cefotaxime cetrixin

DOI 10.1378/chest.96.6.1292 1989;96;1292-1297Chest

J H Reeves, G M Russell, J F Cade and M McDonald serious chest infections.Comparison of ceftriaxone with cefotaxime in

http://chestjournal.chestpubs.org/content/96/6/1292

can be found online on the World Wide Web at: The online version of this article, along with updated information and services

) ISSN:0012-3692http://chestjournal.chestpubs.org/site/misc/reprints.xhtml(without the prior written permission of the copyright holder.reserved. No part of this article or PDF may be reproduced or distributedChest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights

ofbeen published monthly since 1935. Copyright1989by the American College is the official journal of the American College of Chest Physicians. It hasChest

© 1989 American College of Chest Physicians by guest on April 13, 2012chestjournal.chestpubs.orgDownloaded from


http://chestjournal.chestpubs.org/site/misc/reprints.xhtml

http://chestjournal.chestpubs.org/

*From the Intensive Care Unit, Royal Melbeurne Hospital, Victoria,

Australia.Manuscript received January 10; reviSio)n accepted May 16.Reprint requests: Dr. Cads?, Royal Melbourne Hospital, Victoria3050, Australia

1292 Ceftriaxone vs Cefotaxime in Chest Infections (Reeves et a!)

Comparison of Ceftriaxone with Cefotaximein Serious Chest lnfections*

John H. Reeves, M. B. ; Gary Al. Russell, M. B.;

John F. Cade, M.D. , Ph.D. , F.C.C.P; and Malcolm McDonald, MB.

Ceftriaxone is a new, third-generation cephalosporin that,

because of its long half-life, offers potential advantages of

cost and convenience over similar agents such as cefotaxime.We compared the two drugs in a prospective, randomized

study of the treatment of chest infections in seriously ill

patients. Fifty-one patients (90 percent of whom were

C hest infection is one of the most common compli-

cations in critically ill patients. ‘� It may be the

primary cause of the patient’s serious illness. More

frequently, patients in an ICU who are already seri-

ously ill or injured develop a supervening chest

infection, which then becomes a source of significantly

increased morbidity and mortality.2’3 Chest infection

in the seriously ill is most commonly due to Gram-

negative microorganisms, and a variety of antibiotic

options exists for treatment, including the use of a

third-generation cephalosporin such as cefotaxime.�’5

The recent introduction of ceftriaxone,6 an antibiotic

with a spectrum of antimicrobial activity similar to

cefotaxime7’� but with a sixfold longer half-life,7” has

stimulated interest in cost-effectiveness comparisons

among these agents. 1213 Specifically, it has been rec-

ommended that ceftriaxone can be given once daily,

with significant savings in drug cost and staff time.’3-’5

While the relative costs of different antibiotic regi-

mens may be readily calculated, respective efficacy

requires specific clinical evaluation. We compared

ceftriaxone with cefotaxime in the treatment of chest

infections in seriously ill patients in a prospective,

randomized, controlled, single-blind study, using both

clinical and microbiologic responses as endpoints.

Patients

PATIENTS AND METHODS

Patients eligible for entry were those seriously ill or injured and

in a general ICU. The specific criteria for entry included the

presence ofthree or more ofthe following: macroscopically purulent

sputum, chest x-ray evidence of recent consolidation (<48 h), fever

(>38#{176}C), and leukocytosis (>12,000/cu mm�). The presence of

hypotension (mean bloxxl pressure <60 mm Hg) was noted for

response scoring but was not a criterion for entr�

mechanically ventilated) received either ceftriaxone, 2 g LV

once daily, or cefotaxime, 2 g IV thrice daily, for five days.

The two groups of patients appeared demographically

comparable. Ceftriaxone in a single daily dose of 2 g once

daily may not be satisfactory for the treatment of serious

chest infections. (Chest 1989; 96:1292-97)

The criteria for exclusion were either of the following: known or

suspected need for another antibiotic, or antibiotic requirement for

extrathoracic infection with Gram-negative microorganisms. The

former exclusion applied if the known or suspected microorganism

was or was likely to be resistant to cefotaxime. The latter exclusion

was because the assessment of the response of the chest infection

could have been confounded.

