions. Unfortunately, all currently available diagnostic approaches (IgE, skin-prick-test, tryptase) leave a significant percentage of non-diagnostic results and false positive or negative outcomes.
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Chang UI, Kim HW, Wie SH. Use of cefuroxime for women with community-onset acute pyelonephritis caused by cefuroxime-susceptible or -resistant Escherichia coli. Korean J Intern Med 2016; 31:145-55. [PMID: 26767868 PMCID: PMC4712418 DOI: 10.3904/kjim.2016.31.1.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli. METHODS We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN. RESULTS Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p = 0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319). CONCLUSIONS Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low.
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Affiliation(s)
- U-Im Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong-Heon Wie
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Seong-Heon Wie, M.D. Department of Internal Medicine, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: +82-31-249-8169 Fax: +82-31-253-8898 E-mail:
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17
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Kędziora W, Żarnowski T. [Anaphylactic shock due to Aprokam application to the anterior chamber during cataract surgery – case report]. Klin Oczna 2016; 118:298-300. [PMID: 29911363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intracameral application of Aprokam (cefuroxime) during cataract surgery is documented to significantly reduce the incidence of endophthalmitis. It is very important to consider its very rare but potentially very dangerous complication, that is anaphylactic reaction of varying severity in patients at risk of such allergy. It is necessary to take a detailed history and check all relevant medical records concerning previous treatment to avoid this complication.
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Lim CHL, Yun STH, Aulia FA, McPherson ZE, De Silva D, Jain NS, Irvine S, Francis IC. Reply: To PMID 24957443. J Cataract Refract Surg 2014; 40:1941. [PMID: 25442900 DOI: 10.1016/j.jcrs.2014.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Indexed: 11/17/2022]
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Kuzman I, Daković-Rode O, Oremus M, Banaszak AM. Clinical Efficacy and Safety of a Short Regimen of Azithromycin Sequential Therapy vs Standard Cefuroxime Sequential Therapy in the Treatment of Community-Acquired Pneumonia: An International, Randomized, Open-Label Study. J Chemother 2013; 17:636-42. [PMID: 16433194 DOI: 10.1179/joc.2005.17.6.636] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
An international, randomized, open-label, comparative study was undertaken in order to assess the efficacy and safety of azithromycin and cefuroxime, short sequential vs standard sequential therapy, respectively, in the treatment of patients with community-acquired pneumonia (CAP). 180 adult patients were included in the study. 89 patients received azithromycin 500 mg intravenously (i.v.) once daily for 1-4 days followed by azithromycin 500 mg orally once daily for 3 days. 91 patients received cefuroxime 1.5 g i.v. three times daily for 1-4 days followed by cefuroxime axetil 500 mg orally twice daily for 7 days. Clinical efficacy was achieved in 67/82 (81.7%) patients treated with azithromycin, and in 73/89 (82.0%) patients treated with cefuroxime. The mean duration of total (i.v. and oral) therapy was significantly shorter for the azithromycin group than for the cefuroxime group (6.2 days vs 10.1 days). Adverse events were recorded in 38.2% of patients treated with azithromycin, and in 29.7% of patients treated with cefuroxime (p = 0.20). Shorter sequential i.v.-to-oral azithromycin therapy of patients with CAP was as effective as standard sequential i.v.-to-oral cefuroxime therapy.
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Affiliation(s)
- I Kuzman
- University Hospital for Infectious Diseases, Mirogojska 8, Zagreb, Croatia.
