Solubility enhancementofcefixime trihydrate by solid dispersions using hydrotropic solubilization technique and their characterization

Abstract The aqueous solubility of cefixime trihydrate (a water insoluble drug) using different hydrotropic agents was determined and solid dispersions of cefixime trihydrate were prepared by hydrotropic solubilization technique. The drugs content were determined. The aqueous solubility of v was increased many fold in presence of sodium acetate trihydrate as hydrotropic agent. This hydrotropic agent was used to prepare solid dispersion of cefixime trihydrate. Cefixime trihydrate and sodium acetate trihydrate were accurately weighed and taken in a 200 mL beaker. Distilled water 10-15 mL was taken to dissolve hydrotropic agent using heat (48-50 °C). The drug was then added to it and magnetically stirred till whole mass get viscous. The solid dispersions of cefixime trihydrate were characterized by XRD, DSC and IR studies. DSC thermogram, XRD and Infra-Red spectra were studied. Solid dispersions, thus prepared, showed faster release of the drug as compared to pure drug and physical mixture.

Resistência de Neisseria gonorrhoeae a antimicrobianos na prática clínica: como está o Brasil? / Antimicrobials resistance of Neisseria gonorrhoeae in clinical practice: where Brazil stands?

Estima-se que um milhão de infecções sexualmente transmissíveis (IST) sejam adquiridas por dia no mundo, segundo a Organização Mundial da Saúde. Elas podem ser causadas por diversos micro-organismos pelo contato sexual. Embora tratáveis, as infecções, como a clamidiana, sífilis, tricomoníase e gonorreia, são responsáveis por 350 milhões de novos casos de IST anualmente no mundo. A gonorreia é a segunda IST bacteriana mais prevalente no planeta e tem chamado atenção nos últimos anos em decorrência da baixa eficácia em seu tratamento. O agente etiológico é a Neisseria gonorrhoeae. Na maioria das mulheres, a infecção por esse micro-organismo é assintomática, dificultando ainda mais seu diagnóstico e tratamento e, portanto, aumentando o risco de desenvolvimento de suas complicações associadas. Mesmo quando diagnosticada, essa infecção está sujeita a um alto índice de insucesso terapêutico que se deve, principalmente, à grande plasticidade genética da N. gonorrhoeae para aquisição de genes cromossômicos ou plasmidiais de resistência. O aumento da resistência desse micro-organismo a antimicrobianos comumente utilizados no tratamento, como penicilina, tetraciclina e ciprofloxacina, tem sido relatado em diversos países. No Brasil, poucos estudos estão disponíveis, mas em alguns estados já foram relatadas linhagens resistentes à ciprofloxacina. Dessa forma, deve-se ressaltar a importância de novos estudos que visem descrever o perfil da resistência da N. gonorrhoeae a antimicrobianos. Tais achados certamente nortearão a implementação de sistemas de vigilância epidemiológica no país visto que, até o momento, as infecções por N. gonorrhoeae sequer estão incluídas na lista nacional de doenças e agravos de notificação compulsória.(AU)

According to the World Health Organization, approximately one million sexually transmitted infections (STI) are acquired daily in the world. These infections can be caused by several microorganisms via contact. The treatable STI, such as chlamydia, syphilis, trichomoniasis and gonorrhea, account for 350 million new cases of STI each year worldwide. Gonorrhoea is caused by Neisseria gonorrhoeae and is the second most common bacterial STI in the world. It has drawn more attention in the last years due to the low efficacy in its treatment. Most women with this infection are asymptomatic, which makes its diagnosis and treatment troublesome increasing the risk for its associated complications. Even when diagnosed, this infection is subject to a high rate of therapeutic failure mainly due to the great genetic plasticity of N. gonorrhoeae for the acquisition of chromosomal or resistance plasmid enes. Increased resistance of this microorganism to antimicrobials commonly used in treatment such as penicillin, tetracycline and ciprofloxacin has been reported in several countries. In Brazil, few studies are available, but in some states strains resistant to ciprofloxacin were alreadyreported. The refore, it is important to highlight the importance of new studies aimed at describing the resistance profile of N. gonorrhoeae to antimicrobials in Brazil context. These findings will certainly guide the implementation of epidemiological surveillance systems in the country, since until now N. gonorrhoeae infections do not figure into the national list of compulsorily notifiable diseases.(AU)

