cefamandole and Meningitis

The therapy of gram-negative bacillary meningitis is less than adequate to date; the agents recommended do not achieve bactericidal levels in purulent cerebrospinal fluid. Because optimal antibiotic therapy of meningitis occurs when the cerebrospinal fluid level of an antibiotic is above the concentration needed to kill the offending pathogen, another group of agents needs to be considered. The newer cephalosporins or cehalosporin-type antibiotics (cefotaxime, moxalactam), by virtue of their marked activity against gram-negative bacilli and their ability to achieve significant CSF levels, merit serious consideration as therapy for gram-negative bacillary meningitis. Investigators in Europe and the United States have developed preliminary data demonstrating the efficacy of these agents in a growing number of cases. In the group presented herein, of the 35 cases in which gram-negative bacillary meningitis was treated with the newer cephalosporins, there were only four failures.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Blood-Brain Barrier; Cefamandole; Cefotaxime; Cefoxitin; Cephaloridine; Cephalosporins; Cephalothin; Cephamycins; Child, Preschool; Enterobacteriaceae; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Middle Aged; Moxalactam; Pseudomonas aeruginosa

Clinical trials were carried out with cafamandole (sodium salt) in pediatric infections. Results were as follows; 1. CMD was applied to 13 patients with pneumonia, 1 patient each with submandibular abscess, urinary tract infection and bacterial meningitis. 2. Results were excellent in 1 and good in 13 patients, being overall efficacy rate 93.3%. 3. Slight elevations of GOT and GPT were observed in 1 patient. No other serious side effects were observed or reported.

Topics: Acute Disease; Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Male; Meningitis; Pneumonia; Pyelonephritis

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

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: Animals; Cefamandole; Cephalosporins; Injections, Intravenous; Meningitis; Meningitis, Haemophilus; Rabbits; Staphylococcal Infections

Laboratory and clinical studies of cefamandole (CMD), a new semisynthetic cephalosporin, were investigated and following results were obtained. 1) Absorption and excretion study following 25 mg/kg intravenous administration was carried out in pediatric patients. In 6 cases, mean serum levels of 116.7 +/- 24.0 micrograms/ml, 62.1 +/- micrograms/ml, 12.2 +/- 2.7 micrograms/ml, 2.9 +/- 1.1 micrograms/ml, 0.6 +/- 0.6 micrograms/ml and 0.1 +/- 0.2 micrograms/ml obtained after 15, 30 minutes, 1, 2, 4 and 6 hours administration. In 4 cases, mean urinary recovery of 68.2 +/- 17.2% (0 approximately 8 hours) was obtained. The mean half life of serum level was 0.36 +/- 0.08 hours. 2) The transfer of cefamandole was poor in infants with meningitis. 3) Cefamandole was given to 22 children with acute pyelitis (1 case), acute pneumonia (19 cases), and meningitis (2 cases). The dosage was 80.0 approximately 284.2 mg/kg/day, and it was divided into 4 approximately 6 times and given intravenous or intravenous drip. The duration of administration was from 3 to 17 days. The overall efficacy rate in 22 cases was 95.2%, i.e., excellent in 5, good in 15, poor in 1, and unknown in 1. In bacteriological examination, there were eradication of the organisms in 9 (52.9%), decrease in 4, unchange in 4 out of 17 strains. 4) Any noticeable adverse reaction was not observed.

Topics: Adolescent; Cefamandole; Cephalosporins; Child; Child, Preschool; Female; Humans; Infant; Male; Meningitis; Pneumonia; Pyelitis