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Kågedal M, Nilsson D, Huledal G, Reinholdsson I, Cheng YF, Asenblad N, Pekar D, Borgå O. A Study of Organic Acid Transporter-Mediated Pharmacokinetic Interaction Between NXY-059 and Cefuroxime. J Clin Pharmacol 2013; 47:1043-8. [PMID: 17660486 DOI: 10.1177/0091270007303769] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Matts Kågedal
- AstraZeneca R&D, Södertälje, Medical Neuroscience, Södertälje, Sweden
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21
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Kaza M, Leś A, Serafin-Byczak K, Ksycińska H, Rudzki PJ, Gutkowskpi P, Drewniak T, Gutkowska A, Tarasiuk A, Piatkowska-Chabuda E, Skowrońska-Smolak M, Wilkowska E. Bioequivalence study of 500 mg cefuroxime axetil film-coated tablets in healthy volunteers. Acta Pol Pharm 2012; 69:1356-1363. [PMID: 23285702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of the study was to investigate the bioavailability of a generic product of 500 mg cefuroxime axetil film-coated tablets (test) as compared to that of a branded product (reference) at the same strength to determine bioequivalence and to apply for regulatory approval. The secondary objective of the study was to evaluate tolerability of both products. A double blinded, randomized, crossover, two-period, single-dose, comparative study was conducted in Caucasian healthy volunteers in fasting conditions. A single oral dose administration of the test or reference product was followed by 7-day wash-out period. The cefuroxime concentration was determined using a validated HPLC-UV method. The results of the single-dose study in healthy volunteers indicated that the film-coated tablets of Tarsime 500 mg manufactured by Tarchomińskie Zakłady Farmaceutyczne Polfa S.A. (test product) are bioequivalent to those of Zinnat manufactured by GlaxoSmithKline Export Ltd. (reference product). Both products were well tolerated.
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Affiliation(s)
- Michał Kaza
- Pharmaceutical Research Institute, Pharmacology Department, Warszawa, Poland.
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22
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Eskazan AE, Salihoglu A, Gulturk E, Ongoren S, Soysal T. Thrombotic thrombocytopenic purpura after prophylactic cefuroxime axetil administered in relation to a liposuction procedure. Aesthetic Plast Surg 2012; 36:464-7. [PMID: 21853406 DOI: 10.1007/s00266-011-9794-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 07/07/2011] [Indexed: 11/29/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP) or Moschcowitz's syndrome is characterized by platelet and von Willebrand factor (vWF) deposition in arterioles and capillaries throughout the body, which results in organ ischemia. The diagnostic pentad characterizing TTP consists of thrombocytopenia, microangiopathic hemolytic anemia (MAHA), fever, neurologic manifestations, and renal insufficiency. In terms of type, TTP can be either idiopathic or secondary. The causes of secondary TTP include pregnancy, infections, pancreatitis, collagen vascular disease, cancer, bone marrow transplantation, and drugs (including cephalosporins). Postoperative TTP has been reported after vascular surgery, renal and liver transplantations, and orthopedic, urologic, and abdominal surgical procedures. Therapeutic plasma exchange (TPE) therapy has reduced the mortality rates, but sometimes patients may have to receive immunosuppressive drugs including vincristine (VCR). This report describes a 42-year-old woman with TTP after prophylactic usage of cefuroxime axetil in relation to a liposuction procedure who was treated successfully with plasma exchange and VCR. The patient fully recovered after 17 TPEs and three doses of VCR. At this writing, her TTP still is in remission after 6 months of follow-up evaluation. To the authors' knowledge, this is the first report in the literature describing a patient with TTP after cefuroxime axetil administered in relation to a surgical procedure who was treated successfully with TPE and VCR.
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Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Kocamustafapasa, Fatih, Istanbul, Turkey.
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Ekiz F, Usküdar O, Simsek Z, Yüksel I, Basar O, Altinbas A, Yüksel O. Cefuroxime axetil-induced liver failure. Ann Hepatol 2010; 9:306. [PMID: 20720277 DOI: pmid/20720277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Housden PL, Sullivan MF. Do augmentin or cefuroxime reach effective levels in lumbar vertebral discs when used prophylactically for discectomy? A preliminary report. Eur Spine J 2010; 2:145-8. [PMID: 20058467 DOI: 10.1007/bf00301412] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of discitis following discectomy is reported at between 0.75% and 3.0%. We believe this rate could be reduced if an antibiotic that penetrated the disc tissue with an appropriate spectrum were to be given prophylactically to cover surgery. A prospective study of 20 patients undergoing routine lumbar discectomy was performed. Ten patients received Augmentin 1.2 g and ten received cefuroxime 1.5 g pre-operatively. In eight patients sequestrated disc fragments were analysed, and the majority were found to have drug levels higher than in the attached disc material; the reasons for this are discussed. We conclude that Augmentin penetrates damaged disc material to a limited extent, but cefuroxime achieves levels effective against the most commonly implicated pathogens in discitis tissue and is a rational choice of antibiotic for prophylaxis during lumbar discectomy.