Development and evaluation of bilayer tablets of combination of antibiotics for the treatment of sexually transmitted disease

ABSTRACT The present research work was envisaged to develop bilayer tablets to improve therapeutic efficacy of antibiotic combination for the treatment of sexually transmitted diseases. The combination of two antibiotics i.e. cefixime trihydrate and ofloxacin were used for the preparation of bilayer tablets which act against genito-urinary infections. The formulations comprise of cefixime trihydrate as immediate release layer formulated using different superdisintegrants and ofloxacin as extended release layer containing HPMC K100M. Evaluation of bilayer tablets were performed for the immediate release cefixime layer and sustain release ofloxacin layer with optimization of excipients. The immediate release layer of cefixime showed complete release within 30 min and ofloxacin release was extended up to 24 hours. The similarity factor value of ofloxacin sustained release layer was found to be 87.01 for initial and 80.35 after 3 months stability when compared with marketed reference product. The present study revealed that cefixime trihydrate and ofloxacin bilayer tablets were successfully developed for the use against sexually transmitted infections.

Development and validation of a new and economical stability indicating RP-HPLC method for cefixime trihydrate

ABSTRACT The present work describes the development of a new high performance liquid chromatographic (HPLC) method for the determination of Cefixime trihydrate under different stress conditons as specified by ICH. For the analysis, a Phenomenex (250 x 4.6 mm, 5 µm particle size) ODS column and a SPD 20 A UV detector at 289 nm was used. The selected mobile phase was 10 mM disodium hydrogen phosphate (with 0.5% TEA, pH adjusted to 6.3 with OPA) and methanol in the ratio of 75:25 (v/v) in isocratic mode at a flow rate of 1 mL.min-1.The linear regression analysis data for the calibration plots showed good linear relationship with r2 = 0.9997 in the concentration range of 5-100 μg.mL-1. The stress degradation was performed using acid, alkali, water, hydrogen peroxide and uv light.

RESUMO O presente trabalho descreve o desenvolvimento de um novo alta performance cromatografia líquida (HPLC) método para a determinação de cefixima tri-estresse sob diferentes condições, conforme especificado pelo ICH. Para a análise, a Phenomenex (250 x 4,6 mm, 5 µm de granulometria) ODS coluna e a SPD 20 um detector de UV em 289 nm foi utilizado. A fase móvel selecionado foi de 10 mM hidrogenofosfato dissódico (com 0,5% TEA, o pH ajustado para 6,3 com OPA) e de metanol em razão de 75:25 (v/v) no modo isocrático com uma taxa de fluxo de 1 mL.min-1. A análise de regressão linear para dados da calibração parcelas apresentaram boa relação linear com r2 = 0,9997 no intervalo de concentração de cerca de 5 100 µg.mL-1. Degradação do estresse foi realizado utilizando um ácido, alcalino, a água, o peróxido de hidrogênio e luz uv.

[Comparison of single dose and three-day course of cefixime in the treatment of women with uncomplicated acute cystitis referred to health care center in Tehran]

The aim of this study was to compare the efficacy of single dose and three days course of cefiximein in the treatment of women with uncomplicated acute cystitis. This clinical trial was done on 70 women with uncomplicated acute cystitis referred to urologic and gynecologic clinic at Bou Ali hospital in Tehran [Iran], which were randomly divided into two groups. The first group [group A] was prescribed one 800 mg dose of cefixime and the 2[nd] group [group B] was treated with 400mg/day cefixime for 3 days. After one week and 2 week of taking the prescribed antibiotics, urine culture was analyzed. Patients with resistant urine culture to cefixime [3 in group A and 2 in group B] were excluded from the study. Data were analyzed using t-test, chi- square and exact Fisher test using SPSS-16 software. The mean [ +/- standard deviation] age of subjects was 29.97 +/- 5.65. Seventeen subjects in group A and 21 in group B were married. All subjects, excluding six [1 in group A and 5 in group B], were completely cured. However, recoveries in group A were more than group B, but there was no statistically significant difference. Single 800 mg dose of cefixime is as effective as dose of 400 mg/day for 3 days in treatment of women with uncomplicated acute cystitis

