cefamandole and Bacterial-Infections

A prospective double-blind study was designed to assess the efficacy of antibiotic prophylaxis in lung surgery. It included 114 patients undergoing lung surgery for primary or secondary malignant tumours randomly assigned to two groups. Group A patients (n = 59) were given cefamandole intravenously every four hours, three times, starting from induction of anaesthesia. The dose was determined according to the patient's weight: 1.5 g for patients weighing less than 60 kg, 2.5 g for those weighing between 60 and 80 kg, and 3 g for those above 80 kg. Group B patients (n = 55) were given a placebo at the same times. Nineteen other patients were excluded because either the tumour was found to be infected, or the patient had to be mechanically ventilated postoperatively, or an exploratory thoracotomy only was carried out, or they were allergic to beta-lactam antibiotics. The efficacy of antibiotic prophylaxis was assessed by recording the incidence of postoperative infections, the length of the patient's stay in hospital, and the need to use an antibiotic treatment. Patients, their sputum and wound were examined every day, and their temperature recorded. The white blood cell count and chest X-ray was carried out every day for the first week. All the drain and catheter tips were cultured, as well as sputum and blood (every three days). In case of infection, samples were obtained and cultured. Both groups of patients were similar with regard to age, risk factors (smoking habit, diabetes mellitus), and type of surgery (segmentectomy, lobectomy, pneumonectomy). There were 9 postoperative infections in group A, and 22 in group B (p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Bacterial Infections; Cefamandole; Double-Blind Method; Female; Humans; Male; Middle Aged; Placebos; Pneumonectomy; Postoperative Complications; Prospective Studies

Topics: Bacterial Infections; Bacteroides Infections; Cefamandole; Cefazolin; Cefonicid; Cefoxitin; Cefuroxime; Cephalosporins; Gonorrhea; Haemophilus Infections; Humans; Respiratory Tract Infections; Structure-Activity Relationship

The cephalosporins have been available for clinical use for nearly 20 years and a large number is presently marketed, including drugs with a wide range of different pharmacokinetic and microbiologic properties. While some of these agents have certain specific uses in which they excel, the cephalosporins have not replaced older antibiotics but do provide the physician with a broader range of choices for the treatment of many infections, allowing greater individualization of therapy.

Topics: Administration, Oral; Bacteria; Bacterial Infections; Cefamandole; Cefazolin; Cefsulodin; Cephacetrile; Cephalexin; Cephaloridine; Cephalosporins; Cephalothin; Cephamycins; Cephradine; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Injections, Intramuscular

Cefonicid is a 'second generation' cephalosporin administered intravenously or intramuscularly. It is similar to cefamandole in its superiority to first generation cephalosporins against several enterobacteriaceae as well as its activity against Haemophilus influenzae, including beta-lactamase-producing strains. Its activity against Staphylococcus aureus is similar to that of cefoxitin and inferior to cefamandole and first generation cephalosporins. It has excellent in vitro activity against Neisseria gonorrhoeae, but is inactive against Pseudomonas, Acinetobacter, Serratia, and Bacteroides fragilis. Due to high achievable plasma concentrations and a relatively long half-life, in most clinical trials cefonicid has been administered once daily. It was comparable in efficacy with cefamandole or cefazolin in the treatment of patients with urinary tract, lower respiratory tract, and soft tissue and bone infections. It has also been compared with penicillin in the treatment of uncomplicated gonorrhoea. Results from a small series of patients with endocarditis appear to indicate that cefonicid should not be used in patients with serious staphylococcal infections. Single doses of cefonicid given preoperatively appear to offer a similar degree of protection against post-surgical infection as multiple doses of other antibiotics, but further data from studies involving larger numbers of patients are needed to confirm these impressions. Patients who require prolonged antibiotic therapy, such as those with osteomyelitis being treated as outpatients after a relatively short inpatient course, could benefit from the once daily dose regimen of cefonicid.

Topics: Bacterial Infections; Cefamandole; Cefonicid; Humans

The new second-generation cephalosporins, cefonicid, ceforanide, and cefuroxime, have recently become available. These agents are generally less active against gram-positive cocci than first-generation cephalosporins and, at best, equal to cefoxitin and cefamandole against many gram-negative bacteria. Cefuroxime, however, is the most active cephalosporin for beta-lactamase-producing Haemophilus influenzae. These newer agents have superior pharmacokinetic characteristics over cefoxitin and cefamandole. Smaller doses, longer dosing intervals and, potentially, a reduction in total drug cost may be the real advantage of these agents. Open trials and a limited number of comparative studies have documented the effectiveness of cefonicid, ceforanide, and cefuroxime in the treatment of most mild-to-serious infectious diseases, although failures with cefonicid in the treatment of staphylococcal infections have been reported. Notably, cefuroxime has received approval for the treatment of common pediatric bacterial meningitis infections. Replacement of cefamandole or cefoxitin with one of these "longer-acting" agents may be cost-beneficial; however, clinicians must be on alert for the development of bacterial resistance or decreased efficacy.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefonicid; Cefuroxime; Cephalosporins; Costs and Cost Analysis; Humans; Kinetics

Cefamandole and cefoxitin, introduced only 7 years ago, are now the most commonly prescribed parenteral antibiotics in the United States. These drugs are similar to the first-generation cephalosporins in toxicity, but their in-vitro spectrum of activity is greater. Their serum half-lives are longer than those of cephalothin and cephapirin but shorter than that of cefazolin. Although cefamandole has been recommended in empiric therapy for patients with community-acquired pneumonia and as a prophylactic agent for patients having various surgical procedures, other regimens are less expensive and just as effective. Cefamandole should not be used to treat intra-abdominal, enterobacter, or ampicillin-resistant Haemophilus influenzae infections. Cefoxitin is effective in the treatment and prevention of mixed aerobic-anaerobic skin and soft-tissue, intra-abdominal, gynecologic, and penicillinase-producing, spectinomycin-resistant Neisseria gonorrhoeae infections. Cefoxitin represents a greater advance than cefamandole in our continuing search for safe and more effective antimicrobial agents.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefoxitin; Child; Costs and Cost Analysis; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Premedication

In vitro susceptibility of Streptococcus pyogenes, Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Serratia marcescens, Hemophilus influenzae, Bacteroides fragilis, and Neisseria gonorrhea to three new second-generation and eight third-generation cephalosporins is tabulated. In general, the newer cephalosporins have an extended spectrum of activity against gram-negative bacteria, including Serratia marcescens, Pseudomonas aeruginosa, and Neisseria gonorrhea. They also tend to be active against anaerobes, including Bacteroides fragilis. However, they generally have less activity against gram-positive bacteria when compared with the first- and second-generation cephalosporins. Clinical summaries are given for each of the cephalosporins, with emphasis on the results of comparative clinical trials. These cephalosporins may prove especially useful in nosocomial infections with resistant organisms, intraabdominal infections, febrile episodes in the granulocytopenic patient, and meningitis.

Topics: Bacteria; Bacterial Infections; Bacteroides fragilis; Cefamandole; Cefoperazone; Cefotaxime; Cefotiam; Cephalosporins; Enterobacteriaceae; Haemophilus influenzae; Humans; Moxalactam; Pseudomonas aeruginosa

The therapy of gram-negative bacillary meningitis is less than adequate to date; the agents recommended do not achieve bactericidal levels in purulent cerebrospinal fluid. Because optimal antibiotic therapy of meningitis occurs when the cerebrospinal fluid level of an antibiotic is above the concentration needed to kill the offending pathogen, another group of agents needs to be considered. The newer cephalosporins or cehalosporin-type antibiotics (cefotaxime, moxalactam), by virtue of their marked activity against gram-negative bacilli and their ability to achieve significant CSF levels, merit serious consideration as therapy for gram-negative bacillary meningitis. Investigators in Europe and the United States have developed preliminary data demonstrating the efficacy of these agents in a growing number of cases. In the group presented herein, of the 35 cases in which gram-negative bacillary meningitis was treated with the newer cephalosporins, there were only four failures.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Blood-Brain Barrier; Cefamandole; Cefotaxime; Cefoxitin; Cephaloridine; Cephalosporins; Cephalothin; Cephamycins; Child, Preschool; Enterobacteriaceae; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Middle Aged; Moxalactam; Pseudomonas aeruginosa

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

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefoxitin; Cephalosporins; Cephalothin; Drug Hypersensitivity; Humans; Injections

Since the introduction of cephalothin and cephaloridine as the first parenteral cephalosporins and cephalexin as the first member of the group which is absorbed from the gastrointestinal tract, several new cephalosporin derivatives have been developed. Most of these have no major advantages over cephalothin, cephaloridine or cephalexin. Increased knowledge about the importance of beta-lactamases for bacterial resistance against beta-lactam antibiotics has focused interest on development of drugs with increased resistance to degradation by these enzymes. Among the caphalosporins, cefamandole and cefuroxime have been found to be markedly more active against beta-lactamase producing Gram-negative bacteria. A new group of beta-lactam antibiotics, the cephamycins, have been introduced with cefoxitin as the first clinically useful member. Cefoxitin has the spectrum of a beta-lactamase-resistant cephalosporin and is also active against Bacteroides fragilis. The review concentrates on the antibacterial spectrum of these three new antibiotics and on their clinical efficacy.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefoxitin; Cephalosporinase; Cephalosporins; Cephamycins; Clinical Trials as Topic; Drug Evaluation; Drug Resistance, Microbial; Furans; Humans; Penicillinase

Infections are still the most frequent postoperative complications and one of the limiting factors of successful gynaecological surgery. In recent years information on successful anti-microbial chemoprophylaxis is increasing and is associated with reduced postoperative inflammations, febrile morbidity and early complications. Views differ above all as regards indications for the use of antibiotic prophylaxis and the selection of a suitable antibiotic. Data in the literature differ also as regards achieved results. The submitted work had the objective to test on a representative group the success and rationality of medicamentous prophylaxis in gynaecological surgery and to contribute to a clearer view on controversial points. 203 women admitted to the Second Gynaecological and Obstetric Department of the First Medical Faculty Charles University and General Faculty Hospital Prague for elective abdominal or vaginal hysterectomy on account of a benign indication were divided into three groups which did not differ from the demographic or medical aspect. In group A (53 women) for prophylaxis two doses of Augmentin were used (combination of amoxycillin with clavulanic acid) i.v., patients in group M (50 women) had three doses of Mandol (Cefamandol) i.m., and in control group K (100 patients) no antibiotics were administered prophylactically. The authors investigated the postoperative course and evaluated some parameters in relation to possible postoperative infectious complications. The results proved unequivocally that prophylaxis with Augmentin reduces significantly the postoperative infectious morbidity (11.5%), febrile morbidity (5.6%) and the incidence of early infectious complications (3.8%) after abdominal or vaginal hysterectomy, as compared with the control group (35%, 31% and 11% resp.). Prophylaxis with Cefamandol reduced only in few parameters postoperative complications, but in general did not lead to a significant improvement of the postoperative course nor to a reduction of postoperative inflammatory complications. Similar results were obtained when only complications after abdominal hysterectomy were evaluated. The results of bacteriological examination confirmed the expected differences in the spectrum of efficacy of the two antibiotics on the most common microbial flora in the given area, i.e. a high sensitivity of Augmention to enterococci and bacterioids and resistance of these bacteria to Mandol. These results can be considered one of the re

Topics: Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bacterial Infections; Cefamandole; Cephalosporins; Drug Therapy, Combination; Female; Humans; Hysterectomy; Middle Aged; Postoperative Complications

To determine the value of antibiotic prophylaxis for the prevention of infection following postoperative T-tube cholangiography.. A prospective, controlled study.. A tertiary care center.. The role of antibiotic prophylaxis during postoperative T-tube cholangiography was prospectively evaluated in 164 patients.. Sixty-two patients were administered antibiotic prophylaxis treatment (1 g of cephalothin sodium was infused intravenously 30 minutes before the procedure and 500 mg of cephalexin was given orally every 6 hours for 3 days after the procedure). Seventy-one patients were in the control group and did not receive antibiotic therapy.. Complications and adverse reactions following postoperative T-tube cholangiography were recorded and compared between the two groups.. There was no significant difference between the groups in regard to age, sex, serum amylase level before T-tube cholangiography, white blood cell count, and liver function. The results of the bacteriologic culture specimens of the bile were also comparable between the groups. One patient who had received antibiotic therapy and one patient in the control group had fever (temperature, > 38 degrees C) and chills after the procedure. Two patients who had received antibiotic therapy and one patient in the control group had mild abdominal pain. These complications were treated conservatively without any event. No significant difference was found in the rates of complications and the success of postoperative T-tube cholangiography between the groups.. Routine antibiotic prophylaxis for the prevention of infection following postoperative T-tube cholangiography is not necessary under selected conditions.

Topics: Bacterial Infections; Cefamandole; Cephalothin; Cholangiography; Cholangitis; Drug Therapy, Combination; Drug Utilization Review; Female; Humans; Male; Middle Aged; Postoperative Period; Premedication; Prospective Studies; Taiwan

In a randomized prospective study ampicillin/sulbactam and cefamandole were compared in the therapy of patients hospitalized with community acquired pneumonia. Patients receiving ampicillin/sulbactam (n = 37) and cefamandole (n = 38) were similar with respect to age (mean age 70 vs. 76 years respectively), clinical characteristics, severity of illness and underlying disease. Pathogens isolated from patients in the cefamandole and ampicillin/sulbactam group, respectively, were Streptococcus pneumoniae (7 vs. 7 patients), Haemophilus parainfluenzae (7 vs. 6 patients), Haemophilus influenzae (5 vs. 5 patients), Staphylococcus aureus (5 vs. 4 patients), Escherichia coli (4 vs. 4 patients), Klebsiella pneumoniae (3 vs. 3 patients), Enterobacter spp. (2 vs. 3 patients), Moraxella catarrhalis (1 vs. 2 patients), and organisms of the oral flora (4 vs. 3 patients). The rate of resistance to penicillin was 80%, to clindamycin 76%, to erythromycin 45%, to ampicillin 43%, and to cefazolin 18%. Overall successful treatment rates of 81% for cefamandole and 97% for ampicillin/sulbactam (p = 0.05) were observed. Both cefamandole and ampicillin/sulbactam were shown to be effective agents for therapy of community acquired pneumonia; however ampicillin/sulbactam demonstrated superior overall clinical efficacy.

