Comparison of ceftriaxone with cefotaxime in

serious chest infections.

J H Reeves, G M Russell, J F Cade and M McDonald
Chest 1989;96;1292-1297
DOI 10.1378/chest.96.6.1292
The online version of this article, along with updated information and services
can be found online on the World Wide Web at:
http://chestjournal.chestpubs.org/content/96/6/1292

Chest is the official journal of the American College of Chest Physicians. It has
been published monthly since 1935. Copyright1989by the American College of
Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights
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1989 American College of Chest Physicians

Comparison
of Ceftriaxone with Cefotaxime
in Serious Chest lnfections*
John

H. Reeves,

John

F. Cade,

Ceftriaxone

M. B.
M.D.

is a new,

because

of

its

long

study
patients.

hest

potential

agents

patients

infection

is one

most

common

ill

ously

or

patients
injured

infection,

which

increased

morbidity

in the
negative

then

exists

for

third-generation

Chest

introduction

cefotaxime7

with

interest
these

that

significant

in drug

While
the relative
mens
may be readily
requires

specific

ceftriaxone
infections

staff

clinical

evaluation.

controlled,
microbiologic

We

in the
patients

PATIENTS

AND

the

Patient

in

ICU.

general

presence

ofthree

sputum,

chest

x-ray

(>38#{176}C), and
hypotension
response

The
or more

were
specific
ofthe

evidence

of recent

leukocytosis
(mean

scoring

was

for

pressure
not

a criterion

entry

consolidation
mm).
<60

mm
for

days,

the

another

the

Intensive

Care

Unit,

1292

Royal

noted

of
for

10; reviSio)n
accepted
Royal
Melbourne

Hospital,
May

Hospital,

response

fiucloxacillin

trauma,

penicillin

surgery,

recorded,

after

and

vancoS aureus

and

outcome.

within
study,

and

was

based

on

testing

was

standard

(APACHE

patients
examined
viz,

and expecmicrobio-

initially

subsequently

these

24 h on
goal

the

carried

methods

either

it was

side

of entry

achieved

stain

out
and

four

ranges,

was

Gram

between

between

permitted

this

score

evaluation

twice,
and

Within

specimens

using

health

culture
entry

underlying

intervention

in ventilated
patients
was

of the

Sensitivity

including

therapeutic
chronic

entry.

culture

dilution,

were

randomized

Pharmaceuticals),
Products),
unless

on

all

break

in most

using

accepted

pathogens

by

points.

to receive

either

2 g IV 8-h,

or

2 g IV once

either

daily.

complete

antibiotic

Treatment

cure

occurred

cefotaxime

sooner.

(Rochephin,

was

therapeutic

or

given

failure

Randomization

set of random

(Claforan,

ceftriaxone

was

numbers

for

five

requiring
by

means

in blocks

of ten.

ofchange

between

Assessment
The
entry

entr

Melbeurne

other

the

methicillin-resistant

and

h after

after

The

clinical
and

response

Victoria,

for each
scoring

16.

Victoria

(viz,

of these
system:

assessed

the

hypotension.

five
3.
and

In

chest

the

event

basis
the

four

x-ray

the
scored

that
normal,

vs Cefotaxime

Downloaded from chestjournal.chestpubs.org by guest on April 13, 2012

1989 American College of Chest Physicians

objective

changes,

was

response

using
was

remained

Ceftriaxone

in

The

criteria,

the

on

study

sputum,

improvement

as
normal

of

purulent
plus

deterioration
initially

was

completion

leukocytosis)

