cefamandole and Acute-Disease

A total of 203 patients were randomized into a prospective trial to compare short (SC) versus long courses (LC) of systemic antibiotic for acute cholecystitis treated by early cholecystectomy. The initial pre-operative management was the same and all patients received 2 g of cefamandole intravenously just before operation. Two further doses of cefamandole 500 mg were given 6 and 12 h later for patients on SC while the antibiotic was continued at 500 mg at 6 h intervals for 7 days for patients on LC. Seven patients developed wound infection on SC compared with five patients with wound infection and an additional patient with a subphrenic abscess on LC (P greater than 0.05). Thrombophlebitis related to intravenous antibiotic injections was more common in patients on LC (P less than 0.05). Also, patients on LC had to stay statistically longer in hospital in order to complete the course of antibiotic (P less than 0.05). We therefore recommend a SC to be used, as it is more cost-effective and causes fewer complications.

Topics: Acute Disease; Aged; Cefamandole; Cholecystectomy; Cholecystitis; Combined Modality Therapy; Drug Administration Schedule; Female; Humans; Infection Control; Infections; Length of Stay; Male; Middle Aged; Premedication; Prospective Studies; Randomized Controlled Trials as Topic

Acute appendicitis continues as a medical challenge with newer approaches failing to improve diagnostic accuracy. The role of antibiotics in acute nonperforative appendicitis (NPA) remains unclear. In 175 patients studied at two hospitals, preoperative guidelines were used to exclude perforative appendicitis. Nevertheless, 14% of patients were found to have this condition. Surgeon's reports significantly underestimated the diagnosis when compared with the pathologists' reports. Antibiotic prophylaxis in 122 patients with NPA was studied prospectively comparing ceftizoxime (CTZ), cefamandole (CFM), and placebo (PLA). Ceftizoxime decreased the infection rate compared with PLA (0 vs. 8; P less than .01). Use of antibiotics (CTZ or CFM) resulted in decreased infections when compared with PLA (3 vs. 8; P less than .01) and fewer days of hospitalization (3.8 vs. 5.4 d, P less than .005). Analysis of infection risk factors showed no correlations except for failure to administer antibiotics and the finding of a gangrenous appendix. Operative culture results had no predictive value for either infection or pathogen identification. It is recommended that all patients undergoing surgery for NPA be given 1 d of antibiotic prophylaxis.

Topics: Acute Disease; Adolescent; Adult; Aged; Appendicitis; Ascitic Fluid; Bacterial Infections; Cefamandole; Ceftizoxime; Child; Clinical Trials as Topic; Diagnostic Errors; Double-Blind Method; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Random Allocation; Risk Factors

In a randomized comparative study, 113 patients were treated with cefoperazone or cefamandole for acute bacterial lower respiratory tract infections. Most patients had Streptococcus pneumoniae or Haemophilus influenzae infections, although five patients in the cefoperazone group had infections caused by other Gram-negative bacilli (two with Pseudomonas aeruginosa). The clinical responses and adverse effects were not significantly different between the two treatment groups. Satisfactory clinical responses occurred in 36/39 (92%) of evaluable patients in the cefoperazone group and 33/34 (97%) of evaluable patients treated with cefamandole. Two failures in the cefoperazone group were secondary to superinfection (Acinetobacter and Ps. aeruginosa). Bacteriological and symptomatic failure occurred in one patient with Ps. aeruginosa lung abscess treated with cefoperazone and in one patient with a polymicrobial empyema treated with cefamandole. The results of this study indicate that cefoperazone is safe and effective in the therapy of acute bacterial lower respiratory tract infections.

Topics: Acute Disease; Cefamandole; Cefoperazone; Cephalosporins; Humans; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections

In a prospective, randomized trial involving 11 patients, thoracic duct drainage failed to equal the immediate and reliable benefit gained by peritoneal dialysis in the treatment of severe alcoholic pancreatitis. Instead, patient management was perhaps even more complicated by such an approach.