Drug utilization evaluation of third generation cephalosporins using core drug use indicators

To evaluate the drug utilization of third generation cephalosporins using core drug use indicators in various wards of Sri Ramachandra Hospital. Third generation cephalosporins are the most commonly prescribed broad spectrum antibiotic even before the culture sensitivity results arrives. Hence this study was undertaken to study the drug utilization evaluation of third generation cephalosporins in the inpatient department of various wards of Sri Ramachandra Hospital. A prospective study was conducted between July 2009 and February 2010. Prescriptions of 364 patients containing third generation cephalosporins admitted in inpatient department of various wards of Sri Ramachandra Hospital, Chennai were collected and using WHO basic drug indicators, the utilization pattern were analyzed. The average number of drugs per prescription was found to be 7.89 on prescription analysis. Cefixime was the most frequently prescribed [32.69%] oral third generation cephalosporins, followed by cefotaxime [31.32%]. Among IV third generation cephalosporins, cefotaxime was the most frequently prescribed injections [35.4%]. Only 28.02% of drugs were prescribed by generic name. The results obtained represent the over all prescribing pattern of third generation cephalosporins in the Tertiary Care Teaching Hospital, Chennai

Nasopharyngeal Colonization of Moraxella catarrhalis in Young Korean Children / 감염과화학요법

BACKGROUND: Nasopharyngeal bacterial flora can cause respiratory tract diseases as well as invasive bacterial diseases. Moraxella catarrhalis colonizing in the nasopharynx is considered an important potential pathogen with an increasing production of beta-lactamase. This study examined the nasopharyngeal colonization rate of M. catarrhalis and the antibiotic susceptibility of M. catarrhalis. MATERIALS AND METHODS: Healthy children who visited one of the three University hospitals in the Republic of Korea or attended a day-care center around the participating hospitals were enrolled in this study. The nasopharyngeal samples were obtained by nasopharyngeal washing with normal saline and M. catarrhalis was isolated. The nasopharyngeal colonization rate of M. catarrhalis was investigated and the minimal inhibitory concentrations (MICs) were measured for commonly used oral antibiotics (amoxicillin, amoxicillin/clavulanate, cefaclor, cefixime, cefdinir, cefditoren, erythromycin and trimethoprim). RESULTS: Three hundred and seventy-nine children aged between 6 months and 5 years were enrolled, and the nasopharyngeal colonization rate of M. catarrhalis was 33% (124 children). All isolated M. catarrhalis produced beta-lactamase. The MIC90 of the antibiotics were as follows: amoxicillin, >16 mg/L; amoxicillin/clavulanate, 0.5 mg/L; cefaclor, 8 mg/L ; cefixime, 0.125 mg/L; cefdinir, 0.25 mg/L; cefditoren, 0.25 mg/L; erythromycin, 0.5 mg/L; and trimethoprim, >16 mg/L. CONCLUSIONS: M. catarrhalis was colonized in 33% of the children aged 6 months to 5 years, and showed low MICs for amoxicillin/clavulanate and oral 2nd and 3rd generation cephalosporins.

Comparative study on resistance pattern of different pathogens against cefixime and cefepime

Irrational use of antibiotics has fueled a major increase in prevalence of multi drug resistant pathogens, leading some to speculate that we are nearing the end of antibiotic era. The assessment of the activity of an antibiotic is crucial to the successful outcome of antimicrobial therapy. The objective of the study is to evaluate the resistance pattern between cefixime [a third generation cephalosporin] of 5micro g and cefepime [a fourth generation cephalosporin] of 30 micro g, on a total of 138 different clinical isolates namely as; Escherichia coli [30%], Staphylococcus aureus [30%], Salmonella typhi [14%], Klebsiella pneumoniae [13%] and Pseudomonas aeruginosa [13%]. The isolates were collected over a period of one year [January 2008 to January 2009] from pathological laboratories of different hospitals in Karachi, Pakistan, which comprised of 59 urine, 30 skin pus, 29 ear pus, 15 blood and 5 stool samples. In-vitro antibiotic sensitivity was performed by disk diffusion or Bauer-Kirby method using 0.5 McFarland standard. Cefepime showed good sensitivity of about 92.6% against Escherichia coli, 85% against Staphylococcus aureus, 94% against Klebsiella pneumoniae, 77.77% against Pseudomonas aeruginosa and 65% against Salmonella typhi. Cefixime showed least sensitivity against Pseudomonas aeruginosa [16.66%] and maximum effectiveness against Salmonella typhi [90%]. Results of the study indicate that cefepime is more effective for the treatment of infections caused by the above pathogens except for Salmonella typhi. It is concluded that in the face of continuing development of resistance, considerable effort will be required to maintain the effectiveness of these drug groups

