cefamandole and Klebsiella-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

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

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

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