Australia.
Manuscript
received
January
Reprint
requests:
Dr. Cads?,
3050,
Australia

were

and

48

to collect

criteria
*From

certain

h), fever

presence
was

for

bowel

grI6

stay,

of a computer-generated

purulent
(<48

Hg)

and

included

The

infection

Treatment

ill or injured

macroscopically

(>12,000/cu

bloxxl
but

criteria
following:

exclusion

chest

obscured-eg,

with

data

microscopy

and

days

Patients

seriously

latter

both

METHODS

those

The
of the

provided

multiple

following

of illness

ofICU

by

Roche
for entry

thereby
in

tracheobronchial
aspirate
sputum
in nonventilated

criteria.9

response

The

microorganism

indication

infection

on completion

agar

not

physiology

duration

patients.

or

for

permitted.

acute

planned

Patients
eligible

was

severity

ten

known

requirement

microorganisms.

for exclusion,

prophylaxis

demographic

The
to)rated

following:

or suspected

continuing

a criterion

infection

were

Roussel

Patients

or
not

extrathoracic

for

of the

to cefotaxime.
of the

metronidazole

condition,

and

compared

study, using
as endpoints.

was

splenectomy,

1989; 96:1292-97)

or antibiotic

known

once

of serious

confounded.

concomitant
chest

treatment

Gram-negative

if the

to be resistant

o)rthopedic

and

with

assessment

been

24 h before

treatment
of chest
in a prospective,

single-blind
responses

likely

because

logically

time.3-5

costs of different
antibiotic
regicalculated,
respective
efficacy

with cefotaxime
in seriously
ill

randomized,
clinical
and

and

or was

was

either

antibiotic,

applied

was

II),

has been
recgiven
once daily,
it

cost

infection

have

for the

were

for another

exclusion

(TISS),7

comparisons

Specifically,
ceftriaxone
can be

savings

has

satisfactory

for exclusion

need

(MRSA)

to

be

(Chest

criteria

suspected

Inycin

half-life,7

1213

infections.

for

similar

in cost-effectiveness

agents.

ommended

longer

chest

of the

an antibiotic

activity

a sixfold

not

The

as cefotaxime.5

of antimicrobial

but

stimulated
among

such

of ceftriaxone,6

days.

may

antibiotics

of a

2 g LV

for five

daily

could

use

ceftriaxone,
daily,

groups
of patients
appeared
demographically
Ceftriaxone
in a single daily dose of 2 g

infection

the

either

2 g IV thrice

two
comparable.

former

serichest

received

or cefotaxime,

extrathoracic

More

due to Gramof antibiotic

including

ventilated)

daily,

The

the

of significantly

mortality.23

treatment,

a spectrum

with

illness.

a source

cephalosporin

recent

with

and

be

who are already

a supervening

becomes

mechanically
once

compli-

It may

seriously
ill is most
commonly
microorganisms,
and a variety

options
The

in an ICU
develop

MB.

The

in seriously
ill
of whom
were

percent

of the

of

randomized

infections

(90

that,

such as cefotaxime.

cations
in critically
ill patients.

primary
cause
of the patients
serious
frequently,

McDonald,

advantages

in a prospective,

of chest

Fifty-one

Malcolm

cephalosporin

offers

drugs

two

treatment

M. B.;
and

third-generation
over similar

the

the

of

Al. Russell,
F.C.C.P;

half-life,

cost and convenience

We compared

Gary

Ph.D.

coded

following
as

the

change

specific

in Chest

and

separately

semiquantitative

1, no

it was

entry

fever,

omitted

Infections

as

2, and

criterion

was

as

it was

(Reeves

et a!)

1-Patient

Table

No.

Age,

Primary

Sex

yr

Diagnosis

Details

and Microbiologic

ICU
Class

TISS

APACHE

Days

Findings5

Clinical
Antibiotic

Subsequent

Response,

Initial

Microbiology

aureus
aureiss

Microbiology

71

Multitrauma

70

26

Ctx

67

19

Burns

64

13

Ctx

33

28

Headinjury

44

12

13

Ctrfl

78

Clear

MRSA(R)

24

Head

44

24

15

Ctr

1001)

Clear

71

COADt

13

13

Ctr

7811

H influenzae
P aeruginosa

23

Asthma

48

Ctx

42

Clear

35

Headinjury

45

17

10

Ctx

5811

K. pneumoniae

73

Abd.