Etiology and antimicrobial susceptibility pattern of bacterial conjunctivitis in children at Princess Rahmah Hospital in Jordan

bacterial conjunctivitis, chiefly affecting young children, is generally caused by different pathogens. Therefore, this study aims to investigate microorganisms causing bacterial conjunctivitis in children and to assess their sensitivity to various groups of antimicrobial. A retrospective study was conducted on positive cultures taken from 39 children aged below 15 years, who attended as outpatient or inpatient at Princess Rahmah Hospital between January and December/ 2008. The obtained data were analyzed and the results were tabulated. A total of 39 isolates were recovered from cultures obtained from children patients. The male and female isolates ratio was [1.6: 1.0]. The most frequent pathogen found was S. aureus [56.4%], followed by Klebsielia spp. [18.0%], Streptococcus spp. [12.8%], Pseudomonas spp [5.1%], E. coli [5.1%] and Moraxella was found in only one culture [2.6%]. Ciprofloxacin had the highest susceptibility rate [90.4%] for all the tested isolates, followed by cefotaxime [72.7%] and vancomycin [71.4%]. Whereas, cefixime showed the lowest susceptibility rate [0.0%] for all the tested isolates. S. aureus was the main isolate of conjunctivitis in children, which almost all isolates were susceptible to ciprofloxacin, cefotaxime, and vancomycin. Overall cefixime resistance rate was 100%. This information should be considered when empirical therapy is recommended or prescribed for children with bacterial conjunctivitis

Resistance pattern of breakthrough urinary tract infections in children on antibiotic prophylaxis

Prophylactic antibiotics are commonly used for prevention of urinary tract infections [UTIs] in children. It was postulated that the organisms and resistance patterns of breakthrough infections would differ with the choice of antimicrobial prophylaxis. This was a retrospective descriptive study of all breakthroughs UTI from 2000 to 2006 in children over 1 month of age discharged from a referral children's hospital in Tehran, Iran on continuous antibiotic prophylaxis for UTIs. Fifty-seven children discharged on prophylaxis had breakthrough UTIs of which 32 [56%] had a previously diagnosed urinary tract anomaly. Escherichia coli was responsible for the majority of infections irrespective of choice of prophylaxis. Thirty-three of 56 breakthrough UTIs [59%] were with organisms that were resistant to the prophylactic antibiotic. There was an increased incidence of resistance to prophylaxis in children on cefixime [16 of 22; 78%] when compared with children on cephalexin [7 of 19; 37%; p = 0.02] and a trend toward increased resistance when compared with children on trimethoprim-sulfamethoxasole [3 of 8; 37%] [p = 0.10]. In conclusion, the resistance pattern of organisms causing breakthrough UTIs varies with the choice of prophylaxis which should be taken into consideration in choosing empiric therapy for such infections

Aqueous and vitreous penetration of oral cefixime and ciprofloxacin in rabbit eye

To investigate the penetration of cefixime and ciprofloxacin to the rabbit eye on the basis of microbial inhibition of aqueous and vitreous humour after oral administration. In this experimental study, 36 rabbits [72 eyes] were randomly divided into two groups; group A consisted of 20 rabbits and group B 16 rabbits. Each group was divided into four equal subgroups. The rabbits in each subgroup of group A received 4, 8, 12, and 20 mg/kg of syrup of cefixime every 12 hr respectively and the rabbits in each subgroup of group B received 20, 40, 60, and 80 mg/kg tablet of ciprofloxacin respectively every 12 hr. Immediately after the first dose of the drugs, the anterior chamber of one eye was irrigated randomly by 30-40 cc of ringer lactate solution alongside with mild traumatization of iris. Then by 4, 8, 12, 24 and 72 hr intervals after the 3rd dose, 0.1 cc of aqueous, 0.2-0.5 cc of vitreous, 3 cc of blood and one standard disk of the used antibiotic was placed on culture media of a known bacteria which was completely sensitive to the respective antibiotic. Forty eight hours later, the microbial inhibition zone of each sample and the standard disk of antibiotic were compared. No microbial inhibition was seen by sample of aqueous and vitreous, although very large zone of inhibition was seen by blood sample and standard disk of antibiotic. It seems that oral cefixime and ciprofloxacin do not produce an effective dose for microbial inhibition in rabbit eye