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Affiliation(s)
- P L Housden
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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26
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Rosen E. Endophthalmitis. J Cataract Refract Surg 2010; 36:191-2. [PMID: 20152594 DOI: 10.1016/j.jcrs.2009.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gårdlund B, Kalin M. [To be or not to be for cefuroxime]. Lakartidningen 2009; 106:2382-2384. [PMID: 19848348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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28
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Walecka I, Olszewska M, Rakowska A, Slowinska M, Sicinska J, Piekarczyk E, Kowalska-Oledzka E, Goralska B, Rudnicka L. Improvement of psoriasis after antibiotic therapy with cefuroxime axetil. J Eur Acad Dermatol Venereol 2009; 23:957-8. [PMID: 19368618 DOI: 10.1111/j.1468-3083.2009.03145.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Varela Losada S, González de la Cuesta C, Alvarez-Eire MG, González González C. Immediate-type allergic reaction to cefuroxime: cross-reactivity with other cephalosporins, and good tolerance to ceftazidime. J Investig Allergol Clin Immunol 2009; 19:164-165. [PMID: 19476025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- S Varela Losada
- Allergy Unit, Santa María Nai Hospital, Ourense Hospital Complex, Ourense, Spain.
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Grgurević I, Pejsa V, Morović-Vergles J, Dobrić I, Gasparović V, Tudorić N. Fatal toxic epidermal necrolysis and severe granulocytopenia following therapy with cefuroxime. Acta Dermatovenerol Croat 2008; 16:133-137. [PMID: 18812062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Toxic epidermal necrolysis (TEN) is one of the most threatening adverse reactions to various drugs. No case of concomitant occurrence TEN and severe granulocytopenia following the treatment with cefuroxime has been reported to date. Herein we present a case of TEN that developed eighteen days of the initiation of cefuroxime axetil therapy for urinary tract infection in a 73-year-old woman with chronic renal failure and no previous history of allergic diathesis. The condition was associated with severe granulocytopenia and followed by gastrointestinal hemorrhage, severe sepsis and multiple organ failure syndrome development. Despite intensive medical treatment the patient died. The present report underlines the potential of cefuroxime to simultaneously induce life threatening adverse effects such as TEN and severe granulocytopenia. Further on, because the patient was also taking furosemide for chronic renal failure, the possible unfavorable interactions between the two drugs could be hypothesized. Therefore, awareness of the possible drug interaction is necessary, especially when given in conditions of their altered pharmacokinetics as in case of chronic renal failure.
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Affiliation(s)
- Ivica Grgurević
- University Department of Medicine, Dubrava University Hospital, Avenija Gojka Suska 6, Zagreb, Croatia.
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Sipsas NV, Kosmas C, Ziakas PD, Karabelis A, Vadiaka M, Skopelitis E, Kordossis T, Tsavaris N. Comparison of two oral regimens for the outpatient treatment of low-risk cancer patients with chemotherapy-induced neutropenia and fever: ciprofloxacin plus cefuroxime axetil versus ciprofloxacin plus amoxicillin/clavulanate. ACTA ACUST UNITED AC 2007; 39:786-91. [PMID: 17701717 DOI: 10.1080/00365540701367769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The objective of this investigation was to assess retrospectively the safety and the efficacy of oral ciprofloxacin plus cefuroxime axetil compared to the combination of oral ciprofloxacin plus amoxicillin/clavulanate, as initial outpatient treatment, in low-risk cancer patients with fever and neutropenia. We analysed retrospectively 120 episodes of febrile neutropenia, treated on an outpatient basis at 2 different oncology units; 63 episodes were treated with the oral regimen of ciprofloxacin plus amoxicillin/clavulanate and 57 were treated with the combination of oral ciprofloxacin plus cefuroxime. 20 treatment failures were recorded-2 of them among patients receiving ciprofloxacin plus amoxicillin/clavulanate and 18 in the ciprofloxacin plus cefuroxime group. Univariate analysis showed that the administration of ciprofloxacin plus cefuroxime was associated with a worse outcome compared to the regimen ciprofloxacin plus amoxicillin/clavulanate (OR 11, CI 2.42-49.9, p =0.002). In the multivariate model, after adjusting for the absolute number of neutrophils and the duration of neutropenia, the effect of the antibiotic regimen on the outcome disappeared, and no significant differences between the 2 regimens were noted, although the regimen of ciprofloxacin plus cefuroxime was associated with a trend to a worse outcome (OR 4.74, CI 0.72-31.1, p =0.10). In conclusion, the 2 regimens appeared equally safe and effective but prospective studies are needed to confirm these results.
