cefamandole and Enterobacteriaceae-Infections

We randomized 400 patients who were scheduled for an elective cardiovascular operation involving median sternotomy to receive cefamandole nafate or cefonicid in a prospective double-blind study. Three hundred fifty-seven patients were evaluable for prophylactic efficacy. Chest wound and donor site infections and early prosthetic valve endocarditis occurred more frequently with cefonicid (11 patients, 6.3%) than with cefamandole (4 patients, 2.2%) (p = 0.05). Three patients, all in the cefonicid group, required sternal debridement to control postoperative deep wound infections. Twenty-five miscellaneous postoperative infections (urinary tract infection, pneumonia, intravenous site infection, bacteremia, sepsis, Clostridium difficile diarrhea) occurred in 16 patients (9.19%) in the cefonicid group and four in 4 patients (2.19%) in the cefamandole group (p = 0.003). These data indicate that cefamandole is superior to cefonicid in preventing both surgical wound infections and miscellaneous nonsurgical infections after cardiovascular operations.

Topics: Cardiac Surgical Procedures; Cefamandole; Cefonicid; Double-Blind Method; Endocarditis, Bacterial; Enterobacteriaceae Infections; Heart Valve Prosthesis; Humans; Premedication; Prospective Studies; Random Allocation; Staphylococcal Infections; Surgical Wound Infection

Ceftizoxime, a new beta-lactamase-resistant, semisynthetic antibiotic, was compared to cefamandole in a prospective randomized trial to determine its efficacy and safety in 21 patients with acute, complicated urinary tract infections. Four patients randomized initially to receive cefamandole were found to have resistant organisms and were treated with ceftizoxime. Dosage for ceftizoxime was 1 gm. administered parenterally every 12 hours, while 1 gm. cefamandole was given every 6 hours. Urine cultures were obtained before the initiation of therapy, on day 4, after completion of therapy and 4 to 6 weeks after therapy. Specified laboratory tests were obtained. Of 14 patients receiving ceftizoxime 11 (79 per cent) and of 7 patients receiving cefamandole 7 (100 per cent) had negative cultures at the completion of therapy and 4 to 6 weeks later. No patient had any adverse reaction to ceftizoxime. Ceftizoxime is a safe and effective antibiotic agent when used as a single agent for complicated urinary tract infections. However, ceftizoxime is much more expensive than cefamandole therapy. Therefore, it is recommended that ceftizoxime be reserved for treatment of urinary tract infections stemming from pathogenic species resistant to the less expensive antimicrobials.

Topics: Adolescent; Adult; Aged; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Clinical Trials as Topic; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Prospective Studies; Pseudomonas Infections; Random Allocation; Urinary Tract Infections

The clinical efficacy and tolerance of cefamandole, a new cephalosporin antibiotic effective against indole-positive strains of Proteus, and cefazolin were studied after intramuscular administration of 500 mg of either of the two cephalosporins every 8 hr for seven days in a prospective, randomized study of 65 elderly male patients with complicated urinary tarct infections. Both antibiotics were effective in eradicating the infections, and there was no significant difference between the two groups in regard to tolerance and cure rate, as defined by a negative urine culture one week and four to six weeks following discontinuation of the treatment. Because of its broader antibacterial spectrum, cefamandole appears to represent an improvement over previously available cephalosporin antibiotics.

Topics: Aged; Cefamandole; Cephalosporins; Enterobacteriaceae Infections; Escherichia coli Infections; Humans; Klebsiella Infections; Male; Proteus Infections; Staphylococcal Infections; Streptococcal Infections; Urinary Tract Infections

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Aortic Aneurysm, Abdominal; Bacteremia; Cefamandole; Cephalosporin Resistance; Cephalosporins; Drug Resistance, Multiple; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Male; Pneumonia, Bacterial; Postoperative Complications

Cefamandole resistance in five patients was studied. Microorganisms emerged resistant to cefamandole during therapy with the drug in three patients with complicated infections. This resistance was associated with an enhanced production of beta-lactamase and/or with a change in the substrates and the isoelectric focusing patterns of the enzymes. Cross-resistance to other beta-lactam antibiotics developed concurrently in isolates from these patients. Disk diffusion tests did not detect resistance to cefamandole in the pretreatment isolate from the fourth patient; this isolate produced inactivating enzymes, and resistance was detected only in broth dilution tests. In the fifth patient, infection with a cefamandole-resistant Enterobacter developed during postoperative therapy with the drug. Resistance to cefamandole in the isolate from this patient was unstable and was associated with inducible beta-lactamase activity. These examples emphasize the need for close monitoring of patients who are given cefamandole and for thorough in vitro evaluation of isolates from the patients both before and after treatment.

Topics: Adult; Aged; Bacteroides Infections; beta-Lactamases; Cefamandole; Cefotaxime; Cefoxitin; Cephalosporins; Cephamycins; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Humans; Isoelectric Focusing; Male; Middle Aged; Moxalactam; Penicillin Resistance; Penicillins

Cefoperazone (10 mg/kg) and cephalothin (20 mg/kg) administered intramuscularly every 6 h were both effective in reducing the number of Staphylococcus aureus cells in vegetations in rabbits with endocarditis. Cefoperazone produced higher peak concentrations and greater bactericidal activity in serum than did cephalothin. Cefoperazone (40 mg/kg) administered every 6 h was significantly more effective than cefamandole (40 mg/kg) administered every 6 h in reducing the number of Enterobacter aerogenes cells in vegetations. Although cefamandole produced higher peak concentrations in serum, the serum bactericidal activity was greater with cefoperazone. The half-lives in serum were 0.64 h for cefoperazone and 0.46 h for cephalothin and cefamandole.