The concomitant or continuing indication for certain other

antibiotics was not a criterion for exclusion, provided the response

of the chest infection was not thereby obscured-eg, fiucloxacillin

for o)rthopedic prophylaxis in multiple trauma, penicillin after

splenectomy, metronidazole following bowel surgery, and vanco-

Inycin for extrathoracic infection with methicillin-resistant S aureus

(MRSA) were permitted.

Patient demographic data were recorded, including underlying

condition, severity of illness grI6 therapeutic intervention score

(TISS),7 acute physiology and chronic health evaluation (APACHE

II),’ duration ofICU stay, and outcome.

The tracheobronchial aspirate in ventilated patients and expec-

to)rated sputum in nonventilated patients was examined microbio-

logically by microscopy and culture twice, viz, initially between

24 h before and 48 h after entry and subsequently between four

and ten days after entry. Within these permitted ranges, it was

planned to collect specimens within 24 h on either side of entry

and on completion of the study, and this goal was achieved in most

patients. The culture was based on the Gram stain using accepted

criteria.’9 Sensitivity testing was carried out on all pathogens by

agar dilution, using standard methods and break points.�

Treatment

Patients were randomized to receive either cefotaxime (Claforan,

Roussel Pharmaceuticals), 2 g IV 8-h, or ceftriaxone (Rochephin,

Roche Products), 2 g IV once daily. Treatment was given for five

days, unless either complete cure or therapeutic failure requiring

another antibiotic occurred sooner. Randomization was by means

of a computer-generated set of random numbers in blocks of ten.

Assessment

The clinical response was assessed on the basis ofchange between

entry and completion of the study in the four objective entry

criteria (viz, purulent sputum, chest x-ray changes, fever, and

leukocytosis) plus hypotension. The response was coded separately

for each of these five criteria, using the following semiquantitative

scoring system: improvement was scored as 1, no change as 2, and

deterioration as 3. In the event that the specific criterion was

initially normal and remained normal, it was omitted as it was



Age, Primary ICU Clinical Subsequent

No. Sex yr Diagnosis Class TISS APACHE Days Antibiotic Response, % Initial Microbiology Microbiology

1 M 71 Multitrauma 4 70

2 M 19 Burns 4 64

3 M 28 Headinjury 3 44

4 M 24 Head injury 4 44

5 F 71 COADt 3 13

6 M 23 Asthma 4 48

7 M 35 Headinjury 4 45

8 M 73 Abd. sepsis 4 34

9 M 59 Post-CABG 4 56

10 M 71 Abd. sepsis 3 38

11 F 85 Ca esophagus 4 32

12 M 69 Esophagectomy 4 62

13 F 74 ARDS 4 69



16 M 66 Esophagectomy 3 100

17F 38SAH 4 30


19 F 24 Asthma 4 39

20 F 20 Guillain-Barr#{233}t 3 19

S aureus Clear

S aureiss S pipgenes Clear

Clear MRSA(R)

H influenzae Clear

P aeruginosa (R) P aeruginosa (R)

Clear Clear

K. pneumoniae K pneumoniae

MRSA (R) Clear

NA NA

P aeruginosa (R), E coli MRSA (R), P aeruginosa (R)

Clear NA

E aerogenes Clear

S aureus (R) P aeruginosa (R)

Clear NA

Clear MRSA (R)

S marcescens S marcescens, MRSA (R)

Clear Clear

Clear NA

Clear S aureus

Clear NA

Pmirabilis NA

H influenzae Clear

Clear Clear

Pmirabilis Clear

Clear Clear

Clear MRSA (R)

Clear Clear

S pnet4moniae P inaltophilia (R)

Clear MRSA(R)

Clear Clear

Clear Clear

H influenzae Clear

Clear Clear

Clear Clear

Clear Clear

Clear MRSA(R)

Clear Clear

Clear Clear

Clear Clear

Clear Clear

S marcescens Clear

Clear S aureus

Pmirabilis Clear

S aureus Clear

Clear MRSA (R)

Clear NA

MRSA (R), E cloacae MRSA (R)

