cefamandole and Abscess

Topics: Abdomen; Abdominal Injuries; Abscess; Amikacin; Animals; Bacterial Infections; Carbenicillin; Cefamandole; Cefoxitin; Chloramphenicol; Clindamycin; Clinical Trials as Topic; Humans; Metronidazole; Rats; Ticarcillin

Topics: Abscess; Adolescent; Adult; Anti-Bacterial Agents; Cefamandole; Cesarean Section; Drug Therapy, Combination; Female; Gentamicins; Humans; Parametritis; Penicillins; Postoperative Complications; Pregnancy; Preoperative Care; Puerperal Infection

We compared the effects of single dose (750 milligrams) prophylactic cefamandole delivered directly into the operative wound with local anesthesia (n = 162) with a control group (no antibiotics) (n = 162) in a randomized trial. No adverse effects were observed. There were seven wound abscesses in the untreated group compared with none in the group receiving antibiotic prophylaxis (p = 0.007). Six of the seven abscesses occurred as late as one month after the patient was discharged from the hospital. The costs of antibiotics used were ten times less than the costs of treatment of wound complications in the control group.

Topics: Abscess; Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Cefamandole; Child; Combined Modality Therapy; Drug Costs; Drug Therapy, Combination; Female; Follow-Up Studies; France; Hernia, Inguinal; Humans; Length of Stay; Lidocaine; Male; Middle Aged; Prevalence; Surgical Wound Infection; Surveys and Questionnaires

Postoperative infection accounts for significant morbidity and mortality following penetrating abdominal trauma. During a 2 1/2-year period, December 1980 through June 1983, 257 patients sustaining penetrating abdominal injury were initially treated at Parkland Memorial Hospital in Dallas. Following the patient's written consent, they were prospectively randomized to receive, prior to surgery, intravenous clindamycin 600 mg every 6 hours and tobramycin 1.2 mg/kg every 6 hours (CT), or cefamandole 1 gm every 4 hours (M), or cefoxitin 1 gm every 4 hours (C). The antibiotics were continued for 48 hours. Major organ injuries in the three groups were comparable. The overall infection rate was significantly less in the cefoxitin group (13%), compared to cefamandole at 29%, and was comparable to the combination of clindamycin/tobramycin at 20%. The most significant difference followed colon injury. There were 96 patients who sustained colon injuries and the infection rate was CT 33%, M 62%, and C 19% (p = 0.002). If nonoperative wound infections were excluded from the colon group and only severe infections were evaluated, the infection rate was CT 18%, M 38%, and C 13% (p = 0.021). The infection rate was higher in the shock patients and tended to increase as age increased. Enterococcus, Escherichia coli, and Klebsiella pneumoniae were the most frequent aerobes isolated along with anaerobes. Five of six Bacteroides isolates from major infections occurred in the cefamandole group; two of which were in bacteremic patients. The hospital stay corresponded with infection rates, being 11.4 days (CT), 13.1 days (M), and 9.4 days (C). The results of this study indicate that cefoxitin is comparable to the combination of clindamycin/tobramycin and superior to cefamandole when used before surgery in patients sustaining penetrating abdominal trauma. The study suggests that antibiotic coverage should be against aerobes and anaerobes. Routine administration of an aminoglycoside is unnecessary.

Topics: Abdominal Injuries; Abscess; Adolescent; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Cefamandole; Cefoxitin; Clindamycin; Colostomy; Drug Therapy, Combination; Humans; Ileostomy; Middle Aged; Premedication; Prospective Studies; Random Allocation; Tobramycin; Wound Infection; Wounds, Gunshot; Wounds, Stab

From 1979 through 1981, 152 patients with penetrating injuries of the intra-abdominal gastrointestinal tract were placed on one of three different perioperative antibiotic regimens in a prospective randomized fashion. The three regimens were A) cefamandole 2 grams every 4 hours, B) cefoxitin 2 grams every 6 hours, and C) ticarcillin 3 grams every 4 hours and tobramycin 1.5 mg/kg every 8 hours. Antibiotics were administered intravenously before and for 48 hours following surgical exploration and repair. The three treatment groups were similar with respect to age, average number of organ injuries, and distribution of organ injuries. Cefoxitin-treated patients experienced uneventful recoveries more often than cefamandole-treated patients (94% vs. 80.3%, p less than 0.05) when the incidence of gram-negative wound infection and intra-abdominal abscess formation was considered, while the number of patients who experienced uneventful recoveries in the ticarcillin-tobramycin group was not statistically different from the other two groups of patients. Bacteroides fragilis was isolated from three of the six abscesses occurring in the cefamandole-treated group, while no anaerobes were isolated from abscesses in patients treated with either of the other two regimens. The results of this study suggest that the most effective perioperative antibiotic regimen for patients with penetrating gastrointestinal wounds should possess activity against both aerobic and anaerobic flora of the bowel.