34

15

CtxII

67

MRSA

injury

sepsis

Clear
S pipgenes

Clear

P aeruginosa

(R)

K pneumoniae
Clear

(R)

59

Post-CABG

56

17

Ctr

56

NA

10

71

Abd.

sepsis

38

11

Ctr

8311

11

85

Ca esophagus

32

14

Ctr

33

Clear

NA

12

69

Esophagectomy

62

18

33

CtxII

50

74

ARDS

69

16

52

Ctr

50

E aerogenes
S aureus (R)

Clear

13
14

58

Multitrauma

35

12

CtxlI

44

Clear

NA

15

43

Multitrauma

39

11

Ctx

53

Clear

MRSA

16

66

Esophagectomy

100

19

131

Ctr

7511

S marcescens

S marcescens,

30

Ctx

50

Clear

Clear

17F

38SAH

NA
(R), E coli

aeruginosa

(R), P aeruginosa

MRSA

P aeruginosa

18

38

Multitrauma

53

Ctr

56

Clear

NA

24

Asthma

39

14

Ctr

78

Clear

S aureus

20

20

Guillain-Barr#{233}t

19

Ctx

44

Clear

NA

21

71

Ischemic

61

20

Ctx

67

Pmirabilis

NA

22

68

AAA

37

11

Ctx

42

H influenzae

Clear

23

59

IschemicHD

28

14

Ctr

50

Clear

Clear

24

75

Multitrauma

100

16

16

Ctrfl

6711

Pmirabilis

Clear

25

27

Multitraumat

24

13

Ctr

33

Clear

Clear

26

88

Ischemic

53

21

Ctx

58

Clear

MRSA

27

42

CML

77

13

18

CtxII

75

Clear

Clear

HD

(R)

MRSA

67

Penumonia

60

18

CtxII

83

S pnet4moniae

P inaltophilia

29

65

PVD

56

Ctrfl

75

Clear

MRSA(R)

30

34

Multitrauma

35

12

Ctrfl

33

Clear

Clear

31

69

Burns

14

Ctr

50

Clear

Clear

32

28

Bulbarpalsyt

24

10

15

Ctx

33

H influenzae

Clear

33

54

COAD

40

15

Ctr

33

Clear

Clear

34

24

Multitrauma

79

Ctx

58

Clear

Clear

35

28

Bulbar

21

19

Ctx

56

Clear

Clear

36

78

Multitrauma

76

21

44:1:

Ctr

6711

Clear

MRSA(R)

37

56

Multitrauma

42

12

Ctx

58

Clear

Clear

38

44

Burns

68

14

36

Ctrfl

10011

Clear

Clear

39

79

CVA

49

17

14

Ctr

42

Clear

Clear

40

75

PVD

55

14

12

Ctx

42

Clear

Clear

41

67

Multitrauma

38

12

18

Ctx

58

S marcescens

Clear

42

17

Multitrauma

41

13

13

Ctx

67

Clear

S aureus

43

67

COAD

20

15

15

Ctr

67

Pmirabilis

Clear

44

31

Multitrauma

17

11

Ctr

67

S aureus

Clear

45

58

Myasthenia

55

18

Ctrfl

44

Clear

MRSA

46

70

CCF

32

19

Ctx

67

Clear

NA

47

58

Myasthenia

55

18

CtxIl

58

MRSA

48

77

AAA

41

16

13

Ctx

50

P mirabilis

Clear

49

44

Burnst

18

18

CtrlI

56

Clear

Clear

50

43

Cirrhosis

28

17

Ctr

67

S pipgenes

Clear

51

75

Multitrauma

100

16

16

CtxII

42

Clear

*For

primary

distress

diagnosis,

syndrome;

leukemia;

PVD

cefotaxime,

ctr

tPatment

was

tPatient
Patient

died
died

not

SAH

mechanically

resistance

obstructive

airways

hemorrhage,
disease;