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Affiliation(s)
- Nikolaos V Sipsas
- Pathophysiology Department, Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Höffken G, Barth J, Rubinstein E, Beckmann H. A randomized study of sequential intravenous/oral moxifloxacin in comparison to sequential intravenous ceftriaxone/oral cefuroxime axetil in patients with hospital-acquired pneumonia. Infection 2007; 35:414-20. [PMID: 18034211 DOI: 10.1007/s15010-007-6193-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 08/15/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Empiric treatment of hospital-acquired pneumonia (HAP) should be focused on the suspected pathogens. We evaluated the efficacy and safety of moxifloxacin vs ceftriaxone in patients with HAP without risk of infections with Pseudomonas aeruginosa and other non-fermentative Gram-negative bacteria. PATIENTS AND METHODS We performed a prospective, randomized, non-blind, multicentric and multinational study to compare the efficacy and safety of moxifloxacin 400 mg IV once daily followed by oral moxifloxacin 400 mg once daily to ceftriaxone 2 g IV once daily followed by oral cefuroxime axetil 500 mg twice daily to treat mild-to-moderate HAP in adult patients requiring initial parenteral therapy. The primary efficacy variable was clinical response 7-10 days after the end of a 7-14-day treatment period, secondary endpoints included clinical and bacteriologic response at different intervals for up to 31 days after treatment. The trial was terminated prematurely due to slow patient recruitment. RESULTS A total of 161 subjects (87 men, 74 women) between 18 and 95 years of age were enrolled, 120 of whom were eligible for per protocol efficacy analyses (60 each in the moxifloxacin and the comparator groups). Clinical success rates were 87% for moxifloxacin and 83% for the comparator [95% CI (-9.77 to 15.96%)]. The results for secondary endpoints were comparable between groups. Both treatments were safe and well tolerated. CONCLUSION Moxifloxacin IV/oral can be considered as a possible alternative for the antibiotic treatment of patients with mild-to-moderate nosocomial pneumonia without risk factors for highly resistant microorganisms.
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Affiliation(s)
- G Höffken
- Pulmonology, Medical Clinic 1, University Clinic Carl Gustav Carus, Fetscherstr. 74, D-01309, Dresden, Germany.
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Uz E, Bavbek N, Turgut FH, Kanbay M, Kaya A, Akcay A. Cefuroxime-induced lupus. J Natl Med Assoc 2007; 99:1066-7. [PMID: 17913119 PMCID: PMC2575873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Drug-induced lupus erythematosus (DILE) is a syndrome that shares symptoms and laboratory characteristics with idiopathic systemic lupus erythematosus. Recognition of DILE is important because it usually reverts within a few weeks after stopping the offending drug. Antibiotics are uncommonly associated with DILE, and cefuroxime has never been incriminated as a cause. We present herein the first case of DILE induced by cefuroxime. Although this is the first report of cefuroxime-induced DILE, we should be aware of this occurrence.
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Affiliation(s)
- Ebru Uz
- Department of Nephrology, Fatih University Medical School, Ankara, Turkey.
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Katta R, Anusuri V. Serum sickness-like reaction to cefuroxime: a case report and review of the literature. J Drugs Dermatol 2007; 6:747-8. [PMID: 17763603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
We report a case of a 34-year-old woman who received cefuroxime, a second-generation cephalosporin, as treatment for mastitis. She subsequently developed a serum sickness-like reaction (SSLR) with a generalized pruritic rash, joint pains, and fever. She improved upon treatment with systemic steroids. SSLR is well-described to cefaclor, a second-generation cephalosporin. However, there is a paucity of reports of SSLR to other cephalosporins such as this case.