Topics: Animals; Cefamandole; Cefoperazone; Cephalosporins; Cephalothin; Endocarditis, Bacterial; Enterobacter; Enterobacteriaceae Infections; Female; Half-Life; Rabbits; Staphylococcal Infections

Topics: Cefamandole; Citrobacter; Drug Therapy, Combination; Enterobacteriaceae Infections; Female; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Osteomyelitis; Tibia

Development of resistance during therapy with cefamandole contributes to treatment failure. A simple cefoxitin disk test was recently described which detects a cefamandole-active inducible beta-lactamase not otherwise detectable with cefamandole as the inducer. A case of breakthrough Enterobacter bacteremia due to selection of a resistant subpopulation is reported in an immunocompromised patient. The use of this simple disk test in selected clinical cases is advocated.

Topics: Adult; Bacteria; beta-Lactamases; Cefamandole; Cefoxitin; Cephalosporins; Enterobacter; Enterobacteriaceae; Enterobacteriaceae Infections; Enzyme Induction; Humans; Male; Microbial Sensitivity Tests

Topics: Animals; Bacteriological Techniques; Cefamandole; Cefoxitin; Cephalosporins; Drug Resistance, Microbial; Enterobacteriaceae Infections; Mice

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

Therapy with cephamandole (1.0 g, every eight hours) for five days was effective in eliminating cephamandole-sensitive microorganisms from the urinary tract. A 75% cure rate was achieved in a group of 20 patients, 45% of whom had abnormalities of the urinary tract. Local pain (despite addition of lignocaine) was sufficiently prolonged and severe to make multiple-dose intramuscular administration unacceptable. No other toxic effects were encountered.

Topics: Anti-Infective Agents, Urinary; Cefamandole; Cephalosporins; Enterobacteriaceae Infections; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Pain; Staphylococcal Infections; 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: Bile Ducts; Cefamandole; Cephalosporins; Child; Child, Preschool; Enterobacteriaceae Infections; Female; Humans; Infant; Male; Postoperative Complications

The activity of BL-S786 was compared to that of cephalothin, cefamandole and cefoxitin in vitro and in treatment of experimental infections in mice. In broth dilution tests, the activity of BL-S786 was less than cephalothin or cefamandole against Staphylococcus aureus and less than cefamandole or cefoxitin against Haemophilus influenzae. BL-S786 and cefamandole were the two most active drugs against cephalothin-sensitive Enterobacteriaceae. In tests with cephalothin-resistant Enterobacteriaceae, BL-S786 was generally less active than cefamandole but more active than cefoxitin against all strains except Proteus and Providencia. Regardless of the comparative in vitro activity of the four drugs, BL-S786 was the most effective drug in treatment of mice lethally infected with Enterobacteriaceae. Protection from lethality was associated with clearance of bacteremia by each of the four drugs. In several tests where in vitro activity was not predictive of in vivo efficacy, selection of resistance in vivo was found to have occurred.

Topics: Animals; Cefamandole; Cefoxitin; Cephalosporins; Cephalothin; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Haemophilus influenzae; Mice; Mice, Inbred ICR; Microbial Sensitivity Tests; Staphylococcus aureus

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

The in vitro antimicrobial activities of BL-S786, cefoxitin, and cefamandole against 90 isolates of Enterobacteriaceae, including Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter cloacae and E. aerogenes, were studied by using an agar dilution procedure. Comparison of geometric mean minimal inhibitory concentrations showed that BL-S786 was half as active as cefamandole against Enterobacter species, 2 to 4 times more active than cefamandole against all other species, and 4 to 25 times more active than cefoxitin against all species. In vivo experiments employed acute protection tests in infected mice, using five isolates each of the five genera. Drugs were administered intramuscularly in two doses 3 h apart at dosages of 2.5, 5, 10, 20, and 40 mg per mouse. In most instances, BL-S786 was the most efficacious drug, being some 1.3 to 9.1 times more active than cefoxitin in all experiments and 1.5 to 8.7 times more active than cefamandole in most experiments. BL-S786 and cefamandole were comparable in activity in experiments with E. aerogenes, whereas BL-S786 was superior in experiments with E. cloacae.

Topics: Animals; Cefamandole; Cefoxitin; Enterobacter; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Female; Klebsiella pneumoniae; Mice; Mice, Inbred ICR; Microbial Sensitivity Tests; Proteus mirabilis

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

Clinical and bacteriologic results are reported for 80 patients treated with 1.5--12 g of cefamandole daily for a variety of infections caused by Enterobacter and indole-positive Proteus, organisms that have been resistant to most available cephalosporins. Of 45 patients with infections due to Enterobacter, 41 (91%) had satisfactory clinical responses; 36 were bacteriologic successes, and six cases of complicated urinary tract infections relapsed. Of 37 patients with infections due to indole-positive Proteus, 28 (88%) were clinical successes and 30 (81%) were bacteriologic successes. Fourteen cases of complicated urinary tract infection relapsed. Of 104 patients in whom the drug was evaluated for safety, use of cefamandole was discontinued in five; nine adverse reactions were considered drug-related. A summary of published in vitro data shows that the majority of strains of these organisms were susceptible to cefamandole at concentrations achievable in the serum. Minimal inhibitory concentrations are variable, and there is a significant inoculum effect, the clinical significance of which has not been determined.

Topics: Adult; Aged; Cefamandole; Cephalosporins; Enterobacter; Enterobacteriaceae Infections; Female; Humans; Infant; Male; Middle Aged; Proteus Infections; Pyelonephritis; Skin Ulcer; Surgical Wound Infection; Urinary Tract Infections