P mirabilis Clear

Clear Clear

S pipgenes Clear

Clear Clear

21 M 71 Ischemic HD

22 F 68 AAA

23 M 59 IschemicHD

24 M 75 Multitrauma

25 M 27 Multitraumat

26 M 88 Ischemic HD

27 F 42 CML

28 M 67 Penumonia

29 F 65 PVD

30 M 34 Multitrauma

31 M 69 Burns

32 F 28 Bulbarpalsyt

33 M 54 COAD

34 F 24 Multitrauma

35 F 28 Bulbar palsy

36 M 78 Multitrauma

37 M 56 Multitrauma

38 M 44 Burns

39 F 79 CVA

40 F 75 PVD

41 F 67 Multitrauma

42 F 17 Multitrauma

43 M 67 COAD

44 M 31 Multitrauma

45 M 58 Myasthenia

46 M 70 CCF

47 M 58 Myasthenia

48 M 77 AAA

49 M 44 Burnst

50 M 43 Cirrhosis

51 M 75 Multitrauma

*For primary diagnosis, COAD =chronic obstructive airways disease; CABG coronary artery bypass grafting; ARDS adult respiratory

distress syndrome; SAH subarachnoid hemorrhage, HD = heart disease; AAA abdominal aortic aneurysm, CML = chronic myeloid

leukemia; PVD peripheral vascular disease; CVA = cerebrovascular accident; CCF = congestive cardiac failure. For antibiotic, ctx is

cefotaxime, ctr = ceftriaxone. R = resistance to ceftriaxone/cefotaxime; clear no pathogens were cultured; NA = not available.

tPatment was not mechanically ventilated.

tPatient died in the ICU.§Patient died during the trial.

#{182}Failure requiring antibiotic change.

IlConcomitant antibiotics were given.

unassessable. To avoid bias, no subjective global assessments were

made by the investigators.

The scores for the clinical responses were summed, since there

was a semiquantitative grading of each parameter ranging from 1

Table 1-Patient Details and Microbiologic Findings5

CHEST I 96 I 6 I DECEMBER, 1989 1293

9 26 Ctx 67

4 13 Ctx 33

12 13 Ctrfl 78

24 15 Ctr 1001)

13 4 Ctr 7811

6 6 Ctx 42

17 10 Ctx 5811

15 7 CtxII 67

17 3 Ctr 56

9 11 Ctr 8311

14 2 Ctr 33

18 33 CtxII 50

16 52 Ctr 50

12 5 CtxlI 44

9 11 Ctx 53

19 131 Ctr 7511

5 8 Ctx 50

9 8 Ctr 56

7 14 Ctr 78

1 5 Ctx 44

4 61 20 4 Ctx 67

4 37 11 8 Ctx 42

4 28 14 7 Ctr 50

4 100 16 16� Ctrfl 6711

3 24 13 4 Ctr� 33

4 53 21 9 Ctx 58

4 77 13 18� CtxII 75

4 60 18 5 CtxII 83

3 56 8 9 Ctrfl 75

3 35 9 12 Ctrfl 33

2 14 8 5 Ctr 50

3 24 10 15 Ctx 33

4 40 15 9 Ctr 33

4 79 9 7 Ctx 58

4 21 19 4� Ctx 56

4 76 21 44:1: Ctr 6711

4 42 6 12 Ctx 58

4 68 14 36 Ctrfl 10011

3 49 17 14 Ctr 42

4 55 14 12 Ctx 42

4 38 12 18 Ctx 58

4 41 13 13 Ctx 67

4 20 15 15 Ctr 67

2 17 11 5 Ctr 67

2 55 5 18 Ctrfl 44

4 32 19 4� Ctx 67

2 55 5 18 CtxIl 58

4 41 16 13 Ctx 50

3 18 8 18 CtrlI 56

4 28 17 7 Ctr� 67

4 100 16 16� CtxII 42



1294 Ceftnaxone vs Cefotaxime in Chest Infections (Reeies at a!)

(best response) to) 3 (worst response). The summed scores were

divided by the maximum possible score in any individual patient to

give a final global score, expressed as a percentage. Thus, if all five

clinical criteria were assessable in any individual patient, the best

po)ssil)le score wO)tlld l)e 5 of 15 (33 percent) and the worst possible

score 15 O)f 15 (100 percent); no change would he 10 of 15 (67

percent), improvement would be any score <67 percent, and

deterioration would be score any score >67 percent.

The microbiologic n’s;xmse was classified as cure, failure or not

assessable.

Cure was coded as 1 , with 1A indicating that no other antibiotic

was given and lB that other antibiotics were given concomitantly

(as indicated above).