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Affiliation(s)
- Rajani Katta
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
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Petitpretz P, Choné C, Trémolières F. Levofloxacin 500mg once daily versus cefuroxime 250mg twice daily in patients with acute exacerbations of chronic obstructive bronchitis: clinical efficacy and exacerbation-free interval. Int J Antimicrob Agents 2007; 30:52-9. [PMID: 17512704 DOI: 10.1016/j.ijantimicag.2006.11.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 11/02/2006] [Accepted: 11/05/2006] [Indexed: 11/19/2022]
Abstract
The long-term outcome time to relapse determined as the exacerbation-free interval (EFI) has been proposed as a standard measure for comparing the efficacy of antimicrobial therapies in acute exacerbation of chronic obstructive bronchitis (AECOB). In this 6-month, randomised, open-label study, the efficacy of 10 days of oral levofloxacin 500 mg once daily or cefuroxime 250 mg twice daily was evaluated in 689 well-defined patients experiencing AECOB episodes. In the clinically evaluable per-protocol (PPc) population and the modified intent-to-treat population, the clinical cure rates at test of cure were, respectively, 94.6% for levofloxacin versus 93.8% for cefuroxime (0.8% difference, 95% confidence interval (CI) -3.2 to 4.8) and 94.5% for levofloxacin versus 92.2% for cefuroxime (2.3% difference, 95% CI -1.8 to 6.2), whilst the probability that 25% of patients would relapse during follow-up was reached within 93 days for levofloxacin compared with 81 days for cefuroxime in the PPc population (P=0.756). A multivariate analysis revealed that only congestive heart failure and number of AECOB episodes in the previous 12 months were predictive of relapse. Safety was comparable in the two treatment groups, with possibly related treatment-emergent adverse events occurring in 5.0% and 2.9% of subjects in the levofloxacin and cefuroxime groups, respectively. In addition to demonstrating the non-inferiority of levofloxacin compared with cefuroxime in AECOB, the data from this study raise the question of whether EFI is a useful discriminative endpoint for comparing antimicrobial therapies.
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Hasdenteufel F, Luyasu S, Renaudin JM, Trechot P, Kanny G. Anaphylactic Shock Associated with Cefuroxime Axetil: Structure—Activity Relationships. Ann Pharmacother 2007; 41:1069-72. [PMID: 17488833 DOI: 10.1345/aph.1k050] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To present a predictive model of allergenicity based on a structure– activity relationship analysis of β-lactam antibiotics using appropriate skin testing procedures. CASE SUMMARY: A 39-year-old woman was diagnosed with anaphylactic shock a few minutes after taking a 500 mg tablet cefuroxime of axetil and was admitted to the emergency department with dizziness, facial angioedema, generalized skin rash, and inferior cardiac ischemia. Skin testing confirmed the involvement of cefuroxime as the cause of the anaphylactic reaction, and the reaction was defined as probable according to the Naranjo probability scale. We then performed skin testing to study cross-reactivity between different β-lactam antibiotics. In addition to this initial assessment, a structure—activity relationship (SAR) analysis was done. It showed that the patient was sensitized to β-lactam antibiotics presenting a methoxyimino group, but not to similar compounds lacking this chemical group (eg, amoxicillin or penicillin G or V). Challenge with amoxicillin under intensive medical monitoring was tolerated up to a cumulated dose of 1 g, administered intravenously over 2 hours. DISCUSSION: This study demonstrates that SAR analysis could be useful to predict potential adverse reactions to related antibiotics and to select alternative strategies when antibiotic administration is essential. CONCLUSIONS: An SAR-based approach could help physicians and pharmacists provide allergic patients with relevant advice and propose viable alternatives regarding drug therapy.
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Affiliation(s)
- Frédéric Hasdenteufel
- EA 3999 maladies allergiques: diagnostic et thérapeutique, Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital of Nancy, Nancy, France
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Abstract
Acute interstitial nephritis (AIN) is a known cause of acute renal failure in children. In most instances, drug therapy is the offending agent. Although granuloma formation has been observed in drug-induced interstitial nephritis, it is not a commonly associated manifestation. This is a case of a 15-year-old white female with Tetralogy of Fallot and pulmonary atresia who developed acute renal failure secondary to drug-induced interstitial nephritis and renal granulomas. In addition to interstitial edema with eosinophils and lymphocytes, her renal biopsy showed interstitial granulomas, immune complexes within tubular basement membranes, and the unusual feature of multinucleated giant cells engulfing tubules. Her acute renal failure resolved after the withdrawal of antibiotics and the initiation of intravenous steroid therapy.
