cefamandole and Escherichia-coli-Infections

A controlled randomized trial was carried out in 324 patients with inguinal hernia. Efficacy was evaluated of a single injection of cefamandole (n = 162) administered at operative site during local anesthesia, using an untreated group as control (n = 162), as prophylaxis against post-operative local infection. Seven patients in the control group developed abscesses at the operative site after discharge, 6 of the 7 during one-month follow up, compared with none in the treated group (n = 0.07). No side effects were reported due to the antibiotic therapy. The cost of the antibiotic treatment was 10 times less than that for treating the suppurations in the control group.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia, Local; Bacteremia; Cefamandole; Child; Drug Evaluation; Escherichia coli Infections; Female; Hernia, Inguinal; Humans; Male; Middle Aged; Postoperative Complications; Staphylococcal Infections; Streptococcal Infections

A double-blind, multicenter trial compared cefonicid and cefazolin for prophylaxis against postoperative infection in 117 patients undergoing joint replacement. Cefonicid, which has an extended serum half-life, was administered once daily, while cefazolin was given every eight hours. The drug was administered one half to one hour before surgery and continued for up to 72 hours. Patients were observed throughout their hospitalization period and followed for 30 days after discharge. No evidence of wound or joint infection was observed in any of the patients who met the criteria for evaluation. Adverse reactions consisted mainly of infrequent gastrointestinal symptoms and laboratory abnormalities. Three patients died from causes unrelated to study medication. No differences between the two regimens were found with respect to safety or efficacy in the prevention of postoperative infection after arthroplasty. The effectiveness of once-daily administration should make cefonicid a highly cost-effective alternative to many of the more expensive first- and second-generation cephalosporin antibiotics currently used in hospital practice.

Topics: Adult; Aged; Aged, 80 and over; Arthroplasty; Cefamandole; Cefazolin; Cefonicid; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Random Allocation; Staphylococcal Infections

The possible advantages of the monobactam antibiotic aztreonam in the treatment of hospital-acquired urinary tract infection were assessed in a study comparing aztreonam (0.5 to 1 g twice daily or three times daily) to cefamandole (1 g three times daily) in 159 patients. Initial pathogens were eradicated in 91.7 percent of the patients of the aztreonam group who were treated three times daily, in 82.7 percent of the group treated twice daily, and in 78.3 percent of the patients receiving cefamandole. Reinfection and superinfection were most commonly caused by enterococci in the aztreonam groups and by Pseudomonas aeruginosa in the cefamandole group. In a second study, 35 patients infected with organisms resistant to other antibiotics were treated with aztreonam 1 to 6 g per day for eight days. The overall cure rates were 93 percent for Pseudomonas infections, 87.5 percent for Escherichia coli infections, and 100 percent for other pathogens.

Topics: Anti-Bacterial Agents; Aztreonam; Cefamandole; Cross Infection; Drug Resistance, Microbial; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Random Allocation; Recurrence; Urinary Tract Infections; Urine

Fifty patients with empyema of the gall bladder took part in a prospective comparative study. One treatment group received ceftazidime 2 g bd, while the other received combined therapy with cefamandole 2 g tds and tobramycin 80 mg bd. The intraoperative administration of the antibiotic was started immediately after a sample had been obtained for culture, by puncture of the gall bladder. Results with ceftazidime monotherapy in severe infections were superior to the combined therapy. No septic complications of wound healing were observed.

Topics: Adult; Cefamandole; Ceftazidime; Cephalosporins; Drug Therapy, Combination; Empyema; Escherichia coli Infections; Female; Gallbladder Diseases; Humans; Male; Prospective Studies; Tobramycin

Topics: Adolescent; Adult; Aged; Bile; Cefamandole; Cephalosporins; Cephalothin; Cholecystectomy; Double-Blind Method; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Random Allocation; Risk; Sepsis; Surgical Wound Infection

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

As a consequence of their bactericidal actions, many antibiotics cause the release of endotoxin, a primary mediator of gram-negative sepsis. Bactericidal/permeability-increasing protein (BPI) has bactericidal activity and neutralizes endotoxin in vitro and in vivo. We sought to examine the effect of a recombinant N-terminal fragment of BPI (rBPI21) in conjunction with cefamandole, a cephalosporin antibiotic, in the treatment of Escherichia coli bacteremia and septic shock in rabbits. Cefamandole (100 mg/kg of body weight) was injected intravenously. This was followed by simultaneous 10-min infusions of E. coli O7:K1 (9 x 10(9) CFU/kg) and rBPI21 (10 mg/kg). rBPI21 was continuously infused for an additional 110 min at 10 mg/kg/h. The administration of rBPI21 in conjunction with the administration of cefamandole prevented the cefamandole-induced increase of free endotoxin in plasma, accelerated bacterial clearance, ameliorated cardiopulmonary dysfunction, and thereby, prevented death, whereas neither agent alone was protective in this animal model. The efficacy of the combined treatment with rBPI21 and cefamandole suggests a synergistic interaction between the two agents. The data indicate that rBPI21 may be useful in conjunction with traditional antibiotic therapy.