Antibiotic susceptibility of pathogens isolated from patients with community-acquired respiratory tract infections in Pakistan-the active study

Respiratory tract infections [RTIs] are amongst the most wide spread and serious infections, accounting for over 50 million deaths globally each year. In developing countries, infants under 4 years of age are at greatest risk of lower RTIs, whereas in developed countries the severity of infection and rate of mortality are greater in elderly. The objective of the survey was to determine the in vitro susceptibility of antibiotics commonly prescribed RTIs against Streptococcus pneumoniae [SP], Haemophilus influenzae [HI] and Streptococcus pyogenes, isolated from patients with communityacquired RTIs globally. This survey involved 9 countries. In this study we present the results from Pakistan where SP and HI only were tested. A total of 200 isolates were included in the study. Both SP and HI were in equal number. Antibiotic susceptibility testing was performed by using Clinical and Laboratory Standards Institute guidelines and E test for determination of the minimal inhibitory concentration. For non-US products the Committee of the Antibiogram of the French Society of Microbiology Breakpoints was used. All SP were found susceptible to amoxicillin, coamoxiclave and cefixime, 72% isolates were found sensitive to macrolide and 97% to levofloxacin. All HI were found sensitive to co-amoxiclave and to cefixime, 97% to ampicillin, 98% to clarithromycin and 99% to levofloxacin. In isolates collected from Pakistan, SP resistance rate was elevated for macrolide. SP and HI remain susceptible to beta-lactams as well as to levofloxacin

[In vitro antimicrobial drug-resistance of urinary tract pathogens in patients admitted to Vali-E-Asr Hospital Wards]

Extensive use of antibiotics in medicine has led to resistance of microorganisms in urinary tract infection [UTI] in both children and adults. Therefore, conducting studies on antibiotic susceptibility is needed for selection of antibiotics based on regional studies. During the year 2006 urine samples from all symptomatic patients admitted to neonatal, pediatrics, obstetric and neurologic wards were collected through midstream clean-catch, catheterization, or urine bags. An antibiogram test was performed for all 118 urine samples which were culture positive. The most common organisms found in neonatal urine culture were klebsiella pneumoniae [44/5%] followed by Escherichia coli [33/5%]. Escherichia coli was the most common organism in pediatrics [41%], obstetric [46%], and neurologic wards [73%]. Resistance to ampicillin [82/6%] and cefixime [73/6%] was significant in all samples. Ciprofloxacine was the most effective drug against E.coli and klebsiella pneumoniae in all wards [resistance rate: 24/1%] followed by nitrofurantoin [resistance rate: 41/4%], ceftriaxone [resistance rate: 44/8%] and amikacin [resistance rate: 51/9%]. Vancomycin was the most effective drug against staphylococcus epidermidis [resistance rate: 37/1%] followed by cephtasidim [resistance rate: 40/1%] and ciprofloxacine [resistance rate: 48/5%]. Unfortunately due to irrational use of antibiotics, high resistance to ampicillin, cefixim, gentamycin, cotrimoxazol, and some other drugs was observed. Continuous studies regarding the drug resistance are recommended for better assessment in the future

