cefamandole and Fever

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

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

Fifty-nine community-acquired pneumonias were treated in a randomized double blind trial with cefamandole or ceftazidime. A prospective scoring system was used to define severity. This made use of basic clinical data, associated diseases, white blood count, blood gases and chest radiographs. There were no serious side-effects from the drugs. There were two deaths and six failed treatment. The scoring system which defined an 'ill group' showed as good a response of these ill patients to the new cephalosporin, ceftazidime as to cefamandole.

Topics: Adult; Cefamandole; Ceftazidime; Cephalosporins; Clinical Trials as Topic; Double-Blind Method; Female; Fever; Humans; Injections, Intravenous; Male; Middle Aged; Phlebitis; Pneumonia; Random Allocation

At Parkland Memorial Hospital a group of women at high risk for infection following cesarean delivery was identified. These included nulliparas who underwent cesarean section for cephalopelvic disproportion 6 or more hours following membrane rupture. During the puerperium, uterine infection developed in 85 to 95% of such women, and one third of this high-risk group had associated complications. The authors have previously reported the efficacy antimicrobial agents given to these women at the time of cesarean section and continued for 4 days. The present prospective study was designed to assess the efficacy of a shorter course of perioperative antimicrobial therapy for these high-risk women. Three doses of antimicrobial agents were given perioperatively to 305 women randomly assigned to 1 of 3 treatment regimens: 115 were given penicillin plus gentamicin, 82 received 2, 1, and 1 g of cefamandole, respectively, and the remaining 108 were given 2, 2, and 2 g of cefamandole, respectively. The incidence of uterine infection in these 305 women was 24% and associated complications were identified in 7% of all women. Based upon a comparison of results with the progenitor study, the authors conclude that 3-dose perioperative antimicrobial therapy is preferred to 4 days of treatment for women at high risk for infection following cesarean delivery.

Topics: Anti-Bacterial Agents; Cefamandole; Cesarean Section; Chloramphenicol; Clinical Trials as Topic; Drug Administration Schedule; Female; Fever; Gentamicins; Humans; Penicillin G; Postoperative Care; Pregnancy; Puerperal Infection; Random Allocation; Risk

A total of 120 patients who were to be delivered by cesarean section and who were at high risk of postoperative infection received three doses of either cefamandole, cephalothin or placebo perioperatively. Maternal serum levels for both antibiotics were in the therapeutic range. Although both drugs reduced the incidence of febrile morbidity and endometritis, only cefamandole significantly reduced the fever index. Risk factors for postoperative infections were the presence of ruptured membranes, labor, and internal fetal monitoring. Cefamandole beneficially influenced all risk factors while cephalothin was able to reduce only the risk of ruptured membranes. When a new method for obtaining endometrial tissue was utilized, 50% of cultures were negative. There was no difference in the organisms isolated from patients with and without endometritis.

Topics: Adult; Cefamandole; Cephalosporins; Cephalothin; Cesarean Section; Clinical Trials as Topic; Drug Resistance, Microbial; Endometritis; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Fetal Monitoring; Fever; Humans; Infant, Newborn; Labor, Obstetric; Pregnancy; Risk

The present study was carried out to determine the relationship between fever (> or = 38 degrees C) after extracorporeal shock wave lithotripsy (ESWL) and the history of bacteriuria before ESWL. The subjects of this study comprised 958 patients. Significant bacteriuria before ESWL was found in 75 patients. These patients were treated with antibiotics and underwent ESWL after bacteriuria disappeared. Despite treatment with antibiotics, the patients with bacteriuria before ESWL had a significantly higher incidence of fever after ESWL than those without bacteriuria. Among the 14 patients whose high fever persisted after ESWL, the patients with bacteriuria included 7 (50%) with stones > 20 mm in size. The patients with stones > 20 mm and bacteriuria before ESWL had a high risk of persistent high fever after ESWL.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteriuria; Cefamandole; Chi-Square Distribution; Female; Fever; Humans; Lithotripsy; Male; Middle Aged; Urinary Calculi

Complete microbial decontamination (laminar air flow room, sterile nursing and oral administration of cefamandole, gentamicin and nystatin) was carried out in 65 consecutive patients prior to allogeneic BMT for leukaemia (n = 58) or aplastic anaemia (n = 7). Very few microorganisms persisted during the post-transplant treatment period, and the gut became sterile in all except for Candida in 11 patients. Six uncomplicated septicaemias, all with persistent organisms simultaneously present in the mouth (Pseudomonas 3, Serratia 1, Candida 2) occurred during a total of 1,360 days with granulocyte counts less than 0.5 X 10(9)/l. Post-transplant fever occurred in 52 patients, exceeding 40 degrees C in 25. Guided by the surveillance cultures only 46% of 43 unexplained febrile reactions were treated with systemic antimicrobials. Significant acute graft versus host disease (AGVHD) occurred in 14 (27%) of 52 patients receiving standard prophylaxis and HLA-matched grafts; immunosuppressive treatment was needed in 8 cases (16%). Thus, the additional costs of total microbial decontamination appear partially regained by a decreased morbidity and a reduced need for antimicrobial and immunosuppressive treatment, although neither fever nor AGVHD could be prevented.

Topics: Adolescent; Adult; Bone Marrow Transplantation; Cefamandole; Child; Child, Preschool; Environment, Controlled; Fever; Gentamicins; Graft vs Host Disease; Humans; Immunosuppression Therapy; Infection Control; Middle Aged; Nystatin; Patient Isolation; Transplantation, Homologous

The effectiveness of intrauterine irrigation during cesarean section with a solution of cefamandole nafate in reducing febrile morbidity was studied in a prospective double-blind fashion. Ninety patients who were undergoing cesarean section at Tripler Army Medical Center were randomized into three groups: (1) intrauterine irrigation with cefamandole nafate solution, (2) intrauterine irrigation with normal saline solution, and (3) no irrigation. Febrile morbidity was evaluated by means of a fever index. There was a statistically significant reduction in the fever index in the group that received intrauterine irrigation with cefamandole nafate. The incidences of clinically diagnosed endomyometritis in the three groups were 0%, 26.7%, and 23.3%, respectively. Prophylactic intrauterine irrigation with cefamandole nafate during cesarean section markedly reduces febrile morbidity, primarily by reducing the incidence of endomyometritis.

Topics: Cefamandole; Cephalosporins; Cesarean Section; Double-Blind Method; Endometritis; Female; Fever; Humans; Intraoperative Care; Postoperative Complications; Pregnancy; Prospective Studies; Puerperal Infection; Risk; Therapeutic Irrigation; Uterus