CVA

HD
=

disease;
=

heart

cerebrovascular

CABG

coronary

disease;

AAA

accident;
clear

to ceftriaxone/cefotaxime;

abdominal
=

were

MRSA

bypass

grafting;

aortic

aneurysm,

congestive

no pathogens

(R)
(R)

Clear

artery

CCF

(R)

cardiac
cultured;

ARDS

failure.
NA

adult

CML

not

For

respiratory

chronic

myeloid

antibiotic,

ctx

is

available.

ventilated.

ICU.
the trial.
antibiotic

antibiotics

unassessable.

To avoid

by the

vascular

ceftriaxone.

IlConcomitant

made

=chronic

subarachnoid

peripheral

in the
during

#{182}Failure requiring

COAD

(R), E cloacae

(R)

(R)

28

palsy

(R)

(R)

19

HD

(R)

Clear

investigators.

change.
were

bias,

given.
no subjective

global

assessments

were

The
was

scores

for the

a semiquantitative

clinical

responses

grading

of each

CHEST

were

I 96 I 6 I

Downloaded from chestjournal.chestpubs.org by guest on April 13, 2012

1989 American College of Chest Physicians

summed,

parameter

since
ranging

DECEMBER,

1989

there
from

1293

(best

response)

divided

to) 3 (worst

by the
a final

give

clinical

maximum

global

score,

criteria

po)ssil)le

were

score

score

15

wO)tlld

percent),

expressed

The

summed

in any

percent);

no

would

would

microbiologic

any

ns;xmse

and

any

>67

the

worst

he

score

score

was

the
<67

Parameter

percent,

and

failure

Sex,

Cure

coded

was

given

and

(as indicated

or not

was

other

as 2, with

2C

2B the

the

assessable

isolated

could

was

either

culture

was

occur

coded

initially

and

For the

resistant

of the

pathogen

during

with

than

initial

on

treatment

more

and

orne code

that

of statistical

the

new

the

available

literature,

antil)io)tic

would

be better,

antil)iotics

used

wotild
a data

base

that

the

result

clinical

2D
in an

of either

which.

two)

matching,

The

groups
clinical

variables

variables

was

using

on

analyses

drug

were

o)f 1)atiellts

were

two

tabulated

a microcomputer
temporary

de-

treatment,

so that
Only

which

drug

performed

using
(Apple

micro)computer

the

For

respomse

compared

the

the

study

Research

and

analyses,

than

the

was

approved

the

and

discrete

were

o)f matching,

tests

the

either
of significance

was that

the

tests

way

was
were

new

51

and

the

two

on demographic
basis

were

of severity

APACHE

by

the

Hospitalo

Advisory

Board

of

Medical

Committee.

patients,
26

25

cefotaxime.

of

whom

The

scores

groups

of patients

grounds,

except

significantly
of illness
were

received

chief

clinical

are
28)

3). Three

patients

were

NS

126

NS

249161

234162

NS

22

24

NS

NS

P(A-a)O,difference,mmHg
IPPV
Serum

creatinine

(abnormal)

DaysinlCU
Died

1827

in ICU

127

are

mean

SD

where

indicated.

ventilation

IPPV

(mechanical

is alveolar-arterial

NS
4

NS

is

intermittent

ventilation).

difference

in oxygen

P(A-a)O,

tension.

days

for

antibiotics

antibiotics
showed
another
changed
changed

to
to

failure
change

that

more
grading,

curtailed.