Topics: Adult; Aged; Aged, 80 and over; Ampicillin; Bacteria; Bacterial Infections; Cefamandole; Community-Acquired Infections; Female; Humans; Male; Middle Aged; Pneumonia; Prospective Studies; Sputum; Sulbactam

The efficacy of amoxycillin-clavulanic acid for prevention of postoperative wound infection was compared with that of cefamandole in 150 patients at risk for infected bile while undergoing elective biliary surgery in a prospective, randomized study. The two groups were comparable for age, sex, risk factors, operative procedures and positive bile cultures. Similar numbers of patients had an uncomplicated postoperative course (amoxycillin-clavulanic acid 70%; cefamandole 73%). Four patients in each group developed wound infection. The incidence of postoperative pneumonia, urinary tract infection and number of days (+/- SD) in hospital (amoxycillin-clavulanic acid 10.1 +/- 4.7; cefamandole 9.7 +/- 5.6) were similar. The efficacy of amoxycillin-clavulanic acid and cefamandole in preventing wound sepsis in high-risk patients undergoing biliary surgery was similar. Economic considerations may favour the use of amoxycillin-clavulanic acid.

Topics: Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacterial Infections; Biliary Tract Surgical Procedures; Cefamandole; Clavulanic Acids; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Risk Factors; Surgical Wound Infection

Fourty-two febrile episodes of 32 patients with hematologic disease during neutropenia were treated with two randomly assigned antibiotic combinations of either piperacillin plus gentamicin or piperacillin plus aztreonam. Eleven of the 22 febrile episodes treated with piperacillin plus gentamicin and 12 of the 20 febrile episodes treated with piperacillin plus aztreonam responded. Addition of cefamandole to non-responders improved the outcome in 2 of the 16 febrile episodes. Mean nadir leucocyte count, age, sex, and underlying disease were not significantly different in both groups. Side effects were tolerable in both groups, although 1 patient treated with piperacillin plus gentamicin showed severe renal impairment. Piperacillin plus aztreonam is as effective as piperacillin plus gentamicin as an empiric antibiotic combination in the treatment of febrile episodes with hematologic disease during neutropenia.

Topics: Adolescent; Adult; Aged; Anemia, Aplastic; Aztreonam; Bacterial Infections; Cefamandole; Drug Therapy, Combination; Female; Fever; Gentamicins; Humans; Leukemia; Lymphoma; Male; Middle Aged; Neutropenia; Piperacillin; Prospective Studies

A prospective double-blind study was designed to assess the efficacy of antibiotic prophylaxis in lung surgery. It included 114 patients undergoing lung surgery for primary or secondary malignant tumours randomly assigned to two groups. Group A patients (n = 59) were given cefamandole intravenously every four hours, three times, starting from induction of anaesthesia. The dose was determined according to the patient's weight: 1.5 g for patients weighing less than 60 kg, 2.5 g for those weighing between 60 and 80 kg, and 3 g for those above 80 kg. Group B patients (n = 55) were given a placebo at the same times. Nineteen other patients were excluded because either the tumour was found to be infected, or the patient had to be mechanically ventilated postoperatively, or an exploratory thoracotomy only was carried out, or they were allergic to beta-lactam antibiotics. The efficacy of antibiotic prophylaxis was assessed by recording the incidence of postoperative infections, the length of the patient's stay in hospital, and the need to use an antibiotic treatment. Patients, their sputum and wound were examined every day, and their temperature recorded. The white blood cell count and chest X-ray was carried out every day for the first week. All the drain and catheter tips were cultured, as well as sputum and blood (every three days). In case of infection, samples were obtained and cultured. Both groups of patients were similar with regard to age, risk factors (smoking habit, diabetes mellitus), and type of surgery (segmentectomy, lobectomy, pneumonectomy). There were 9 postoperative infections in group A, and 22 in group B (p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Bacterial Infections; Cefamandole; Double-Blind Method; Female; Humans; Male; Middle Aged; Placebos; Pneumonectomy; Postoperative Complications; Prospective Studies

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 this multicentre study, 883 evaluable patients undergoing orthopedic surgery were randomly assigned to receive antiinfective prophylaxis with either ceftriaxone (Rocephin) or cefamandole. 25 patients in the ceftriaxone group and 29 patients in the cefamandole group (5.6 vs 6.5%) presented with infectious complications within the first 60 days after surgery. Delayed deep wound infections developed in only 1 of 435 patients in the ceftriaxone group compared with 4 of 413 patients in the cefamandole group. Both drugs were well tolerated. The infection rate was twice as high after surgery in conventional operating theatres than after treatment in hypersterile operating theatres (3.3 vs 6.5%); this difference is not statistically significant.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Bone Diseases; Cefamandole; Ceftriaxone; Child; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multicenter Studies as Topic; Muscular Diseases; Postoperative Complications; Premedication

In a prospective study on infectious morbidity after vaginal hysterectomy we examined the clinical symptoms of an infection and partly also the microbial conditions of the vaginal wound. With a group of 49 patients without antibiotic prophylaxis we tried to find out if the type of vaginal occlusion might have any influence on the microbial situation and the healing process. The results of this first group were compared to those of a second group consisting of 31 patients, who had received antibiotic prophylaxis before the operation with a cephalosporin. Though it was not possible to make any microbial analyses in the second group, the clinical evaluation showed distinctly that antibiotic prophylaxis is an important contribution to the prevention of infections after vaginal hysterectomy. The careful consideration of septic-surgical precautions, however, and this was proved by the first part of the study, contributes as well to the prevention of infections.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefotaxime; Cefuroxime; Cephalosporins; Clinical Trials as Topic; Drainage; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Middle Aged; Premedication; Prospective Studies; Risk Factors; Surgical Wound Infection

This prospective study examined microbiologic features of arterial tissue and pharmacokinetics and bioactivity of cefamandole and cefazolin in patients undergoing elective primary prosthetic aortoiliofemoral/infrainguinal reconstruction. Double-blind, randomized, perioperative prophylaxis (1 gm intravenously every 6 hours for nine doses) with cefamandole or cefazolin was administered to 47 patients. Specimens of blood serum, subcutaneous fat, thrombus, atheroma, and arterial wall were obtained for culture and minimal inhibitory concentration and drug level analysis by high-pressure liquid chromatography. The serum half-life (hr +/- SEM) was 1.43 +/- 0.36 for cefamandole and 2.22 +/- 0.40 for cefazolin. Over the first 2 hours of surgery and for all time intervals combined, the serum concentration of cefazolin was significantly higher (p less than 0.025) than cefamandole. Irrespective of sampling time, the tissue concentration of cefazolin was significantly greater (p less than 0.005) than cefamandole. Positive arterial tissue cultures were obtained in 12 of 29 patients (41.4%) from 23 of 116 (19.8%) arterial tissue specimens. Coagulase-negative Staphylococcus was the predominant isolate, 64 of 93 (68.8%). Twenty-five of the 51 coagulase-negative staphylocci tested (49%) were slime-producers. During surgery, the arterial tissue concentration of cefamandole fell below the geometric mean minimal inhibitory concentration against all organisms combined, and against S. aureus (with the highest minimal inhibitory concentration of the prevalent isolates), significantly more often than the concentration of cefazolin. The data show that a significant number of primary elective aortoiliofemoral/infrainguinal reconstructions are associated with positive arterial tissue cultures, which represent a potential source of graft infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Arteries; Bacterial Infections; Blood Vessel Prosthesis; Cefamandole; Cefazolin; Female; Humans; Male; Prospective Studies; Serum Bactericidal Test

The necessary duration of antibiotic administration after open fracture has not been established. In a double-blind prospective trial we randomized 248 patients with open fractures to receive one or five days of cefonicid sodium therapy or five days of cefamandole nafate therapy as part of the initial treatment. Rates of fracture-associated infections in the three groups were ten (13%) of 79, ten (12%) of 85, and 11 (13%) of 84, respectively. The 95% confidence limit for the difference in infection rates between the one-day group and the combined five-day groups was 0% to 8.3%. The actual difference was 0.2%. A brief course of antibiotic administration is not inferior to a prolonged course of antibiotics for prevention of postoperative fracture-site infections.

Topics: Adult; Bacterial Infections; Cefamandole; Cefonicid; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Extremities; Female; Fractures, Open; Humans; Male; Prospective Studies; Random Allocation

In a prospective, double-blind study, 193 patients hospitalized for established hand infections were randomized to receive either cefamandole intravenously followed by cephalexin by mouth or methicillin intravenously followed by dicloxacillin by mouth. Careful aerobic and anaerobic cultures were performed. Multiple organisms grew in cultures from 84% of the patients (over three isolates per infection on average). Human bite wounds contained anaerobes 43% of the time compared with 12% for other wounds. The majority of wounds (72%) required operative treatment. In 128 patients assessable for treatment outcome, results were unsatisfactory in 11 (9%). There was no difference in outcome between cefamandole (6/59, 10%) and methicillin (5/59, 8%). The presence of anaerobes, Eikenella corrodens, human bites, or an increasing number of organisms was associated with an unsatisfactory response. The presence of Staphylococcus aureus and/or beta-hemolytic streptococci was associated with a favorable response. The incidence of antibiotic-resistant isolates did not correlate with outcome.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bites and Stings; Bites, Human; Cefamandole; Clinical Trials as Topic; Combined Modality Therapy; Debridement; Double-Blind Method; Follow-Up Studies; Hand Injuries; Humans; Methicillin; Middle Aged; Prospective Studies; Random Allocation; Time Factors

From July 1, 1978 to June 30, 1984, 45 radical abdominal hysterectomies were performed by the authors at Tripler Army Medical Center. Management was uniform except for the use of prophylactic antibiotics. Three patterns of practice were identified: Group I, no antibiotics were used; Group II, intravenous (i.v.) antibiotics were given in the induction room and for less than 48 h post-surgery; Group III, prophylactic i.v. antibiotics were given and the surgical site was also irrigated with a cefamandole and saline solution. The three groups were found to be similar with regard to age, parity, weight-height index, pre- and postoperative hematocrit, pre-operative white blood cell count, operative and anesthesia times, estimated blood loss, and amount of blood transfused. Groups I and II had a higher surgical site infection rate (87.5% and 63.6%, respectively) than Group III (3.8%). The mean 10-day fever index in degree hours was 109 for Group I, 71 for Group II, and 30 for Group III (P less than 0.001). Irrigation of the surgical site with a cefamandole and saline solution in addition to i.v. antibiotics decreases the infectious morbidity of radical hysterectomy.

Topics: Adenocarcinoma; Administration, Topical; Adult; Bacterial Infections; Carcinoma, Squamous Cell; Cefamandole; Clinical Trials as Topic; Doxycycline; Female; Humans; Hysterectomy; Lymph Node Excision; Middle Aged; Postoperative Complications; Premedication; Therapeutic Irrigation; Uterine Cervical Neoplasms

The purpose of this prospective investigation was to compare a single intravenous dose of cefazolin to a single dose of cefonicid as prophylaxis for women having unscheduled cesarean delivery. In a double-blind, randomized design, 96 patients were assigned to receive a 1-g dose of cefazolin and 103 patients were designated to receive a 1-g dose of cefonicid. The antibiotics were administered after delivery of the infant. The two groups were comparable with respect to recognized risk factors for postcesarean infection. There were no statistically significant differences between the groups in the incidence of standard febrile morbidity, endomyometritis, urinary tract infection, wound infection, and bacteremia. There were also no significant differences between the groups in the fever index or the duration of hospitalization. We conclude that cefazolin and cefonicid provide a similar degree of prophylaxis against infection in patients having unscheduled cesarean delivery.

Topics: Bacterial Infections; Cefamandole; Cefazolin; Cefonicid; Cesarean Section; Double-Blind Method; Endometritis; Female; Humans; Injections, Intravenous; Pregnancy; Prospective Studies; Random Allocation

Topics: Aged; Aztreonam; Bacterial Infections; Cefamandole; Clinical Trials as Topic; Drug Resistance, Microbial; Female; Gram-Negative Bacteria; Humans; Male; Middle Aged; New Jersey

A total of 337 patients undergoing coronary artery bypass grafting or cardiac valve replacement were randomly assigned to receive cefazolin (1 g every 8 h [q8h]), cefamandole (2 g q6h), or cefuroxime (1.5 g q12h) as an intravenous antibiotic prophylaxis. All drugs were administered within 60 min before the initial incision and were continued for 48 h postoperatively. No adverse effects related to the study drugs were observed. The percentage of patients with postoperative infection was 9% for the cefazolin group, 6% for the cefamandole group, and 5% for the cefuroxime group or 6.5% overall. There were more infection sites in patients treated with cefazolin than in those treated with cefuroxime (P = 0.05) or cefamandole (P = 0.06). Fewer wound infections occurred with cefuroxime (P less than 0.01) and cefamandole (P = 0.06) than with cefazolin. Analyses of the prophylactic regimens used in this study showed cefazolin and cefuroxime to be less costly than cefamandole.

Topics: Adult; Aged; Bacterial Infections; Cardiac Surgical Procedures; Cefamandole; Cefazolin; Cefuroxime; Cephalosporins; Clinical Trials as Topic; Costs and Cost Analysis; Double-Blind Method; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Random Allocation

The subject of whether an optimal duration of prophylactic antibiotic therapy exists was evaluated by comparing results of short and medium-term treatment in aseptic surgery during a double-blind, randomized, prospective trial in 507 patients undergoing vascular or thoracic operations. Patients were randomly allocated to receive either 3 injections of cefamandole: at induction of anesthesia and after 4 and 10 hours (251 cases) or 8 injections of the same antibiotic: at induction of anesthesia, after 4 hours and then every 6 hours up to 40 hours (256 cases). Evaluation on discharge showed that among the 251 patients receiving 3 injections, 21 (8.33%) were infected while in the group treated with 8 injections (256 cases) 25 (9.8%) were infected. The X2 was 0.25 and there is a lack of statistically significant difference between treatments. Duration of prophylactic antibiotic therapy can be shortened, without loss of efficacy in thoracic or vascular aseptic surgery, to reduce selection of resistant germs and to lower costs.

