Background: Urinary tract infection (UTI) is one of the most common bacterial diseases in children and antibiotic treatment is usually started empirically (cefexime, trimethoprim-sulfamethoxazole or ceftriaxone) before urine culture results are available. Unfortunately, antibiotic resistance has become an increasingly critical problem in many countries like Iran. The high resistance rate seems to be result of widespread antibiotic usage of families even in the absence of prescription.Methods: We evaluated 115 urine culture of patients 2 months to 12 years old with fever and suspected UTI (outpatient or hospitalized). Urine culture was obtained with catheter or suprapubic in patients under two years old and midstream in older than 2 years. Disk diffusion method was used for antibiotic susceptibility. All E. coli isolates were microbiologically identified and minimum inhibitory concentrations (MIC) of selected antimicrobial agents of different classes against E. coli isolates were determined.Findings: In this study most frequency isolated pathogen was E-coli 100/115 (87%). Twenty three patients out of 100 (23%) were admitted with primary diagnosis of pyelonephritis and 77 patients (77%) were outpatients. The total frequency of resistance rates against ceftriaxone and cefexim was 45% and 46% respectively and resistance to trimethoprim-sulfamethoxazole was seen in 88%.Conclusion: Cephalosporins are most common and favorite antimicrobial agents for the empirical treatment of UTI, but results of this study showed alarmingly high proportionsof resistance to them. There is much evidence suggesting a relationship between prescribing habits and antibiotic resistance.

Background: A 57-year-old Iranian woman with a 4-day history of fever, malaise, and disorientation is presented. Signs of meningeal irritation were evident on examination. The patient’s medical history was remarkable for diabetes mellitus, and hypertension with several admissions to hospital. Ampicilin, ceftriaxon, and vancomycin were administered for possible bacterial meningitis. A brain CT scan without contrast was unremarkable. Analysis of CSF revealed compatible values for bacterial meningitis. Culture of urine and CSF samples led to isolation of E. coli. The patient's clinical condition showed no improvement after 3 days. Four days following hospitalization, re-culture of CSF sample again produced positive result for E. coli. Using disk diffusion method, the isolate was found to be resistant to ceftriaxone and imipenem but sensitive to ciprofloxacin. Ceftriaxone was replaced by IV ciprofloxacin plus ceftazidime. The results of repeated analyses of CSF were indicative of clinical improvement with negative result for CSF culture. Ciprofloxacin and ceftazidime were continued for a total of 21 days. The patient remained asymptomatic with no recurrence.

Objective: Ceftriaxone is a third-generation cephalosporin which is widely used for treatment of infection in children accompanied by complications like urinary tract lithiasis and gallbladder psudolithiasis or sludge. The aim of this study was to investigate the incidence and predisposing factors that contribute to these complications in children.Methods: This quasi-experimental and before- and after-study was conducted in 96 children who were hospitalized for treatment of different bacterial infections and received 50-100 mg/kg/day ceftriaxone divided into two equal doses intravenously under conditions of adequate hydration. Sonographic examinations of urinary tract and gallbladder were carried out before and after treatment for that purpose. Patients with positive sonographic findings after treatment were followed with serial sonographic examinations.Findings: Post-treatment sonography demonstrated nephrolithiasis in 6 (6.3%) and gallbladder stone in one (1%), all were asymptomatic. Comparison of the groups with and without nephrolithiasis demonstrated no significant differences with respect to age, body weight, diagnosis, season of hospitalization, dosage of drug and the duration of treatment. Nephrolithiasis had a significant relation with male gender (P=0.02).Conclusion: Our results showed that pediatric patients may develop small sized, asymptomatic renal stones during a 2-6 day course of normal or moderate dose of ceftriaxone therapy. Close monitoring of ceftriaxone treated patients especially on high dose long term therapy for nephrolithiasis and gallbladder psudolithiasis or sludge is recommended.

Background: Ceftriaxone is a prolonged third-generation cephalosporin and its intramuscular single dose can provide the necessary serum level against typical pathogens of acute otitis media up to 72 hours. Methods: In a prospective, randomized clinical trial study, the efficacy of intramuscular single dose of ceftriaxone (50mg/kg/dose) was compared to 10 days amoxicillin (50mg/kg/day, divided 3 time per day) to treat acute otitis media in children. A total of 110 children aged 5 months to 12 years, with uncomplicated acute otitis media were randomly selected to receive either an oral suspension amoxicillin for 10 days or an intramuscular single dose of ceftriaxone. Results: Clinical manifestation and demographic characteristics were similar in both groups. In ceftriaxone group, 48 (88.9%) of 54 cases were recovered completely, and in amoxicilline group, the treatment was successful in 51 (99.1%) of 56 cases (p>0.05). In ceftriaxone, 2 cases and in amoxicilline group, 3 cases developed a skin rash (p>0.05).Conclusion: The efficacy of intramuscular single dose of ceftriaxone (50mg/kg) to treat uncomplicated acute otitis media in children is as effective as amoxicillin (50mg/kg/day, divided 3 times per day).

