INDICES> Research in Rational use of cefotaxime (3)

["Andy Gray" <Graya1@nu.ac.za>]

Indices: Research in Rational use of cefotaxime (3)

Hi Teboho

The SA STG/EDL lists cefotaxime for the following indications:

* Bacterial meningitis in adults - but only where the bacterial aetiology is
unknown, the infection is community cquired, and if it is known that there
is significant resistance of pneumococci to penicillin or of H. influenzae
to chloramphenicol, when the addition of a third generation cephalosporin
(e.g. Cefotaxime, IV, 8-12 g/day in 4 divided doses, 6 hourly or
Ceftriaxone, IV, 4 g/day divided in 12 hourly doses) is suggested. The same
goes for proven resistant Streptococcus pneumonia and resistant Haemophilus
influenzae, for Enterobacteriaceae and Enterobacteriaceae (with gentamicin)
or in hospital-acquired infection where the organism is unkown (with
Tobramycin, IV, 5 mg/kg/day in 3 divided doses and Tobramycin,
intrathecally, 8-10 mg daily for 3 weeks, and also corticosteroids, e.g.
Dexamethasone, IM, 4 mg 6 hourly for 2-4 days, may be used when severe brain
oedema is suspected or in cases with extreme high CSF pressure initially
(>400 mm water).

* as surgical prophylaxis in paediatrics - eg a pre-operative dose of
cefotaxime + metronidazole and then a single dose after 12 hours (in
neonates <1wk) or 8 hours (neonates 1-4wk, infants 4 wks to 12 years)

* as an alternative in peritonitis in adults  caused by resistant
Enetrobacter - a third generation cephalosporin IV, e.g. cefotaxime,
depending on sensitivity
Cefotaxime, IV, 1-2 g 8 hourly (up to 12 g per day in life-threatening
disease)

* in septicaemia in the newborn - especially when an antibiotic that crosses
the blood0brain barrier is needed eg when complicated by meningitis -
cefotaxime 50-100 mg/kg/24 hours in 3 divided doses for 7-10 days.
Meningitis: 200 mg/kg/24 hours in 3 divided doses for 14 days. Note that
ceftazidime (at 25-50 mg/kg/24 hours in 2 divided doses for 7-10 days) is
also listed for Pseudomonas infections, despite not being registered for use
in infants < 2 months old.

* in acute bacterial meningitis in paediatrics - either as empiric treatemtn
for those aged 3 months to 16 years (Cefotaxime, IV, 200 mg/kg/24 hours in 3
divided doses (8 hourly) for 10-14 days or Ceftriaxone, IV, 80 mg/kg/24
hours as a single daily dose (maximum 4g/24 hours)). In neonates and infants
< 3 months one of the options is Cefotaxime, IV, 200 mg/kg/24 hours in 3
divided doses (8 hourly) for 14 days (Gram-negative organisms, 21 days)
plus Ampicillin, IV, 200 mg/kg/24 hours in 4 divided doses (6 hourly) for 14
days. Third gen cephs are also used for proven penicillin-resistant
pneumococci.

* Septic or pyogenic arthritis in paediatrics, caused by
Ampicillin-resistant H. influenzae (Cefotaxime, IV, 501100 mg/kg/24 hours in
3 divided doses for 10-14 days).

* as an option in epiglottitis in paediatrics - Cefotaxime, IV, 100 mg/kg/24
hours in 3 divided doses (8 hourly) for 7 days.

* as an option in pyelonephritis and obstructive/reflux nephropathy in
paediatrics - Cefotaxime, IV, 50-100 mg/kg/24hours in 2-3 divided doses for
7-14 days.

* as part of an antibiotic option in shock in paediatrics (vancomycin +
cefotaxime + metronidazole)

* for H. influenzae chest infection in cystic fibrosis in paediatrics -
Cefotaxime, IV, 50-100 mg/kg 8 hourly for 10-14 days.

These guidelines can be downloaded from
http://www.doh.gov.za/docs/factsheets/pharma/paediatric/edlpaed.pdf and
http://www.doh.gov.za/docs/factsheets/pharma/adult_hospital/edladult.pdf

However, please note that these hospital-level documents are now being
revised by the National EDL Committee.

It might be worthwhile sitting down with your clinicans and agreeing on what
local policy actually is - but stated explicitly as a set of criteria for
use. A prospective audit can then measure actual practice against the
espoused policy (as a DUR).

regards
Andy

>~~~~~~~~~~~~~~~~~~~
>Andy Gray MSc(Pharm) FPS
>* Senior Lecturer
>Dept of Experimental and Clinical Pharmacology
>* Study Pharmacist
>Centre for the AIDS Programme of Research
>in South Africa (CAPRISA)
>Nelson R Mandela School of Medicine
>University of KwaZulu-Natal
>PBag 7 Congella 4013
>South Africa
>Tel: +27-31-2604334/4298 Fax: +27-31-2604338
>email: graya1@ukzn.ac.za or andy@gray.za.net
>
>>>> pharmacy@ilesotho.com 02/17/04 09:13AM >>>
>
>
>Indices: Assessing the rational use of cefotaxime at QEII hospital in
>Lesotho
>
>
>Dear Indices members,
>
>I am a research scholar , working on a research project "Assessing the
>rational use of cefotaxime". This is a study amongst inpatients in a
>tertiary
>hospital in Maseru, Lesotho. One finds that antibiotic use accounts for a
>large proportion of the pharmacy budget in the hospital and in many
>instututions cephalosporins in general have been overused and abused
>resulting
>in emergence of resistant organisms and an increasing burden on resources.
>
>I would appreciate information from other tertiary care hospitals in other
>countries, more specifically in the following areas
>
>1.  the prescribing patterns
>2.  indications
>3.  importance of susceptability assessment prior to initiating therapy
>
>And any other!
>-----------
>Mrs Teboho Khetsi, senior pharmacist
>Queen Elisabeth II Pharmacy, Maseru, Lesotho
>Email: pharmacy@ilesotho.com
>Tel +266-22321373  Fax +266-22310790
>
>--------------------------------------------------------------------
>Please find our disclaimer at http://www.disclaimer.nu.ac.za
>--------------------------------------------------------------------
><<<<gwavasig>>>>

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