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Affiliation(s)
- James E Tong
- Department of Pediatrics, University of California at San Francisco, San Francisco, CA, USA
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Liu DTL, Lee VYW, Chan VCK, Lam DSC. Severe anaphylactic reaction after intracameral antibiotic administration during cataract surgery. J Cataract Refract Surg 2006; 32:188; author reply 188. [PMID: 16564975 DOI: 10.1016/j.jcrs.2005.12.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Few studies have reported delayed hypersensitivity reactions to systemically administered cephalosporins. The diagnostic procedures and extracts for these reactions are not standardized, and little is known about the extent of cross reactivity among different cephalosporins. CASES REPORT We report 2 cases of delayed hypersensitivity reactions due to cephalosporins presenting as erythrodermia. Case 1. An 80-year-old man developed generalized pruritus and erythema 2-3 days after starting treatment with cefuroxime. The drug was stopped and antihistamines and corticosteroids were administered. The patient improved 5-6 days later, and mild superficial desquamation was observed. Case 2. A 66-year-old woman experienced similar symptoms 4-5 days after beginning cefazolin. She reported a similar reaction with ceftazidime 8 years previously. METHODS AND RESULTS Skin prick tests and specific IgE against penicillin G and V, amoxicillin, ampicillin and cephalosporins were negative. Intradermal tests with ceftazidime and cefazolin were positive in case 2 at delayed reading. Patch tests using benzylpenicillin, ampicillin, amoxicillin, several cephalosporins, aztreonam and imipenem were positive to all the cephalosporins tested (at 48 and 96 hours) and were negative to the other betalactams. Controlled administration of amoxicillin, benzylpenicillin, aztreonam and imipenem was well tolerated by both patients. CONCLUSIONS 1) We report 2 cases of delayed hypersensitivity reactions due to cephalosporins presenting as erythrodermia. 2) Epicutaneous tests were useful for diagnosis. 3) Both patients tested positive to all cephalosporins and negative to other betalactams.
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Affiliation(s)
- M A Gonzalo-Garijo
- Department of Allergology, Infanta Cristina University Hospital, Badajoz, Spain.
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41
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Filip M, Dragne C, Filip A, Măgureanu M, Zemba M, Asandi R. [Toxic anterior segment syndrome]. Oftalmologia 2006; 50:27-9. [PMID: 17345798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The authors present two cases of TASS which occurred consequent upon anterior chamber administration of cefuroxime(Axetin). The ESCRS guidelines on prevention, investigation and management of postoperative endophthalmitis recommends intracameral injection of an antibiotic agent (cephalosporin) at the conclusion of surgery. In our group of patients TASS occurred. Elements of diagnosis and treatment in TASS are discussed. As a conclusion to our study we decided to discontinue cefuroxime administration.
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Affiliation(s)
- M Filip
- Clinica de Oftalmologie Amaoptimex, Bucureşti.
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Benyamini L, Merlob P, Stahl B, Braunstein R, Bortnik O, Bulkowstein M, Zimmerman D, Berkovitch M. The Safety of Amoxicillin/Clavulanic Acid and Cefuroxime During Lactation. Ther Drug Monit 2005; 27:499-502. [PMID: 16044108 DOI: 10.1097/01.ftd.0000168294.25356.d0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast-feeding is considered the gold standard for infant nutrition. In spite of statements about the safe use of drugs in lactation by the American Academy of Pediatrics, medical professionals remain confused regarding the management of drug therapy in nursing mothers, and this can lead to suboptimal prescribing and poor compliance. The aim of our study was to evaluate the safety of 2 of the newer antibiotics, amoxicillin/clavulanic acid and cefuroxime, during lactation. Breast-feeding women who called a drug consultation center to obtain information about the potential risks of amoxicillin/clavulanic acid (67 women) and cefuroxime (38 women) were prospectively recruited. As a control group, women who were treated with antibiotics known to be safe during lactation were recruited: amoxicillin (n = 40) for the amoxicillin/clavulanic acid group and cephalexin (n = 11) for the cefuroxime group. Women in the control group were matched for indication for antibiotic therapy, duration of treatment, and maternal age. Participants were interviewed after treatment termination regarding adverse reactions during therapy. In the amoxicillin/clavulanic acid group, 15 infants (22.3%) had adverse effects, and the rate increased with dosage (P = 0.0139). This was significantly higher than the amoxicillin group, where 3 infants (7.5%) had adverse effects (P = 0.046, relative risk (RR) = 2.99, 95% confidence interval (CI) 0.92-9.68). However, there were no significant differences between rates of specific events. The rate of adverse effects in the cefuroxime group (2.6%) was not significantly different from that in controls (9%) (P = 0.58, OR = 0.92, 95% CI 0.94-1.06). All adverse effects were minor, self-limiting, and did not necessitate interruption of breast-feeding. Our data suggest that amoxicillin/clavulanic acid and cefuroxime may be safe during lactation. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Lilach Benyamini
- Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Zerifin, Israel
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Abstract
Allergic angina and allergic myocardial infarction (Kounis syndrome) occurring during the course of a drug-induced allergic reaction in the absence of angiographically stenosed coronary arteries, is rare in clinical practice. This paper reports the case of a 70-year-old woman with no significant risk factors for coronary artery disease who developed coronary artery spasm after intravenous injection of cefuroxime. A subsequent coronary angiogram revealed normal coronary arteries (type I variant of the syndrome). The allergic reaction following cefuroxime administration seems to have triggered the development of coronary artery spasm. Susceptible individuals expressing an amplified mast cell degranulation effect may be more vulnerable to coronary artery spasm. The clinical implications of this syndrome are also discussed.