Topics: Bacterial Infections; Cefamandole; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Humans; Prospective Studies; Random Allocation; Thoracic Surgery; Vascular Surgical Procedures

One hundred one patients undergoing total hip and knee arthroplasty were randomly assigned to receive either two 1 gm doses of ceforanide or five doses of cephalothin perioperatively. Simultaneous plasma and cancellous bone specimens were obtained intraoperatively and assayed for antibiotic concentration. Ceforanide plasma and bone levels remained sustained over six hours. Cephalothin plasma and bone levels obtained three to four hours post administration were 91% lower than levels obtained one hour post-dose. Patients were examined for infection for up to 18 months following surgery. None of the patients developed an infected implant. The sustained plasma and bone levels achieved with ceforanide obviate the need for intraoperative dosing necessary with other agents.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefamandole; Cephalothin; Clinical Trials as Topic; Hip Prosthesis; Humans; Knee Prosthesis; Middle Aged; Premedication; Random Allocation

A prospective, randomized, double-blind study was conducted to determine the efficacy of cefamandole nafate in reducing infections in general orthopedic procedures. Of 743 patients initially entered into the study, 715 (362 on cefamandole, 353 on placebo) fulfilled the requirements of the protocol. The infection rate was 1.6% for the cefamandole-treated group and 4.2% for the placebo group. In operations lasting longer than two hours, there were two infections in the cefamandole group and seven infections in the placebo group (p less than 0.05). Staphylococcus aureus and gram-negative bacilli were the common pathogens. Adverse side effects were limited to transient elevations in liver enzymes.

Topics: Adult; Bacterial Infections; Cefamandole; Double-Blind Method; Female; Humans; Male; Middle Aged; Placebos; Prospective Studies; Random Allocation; Surgical Wound Infection

A prospective, randomized study was carried out to evaluate two antibiotic prophylactic regimens for patients undergoing cardiac surgery with cardiopulmonary bypass. Each patient of the first group (cefazolin) received four intravenous injections of 1 g cefazolin during 12 hours, patients of second (cefamandole), four doses of 750 mg. 155 patients scheduled for cardiac operation were included in the study. (May 1983 to April 1984). Patients were not admitted to the study in case of emergency, if their weight was less than 20 kg, if they had received antibiotics during the week before surgery or if they had a history of anaphylactic reactions to cephalosporins. There were no differences between the two groups on age, weight, height, sex, previous history of infectious disease, surgery and intensive care. There were no significant differences between the two groups in minor infections. The rate of urinary tract infection by streptococci was significatively higher (p less than 0.02) in the cefamandole group (38.3%) than in the cefazolin group (17.6%). There were no major infections (septicemia, mediastinitis, endocarditis). Patients temperature was the same during the first four postoperative days. Hospital stay was the similar in the two groups. The two antibiotics are similarly effective to prevent major infections in cardiac surgery. However cefazolin was preferred for antibiotic prophylaxis in cardiac surgery because of the higher rate of streptococcal urinary infections in patients given cefamandole.

Topics: Adult; Aged; Bacterial Infections; Cardiac Surgical Procedures; Cefamandole; Cefazolin; Double-Blind Method; Extracorporeal Circulation; Female; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Random Allocation

The efficacy of intraoperative irrigation with cefamandole nafate at cesarean section was evaluated in a prospective, randomized double-blind study. Two hundred and eight patients were treated with antibiotic irrigation and intravenous placebo or with perioperative intravenous cefamandole and irrigated with normal saline. The rate of endometritis was 10.9% in the irrigation group and 14% in the intravenous group, but the difference was not statistically significant. The rate of any infection, the number of days with fever, additional hospitalization days, and number of antibiotics used for treatment were similar in the two groups. It thus was concluded that irrigation with antibiotic is equal but not superior to perioperative intravenous antibiotics.

Topics: Adult; Bacterial Infections; Cefamandole; Cesarean Section; Double-Blind Method; Female; Humans; Injections, Intravenous; Intraoperative Care; Pregnancy; Premedication; Prospective Studies; Random Allocation; Therapeutic Irrigation

In this study, 52 high risk patients who underwent operations upon the biliary tract were assigned to receive either antibiotic prophylaxis or no treatment with antibiotics. Twenty-seven patients were given 2 grams of cefamandole intramuscularly 30 minutes before operation and 2 grams every eight hours for two days postoperatively. The remaining patients were in the control group and did not receive antibiotics. Surgical wounds were inspected daily by a surgeon while the patients were in the hospital and a follow-up revision was done four weeks after discharge from the hospital. Samples of exudate or pus were taken when the wound appeared infected and cultures of aerobic and anaerobic organism done. Chi-square affinity test with Yate's correction was used for statistical results; only p values more than or equal to 0.5 were considered significant. Seven patients (28 per cent) in the control group had complications develop postoperatively; seven surgical wound infections, one of which included a subphrenic abscess. Postoperatively, there were no septic complications in the group who received cefamandole as a prophylaxis. The incidence of infection was higher for females than males. The organisms most frequently isolated were Escherichia coli and Klebsiella; only in one instance was Clostridum sporogenes found. Polymicrobial infections accounted for 42.8 per cent of the infections. No incidences were reported with the use of cefamandole in those patients who were treated prophylactically. In view of these results, we believe that cefamandole is an ideal antibiotic to be used in the prophylactic treatment of infections of high risk patients who undergo operations upon the biliary tract.

Topics: Age Factors; Aged; Bacterial Infections; Bile; Biliary Tract Surgical Procedures; Cefamandole; Cholestasis; Common Bile Duct; Drug Evaluation; Exudates and Transudates; Female; Humans; Male; Middle Aged; Postoperative Care; Premedication; Random Allocation; Risk; Surgical Wound Infection

One hundred and five patients with penetrating abdominal injuries were treated with single-antibiotic regimens. Forty-seven patients were treated with intravenous (IV) cefamandole and for comparison 58 patients were treated with IV carbenicillin previously shown to be effective against postoperative infections associated with abdominal trauma. The overall incidence of deep infection on a single antibiotic therapy was 8.6 per cent, including two patients on cefamandole alone (4.3%) and seven (12.1%) on carbenicillin alone. One in each antibiotic group died of sepsis with a total mortality of 1.9 per cent. The authors concluded that cefamandole when used alone was found to be safe and more effective than carbenicillin alone in preventing sepsis in patients with abdominal trauma.

Topics: Abdominal Injuries; Adult; Bacterial Infections; Carbenicillin; Cefamandole; Colon; Female; Fever; Humans; Infusions, Parenteral; Intestinal Perforation; Length of Stay; Male; Premedication; Prospective Studies; Random Allocation; Rectum; Wound Infection; Wounds, Penetrating

Our data support the premise that antimicrobial therapy for peritonitis must be individualized. In the patient with minimal and moderate contamination who is not suppressed and who will undergo prompt and correct surgical therapy, then a single antimicrobial agent, such as cefamandole or perhaps even a first generation cephalosporin, such as cefazolin, will be adequate therapy even in instances of polymicrobial peritonitis when anticipated resistant organisms are present. In this situation, a single drug will be just as effective and safer when compared with the combination of an aminoglycoside and a specific antianaerobic agent. On the other hand, in the patient with immunosuppression, who is late to come to treatment or who has hospital acquired sepsis with probably a large contamination of resistant organisms, either a third generation cephalosporin with extended coverage or triple drug therapy, including a broad spectrum penicillin, an aminoglycoside and an anaerobic effective agent, should be the treatment of choice. Also, for infections with a culture proved overwhelming anaerobic flora, an antimicrobial specific for these pathogens should be used. The dictum, however, that all instances of peritonitis mandate double or triple drug therapy is a clinical impression based upon experimental models which do not correctly simulate the clinical situation.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Clindamycin; Clinical Trials as Topic; Costs and Cost Analysis; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Gentamicins; Humans; Kidney; Male; Middle Aged; Peritonitis; Prospective Studies; Subphrenic Abscess; Surgical Wound Infection

The response of serious skin and skin structure infections to ceforanide 1 gm every twelve hours or cefazolin 1 gm every eight hours was evaluated in ninety-six patients hospitalized for treatment. Most of the patients had decubitus ulcers; predominant pathogens were Staphylococcus aureus, Escherichia coli, and Proteus mirabilis. Ceforanide produced a satisfactory clinical response in 89 percent (forty-eight of fifty-four) of the patients evaluated and eradicated 90 percent (seventy-four of eighty-two) of the pathogens. Although the clinical response of forty-two cefazolin-treated patients was similar (satisfactory response in 86 percent, thirty-six patients), only 81 percent (forty-eight of fifty-nine) of the pathogens were eradicated. Both ceforanide and cefazolin were very well tolerated systemically and locally.

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cefazolin; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Pressure Ulcer; Skin Diseases, Infectious

Cefamandole in combination with tobramycin was evaluated in the treatment of peritonitis as an adjunct to laparotomy and performance of the indicated surgical procedure in 88 patients. The clinical response was judged satisfactory in 91 per cent. Of four deaths, only one could be attributed to infection. Side effects noted were decreased creatinine clearance in 16 patients, increased liver enzymes in ten patients, and eosinophilia in nine patients. Microbiologic studies revealed aerobic peritonitis in 44 cultures and anaerobic in 32. Eighty-five per cent of the gram-negative and 69 per cent of the gram-positive strains were susceptible to cefamandole. Cefamandole alone or in combination with tobramycin appears to be an effective and safe antibiotic when used in appropriate doses for the treatment of bacterial peritonitis.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Child; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Laparotomy; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Postoperative Complications; Risk; Tobramycin

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefonicid; Clinical Trials as Topic; Humans; Kinetics; Microbial Sensitivity Tests

Topics: Adult; Bacteria; Bacterial Infections; Cefamandole; Child; Clinical Trials as Topic; Humans; Kinetics; Microbial Sensitivity Tests

The role of prophylactic antibiotic lavage in elective biliary tract operations is controversial. To investigate this question, a prospective, randomized study was undertaken between 1979 and 1983. All patients more than 18 years of age who underwent elective biliary operations were included. Eighty-eight patients were enrolled in the study and were stratified into the following antibiotic groups: (1) cefamandole nafate 2 gm administered intravenously preoperatively and 6 hours postoperatively in four doses; (2) cefamandole nafate 0.4% solution: 250 ml to irrigate the abdominal wound on opening, 500 ml to irrigate the peritoneal cavity, and 250 ml to irrigate the wound on closing; and (3) systemic plus topical administrations as in Nos. 1 and 2. Age, sex, type of operation, and underlying diseases were comparable in all groups. The patients were then evaluated for postoperative infections. In the intravenous cefamandole group there was only one patient who developed a urinary tract infection after operation. In the topical cefamandole group there were four postoperative infections: wound-one, urinary tract--two, and cholangitis--one. In the intravenous plus topical cefamandole group there were four postoperative infections: wound--one, urinary tract--two, and pneumonia--one. No deaths occurred in any group. Blood, subcutaneous, and peritoneal drug levels were sampled 1 hour after opening and before closing. Therapeutic serum levels of cefamandole are 1 to 16 micrograms/ml and adequate serum levels were achieved in all groups. However, higher levels were obtained in the subcutaneous tissue and peritoneum when topical cefamandole was used. We conclude: (1) Topical cefamandole lavage alone is adequate prophylaxis in elective biliary operations and achieves comparable results as perioperative systemic administration; (2) topical cefamandole resulted in higher subcutaneous tissue and peritoneal levels than intravenous cefamandole and also achieved therapeutic serum levels; and (3) there is no advantage to the use of systemic plus topical antibiotics in elective biliary operations.

Topics: Administration, Topical; Adult; Aged; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Bile; Biliary Tract Surgical Procedures; Cefamandole; Cephalosporins; Drug Evaluation; Female; Humans; Injections, Intravenous; Intraoperative Care; Male; Middle Aged; Peritoneum; Postoperative Complications; Random Allocation; Risk; Therapeutic Irrigation

A combination of tobramycin sulfate and cefamandole nafate was used as initial empiric therapy for the treatment of 71 evaluable febrile (temperature greater than 38.5 degrees C) episodes in 64 (neutrophils, less than 1,000/microL) adult patients with cancer and granulocytopenia. Carbenicillin sodium or ticarcillin disodium was substituted for cefamandole in patients with Pseudomonas infections and in patients in whom the initial regimen was unsuccessful. Twenty-nine episodes were randomized to receive tobramycin by continuous infusion, while 42 were randomized to receive tobramycin by interrupted infusion. Twenty-seven (79%) of the 34 documented infections responded to the initial empiric antibiotic combination, ten (83%) of 12 being given continuous infusion and 17 (77%) of 22 being given interrupted infusion of tobramycin. Nephrotoxic reaction occurred in 7% of patients treated with continuous infusion and 15% treated with interrupted infusion, mostly patients older than 60 years. Tobramycin, by either continuous or interrupted infusion, plus cefamandole is safe and efficacious empiric therapy for infections in patients with cancer and granulocytopenia.

Topics: Adult; Aged; Agranulocytosis; Bacterial Infections; Blood Urea Nitrogen; Cefamandole; Clostridium Infections; Creatinine; Drug Administration Schedule; Drug Therapy, Combination; Ear Diseases; Female; Humans; Infusions, Parenteral; Kidney Diseases; Male; Middle Aged; Neoplasms; Pseudomonas Infections; Tobramycin

In a randomized, prospective clinical trial cefamandole therapy was compared with cefamandole plus amdinocillin in infants and children with suspected bacterial infections. Fifty-two infections in 50 patients with bone and joint (19 infections), pulmonary (19 infections), soft tissue (eight infections), and urinary tract (6 infections) diseases were treated. Bacterial infection was documented in 31 patients. All isolates were susceptible to cefamandole except one strain of Serratia marcescens, which was susceptible to the combination. In vitro synergy was demonstrated in all coliform bacilli, in three of seven Haemophilus strains, and in six of 16 gram-positive cocci. No correlation between degree of serum bactericidal activity and presence or absence of synergy could be demonstrated. One patient treated with cefamandole died; all other patients responded promptly to therapy without serious adverse drug effects.