Topics: Acute Disease; Alcoholism; Cefamandole; Clinical Trials as Topic; Drainage; Humans; Lymph; Pancreatitis; Peritoneal Dialysis; Prospective Studies; Random Allocation; Thoracic Duct

Topics: Acute Disease; Adult; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Clinical Trials as Topic; Female; Humans; Male; Respiratory Insufficiency

Topics: Acute Disease; Adult; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Female; Humans; Time Factors; Urinary Tract Infections

The authors question the need to give prophylactic antibiotics perioperatively in all cases of acute appendicitis without perforation to reduce the rate of wound infection. A retrospective study of 82 patients showed a wound infection rate of 4.8%; 3 of 53 patients who did not receive antibiotics had a wound infection compared with 1 of 29 patients who received antibiotics. A prospective double-blind clinical trial was performed comparing the results of perioperative administration of cefamandole and placebo. One of 21 patients who received the placebo had a wound infection; none of the 21 patients given cefamandole had infection. Thus, the authors conclude that, although reports in the literature suggest that antibiotics given perioperatively decrease the rate of wound infection in acute appendicitis without perforation, the incidence of such infection is too low to warrant routine administration. They suggest that such antibiotic use be reserved for those suspected of having more serious disease.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Cefamandole; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Humans; Premedication; Retrospective Studies; Surgical Wound Infection

A prospective, randomized, double-blind clinical study was performed to determined the efficacy of short-term (24 hr) perioperative antibiotics in preventing septic complications after emergency appendectomy for nonperforated appendicitis. The patients were stratified into three clinical arms: Group I (placebo, n = 45), Group II (cefamandole, n = 46) and Group III (cefamandole plus carbenicillin, n = 45). The three groups of patients were similar in regard to age, sex, duration of operation and pathologic classification of the appendix. The overall incidence of infection in the study was 5.1%. The infection rates in Groups II (2.2%) and III (0%) were significantly lower than Group I (placebo) (13.3%), (p less than 0.05). No difference was observed between cefamandole alone and cefamandole plus carbenicillin. Average postoperative hospital days per patient for each group was: Group I - 3.8 days; Group II - 2.9 days; Group III - 3.1 days. Cost analysis of hospitalization including cost of prophylactic antibiotics revealed a $247.99 per patient saving for Group II versus Group I and $95.53 for Group III versus Group I. Systemic prophylactic antibiotics can successfully reduce septic complications after appendectomy for nonperforated appendicitis, and a single drug (cefamandole) directed at the facultative pathogens is as effective as double drug therapy, which includes specific anaerobic coverage.

Topics: Acute Disease; Adolescent; Adult; Aged; Appendicitis; Bacterial Infections; Carbenicillin; Cefamandole; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Rupture, Spontaneous

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

The safety and efficacy of treatment with cefamandole were evaluated in 77 patients (from 33 institutions) with serious bone and joint infections. The antibiotic was given intramuscularly or intravenously in doses ranging from 1.5 to 12 g/day for 6 to 58 days. Seventy-three of the 77 patients responded satisfactorily, and 63 (of 70 from whom material for culture was obtainable) patients had a bacteriologic cure. Forty-one of 81 isolates were identified as Staphylococcus aureus. Other pathogens included Streptococcus epidermidis, Haemophilus influenzae, Enterobacter sp., Escherichia coli, aerobic and anaerobic cocci, as well as Bacteroides fragilis. The drug was well tolerated. Pharmacological studies indicated that cefamandole penetrated the bones and joints. Cefamandole would seem to be a safe and efficacious drug, for the treatment of serious bone and joint infections due to a wide variety of gram-positive and gram-negative microorganisms.