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Affiliation(s)
- Andreas Mazarakis
- Department of Cardiology, University of Patras, Medical School, Patras, Greece
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Abstract
PURPOSE To determine whether the use of prophylactic intracameral cefuroxime during phacoemulsification cataract surgery is associated with increased macular thickening in the postoperative period. SETTING Hull and East Yorkshire Eye Hospital, Hull, United Kingdom. METHODS In this prospective randomized double-masked clinical study, the study group received 1 mg of intracameral cefuroxime and the control group received intracameral balanced salt solution only. Ocular coherence tomography was performed 5 (+/-1) weeks after surgery. RESULTS Intracameral cefuroxime did not have a statistically significant effect on postoperative macular thickness compared with nonadministration of intracameral antibacterials. All patients in both groups achieved a postoperative best corrected visual acuity of 6/9 or better. CONCLUSION Use of 1 mg of intracameral cefuroxime was not associated with increased macular thickness 4 weeks to 6 weeks postoperatively.
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Affiliation(s)
- Mamta S Gupta
- Hull and East Yorkshire Eye Hospital, Hull, Yorkshire, UK.
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Häusermann P, Harr T, Bircher AJ. Baboon syndrome resulting from systemic drugs: is there strife between SDRIFE and allergic contact dermatitis syndrome? Contact Dermatitis 2005; 51:297-310. [PMID: 15606657 DOI: 10.1111/j.0105-1873.2004.00445.x] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The term 'baboon syndrome' (BS) was introduced 20 years ago to classify patients in whom a specific skin eruption resembling the red gluteal area of baboons occurred after systemic exposure to contact allergens. Thereafter, similar eruptions have been reported after systemic exposure to beta-lactam antibiotics and other drugs. In addition to the presentation of 2 of our own cases, we have reviewed and characterized the main clinical and histological aspects of published reports of drug-related baboon syndrome (DRBS) and compared the primary clinical signs from such cases to those found in other distinct drug eruptions. Of approximately 100 published baboon syndrome cases, 50 were identified as drug-induced. Of these, 8 were representatives of systemically induced contact dermatitis (SCD), and 42 were examples of drug eruptions elicited by systemic administration of either oral or intravenous drugs. The main clinical findings included a sharply defined symmetrical erythema of the gluteal area and in the flexural or intertriginous folds without any systemic symptoms and signs. 14 of 42 cases were elicited by amoxicillin, 30 of the 42 patients were male, and latency periods were between a few hours and a few days after exposure. DRBS is a rare, prognostically benign and often underdiagnosed drug eruption with distinct clinical features. The term baboon syndrome, however, does not reflect the complete range of symptoms and signs and is ethically and culturally problematic. Moreover, baboon syndrome is historically often equated with a mercury-induced exanthem in patients with previous contact sensitization. Symmetrical drug-related intertriginous and flexural exanthema, or SDRIFE, specifically refers to the distinctive clinical pattern of this drug eruption, and the following diagnostic criteria are proposed: 1) exposure to a systemically administered drug either at the first or repeated dose (excluding contact allergens); 2) sharply demarcated erythema of the gluteal/perianal area and/or V-shaped erythema of the inguinal/perigenital area; 3) involvement of at least one other intertriginous/flexural localization; 4) symmetry of affected areas; and 5) absence of systemic symptoms and signs.