Topics: Amdinocillin; Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Drug Synergism; Drug Therapy, Combination; Humans; Infant; Microbial Sensitivity Tests; Pediatrics; Penicillanic Acid; Random Allocation

A randomized, prospective study of 200 consecutive established hand infections was designed to compare the efficacy of two antibiotics, cefamandole and nafcillin. Bacteriologic data revealed 63.5% of the patients grew multiple organisms (2.3 organisms per culture) and 26% of the patients had anaerobic infections. Complications were noted in 13% of all patients--26% in patients who grew aerobes and anaerobes and 9.8% in patients who grew aerobes alone (p less than 0.05). Despite the fact that 95% of all organisms were sensitive in vitro to cefamandole whereas only 67% of organisms were sensitive to nafcillin (p less than 0.01), complications occurred more frequently in patients treated with cefamandole. We conclude that the empirical selection of a broad-spectrum antibiotic is reasonable based on in vitro sensitivity studies; however, other factors such as treatment delay, initial extent of infection, anatomic location of infection, cause of infection, and extent of surgical debridement are important in the development of complications.

Topics: Adolescent; Adult; Aged; Bacteria, Anaerobic; Bacterial Infections; Cefamandole; Clinical Trials as Topic; Female; Hand Dermatoses; Humans; Male; Middle Aged; Nafcillin; Prospective Studies; Random Allocation; Skin Diseases, Infectious; Staphylococcal Infections; Streptococcal Infections

A randomized, double-blind, placebo-controlled study was done of a short course of cefamandole administered intravenously after cord clamping as prophylaxis in women undergoing primary nonelective cesarean section in a community hospital. Duration of labor equal to or more than 14 hours was the only significant risk factor between patients who had postoperative infectious morbidity and those who had none. Four of 43 patients (9.3%) who received cefamandole, as opposed to 13 of 47 (27.7%) who received the placebo, developed infections (p less than 0.05). This difference was reflected totally in the difference in endomyometritis development between the groups. The use of intraoperative culturing predicted infection in 4 of 13 patients in the placebo group who developed infections postoperatively. No adverse side effects were noted, and there were no cases of delayed serious infection.

Topics: Adult; Bacterial Infections; Cefamandole; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Intraoperative Period; Kentucky; Placenta; Postoperative Complications; Pregnancy; Premedication; Random Allocation; Surgical Wound Infection

A prospective, randomized study was performed to compare the efficacy and safety of mezlocillin plus sisomicin (Regimen A) and cefamandole plus tobramycin (Regimen B). Sixty-one episodes of documented infections were treated in 49 adult myelosuppressed cancer patients. About two-thirds of the patients treated with either regimen responded to this antibacterial therapy. The patients failing to respond to the initial therapy were treated with additional antibiotics, either with the empiric Regimen C (cefotaxime plus amikacin plus azlocillin) or with antibiotics selected on the basis of bacteriological results (Regimen D). With these schedules, the over-all response rate was increased to about 90%. The data suggest that febrile granulocytopenic cancer patients may profit from this empiric and sequential antibiotic treatment.

Topics: Adult; Aged; Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Clinical Trials as Topic; Drug Therapy, Combination; Humans; Leukemia; Lymphoma; Mezlocillin; Middle Aged; Neoplasms; Penicillins; Prospective Studies; Random Allocation; Sisomicin; Tobramycin

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Female; Humans; Male; Middle Aged; Random Allocation

A double-blind, prospective and randomized clinical trial of the efficacy of antibiotic prophylaxis in gastroduodenal operations was studied in 39 patients over an 18 month period. All patients had clinical features that placed them at high risk for the development of postoperative wound or intraabdominal sepsis. In the placebo group of 20 patients seven gastric-related infections developed, while 1 of the 19 patients who received perioperative cefamandole had one gastric-related infection (p less than 0.01). The responsible microorganisms were those that are normal components of the oral or intestinal microflora. Nongastric-related infections and deaths did not differ significantly in the two study groups. The results of this study confirm the efficacy of the use of short-term perioperative antibiotic prophylaxis in patients undergoing gastroduodenal surgery for bleeding duodenal or gastric ulcer, obstructing duodenal ulcer, gastric ulcer or malignancy.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Clinical Trials as Topic; Double-Blind Method; Duodenum; Gastric Juice; Humans; Postoperative Complications; Premedication; Prospective Studies; Stomach; 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

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

During an 18-month period, antibiotic prophylaxis in 120 patients undergoing closed tube thoracostomy was evaluated by a prospective, randomized double-blind technique. Forty-six subjects had sustained penetrating chest trauma. Either placebo (n = 60) or 1 gm/6 hours cefamandole (n = 60) was begun intravenously at the time of tube insertion and was continued intravenously or intramuscularly until the second day following tube removal. Cultures were taken of the pleural drainage, usually blood, at tube insertion, on tube removal, and on several occasions between those times. Antibiotic concentrations were determined biologically on the same specimens of pleural fluid as well as selectively on concomitant venous blood samples. Cultures were also obtained from all subsequent foci of infection, including the wound, any empyema, bronchial secretions, urine, or infected intravenous sites. Aerobic and anaerobic isolation and identification were carried out according to standard laboratory procedures with sensitivity testing (disc and tube dilution) only of the aerobes. Results demonstrated that infection of the lung and/or pleural space was eight times more common in the placebo groups (13.3%) than in the group receiving cefamandole (1.7%) (p less than 0.01). In addition, the single infection that developed despite use of the antibiotic was due to a susceptible organism. No major adverse drug reactions were noted.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Female; Humans; Male; Middle Aged; Pleura; Postoperative Complications; Premedication; Thoracic Surgery

A double-blind placebo-controlled experiment was performed in 100 patients in labor with membrane rupture to determine the bacteriologic effects of antibiotic prophylaxis. Each subject received either 2.0 g cefamandole or placebo after cord clamping and 4 and 8 hours later. The cefamandole group had significantly less endometritis, but did not have significantly fewer major complications. Amniotic fluid cultures of the 2 groups were similar, but uterine lavage cultures of the cefamandole group showed significant increases in enterococci and gram-negative aerobes and decreases in gram-positive anerobes and low virulence organisms (Staphylococcus epidermidis, lactobacilli, and diphtheroids). Although clinical problems did not regularly accompany these changes, it would be foolhardy to ignore them. Thus, when patients develop infection after antibiotic prophylaxis, the physician should check for infection with resistant organisms.

Topics: Bacterial Infections; Cefamandole; Cephalosporins; Cesarean Section; Double-Blind Method; Female; Humans; Placebos; Postoperative Complications; Pregnancy

Ten patients suffering from genital organ infections, urinary tract infections and symptomless bacteriuria were treated with cefamandole (CMD). CMD was administered intravenously and drip infusion at a dosage of 4.0 g/day for 4 approximately 10 days. Clinical results obtained were as follows: Of 6 patients with genital organ infections, excellent responses were seen in 2 patients, good responses in 4 patients. Of 3 patients with urinary tract infections, excellent responses were seen in 2 patients, and good response in 1 patient. The overall efficacy rate was 100%. In the cases of urinary tract infections and symptomless bacteriuria, 3 strains of E. coli and 1 strain of Streptococcus faecalis disappeared. On the other hand, in genital organ infections, we had no bacterial findings. No significant reaction was observed in clinical laboratory findings of hemogram or in test on renal and hepatic functions, except slight transient leukopenia observed in 1 patient.

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Clinical Trials as Topic; Female; Genital Diseases, Female; Humans; Middle Aged; Urinary Tract Infections

1) Tissue concentrations of cefamandole (CMD) one hour after the end of 2 g/30 approximately 60 minutes drip infusion were 7.3 approximately 13.1 microgram/g in uterus, ovary and oviduct. These concentrations were higher than MICs of 70 approximately 100% of causative organisms, including Staphylococcus aureus, Escherichia coli, Klebsiella, Proteus mirabilis, Enterobacter and Citrobacter, isolated from the infections in the field of obstetrics and gynecology. 2) CMD was administered to 14 patients with moderate infections in the field of obstetrics and gynecology at a daily dose of 4 g for 5 approximately 7 days. The overall clinical efficacy obtained was as follows; excellent in 7 cases (50%), good in 3 cases (21%) and poor in 4 cases (29%). 3) Antimicrobial activity of CMD against causative organisms resembled that of CEZ. 4) No adverse effects and abnormal laboratory findings were observed. From the above, we considered that CMD was an effective and safe antibiotic against infections in the field of obstetrics and gynecology.

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Clinical Trials as Topic; Female; Genital Diseases, Female; Genitalia, Female; Humans; Middle Aged

Five patients with suppurative tonsillitis (1), urinary tract infection (1), staphylococcal impetigo (1), cervical lymphadenitis (1) and mycoplasma pneumonia were treated with cefamandole (CMD). CMD was administered by one shot intravenous or drip infusion at a dosage of 100 approximately 135 mg/kg/day for 4 approximately 14 days. Of 5 patients with those infections, excellent response was obtained in 3 patients, good response in 1 patient and unknown response in 1 patient. The overall efficacy rate was 100% except unknown response in mycoplasma pneumonia. In 3 of these 5 cases causative organisms were S. epidermidis, E. coli, and S. aureus, respectively. These organisms were all eliminated. No side effects were observed.

Topics: Age Factors; Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Male

140 cases of patients requiring sternotomy incisions were divided into two groups receiving Penicillin/Flucloxacillin and Cefamandole prophylaxis. Pre- and post-operative and bypass circuit bacteriology was performed to determine the extent of contamination and infection with each regime after operations lasting 7 or more hours. Unexpectedly high contamination of the respiratory tract was observed in patients receiving Penicillin/Flucloxacillin prophylaxis. Significantly higher Slesser Intensive Therapy Unit stays were observed in 8 of these patients, 3 of whom succumbed to chest infection associated pathology. The 50% resistant organism rate in the Cefa group (Table IV) suggests that short sharp course prophylaxis (i.e. less than 48 hours) using wide spectrum antibiotics is effective and does not necessarily promote emergence of resistant organisms over or above that of any narrow spectrum antibiotic prophylaxis. Acceptably low wound infection rates in both groups suggests that wound healing (aided by iodine sprays topically before closure) is more dependent on closing technique than on type of antibiotic prophylaxis. The very similar bacteriaemia rates, with odd organisms, in both groups in the immediate post-operative period suggests that vigilance and frequent post-operative blood cultures are a surer policy in the prevention and treatment of early endocarditis than faith in any particular antibiotic prophylaxis.

Topics: Bacterial Infections; Cardiac Surgical Procedures; Cefamandole; Cephalosporins; Clinical Trials as Topic; Endocarditis; Floxacillin; Humans; Penicillins; Surgical Wound Infection

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

Cefamandole nafate has been shown to have good in vitro activity against a wide spectrum of aerobic and anaerobic pathogens frequently isolated from women with obstetrical and gynecological infections. One hundred and twenty seven women with these infections were treated with cefamandole: 78 had post-cesarean section metritis; 24 acute pelvic inflammatory disease; 18 post-hysterectomy cuff cellulitis/abscess; and 7 had vulvar or abdominal wound abscesses. All but 13% of these women had either polymicrobial aerobic/anaerobic bacterial infections, or had an anaerobic infection alone. Of these 127 women, 116 responded to cefamandole administration alone, and in the other 11 chloramphenicol was added. Of these 11, surgical therapy was necessary to eradicate infection in six women. Phlebitis, mild to severe, was demonstrated in 14% of the women and responded to conservative measures. Of 402 bacterial isolates from these women, 94% were sensitive to cefamandole at 32 microgram/ml, an easily achievable serum level. Anaerobic streptococci were the most common isolate and 94% of these organisms were sensitive at 32 microgram/ml. Of the 43 Bacteroides species isolated, 90% were susceptible at 32 microgram/ml; 84% of Bacteroides fragilis were susceptible ast this concentration. Data now presented indicate that cefamandole given alone is safe and effective for treatment of women with polymicrobial mixed aerobic/anaerobic pelvic infections and approximately 5% will require surgical therapy for eradication of these infections.

Topics: Aerobiosis; Anaerobiosis; Bacteria; Bacterial Infections; Bacteroides; Cefamandole; Cephalosporins; Cesarean Section; Chloramphenicol; Clinical Trials as Topic; Female; Genital Diseases, Female; Humans; Phlebitis; Postoperative Complications; Pregnancy; Puerperal Disorders

Thirty-one adult patients with infections due to anaerobic bacteria were treated with cefamandole. Bacteroides fragilis group (17) and Bacteroides melaninogenicus (13) were the most frequent anaerobes isolated. Duration of therapy varied from 2 to 49 days. Results were judged satisfactory in 26 cases, and unsatisfactory in 1 case. Four cases could not be evaluated. Adverse reactions occurred in 16 patients and included positive direct Coomb's test without hemolysis, transient liver function abnormalities, phlebitis, reversible neutropenia, fever, eosinophilia, and toxic epidermal necrolysis. The more significant reactions were associated with prolonged therapy. None was lethal. These data suggest that cefamandole is effective in treatment of most anaerobic infections.

Topics: Aerobiosis; Anaerobiosis; Bacteria; Bacterial Infections; Bacteroides Infections; Cefamandole; Cephalosporins; Clinical Trials as Topic; Humans

Topics: Anaerobiosis; Bacterial Infections; Bacteroides Infections; Cefamandole; Cephalosporins; Clinical Trials as Topic; Female; Humans

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

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Child; Child, Preschool; Clindamycin; Drug Therapy, Combination; Erythromycin; Female; Gentamicins; Humans; Infant; Male; Metronidazole; Middle Aged; Peritonitis; Surgical Wound Infection

Thirty-one adult patients with infections due to anaerobic bacteria were treated with cefamandole. Bacteroides fragilis group (17) and Bacteroides melaninogenicus (13) were the most frequent anaerobes isolated. Duration of therapy varied from 2 to 49 days. Results were judged satisfactory in 26 cases, and unsatisfactory in 1 case. Four cases could not be evaluated. Adverse reactions occurred in 16 patients and included positive direct Coombs' test without hemolysis, transient liver function abnormalities, phlebitis, reversible neutropenia, fever, eosinophilia, and toxic epidermal necrolysis. The more significant reactions were associated with prolonged therapy. None was lethal. These data suggest that cefamandole is effective in treatment of most anaerobic infections.

