cefamandole and Endophthalmitis

Postoperative fibrinoid reactions are regarded as a localized form of endophthalmitis caused by microbial contamination of the capsular bag during intraocular lens implantation. The incidence of early fibrinoid reactions within the first 6 postoperative days following extracapsular cataract extraction was examined after intraocular administration of antibiotics vs placebo. In a double-blind randomized trial, 2 mg cefamandol or a placebo was administered in a 0.4-ml volume at the end of the operation. A group of 28 patients received the antibiotic (mean age 74.6 years; 15 f, 13 m), while 33 patients received the placebo (mean age 72,1 years; 21 f, 12 m). Fibrinoid reactions were observed in 8 out of 61 patients during the first 6 postoperative days. There was no significant difference between the antibiotic group and the placebo group (P = 0.31). We were unable to reduce the incidence of fibrinoid reactions although we had selected a broad-spectrum cephalosporin for antibiotic treatment. The results give rise to the suspicion that most of the early postoperative fibrinoid reactions we observed were not caused by contamination with bacteria of low pathogenicity.

Topics: Cefamandole; Double-Blind Method; Endophthalmitis; Fibrin; Humans; Injections; Lenses, Intraocular; Postoperative Complications

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

We compared the intraocular pharmacokinetics of cefazolin with those of cefamandole, a recently marketed cephalosporin with enhanced activity against gram-negative bacilli. Following subconjunctival injection of 12.5 mg into infected eyes (S. aureus endophthalmitis) of pigmented rabbits, both drugs reached peak concentrations greater than 100 microgram/gm in cornea, sclera, and choroid-retina. The half-life was markedly shorter in sclera and choroid-retina than in cornea. Levels in the aqueous humor rose and fell more slowly than those in ocular tissues, reaching a maximum of only 5 to 10 microgram/ml. The pharmacokinetics of the two drugs were virtually identical in most intraocular sites. When cefazolin, which was less irritating than cefamandole by the subconjunctival route, was given in a dosage of 100 mg, levels in ocular tissues were increased by twofold to fourfold and in aqueous humor by 15-fold, compared to the concentrations produced by the 12.5 mg dosage. Levels in the vitreous humor were exceedingly low with both drugs; mean peak concentrations were 0.24 microgram/ml after the 12.5 mg dosage of cefamandole and less than 1.6 microgram/ml after the 100 mg dose of cefazolin.

Topics: Animals; Aqueous Humor; Cefamandole; Cefazolin; Cephalosporins; Conjunctiva; Dose-Response Relationship, Drug; Endophthalmitis; Eye; Half-Life; Injections; Kinetics; Rabbits; Staphylococcal Infections

We administered cefamandole nafate to 69 patients before cataract extraction and assayed serum and aqueous humor for antibiotic content at the time of surgery. Average aqueous humor levels of 0.33, 0.59, 0.21, and 0.14 microgram/ml were achieved at one half, one, two and four hours, respectively, after a 1-g intravenous dose. After a 2-g intravenous dose, we found average aqueous humor levels of 1.26, 1.0, 1.57, 0.73, and 0.34 microgram/ml at one half, one, two, four and six hours, respectively. Therapeutic levels in primary aqueous humor effective against common grampositive pathogens were consistently achieved with the 2-g dose, but levels effective against Enterobactereaceae were attained only erratically.

Topics: Aqueous Humor; Biological Availability; Cataract Extraction; Cefamandole; Cephalosporins; Endophthalmitis; Humans; Injections, Intramuscular; Injections, Intravenous; Preoperative Care; Surgical Wound Infection; Time Factors