Studies on the effects of perorally administered cephalosporins are summarized in Table 3.
Alterations in the intestinal microbiota during administration of cefaclor have been studied in patients (19) and in healthy volunteers (51,52). In the microbiota of patients there were reduced numbers of both aerobic and anaerobic Gram-positive cocci. Enterococci, enterobacteria and Bacteroides species increased and there were also increased numbers of Candida albicans. In healthy subjects only minor changes occurred in the anaerobic microbiota.
Reduced numbers of intestinal viridans streptococci have been observed during administration of cefadroxil in adult healthy subjects (5). In infants being treated for infections, disturbances were restricted to the anaerobic microbiota with reduced numbers of bifidobacteria and bacteroides (7).
Cefetamet has a broad spectrum of activity against both aerobic Gram-positive and Gramnegative microorganisms. The modification on the intestinal microbiota during treatment of patients has, however, been shown to be slight and nonsignificant (53).
The ecological effects on the intestinal microbiota of cefixime have been investigated in healthy volunteers (51,54) and in patients with exacerbation of chronic bronchitis (53). In all three studies, disturbances were observed in the aerobic microbiota as reduced numbers of enterobacteria and increased numbers of enterococci. Growth of C. difficile was common in all studies while the impact on the anaerobic microbiota varied between the studies, from reduced numbers of clostridia to reductions of several species including bacteroides.
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