In

due

to

response

The

global
than

13

and

difference

was

However,

the
these

of

not

all

patients

higher

analyzed

on
=

failure
requiring
antibiotic
more common
with ceftriaxone

cefotaxime

(7/24,

percent,

this

the

basis

of

0.04),
or improveMoreover,
prema-

ture
clinical
significantly

29

vs

but

(p = 0.07).
significant

statistically

or worse
(p
(p = 0.01).

in

after

percent

SD),

significant

was
were

shown

(worse)

(62 20

mean

statistically

results

is

four
adverse

cefotaxime

no change
improvement

vs

1123,

change
than

was
with

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).

in

those

Table

receiving

3-Antibiotic

Course

Ceftriaxone

seriously

ill on the

although

TISS

completed
treatment

sufficiently

ICU
No
antibiotic.

was

respectively,
difference

A further

in the
for either

score

after

percent,

one with
S aureus
was
eight
patients,
clinical

infection.

subsequently
were noted

clinical

patients,

ofentry
criteria)
led to antibiotic
days.
Two patients
died
during

neither
died
effects

In two

because
the initial
culture
appropriately
treated
with
with
pneumococci
was

and

Complete

before

the
(Table
five

Cefotaxime

15

21

Incomplete
Improved

(71 percent)
of antibiotic

improved

penicillin
flucloxacillin.

(ie, worsening
before
five

patients
clinical

to be

were
changed
pathogens
more
antibiotic-one

comparable

similar.

Thirty-six
patients
planned
five-day
course

1294

4919

135

improved,
ment/no

cefotaxime

0.02

4524

when

antibiotic

details
and microbiologic
findings
in all patients
shown
in Table
1 All patients
except
one (patient
had hospital-acquired
chest
infection.
As shown
2,

APACHEII

55

old.

Pharmaceutical

ceftriaxone

Table

ceftriaxone

Continu-

t test

a difference

hypothesis

RES

There

Class2

The

Ethics
This

23

Table

demographic

response.

unpaired

analyses
as

null

for

microbiologic

using

two-tailed,

as the original

not worse

and

x2 test.

were

For

13

Class3

treatment,

blind.

were

Ofl

newer
the

it revealed

analyses
512)

the
that

performed

was

statistical

than

spectrum

were

permitted

specific

(StatView

was
data

II)

worse
its

that

The

completed

co)nlpared

the

of significance
so)ught.

NS
NS

of illness
4

positive-pressure

of the

not
on

surmise

program
the

response

were

one-tailed,

22

16/10

TISS

SE).

The

26

52

19/6

*Values

were

hypthesis

considered

(Framework

were

program

Macintosh

not

the

This

revie#{231}and
analyses

was

statistical

it was

showing

null
(based

in efficacy).

program

column

final

regimen

pathogens

the

cefotaxime

and

Vectra).

checking,

the

no

ceftriaxone,

antibiotic,

he equivalent

(hewlett-Packard
of the

analyses,

antibiotic,

and

all data

that

Analysis

purposes

was

letion

or

M/F

difference

previously

using

as 3, indicating

or Sul)sequentl);

the

was

ofa

persistence

unavailable.

Hypothesis

0)115

antibiotic

concomitantly

patient.

Not

no other
given

the

of resistance

Failure

individual

after

that
were

2A indicating

presence

occurrence

supennfection.

study

1A indicating
antibiotics

coded

pathogen(s),

culture,

as 1 , with
that

above).

Failure
initial

lB

25

Class

assessable.
was

Cefotaxime

55 19

Age, yr
Severity

as cure,

Details5

Ceftriaxone

Number

15 (67

percent.

classified

ofPatient

best

possible

10 of

2-Comparison

Table
to

if all five

patient,

would

were

patient

Thus,

individual

change

be

be score

scores

individual

as a percentage.
in any

l)e 5 of 15 (33 percent)

improvement

deterioration

The

score

assessable

15 (100

O)f

response).
possible

Change

(sensitivity)

Change

(failure)

Died

Ceftnaxone

vs Cefotaxime

Downloaded from chestjournal.chestpubs.org by guest on April 13, 2012

1989 American College of Chest Physicians

in Chest

Infections

(Reeies

at a!)