Topics: Amino Acid Sequence; Animals; Anti-Infective Agents; Antimicrobial Cationic Peptides; Blood Gas Analysis; Blood Glucose; Blood Proteins; Cefamandole; Cephalosporins; Colony Count, Microbial; Drug Synergism; Endotoxins; Escherichia coli Infections; Hemodynamics; Lactates; Male; Membrane Proteins; Rabbits; Recombinant Proteins; Shock, Septic

Effects of an N-terminal fragment of bactericidal/permeability increasing protein (rBPI21) on bacterial infections were determined. Intravenous (i.v.) rBPI21 increased survival and reduced bacteremia in rats after an iv injection of Escherichia coli O7:K1 bacteria. rBPI21 inhibited the rise in tumor necrosis factor-alpha resulting from challenge with 2 strains of E. coli. Intraperitoneal (ip) injection of rBPI21 increased survival of mice after ip injection of E. coli O7:K1 and Pseudomonas aeruginosa and reduced bacteria in peritoneal lavage fluid and blood and inhibited cytokine production in response to E. coli. rBPI21 alone did not protect mice challenged with E. coli O111:B4 but was protective and reduced bacterial counts when administered in combination with the antibiotic cefamandole. The data show that protection with rBPI21 is associated with reductions in bacterial counts and is enhanced by antibiotics. Bactericidal activity, in addition to antiendotoxin activity, is involved in the efficacy of rBPI21 in models of gram-negative infection.

Topics: Animals; Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Blood Proteins; Bronchoalveolar Lavage Fluid; Cefamandole; Colony Count, Microbial; Escherichia coli; Escherichia coli Infections; Interleukin-6; Male; Membrane Proteins; Mice; Mice, Inbred ICR; Pseudomonas aeruginosa; Pseudomonas Infections; Rats; Recombinant Proteins; Systemic Inflammatory Response Syndrome; Tumor Necrosis Factor-alpha

The in vitro activity of four cephalosporins was compared with their effects in an experimental thigh infection (cefuroxime and cefamandole against Escherichia coli and cefamandole, ceftriaxone, and ceftazidime against Klebsiella pneumoniae) in granulocytopenic mice. The effect in vitro (ER) was defined as the difference between the growth rate without antibiotic and the growth rate at the steepest part of a 3-h growth curve in the presence of an antibiotic. The relation between concentration and ER was described with the Hill equation. Using pharmacokinetic parameters of the plasma concentrations in vivo and those of the Hill equation the corresponding time course of ER was calculated and by integration with respect to time (0tERdt), an estimate was obtained of the effect on bacteria. For all four antibiotics this estimate was significantly correlated with the actual values of the effect in vivo (EN), defined as the difference in numbers of bacteria between controls and antibiotic-treated animals at 4 h.

Topics: Agranulocytosis; Animals; Cefamandole; Ceftazidime; Ceftriaxone; Cefuroxime; Cephalosporins; Disease Models, Animal; Escherichia coli; Escherichia coli Infections; Klebsiella Infections; Klebsiella pneumoniae; Mice; Protein Binding; Specific Pathogen-Free Organisms

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

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

We evaluated under controlled conditions the efficacy of topical and systemic antibiotics, alone and in combination, in the prevention of wound infection and measured serum and tissue antibiotic levels in the wound and distant tissue after administration of antibiotics topically, systemically, and in combination. Adult Sprague-Dawley rats were contaminated on the dorsal paravertebral muscles with a preset standardized inoculum of Staphylococcus aureus, Escherichia coli, and Bacteroides fragilis. A second-generation cephalosporin was used; systemic administration was given intramuscularly and topically in powder form. Wound infection was confirmed by the recovery of the organism by culture. Prophylactic antibiotics were effective in preventing wound infection in all groups. Topical antibiotic and a combination (topical/systemic) antibiotic were significantly more effective than was systemic antibiotic alone in preventing wound infection. Adequate levels of antibiotic were achieved in serum and tissue with both topical and systemic antibiotics. Wound tissue concentration of antibiotic was significantly higher when topical antibiotic was used.