Topics: Abdomen; Abdominal Injuries; Abscess; Adult; Anti-Bacterial Agents; Cefamandole; Cefoxitin; Clinical Trials as Topic; Female; Humans; Male; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection; Ticarcillin; Tobramycin; Wounds, Penetrating

Topics: Abdomen; Abdominal Injuries; Abscess; Amikacin; Animals; Bacterial Infections; Carbenicillin; Cefamandole; Cefoxitin; Chloramphenicol; Clindamycin; Clinical Trials as Topic; Humans; Metronidazole; Rats; Ticarcillin

Cefamandole, a new antibiotic with various characteristics was applied clinically in the field of obstetrics and gynecology, and following results were obtained. Cefamandole was administered to 8 cases with cystitis, 2 cases with pelvic infection. The organisms isolated were 5 cases of Escherichia coli, 4 cases of Staphylococcus epidermidis and one case of Klebsiella. Bacteria disappeared in all cases after 5-day treatment with cefamandole. No side effects of the drug were noticed throughout all cases. From the above mentioned clinical experience, cefamandole is considered to be a useful drug for clinical application.

Topics: Abscess; Acute Disease; Adolescent; Adult; Cefamandole; Cephalosporins; Clinical Trials as Topic; Cystitis; Female; Humans; Male; Middle Aged; Peritonitis; Vaginal Diseases

Topics: Abscess; Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Skin Diseases, Infectious; Wound Infection

126 children (aged 3-14 years) with severe purulent-inflammatory maxillofacial lesions underwent complex treatment: lymhotropic method of antibiotic (cefamabol) therapy was used in 64 of them. Clinical, microbiological and pharmacokinetic investigations have shown the method of lymphotropic regional antibiotic therapy to be effective and feasible to treat purulent-inflammatory maxillofacial lesions in children.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Cefamandole; Cellulitis; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Injections, Subcutaneous; Jaw Diseases; Male; Suppuration; Treatment Outcome

Cefamandole, cefoxitin, cefotetan, ceftizoxime, imipenem plus cilastatin, and ampicillin plus sulbactam were compared in the eradication of subcutaneous abscess in mice caused by Bacteroides fragilis group organisms and Escherichia coli alone or in combination. The abscesses were examined 5 d after inoculation. B. fragilis group reached log10.1-11.0 organisms per abscess and E. coli log11.6-12.5. Imipenem plus cilastatin significantly reduced (in 6.9-10.6 logs) the number of E. coli and all members of B. fragilis group alone or in all combinations. Ampicillin plus sulbactam reduced the numbers of all B. fragilis group (in 4.2-7.2 logs) but was less effective against E. coli (reduction of 1.8-4.2 logs). Cefoxitin was effective in significantly reducing (in 4.9-6.2 logs) the number of E. coli and all members of B. fragilis group alone or in all combinations. Cefotetan was effective against B. fragilis (reduction of 5.1-6.6 logs) and E. coli alone or in combination but did not reduce the number of Bacteroides thetaiotaomicron, Bacteroides vulgatus, and Bacteroides ovatus. Ceftizoxime was effective against only B. ovatus (reduction of 3.7-5.8) and E. coli (reduction of 6.0-8.1 logs); it did not reduce the number of other organisms. Cefamandole was effective against only E. coli and was not effective against any member of the B. fragilis group. These in vivo data confirm the in vitro activity of these antimicrobials.

Topics: Abscess; Ampicillin; Animals; Anti-Bacterial Agents; Bacteroides fragilis; Bacteroides Infections; Cefamandole; Cefotetan; Cefoxitin; Ceftizoxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Disease Models, Animal; Drug Combinations; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Imipenem; Male; Mice; Skin Diseases; Sulbactam

Hemorrhagic shock increases the susceptibility to infection in both clinical and laboratory settings. Hemorrhagic shock also is associated with a decreased production of interferon-gamma (IFN-gamma), a potent modulator of immune function. We investigated the effect of IFN-gamma both alone and in addition to antibiotic prophylaxis upon infection following hemorrhagic shock. Sprague-Dawley rats were bled to a mean arterial pressure of 45 mm Hg for 45 min and then were resuscitated with shed blood and normal saline. Abscess formation was induced 1 hr later by subcutaneous injection of 1 X 10(8) Staphylococcus aureus. Four treatments were investigated: (1) control; (2) recombinant rat IFN-gamma, 7500 units, 30 min after inoculation and daily for 3 days; (3) cefamandole (CEF) nafate, 30 mg/kg, 30 min before and 4 hr after inoculation; and (4) IFN-gamma + CEF as in (2) and (3). Abscess size, weight, and quantitative bacterial counts were measured 7 days after inoculation. Hemorrhagic shock increased mean abscess size from 11.7 +/- 2.8 to 14.1 +/- 1.9 mm (P less than 0.05), in untreated rats. IFN-gamma alone resulted in minor changes in abscess formation in both shocked and unshocked animals. Shock rendered CEF ineffective in reducing abscess size. IFN-gamma + CEF significantly reduced abscess size (14.1 +/- 1.9 to 8.1 +/- 1.8 mm) and weight (771 +/- 214 to 252 +/- 132 mg) and decreased bacterial count after shock to 12% of control (all P less than 0.05). These data demonstrate that hemorrhagic shock impairs antibiotic efficacy; however, the addition of IFN-gamma restores the ability of host defenses to combat bacterial infection.