Table

Response

4-Clinical
Ceftriaxone

Global

score,

Improved

Cefotaxime

62 20

(33-66%)

12

p Value

55 13

(48%)

Worse

0.07

No other
0.04

Other

the

findings

two
in Table

comparison
initial

cultures

appeared
were
but

comparable
(Table
identified

groups

were

taxime,
icant

but

this

patients
(29
Twenty-eight

ceftriaxone

after
cally

cefotaxime,
significant

the

was

not

two

1,

in Table
isolated

percent)

and

treatment

the

statistically

signif-

from

15

(57

8/14

6). Of
cure

after

superinfection

after

cefotaxime

occurred

ceftriaxone
(p

vs

4/22

(18

DISCuSSIoN

The

initial,

empiric

in

many

would

unless

other

the

choice

of

seriously

favor

ill

or institution
we have

dictated
often
used

purpose

for

years

several
5-initial

Pathogen

with

in
difficult,

chest
but

cephalosporin,

related

patient
others,2

Table

antibiotic

is often

a third-generation

considerations

to the
differently.5
cefotaxime

generally

Microbiologic

individual
Like
for this
satisfactory

Findings5

Spipgenes

it

Spneumoniae

it
it

Saureus
S aures(R)

it

2t

it

MRSA(R)

2 (it)

H influenzae

it

2t

Ecoli

it

Ecloacae

Pmirabilis

2t

Smarcescens

2 (it)
It

P aeruginosa(R)

*Mic,.rgjisms
indicated
tClearance

initially

resistant

Not

to ceftriaxone

pathogen

on subsequent

treatment

assessable

*Fail,,re

11

occurred

with

and

more

than

2 receiving

OflC (3)de

i2

in 7 patients

(5 receiving

cefotaxiine).

Ceftriaxone,

with

its

but

longer

half-life,79

spectrum78
to

offer

much

some

advantages

efficacy
would
and convenience
These
a large

body

ceftriaxone
ofa wide

or cefotaxime

culture.

similar

over

be expected
more

theoretical

would

seem

cefotaxime,

in

that

to be comparable

but

cost

1215

considerations

ofclinical

antimicrobial

data,

is an effective
variety
ofinfections,

are

which
antibiotic

supported

by

has confirmed

that

in the treatment
including
respiratory
in

lower respiratory
tract infections.#{176}37 In these
reports,
comparability
of the two antibiotics
both clinically
and
studies

possible
risk ofa

has
have

regularly

in fact

difference
beta error

been

been

too

found,
small

with confidence.
in small studies

although

to exclude

This
greatly

the

strength
of the available
literature
However,
it was perhaps
unexpected
present
study
that ceftriaxone
was

in this

area.

to find

not

significant
diminishes
in the

clinically

as

effective
percent,

as cefotaxime
(clinical
response
48 vs 73
p=O.Ol;
premature
clinical
failure
29 vs 4

percent,
ceftriaxone

rejected.

The

clearance

0.01)
and that the null hypothesis
was not worse
than cefotaxime
had
trend

for ceftriaxone

to be less

applied
also
to
57 percent
cure,

of initial

pathogens),

the
50

although

The

diagnosis

of

bacterial

that

to be

effective

microbiologic
vs 79 percent
these

ences
were
not statistically
significant,
because
of few numbers,
only 55 percent
being
microbiologically
evaluable.

differ-

presumably
of patients

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

it

by (R).
of initial

during

than
cefotaxime
response
(36 vs

Cefotaxime

Ceftriaxone

K pneumoniae
Eaerogenes

pathogen

Superinfection

all

infections

resistant

microbiologically

0.08).

tract
infections.m
In addition,
specific
comparison
has been
made
of ceftriaxone
with
cefotaxime
several
small studies
in various
infections,
including

percent)

but this difference

was not statisti(p = 0. 13). In patients
microbiologipercent)

Resistance

results.

initial

after
cefafter cefo-

isolated

with

of initial

pathogen

ceftriaxone

at the completion
of the study.
(55 percent)
were
thus micro-

compared

3
antibiotic

tract
flora
(31 percent)
Of

were

at completion,

(36

percent)

(41

percent)
were
cleared
with 1 1/14 (79 percent)

difference

Table

groups
were

pathogens.