Failure was coded as 2, with 2A indicating the persistence of the

initial pathogen(s), 2B the presence ofa resistant pathogen on initial

culture, 2C the occurrence of resistance during treatment and 2D

supennfection. Failure could occur with more than orne code in an

individual patient.

Not assessable was coded as 3, indicating that no pathogens were

isolated either initially or Sul)sequentl); or that the result of either

culture was unavailable.

Hypothesis and Analysis

For the purposes of statistical analyses, the null hypthesis of the

study was that the new antibiotic, ceftriaxone, was not worse than

the previously used antibiotic, cefotaxime (based on its spectrum

and the available literature, it was not considered that the newer

antil)io)tic would be better, and the clinical surmise was that the two

antil)iotics wotild he equivalent in efficacy). The data were tabulated

using a data base program (Framework II) on a microcomputer

(hewlett-Packard Vectra). This program permitted temporary de-

letion of the column showing the specific drug treatment, so that

all data checking, revie�#{231}and analyses were performed blind. Only

after the final analyses were completed was it revealed which drug

regimen was which. The statistical analyses were performed using

a statistical program (StatView 512) Ofl a micro)computer (Apple

Macintosh SE).

The two) groups o)f 1)atiellts were compared for demographic

matching, clinical response , and microbiologic response. Continu-

0)115 variables were co)nlpared using the unpaired t test and discrete

variables using the x2 test. For the analyses o)f matching, the tests

of significance were two-tailed, as a difference either way was

so)ught. For the respomse analyses, the tests of significance were

one-tailed, as the original null hypothesis was that the new antibiotic

was not worse than the old.

Ethics

This study was approved by the Hospital�o Board of Medical

Research and Pharmaceutical Advisory Committee.

RES U

There were 51 patients, 25 of whom received

ceftriaxone and 26 cefotaxime. The chief clinical

details and microbiologic findings in all patients are

shown in Table 1 . All patients except one (patient 28)

had hospital-acquired chest infection. As shown in

Table 2, the two groups of patients were comparable

on demographic grounds, except that those receiving

cefotaxime were significantly more seriously ill on the

basis of severity of illness grading, although TISS and

APACHE scores were similar.

Thirty-six patients (71 percent) completed the

planned five-day course of antibiotic treatment (Table

3). Three patients improved sufficiently before five

Table 2-Comparison ofPatient Details5

Parameter Ceftriaxone Cefotaxime P

Number 25 26

Age, yr 55 ± 19 52 ± 22 NS

Sex, M/F 19/6 16/10 NS

Severity of illness

Class 4 13 23

Class3 9 2 0.02

Class2 3 1

TISS 45±24 49±19 NS

APACHEII 13±5 12±6 NS

P(A-a)O,difference,mmHg 249±161 234±162 NS

IPPV 22 24 NS

Serum creatinine (abnormal) 3 4 NS

DaysinlCU 18±27 12±7 NS

Died in ICU 2 4 NS

*Values are mean ± SD where indicated. IPPV is intermittent

positive-pressure ventilation (mechanical ventilation). P(A-a)O,

difference is alveolar-arterial difference in oxygen tension.

days for antibiotics to be curtailed. In two patients,

antibiotics were changed because the initial culture

showed pathogens more appropriately treated with

another antibiotic-one with pneumococci was

changed to penicillin and one with S aureus was

changed to flucloxacillin. In eight patients, clinical

failure (ie, worsening ofentry criteria) led to antibiotic

change before five days. Two patients died during

treatment, neither due to infection. A further four

patients died subsequently in the ICU . No adverse

clinical effects were noted for either antibiotic.

The clinical response of all patients is shown in

Table 4 . The global score was higher (worse) after

ceftriaxone than after cefotaxime (62 ± 20 percent vs

55 ± 13 percent, respectively, mean ± SD), but this

difference was not statistically significant (p = 0.07).

However, the difference was statistically significant

when these results were analyzed on the basis of

improved, no change or worse (p = 0.04), or improve-

ment/no improvement (p = 0.01). Moreover, prema-

ture clinical failure requiring antibiotic change was

significantly more common with ceftriaxone than with

cefotaxime (7/24, 29 percent, vs 1123, 4 percent,

p = 0.01), this comparison excluding as unevaluable

the four patients who either died or were changed to

another antibiotic because of the presence of an initial

pathogen more sensitive to another antibiotic

(Table 3).