Topics: Administration, Topical; Animals; Bacteroides Infections; Cefamandole; Escherichia coli Infections; Injections, Intramuscular; Rats; Rats, Inbred Strains; Staphylococcal Infections; Wound Infection

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

An experimental wound model was used to evaluate the effectiveness of cefazolin, cefamandole, and cefotaxime in the prevention of wound infection. Incisions were contaminated with Staphylococcus aureus, Escherichia coli, or a standardized fecal suspension. Regardless of the contaminant employed, the prophylactic use of either cefazolin, cefamandole, or cefotaxime yielded lower concentrations of bacteria in the wounds and fewer infections compared with treatment with saline solution. Within the context of this experimental model, cefazolin proved equally as effective as the newer and more expensive cephalosporins, cefamandole and cefotaxime.

Topics: Animals; Cefamandole; Cefazolin; Cefotaxime; Cephalosporins; Escherichia coli Infections; Feces; Female; Mice; Staphylococcal Infections; Surgical Wound Infection

Topics: Aged; Amoxicillin; Anti-Bacterial Agents; Cefamandole; Escherichia coli Infections; Humans; Hypoprothrombinemias; Male; Moxalactam; Prothrombin Time; Urinary Tract Infections; Vitamin K

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

Cefamandole (CMD) was intravenously drip infusion administered at daily dose of 400 mg/kg to the neonate with purulent meningitis caused by E. coli which was resistant to ABPC. In clinical application, CMD was evaluated as effective, although 6 mg/kg/day of GM given concomitantly. No adverse effect and abnormal laboratory findings were observed. This study would support the clinical usefulness of CMD in severe neonatal infection especially like meningitis.

Topics: Cefamandole; Cephalosporins; Drug Therapy, Combination; Escherichia coli Infections; Female; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis

The activities of cefamandole, cephalothin, ampicillin, and chloramphenicol were compared in fulminant and temperate Escherichia coli meningitis in rabbits. Intensive dosing schedules were employed to achieve maximal therapeutic benefits with short-term treatment. In an 8-h schedule chloramphenicol was significantly more effective in sterilizing the cerebrospinal fluid and curing both fulminant and temperate infections than cefamandole or ampicillin. Cephalothin was without effect in fulminant meningitis. Cefamandole and ampicillin were equivalent in activity in this and longer (12- and 24-hr) treatment schedules. The therapeutic benefits of chloramphenicol were purchased via use of doses above those generally regarded as safe for human use. The mean serum, cerebrospinal fluid, and brain concentrations of chloramphenicol, cefamandole, and ampicillin were significantly greater in rabbits with fulminant meningitis than in those with temperate meningitis. The difference was of such magnitude as to support the need to monitor drug concentrations.

Topics: Ampicillin; Animals; Brain Chemistry; Cefamandole; Cephalosporins; Cephalothin; Chloramphenicol; Escherichia coli Infections; Female; Male; Meningitis; Rabbits; Time Factors

Topics: Cefamandole; Cerebral Ventricles; Escherichia coli Infections; Female; Gentamicins; Humans; Infant, Newborn; Ultrasonography

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

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

The synergy of four combinations of antimicrobial agents potentially useful in the treatment of neonatal meningitis was examined with 19 strains of Escherichia coli K1. The effect on antimicrobial activity of changes in E. coli concentration and in pH to values similar to those of cerebrospinal fluid from infected neonates was also assessed. The degree of synergy, assessed by checkerboard agar dilution of the antimicrobial agents in combination with gentamicin, decreased in the following order: trimethoprim, cefamandole, ampicillin, and chloramphenicol. Significant variation in activity against different strains of E. coli was not observed. In broth dilution tests, the individual antimicrobial agents, but not the combinations, were notably less active at pH 7.00 with an inoculum of 10(7) cfu/ml than at pH 7.40 with 10(5) cfu/ml. Bactericidal activities of the beta-lactam and trimethoprim combinations were similar. Chloramphenicol antagonized the bactericidal effect of gentamicin and of ampicillin plus gentamicin.

Topics: Ampicillin; Anti-Bacterial Agents; Cefamandole; Cerebrospinal Fluid; Chloramphenicol; Drug Combinations; Drug Interactions; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Trimethoprim

Topics: Adult; Brazil; Cefamandole; Cefoxitin; Cross Infection; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Humans; Israel; Male; Proteus Infections; Providencia; South Africa; Transients and Migrants

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

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