Topics: Abscess; Animals; Cefamandole; Immunity; Interferon-gamma; Shock, Hemorrhagic; Staphylococcal Infections

Hemophilus aphrophilus is an uncommon pathogen in man. It has rarely been reported as a cause of meningitis, exclusively in boys three years or younger. Osteomyelitis due to this organism is also rare. H. aphrophilus was responsible for meningitis, probable thoracic empyema, and ultimately vertebral osteomyelitis and suppurative psoas abscess formation in a woman following metrizamide myelography. The patient responded well to antibiotic treatment and surgical drainage. The organism was sensitive not only to chloramphenicol but also to newer cephalosporin antibiotics.

Topics: Abscess; Aged; Ampicillin; Cefamandole; Child, Preschool; Chloramphenicol; Female; Humans; Infant; Lumbar Vertebrae; Male; Meningitis, Haemophilus; Osteomyelitis; Tomography, X-Ray Computed

Osteomyelitis of the pubic bone due to anaerobic bacteria has been reported infrequently, although an entity known as "sterile" osteitis pubis is common to the literature. We have described two cases of pubic osteomyelitis due to anaerobic bacteria, discussed two previously reported cases, and suggested that most cases of what has previously been termed sterile osteitis pubis may actually have been due to anaerobic bacteria that were not isolated because of deficiencies in collection, transport, and culture of clinical specimens. Included are the pathogenesis and an approach to the treatment of this entity.

Topics: Abscess; Adult; Aged; Bacteria, Anaerobic; Bacterial Infections; Bone Marrow; Carcinoma, Squamous Cell; Cefamandole; Clindamycin; Female; Humans; Osteomyelitis; Pubic Bone; Vulvar Neoplasms

Strains of Bacteroides fragilis group isolated from peritoneal pus were tested for susceptibility to cefalotin, cefamandole, cefoxitin, clindamycin and metronidazole. Clindamycin and metronidazole were found to display the lowest MIC and MBC values. The median serum level of these antimicrobials was 2-4 times as high as the MIC effective against 100% of strains. The most active cephalosporin was the cephamycin derivative cefoxitin that inhibited 98% of strains at 16 mg/l which corresponds with the usual median serum level achieved at commonly recommended treatment regimens. The MICs of 16 mg/l to cefalotin and cefamandole were found in 9.8% and 3.7% of strains, respectively. These findings are consistent with data reported in the literature. Attention is also centered on the mode of antimicrobial action, principles of bacterial resistance and on factors which are co-responsible for the therapeutic effectiveness of the antimicrobials studied.

Topics: Abscess; Bacteroides; Bacteroides Infections; beta-Lactamases; Cefamandole; Cefoxitin; Cephalosporins; Cephalothin; Clindamycin; Humans; Metronidazole; Peritoneal Diseases

The pharmacokinetic properties of 10 antimicrobial agents were examined in sterile and infected encapsulated subcutaneous abscesses in mice. The inoculum for sterile abscesses was autoclaved cecal contents; that for infected abscesses was autoclaved cecal contents combined with Bacteroides fragilis. The antimicrobial agents examined were rosaramicin, clindamycin, chloramphenicol, metronidazole, and six beta-lactam antibiotics. All antimicrobial agents entered abscesses, produced peak levels of biological activity that were somewhat delayed in comparison to serum levels, and were present in negligible levels 8 hr after administration. The highest concentration in abscesses was achieved with rosaramicin and clindamycin, with peak levels of 43%--63% of the peak serum level. Peak levels of other antimicrobial agents in sterile abscesses were 13%--27% of the peak serum level. Levels of biologically active during were significantly lower in infected abscesses than in sterile abscesses for antimicrobial agents that are inactivated by B. fragilis beta-lactamase.