Effectiveness of anti-typhoid drugs currently used in Pakistan

To study the effectiveness of A nil-Typhoid drugs in the Pakistani population. Prospective comparative study conducted from Jan. 2003 to Jan. 2004. Department of Surgery, S. S Hospital, Karachi. Diagnosed cases of Typhoidfever on Blood or Faeces Culture, Widal test and/or Dot Enzyme Immunosorbant Assay [Dot EJA or Typhi Dot], above 12 years of age. Patients were randomly assigned to one of the five treatment groups named after the antibiotic used i.e. CzroJloxacin [48], Ofloxacin [45], Cefixime [46], Chloramphenicol [44] and Co-trimoxazole [44]. Treatment was administered for 7 or 14 days, and the results of the clinical and investigational assessment of patients, before and after the treatment, were compiled and tabulated. Out qf the total 227 patients included in the study, there were 112 males and 115 females, with a mean age of 31.7 +/- 8.2 years. There was no sign jfIcant difference between the treatment groups with respect to demography. A part from fever abdominal pain [79%], splenomegaly [34%], hepatomegaly [21%], diarrhoea [51%], vomiting [12%], dehydration [15%] and rose spots on the skin [18%] were the main clinical features. Salmonella typhi was isolated from the blood of 184 and stool of 24 patients, while S. paratyphi was isolated from the blood of 15 and stool of three patients. In 159 patients the Typhi -dot and in 87 the Widal test was +ve. The mean duration of fever or fever clearance time was 3 +/- 1 days with ciprofioxacin, 2.5 +/- 1 days with ofioxacin, 3.5 +/- 1.5 with cefixime, 6 +/- 2 days with chloramphenicol and 6.5 +/- 2 days with co-trimaxazole. There were no serious side effects or mortality in this series. Oprofloxacin, Ofioxacin and C_efixime has an excellent 000%] cure rate and efficacy whereas C_hloramphenicol has an 80% and Co-trimoxazole a 70% cure rate only

In vitro antimicrobial activity of cefditoren against Streptococcus pneumoniae and Haemophilus influenzae clinical isolates / 대한내과학회지

BACKGROUND: The aim of this study was to determine the in vitro activity of cefditoren, an oral third-generation aminothiazolyl cephalosporin, against Streptococcus pneumoniae and Haemophilus influenzae clinical isolates in a tertiary hospital. METHODS: We have studied the in vitro activities of cefditoren and other oral antibiotics against 120 S. pneumoniae isolates, including 80 penicillin non-susceptible isolates and 80 H. influenzae isolates from clinical specimens of patients at the Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined by the agar dilution method. RESULTS: All S. pneumoniae strains tested were inhibited by 1 g/mL of cefditoren (MIC50/MIC90 0.25/1 microgram/mL; range 0.015~1 microgram/mL). The MICs were lower for penicillin-susceptible S. pneumoniae (MIC90 0.015 g/mL) as compared to penicillin-intermediate resistant (MIC90 0.5 g/mL) or penicillin- resistant strains (MIC90 1 microgram/mL). Cefditoren was active against all tested H. influenzae strains (MIC50/MIC90 0.015/0.03 microgram/mL; range <0.008~0.03 g/mL) and its activity was comparable to levofloxacin and cefixime. CONCLUSIONS: Cefditoren had an excellent activity against S. pneumoniae and H. influenzae irrespective of penicillin or ampicillin resistance, respectively. The results of this study suggest that cefditoren is a good choice of an antibiotic to use for empirical oral treatment of community-acquired respiratory tract infections.

In-Vitro Susceptibility Study of Oral Antibiotics to Escherichia coli, Isolated From Acute Uncomplicated Cystitis in Female Outpatients / 감염과화학요법

BACKGROUND: The objective of this study was to obtain data on the susceptibility of oral antibiotics to pathogens responsible for acute uncomplicated cystitis in female outpatients. MATERIALS AND METHODS: We performed urine culture from total of 118 female outpatients with acute uncomplicated cystitis between October 2004 and June 2005. A total of 134 isolates were obtained from female outpatients with acute uncomplicated cystitis. Antimicrobial susceptibilities to ampicillin, amoxicillin, ciprofloxacin, levofloxacin, trimethoprim/sulfamethoxazole (TMP/SMX), and cefixime were determined by Densichek kit (Biomerieux Inc., USA) antimicrobial susceptibility test systems. RESULTS: The most prevalent causative organism was Escherichia coli (76.1%), followed by P. aeruginosa, S. agalactiae, E. faecium, S. aureus, K. pneumoniae, E. fecalis, E. aerogenes, K. oxytica. The mean rates of susceptibility to each drug were ampicillin 39.25%, amoxicillin 39.2%, ciprofloxacin 69.6%, levofloxacin 72.5%, TMP/SMX 39.2%, and cefixime 87.3%. CONCLUSION: Escherichia coli was the most important pathogen of acute uncomplicated cystitis in female outpatients. The high prevalence of resistance to ampicillin, amoxicillin and TMP/SMX suggests that they would not provide adequate initial therapy and therapies other than TMP/SMX may need to be considered. The prevalence of resistance to ciprofloxacin was higher than that of previous study. We think that the further evaluation for the pathogen of cystitis and the resistance of antibiotics is necessary.

