ABSTRACT
Simultaneous drug-induced immune hemolytic anemia (DIIHA) caused by multiple drugs is rare. We report a case of a patient who developed DIIHA caused by 2 drugs. The patient's serum exhibited agglutination of ceftizoxime- or sulbactam-coated red blood cells (RBCs; via a drug-adsorption mechanism) and of uncoated RBCs in the presence of sulbactam (via an immune-complex mechanism). Although ceftizoxime is known to exhibit a positive reaction by an immune-complex method with or without reactivity with drug-coated RBCs, this patient's antibodies were reactive only against drug-coated RBCs. On the other hand, sulbactam, which is known to cause hemolytic anemia by nonimmunologic protein adsorption, exhibited positive reactions in tests with both drug-coated RBCs and in the presence of sulbactam. This is the first report of DIIHA due to a sulbactam-cefoperazone combination and the fourth report of DIIHA due to ceftizoxime. Owing to the patient's complicated laboratory results, DIIHA was suspected only at a late stage. We propose that for the prompt diagnosis of DIIHA, tests for all possible causative drugs should be conducted by 2 methods.
Subject(s)
Female , Humans , Middle Aged , Anemia, Hemolytic/chemically induced , Anti-Bacterial Agents/adverse effects , Cefoperazone/adverse effects , Ceftizoxime/adverse effects , Erythrocytes/chemistry , Sulbactam/adverse effectsABSTRACT
OBJECTIVE: The emergence of penicillin and macrolide resistant strains, responsible for Acute Lower Respiratory Tract Infections in children has offered third generation cephalosporins the platform to perform. The aim of the present study was to evaluate two third generation oral cephalosporins for their empirical use in community acquired lower respiratory tract infections in pediatric patients. An assessment of the clinical cure and bacteriological eradication rates and an overall tolerability was made. METHODS: It was a prospective, open, comparative, multicentric study. 776 children (Mean age 10 years) with LRTIs were included and randomly allotted to two groups respectively. A total of 396 children were given cefpodoxime susp 5 mg/kg b.i.d. and 380 patients on cefixime 4 mg/kg b.i.d. for 10-14 days. RESULTS: At the end of therapy, the clinical success with cefpodoxime was 97% as against 86.8% with cefixime. Bacterial eradication was 93.4% with cefpodoxime and 82.9% with cefixime. CONCLUSION: Cefpodoxime has been found to be a well-tolerated and superior alternative to cefixime synergistically documenting the extended spectrum of activity.
Subject(s)
Acute Disease , Anti-Bacterial Agents/adverse effects , Cefixime/adverse effects , Ceftizoxime/adverse effects , Child , Child, Preschool , Female , Humans , India , Infant , Male , Prospective Studies , Respiratory Tract Infections/drug therapy , Treatment OutcomeABSTRACT
Cefpodoxime is a semi-synthetic, third generation cephalosporin. The drug is available for use as a prodrug-Cefpodoxime proxetil, which is absorbed readily from the gut. It reaches adequate levels exceeding the MIC in most of the body fluids. It is excreted by kidneys, unchanged. Dose needs adjustment in compromised renal function. The drug is active against common gram-positive cocci like staphylococci including penicillinase producing strains, streptococci and gram negative bacteria like Hemophilus, E. coli, Klebsiella, Moraxella, Meningococci, Gonococci etc. The drug is useful in common upper and lower respiratory tract infections, sinusitis, and otitis media. The drug is also used in skin and soft tissue infections, urinary tract infection and respiratory tract infection. Cefpodoxime is being used as a step down from parenteral cephalosporin. The recommended dose is 8-10 mg/kg/d in a single or two doses. Different schedules have been given for different infections. The drug is safe, effective as a short course (5 vs. 10 days). With a low incidence of side effects, and twice a day dosing, it proves to be a useful drug.