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Affiliation(s)
- P Häusermann
- Department of Dermatology, University Hospital Basel, CH-4031 Basel, Switzerland
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Abstract
This article reports the case of an acute monoarthritis of the ankle occurring in a HLA-B27 positive female patient who presented with diarrhea and fever. We retained the hypothesis of a Clostridium difficile colitis, as she had previously received an antibiotic treatment. The culture of the synovial fluid remained sterile, which postulated that this arthritis was reactive. The diagnosis was confirmed by the presence of toxins A and B in the stool and positive culture. The outcome was satisfactory with metronidazole therapy.
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Affiliation(s)
- P Guillemin
- Service de Rhumatologie, Médecine Physique et Réhabilitation, CHUV, Lausanne
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Villada JR, Vicente U, Javaloy J, Alió JL. Severe anaphylactic reaction after intracameral antibiotic administration during cataract surgery. J Cataract Refract Surg 2005; 31:620-1. [PMID: 15811754 DOI: 10.1016/j.jcrs.2004.06.086] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2004] [Indexed: 11/19/2022]
Abstract
We report a severe anaphylactic reaction that occurred about 5 minutes after 1.0 mg of cefuroxime was injected into the anterior chamber after routine phacoemulsification and intraocular lens implantation. The patient was known to be allergic to penicillin. Immediate action was taken, and the patient recovered well. The presence of staff trained in resuscitation was essential in this case and raises questions about the trend to perform routine topical anesthesia cataract surgery without an anesthesiologist in the operating room.
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Affiliation(s)
- José R Villada
- Clínica Oftalmológica Castilla-La Mancha, Alicante, Spain.
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Butler RH, Gupta R. Postcoital allergic reaction in a woman. J Emerg Med 2005; 28:153-4. [PMID: 15707809 DOI: 10.1016/j.jemermed.2004.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Revised: 07/19/2004] [Accepted: 08/11/2004] [Indexed: 10/25/2022]
Abstract
Postcoital allergic reaction to drugs is a rare condition that has not been previously described in the Emergency Medicine literature. We report a case of postcoital allergic reaction in a woman who had a history of allergy to cephalosporins, which were used by her sexual partner.
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Affiliation(s)
- Rhett H Butler
- Department of Emergency Medicine, Westchester Medical Center, Valhalla, New York Medical College, NY 10595, USA
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García-Avilés C, Sanz ML, Gamboa PM, Urrutia I, Antépara I, Jauregui I, De Weck AL. Antigen specific quantification of sulfidoleukotrienes in patients allergic to Betalactam antibiotics. J Investig Allergol Clin Immunol 2005; 15:37-45. [PMID: 15864881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND After in vitro allergen-specific stimulation, basophils become activated and release sulfidoleukotrienes LTC4, LTD4 and LTE4. This can be detected by means of the CAST assay. We assessed the positivity criteria and the reliability of antigen-specific sulfidoleukotriene production (CAST) in the in vitro diagnosis of betalactam (BL) allergic patients. MATERIAL AND METHODS We studied a sample of 67 patients (age 48.94 +/- 15.76 years) who had presented with anaphylaxis or urticaria-angioedema within the first 60 minutes after administration of Amoxicillin (54/67), Penicillin G (7/67), Cefuroxime (5/67) or Cefazoline (1/67). All of them had a positive skin test to at least one of the antigenic determinants of Penicillin. As control group 30 adults with negative skin tests who tolerated BL were included. All of them underwent skin tests, oral provocation tests, specific IgE (CAP-FEIA, Pharmacia) and CAST. RESULTS Positivity criteria were established by means of ROC curves: a sLT release induced by Betalactams of at least 100 pg/ml and greater than or equal to 3 times the basal value. The overall sensitivity of CAST is 47.7% and specificity 83.3%. Sensitivity of specific IgE is 37.8% and specificity 83.3%. CONCLUSIONS We have established validated positivity criteria for the CAST technique in patients allergic to Betalactams. This technique is a useful in vitro diagnostic method in patients with IgE-mediated allergy to Betalactam antibiotics.
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Affiliation(s)
- C García-Avilés
- Departamento de Alergología e Inmunología Clínica, Clínica Universitaria de Navarra, Pamplona, Spain.
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Köklü S, Yüksel O, Yolcu OF, Arhan M, Altiparmak E. Cholestatic attack due to ampicillin and cross-reactivity to cefuroxime. Ann Pharmacother 2004; 38:1539-40. [PMID: 15266040 DOI: 10.1345/aph.1e025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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