Background: Extended-Spectrum b-lactamases (ESBLs) are plasmid-mediated enzymes that hydrolyze the oxyimino β-lactam substance such as third-generation Cephalosporins (Ceftazidim, Ceftriaxone, Cefotaxime). Presence of ESBL-producing organisms results in decrease in efficacy of extended-spectrum Cephalosporines in treatment of serious clinical infections caused by these organisms. So the treatment options are limited and failure treatment and antibiotic resistance are the consequence of inadequate options.Materials and Methods: A total of 160 isolates of Escherichia coli were collected from clinical samples of three hospitals in Tehran. MICs for Ceftriaxone, Ceftazidim and Cefepime were determined by standard agar dilution method. A MIC above 1 mg/L to any of these three was subjected to confirmatory testing as per CLSI method.Results: Primary phenotypic tests revealed that 56.68% (n=89) of E.coli isolates produced extended-spectrum beta-lactamases. Using of clavulanic acid in confirmatory tests, ESBL production was confirmed in 96.7% (n=86) of isolates with primary positive phenotype. The presence of an ESBL was not confirmed in 3.3% (n=3) of the screen positive isolates.Conclusion: This study showed that ESBL productions in clinical isolates of E. coli in Tehran city's university hospitals were extremely high and it is suggested detection of ESBLs as routine tests in order to increase the effectiveness of treatment.

Escherichia coli is one of the most common pathogens in poultry that causes Colibasilosis. Until now many Extended-spectrum beta-lactamases (ESBLs) were identified that we can refer to SHV and OXA that they are coded by blaSHV and blaOXA, respectively. Regarding the development of antibiotics resistance and harmful effects of resistant bacteria on beta-lactam antibiotics, they can have an effect on human health and animal health, and due to the high mortality rate of disease, reducing production, as well as damage caused by drug use, it’s very important to control and prevention this disease. In the present study, 50 isolates of Escherichia coli were collected from 60 cloacal swabs from broiler chicken farms between 7 to 21 days old in Zabol. Antibiogram test was performed by disk diffusion method to investigate drug resistance to Ceftriaxon, Cefazolin, Ceftizoxime, Cephalothin, Ceftazidime and Cefixime. Besides, the frequency of blaSHV and blaOXA were investigated by PCR. The results showed that the highest resistance was to Cefazolin (80%) and the lowest resistance was to Ceftriaxon (8%). The frequency of blaSHV and blaOXA genes in Escherichia coli isolates was 24% and 0.0%, respectively.

Introduction: Acute pyelonephritis is one of the bacterial infections which is treated through injection drugs. As, using IV antibiotics has a lot of expense, thus this study was performed to compare the treatment efficacy of two regimens. IV and oral regimen and alternating oral instead of IV treatment. Materials and Methods: This clinical trial study was carried out on 54 patients \vith acute pyelonephritis without any complication in Fatemieh hospital from Aug.2002. Randomly each patient was prescribed one of the two regimes: oral ciprofloxacin (Regimen I) and IV Ceftriaxon (Regimen II). Seven patients from Regimes I, due to the incomplete treatment with the given medicine were set aside. And the rest of the cases, 24 , 48 and 72 hours after beginning the treatment were checked for disappearing or continuing the fever and clinical symptoms. Chisqure and t tests were used in the meaningful level of 5% to analyse the data.Results: Age mean and standard deviation for regimen. one were 50.40 ± 18.7 and for II 33.2± 22.4, showing no meaningful difference statistically. Both regimens were homogeneous from gender distribution. Response to treatment was 95% and 100%; respectively and showing no meaningful difference statistically. But the duration response mean (standard divination) to treatment in both regimen were 2.67 ± 0.49 days and 1.6 ± 0.63 ; respectively. And having meaningful difference statistically (P=0.000).Conclusion: This study showing that oral ciprot1oxacin is as effective as IV ceftriaxon, however, the response speed to treatment has been less.

Emphysematous cystitis is defined by the presence of gas in the urinary bladder wall. It complicates urinary tract infections especially in adults and diabetic women. It is also associated with neuropathic bladders, bladder outlet obstruction, in-dwelling urinary catheters, chronic urinary tract infections and immunosuppression.This report is a 71 year-old man that was presented with frequency, dysuria, fever and abdominal pain.We diagnosed emphysematous cystitis, during the work up. E-coli were isolated. He was empirically treated with ceftriaxon and based on the sensitivities of culture; he was treated at home using ciprofloxacin.

Background and Objective: Urinary tract infection (UTI) is one of the most common bacterial infections in the childhood which could result in chronic renal failure and hypertension. Antibiotic resistance is increasing due to widely using of antibiotics. The aim of this study was to determine the MIC of antibiotics which are using in the treatment of UTI in children by E-test.Materials and Methods: In this descriptive study, 87 E.coli strains were isolated from the urine samples of the patients with UTI. E.coli antimicrobial susceptibility was determined using E-test. The MIC for each antibiotic was determined and classified using NCCLS criteria.Results: Eighty seven urine samples were collected from 57 girls (65.5%) and 30 boys (34.5%). The mean age for girls was 61 months and for boys was 41 months (p=0.015). The MIC (50 and 90 percentiles) for each antibiotic was as fallow: Ampicillin (256, 256), Amikacin (1/5, 4/8), Gentamycin (0.38, 32), Nalidixic Acid (1/5, 256), Ceftriaxon (0.023, 32), Cefixim (0.19, 256) and Trimethoprim-Sulfamethoxazole (32, 32). The antibiotic susceptibility rate for each antibiotic was as fallow: Ampicillin (21.8%), Amikacin (92%), Gentamycin (75.5%), Nalidixic Acid (64/4%), Ceftriaxon (72/4%), Cefixim (65/5%) and Trimethoprim- Sulfamethoxazole (41/4%).Conclusion: This study showed that the antibiotic resistance of E.coli was very high. Due to increasing rate of E.coli resistance to Ampicillin and Cotrimoxasole in children, it is better to reconsider the empirical therapy with these antibiotics. Since in this study a lower resistance rate of E.coli was observed for Amikacin and Gentamycin therefore, we could suggest these antibiotics as alternatives in the treatment of children with urinary tract infection.