Topics: Adult; Anaerobiosis; Bacterial Infections; Cefamandole; Cephalosporins; Clinical Trials as Topic; Humans; Microbial Sensitivity Tests; Time Factors

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

Patients were randomly assigned to receive carbenicillin plus tobramycin by continuous infusion (C+T), carbenicillin plus cefamandole by continuous infusion (C+CC) or carbenicillin plus cefamandole by intermittent infusion (C+IC) during 490 febrile episodes. Carbenicillin was administered over 2 hours every 4 hours. The per cent of cures achieved during the 235 documented infections was 65 per cent for C+CC, 57 per cent for C+IC and 54 per cent for C+T. Among those infections caused by single gram-negative bacilli, C+CC produced a higher cure rate than C+IC or C+T(74 per cent versus 59 per cent versus 50 per cent). C+CC was significantly more effective than C+IC among patients with persistent severe neutropenia of less than 100 neutrophils/mm3 (65 per cent versus 21 per cent, p = 0.03). If the infecting organism was sensitive to both antibiotics, the cure rate which occurred during 12 per cent to 13 per cent of the febrile episodes, regardless of antibiotic regimen. However, it occurred significantly more often during documented infections than during fevers of unknown etiology (20 per cent versus 6 per cent, p less than 0.001). C+CC appears to be the most effective of the three regimens for the treatment of infections in patients with persistent severe neutropenia.

Topics: Bacterial Infections; Carbenicillin; Cefamandole; Cephalosporins; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever of Unknown Origin; Humans; Male; Middle Aged; Neoplasms; Tobramycin

Since the introduction of cephalothin and cephaloridine as the first parenteral cephalosporins and cephalexin as the first member of the group which is absorbed from the gastrointestinal tract, several new cephalosporin derivatives have been developed. Most of these have no major advantages over cephalothin, cephaloridine or cephalexin. Increased knowledge about the importance of beta-lactamases for bacterial resistance against beta-lactam antibiotics has focused interest on development of drugs with increased resistance to degradation by these enzymes. Among the caphalosporins, cefamandole and cefuroxime have been found to be markedly more active against beta-lactamase producing Gram-negative bacteria. A new group of beta-lactam antibiotics, the cephamycins, have been introduced with cefoxitin as the first clinically useful member. Cefoxitin has the spectrum of a beta-lactamase-resistant cephalosporin and is also active against Bacteroides fragilis. The review concentrates on the antibacterial spectrum of these three new antibiotics and on their clinical efficacy.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefoxitin; Cephalosporinase; Cephalosporins; Cephamycins; Clinical Trials as Topic; Drug Evaluation; Drug Resistance, Microbial; Furans; Humans; Penicillinase

Intravascular catheters are widely employed in medical practice. However, complications such as local or systemic infections are frequently related to their use. The significant increase in this type of nosocomial infection has prompted the search for new strategies to prevent them. This paper reports on an experimental model to prevent catheter-related infections based on the adsorption of a beta-lactam antibiotic (cefamandole nafate) on functionalized urethane polymers. The polyurethanes synthesized were used to coat a commercial central venous catheter. The influence of functional groups on the polymer-antibiotic interaction was analyzed and the kinetics of the antibiotic release from the catheters was dynamically studied. We were able to realize a polymer-antibiotic system able to inhibit bacterial growth up to 7 days. These promising results have encouraged us to extend this experimental model to other polymer-antibiotic systems in order to identify those allowing bacterial growth inhibition for longer times.

Topics: Anti-Bacterial Agents; Bacterial Infections; Biofilms; Catheterization, Central Venous; Cefamandole; Drug Delivery Systems; Humans; Polymers

Topics: Adenocarcinoma; Adult; Bacterial Infections; Bronchoalveolar Lavage Fluid; Carcinoma, Squamous Cell; Cefamandole; Glottis; Humans; Intraoperative Care; Lung Neoplasms

More than 12,800 clinical isolates from 115,373 in-patient specimens obtained at the Sir Charles Gairdner Hospital, Perth, Western Australia, were identified and analysed statistically for relationships with usage of three generations of cephalosporins over the 5-year period from July 1984 to June 1989. A positive relationship between cephalosporin usage and significantly increasing isolation rates for those species capable of producing chromosomal beta-lactamases was observed. Simultaneously, a small increase in the isolation frequency of non-chromosomal beta-lactamase-producing strains was noted and no correlation with cephalosporin usage was demonstrated. The trend toward predomination in the hospital environment of strains possessing substantial cephalosporin resistance has implications for future antimicrobial policy, choice of empiric therapy and the predictive value of standard antimicrobial susceptibility tests.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Humans; Western Australia

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteria; Bacterial Infections; Cefamandole; Ceftriaxone; Cesarean Section; Female; Humans; Hysterectomy, Vaginal; Middle Aged; Pregnancy; Preoperative Care; Surgical Wound Infection

A prospective study of 443 patients undergoing clean contaminated operations of the colon was undertaken to determine the efficacy of subcutaneous and intraperitoneal antibiotics in reducing infection. All of the patients received a mechanical intestinal preparation as well as preoperative antibiotics taken orally and preoperative and postoperative antibiotics administered intravenously. The over-all wound infection rate was 2 per cent. The routine additional use of subcutaneous or intraperitoneal antibiotics had no proved efficacy in this study.

Topics: Administration, Cutaneous; Administration, Oral; Ampicillin; Bacterial Infections; Cefamandole; Colectomy; Erythromycin; Humans; Infusions, Parenteral; Kanamycin; Neomycin; Premedication; Prospective Studies; Surgical Wound Infection; Therapeutic Irrigation; Urinary Catheterization

Topics: Adult; Bacterial Infections; Cefamandole; Cefonicid; Cefoxitin; Cesarean Section; Cost-Benefit Analysis; Female; Humans; Postoperative Complications; Pregnancy

Patients with serious infections often remain hospitalized solely to continue parenteral antibiotic therapy although many who are afebrile and medically stable could complete treatment in an outpatient setting. Potential advantages of outpatient treatment include lower costs and greater efficiency in the use of hospital beds, and economic and psychological benefits to patients. Cefonicid, a parenteral cephalosporin with an extended antibacterial spectrum and a prolonged serum half-life, was used to treat 39 patients with serious infections, mostly those of bone or soft tissues. Staphylococcus aureus was the predominant pathogen isolated (18 patients); nine gram-negative aerobes were observed in single instances. After indicated surgical procedures and inpatient intravenous antibiotic therapy, the patients were discharged to continue parenteral therapy at home with once-daily intramuscular doses of cefonicid. Mean duration of outpatient therapy was 16 days. The clinical response was satisfactory in all but two patients, one with relapse of a S aureus wound infection, the second with a gram-negative reinfection at the site of a bone cyst. Systemic and local tolerability of cefonicid were good. It is concluded that outpatient antibiotic therapy with intramuscular cefonicid can benefit both patients and hospitals.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefamandole; Cefonicid; Child; Female; Home Care Services; Home Nursing; Humans; Injections, Intramuscular; Male; Middle Aged; Retrospective Studies; Self Administration

The in vitro antimicrobial activity of cefonicid has been tested against 27 recent clinical isolates of 7 different species (S. aureus, E. coli, K. pneumoniae, P. mirabilis, S. marcescens, E. cloacae and P. aeruginosa) using the MS-2 Research System, contrast phase microscopy and the colony forming unit assay. With the exception of P. aeruginosa, S. marcescens and E. cloacae, cefonicid showed excellent activity against the different bacterial species tested (i.e. S. aureus, E. coli, K. pneumoniae and P. mirabilis). Tissue penetration of cefonicid after a single i.m. or i.v. dose (1 or 2 g, respectively) was also studied using the suction blister method. In 14 adult subjects with normal renal and liver functions, cefonicid plasma half-life was 5.1 and 5.4 h following i.v. and i.m. administration. Drug concentrations achieved at peak in plasma and suction blister fluid were higher than the minimum inhibitory concentrations for most sensitive pathogens and remained above these values for 24 h. These data support the use of a single daily dose regimen of cefonicid, both i.v. and i.m., for the treatment of most common infections caused by sensitive pathogens in blood and tissues.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefonicid; Drug Resistance, Microbial; Female; Half-Life; Humans; Injections, Intramuscular; Injections, Intravenous; Kinetics; Male; Microbial Sensitivity Tests; Middle Aged; Skin Absorption

Cefonicid (Monocid) and ceftriaxone (Rocephin) are long half-life cephalosporins that may be used for serious infections in the outpatient setting. They may be used as an extension of initial hospital treatment, or therapy can be initiated and completed in many cases with the patient remaining at home. Sufficient clinical experience exists with both ceftriaxone and cefonicid to recommend these agents for selected patients having pyelonephritis, osteomyelitis, or soft tissue infections. Cefonicid, perhaps in combination with erythromycin, will provide excellent coverage for complicated community-acquired pneumonias. Ceftriaxone is effective as single-dose therapy for even complicated gonococcal infections. The use of long half-life cephalosporins in ambulatory practice may result in substantial cost savings for certain patients.

Topics: Ambulatory Care; Bacterial Infections; Cefamandole; Cefonicid; Ceftriaxone; Cellulitis; Cephalosporins; Gonorrhea; Half-Life; Humans; Injections, Intramuscular; Osteomyelitis; Pyelonephritis; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections

The third-generation cephalosporins offer considerable appeal for treatment of specific life-threatening infections (nosocomial pneumonia, meningitis, urosepsis) in elderly patients when the disorders are caused by aerobic gram-negative bacilli. Despite the frequent presence of cross-reactive antibodies in the sera of recipients of cephalosporins, clinically evident serious reactions to cephalosporins occur infrequently in patients with known penicillin allergy.

Topics: Bacterial Infections; Cefamandole; Cefazolin; Cefonicid; Cefotetan; Cefoxitin; Cefuroxime; Cephalosporins; Cephamycins; Geriatrics; Humans

Plasma levels of antibiotics often do not correlate well with their tissue levels. To determine optimal antibiotic coverage for prophylactic effect in vascular surgery, we studied the tissue pharmacokinetics of four cephalosporins in dogs: cefazolin, cefoxitin, cefamandole, and moxalactam for 3 hours after a single (25 mg/kg) intravenous injection. The minimal inhibitory concentration (MIC) of these antibiotics for the three most common pathogens involved in graft infections (Staphylococcus aureus, S. albus, and Escherichia coli) and their tissue concentration (TC) in the plasma, muscle, subcutaneous tissue, and aortic wall were assayed. The data are presented as TC/MIC ratio. Cefoxitin and moxalactam failed to achieve an effective therapeutic TC/MIC ratio (greater than 10) for S. aureus and S. albus in all the tissues studied whereas cefoxitin and cefamandole were above therapeutic levels. All antibiotics achieved an effective therapeutic ratio against E. coli, but cefamandole performed better (p less than 0.05) than cefoxitin; the latter reached effective levels at 3 hours. Cefamandole attained the most effective bioactive aortic tissue levels when the three most common pathogens were considered together and should therefore be considered as an antibiotic agent of choice for prophylaxis in vascular surgery.

Topics: Animals; Aorta; Bacterial Infections; Cefamandole; Cefazolin; Cefoxitin; Cephalosporins; Dogs; Escherichia coli Infections; Kinetics; Moxalactam; Muscles; Staphylococcal Infections; Time Factors; Tissue Distribution; Vascular Surgical Procedures

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefamandole; Cefonicid; Costs and Cost Analysis; Humans; Middle Aged

Topics: Bacterial Infections; Cefamandole; Child; Humans; Injections, Intramuscular; Safety

Infectious complications were studied in 14 patients who received heart-lung transplants at Stanford University Medical Center from March 1981 to November 1983. Twenty-nine infections occurred in 12 patients: 18 bacterial, nine viral, and two fungal. Sixteen (89 percent) of the bacterial infections occurred in the lung. Because of frequent colonization of the lower respiratory tract, the specificity of transtracheal aspiration and bronchoscopy was low. Empiric broad-spectrum antibiotic therapy was usually successful, and no patient died of bacterial infection. Cytomegalovirus infection occurred in six and herpes simplex virus infection in three patients. Two patients had invasive candidiasis at postmortem examination. This series emphasizes the importance of infection, particularly of the lung, in causing morbidity and mortality in heart-lung transplant recipients.

Topics: Adult; Antilymphocyte Serum; Bacterial Infections; Candidiasis; Cefamandole; Cyclosporins; Cytomegalovirus Infections; Female; Graft Rejection; Heart Transplantation; Heart-Lung Transplantation; Herpes Simplex; Humans; Lung Transplantation; Male; Methylprednisolone; Middle Aged; Pneumonia; Postoperative Care; Postoperative Complications; Premedication; T-Lymphocytes

Risk factors for severe bacterial infections, that is, deep sternal wound infection, pneumonia, septicemia, and prosthetic valve endocarditis, were evaluated in 246 consecutive patients undergoing valve replacement (N = 84) or aortocoronary bypass operation (N = 162). Multiple logistic regression analysis was applied to determine the ability of putative risk factors to predict infection. The risk factors considered were age, sex, diabetes mellitus, duration of cardiopulmonary bypass (CPB), duration of operation, amount of blood restored on the day of operation, repeat thoracotomy for bleeding, intraaortic balloon pumping, reoperation, emergency operation, and the professional status of the surgeon. Severe infections occurred in similar frequency after valve replacement (8/84; 9.5%) and aortocoronary bypass (11/162; 6.8%). For patients who had a bypass procedure, repeat thoracotomy was the only factor significantly associated with infection (p = 0.0004). However, the classification analysis revealed that this variable alone is too unspecific for a reliable prediction. Univariate analysis indicated that restoration of more than 2,500 ml of blood (p = 0.0001), reoperation (p = 0.0821), duration of operation (p = 0.0061), duration of CPB (p = 0.0318), and intraaortic balloon pumping (p = 0.0281) were associated with infection following valve replacement. A model with three variables emerged from the multiple logistic regression: after correction for blood restoration, reoperation, and duration of CPB, no other variable was of additional predictive value. For patients who underwent valve replacement, the model performed well in predicting complications. The classification analysis revealed a high correspondence between observed and predicted instances of infection: it correctly predicted 75% of the patients with infection and 96% of those without infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Age Factors; Aged; Bacterial Infections; Blood Transfusion; Cardiopulmonary Bypass; Cefamandole; Coronary Artery Bypass; Diabetes Mellitus; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Premedication; Regression Analysis; Reoperation; Risk; Sex Factors; Surgical Wound Infection; Time Factors

Topics: Administration, Topical; Bacterial Infections; Cefamandole; Drainage; Escherichia coli Infections; Female; Humans; Hysterectomy; Parametritis; Postoperative Complications; Premedication; Random Allocation; Therapeutic Irrigation

Transfer of Cefamandole resistance was demonstrated from strains of Citrobacter freundii as well as from individual strains of Enterobacter cloacae, Acinetobacter anitratus and Klebsiella pneumoniae isolated from patients in two newborn units. In Citrobacter freundii, Cefamandole resistance was transferred always with Cephalotin resistance as well as with a TEM-like beta lactamase (conferring resistance to Ampicillin, Carbenicillin and Azlocillin). Citrobacter freundii strains from Hospital I were completely susceptible to gentamicin, while strains of other species, resistant to Cefamandole plus Cephalotin, were resistant to Gentamicin as well, and transferred this resistance, too. In one Enterobacter cloacae strain from Hospital I, Cefamandole resistance could be separated from resistance to Cephalotin, but only in clones selected with gentamicin and not with any of the cephalosporins. Acinetobacter anitratus strain was also resistant to Cefotaxime, but did not transfer this resistance. It might be concluded that special nosocomial bacteria may carry plasmids conferring a transferable type of resistance to Cefamandole together with resistance to classical cephalosporines. Second cycle of transfers, i.e. between two variants of E. coli K-12 strains confirmed the contransferability of Cefamandole and Cephalotin resistance.