Table 3-Antibiotic Course

Ceftriaxone Cefotaxime

Complete 15 21

Incomplete

Improved 2 1

Change (sensitivity) 1 1

Change (failure) 7 1

Died 0 2



Table 4-Clinical Response Table 6-Microbiologic Response5

CHEST I 96 I 6 I DECEMBER, 1989 1295

Ceftriaxone Cefotaxime p Value

Global score, % 62 ± 20 55 ± 13 0.07

Improved (33-66%) 12 (48%) 19 (73%)

Nochange(67%) 5 5 0.04

Worse (68-100%) 8 2

The microbiologic findings are shown in Table 1,

the comparison of the two treatment groups in Table

5 and the responses in Table 6. Pathogens were isolated

from initial cultures in 21 patients (41 percent) and

appeared comparable between the two treatment

groups (Table 5). Mixed upper respiratory tract flora

were identified in a further 16 patients (31 percent)

but were not classified as pathogens. Of the initial

pathogens, 5/10 (50 percent) were cleared after cef-

triaxone compared with 1 1/14 (79 percent) after cefo-

taxime, but this difference was not statistically signif-

icant (p = 0.07). Pathogens were isolated from 15

patients (29 percent) at the completion of the study.

Twenty-eight patients (55 percent) were thus micro-

biologically evaluable (14 in each group) (Table 6). Of

these, 5/14 (36 percent) showed a microbiologic cure

after ceftriaxone compared with 8/14 (57 percent)

after cefotaxime, but this difference was not statisti-

cally significant (p = 0. 13). In patients microbiologi-

cally evaluable at completion, superinfection occurred

in 8/22 (36 percent) after ceftriaxone vs 4/22 (18

percent) after cefotaxime (p = 0.08).

DISCuSSIoN

The initial, empiric choice of antibiotic in chest

infections in the seriously ill is often difficult, but

many would favor a third-generation cephalosporin,

unless other considerations related to the individual

patient or institution dictated differently.’5 Like

others,2’ we have often used cefotaxime for this

purpose for several years with generally satisfactory

Table 5-initial Microbiologic Findings5

Pathogen Ceftriaxone Cefotaxime

Spipgenes it it

Spneumoniae - it

Saureus it 2t

S aures(R) it -

MRSA(R) - 2 (it)

H influenzae it 2t

Ecoli 1 -

K pneumoniae - 1

Eaerogenes - it

Ecloacae - it

Pmirabilis 2t 2 (it)

Smarcescens 1 It

P aeruginosa(R) 2 -

*Mic,.�rg�j�isms initially resistant to ceftriaxone or cefotaxime are

indicated by (R).

tClearance of initial pathogen on subsequent culture.

Response Ceftriaxone Cefotaxime

Cure

No other antibiotic 3 6

Other concomitant antibiotic 2 2

Failure

Persistence of initial pathogen 3 1

Initial pathogen resistant 3 1

Resistance during treatment 0 i

Superinfection S 4

Not assessable 1 1 i2

*Fail,,re occurred with more than OflC (3)de in 7 patients (5 receiving

ceftriaxone and 2 receiving cefotaxiine).

results. Ceftriaxone, with its similar antimicrobial

spectrum7’8 but much longer half-life,79” would seem

to offer some advantages over cefotaxime, in that

efficacy would be expected to be comparable but cost

and convenience more 1215

These theoretical considerations are supported by

a large body ofclinical data, which has confirmed that

ceftriaxone is an effective antibiotic in the treatment

ofa wide variety ofinfections,�’� including respiratory

tract infections.�m In addition, specific comparison

has been made of ceftriaxone with cefotaxime in

several small studies in various infections,��’ including

lower respiratory tract infections.’#{176}�’37 In these reports,

comparability of the two antibiotics both clinically and

microbiologically has regularly been found, although

all studies have in fact been too small to exclude a

possible difference with confidence. This significant

risk ofa beta error in small studies greatly diminishes

the strength of the available literature in this area.

