" No data available.

Abbreviations'. +, mild to moderate effect, increase or decrease 2^4-loglO cfu/g feces; + +, strong impact >41ogl0 cfu/g feces; —, no significant changes; d, the detection limit; n.e., not examined.

" No data available.

Abbreviations'. +, mild to moderate effect, increase or decrease 2^4-loglO cfu/g feces; + +, strong impact >41ogl0 cfu/g feces; —, no significant changes; d, the detection limit; n.e., not examined.


Cefotaxime is excreted in bile to a lesser extent than cefoperazone and the effects on the intestinal microbiota are usually more moderate. The numbers of enterobacteria are suppressed and overgrowth of Pseudomonas species and occasionally of enterococci have been observed (33,40,41).


Cefotiam has been shown to decrease the numbers of intestinal enterobacteria and lactobacilli and to increase the numbers of Pseudomonas and Candida species (37).


Pronounced changes in the gastrointestinal microbiota have been shown to occur after cefoxitin prophylaxis of patients undergoing colorectal surgery (42) and in hospitalized male patients (43). In both studies the major changes observed were decreased numbers of enterobacteria and Gram-negative anaerobic species, while there was a proliferation of resistant enterococci and enterobacteria. Growth of C. difficile was found in 5 of 6 hospitalized patients (43).


In patients receiving prophylactic antimicrobial treatment after gastrointestinal surgery, cefozopran induced decreased numbers of enterobacteria, streptococci, Veillonella and Lactobacillus species and overgrowth of enterococci (34).


Administration of cefpirome to healthy male volunteers suppressed the numbers of E. coli below the detection limit (44). No other major changes were observed.

Ceftazidime and Ceftizoxime

The impact of a single dose of ceftazidime or ceftizoxime on the intestinal microbiota has been investigated in healthy volunteers (37). Ceftazidime significantly reduced the numbers of enterobacteria and lactobacilli. The number of enterobacteria was suppressed also by administration of ceftizoxime, and resistant enterobacteria like Citrobacter and Proteus species proliferated.

Ceftriaxone and Ceftriaxone/Loracarbef

Ceftriaxone is, as well as cefoperazone, to a large extent excreted biliary and the agent induced marked changes in the intestinal microbiota (40,45-49). Ceftriaxone has been shown to give rise to elimination or strong suppression of the numbers of Gram-negative aerobic rods, reduced numbers of streptococci and staphylococci and also to reduced numbers of anaerobic microorganisms. Overgrowth of species resistant to ceftriaxone like enterococci and Candida species is common.

The ecological effect of ceftriaxone has been compared with a step-down therapy of ceftriaxone followed by loracarbef in patients with community-acquired pneumonia (49).

Both the aerobic and the anaerobic microbiota were affected in a similar way as with ceftriaxone only, although the reduction of enterobacteria occurred to a lesser extent.

Flomoxef or Moxalactam

Changes in intestinal microbiota have been investigated after administration of flomoxef to patients undergoing gastrectomy (34). The effect on the aerobic microbiota was mainly detected as decreased numbers of streptococci and overgrowth of enterococci. Anaerobic Gram-positive rods and cocci as well as Gram-negative cocci were suppressed.

In an earlier study, the effect of a single dose of moxalactam was compared with a three-dose prophylaxis (50). In both groups of patients there was a reduction in the numbers of enterobacteria and streptococci while enterococci proliferated. Several anaerobic species decreased significantly in connection with the administration.

Pregnancy And Childbirth

Pregnancy And Childbirth

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