Topics: Acute Disease; Bacteria; Bacterial Infections; Bone Diseases; Bursitis; Cefamandole; Cephalosporins; Chronic Disease; Clinical Trials as Topic; Female; Humans; Joint Diseases; Male; Middle Aged; Osteomyelitis

Ninety-four cases of pyelonephritis including 20 who had concurrent bacteremia were treated with cefamandole alone or in combination with either gentamicin or tobramycin. Doses of cefamandole ranged from 1--2 g by intermittent intravenous (VI) infusion every 4 to 8 h; gentamicin and tobramycin doses ranged from 1--1.7 mg/kg every 8 h also by intermittent IV infusion. Duration of therapy ranged from 5 to 23 days (mean 7.3 days). Both single and combination therapy successfully treated acute pyelonephritis and bacteremia in all patients. Seven strains of E. coli and one of Klebsiella pneumoniae responsible for initial infection were resistant to cephalothin but sensitive to cefamandole. Relapse with cefamandole sensitive bacteria occurred in 27% of patients receiving only cefamandole and 8% of those patients receiving combination therapy. Reinfection with cefamandole resistant organisms, predominantly Pseudomonas aeruginosa occurred in five patients. One patient had an intrarenal abscess due to E. coli which was successfully treated with 23 days of cefamandole. One patient died. However, death was due to acute pulmonary embolism, not infection. None of the patients receiving cefamandole plus gentamicin or tobramycin experienced a significant decrease in creatinine clearance during or after therapy. Skin rash, mild thrombophlebitis at the IV site and transient elevation of alkaline phosphatase and SGOT were the only side effects noted.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Cephalosporins; Clinical Trials as Topic; Gentamicins; Humans; Middle Aged; Pyelonephritis; Tobramycin

Clinical trials were carried out with cafamandole (sodium salt) in pediatric infections. Results were as follows; 1. CMD was applied to 13 patients with pneumonia, 1 patient each with submandibular abscess, urinary tract infection and bacterial meningitis. 2. Results were excellent in 1 and good in 13 patients, being overall efficacy rate 93.3%. 3. Slight elevations of GOT and GPT were observed in 1 patient. No other serious side effects were observed or reported.

Topics: Acute Disease; Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Male; Meningitis; Pneumonia; Pyelonephritis

Topics: Acute Disease; Adolescent; Adult; Aged; Cefamandole; Cephalosporins; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Time Factors; Urinary Tract Infections

Nine mongrel dogs were studied to evaluate the excretion of cefamandole (five dogs) and cephalothin (four dogs) in the pancreatic fluid. Each dog was studied before and after the induction of pancreatitis, with 2 weeks between studies. After intravenous administration of a 25-mg/kg dose of either cephalosporin, serum and pancreatic fluid concentrations were monitored for 6 h. Both cephalothin and cefamandole were excreted in bactericidal concentrations in the normal pancreas and in acute pancreatitis. Clearance of cefamandole (290 ml/min) and cephalothin (348 ml/min) were similar pre- and postinduction of pancreatitis. Serum albumin concentration was less during the post-pancreatitis phase compared with the prepancreatitis phase. Penetration of cephalothin was reduced in pancreatitis, whereas cefamandole penetration increased in pancreatitis.

Topics: Acute Disease; Animals; Cefamandole; Cephalothin; Dogs; Kinetics; Pancreas; Pancreatitis

Seventy-five infants and children with suppurative skeletal infections were managed with a sequential parenteral-oral regimen of cephalosporin antibiotic therapy. Initially, parenteral antibiotics (cefamandole for 48 patients and cefuroxime for 27 patients) were given for a median of 5 days. Oral therapy was with large doses of cefaclor (150 mg/kg/day) or cephalexin (100 mg/kg/day). Eight patients (11%) had inadequate serum bactericidal activity with cefaclor. Six of them were successfully managed with alternative oral antibiotics, and parenteral therapy resumed in one patient. Chronic disease developed in a child who was continued on oral cloxacillin therapy in spite of absent serum bactericidal activity. It is concluded that oral therapy can be successful for the majority of patients but that it is hazardous and not indicated if careful laboratory monitoring of compliance and serum bactericidal activity cannot be performed.

Topics: Acute Disease; Administration, Oral; Arthritis, Infectious; Bacterial Infections; Cefaclor; Cefamandole; Cefuroxime; Cephalexin; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Infusions, Parenteral; Male; Osteoarthritis; Osteomyelitis; Suppuration

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