Topics: Acinetobacter; Bacteria; Bacterial Infections; Cefamandole; Citrobacter; Drug Resistance, Microbial; Enterobacter; Humans; Infant, Newborn; Klebsiella pneumoniae; Nurseries, Infant; R Factors

All patients receiving cefoxitin and cefamandole were prospectively reviewed for appropriate and inappropriate utilization. There were two eight-week survey periods. In period 1, 81 (70%) of 115 patients received cefoxitin appropriately and six (40%) of 15 patients received cefamandole appropriately. In patients receiving antibiotics inappropriately, 12 (35%) of the 34 receiving cefoxitin and eight (89%) of the nine receiving cefamandole had infections that could have been treated with less expensive, equally efficacious antibiotics. Changes in antibiotic therapy were made in 79% of patients based on our recommendations. The estimated annual cost saving for these antibiotics was $40,290. During period 2, 73 (91%) of 80 patients were given cefoxitin appropriately and 14 (61%) of 23 patients received cefamandole appropriately. Forty-three percent of those receiving cefoxitin and 33% of those receiving cefamandole inappropriately could have been treated with a less expensive, equally efficacious antibiotic. In 88% of patients, the attending physicians followed our recommendations.

Topics: Bacterial Infections; Cefamandole; Cefoxitin; Cost Control; Drug Utilization; Hospitals, Community; Hospitals, Teaching; Humans; New Jersey; Prospective Studies

Results of treatment of urinary tract infection in 110 patients using new beta-lactam antibiotics are presented in summary. While in the uncomplicated infections a cure rate approaching 100% was observed even with very small dosages, complicated cases required higher dosages to achieve satisfactory clinical cure rates and especially to achieve acceptable bacteriological cure rates. The continuous need for new, more potent antibiotics is becoming apparent due to the increasing resistance rates of pathogens to the existing agents. The group of beta-lactam antibiotics offers much hope due to the continuous development of numerous new compounds with better antibacterial and kinetic properties, offering at the same time a very high degree of safety, compared to aminoglycosides and most other antibiotic groups.

Topics: Anti-Bacterial Agents; Bacterial Infections; beta-Lactamase Inhibitors; Cefamandole; Ceftazidime; Humans; Penicillins; Urinary Tract Infections

The present study was designed to evaluate perioperative antibio-therapy with cefamandol for the prevention of post-operative infections after surgery under cardiopulmonary bypass. 1 300 patients were studied. The incidence for wound infections was 1.3%, 0.9% for systemic, 1.3% for other infections. These results show a decrease in the frequency of infections in comparison with data from the literature.

Topics: Adult; Bacterial Infections; Cefamandole; Child; Extracorporeal Circulation; Humans; Surgical Wound Infection; Thoracic Surgery

One-gram doses of cefonicid sodium were given intravenously to patients prior to cataract surgery. Although serum levels were high, cefonicid levels in aqueous humor were low: mean peak concentrations of 0.25 and 0.27 mg/L were observed two and four hours after administration, respectively. The unusually high protein binding of cefonicid may explain these observations. The observed concentrations were not above the minimum inhibitory concentrations of cefonicid for those pathogens commonly involved in bacterial endophthalmitis.

Topics: Aqueous Humor; Bacterial Infections; Cefamandole; Cefonicid; Endophthalmitis; Eye Proteins; Humans; Protein Binding

Topics: Bacterial Infections; Cefamandole; Cefuroxime; Cephalosporins; Humans; Kidney; Liver

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Child; Female; Gentamicins; Humans; Injections, Intravenous; Male; Middle Aged

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cross Infection; Female; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritonitis

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

Hand lacerations, especially when inadequately treated, may result in infections caused by aerobic or anaerobic bacteria. Anaerobic infections most commonly result from human bite injuries in which there is contact between hand and mouth. The search continues for an ideal antibiotic to employ when anaerobic organisms are suspected. In this study cefamandole, a new cephalosporin antibiotic, was employed whenever anaerobic hand infections were suspected following trauma. In each patient quantitative cultures for both aerobic and anaerobic organisms were obtained. All organisms isolated were tested by standard susceptibility assays for both aerobes and anaerobes. In the case of anaerobes, minimum inhibitory concentration assays were also performed. After the initial culture was obtained, each patient received approximately 1.5 gm of cefamandole every 6 hours for a period of 5 days. This therapy was changed only if susceptibility studies indicated resistance to cefamandole. In our patients, 58% of the infectious organisms were aerobic and facultative anaerobic and 42% were obligate anaerobes. The predominant organisms isolated were Staphylococcus aureus and Peptostreptococcus anaerobius, which accounted for 42% of the infections. In most of the aerobic infections a single organism was isolated, whereas multiple organisms were identified in the anaerobic infections. All but one of the infections responded to cefamandole; the one that didn't was caused by Enterobacter cloacae and required treatment with an aminoglycoside. Because of its broad-spectrum coverage, which includes both aerobes and anaerobes, cefamandole is useful in treating infections, especially those resulting from human bites.

Topics: Adolescent; Adult; Bacterial Infections; Cefamandole; Enterococcus faecalis; Female; Hand Dermatoses; Humans; Male; Peptostreptococcus; Skin Diseases, Infectious; Staphylococcal Infections; Streptococcal Infections

The enthusiasm for the use of peritoneal irrigation has waxed and waned since its introduction by Dr. Pierce in 1905. The purpose of this study was to devise a relatively low-cost irrigant that could be used for continuous intraperitoneal lavage, with the intent of decreasing abscess formation following surgical treatment for generalized bacterial peritonitis. A solution of 1 L of normal saline containing 50 mg erythromycin, 50 mg cefamandole, 500 U heparin, and 5 mEq KCl was proven in in vitro studies to be bactericidal to Peptococcus anaerobius and Clostridium perfringens, and bacteriostatic to Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Streptococcus faecalis, and Bacteroides fragilis. In a prospective study 50 patients underwent peritoneal lavage with 36 L over 2 days. No lavage patients developed intraabdominal abscesses. In a control group of 44 patients seven patients (15.9%) developed postoperative abscesses.

Topics: Adult; Bacterial Infections; Cefamandole; Drug Combinations; Erythromycin; Heparin; Humans; In Vitro Techniques; Middle Aged; Peritonitis; Postoperative Complications; Prospective Studies; Therapeutic Irrigation

Cefamandole was evaluated for the initial management of bacterial infections in 60 infants and children. Infections included cellulitis (22), pneumonia (21), cervical lymphadenitis (8), arthritis or osteomyelitis (6), otitis media (2), and epiglottitis 91). Appropriate bacterial cultures and laboratory tests were performed for all patients. Cefamandole, 100 to 150 mg/kg/day divided into four doses given every six hours, was administered by the intravenous route. All bacterial isolates were sensitive to cefamandole, and all patients had good clinical and bacteriological responses. Duration of cefamandole therapy ranged between three and 30 days. Some of the patients' treatments were changed to specific narrow-spectrum antimicrobials after availability of the bacterial sensitivities. Cefamandole was tolerated well by most patients. Mild leukopenia and neutropenia developed in one patient and slight eosinophilia in four patients. These hematological abnormalities resolved spontaneously. These data suggest that cefamandole is an effective agent for the initial treatment of nonmeningitic infections in children.

Topics: Adolescent; Arthritis, Infectious; Bacterial Infections; Cefamandole; Cellulitis; Child; Child, Preschool; Epiglottitis; Female; Humans; Infant; Lymphadenitis; Male; Osteomyelitis; Otitis Media; Pneumonia

Topics: Adolescent; Adult; Bacterial Infections; Cefamandole; Cephalosporins; Cesarean Section; Female; Genital Diseases, Female; Humans; Middle Aged; Postoperative Complications

Topics: Bacterial Infections; Carbenicillin; Cefamandole; Cefazolin; Cefotaxime; Ceftizoxime; Cephalothin; Humans; Penicillin Resistance; Tobramycin

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Cefazolin; Cefotaxime; Ceftizoxime; Cephalosporins; Humans; Respiratory Tract Infections; Skin Diseases, Infectious; Tobramycin; Urinary Tract Infections

The ability of cefoxitin to antagonize the in vivo efficacy of cefamandole and carbenicillin as predicted by in vitro assays was analyzed in experimental infections in mice. Cefoxitin was administered in a nonprotective dose either at the time of challenge or simultaneously with the protective drug, 1 and 3.5 h postchallenge. In mice infected with Enterobacter cloacae, median 50% protective doses of cefamandole and carbenicillin were markedly increased by cefoxitin, especially when the latter was given at the time of challenge. The antagonistic effect was also associated with increased numbers of challenge bacteria present in animal heart blood within a 6.5-h period after infection. In infections with Pseudomonas aeruginosa, cefoxitin antagonized carbenicillin; however, the effect was less dramatic than that seen with E. cloacae. Antagonism in this model was pronounced with simultaneous administration of antagonizing and protective drugs. The antagonistic effects observed in all in vivo tests were not due to the selection of stable resistance to the protective drugs, but appeared to be due to a reversible induction of beta-lactamases by cefoxitin.

Topics: Animals; Bacterial Infections; Carbenicillin; Cefamandole; Cefoxitin; Cephalosporins; Lactams; Male; Mice; Penicillin Resistance; Sepsis

We studied the pharmacokinetics of intramuscular ceforanide in 46 infants, children, and adolescents, ranging in age from 1 month to 17 years. After the subjects were given 20-mg doses of ceforanide per kg, the mean peak plasma concentration was 56.3 microgram/ml (range, 27.0 to 95.0), the mean 8-h level was 5.9 microgram/ml (range, 1.5 to 13.5), and the mean 12-h level was 1.5 microgram/ml (range, 0.2 to 4.2). Ceforanide half-life varied with the ages of the patients: in 1- to 2-year-old children, in half-life was significantly shorter (1.5 h) than in younger or older children. Plasma concentrations at 8 and 12 h after a dose were lowest in 1- to 2-year-old children. There was no relationship between the area under the curve, the volume of distribution, or the body clearance of ceforanide to the ages of the patients. Within 6 h of administration of the drug, a mean of 77.5% of a dose was excreted in urine, and at the end of 12 h, virtually all (93.9%) of the administered dose was recovered in urine samples. The administration of ceforanide every 12 h did not result in drug accumulation. A dose of 20 mg of ceforanide per kg every 12 h is recommended for most pediatric patients. Dosage recommendations for 1- to 2 year-old children are presented.

Topics: Adolescent; Age Factors; Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Drug Administration Schedule; Female; Half-Life; Humans; Infant; Injections, Intramuscular; Kinetics; Male

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cefuroxime; Cephalosporins; Female; Femur Head; Hip Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Premedication

27 male adult patients with acute soft tissue infections including cellulitis, abscesses, ulcers and wound infections were treated with a dose of 2-4 g/day of cefamandole nafate by the intravenous route for a minimum of 10 days. Most patients were seriously ill with underlying conditions like diabetes mellitus, alcoholism and congestive heart failure and required hospitalization and parenteral antibiotics. Gram-positive cocci (predominantly Staphylococcus aureus) and gram-negative bacilli were recovered on pretreatment cultures from 81% of the patients. Clinical and bacteriologic response was excellent. Disappearance of the signs of infection occurred by the 7th day of treatment, by day 3 of treatment fever was down to normal, and by day 5 of treatment the WBC count was below 8,000. There were very few side effects noted, and there was excellent tolerance to the intravenous drug administration. Cefamandole nafate is a safe, effective and well-tolerated agent in the treatment of skin and soft tissue infections of adult patients caused by susceptible organisms.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefamandole; Cephalosporins; Cephalothin; Humans; Male; Methicillin; Middle Aged; Penicillins

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

The in vitro activity of cefmenoxime (SCE-1365 or A-50912), a new semisynthetic cephalosporin antibiotic, was compared with those of cefazolin, cefoxitin, and cefamandole against a broad spectrum of 486 organisms and with that of cefotaxime against 114 organisms. Cefmenoxime and cefotaxime exhibited nearly equivalent activities against those organisms tested and were the most active of these cephalosporins against all aerobic and facultative organisms except Staphylococcus aureus. The minimum inhibitory concentration (MIC) of cefmenoxime required to inhibit at least 90% of strains tested (MIC(90)) ranged from 0.06 to 8 mug/ml for the Enterobacteriaceae. The MIC(90)s for gram-positive cocci were 0.015 and 128 mug/ml with good activity against the gram-positive organisms. In addition, cefmenoxime activity was bactericidal and only slightly affected by differences in inoculum size. The combination of cefmenoxime and gentamicin was synergistic against 80% of the Enterobacteriaceae and 100% of P. aeruginosa strains tested. Development of resistance to cefmenoxime was slow or absent for organisms with low initial MICs but more rapid for those with higher initial MICs. Cefmenoxime exhibited good protective activity in mice infected with Escherichia coli, Enterobacter cloacae, Proteus mirabilis, Proteus vulgaris, or S. aureus but was less effective against P. aeruginosa.