Pathogens

evaluable
8/22

in

evaluable
(14 in each group)
(Table
(36 percent)
showed
a microbiologic

after

in

as

percent)
patients

biologically
these,
5/14

patients

between

(50

0.07).

21

classified

5/10
compared
(p

shown

5). Mixed
upper
respiratory
in a further
16 patients

not

pathogens,
triaxone

cally

in

Cefotaxime

Failure

treatment
6. Pathogens

of the

5 and the responses

from

are

Ceftriaxone

antibiotic

concomitant

Persistence

microbiologic

Response5

Cure

Initial

The

6-Microbiologic

Response

19 (73%)

Nochange(67%)
(68-100%)

Table

clinically
intention

are

relevant
to treat

when
analyzed
on the basis
than when
analyzed
solely
on

of
the

basis of culture
results.
The latter
have been
considered
of importance
chiefly
in demonstrating
comparability
between
treatment
groups
and in providing
information

to supplement
CHEST

the

clinical

assessment.

I 96 I 6 I DECEMBER,

Downloaded from chestjournal.chestpubs.org by guest on April 13, 2012

1989 American College of Chest Physicians

1989

1295

The

reasons

for

the

difference

between

the

antibiotics
are not immediately
apparent.
result
could
be a chance
finding,
although
nature

of statistical

analysis

bility on this, and

(ie, conventionally
that

the

result

to put

the present
statistically

is due

a numerical

Second,

matching

showed

the

two

groups

appeared
documented

to be comparable
criteria,
except

with
that

respect
those

fotaxime
illness

were
grading)

difference
favor

of the

not

ill (based
receiving

if real,

be

latter

reflected
related

grading.

to the

Third,

metabolite

it

thought

imprecision
is possible

parent

molecule

the two
mended

it is possible

single

that

daily
daily
trials

Fourth,

in

dose

clinical

although

the

setting

of

of ceftriaxone
dose

would

once-

and

twice-daily

shown
similar
efficacy
and pharmacokinetic

be

more

nia:

It

thus

present

Am

most
are

setting
These

and

9 Wise

tissue

of serious

10

have

ii

results

of

the

be

related

to

the

study

failure

rate

trolled
treated

assessment
of lower
respiratory
tract infection
with
ceftriaxone
once
daily.#{176}Formal
confir-

mation
is thus
It

dose

confined

concluded
dose

of chest

conclusion,
other
triaxone

reminder
ceptibility
ommendations
especially

may

that,
and
in the

in

recorded

by further

which

in an

15

less

satisfactory

of 6 g daily

infections

than

for

the

17

in the

does

in

which

be

appropriate,

not

a single

daily
but

for antibiotics,

seriously

it

extrapolation

daily

dose
is

pharmacokinetic
data
to dosage
needs
to be confirmed
by clinical
seriously

ill.

19

man.

Am

Scully

Med

BE,

Fu

after

intravenous

Med

1984;

1988:

20

DJ,

21

medicine.

PR,

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In:

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1984:577-79
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1982;

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77(4C):3-ii

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A comparison
1983;

phar-

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moxalactam

and

and
cefotaxime.

2:505-08

SA.

Pharmacokinetic

1984;

77(4C):17-25

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and

2:140-43

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Neu

HC.

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Nazarian

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PB.

Courier

1987;

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Pharmacokinetics

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in

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intramuscular

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ME

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1296

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is

13

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Comparison of ceftriaxone with cefotaxime in serious chest infections.

J H Reeves, G M Russell, J F Cade and M McDonald
Chest 1989;96; 1292-1297
DOI 10.1378/chest.96.6.1292
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1989 American College of Chest Physicians