Topics: Abscess; Animals; Bacteroides fragilis; Cefamandole; Cefoperazone; Cefoxitin; Cephalosporins; Cephalothin; Chloramphenicol; Clindamycin; Dose-Response Relationship, Drug; Lactams; Male; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Skin

In review of our data, 12 of 38 patients (31.5 percent) had adverse drug reactions, a somewhat bothersome factor. Disturbing side effects of leukopenia and pancytopenia were seen in two patients, respectively, who were receiving cefamandole 12 g/d. Other cephalosporins, including cephalothin and cefazolin, have been reported to cause leukopenia. Eosinophilia and elevations of alkaline phosphatase and SGOT levels were noted with other cephalosporins. We observed no adverse clinical reactions associated with these findings. Although our study was able to demonstrate the therapeutic effectiveness of cefamandole in the treatment of soft tissue and skeletal infections, it should be reemphasized that cefamandole should be used only as an alternative treatment for the penicillin-allergic patient. In reality, a first-generation cephalosporin should be used for gram-positive organisms if one is required in soft tissue infections.

Topics: Abscess; Adolescent; Adult; Aged; Arthritis, Infectious; Bacterial Infections; Bone Diseases; Cefamandole; Cellulitis; Cephalosporins; Female; Half-Life; Humans; Joint Diseases; Male; Middle Aged; Osteomyelitis

Four perforated capsules were implanted into the abdominal cavity of each of three rabbits. After 4 to 5 weeks, single doses of cefazolin (30 mg/kg) or cefamandole (90 mg/kg) were administered intramuscularly. Peak levels of the respective drugs in serum were 104 +/- 10 and 127 +/- 5 micrograms/ml (mean +/- standard error); corresponding peak levels in capsule fluid were 6.3 +/- 2.3 micrograms/ml. Sixteen weeks after implantation, 2 X 10(6) colony-forming units of a strain of Escherichia coli susceptible to cefazolin (minimum inhibitory concentration, 1.0 microgram/ml) and cefamandole (minimum inhibitory concentration, less than 0.125 microgram/ml) was introduced into each of the 12 capsules. Chronic infection was established in seven of the capsules. At 4 to 6 weeks after infection, cefazolin and cefamandole were again administered. Peak serum concentrations were 102 +/- 3.3 micrograms/ml for cefazolin and 148 +/- 6.7 micrograms/ml for cefamandole. Peak concentrations in noninfected capsules were 7.5 +/- 3.4 and 12.1 +/- 2.1 micrograms/ml, respectively, not statistically different from the first study (P greater than 0.2). However, peak concentrations in infected capsules (less than 0.3 microgram/ml) were strikingly lower than in uninfected capsules (P less than 0.002). In keeping with the latter finding, quantitative cultures of E. coli in the infected capsules remained unchanged. Administration of [14C]cefamandole indicated that low drug levels were a result of poor drug penetration rather than drug inactivation or binding. Lack of vascularity and capsule wall necrosis may be responsible for poor drug penetration.

Topics: Abdomen; Abscess; Animals; Cefamandole; Cefazolin; Cell Membrane Permeability; Cephalosporins; Chronic Disease; Escherichia coli Infections; Rabbits; Time Factors

Cefamandole nafate is a derivative of 7-aminocephalosporanic acid which has been shown to have good in vitro activity against aerobes traditionally susceptible to cephalosporins as well as many anaerobes, including B. fragilis. One hundred women with obstetric or gynecologic infections completed treatment with cefamandole: 53 had post-cesarean section infections: 24, acute pelvic inflammatory disease: 16, posthysterectomy cuff cellulitis/abscess; and seven, vulvar or abdominal wound abscess. Almost 90% of these women had either polymicrobial aerobic/anaerobic bacterial infections or an anaerobic infection alone. Ninety women responded to cefamandole alone; in 10 cases chloramphenicol was added, but in addition five of these women required surgical therapy for eradication of infection. Mild to severe phlebitis at the infusion site that responded to conservative therapy was demonstrated in 14 women. Of 312 bacterial isolates from these women, 89% were sensitive to cefamandole at 32 microgram/ml, an easily achievable serum level; 93% of anaerobic streptococci, the most common isolates, were sensitive at 32 microgram/ml. Also, 90% of all Bacteroides species were susceptible at 32 microgram/ml; 82% of B. fragilis were susceptible at this concentration. These data indicate that cefamandole is safe and effective for treatment of women with polymicrobial pelvic infections but that approximately 5% of these women will require surgical exploration in addition to antimicrobial administration.

Topics: Abscess; Acute Disease; Bacterial Infections; Bacteroides Infections; Cefamandole; Cellulitis; Cephalosporins; Cesarean Section; Clostridium Infections; Endometritis; Enterobacteriaceae Infections; Female; Genital Diseases, Female; Humans; Hysterectomy; Peptococcus; Peptostreptococcus; Peritonitis; Pregnancy; Streptococcal Infections; Surgical Wound Infection; Vulvitis