However, it was perhaps unexpected to find in the

present study that ceftriaxone was not clinically as

effective as cefotaxime (clinical response 48 vs 73

percent, p=O.Ol; premature clinical failure 29 vs 4

percent, p = 0.01) and that the null hypothesis that

ceftriaxone was not worse than cefotaxime had to be

rejected. The trend for ceftriaxone to be less effective

than cefotaxime applied also to the microbiologic

response (36 vs 57 percent cure, 50 vs 79 percent

clearance of initial pathogens), although these differ-

ences were not statistically significant, presumably

because of few numbers, only 55 percent of patients

being microbiologically evaluable.

The diagnosis of bacterial pneumonia can be ex-

tremely difficult in such patients, even in retrospect,

because ofthe limitations of microbiologic examination

ofsputum.’9 We have thus considered the results more

clinically relevant when analyzed on the basis of

intention to treat than when analyzed solely on the

basis of culture results. The latter have been consid-

ered of importance chiefly in demonstrating compa-

rability between treatment groups and in providing

information to supplement the clinical assessment.



ACKNOWLEDGMENTS: The authors thank Roche Products,Sydney, Australia, for their support, for donation of supplies ofceftriaxone, and for independent confirmation of the authors’statistical analyses.

1296 Ceftrlaxone vs Cefotaxime in Chest Infections (Reeves et a!)

The reasons for the difference between the two

antibiotics are not immediately apparent. First, the

result could be a chance finding, although it is the

nature of statistical analysis to put a numerical proba-

bility on this, and the present analyses indicate a low

(ie, conventionally statistically significant) probability

that the result is due to chance. Second, analysis of

matching showed that the two groups of patients

appeared to be comparable with respect to relevant

documented criteria, except that those receiving ce-

fotaxime were more seriously ill (based on severity of

illness grading) than those receiving ceftriaxone, a

difference which, if real, might be expected to act in

favor of the latter drug. However, this difference was

not reflected in the more sophisticated TISS and

APACHE scores, and was thought most likely to be a

quirk related to the imprecision of severity of illness

grading. Third, it is possible that the unique, active

metabolite of cefotaxime7 confers clinical benefit over

and above that which may be expected from the

antimicrobial spectrum and pharmacokinetics of the

parent molecule alone. Fourth, although the doses of

the two antibiotics chosen were based on recom-

mended schedules and were considered comparable,

it is possible that in the setting of serious illness a

single daily dose of ceftriaxone is inadequate and a

twice daily (q 12h) dose would be more appropriate.

Yet trials of once- and twice-daily ceftriaxone have

shown similar efficacy for the two dosage regimens’4

and pharmacokinetic studies in hospital patients with

severe infections have shown results similar to those

in normal subjects (is, half-life about 8 h).�m If,

however, a twice-daily dose is required in seriously ill

patients, the advantages of ceftriaxone in cost and

convenience over cefotaxime disappear.

It thus seems most likely that the results of the

present study are valid and may be related to the

specific setting of serious infection in patients in the

ICU . These observations are supported by the single

other study confined to such patients, in which a

failure rate of 39 percent was recorded in an uncon-

trolled assessment of lower respiratory tract infection

treated with ceftriaxone once daily.’#{176}Formal confir-

mation of our findings by further appropriate studies

is thus recommended.

It is concluded that ceftriaxone in a single daily

dose of 2 g appears less satisfactory than cefotaxime

in a divided dose of 6 g daily for the initial, empiric

treatment of chest infections in the seriously ill. This

conclusion, of course, does not necessarily apply to

other settings in which a single daily dose of cef-

triaxone may be appropriate, but it is perhaps a

reminder that, for antibiotics, extrapolation from sus-

ceptibility and pharmacokinetic data to dosage rec-

ommendations needs to be confirmed by clinical trials,

especially in the seriously ill.

REFERENCES

1 Bartlett JG. Pneumonia. In: Bone RC, ed. Critical care: a

comprehensive approach. Park Ridge, Il: American College of

Chest Physicians, 1984:434-45

2 Bender BS, Bartlett JG. Nosocomial infections. In: Bone RC,

ed. Critical care: a comprehensive approach. Park Ridge, II:

American College ofChest Physicians, 1984:446-63

3 Hoyt JW. Complications of infection in the critically ill patient.

In: Lumb PD, Bryan-Brown CW, eds. Complications in critical

care medicine. Chicago: Year Book Medical Publishers, 1988:

205-19

4 Wolinsky E. Pulmonary infection in critical care medicine. In:

Shoemaker WC, Thompson WL, Holbrook PR, eds. Textbook

ofcritical care. Philadelphia: WB Saunders, 1984:577-79

5 Summer WR, Nelson S. Severe community-acquired pneumo-

nia: how to decide on initial therapy. Pulmonary perspectives,

ACCP 1988; 5:4-8

6 Moellering RC, ed. Ceftriaxone: a long-acting cephalosporin.

Am J Med 1984; 77(4C):1-118

7 Wise R. Penicillins and cephalosporins: antimicrobial and phar-

macological properties. Lancet 1982; 2:140-43

8 Cleeland R, Squires E. Antimicrobial activity of ceftriaxone: a

review. Am J Med i984; 77(4C):3-ii9 Wise R, Andrews JM. A comparison of pharmacokinetics and

tissue penetration of ceftriaxone, moxalactam and cefotaxime.

Eur J Clin Microbiol 1983; 2:505-08

10 Pate IH, Kaplan SA. Pharmacokinetic profile of ceftriaxone in

man. Am J Med 1984; 77(4C):17-25

ii Scully BE, Fu KP, Neu HC. Pharmacokinetics of ceftriaxone

after intravenous infusion and intramuscular injection. Am JMed 1984; 77(4C):112-i6

12 Tanner DJ, Nazarian MQ. Cost containment associated with

decreased parenteral antibiotic administration frequencies. Am

J Med 1984; 77(4C):104-ii

13 lannini PB. Once-daily dosing: economic considerations. Clin

Courier 1987; 4:10-il

14 McCloskey RV. Once-daily dosing: the clinical view. Clin Courier

1987; 4:10

15 Baumgartner JD, Glauser ME Single-daily-dose treatment of

severe refractory infections with ceftriaxone: cost savings and

possible parenteral outpatient treatment. Arch Intern Med

1983; 143:1868-73

16 CivettaJM. The inverse relationship between cost and survival.

J Surg Res 1973; 14:265-69

17 Cullen DJ, Civetta JM, Briggs BA, Ferrara LC. Therapeutic

intervention scoring system: a method for quantitative compar-

ison ofpatient care. Crit Care Med 1974; 2:57-60

18 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE

II: a severity of disease classification system. Crit Care Med

1985; 13:818-29

19 Isenberg HD, Washington JA, Balons A, Sonnenwirth AC.

Collection handling and processing of specimens. In: Lennette

EH, Balons A, Hausler WJ, et al, eds. Manual of clinical

microbiology. 4th ed. Washington, DC: American Society for

Microbiology, 1985:79-81

20 Washington JA. Susceptibility tests: agar dilution. In: Lennette

EH, Balons A, Hausler WJ, et al, eds. Manual of clinical

microbiology. 4th ed. Washington, DC: American Society for

Microbiology, 1985:967-71

21 Rondanelli R, Dionigi RV, CaM M, Dell’Antonio M, Corsico G,

Mapelli A. Cefotaxime therapy of lower respiratory tract infec-



CHEST I 96 I 6 I DECEMBER, 1 989 1297

tions in intensive-care patients. mt J Clin Pharmacol Res 1987;

7:73-76

22 Fernex M . Worldwide experience with ceftriaxone. Clin Courier

1987; 4:2

23 McCloskey RV. Clinical and bacteriologic efficacy of ceftriaxone

in the United States. Am J Med 1984; 77(4C):97-l03

24 Baumgartner JD, Glauser ME Tolerance study of ceftriaxone

compared with amoxicillin in patients with pneumonia. Am JMed 1984; 77(4C):54-58

25 Lode H, Hampel B. The clinical efficacy and tolerability of

ceftriaxone in respiratory tract infections. Insights into the

Treatment ofSerious Infections 1988; 2: 121-23

26 Grassi C, Mangiarotti P. International experience with ccl’

triaxone in the treatment of lower respiratory tract infections.

Chemioterapia 1987; 6:364-73

27 Eron L, Jauregui L, Condoluci D, Wilson D, Evrard H.

Treatment of serious infections with ceftriaxone given omce

daily. 15th International Congress of Chemotherapy, Istanbul,

1987

28 Potgieter PD, Linton DM, Forder AA, Plumb H. Ceftriaxone

therapy in adults with severe lower respiratory tract infections.