Topics: Animals; Bacteria; Bacterial Infections; Cefamandole; Cefazolin; Cefmenoxime; Cefotaxime; Cefoxitin; Cephalosporins; Drug Synergism; Female; Mice

Moxalactam was evaluated in the therapy of lower respiratory tract infections in 40 patients. The most common organisms isolated were Streptococcus pneumoniae (37.2%) and Haemophilus influenzae (21.5%). Gram-negative enteric organisms were isolated from six patients. No patient was evaluated as a treatment failure; however, two patients died of unrelated causes either during therapy or in the immediate posttherapy period. We determined the comparative minimal inhibitory concentrations of moxalactam, cefamandole, and cephalothin for our aerobic clinical isolates. Susceptibilities of the anaerobic isolates were measured by the Kirby-Bauer method. All isolates were susceptible to moxalactam. Moxalactam was found to be highly effective in the therapy of lower respiratory tract infections.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefamandole; Cephalosporins; Cephalothin; Cephamycins; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Moxalactam; Pneumonia; Species Specificity

Topics: Bacteria; Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Enteritis; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Otitis Media; Respiratory Tract Infections; Tonsillitis; Urinary Tract Infections

We used cefamandole in the initial treatment of 34 children (10 months to 15 years of age) with suspected bone, joint, or soft tissue infections. The minimal inhibitory concentration of organisms encountered ranged between 0.015 and 2 microgram/ml. At 1 h after intravenous infusion of 25 mg/kg, the mean serum level of cefamandole was 26.2 microgram/ml (range, 8.9 to 47.5 microgram/ml), and at 3 h the level was 1.8 microgram/ml (range, 0.6 to 4.4 microgram/ml), which is above the minimal inhibitory concentration for most of the organisms encountered. However, when the drug was given intravenously every 6 h, the mean level after a 37-mg/kg dose was 0.9 microgram/ml (range, less than 0.5 to 1.9 microgram/ml) at 4 h and, by extrapolation, would have fallen below 0.1 microgram/ml at 6 h. The mean serum half-life was 34 min. Cefamandole appeared to diffuse well into synovial fluid, with joint fluid levels between 5 and 40 microgram/ml. The drug was tolerated well. Cefamandole appears to be a reasonable alternative in the initial treatment of skeletal infections in children, but need to be administered every 4 h to maintain suprainhibitory serum levels between doses.

Topics: Adolescent; Arthritis, Infectious; Bacterial Infections; Cefamandole; Cellulitis; Cephalosporins; Child; Child, Preschool; Half-Life; Humans; Infant; Osteomyelitis; Wound Infection

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

Specimens received at a district laboratory over a period of 4 months were investigated for determination of the sensitivities of common pathogens to 4 cephalosporins, ampicillin and mecillinam. A total of 1035 freshly isolated clinically significant organisms was studied. When sensitivities of all pathogens were considered, the majority were found to be resistant to ampicillin and mecillinam and sensitive to the cephalosporins. Sensitivity figures changed considerably when individual groups of organisms were considered. The great majority of urinary pathogens were sensitive to mecillinam, but not to ampicillin. This pattern was reversed when respiratory pathogens were considered. Only a few pathogens from wound swabs were sensitive to either ampicillin or mecillinam. All the cephalosporins tested showed much wider spectrum of activities. Of all antibiotics tested, only cefoxitin was active against the vast majority of Bacteroides spp. These findings are discussed in relation to the clinical uses of these antibiotics.

Topics: Amdinocillin; Ampicillin; Bacterial Infections; Cefamandole; Cefoxitin; Cefuroxime; Cephalexin; Cephalosporins; Humans; Microbial Sensitivity Tests; Penicillanic Acid

Sixty women with endometritis following cesarean section were treated with cefamandole (12 gm/day) alone. Specimens for culture were obtained by endometrial lavage and from peripheral blood. Minimum inhibitory concentrations were performed on anaerobes and enterococci by an agar dilution technique. Anaerobic organisms were isolated in 55 of 60 (91.7%) endometrial specimens. Bacteremia was documented in 12 patients (20%). Of 387 isolates from uterine cultures, 20 (5%) were resistant or had MIC's greater than or equal to 32 micrograms/ml. Ten patients (17%) were judged clinical failures and responded to additional antibiotics. Of 19 patients with Bacteroides fragilis or related species isolates in the uterus, three (15%) were judged as failures. Cefamandole was well tolerated and appears to be useful in the initial treatment of endomyometritis.

Topics: Adult; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefamandole; Cephalosporins; Cesarean Section; Endometritis; Enterobacteriaceae Infections; Female; Humans; Postoperative Complications; Pregnancy; Staphylococcal Infections; Streptococcal Infections

The results of a pharmacokinetic and clinical study of cephamandol naphate indicated that the drug quickly reaches high plasma concentration after both i.m. and i.v. bolus administration. Urinary excretion of the biologically active form is as much as 84--90% of the total dose and mostly takes place in the first 6 hr. The therapeutic response was good: clinical cure in 90%, marked improvement in 6.6%, no change in 3.3%.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Child; Female; Humans; Male; Middle Aged; Mumps; Otitis; Respiratory Tract Infections; Scarlet Fever; Urinary Tract Infections

Increased understanding of bacterial infections of the pelvis has led to the frequent administration of double and triple antimicrobial chemotherapy for polymicrobial infections in hospitalized patients. This study evaluated the use of high-dose cefamandole as a single agent in the treatment of obstetric and gynecologic infections. Cefamandole was administered by intravenous infusion of 2 gm every 4 hours or, less often, every 3 hours. Twenty patients were entered into the study, 11 with postpartum endometritis and nine with pelvic inflammatory disease. Seventeen of the 20 patients (85%) were successfully treated; all failures were in the endometritis group. The aerobic organisms and the gram-positive anaerobic organisms isolated from these infections were susceptible in vitro to cefamandole at attainable serum concentrations. The bacteroides isolated were more resistant. The data suggest that high-dose cefamandole therapy is effective as a single agent for the majority of moderate obstetric and gynecologic infections.

Topics: Bacteria; Bacterial Infections; Bacteroides Infections; Cefamandole; Cephalosporins; Drug Resistance, Microbial; Endometritis; Female; Humans; Pelvic Inflammatory Disease

Topics: Bacterial Infections; Biological Availability; Bone Diseases; Cefamandole; Cephalosporins; Humans; Joint Diseases

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefoxitin; Cephalosporins; Costs and Cost Analysis; Haemophilus influenzae; Humans

Agar minimal inhibitory concentrations and mouse protection test effective doses were determined for each of four beta-lactam antibiotics against each of 12 Gram-negative and 3 Gram-positive bacterial cultures. The beta-lactamase activity of these cultures also was studied. The data were examined to determine whether relative in vivo efficacies could be predicted from relative in vitro activities. Although such predictions were quite accurate for cefoxitin and cefazolin, this was not true for cefamandole or for cephalothin. Such poor predictability was not necessarily associated with the susceptibility of these cephalosporins to hydrolysis by bacterial beta-lactamases. Although the clinical significance of these observations is not known, these data emphasize that relative in vitro activities should be used only with caution to estimate in vivo efficacies, since not all compounds show the excellent predictability observed here for cefazolin and cefoxitin.

Topics: Animals; Bacteria; Bacterial Infections; beta-Lactamases; Cefamandole; Cefazolin; Cefoxitin; Cephalosporins; Cephalothin; Female; Hydrolysis; Mice

The authors have carried out the laboratory and clinical studies of cefamandole (CMD). The results are as follows: The sensitivity was measured by plate dilution method on 26 strains of Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and 14 strains of Salmonella typhimurium isolated from patients. The distribution of sensitivity of S. aureus was 0.39 approximately 3.13 micrograms/ml and the peak of distribution was 1.56 micrograms/ml. The distribution of sensitivity of E. coli was 0.78 approximately greater than 100 micrograms/ml, and K. pneumoniae, 1.56 approximately greater than 100 micrograms/ml. The distribution of sensitivity of Salmonella typhimurium was 6.25 approximately greater than 100 micrograms/ml and its peak was 6.25 micrograms/ml. CMD were given intravenously for 30 and 60 minutes at a single dose of 25 mg/kg body weight to 6 children. The serum mean levels of CMD were 105.3 micrograms/ml at 30 minutes, 15.1 micrograms/ml at 1.5 hours, 1.6 micrograms/ml at 2.5 hours after drip infusion for 30 minutes, respectively, and 34.7, 5.2, 0.6 micrograms/ml at 1, 2, 3 hours after drip infusion for 60 minutes, respectively. And the serum level at 4 hours after administration was not detected. The mean urinary excretion rates were 73.3% in the drip infusion for 30 minutes and 60.7% in its for 60 minutes, up to 8 hours after administration. Half life was 26 minutes. CMD was effective in 18 of 21 cases of bacterial infections. No side effects were observed except for 2 cases with elevation of serum transaminase.

Topics: Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Infant; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Pneumonia; Salmonella typhimurium; Staphylococcus aureus; Tonsillitis

Topics: Bacterial Infections; Cefamandole; Cefazolin; Cephalosporins; Child; Child, Preschool; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Infant; Infant, Newborn; Infusions, Parenteral; Male; Meningitis, Aseptic; Microbial Sensitivity Tests; Pneumonia; Staphylococcus aureus; Urinary Tract Infections

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

Topics: Bacteria; Bacterial Infections; Cefamandole; Cephalosporins; Cephalothin; Humans; Injections, Intravenous

The experience with the cefamandole prophylaxis in 244 patients with open heart-surgery, and another 84 patients operated upon on prosthetic vascular reconstruction was evaluated. No case of endocarditis, sepsis or massive wound infection with infected prosthesis was found in the reviewed patients. Considering the fact that patients undergoing open heart-surgery and prosthetic vascular reconstruction are subjected to much more bacterial contamination than patients undergoing any other surgical procedure, the cephalosporin treatment (in our study cefamandole) should be considered the antibiotic of choice in preventing of infection during and after such surgical intervention.

Topics: Adult; Aged; Bacterial Infections; Cardiac Surgical Procedures; Cefamandole; Cephalosporins; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Surgical Wound Infection

Community-acquired bacterial pneumonia in the elderly has for years been attributed almost exclusively to Streptococcus pneumoniae. Recent technical advances have provided bacteriologic and epidemiologic data demonstrating that other pathogens are important causes of pulmonary infection in older patients. This report reviews these data and reappraises the conventional therapy of community-acquired bacterial pneumonia in geriatric patients. Some properties of a new antibiotic, cefamandole nafate, are described.

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Humans; Nursing Homes; Pneumonia

35 males and 23 females with skin and soft tissue infection, lower respiratory tract infection, urinary tract infection or septicemia with known etiology were treated with cefamandole nafate. The patients were to a large extent (30%) alcoholics and/or drug abusers. Cefamandole was given intravenously as 4 daily doses of 1 g in 52 cases and of 2 g in 6 cases for 8 to 16 (mean 10) days. The effect was considered to be good in 40 patients (70%). Adverse reactions, mostly slight and transient, were seen in 22 patients (38%). Peak serum levels varied from 26 to 82 (mean 50) micrograms/ml after 1 g doses and from 68 to 100 micrograms/ml after 2 g. Previous statements of a better in vitro activity of cefamandole than of older cephalosporins against some gram-negative bacilli were corroborated.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Drug Evaluation; Female; Humans; Male; Middle Aged

Cefamandole (sodium salt) was administered to total 32 cases of bacterial infectious diseases of children, and in 3 cases, there were investigated of these absorption and excretion. The results are as follows; 1. Blood levels: Cefamandole was given intravenous dose of 25 mg/kg to 3 children. The blood level of 15 minutes after intravenous injection was 140.4 micrograms/ml in average, and 0.3 micrograms/ml in average at 4 hours after intravenous injection. T 1/2 was 13.9 minutes. 2. Urinary concentration: Within 6 hours after intravenous injection, 51.8% of the drug was recovered in average from the urine and the urinary concentration reached to 3,050 micrograms/ml in average (0 approximately 2 hours), 1,262 micrograms/ml in average (2 approximately 4 hours), 41 micrograms/ml in average (4 approximately 6 hours) after injection. 3.. The drug was given 109 mg/kg/day (t.i.d. or q.i.d.) by intravenous route. The duration of administration was 11 days in average. The overall efficacy rate was 97%. In bacteriological results, excellent in 2, failure in 1, out of 3 strains. As side effects vascular pain was observed in 3 cases at the intravenous injection, and eosinophilia in 2 cases.