In-Vitro Susceptibility Study of Oral Antibiotics to Escherichia coli, Isolated From Acute Uncomplicated Cystitis in Female Outpatients / 감염과화학요법

BACKGROUND: The objective of this study was to obtain data on the susceptibility of oral antibiotics to pathogens responsible for acute uncomplicated cystitis in female outpatients. MATERIALS AND METHODS: We performed urine culture from total of 118 female outpatients with acute uncomplicated cystitis between October 2004 and June 2005. A total of 134 isolates were obtained from female outpatients with acute uncomplicated cystitis. Antimicrobial susceptibilities to ampicillin, amoxicillin, ciprofloxacin, levofloxacin, trimethoprim/sulfamethoxazole (TMP/SMX), and cefixime were determined by Densichek kit (Biomerieux Inc., USA) antimicrobial susceptibility test systems. RESULTS: The most prevalent causative organism was Escherichia coli (76.1%), followed by P. aeruginosa, S. agalactiae, E. faecium, S. aureus, K. pneumoniae, E. fecalis, E. aerogenes, K. oxytica. The mean rates of susceptibility to each drug were ampicillin 39.25%, amoxicillin 39.2%, ciprofloxacin 69.6%, levofloxacin 72.5%, TMP/SMX 39.2%, and cefixime 87.3%. CONCLUSION: Escherichia coli was the most important pathogen of acute uncomplicated cystitis in female outpatients. The high prevalence of resistance to ampicillin, amoxicillin and TMP/SMX suggests that they would not provide adequate initial therapy and therapies other than TMP/SMX may need to be considered. The prevalence of resistance to ciprofloxacin was higher than that of previous study. We think that the further evaluation for the pathogen of cystitis and the resistance of antibiotics is necessary.

Susceptibility tests of oral antibiotics including cefixime against Escherichia coli, isolated from pediatric patients with community acquired urinary tract infections / 소아과

PURPOSE: Urinary tract infection(UTI) is one of the most frequent infections in children. E. coli is the most frequent etiological micropathogen in pediatric community UTI, and E. coli has developed resistance to many antibiotics, highlighting the need for regular surveys of this organism resistant patterns in the community. The aim of this study was to determine the oral antibiotic susceptibility patterns of E. coli, isolated from pediatric patients with uncomplicated community acquired UTI. METHODS: E. coli isolates, obtained from pediatric patients with uncomplicated community acquired UTI between October in 2004 to September in 2005. And minimal inhibitory concentrations(MICs) of oral aminopenicillins and beta-lactamase inhibnitors(ampicillin, amoxacillin, ampicillin-sulbactam), oral cephalosporins(cefaclor, cefixime) and sulfa drug(trimethoprime-sulfamethoxazole) were performed according to the National Committee for Clinical Laboratory Standards(NCCLS) guide line. RESULTS: Total 211 organisms were isolated from pediatric out-patients with community UTI. E. coli was the most common organism(89 percent), followed by E. fecalis, Proteus species, S. aureus, M. morganii, and P. aeruginosa. The resistant rates of aminopenicillins and beta-lactamase inhibitors, cefaclor and sulfa drug to E. coli were very high. But, the resistant rate of cefixime was markedly low, and ESBL strains were isolated with small rates. CONCLUSION: Our study results suggest that aminopenicillins, cefaclor and sulfa drug may not be useful as first line empirical antibiotics to treat pediatric patients with community UTI in Korea. But, 3rd generation cephalosporin such as cefixime can be used as effective second line antibiotics after primary treatment failure, also may be useful as an empirical first line antibiotic. Finally, we conclude that a continuous surveillance study to monitor susceptibility patterns of E. coli in community UTI will be needed for the standard guide lines of empirical oral antibiotic treatment.