S Mr Med J 1986; 69:495-97

29 Bittner MJ, Pugsley MP, Horowitz EA, Strike DG, Sanders CC,

Preheim IC. Randomised comparison of ceftriaxone and cefa-

mandole therapy in lower respiratory tract infections in an

elderly population. J Antimicrob Chemother 1986; 18:621-27

30 Fraschini F, Braga PC, Falchi M, Gattei G, Scaglione F,

Scarpazza G, et al. Ceftriaxone therapy in otolaryngological and

pulmonary infections. Chemotherapy 1986; 32:200-04

31 Pulay I, Flautner F, Tarjanyi M, Tihanyi T, Darras K, Magyar

A. Comparative study on antibiotic prophylaxis with cefotaxime

and ceftriaxone in pancreatic surgery. 15th Internatio)nal Con-

gress ofChemotherapy, Istanbul, 1987

32 Gerstner GJ. Ceftriaxone versus cefotaxime in the treatment of

O1)stetrlc and gynecologic infections-a randomized and clinical

trial. 15th International Congress of Chemotherapy, Istanbul,

1987

33 Korting HC, Abdeck D, Neubert U. Ceftriaxone 250 mg are

equally effective as cefotaxime 500 mg for the one-shot treatment

of uncomplicated gonorrhea: preliminary results of a controlled

trial. 15th International Congress of Chemotherapy, Istanbul,

1987

34 Hahn LB. Barclay CA, Irribarren MA, Traballi CA, Casellas

JM , Farinati A. Comparative study ofceftriaxone and cefota.xime

in co)mplicated urinary tract infections. 15th International

Congress ofChemotherapy, Istanbul, 1987

35 Lassere R, Leu H-S. Gram-negative septicemia in adults: a

randomized comparative study with ceftriaxone and cefotaxime.

15th International Congress of Chemotherapy, Istanbul, 1987

36 Abbate GF, Alagia I, Giaquinto E, Leonessa V, Caputi M,

Guarino C , et al. Comparative clinical evaluation of ceftriaxone

in treating lower respiratory tract infections. Chemioterapia

1986; 5:26-32

37 Lanni N, Scaglione B. Ceftriaxone in the therapy of infections

of the lower respirato)ry tract: comparison with cefotaxime.

Minerva Med 1986; 77:317-19

38 Joos B, Loiethy R, Muehier E, Siegenthaler W. Variability of

ceftriaxone pharmacokinetics in hospitalized patients with se-

vere infections. Am J Med 1984; 77(4C):59-62

39 Fraschini F, Braga PC, Scarpazza C, Scaglione F, Pignataro 0,

Sambataro G, et al. Human pharmacokinetics and distribution

in vario)us tissues ofceftriaxone. Chemotherapy 1986; 32:192-99

40 Mouton Y, Beuscart C, Deboscker Y, Leroy 0, Chidiac C,

Beaucaire C. Ceftriaxone in intensive care units. In: Changing

concepts in management ofserious infections. 5 years experience

with ceftriaxone. Basel: Poster Book, Roche, 1986; ch 21



DOI 10.1378/chest.96.6.1292 1989;96; 1292-1297Chest

J H Reeves, G M Russell, J F Cade and M McDonaldComparison of ceftriaxone with cefotaxime in serious chest infections.

April 13, 2012This information is current as of

http://chestjournal.chestpubs.org/content/96/6/1292Updated Information and services can be found at:

Updated Information & Services

http://chestjournal.chestpubs.org/content/96/6/1292#related-urlsThis article has been cited by 3 HighWire-hosted articles:

Cited Bys

http://www.chestpubs.org/site/misc/reprints.xhtmlonline at: Information about reproducing this article in parts (figures, tables) or in its entirety can be foundPermissions & Licensing

http://www.chestpubs.org/site/misc/reprints.xhtmlInformation about ordering reprints can be found online:

Reprints

the right of the online article.Receive free e-mail alerts when new articles cite this article. To sign up, select the "Services" link to

Citation Alerts

slide format. See any online figure for directions. articles can be downloaded for teaching purposes in PowerPointCHESTFigures that appear in Images in PowerPoint format



http://chestjournal.chestpubs.org/content/96/6/1292#related-urls

http://www.chestpubs.org/site/misc/reprints.xhtml

http://www.chestpubs.org/site/misc/reprints.xhtml


cefotaxime cetrixin

Documents