Topics: Adolescent; Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Female; Humans; Infant; Injections, Intravenous; Male; Time Factors

Ceforanide, a new cephalosporin antibiotic with a long half-life (3 h), can be administered twice daily. We evaluated its antimicrobial activity, pharmacology, and clinical efficacy. Twenty-seven patients with infections due to susceptible organisms received ceforanide, 0.5, 1, or 2 g, intramuscularly or intravenously every 12 h for 6 to 28 days. In vitro studies with the clinical isolates from 27 patients treated plus 263 additional isolates showed that ceforanide was active against cephalothin-susceptible gram-positive and gram-negative microorganisms. In addition, ceforanide inhibited 65% of cephalothin-resistant Escherichia coli and 65% of Enterobacter spp. at

Topics: Adult; Bacteria; Bacterial Infections; Cefamandole; Cephalosporins; Humans; Microbial Sensitivity Tests; Time Factors

Topics: Aged; Bacterial Infections; Bile; Bile Duct Diseases; Cefamandole; Cephalosporins; Female; Humans; Male; Middle Aged

Laboratory and clinical studies were performed on a new semisynthetic cephalosporin, cefamandole (CMD), and following results were obtained. (1) Serum concentrations and urinary recovery rates of CMD were determined after an intravenous administration of CMD 30 mg/kg in 13 children with normal renal function. In 5 of 13 children, mean serum levels after a one shot intravenous injection were 112.5 micrograms/ml at 15 minutes, 52.2 micrograms/ml at 30 minutes, 23.3 micrograms/ml at 1 hour, 4.9 micrograms/ml at 2 hours and trace at 4 hours. In other 5 children, mean serum levels after drip infusion for 1 hour were 78 micrograms/ml at 30 minutes, 59 micrograms/ml at 1 hour, 9.8 micrograms/ml at 2 hours and trace at 4 hours, after the onset of drip infusion. In the remaining 3 children who received CMD by drip infusion for 2 hours, mean serum levels were 24.3 micrograms/ml at 30 minutes, 35.3 micrograms/ml at 1 hour, 30.2 micrograms/ml at 2 hours, 5.3 micrograms/ml at 3 hours and 1.5 micrograms/ml at 4 hours after the onset of drip infusion. Urinary recovery rates in 5 children were 154.7%, 98.3%, 93.2%, 111.8% and 66.9%, respectively, during 8 hours. (2) CMD was administered to 40 patients with various infections (acute U.T.I. 8, acute angina lacunaris; 2, acute bronchitis; 5, cervical purulent lymphadenitis; 2, post-measles bronchopneumonia; 3, acute bronchopneumonia; 18, pyothorax; 2, S.S.S. syndrome; 1) by one-shot intravenous injection at a dose of 40-120 mg/kg per day. The clinical efficacy rate was 92.5% and bacteriological efficacy rate was 79.2%. (3) As the side effect of CMD, eosinophilia was observed in 1 case, rash and elevation of GOT and GPT in 1 case, and proteinuria in 1 case.

Topics: Adolescent; Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Infusions, Parenteral; Male; Respiratory Tract Infections; Urinary Tract Infections

Cefamandole sodium (CMD) was intravenously administered and following laboratoric and clinical results were obtained. (1) The peak blood concentration was 32 approximately 44 micrograms/ml when the drip infusion was finished. At 1 hour after the end of the drip infusion the blood concentration was 7.6 approximately 8.1 micrograms/ml. Half life was approximately 0.64 hours. (2) Urinary recovery rate was 84.5 approximately 95% in active state within 6 hours. (3) Penetration of cerebrospinal fluid was found in 2 cases. (4) In most of 170 strains of Streptococcus haemolyticus MICs of cefamandole were 0.05 microgram/ml. They were less susceptible to cefazoline, cefmetazole and ceftezole. (5) CMD was administered to 35 pediatric patients (upper or lower RTI, lymphadenitis, enteritis or UTI) at 100 mg/kg/day for 3 approximately 9 days, the efficacy rate was 97.1%. (6) Side effect: Rash occurred in one case, and eosinophilia was observed in 4 cases. No abnormal finding of renal and liver function was observed.

Topics: Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male; Respiratory Tract Infections; Streptococcus

SK&F 75073, a new parenteral cephalosporin, was found to have broad in vitro and in vivo antibacterial activity including isolates usually resistant to cephalothin and cefazolin. This activity included indole-positive Proteus and Enterobacter species and some Serratia isolates. Proteus mirabilis strains were particularly susceptible, as were Haemophilus influenzae and Neisseria species. The activity of SK&F 75073 against gram-positive bacteria was poorer than that of the control cephalosporins. This cephalosporin is highly bound to serum proteins, and a loss in in vitro activity was observed in the presence of serum. Parenteral administration of SK&F 75073 to experimental animals (mice, dogs, squirrel monkeys) resulted in high and prolonged serum levels when compared with cefazolin and other injectable cephalosporins. This favorable serum profile was reflected in the excellent protection observed in mice infected with pathogenic bacteria.

Topics: Animals; Bacterial Infections; Cefamandole; Cephalosporins; Dogs; Female; Haplorhini; Injections, Intramuscular; Injections, Subcutaneous; Kinetics; Male; Mice; Microbial Sensitivity Tests; Saimiri

Fifty-three infants and children, aged three months to 15 years, were treated with an average daily dose of 100 mg of cefamandole/kg intravenously. Of these patients, 47 had soft tissue cellulitis and six had pneumonia. Primary pathogens, including Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae, were isolated from 43 of the 53 patients. Bacteremia was documented in six of the 53 patients. A satisfactory clinical and bacteriologic response to cefamandole was achieved in all cases except on (98%). The only treatment failure occurred in an infant with both periorbital cellulitis and bacteremia due to H. influenzae who developed meningitis while receiving cefamandole; no extravasation of the drug across the blood-brain barrier could be detected in spite of inflamed meninges. In general, the only aberrant effects of cefamandole were the appearance of eosinophilia in 28% of patients and a positive indirect Cooms' test without hemolysis in one patient. Cefamandole showed excellent in vitro activity against 87 ampicillin-resistant strains of H. influenzae. Because it has greater activity than any of the other cephalosporins against this important pediatric pathogen, cefamandole may have particular pertinence in the treatment of infections in infants and young children.

Topics: Adolescent; Bacterial Infections; Cefamandole; Cellulitis; Cephalosporins; Child; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Pneumonia; Pneumonia, Pneumococcal; Staphylococcal Infections; Streptococcal Infections

Forty-seven infants and children with a variety of infections including bacteremia, ethmoiditis, and periorbital cellulitis, soft tissue infection, pneumonia, and lymphadenitis were treated with intravenous cefamandole. The infections were due to Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae. The clinical response was prompt, and, with the exception of two cases who developed skin rash, significant side effects were not noted. In vitro cefamandole was very effective in inhibiting the growth of H. influenzae, including ampicillin-resistant isolates.

Topics: Adolescent; Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Haemophilus influenzae; Humans; Infant; Microbial Sensitivity Tests

Thirty-one patients with severe gram-negative bacterial infections were treated successfully with a combination of cefamandole nafate plus gentamicin or tobramycin. The patients were divided into two treatment groups: group 1 received low-dose therapy (80--100 mg of cefamandole nafate/kg per 24 hr plus 3 mg of either gentamicin or tobramycin/kg per 24 hr), and group 2 patients, who had suspected bacteremia, received high-dose therapy (170 mg of cefamandole nafate/kg per 24 hr plus 5 mg of either gentamicin or tobramycin/kg per 24 hr). All of the patients were clinically and bacteriologically cured of their primary infections. All four episodes of bacteremia were cleared within 24 hr after therapy was initiated. There was a uniform decrease in the rate of creatinine clearance which was slightly greater in group 2 patients; however, all creatinine clearance values were within the normal range and actually improved during therapy. There was no difference between the clearance values of the tobramycin-treated patients and gentamicin-treated patients. A few transient abnormalities in results of liver function tests occurred during the study. In one patient whose serum was positive for hepatitis-associated antigen, the alkaline phosphatase, aspartate aminotransferase, and bilirubin values were elevated on admisssion of the patient to the hospital, increased fivefold during therapy, and decreased to the base-line admission values six days after therapy; however, it is difficult to establish that this reaction was antibiotic-induced hepatic toxicity.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Cephalosporins; Drug Therapy, Combination; Endometritis; Escherichia coli Infections; Female; Gentamicins; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Pneumonia; Proteus Infections; Proteus vulgaris; Pyelonephritis; Sepsis; Tobramycin

Cefamandole nafate was effective in the treatment of a variety of infections caused by Staphylococcus aureus, Streptococcus pyogenes group A, Streptococcus pneumoniae, and Haemophilus influenzae in infants and children. The infections included periorbital cellulitis and ethmoiditis, bacteremia, cellulitis, pneumonia, and lymphadenitis. In vitro, cefamandole was effective in inhibiting the growth of H. influenzae isolated from blood or cerebrospinal fluid of patients with meningitis or sepsis. In two patients rash developed and cefamandole was discontinued. Other significant adverse effects were not noted.

Topics: Adolescent; Bacterial Infections; Cefamandole; Cellulitis; Cephalosporins; Child; Child, Preschool; Ethmoid Sinus; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Microbial Sensitivity Tests; Pneumonia, Pneumococcal; Sinusitis; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes

Forty-four patients with serious bacterial infections were treated with cefamandole in a dose 1--2 g every four to six hours. Thirty-two patients were cured and six were markedly improved. Three of six failures were due to superinfection with cephalothin-resistant microorganisms. The over-all bacteriologic response was 80%. In 12 of 13 patients with bacteremia the blood was sterilized. Ten of 14 patients with gram-negative bacillary infections responded to treatment. Six of these were due to cephalothin-resistant microorganisms, three of which responded. Fifteen patients who were treated had a history of penicillin allergy. There were no serious reactions although skin rash did develop. Phlebitis was uncommon.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Sepsis; Staphylococcal Infections; Streptococcal Infections

Topics: Bacterial Infections; Carbenicillin; Cefamandole; Cefazolin; Cefoxitin; Cephalosporins; Dose-Response Relationship, Drug; Escherichia coli Infections; Humans; Klebsiella Infections; Penicillins; Ticarcillin

Topics: Adult; Bacterial Infections; Cefamandole; Cellulitis; Cephalosporins; Enterobacteriaceae Infections; Enterococcus faecalis; Haemophilus Infections; Humans; Pneumococcal Infections; Respiratory Tract Infections; Skin Diseases, Infectious; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes

Cefamandole was evaluated as the sole antimicrobial agent used to treat bacterial peritonitis in 113 patients. Dosage varied between 1 and 2 g given intravenously every 6 hr. Laparotomy for excision of infected or gangrenous tissues, closure of gastrointestinal perforations, or drainage of an established abscess was required in 99 of the cases. A good clinical response was obtained in 107 patients, or 95% of the total group. Of the six deaths only one could be attributed to infection. No evidence of renal, hepatic, or hematopoietic toxicity was noted. There were no allergic reactions, although 13 patients (12%) developed phlebitis in a vein used for antibiotic administration. Bacteriological studies revealed aerobic peritonitis in 99% of the patients, with anaerobe participation in 60% of these cases. Sensitivity testing by the disk diffusion and tube dilution methods confirmed the appropriateness of cefamandole therapy; 91% of the gram-negative rods and 61% of the anaerobes were susceptible. From results of this study, it would appear that cefamandole is a reliably effective antibiotic for use in treatment of most forms of acute peritonitis. Its role in surgical prophylaxis may be even more promising.

Topics: Adult; Aged; Bacterial Infections; Bacteroides Infections; Cefamandole; Cephalosporins; Child, Preschool; Drug Resistance, Microbial; Enterobacteriaceae Infections; Female; Humans; Male; Peritonitis; Staphylococcal Infections

The safety and efficacy of treatment with cefamandole were evaluated in 30 patients (from 18 institutions) with serious bone and joint infections. Five of the subjects were children. The antibiotic was given intramuscularly or intravenously in doses ranging from 2 to 12 g daily for five to 44 days. Twenty-six of the 30 patients responded satisfactorily. Fourteen of the fifteen infections due to Staphylococcus aureus were among the successful cases. Other pathogens were streptococci, Escherichia coli, Proteus mirabilis, and Bacteroides fragilis. The drug was well tolerated in patients in this series. Studies indicated that cefamandole penetrated the bones and joints. Further investigation of cefmandole in the treatment of bone and joint infections is warranted.

Topics: Adolescent; Adult; Aged; Arthritis, Infectious; Bacterial Infections; Bacteroides Infections; Bursitis; Cefamandole; Cephalosporins; Child; Child, Preschool; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Osteomyelitis; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Surgical Wound Infection

The combination of carbenicillin plus cefamandole was administered to 88 patients with cancer during 116 evaluable episodes of fever. The overall response rate to carbenicillin plus cefamandole for the 116 episodes was 57%. There were 60 documented infections, of which 60% responded to this combination of antibiotics. The response rate was only 43% in patients with pneumonia. The etiologic agent was identified during 38 infections, of which 74% responded to carbenicillin plus cefamandole. Responses occurred less frequently in patients with neutropenia than in those without neutropenia and less frequently in patients whose infection was caused by organisms resistant to both antibiotics than in those with infection caused by organisms sensitive to one or both of the drugs. No side effects could be attributed to the antibiotic regimen.

Topics: Adolescent; Aeromonas; Aged; Bacterial Infections; Carbenicillin; Cefamandole; Cephalosporins; Corynebacterium Infections; Drug Therapy, Combination; Enterobacteriaceae Infections; Female; Flavobacterium; Humans; Listeriosis; Male; Middle Aged; Neoplasms; Respiratory Tract Infections; Sepsis; Tobramycin

Topics: Bacterial Infections; Cefamandole; Cephalosporins

The pharmacokinetic properties of cefamandole were determined and compared with the properties of other cephalosporin agents. Cefamandole was found to be approximately 70% bound to protein. The mean peak concentration in serum after intramuscular (im) injection of 1 g of cefamandole was 20 microgram/ml at 0.5 hr, whereas the level at 6 hr was 1 microgram/ml. After intravenous (iv) infusion of 1 g of cefamandole, levels in serum ranged from 68 to 147 microgram/ml depending on the period of infusion. At 4 hr after infusion, levels were less than 1 microgram/ml. Probenecid elevated serum levels and prolonged excretion. The half-life (t1/2) of cefamandole after im injection ranged from 1 to 1.5 hr and from 0.45 to 1.2 hr after iv injection. Rates of serum and renal clearance of cefamandole ranged from 210 to 300 microliter/min per 1.73 m2. The apparent volume of distribution ranged from 12.4 to 17.9 liters/1.73 m2. Urinary excretion was rapid, with 60% of a dose excreted in the first 2 hr after injection. In 6 hr 90% of a dose was excreted. The pharmacokinetic properties of cefamandole were similar to those of cephalothin and cefoxitin, but the serum t1/2 was shorter than that reported for cefazolin and cefuroxime. Correlation of in vitro studies with pharmacokinetic properties revealed that cefamandole would inhibit most susceptible gram-positive and gram-negative bacteria if given by suggested im or iv regimens.

Topics: Bacterial Infections; Cefamandole; Cephalosporins; Cephalothin; Drug Administration Schedule; Half-Life; Humans; Infusions, Parenteral; Injections, Intramuscular; Kidney; Protein Binding

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefazolin; Cefoxitin; Cephalexin; Cephaloridine; Cephalosporins; Cephalothin; Cephradine; Humans